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INTRODUCTION: Traumatic arteriovenous fistula results from a breach of vascular integrity between a vein and an adjacent artery. Hepato caval fistula is a rare entity. Open surgical approaches have increasingly given way to radiological embolization techniques in the treatment of these arteriovenous fistulae, especially in intrahepatic locations. CASE REPORT: We report the case of a patient diagnosed with a fistula, from the right branch of the liver artery to the right hepatic vein, developed following an open liver trauma. Successful embolization through the transarterial route was achieved with simple outcomes. CONCLUSION: The interventional radiology for endovascular management has revolutionized the treatment of hepatic liver traumas. The conservative treatment is henceforth the common approach even if hepatic artery or hepatic veins are involved in case of arteriovenous fistula.
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Hepatic artery aneurysms are rarely diagnosed. It is mainly because of non specific symptoms. They are generally an incidental findings during imaging studies. They are usually detected in the sixth decade, predominantly in men. We report herein a case of an 80 year-old man with a huge hepatic artery aneurysm revealed by abdominal pain and chronic anemia. It was treated by embolisation. Hepatic artery aneurysms are second among visceral aneurysms. They may cause abdominal pain, jaundice and hemorrhagic events.
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BACKGROUND: during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon. AIM: The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer. METHODS: We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05. RESULTS: Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76% at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival. CONCLUSION: A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.
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Adenocarcinoma/mortalidad , Neoplasias del Recto/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Anciano , Análisis de Varianza , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Rectal prolapse is a rectal static disorder which involves rectal wall intussusception inducing its externalization through the anus. It usually affects children and the elderly. Its occurrence in young adults is rare. Strangulated rectal prolapse is also a rare complication. We report the case of a 30-year old patient who underwent emergency surgery for strangulated rectal prolapse. Emergency perineal rectosigmoidectomy (Altemeier repair) was performed with simple outcome.
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Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Urgencias Médicas , Prolapso Rectal/cirugía , Adulto , Factores de Edad , Humanos , Masculino , Prolapso Rectal/patología , Resultado del TratamientoRESUMEN
Background - The gallbladder cancer is a rare cancer with poor prognosis. The association with gallstone disease is the main risk factor of this cancer. Aim - Describe the demographics, clinic-pathologic and therapeutic management of incidentally gallbladder cancer diagnosed on cholecystectomy specimens. Methods - retrospective study including 30 cases of gallbladder cancer incidentally detected on cholecystectomy specimens. Results - The incidence of gallbladder cancer incidentally discovered was 0.83%. The sex ratio M/F was 0.5 and the average age was 68 years. The main risk factor was cholelithiasis (38%). Adenocarcinoma was the most frequent histological type found in 86.6% of cases and it was biliary-type in 56.6% of cases. 76,7% of the tumors were classified in early stages (stages 0, I and II) and 23,3% were in advanced stages (III and IV). A simple cholecystectomy was curative in 66.7% of cases. Overall survival rate was 56.7% at one year. The best survival rate was for the early stages: 100% stages 0-I and 45.4% stage II. Conclusions - The gallbladder cancer has poor prognosis because of its late diagnosis. Thorough sampling and careful attention on histological examination of all parts of cholecystectomy specimens allows detection of early cancer with better prognosis.
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Adenocarcinoma/diagnóstico , Colecistectomía , Neoplasias de la Vesícula Biliar/diagnóstico , Hallazgos Incidentales , Adenocarcinoma/complicaciones , Anciano , Femenino , Neoplasias de la Vesícula Biliar/complicaciones , Cálculos Biliares/complicaciones , Cálculos Biliares/cirugía , Humanos , Masculino , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon. AIM: The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer. METHODS: We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05. RESULTS: Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76% at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival. CONCLUSION: A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.
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Adenocarcinoma/mortalidad , Neoplasias del Recto/mortalidad , Factores de Edad , Análisis de Varianza , Supervivencia sin Enfermedad , Humanos , Estimación de Kaplan-Meier , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaAsunto(s)
Infarto/diagnóstico por imagen , Epiplón/irrigación sanguínea , Adulto , Humanos , Infarto/cirugía , Laparoscopía , Masculino , Persona de Mediana Edad , Necrosis/diagnóstico por imagen , Necrosis/cirugía , Epiplón/diagnóstico por imagen , Epiplón/cirugía , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , RadiografíaRESUMEN
BACKGROUND: Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas. METHODS: A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment. RESULTS: Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment (hepatic resection) was performed in 53.5% cases while percutaneous treatment was proposed for 46.5%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. Overall survival was significantly lower in the surgical resection group. The corresponding 6 months and 1-year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively (p=0,04). The disease free survival were not significantly different. CONCLUSION: Our results showed the efficacy and safety of percutaneous ablation treatments which were better than those of surgical treatment in patients with small hepatocellular carcinoma.
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Carcinoma Hepatocelular/terapia , Ablación por Catéter , Hepatectomía/métodos , Neoplasias Hepáticas/terapia , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/cirugía , Femenino , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent. AIM: This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity Methods: Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors. RESULTS: 290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance. CONCLUSION: Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease.
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Conversión a Cirugía Abierta/estadística & datos numéricos , Úlcera Duodenal/cirugía , Laparoscopía , Úlcera Péptica Perforada/cirugía , Complicaciones Posoperatorias/epidemiología , Adulto , Conversión a Cirugía Abierta/efectos adversos , Úlcera Duodenal/complicaciones , Úlcera Duodenal/epidemiología , Endoscopía Gastrointestinal/efectos adversos , Endoscopía Gastrointestinal/métodos , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Morbilidad , Úlcera Péptica Perforada/epidemiología , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Hepatocellular carcinoma represents the fifth most common cancer worldwide and account for approximately 90% of primary liver cancer. Men have a higher prevalence than women; the sex ratio varies between 2:1 and 4:1, depending on the geographic region. AIM: To determine the influence of gender on the clinicopathologic characteristics and survival of patients with hepatocellular carcinoma. METHODS: A retrospective analysis of medical records was performed in 63 patients with hepatocellular carcinoma and their clinicopathologic features and survival were compared in relation to gender. The data was summarized by descriptive statistics and analysed with SPSS version 11.5. RESULTS: Among these patients, 36 were men (57.1%) with male-to female ratio of 2:1.5, the mean female age was 59.8 years (p=0.054). Serum albumin level was significantly lower in women (p=0.0061).The average size of the tumor was 45.8mm and the difference was not significant (p=0.638). Hepatocellular carcinoma was significantly more prevalent among 16 men with post viral B cirrhosis (p=0.04). The main reason for therapeutic abstention was multifocal character of the hepatocellular carcinoma. The median survival time (6.52 months) was not different between the 2 groups. CONCLUSION: At diagnosis, men were younger than women. The viral C etiology was statistically more frequent in women than in men. Hepatocellular carcinoma was more aggressive in male but median survival time was not significant between groups. Screening and early treatment can limit this problem.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Anciano , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/virología , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Razón de Masculinidad , Análisis de Supervivencia , Carga Tumoral , Túnez/epidemiologíaAsunto(s)
Actinomicosis/diagnóstico , Hepatopatías/diagnóstico , Hepatopatías/microbiología , Actinomicosis/tratamiento farmacológico , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Hepatopatías/tratamiento farmacológico , Persona de Mediana Edad , Penicilina G/uso terapéuticoRESUMEN
Beta-catenin plays a critical role with E-cadherin in cell-cell adhesion and is also a key molecule of the highly conserved Wnt signaling pathway that regulates cell proliferation and differentiation. Abrogation of this pathway is implicated in the carcinogenesis of several malignancies, especially colorectal cancer. The objective of this study was to determine the prognostic value of ß-catenin/E-cadherin complex in Tunisian patients with colorectal cancer. Matched primary tumors from 150 patients with sporadic colorectal adenocarcinomas were stained for ß-catenin and E-cadherin by using immunohistochemistry. Deletion of exon 3 of CTNNB1 gene was performed by polymerase chain reaction. Our results showed that ß-catenin and E-cadherin expressions were related inversely to tumor differentiation. Furthermore, the nuclear expression of ß-catenin was considerably increased in advanced colorectal adenocarcinomas and was highly associated with shorter survival of patients. Deletion of exon 3 of CTNNB1 was identified in 2 cases by using polymerase chain reaction and was significantly related to tumor invasion and aberrant expression of E-cadherin. The major finding of this study is that activation of ß-catenin gene by deletions involving exon 3 may be considered as an advanced event in colorectal tumorigenesis in Tunisian patients, in contrast to some worldwide studies. Moreover, disruption of ß-catenin/E-cadherin complex may be considered as a dependent predictor of disease outcome.
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Neoplasias Colorrectales , Exones , Regulación Neoplásica de la Expresión Génica , Proteínas de Neoplasias , Eliminación de Secuencia , Vía de Señalización Wnt , beta Catenina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Secuencia de Bases , Cadherinas/biosíntesis , Cadherinas/genética , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas de Neoplasias/biosíntesis , Proteínas de Neoplasias/genética , Estudios Retrospectivos , Tasa de Supervivencia , Túnez/epidemiología , beta Catenina/biosíntesis , beta Catenina/genéticaRESUMEN
AIM: The aim of this study is to review clinical data, histological and immunohistochemical findings and prognosis of stromal gastrointestinal tumors. METHODS: A retrospective Study of 32 cases of stromal gastrointestinal tumors diagnosed in the Department of Pathology of Mongi Slim Hospital of Tunis from 1991 to 2004. RESULTS: The average age of the patients was of 54.4 years, equal for sex. Tumors were essentially gastric (50%) and of the small intestine (37.5%). All the patients had surgical treatment. Gastro-intestinal Stromal Tumors or GIST represent the most frequent stromal tumor with 56.2% of cases. CONCLUSION: After immunohistochimestry study, using CD117 antigen, this revision allows better management of GIST. Glivec is the standard treatment of advanced GIST.
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Biomarcadores de Tumor/metabolismo , Neoplasias Duodenales/metabolismo , Tumores del Estroma Gastrointestinal/metabolismo , Neoplasias del Íleon/metabolismo , Neoplasias del Yeyuno/metabolismo , Proteínas Proto-Oncogénicas c-kit/metabolismo , Neoplasias Gástricas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Benzamidas , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/tratamiento farmacológico , Neoplasias Duodenales/cirugía , Femenino , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Neoplasias del Íleon/diagnóstico , Neoplasias del Íleon/tratamiento farmacológico , Neoplasias del Íleon/cirugía , Mesilato de Imatinib , Neoplasias del Yeyuno/diagnóstico , Neoplasias del Yeyuno/tratamiento farmacológico , Neoplasias del Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Adenomas are rarely diagnosed in the appendix and may be isolated or may coexist with other neoplasms in the gastrointestinal tract. This emphasizes the need for postoperative colonoscopy when a polyp of the appendix is found. Moreover, the polyps are considered to be premalignant lesions. AIM: Report two new cases of adenomas of the appendix. CASES: We report the cases of 23-year-old and 22-year-old men, for whom appendicectomy performed for acute appendicitis. In both cases, histologic studies revealed adenomas in moderate dysplasia ; colonoscopy did not reveal any polyps.
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Pólipos Adenomatosos , Neoplasias del Apéndice , Pólipos Intestinales , Enfermedad Aguda , Pólipos Adenomatosos/diagnóstico , Pólipos Adenomatosos/patología , Adulto , Apendicectomía , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/patología , Apendicitis/diagnóstico , Apendicitis/cirugía , Apéndice/patología , Colonoscopía , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Pólipos Intestinales/diagnóstico , Pólipos Intestinales/patología , Masculino , Factores de TiempoRESUMEN
BACKGROUND: An increasing number of elderly patients have been considered for major surgical procedures, such as pancreaticoduodenectomy. The decision to recommend this operation for localized pancreatic cancer or other periampullary process in a very elderly patient is complicated by the frailty of the patient and the poor prognosis of the disease. Moreover, increased surgical experience associated with better patient selection may reduce the mortality rate, even in very elderly patients (over 80 years of age), after pancreaticoduodenectomy. METHODS: An 84-year-old woman underwent pancreaticoduodenectomy for ampullary adenocarcinoma. The tumor was classified pT3N0M0. RESULT: A good postoperative outcome was obtained. The patient is still alive, 18 months after operation. CONCLUSIONS: Radical resection of periampullary tumors is safe in selected patients of advanced age, with morbidity and mortality rates approaching those observed in younger patients. Age alone should not be a contraindication for pancreatic resection.
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Adenocarcinoma/cirugía , Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco/cirugía , Pancreaticoduodenectomía , Factores de Edad , Anciano de 80 o más Años , Femenino , HumanosRESUMEN
INTRODUCTION: Because of the potential severity of acute appendicitis, many authors recommend the broad use of appendectomy. In this case, 15 to 20% of appendectomies are ultimately found to have been unnecessary. Hospital observation with repeated clinical and laboratory exams can be useful for patients with atypical clinical presentation. This paper assesses our approach, in which some patients with pain in the right iliac fossa (RIF) are admitted for observation before a decision about appendectomy. PATIENTS AND METHODS: All patients (205 cases) admitted from March 2002 through February 2003 for acute abdominal pain of the RIF were included in this prospective study. The 120 women and 85 men (sex ratio=0.7) had a mean age of 27 years. We classified the patients into 3 groups: those who had an emergency appendectomy, those who had surgery after an observation period, and those discharged without appendectomy after observation. RESULTS: The first group included 110 patients: 63% had a (rectal) temperature greater than 38 degrees C; 44% had guarding of the RIF and 87% elevated white blood cell counts (>10000/mm3). At surgery, appendicitis was diagnosed in 92%. After a mean delay of 36 hours of observation, 50 of the patients in the second group underwent surgery: 44% with (rectal) temperature > 38 degrees C, RIF guarding in 8%, and elevated white blood cell count (>10000/mm3) in 74%. In this group, 94% were diagnosed with appendicitis during surgery. Forty-five patients were discharged without surgery after 36 hours of observation. COMMENTARY: In this study, pain and RIF guarding, associated with temperature greater than 38 degrees C and elevated white blood cell counts, were predictive of appendicitis in 96% of cases. Admission for observation of patients with atypical presentation avoided 45 unnecessary appendectomies (22%).