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Chaouch MA, Taieb AH, Kawach A, Zenati H, Gafsi B, Noomen F. Challenges in the management of acute lithiasic cholangitis due to a long-retained plastic biliary stent: A case report. Int J Surg Case Rep 2024; 118:109690. [PMID: 38669806 PMCID: PMC11064558 DOI: 10.1016/j.ijscr.2024.109690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND IMPORTANCE This case report focuses on a rare cause of acute lithiasis cholangitis, which is residual choledocholithiasis on a plastic biliary stent that was placed nine years prior. CASE PRESENTATION An 87-year-old male, with a history of hypertension and previous surgery for gallstone disease including cholecystectomy and placement of a Kehr drain in 2006, was diagnosed with residual stones in 2008 and received a plastic biliary stent after endoscopic sphincterotomy. Lost to follow-up for nine years, he presented with acute lithiasis cholangitis characterized by fever, conjunctival jaundice, leukocytosis, CRP elevation, and biochemical signs of cholestasis. CT imaging revealed choledocholithiasis on the biliary stent. The patient underwent surgical intervention, during which a dilated bile duct was discovered, a complete tangential choledocotomy was performed, and the stent/stone complex along with additional choledocholithiasis was removed. A choledochoduodenal anastomosis was subsequently performed. DISCUSSION The use of plastic biliary stents can paradoxically lead to the formation of biliary stones, a condition termed "stentolith". Such scenarios emphasize the complications arising from prolonged stent presence, including bacterial proliferation and the consequent formation of calcium bilirubin stones. While endoscopic removal of these stent-stone complexes has been successful in a few cases, surgical intervention is often required due to the risks associated with endoscopic extraction, such as potential duodenal perforation. The choice of lithotripsy technique for endotherapy depends on availability and patient-specific factors. CONCLUSION This complication highlights the importance of patient education, meticulous record-keeping, and regular follow-up to prevent such outcomes.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Aymen Kawach
- Department of General Surgery, Sidi Bouzid Regional Hospital, Sidi Bouzid, Tunisia
| | - Hanen Zenati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Anesthesia, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Taieb AH, Chaouch MA, Kaouach A, Ben Jabra S, Zayati M, Gafsi B, Mili E, Noomen F. An uncommon liver abscess secondary to an ingested foreign body: A case report. IDCases 2024; 36:e01934. [PMID: 38601431 PMCID: PMC11002799 DOI: 10.1016/j.idcr.2024.e01934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/09/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction This article discusses a case study involving a unique occurrence of a hepatic abscess caused by the presence of an ingested foreign body. Hepatic abscesses, characterized by pus accumulation within liver tissue, often result from various infections, with some cases having unidentified origins. Case presentation This study focuses on a 75-year-old man who presented at an emergency department with persistent pain in the right upper abdomen and fever for ten days. Diagnostic tests revealed a low-density, multiloculated mass in the liver and a hyperdense linear structure near the duodenum, indicating a hepatic abscess originating from duodenal perforation due to a foreign body that had migrated from ingestion. The patient underwent antibiotic treatment and a surgical procedure involving laparotomy to extract the foreign object and drain the abscess. Conclusion this case study underscores the rare occurrence of hepatic abscesses caused by ingested foreign bodies. Swift and accurate diagnosis, along with appropriate treatment involving foreign body removal and abscess drainage, are pivotal for favorable patient outcomes. The choice of treatment strategy impacts hospital stay duration, and understanding potential complications from foreign body ingestion enhances patient management and care.
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Affiliation(s)
- Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Aymen Kaouach
- Department of General Surgery, Sidi Bouzid Hospital, Sidi Bouzid, Tunisia
| | - Sadok Ben Jabra
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Zayati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | - Emna Mili
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Chaouch MA, Hadj Taieb A, Ben Jabra S, Noomen M, Zayeti M, Mili E, Gafsi B, Noomen F. A case report of a large Splenic epidermoid cyst treated with partial splenectomy. Ann Med Surg (Lond) 2024; 86:1220-1223. [PMID: 38333297 PMCID: PMC10849445 DOI: 10.1097/ms9.0000000000001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Splenic epidermoid cysts are rare primary congenital cysts composed of an epithelial lining that represent a small proportion of nonparasitic splenic cysts. Despite their infrequency, there is a lack of uniform diagnostic and treatment guidelines for these cysts, emphasizing the need for further research and standardized reporting. Case presentation A 45-year-old female presented with left upper quadrant abdominal pain, characterized by a pressing sensation. Physical examination revealed a palpable mass in the upper left quadrant. Laboratory test results were normal. Abdominal ultrasonography and CT tomography confirmed a large splenic unilocular cyst consistent with an epidermoid cyst. Surgical intervention involved aspiration of the cystic fluid, partial splenectomy, and pathological examination. The patient's postoperative recovery was uneventful. Clinical discussion The origin of splenic epidermoid cysts remains unclear, with theories suggesting entrapment of mesothelial cells during embryonic development. The clinical presentation varies with cyst size, often causing abdominal pain and a palpable mass. Diagnostic modalities include ultrasonography and CT scans. Surgical intervention is recommended for symptomatic or suspicious cysts to prevent complications. The chosen approach depends on cyst characteristics and patient factors. This case highlights the challenges and considerations in managing splenic epidermoid the cysts and emphasizes the need for individualized treatment approaches. Conclusion This case contributes to the understanding of splenic epidermoid cysts and demonstrates a successful subtotal splenectomy as a treatment approach. Further research and standardized guidelines are essential to improve the management of these rare lesions and to provide better insights into their etiology and optimal treatment strategies.
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Affiliation(s)
| | | | | | - Mohamed Noomen
- Department of Anesthesia, Monastir University Hospital, Monastir, Tunisia
| | | | - Emna Mili
- Department of Anesthesia, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Anesthesia, Monastir University Hospital, Monastir, Tunisia
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Chaouch MA, Taieb AH, Jallali M, Chedly E, Gafsi B, Noomen F. Rare case report of intestinal obstruction due to incarcerated small bowel in omental breach. Int J Surg Case Rep 2024; 115:109245. [PMID: 38217921 PMCID: PMC10826806 DOI: 10.1016/j.ijscr.2024.109245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intestinal obstruction without a past surgical history of abdominal surgeries or trauma is a rare and challenging clinical situation. This case report describes the presentation, diagnosis, and management of intestinal obstruction in a patient with an uncommon aetiology of small bowel obstruction. CASE PRESENTATION A 62-year-old female with a past medical history of hypertension, diabetes, and atrial fibrillation presented to the Emergency Department with symptoms of vomiting and abdominal distension for two days. The absence of similar prior episodes and lack of surgical or trauma history were notable. Physical examination revealed a mildly distended, tympanic abdomen. Radiographic X-ray and CT imaging identified dilated small bowel loops due to a mechanical small bowel obstruction without any evident aetiology. Surgical intervention involved the release of the incarcerated bowel loops and repair of the omental breach causing the small bowel obstruction, leading to a smooth postoperative recovery. DISCUSSION This case of intestinal obstruction, caused by an incarcerated bowel through an omental breach in a patient with no history of abdominal surgery or trauma, underscores the diagnostic challenges in atypical presentations. The critical role of imaging, specifically abdominal X-ray and CT scan, was key in identifying the rare obstruction cause. The successful surgical release and repair of the incarcerated bowel highlight the need for tailored surgical approaches. This report emphasizes the importance of considering uncommon etiologies and demonstrates the complexities involved in the diagnosis and treatment of gastrointestinal conditions, advocating for a multidisciplinary approach. CONCLUSIONS The importance of considering rare etiologies in patients with abdominal pain, especially those lacking a typical history, is emphasized. The effective use of imaging and tailored surgical approach was key to the successful outcome. This report adds to the limited literature on omental breaches causing intestinal obstruction and underlines the necessity of a multidisciplinary approach in such cases.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Maissa Jallali
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Eya Chedly
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Anesthesia, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Zayati M, Chaouch MA, Taieb AH, Gafsi B, Abdelwahed MB, Noomen F. A rare case of perforated gastric lymphoma presenting a life-threatening condition: A case report. Int J Surg Case Rep 2023; 112:109010. [PMID: 37931503 PMCID: PMC10667931 DOI: 10.1016/j.ijscr.2023.109010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastric lymphomas are non-Hodgkin's lymphomas originating from mucosa-associated lymphoid tissue (MALT). Surgical intervention is recommended in cases of complications such as obstruction, bleeding, or perforation, although the choice of treatment can be a subject of debate and may entail life-threatening risks. This case report aims to describe a complex case of gastric MALT lymphoma with perforation requiring surgical intervention. CASE PRESENTATION A 47-year-old patient with a history of extranodal marginal zone B cell lymphoma presented to the Emergency Department with epigastric pain. Physical examination revealed a patient with hemodynamic instability and generalized abdominal tenderness. An abdominal CT scan revealed intraperitoneal air and effusion, along with a gastric wall defect. An emergent laparotomy was performed, revealing widespread purulent peritonitis resulting from a centimetric perforation in the anterior wall of the stomach near the lesser curvature. Following peritoneal lavage, we repaired the perforation and performed external drainage. The postoperative course was complicated by renal failure, and the patient succumbed to the illness two days after surgery. CASE DISCUSSION Gastric lymphomas, primarily linked to H. pylori infection. Diagnosis relies on endoscopy and histopathology. Endoscopic manifestations vary, making biopsy crucial. H. pylori eradication is the initial treatment, but resistance may require chemotherapy. Gastric lymphoma complications include perforation, with life-threatening consequences. Perforations can occur due to lymphoma or chemotherapy. Timely intervention with suturing is crucial for patient management. The postoperative course is difficult to manage due to the immune system deficiency. CONCLUSION Bowel perforation in gastric lymphomas significantly contributes to morbidity and mortality. Early diagnosis and emergent surgery are imperative to mitigate complications and reduce septicemia even in young patients.
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Affiliation(s)
- Mohamed Zayati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | | | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Chaouch MA, Abdelali M, Hammouda SB, Zayati M, Taieb AH, Noomen F. A case report of small bowel occlusion due to Meckel diverticulum causing a life-threatening condition. Int J Surg Case Rep 2023; 112:108982. [PMID: 37883867 PMCID: PMC10667897 DOI: 10.1016/j.ijscr.2023.108982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Meckel's diverticulum is a common congenital abnormality. In this study, we reported a case of small bowel occlusion due to Meckel's diverticulum causing a small bowel obstruction and a life-threatening condition. CASE PRESENTATION 28-year-old man complaining of abdominal pain for 3 days. The physical examination found the patient appeared profusely unwell with a blood pressure of 80/40 mmHg. The abdominal examination found abdominal rigidity suggesting peritonitis. The patient's C-reactive protein was 210 mg/l with normal white blood cell count. Consequently, the patient was operated on using a laparotomy. A mechanical bowel obstruction due to a gangrenous Meckel's diverticulum was confirmed during the operation. Meckel's diverticulitis with the tip attached to the ileal mesentery through a band. A section of the band was performed followed by a resection of the Meckel's diverticulum and an ileo-ileal anastomosis. The postoperative follow-up was uneventful. CASE DISCUSSION Meckel's diverticulum results from yolk sac persistence during embryonic development, often remaining asymptomatic. However, it can lead to symptoms like abdominal pain, diarrhoea, and fever when inflamed or infected. Treatment involves surgery (diverticulectomy) for severe cases with complications, with good prognosis but associated surgical risks. CONCLUSION The diverticulum can present a life-threatening condition. The treatment is essentially surgical. This surgery should be performed emergently to enhance the prognosis.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Mabrouk Abdelali
- Department of Radiology, Monastir University Hospital, Monastir, Tunisia
| | | | - Mohamed Zayati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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