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Dammak N, Ammar H, Latifa MB, Belkacem O, Mabrouk MB, Ali AB. Gallbladder primary well-differentiated neuroendocrine tumor: A misdiagnosed case. Int J Surg Case Rep 2023; 111:108882. [PMID: 37793232 PMCID: PMC10551650 DOI: 10.1016/j.ijscr.2023.108882] [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: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Gallbladder (GB) Well-Differentiated (WD) Neuroendocrine Tumor (NET) are extremely rare tumors. They represent only about 0.5 % of all Neuroendocrine Neoplasms (NENs). Most GB-NETs are diagnosed after cholecystectomy. They are often misdiagnosed and have good prognosis. CASE PRESENTATION We share our experience of a 42-year-old woman operated on for symptomatic cholelithiasis. We discover on the anatomopathological piece that it was a Grade 1 NET of the GB. Staging scans and octreotide-scans were normal: there is no distant or nodal metastasis. This tumor was classified as T1bN0M0. After multidisciplinary team discussion, additional treatment is deemed unnecessary. She didn't receive any treatment after the surgery. At one year after the cholecystectomy, she is symptom free and there is no sign of recurrence. DISCUSSION The diagnosis of GB-WD NET is difficult at the first evaluation. Surgical management for GB cancer has shown increased survival rates, a similar strategy seems reasonable for GB-NETs. Patients with Grade,1 well-differentiated GB-NETS have an excellent prognosis overall. CONCLUSION Research is required to facilitate earlier diagnosis and to develop management guidelines for GB-NETs.
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Affiliation(s)
- Nouha Dammak
- Department of Digestive and Visceral Surgery, Sahloul University Hospital, Sousse, Tunisia.
| | - Houssem Ammar
- Department of Digestive and Visceral Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Mahdi Ben Latifa
- Department of Digestive and Visceral Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Oussama Belkacem
- Pathology Department, Sahloul Hospital, Sousse, Tunisia; Research Laboratory LR21ES03, Medical School of Sousse, University of Sousse, Tunisia
| | - Mohamed Ben Mabrouk
- Department of Digestive and Visceral Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Ali Ben Ali
- Department of Digestive and Visceral Surgery, Sahloul University Hospital, Sousse, Tunisia
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Ammar H, Dammak N, Ben Latifa M, Said MA, Azri M, Gupta R, Ben Hamada H, Belkacem O, Ben Mabrouk M, Ben Ali A. Rupture of a liver hydatid cyst into the right portal vein leading to right portal vein thrombosis: a case report and literature review. J Int Med Res 2023; 51:3000605231191018. [PMID: 37572078 PMCID: PMC10423452 DOI: 10.1177/03000605231191018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/13/2023] [Indexed: 08/14/2023] Open
Abstract
Hydatid disease (HD) is a worldwide parasitic disease. HD is endemic in many sheep- and cattle-raising areas, with a high prevalence of 5% to 10% in the Mediterranean region. Fistulation of liver hydatid cysts (LHC) in the bile ducts is the most common complication, followed by rupture of cysts in the peritoneal and thoracic cavities. Vascular complications are a rare complication of HD. We describe the case of a 70-year-old woman who was admitted with the chief complaint of pain in the abdominal right upper quadrant for 6 months. Abdominal computed tomography revealed a large LHC in the right liver that had ruptured into the right portal vein branch, with venous thrombosis. Intraoperatively, the right portal vein was opened longitudinally, and the hydatid contents were evacuated. Right hepatectomy was performed to completely excise the LHC. The penetration of a cyst into an adjoining vessel is very rare, and portal vein invasion by HD is extremely rare, with only 10 cases published in the literature, to the best of our knowledge.
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Affiliation(s)
- Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Nouha Dammak
- Department of Gastrointestinal Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Mahdi Ben Latifa
- Department of Gastrointestinal Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Marwa Azri
- Department of Gastrointestinal Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Habiba Ben Hamada
- Department of Anesthesiology, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Oussama Belkacem
- Department of Pathology, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Mohamed Ben Mabrouk
- Department of Gastrointestinal Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
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Belaid I, Ben Moussa C, Melliti R, Limam M, Ben Ahmed T, Ezzaari F, Elghali MA, Bouazzi A, Ben Mabrouk M, Bourigua R, Ammar N, Hochlaf M, Fatma LB, Chabchoub I, Ben Ahmed S. Quality of life in Tunisian colorectal cancer patients: a cross-sectional study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04154-3. [PMID: 35771260 DOI: 10.1007/s00432-022-04154-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Quality of life (QOL) of colorectal cancer (CRC) patients has been little studied in Tunisia. The aim of this work was to evaluate the QOL of CRC patients and to identify factors that may influence it. METHODS A cross-sectional, study spread was made over a period of 6 months on patients with CRC treated in the department of Medical Oncology of Farhat Hached University Hospital of Sousse. The EORTC questionnaires translated and validated in Arabic (QLQ-C30 and QLQ-CR29) were used. RESULTS 142 patients diagnosed with colon or rectal cancer were enrolled. The overall QOL score was 58.5 ± 29.1. The emotional and sexual functional dimensions were the most affected, especially in women and patients under 50 years of age. QOL scores were higher in patients who were in complete remission (71.4 ± 24.7) and in good general condition (63.7 ± 26.6) physical activity may have a significant influence on all functional dimensions of QOL (p < 0.001). Fatigue was significantly (p < 0.001) more present when there was a sedentary lifestyleradiotherapy, palliative chemotherapy (1st and 2nd line) and targeted therapy. CONCLUSION Evaluating quality of life of patients with colorectal cancer in Tunisia is necessary especially those under 50 years old and in women. Laparoscopic surgery with restoration of intestinal continuity, less toxic palliative chemotherapy protocols, more accessibility to new radiotherapy technics will improve QOL of CRC patients. Physical activity and nutrition support are also essential in promoting QOL of these patients.
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Affiliation(s)
- Imtinene Belaid
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie.
| | - Chaimaa Ben Moussa
- Faculté de Médecine de Sousse, Department of Epidemiology, Université de Sousse, 4000, Sousse, Tunisie
| | - Rihab Melliti
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Manel Limam
- Faculté de Médecine de Sousse, Department of Epidemiology, Université de Sousse, 4000, Sousse, Tunisie
| | - Tarek Ben Ahmed
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Faten Ezzaari
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Mohamed Amine Elghali
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of Surgery, Université de Sousse, 4000, Sousse, Tunisie
| | - Amal Bouazzi
- Faculté de Médecine de Sousse, Hôpital Sahloul, Department of Surgery, Université de Sousse, 4000, Sousse, Tunisie
| | - Mohamed Ben Mabrouk
- Faculté de Médecine de Sousse, Hôpital Sahloul, Department of Surgery, Université de Sousse, 4000, Sousse, Tunisie
| | - Rym Bourigua
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Nouha Ammar
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Makrem Hochlaf
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Leila Ben Fatma
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Imene Chabchoub
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
| | - Slim Ben Ahmed
- Faculté de Médecine de Sousse, Hôpital Farhat Hached, Department of MedicalOncology, Association de Recherhe et d'Information Sur Le Cancer du Centre Tunisien, Université de Sousse, 4000, Sousse, Tunisie
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Farhat W, Ammar H, Rguez A, Harrabi F, Said MA, Ghabry L, Gupta R, Ben Cheikh A, Ghali H, Ben Rajeb M, Ben Mabrouk M, Ben Ali A. Radical versus conservative surgical treatment of liver hydatid cysts: A paired comparison analysis. Am J Surg 2021; 224:190-195. [PMID: 34949334 DOI: 10.1016/j.amjsurg.2021.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/24/2021] [Revised: 11/14/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The management of liver hydatid cysts (LHC) is complex and includes surgery, percutaneous drainage, chemotherapy and observation. Broadly, there are two types of surgical treatment for LHC - conservative surgery (CS) and radical surgery (RS). The purpose of this study was to compare the outcome of RS and CS. METHODS Data from all patients with LHC treated in Sahloul Hospital, between January 2000 and December 2019, were retrieved. To minimize selection bias, paired comparison analysis (PCA) was performed. RESULTS A total of 914 patients were included in this study. RS and CS were performed in 284 and 630 patients, respectively. After PCA, 206 patients were included in each group. The incidence of intraoperative bleeding was significantly higher in the RS group. The overall morbidity was significantly lower in the RS group. Thity-four patients developed recurrence with significantly higher recurrence in CS group. CONCLUSION RS is associated with fewer postoperative complications and lower recurrence rate compared to CS. RS may be the preferred procedure for LHC if the expertise is available.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Arib Rguez
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Fathia Harrabi
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Linda Ghabry
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India.
| | - Asma Ben Cheikh
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | - Mohamed Ben Rajeb
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
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Farhat W, Ammar H, Said MA, Mizouni A, Ghabry L, Hammami E, Gupta R, Habiba Ben Hamada, Mabrouk MB, Ali AB. Surgical management of giant hepatic hemangioma: A 10-year single center experience. Ann Med Surg (Lond) 2021; 69:102542. [PMID: 34457247 PMCID: PMC8379432 DOI: 10.1016/j.amsu.2021.102542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic hemangiomas are the most typical benign mesenchymal lesions of the liver. Most of these lesions are asymptomatic. Giant hepatic hemangiomas (GHH) (>10 cm) are often symptomatic and require surgical intervention. This study aimed to describe the clinical findings, risk factors, diagnostic approach and management of GHH. Methods We performed a retrospective analysis of patients with GHH treated at our hospital from January 2008 to December 2018. The medical records of each patient were reviewed to obtain the clinical and surgical data. Results Twelve patients with GHH were treated during the study period. 9 were female and 3 were male. The mean age of diagnosis was 48,2 years. The most common presenting symptom was abdominal pain. Eight patients presented an abdominal mass. Indications for surgical resections were rupture (n = 2), Kasabach-Merritt syndrome (n = 1) and abdominal pain (n = 9). Right hepatectomy was done in four patients, left lobectomy in four patients, and enucleation in four patients. Embolization was performed in 4 patients, but due to the persistence of symptoms or bleeding, surgery was indicated. The mean operative time was 3.5 h, and median blood loss was 870 ml. The median hospital stay was 5.3 days. For four patients, we registered postoperative complications causing death in one case. All alive patients were asymptomatic at a median follow-up of 55 months. Conclusion Despite limitations and alternative modalities, surgery remains the only effective curative treatment for GHH. Hepatic hemangiomas are the most common benign tumors of the liver with the incidence of 0.4–20%. Giant hepatic hemangiomas (GHH) are usually responsible for overt clinical symptoms and complications. Management of liver hemangiomas ranges from close observation to surgery depending upon the site, size and symptoms. Surgical resection is indicated in patients with abdominal complaints or complications, or when diagnosis remains inconclusive.
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Affiliation(s)
- Waad Farhat
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | | | | | - Linda Ghabry
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Eya Hammami
- Department of Gastroenterology, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Sciences, Synergy Institute of Medical Sciences, Dehradun, India
| | | | | | - Ali Ben Ali
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
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Mizouni A, Harrabi F, Farhat W, Ghabri L, Mabrouk MB, Ali AB. [Left paraduodenal hernia: a rare cause of acute intestinal obstruction]. Pan Afr Med J 2020; 36:326. [PMID: 33193980 PMCID: PMC7603818 DOI: 10.11604/pamj.2020.36.326.24958] [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: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 11/24/2022] Open
Abstract
La hernie para duodénale gauche est une hernie interne congénitale qui se complique rarement par une occlusion intestinale aiguë et qui peut mettre en jeux le pronostic vital par ischémie des anses. Nous rapportons un cas d’un jeune homme de 28 ans pris en charge pour un syndrome occlusif. Le scanner abdominal a objectivé une occlusion intestinale aiguë haute, l’exploration peropératoire a trouvé des anses jéjunales incarcérées dans une hernie para duodénale gauche. Le collet a été fermé et les suites opératoires étaient simples. En conclusion, la hernie para duodénale gauche, est souvent diagnostiquée lors d’une complication, son traitement est chirurgical et préférentiellement par laparoscopie.
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Affiliation(s)
- Abdelkader Mizouni
- Service de Chirurgie Générale, CHU Sahloul de Sousse, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
| | - Fathia Harrabi
- Service de Chirurgie Générale, CHU Sahloul de Sousse, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
| | - Waad Farhat
- Service de Chirurgie Générale, CHU Sahloul de Sousse, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
| | - Linda Ghabri
- Service de Chirurgie Générale, CHU Sahloul de Sousse, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
| | - Mohamed Ben Mabrouk
- Service de Chirurgie Générale, CHU Sahloul de Sousse, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
| | - Ali Ben Ali
- Service de Chirurgie Générale, CHU Sahloul de Sousse, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
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Ammar H, Said MA, Mizouni A, Farhat W, Harrabi F, Ghabry L, Gupta R, Ben Mabrouk M, Ben Ali A. Ectopic pancreas: A rare cause of occult gastrointestinal bleeding. Ann Med Surg (Lond) 2020; 59:41-43. [PMID: 32983446 PMCID: PMC7498733 DOI: 10.1016/j.amsu.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/02/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Ectopic pancreas (EP) is a rare entity characterized by the development of pancreatic tissue in areas other than the pancreas. We present the case of a 16-year-old female with a heterotopic pancreas in the jejunum revealed by occult gastrointestinal bleeding. Contrast-enhanced computed tomography (CT) of the abdomen revealed a 2 × 3 cm enhancing nodular jejunal mass suspicious of a neuroendocrine or gastrointestinal stromal tumor. Octreoscan was planned but the patient presented in the emergency department with fever and sudden onset severe abdominal pain. The patient underwent emergency laparotomy. On abdominal exploration, appendicular perforation was present for which appendectomy and peritoneal lavage were performed. The small jejunal lesion seen on CT was identified during surgery and segmental jejunal resection with end-to-end anastomosis was performed. The histopathological examination of the jejunal mass revealed the presence of pancreatic acini and ductal structures without islets of Langerhans in the submucosa of the small intestine covered by normal mucosa. At the last follow-up of eight months after surgery, the patient is symptom-free and the abdominal CT is normal. Preoperative diagnosis of EP requires high clinical suspicion and should be included in the differential diagnosis while treating patients with gastrointestinal bleeding or gastrointestinal mass on CT. Ectopic pancreas (EP) is a rare entity characterized by the development of pancreatic tissue in areas other than the pancreas. It is often asymptomatic and mostly detected incidentally on surgery for other disease or on autopsy. The most common sites of EP are stomach and small intestine but it can be found in the esophagus, ileum, and biliary tree. EP should be included in the differential diagnosis while treating patients with gastrointestinal bleeding or gastrointestinal mass on CT.
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Affiliation(s)
- Houssem Ammar
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Amine Said
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Waad Farhat
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Fathia Harrabi
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Linda Ghabry
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Mohamed Ben Mabrouk
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Ali Ben Ali
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
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Farhat W, Ammar H, Mizouni A, Harrabi F, Bouazzi A, Hammami E, Gupta R, Said MA, Ben Mabrouk M, Ben Ali A. Osteoclastic giant cell tumor of the pancreas with synchronous jejunal gastrointestinal stromal tumor: A case report. Ann Med Surg (Lond) 2020; 51:28-30. [PMID: 32153772 PMCID: PMC7058842 DOI: 10.1016/j.amsu.2019.11.008] [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: 07/25/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/05/2022] Open
Abstract
Osteoclastic giant cell tumor of the pancreas is a rare aggressive tumor, counting for 2–7% of all pancreatic cancers. Surgery is considered the most appropriate treatment. We report a case of a 84-year-old man with incidentally detected 11cm tumor in the pancreatic tail and another 6 cm tumor located in the jejunum on abdominal computed tomography. The patient underwent distal pancreatectomy with splenectomy along with segmental resection of the tumor bearing part of the jejunum. On histological examination, osteoclast-like giant cells with some areas of metaplastic bone were observed which confirmed the diagnosis of osteoclastic tumor of the pancreas. The jejunal tumor was strongly c-kit positive on immunohistochemistry which confirmed the diagnosis of GIST. On the last follow up at 2 years after surgery, there is no evidence of recurrence or distant metastasis. Pancreatic OGCT has a better prognosis after resection than pancreatic adenocarcinoma. Its co-existence jejunal GIST, as seen in the index case, has not been reported in the English literature till date. Osteoclastic giant cell tumor of the pancreas is a rare aggressive tumor, counting 2–7% of all pancreatic cancers. Surgery is considered the most appropriate treatment. Pancreatic OGCT has a better prognosis, after resection than pancreatic adenocarcinoma. Its co-existence jejunal GIST, as seen in the index case, has not been reported in the English literature till date.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Fathia Harrabi
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Amal Bouazzi
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Eya Hammami
- Department of Gastroenterology, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Ben Mabrouk
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Ali Ben Ali
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
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Farhat W, Ammar H, Amine Said M, Mizouni A, Bouazzi A, Abdessaied N, Ben Mabrouk M, Ben Ali A. Solid pseudopapillary neoplasm of the pancreas: a report of 10 cases and literature review. ANZ J Surg 2020; 90:1683-1688. [PMID: 31989788 DOI: 10.1111/ans.15701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/26/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary tumour of the pancreas (SPTP) is a rare pancreatic tumour characterized by a non-specific clinical presentations and vague radiologic features. The aim of this study is to identify these tumours from other pancreatic neoplasms because complete resection is curative in most cases and provides long-term survival. METHODS A retrospective analysis of patients operated for SPTP between January 2000 and December 2018 was conducted. The collected data included age, gender, clinical findings, laboratory tests, radiological findings, anatomopathological examination, immunohistochemistry results, surgical treatment, mortality, morbidity and recurrence. RESULTS Ten cases of SPTP have been diagnosed between January 2000 and December 2018 representing 5.1% of all pancreatic tumours operated during this period (male/female: 2/8; median age 41.2 years; range 19-78 years). The most common symptom was abdominal pain and physical examination was normal in four of 10 cases. The most common tumour localization was the tail of the pancreas. The main tumour size was 7.2 cm (range 2-15 cm). One patient had abdominal disseminated disease. Surgical interventions were distal pancreatectomy in five cases, enucleation in one case, cephalic duodeno-pancreatectomy in two cases, central pancreatectomy in one case and pancreatic biopsy in one case. Only one patient received adjuvant chemotherapy. During follow-up, one patient died after 12 months and another developed unique hepatic metastasis that was resected. CONCLUSION Although it is delayed in diagnosis, the overall prognosis of these tumours remains good even with local recurrence and metastasis. Complete surgical resection is the treatment of choice even in cases of recurrence.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Amal Bouazzi
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Nihed Abdessaied
- Department of Pathology, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
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Farhat W, Azzaza M, Mizouni A, Ammar H, ben Ltaifa M, Lagha S, Kahloul M, Gupta R, Mabrouk MB, Ali AB. Factors predicting recurrence after curative resection for rectal cancer: a 16-year study. World J Surg Oncol 2019; 17:173. [PMID: 31660992 PMCID: PMC6819540 DOI: 10.1186/s12957-019-1718-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/03/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The recurrence after curative surgery of the rectal adenocarcinoma is a serious complication, considered as a failure of the therapeutic strategy. The aim of this study was to identify the different prognostic factors affecting the recurrence of adenocarcinoma of the rectum. METHODS A retrospective analysis of patients operated for adenocarcinoma of the rectum between January 2000 and December 2015 was conducted. The study of the recurrence rate and prognostic factors was performed through the Kaplan Meier survival curve and the Cox regression analysis. RESULTS During the study period, 188 patients underwent curative surgery for rectal adenocarcinoma, among which 53 had a recurrence. The recurrence rate was 44.6% at 5 years. The multivariate analysis identified four parameters independently associated with the risk of recurrence after curative surgery: a distal margin ≤ 2 cm (HR = 6.8, 95% CI 2.7-16.6, 6), extracapsular invasion of lymph node metastasis (HR = 4.4, 95% CI 1.3-14), tumor stenosis (HR = 4.3, 95% CI 1.2-15.2), and parietal invasion (pT3/T4 disease) (HR = 3, 95% CI 1.1-9.4). CONCLUSION The determination of the prognostic factors affecting the recurrence of rectal adenocarcinoma after curative surgery allows us to define the high-risk patients for recurrence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03899870 . Registered on 2 February 2019, retrospectively registered.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Azzaza
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mahdi ben Ltaifa
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Sami Lagha
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Kahloul
- Department of Anesthesia and Intensive Care, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
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Gupta R, Farhat W, Ammar H, Azzaza M, Lagha S, Cheikh YB, Mabrouk MB, Ali AB. Idiopathic segmental infarction of the omentum mimicking acute appendicitis: A case report. Int J Surg Case Rep 2019; 60:66-68. [PMID: 31203002 PMCID: PMC6580434 DOI: 10.1016/j.ijscr.2019.03.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/15/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022] Open
Abstract
Omentum infarction occurs due to torsion, infections and vascular thrombosis. Primary idiopathic segmental omental infarction is rare. Clinically it is difficult to differentiate from acute appendicitis. Idiopathic omental infarction should be included in the differential diagnoses while treating patient with acute abdomen.
Introduction Omentum is a well vascularized organ. Omentum infarction is uncommon. Most of the cases are secondary due to torsion, intra-abdominal infections and vascular thrombosis. Primary idiopathic segmental omental infarction is rare. Presentation of case A 26-year-old male presented with acute onset right iliac fossa pain mimicking acute appendicitis. On radiological imaging, early acute appendicitis was suspected. On diagnostic laparoscopy, appendix appeared normal and there was idiopathic infarction of a part of the greater omentum lying close to the cecum. Patient underwent laparoscopic appendectomy with excision of the diseased segment of the omentum and had uneventful recovery. Conclusion Idiopathic omental infarction should be included in the differential diagnoses while treating patient with acute abdomen.
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Affiliation(s)
- Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India.
| | - Waad Farhat
- Department of General and Digestive Surgery, Sahloul Hospital, University of Medicine of Sousse, University of Sousse, Tunisia.
| | - Houssem Ammar
- Department of General and Digestive Surgery, Sahloul Hospital, University of Medicine of Sousse, University of Sousse, Tunisia.
| | - Mohamed Azzaza
- Department of General and Digestive Surgery, Sahloul Hospital, University of Medicine of Sousse, University of Sousse, Tunisia.
| | - Sami Lagha
- Department of General and Digestive Surgery, Sahloul Hospital, University of Medicine of Sousse, University of Sousse, Tunisia.
| | - Yesser Ben Cheikh
- Department of Radiology, Sahloul Hospital, University of Medicine of Sousse, University of Sousse, Tunisia.
| | - Mohamed Ben Mabrouk
- Department of General and Digestive Surgery, Sahloul Hospital, University of Medicine of Sousse, University of Sousse, Tunisia.
| | - Ali Ben Ali
- Department of General and Digestive Surgery, Sahloul Hospital, University of Medicine of Sousse, University of Sousse, Tunisia.
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Farhat W, Mabrouk MB, Ammar H, Mizouni A, Said MA, Lagha S, Ben Cheikh Y, Gupta R, Moussa M, Ali AB. Gallbladder volvulus: A case report and review of the literature. Int J Surg Case Rep 2019; 60:75-78. [PMID: 31207530 PMCID: PMC6580008 DOI: 10.1016/j.ijscr.2019.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/13/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022] Open
Abstract
Gallbladder volvulus (GV) is a rare disease with less than 400 cases reported in the English literature. Preoperative diagnosis is a major challenge with only 4 cases being diagnosed on radiology. Critical constellation of presenting symptoms and signs along with radiology can help in timely diagnosis of GV.
Introduction: Gallbladder volvulus (GV) is a rare disease with less than 400 cases reported in the English literature. The pre-operative diagnosis of GV is difficult as none of the imaging modalities are accurate. Once diagnosed, the mainstay of treatment is emergency surgical derotation and cholecystectomy. Presentation of case: A 83-old lady presented with right upper quadrant pain and fever for 3 days. Abdominal imaging revealed the presence of a distended, floating gallbladder located outside its normal fossa with thickened non-enhancing wall and a twisted pedicle suggestive GV. The patient underwent emergency laparotomy because the laparoscopic approach was refused by the anesthetist due to the history of pulmonary emphysema. Intraoperatively, the gallbladder was found be gangrenous and rotated in anti-clockwise direction around the cystic pedicle. The gallbladder was de-rotated followed by cholecystectomy. Discussion: GV is an uncommon cause for abdominal pain and occurs due to rotation of gall bladder on its mesentery along the axis of the cystic duct and the cystic artery. Pre-operative diagnosis continues to be a major challenge with only 4 cases reported in the literature diagnosed with pre-operative imaging. This case is one of the rare cases diagnosed with pre-operative imaging. It is often misdiagnosed as acute cholecystitis before surgery. However, critical constellation of presenting signs and symptoms along with radiological findings may guide the surgeon to accurate and timely diagnosis of GV before surgical intervention. Conclusion: Although rare, it is important to consider GV as a differential diagnosis in an elderly patient with acute cholecystitis.
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Affiliation(s)
- Waad Farhat
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
| | - Mohamed Ben Mabrouk
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
| | - Houssem Ammar
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
| | - Abdkader Mizouni
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
| | - Mohamed Amine Said
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
| | - Sami Lagha
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
| | | | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India.
| | - Makram Moussa
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
| | - Ali Ben Ali
- Department of General and Digestive Surgery, Hopital Sahloul, Sousse, Tunisia.
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Chhaidar A, Mabrouk MB, Ali AB. Isolated Roux loop pancreaticojejunostomy versus conventional pancreaticojejunostomy after pancreaticoduodenectomy: A case-control study. Int J Surg Case Rep 2018; 53:223-227. [PMID: 30428436 PMCID: PMC6232583 DOI: 10.1016/j.ijscr.2018.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/05/2018] [Accepted: 10/13/2018] [Indexed: 12/22/2022] Open
Abstract
Pancreaticojejunostomy is commonly used in the reconstruction after pancreaticoduodenectomy, but the incidence of POPF remains high. There are a number of theoretical advantages to the isolated Roux loop pancreaticojejunostomy reconstruction, mainly related to the physical separation of bile acids and the pancreaticojejunostomy. The use of an isolated Roux loop pancreaticojejunostomy seems to be associated with decrease in the rate of postoperative PF in patients undergoing PD.
Objectives The aim of this study was to compare the postoperative outcomes of isolated Roux loop pancreaticojejunostomy (IPJ) and conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy (PD). Methods Data of patients who underwent IPJ were compared with those of a pair-matched equal number of patients undergoing CPJ. The matching was performed according to age, gender, nature of the lesion indicating PD and the texture of the pancreas. The primary outcome was the rate of postoperative pancreatic fistula (POPF). Secondary outcomes included operative time, day to resumption of oral feeding, postoperative morbidity and mortality. Results Seventy patients treated by PD (35 patients in each group) were included in the study. The two groups were comparable with regards to the pre-operative and intra-operative parameters. Postoperative pancreatic fistula developed in 10 out of 35 patients in the CPJ group and 3 out of 35 patients in the IPJ group (p = 0.031). Nine CPJ patients and one IPJ patient had POPF of type B or C (p = 0.006). Re-laparotomy was significantly more frequent in the CPJ group (11.1% versus 34.6%; p = 0.04). Time to resumption of oral feeding was shorter in the IPJ group (p = 0.001). Conclusions The use of IPJ is associated with decrease in the rate of postoperative PF in patients undergoing PD. In addition, patients with IPJ reconstruction have lesser need for re-laparotomy and early resumption of oral feeding.
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Affiliation(s)
- Amine Chhaidar
- Department of Surgery, Sahloul Hospital, Sousse, Tunisia.
| | | | - Ali Ben Ali
- Department of Surgery, Sahloul Hospital, Sousse, Tunisia.
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Hammami A, Hasnaoui B, Guerfala M, Mabrouk MB, Farhat W, Ksiaa M, Jaziri H, Elleuch N, Brahem A, Ajmi S, Ali AB, Sriha B, Slama AB, Jmaa A. Gastrointestinal stromal tumor (GIST) inpatient with Von Recklinghausen's disease. Presse Med 2018; 47:404-408. [PMID: 29588106 DOI: 10.1016/j.lpm.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Aya Hammami
- Departement of Gastroenterology, Sahloul City, Tunisia.
| | | | | | | | - Waad Farhat
- Departement of Surgery, Sahloul City, Tunisia
| | - Mehdi Ksiaa
- Departement of Gastroenterology, Sahloul City, Tunisia
| | - Hanen Jaziri
- Departement of Gastroenterology, Sahloul City, Tunisia
| | - Nour Elleuch
- Departement of Gastroenterology, Sahloul City, Tunisia
| | - Ahlem Brahem
- Departement of Gastroenterology, Sahloul City, Tunisia
| | - Salem Ajmi
- Departement of Gastroenterology, Sahloul City, Tunisia
| | - Ali Ben Ali
- Departement of Surgery, Sahloul City, Tunisia
| | | | | | - Ali Jmaa
- Departement of Gastroenterology, Sahloul City, Tunisia
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