A Rare Case of Ileocolic Obstruction Due to Lithophagia Associated with Cervical Oesophageal Perforation

Lithophagia is a rare syndrome characterized by a repetitive ingestion of stones and pebbles. We herein report a case of a 61-year old mentally retarded man, with a past surgical history of multiple laparotomies for stone ingestion, presenting with cervical oesophagus perforation due to a large butterfly screw and massive impaction of 89 stones and other foreign bodies in the caecum, with consequent mechanical bowel obstruction.

[Meckel's diverticulum and obstruction of the small intestine in adult patients: report of two cases]

Meckel's Diverticulum (MD) is the most frequent congenital anomaly of the ileum. However, its clinical manifestations in adult patients are rare. In this paper, we report cases with two different mechanisms of small intestine obstruction due to MD and we discuss diagnosis and management of these symptomatic lesions in adult patients.

[A huge inguino-scrotal hernia]

We report herein a case of a 76 year-old-man, who presented a huge left inguino-scrotal hernia. Laparoscopic reduction of the hernia contents and hernia repair through an inguinal approach were performed. No recurrence was observed two years and a half postoperatively. Reconstructive surgical approach and important postoperative complications were discussed.

[Iron deficiency anaemia, pancreatitis and epigastric mass in a young female: a rare presentation of a large gastric trichobezoar]

We report the case of a 15-year old girl presenting with a gastric fullness sensation. The biological examination showed iron deficiency anaemia and elevation of the pancreatic enzymes. At endoscopy, a huge trichobezoar is found in the stomach. The endoscopic removal is impossible due to the compacity of the mass. Surgical resection is therefore performed. The postoperative course is uneventful and the biologic anomalies are rapidly corrected. A throughout anamnesis revealed a trichotillomania with trichophagia, this behavioural trouble found its origin in a familial conflict.

Spontaneous cystic artery rupture: a rare cause of haemoperitoneum

We report the case of a 74-year-old man who presented an acute haemoperitoneum further to the rupture of the cystic artery. The bleeding was successfully controlled using embolization. This procedure was complicated by ischaemic necrosis and perforation of the gall-bladder requiring laparoscopic cholecystectomy. Spontaneous rupture of intra-abdominal arteries is a rare event. This usually occurs in abnormal arteries, presenting pseudo-aneurysm or, weakened by arterial hypertension, diabetes or corticotherapy. In the case of a cystic artery rupture, embolization can be safely done as long as the arterial anastomotic network with hepatic parenchyma is sufficient to supply the gall-bladder.

[Acute and latent right side diaphragmatic rupture after blunt trauma: cases studies and review of the literature]

A right diaphragmatic rupture (RDR) after blunt trauma is rare. Diagnosis of this entity remains difficult due to the absence of a precise anamnesis and pathognomonic signs. We report two cases of acute and latent RDR respectively. Immediate laparotomy was performed in the first case and thoracotomy was done nine weeks after blunt trauma for the second one. After the hepatothorax reduction, diaphragmatic lesions were sutured and reinforced by prosthesis. Acute RDR evolve inevitably to a latent and obstructive phases. Then, the mainstay treatment is surgical repair of the diaphragmatic defect. At present, thoracotomy is recommended for latent RDR. In the acute phases, thoracic and/or abdominal approaches depend on associated lesions, hemodynamical patient stability and surgical competence of the practitioner.

Nissen versus Toupet fundoplication: results of a randomized and multicenter trial

BACKGROUND

Laparoscopic Toupet fundoplication (TF) is reported to be as effective as Nissen (NF), but to be associated with fewer unfavorable postoperative side-effects. This study evaluates the one- and three-year clinical outcome of 140 randomized patients after a laparoscopic NF or TF.

PATIENTS AND METHODS

Inclusion criteria included patients over 16 years old with complications of gastro-oesophageal reflux disease (GORD) and persistence or recurrence of symptoms after three months of treatment. Subjects with a previous history of gastric surgery or repeated fundoplication, brachy-oesophagus or severe abnormal manometry results were excluded. Seventy-seven NF and 63 TF were performed. The severity of symptoms was assessed before and after the procedure.

RESULTS

One hundred and twenty-one of the 140 patients after one year, and 118 after three years, were evaluated and no statistically significant clinical difference was observed. The level of satisfaction concerning the outcome of the operation remained high after one or three years regardless of the type of fundoplication performed.

CONCLUSIONS

Functional complications after NF are not avoided with TF.

Stromal tumour of the rectum: laparoscopic approach of a rare localization of GIST

The authors present the case of a 60 year-old man known for a rectal polyp which was diagnosed in 1994 and since then followed-up by means of a colonoscopy associated with periodic biopsies. Recently, the results of a biopsy revealed positive markers for the diagnosis of Gastro-Intestinal Stromal Tumor (GIST). Despite the absence of malignant criteria, an anterior resection of the rectum was performed by laparoscopy and the patient rapidly recovered. Epidemiology, diagnosis and management of this rare location of GIST's are discussed.

Mesenteric cysts. A case treated by laparoscopy and a review of the literature

Mesenteric cysts are one of the rarest abdominal tumors. Since the first report of a mesenteric cyst by Benevienal in 1507, only 820 cases have been reported. The symptoms depend on the size and location of the cyst. The main presenting symptom is abdominal pain, followed by nausea and vomiting. Some mesenteric cysts may present as an acute abdomen due to a possible complication, such as hemorrhage, rupture, or torsion of the cyst. The treatment of choice for mesenteric cyst is complete excision to avoid recurrence and possible malignant transformation. We report an additional case of mesenteric cyst which, to our knowledge, is the first to be treated by laparoscopy.

[An acute pseudo-cholecystitis]

In an emergency department, many patients were admitted with abdominal pain. The problem is to made the right diagnosis between an acute abdomen that must be manage by a medical approach and an acute abdomen with immediate surgical treatment. We present the case of a 44 year-old man admitted in our emergency department with clinical signs of acute cholecystitis. After a new interrogation and the inadequacy of the diagnostic procedures a lead intoxication treated by a medical approach was diagnosed.

Laparoscopic Toupet fundoplication: prospective study of 100 cases. Results at one year and literature review

We report a prospective evaluation of 100 patients who underwent laparoscopic fundoplication according to Toupet. All these cases where suffering from gastro-oesophageal reflux resistant to medical treatment or recurring after stopping it. Only one conversion into laparotomy was required. Perioperative morbidity (4%), mortality (0%), median hospital stay (4 days) and return to work (3 weeks) were lower than in case of open surgery in the literature. One year after the operation, clinical results were similar to those of laparotomy with 93% of patients free of symptoms. Excellent results of this technique lead us to assert that laparoscopic Toupet procedure is an interesting way of treating the gastro-oesophageal reflux that does not respond to medical treatment.

[Indications for and limitations of celioscopic digestive surgery]

Digestive laparoscopic surgery, which appeared in 1987, has developed rapidly, and has effected many procedures. After seven years, the time has come for surgeons to analyse whether their operative results are conclusive in justifying the continual use of this surgical procedure. If laparoscopic surgery respects the basic principles of conventional surgery, it should increase the patient's comfort during the postoperative period. In this article we shall consider similar fields where this new surgical technique could be beneficial.

[Idiopathic retroperitoneal fibrosis]

Reviewing three recent cases of idiopathic retroperitoneal fibrosis, we describe the clinical symptoms, the evolution, the biological data and the histological features. We emphasize the importance of C.T. scan in the investigation of such patients. Treatment was either surgical or medical.

[Indications and surgical technic in gynecomastia]

In our opinion, very few publications represent a practical attitude on surgical level concerning a gynaecomasty; so we tried to sum up the operative indications and to establish a classification of the useful surgical techniques, not only in function of the existence or non-existence of a cutaneous excess, but also of the type and the localization of the vascular stalk feeding the nipple-plate. The post-operative complications are described and finally, we present you our personal experience in 21 cases.