PNEUMATOSE KYSTIQUE INTESTINALE ASSOCIEE A UNE STENOSE BULBAIRE SUR ULCERE

Cystic Pneumatosis or pneumatises cystoides of small intestine is a rare affection. Its defined by the existence of gas is found in the digestive tract wall. This affection can be primitive or more often associated to systematic intestinal inflammatory diseases. The signs of this affection are not specific and most of cases are discovered incidentally during surgery or endoscopies. The diagnosis is based on radiological findings. The treatment, however, remains conservative because of the benignity of this disease. The prognosis is conditioned by the underlying disease. We report two cases of cystic Pneumatosis of the small intestine associated to ulcer pyloric stenosis, and we discuss through these cases all diagnosis and therapeutic features of this disease.La Pneumatose kystique intestinale (PKG) est une affection rare, définie par la présence de gaz dans la paroi du tube digestif. Elle peut être primitive ou le plus souvent associée à des maladies inflammatoires systémiques du tube digestif. Symptomatologie non spécifique, parfois de découverte fortuite. Le diagnostic est porté sur la radiologie.  Le traitement est essentiellement  conservateur vu la bénignité de l’affection. Le pronostic étant conditionné par la maladie sous-jacente. Nous rapportons deux cas de pneumatose kystiques intestinale associé à une sténose bulbaire sur ulcère.  A partir de ces deux cas nous avons discuté les éléments du diagnostiques Et l’attitude thérapeutique généralement conservatrice

LE TRAITEMENT CHIRURGICAL DE L’ ANGIODYSPLASIE DUODENALE SURGICAL TREATEMENT OF DUODENAL ANGIODYSPLASIA

Management of angiodysplasia is usually based on endoscopic therapies. Surgical treatement is required in massive bleeding and when the others procedures failed. However the duodenal seat and diffuse lesions remains a challenging problem. We present two patients with duodenal angiodysplasia who underwent cephalic duodenopancreatectomy. Both patients had good follow-up. We justify our choice which is unusual by the duodenal seat, diffuse and symptomatic lesions and recurrent hemorrhage.Le traitement de l’angiodysplasie fait   habituellement appel aux méthodes endoscopiques. Le recours à la chirurgie s’impose devant une hémorragie massive ou en cas d’échec des autres thérapeutiques .Toutefois le siège duodénal et le caractère diffus des lésions angiodysplasiques rendent difficile la décision thérapeutique. Nous présentons deux cas d’angiodysplasie duodénale traités chirurgicalement. Le geste a consisté en une duodénopancréatectomie céphalique .Les suites immédiates et à distance étaient simples. Nous justifions notre choix thérapeutique qui reste exceptionnel par le siège duodénal des lésions, leur caractère symptomatique et durable ainsi que leur nombre élevé

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. None