Hernie post traumatique de la paroi abdominale antérieure

La hernie post-traumatique de la paroi abdominale antérieure peut être méconnue dans un contexte d’urgence.Nous rapportons l’observation d’un patient âgé de 32 ans, avec un BMI à 30 Kg/m2 ayant présenté une hernie de la paroi abdominale antérieure suite à un accident de la voie publique. Cette lésion était méconnue par l’examen clinique. La tomodensitométrie abdominale montrait un défect de 8 cm de la paroi abdominale antérieure. Le patient était opéré avec découverte d’un défect musculo-aponévrotique sur 12 cm. La réparation était réalisée par une suture par des points séparés. Les suites opératoires étaient marquées par une nécrose secondairement infectée de la peau. Elle avait bien évolué après cicatrisation dirigée. A 3 mois post-opératoire, le patient va bien avec une plaie cicatrisée et une paroi abdominale solide.Pan African Medical Journal 2016; 2

Ostéochondrome solitaire de la symphyse pubienne de découverte fortuite

L'ostéochondrome est la tumeur osseuse bénigne la plus fréquente. Elle touche habituellement les métaphyses des os longs, particulièrement autour du genou et de l'humérus proximal. Il touche très rarement la symphyse pubienne avec fréquemment une symptomatologie atypique. Nous rapportons le cas d'un ostéochondrome de la symphyse pubienne empiétant sur la branche osseuse ilio-pubienne chez un homme de 35 ans, de découverte fortuite. Les explorations radiologiques, l'examen macroscopique et histologique confirment le diagnostic ainsi que l'absence de signe de malignité

Primary renal carcinoid metastasizing to distant sites 12 years after the initial diagnosis

Les carcinoïdes primitifs du rein sont rares avec une centaine de cas rapportés dans la littérature. Sur le plan histologique, il s'agit d'une tumeur bien différenciée dont la morphologie rejoint souvent celle des carcinoïdes dans les autres localisations. Nous rapportons un cas de carcinoïde primitif du rein survenant chez un homme de 41 ans, découvert à la suite de métastases hépatiques. La tumeur était particulière par son architecture tubulo-papillaire, suggérant à tort le diagnostic de carcinome papillaire du rein. Ce diagnostic a été redressé 12 ans après, à la suite de l'apparition d'autres métastases hépatiques, osseuses et pulmonaires.Pan African Medical Journal 2016; 2

Toxic megacolon complicating a first course of Crohn’s disease: about two cases

Toxic megacolon is a rare and serious complication of Crohn’s disease. Because of the associated high morbidity and mortality, early recognition and management of toxic megacolon is important. Through two cases of toxic megacolon complicating Crohn’s disease, we assessed the clinical, radiologic and therapeutic characteristics of this complication. A 35-year-old man presented a first course of Crohn’s disease treated with corticosteroid. He exhibited sudden severe abdominal pain and distension with shock. A plain abdominal radiography revealed toxic megacolon. He underwent medical therapy, but symptoms not relieved. The patient underwent subtotal colectomy with ileostomy. The resected specimen confirmed the diagnosis. Recovery of digestive continuity was performed. Endoscopic evaluation six months later did not shown recurrence. A 57-year-old man presented with severe acute colitis inaugurating Crohn’s disease, was treated with corticosteroid and antibiotics. He exhibited signs of general peritonitis. Computed tomographic examination revealed toxic megacolon with free perforation, showing prominent dilation of the transverse colon and linear pneumatosis. The patient underwent emergent subtotal colectomy and ileostomy. The final histological patterns were consisting with diagnosis of Crohn’s disease associated with cytomegalovirus infection. The patient underwent antiviral therapy during 15 days. Because of the high risk of postoperative recurrence, he underwent immunosuppressive therapy. Recovery of digestive continuity was performed successfully. Toxic megacolon in Crohn’s disease is a serious turning of this disease. We underscore the importance of early diagnosis of toxic megacolon and rapid surgical intervention if improvement is not observed on medical therapy

Pseudotumoral autoimmune pancreatitis mimicking a pancreatic cancer: a very difficult disease to diagnose

Autoimmune pancreatitis (AIP) is a rare disorder, although the exact prevalence is still unkown. It is a type of pancreatitis that is presumed to have an autoimmune aetiology, and is currently diagnosed based on a combination of 5 criteria. However, in this day and age, some patients with AIP are likely to be resected for the suspicion of malignancy. The authors report a case of pseudo-tumoral autoimmune pancreatitis, reviewing some literature about it and underlining the difficulty in the diagnosis. A 56- year-old patient was referred to our unit for upper abdominal pain. In his past medical history we note mellitus diabetes. The clinical examination was unremarkable. Laboratory data showed no abnormal values. Upper endoscopy showed antral gastritis. Transabdominal ultrasonography showed a hepatic steatosis and 5 angiomas. No computed tomography scan was made. Magnetic resonance imaging (MRI) showed 5 angiomas and a lesion of 20x20 mm of the pancreatic tail with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images. Due to concerns of pancreatic malignancy, the patient underwent open distal spleno-pancreatectomy. Histolo gical analysis of the resected specimen revealed no malignancy. Postoperatively, immunoglobulin G fraction 4 was slightly above of the upper limit of the normal range. After corticotherapy the patient is getting better. This case underlines the difficulties still encountered in the diagnosis of AIP. It has been frequently misdiagnosed as pancreatic cancer and caused unnecessary resection. In order to avoid unnecessary resections for an otherwise benign and easily treatable condition, it is urgent to refine diagnostic criteria and to reach an international consensus

Leiomyosarcoma of the inferior vena cava

Vascular leiomyosarcoma (LMS) are unique. The inferior vena cava (IVC) is the most affected organ (about 38% cases). We report the observation of a 50-year old woman who consulted for right upper quadrant pain. Imaging studies revealed a retroperitoneal mass that mimic a LMS of the IVC. The patient was operated. A resection of the IVC along with the tumor was performed without reconstruction. The management of LMS is surgical and depends upon the location and tumor characteristics

A disconcerting false gastric diverticulum mimicking malignancy

Gastric diverticula are the most uncommon form of gastrointestinal diverticula. They can either be of true or false type with different pathogenesis. They may be very challenging to diagnose as symptoms are nonspecific and imaging can simulate a malignant lesion. We report an unusual case of pre-pyloric diverticulum in a 69-year-old man, leading to severe gastric obstruction with a poor general condition. As subsequent endoscopy and imaging were alarming and couldn't exclude malignancy, the patient underwent an antrectomy. The final diagnosis was made on pathological examination. We discuss, through this case, the clinical and pathological features of gastric diverticula with an emphasis on the pathogenesis of this rare entity and the risk of a malignant transformation