An unusual presentation of appendicitis: a 23 cm long appendix in Morocco

The appendix is a diverticulum attached to the caecum. It can have variable lengths and locations. Acute inflammation from long appendix is a diagnostic challenge with unusual signs and symptoms. A 35 years old man admitted to the emergency department for an acute abdominal pain with low-grade fever which had been present for 03 days. The abdomen Ultrasound showed minimal effusion in the right iliac fossa. He underwent an appendicectomy which revealed a very long appendix (23 cm in length) with tip reaching the sub hepatic area. The surgeon must kip in mind all anatomical variations of the appendix for making diagnosis and decisison to operate acute appendicitis because the increasing risk of morbidity

L' agilité organisationnelle : étude exploratoire sur le levier humain de l’entreprise agile

Today, the main challenge for the companies is to gain in effeciency and competitivity to cope with a changing unpredictable, if not turbulent environment, where only the fittest have a say in the market place. To face this challenge, organizations have to be equiped with a staff who can constantly adapt and keep up with the pace by developing the so called « agile » or flexible skills and behavior. These later can’t be reached without the help and support of the organization whose responsability is to put into practice tools to assist employees in these continuous. The aim of this article is to analyse the contribution of the human resources in conducting and developing organizational agility.  De nos jours, l’enjeu majeur des entreprises est de gagner en efficacité et en compétitivité, pour affronter un environnement changeant, imprévisible voire même turbulent, où les plus forts ont une place sur le marché. Pour relever ce défi, les organisations doivent se doter de collaborateurs capables de s’adapter en permanence et suivre le rythme en développant des compétences et comportements dits « agiles ». Ces derniers ne peuvent être acquis sans l’appui et le soutien de l’organisation qui se doit de mettre en place des pratiques et outils visant à accompagner les salariés dans ce contexte de mutation. Le présent article se propose d’analyser la contribution des ressources humaines dans la conduite et le développement de l’agilité organisationnelle

Hémangiome surrénalien: à propos d’un cas

L’hémangiome surrénalien est une entité histologique très rare appartenant au groupe des incidentalomes. Il est souvent asymptomatique, de découverte fortuite lors d’un examen d’imagerie sollicité par une autre affection abdominale. Nous rapportons dans ce travail un seul cas permettant d’étoffer la série internationale qui reste jusqu’à nos jours très limitée.Mots clés: Hémangiome, glande surrénale, hémangiome caverneux, laparoscopieEnglish Title: Adrenal gland hemangioma: about a caseEnglish AbstractAdrenal gland hemangioma is a very rare histologic entity belonging to the group of incidentalomas. It is often asymptomatic, unexpectedly detected during imaging examination and resulting from another abdominal affection. We here report a single case to further enrich international case series which are still very limited.Keywords: Hemangioma, adrenal gland, cavernous hemangioma, laparoscop

An unusual localization of retroperitoneal paraganglioma: a case report

Paragangliomas are rare tumors arising from extra-adrenal chromaffine tissues. The diagnosis of  non-functional retroperitoneal paraganglioma and its surgical management can be difficult. We report a  case of a retroperitoneal paragangliomaof an unusual localization that renders the surgery more  challenging. A 40 year-old woman presented to our department with a four-month history of upper  quadrant pain with no vomiting, no fever, nor jaundice. Physical examination was normal. Ultrasonography showed a retro duodenal homogenous mass and computed tomographyscan showed a well-circumscribed round mass of heterogeneous density, which was in close contact with the aorta and the left kidney vein. Laboratory tests were normal. The patient underwent surgical management. The surgical exploration found a retroperitoneal tumor that was encapsulated and showing intimate contact with the abdominal aorta. We performed a complete resection of the tumor. Histological examination of the surgical specimen revealed a paraganglioma. The post operative course was uneventful. Paragangliomas are rare tumors. They can be asymptomatic for a long time and thus be diagnosed at late stage. A follow-up of patients is then essential. Surgical treatment is the only radical treatment and should be performed even in paragangliomas in close contact with the great vessels.Key words: Retroperitoneal, paraganglioma, surger

An exceptional collision tumor: gastric calcified stromal tumor and pancreatic adenocarcinoma

The authors report an exceptional case of collision tumor comprised of a gastric calcified stromal tumor and a pancreatic adenocarcinoma. The pancreatic tumor was detected fortuitously on the histological exam of resection specimen.Key words: Collision tumor, stromal tumor, adenocarcinom

Primary retroperitoneal malignant melanoma

We report a case of an extremely rare primary malignant melanoma presenting in the retroperitomeum, indurcing a diagnostic and management problem.Pan African Medical Journal 2012; 12:2

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Postsurgical Diagnosis of an Unusual Case of Primary Hepatic Lymphoma Presenting as Liver Abscess with an Uncommon Complication: A Hepatogastric Fistula

Primary hepatic lymphoma (PHL) is a very rare malignancy and constitutes 0.016% of all cases of non-Hodgkin’s lymphoma and 0.4% of extranodal non-Hodgkin’s lymphoma. We describe a rare case of primary hepatic lymphoma presenting as liver abscess which was complicated with the development of a hepatogastric fistula. A 58-year-old man presented with clinical signs of sepsis, high-grade fever, right upper abdominal pain, and weight loss which had progressed in the past 8 months. Noncontrast abdominal computed tomography (CT) revealed a heterogeneously hypodense lesion in the left lobe of the liver with multiple air foci within, which are seen to extend into the body of the stomach. The patient was initially misdiagnosed as a case of rupture of liver abscess into the stomach. Postoperative liver biopsy examination confirmed a diagnosis of diffuse large B-cell lymphoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, so PHL was diagnosed. Chemotherapy was initiated, but discontinued due to the patient’s general condition. Finally, the patient succumbed to neutropenic fever following chemotherapy. Here, we present the exceptional case of a primary hepatic lymphoma with an unusual complication, a hepatogastric fistula, and try through the existing literature to show the difficulties involved in diagnosis and treatment

Métastase pariétale d’un adénocarcinome bronchique

Les métastases cutanées du carcinome bronchogénique sont rares, elles témoignent d'un stade tardif de la maladie. Nous rapportons le cas d'une métastase cutanée d'un adénocarcinome bronchique traitée chirurgicalement en vue d'améliorer le confort du malade

The management of a cystic hepatic lesion ruptured in the bile ducts: a case report

Abstract Background Hepatic cystadenoma is a rare benign cystic tumor; it tends to recur after incomplete surgical resection and has malignant potential. We report the case of a patient with a ruptured biliary cystadenoma in the common bile duct that caused diagnostic and therapeutic problems. Case presentation A 34-year-old North African woman, admitted for angiocholitis, was operated 2 months before for a hepatic cystic lesion taken for a hydatid cyst compressing her common bile duct. The clinical and the complementary examinations converged toward recurrence of the hydatid cyst for which a surgical resection was decided. Intraoperative findings as well as the histological study of the “membranes” extracted from her common bile duct indicated a hepatic cystadenoma. Conclusions The rarity of hepatic cystadenoma and the non-specificity of clinical and imaging signs make diagnosis of hepatic cystadenoma difficult, especially when it is complicated by rupture in the bile ducts; this contributes to a delay in diagnosis and an inadequate therapeutic approach