De novo autoimmune hepatitis following liver transplantation for primary biliary cirrhosis: an unusual cause of late grafts dysfunction

De novo autoimmune hepatitis (AIH) is a rare disorder first described in 1998. It occurs in patients who underwent liver transplantation for a different etiology. We present the case of a 56-year-old woman who was diagnosed with primary biliary cirrhosis and had liver transplantation for refractory pruritis. Seven years after transplantation, she presented alterations in the hepatic profile with hypertransaminasemia, elevated alkaline phosphatase and gamma-glutamyl-transferase. Her liver functions test also showed elevated IgG levels. Serum autoantibodies were negative except for antimitochondrial antibodies. Histological findings indicated features of AIH without bile duct damage or loss. She had a pretreatment AIH score of 13 points and a post treatment score of 15 points according to the International AIH Group. The patient was treated effectively with prednisolone and her liver function and globulin levels rapidly returned to normal.Key words: Primary biliary cirrhosis, liver transplantation, de novo autoimmune hepatiti

Hydatid cysts of the liver opening in the biliary tracts: about 120 cases comparative study between radical and conservative treatment

Background. Hepatic hydatid disease is still common in Tunisia, is deemed benign disease but concerns its complications; the most frequent is the rupture in biliary ducts. The aim of the work was to study the results of surgical treatment of hydatid cysts of the open liver in the bile ducts and to deduce the predictive factors of postoperative complications. Methods. This was a retrospective study, done in the Department of General Surgery of Mongi Slim Hospital, over a period of 11 years (from January 2000 to December 2013) and collecting 115 patients. Judging criteria were specific morbidity, length of postoperative stay and recurrence. Results. The median age was 43 years (62 women and 53 men). The clinic consisted of typical cholangitis episodes (6.95%), 6.95% of patients were asymptomatic. 50 radical interventions and 65 conservative interventions were performed, supplemented by treatment of the fistula as follows: Fistula blindness (43.47%), trans-fistulo-oddian drainage (3.4%), bipolar drainage (2.6%), PERDOMO (6.95%). The overall mortality was zero. The overall morbidity was 27.69% with an overall specific morality of 14.7% mainly represented by the suppuration of the CR and the external biliary fistulas. The median postoperative stay was 6 days; the recurrence rate was 1.7% with a delay of 30 months. The predictive factors of postoperative complications in bi variance were: The size of the cyst (p = 0.02), The location of a cyst in the hepatic dome (p = 0.002), Surgical treatment: radical or conservative (p = 0.02), The sex factor (p = 0.015). The multivariate study who found a significant association between sex only and postoperative complications. Conclusion. Advances in hepatobiliary surgery and anesthesia are changing the surgical attitude in favor of radical procedures with favorable consequences in terms of morbidity, length of stay and recurrence. It is believed that the surgeon’s experience is the most important factor in the success of surgical treatment. This helps to prevent complications

): 24-30 ISSN 1948-5182 (online)

Abstract AIM: To assess the role of the major risk factors for hepatocellular carcinoma (HCC) development in the western part of North Africa. METHODS: A multicenter case control study was conducted in Tunisia, Morocco and Algeria in collaboration with Pasteur Institutes in these countries. A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included. Prevalences of HBsAg, anti-hepatitis C virus (HCV) and diabetes were assessed. HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients. RESULTS: The mean age of patients was 62 ± 10 years old for a 1.5 M:F sex ratio. Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg. Diabetes was detected in 18% of cases. Odd ratio (OR) and 95% confidence intervals (CI) were 32.0 (15.8 -65.0), 7.2 (3.2 -16.1) and 8.0 (3.1 -20.0) for anti-HCV, HBsAg and diabetes respectively. Multivariate analysis indicated that the three studied factors were independent. 1b HCV genotype and D HBV genotype were predominant in HCC patients. HCV was the only risk factor significantly associated with an excess of cirrhosis (90% vs 68% for all other risk factors collectively, P = 0.00168). Excessive alcohol consumption was reliably established for 19 (17.6%) cases among the 108 HCC patients for whom data is available. CONCLUSION: HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa. An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region

Surgical management of splenic tuberculosis with pleural fistulation in a COVID-19 patient

A 38-year-old woman with no past medical history presented to the emergency room with dyspnea, fever and upper left abdominal pain

Non-operative management of perforated jejunal diverticulitis

Diverticula can affect all segments of the gastrointestinal tract, from the esophagus to the colon. In order of decreasing, the jejunoileal location is the least frequent location [1] and has  a prevalence of less than 2% of the population [2]. This location was first described by Sommering in 1794 [3]. More than two-thirds of small bowel diverticula occur in the jejunum. They appear mainly after the age of 60 with higher prevalence in males and rarely occur in patients under the age of 40 [4]. Jejunal diverticula are in general multiple and bigger than ileal ones [5]. Most of them are asymptomatic and do not require surgical treatment. Clinical presentations are diverse and not specific with no pathognomonic clinical symptoms

Primary follicular lymphoma arising from the ascendant colon: A case report

Lymphomas are common hematological malignancies with an increasing incidence in recent years. The main site of extranodal non-Hodgkin’s lymphoma is the gastrointestinal tract, representing 40% of cases. The most common site of gastrointestinal lymphoma is the stomach, followed by the small intestine, accounting for 25% - 50% and 20% - 30%, respectively [1,2]. Primary colorectal lymphoma is a rare disease, accounting for 0.2% to 1% of all colorectal malignancies [1]. Males are more commonly affected with a peak incidence in the sixth and seventh decades of life [3]. Non-Hodgkin’s lymphoma is the most commonly described subtype of colonic lymphoma [1].&nbsp

Laparoscopic repair of a left paraduodenal hernia

Paraduodenal hernias are the most common internal hernias. Their diagnosis is usually made after complication as strangulation or intestinal obstruction. Diagnosis is easily made with abdominal CT scan. 45 years-old woman with no medical history was presented to the emergency department of our hospital with two-days of abdominal pain particularly in the left upper hemi-abdomen. The pain was associated with nausea and bilious vomiting. Abdominal examination revealed an abdominal distension with left upper quadrant tenderness. A CT scan of the abdomen was performed which demonstrated the same encapsulated cluster of jejunal loops having a radial arrangement located in the omental bursa. Their meso and vessels converged towards the transverse mesocolon and pushing back the stomach towards and the pancreas backwards with a distension of the duodenum upstream. Patient underwent emergency laparoscopic surgery under general anaesthesia with the patient placed in supine split-leg position. The patient was discharged on postoperative day second

Incidental discovery of a pancreatic lipoma: a case report

Pancreatic lipoma is a benign, mesenchymal-derived tumor. It is an uncommon entity that is rarely reported. The diagnosis is usually made on a CT scan or MRI. We present a case of a pancreatic lipoma incidentally discovered on imaging in a 53-years old patient presenting for acute cholecystitis

Prolapsus rectal étranglé de l’adulte jeune: à propos d’un cas et revue de la littérature

Le prolapsus rectal est un trouble de la statique du rectum, qui réalise une invagination de la paroi rectale aboutissant à son extériorisation à travers l’anus. Il touche généralement l’enfant et le sujet âgé. Sa survenue chez l’adulte jeune est rare. L’étranglement du rectum prolabé est également une complication rare. Nous rapportons l’observation d’un jeune de 30 ans, opéré en urgence pour un prolapsus rectal étranglé. Il a eu une recto-sigmoïdectomie périnéale (intervention d’Altemeier) en urgence avec des suites simples.The Pan African Medical Journal 2016;2

First multicenter study for risk factors for hepatocellular carcinoma development in North Africa

AIM: To assess the role of the major risk factors for hepatocellular carcinoma (HCC) development in the western part of North Africa