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BackgroundSeveral scores have been developed to evaluate surgical unit mortality and morbidity. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and derivatives use preoperative and intraoperative factors, whereas the Surgical Risk Scale (SRS) and Association Française de Chirurgie (AFC) score use four simple factors. To allow for advanced age in patients undergoing colorectal surgery, a dedicated score—the Elderly (E) POSSUM—has been developed and its accuracy compared with these scores.MethodsFrom 2002 to 2004, 1186 elderly patients, at least 65 years old, undergoing major colorectal surgery in France were enrolled. Accuracy was assessed by calculating the area under the receiver operating characteristic curve (AUC) (discrimination) and calibration.ResultsThe mortality and morbidity rates were 9 and 41 per cent respectively. The E-POSSUM had both a good discrimination (AUC = 0·86) and good calibration (P = 0·178) in predicting mortality and a reasonable discrimination (AUC = 0·77) and good calibration (P = 0·166) in predicting morbidity. The E-POSSUM was significantly better at predicting mortality and morbidity than the AFC score (Pc = 0·014 and Pc < 0·001 respectively).ConclusionThe E-POSSUM is a good tool for predicting mortality, and the only efficient scoring system for predicting morbidity after major colorectal surgery in the elderly.

Purpose A prospective, multicentre, observational study was undertaken to assess Tisseel® fibrin sealant for atraumatic mesh fixation in inguinal hernia repair throughout France. Methods Surgeons recorded data on patients undergoing tension-free inguinal hernioplasty with mesh fixation with Tisseel®, regardless of the hernioplasty technique used. Assessments were made at 2 days and 1 month after surgery. Data on local complications, operation times and ease of product use were collected. Results In total, 1,201 patients were recruited (90% men, mean age 57 years), among which 526 procedures were performed using open techniques and 675 using laparoscopic repairs. Local complications occurred in 4.7% of patients: 3.0% haematoma, 1.4% seroma, 0.3% recurrence. The mean visual analogue scale (VAS)-rated pain scores were 3.2 pre-operatively, 2.3 immediately after surgery and 1.8 at 1 month. Surgeons rated the product as very easy to use. Conclusions Tisseel® fibrin sealant appears to be a well-tolerated and easy-to-use alternative to traditional, tissue-penetrating devices for mesh fixation in hernia repair techniques.

Le miel est reconnu comme un produit efficient dans la cicatrisation des plaies, principalement du fait de son role antibacterien, resultat du peroxyde d’hydrogene produit sous l’effet de la glucose-oxydase. De 1984 a 2009, nous avons traite 3 012 lesions infectees ou non, essentiellement au niveau de la paroi abdominale. Pour 33 kystes sacrococcygiens et 102 fermetures de stomie, l’application du miel est de principe, des la fin de l’acte operatoire. La vitesse moyenne de cicatrisation variait de 21 jours, pour les plaies inferieures a 10 cm2, a 75 jours, pour les necroses parietales superieures a 30 cm2. La cicatrisation a toujours ete obtenue de facon esthetique. Les echecs ont ete le fait de tissus radiotherapes (sein, rectum).

Metastase surranelienne : survie apres chirurgie d’exerese M. Kapella, D. Genet, B. Pech de Laclause, S. Durand-Fontanier, M. Lachachi, A. Fabre, D. Valleix,B. Descottes But : Determiner la survie apres chirurgie d’une metastase surrenalienne apparue au cours de l’evolution des cancers extra surrenaliens. Patients et methodes : Etude retrospective descriptive de 1995 a 2005. Etaient inclus les patients presentant une metastase surrenalienne apparue au cours d’une neoplasie primitive. Pour chaque patient etaient colliges l’âge de survenue, la neoplasie primitive, les circonstances de decouverte clinique, les examens complementaires contributifs, le type de metastase unique ou multiple, synchrone ou asynchrone de la neoplasie primitive, le delai d’apparition, la prise en charge et la survie en mois. La survie a ete estimee par la methode de Kaplan-Meier. Resultats : Seize patients ont ete inclus, 10 hommes et 6 femmes, l’âge moyen etait de 55,5 ans (25 a 74 ans). Aucun signe clinique ne revelait la metastase surrenalienne. Le scanner mettait en evidence la metastase surrenalienne dans 12 cas et dans 4 cas c’etait le TEP scan. La neoplasie initiale etait dans 6 cas un carcinome pulmonaire, dans 3 cas un carcinome renal, dans 2 cas un melanome, dans 2 cas un carcinome colorectal, dans 1 cas un carcinome œsophagien, dans 1 cas un carcinome pancreatique, dans 1 cas un lymphome B. Dans 9 cas la metastase surrenalienne etait associee a d’autres localisations metastatiques, dans 7 cas elle etait unique. Le delai d’apparition variait de 9 mois a 11 ans. Une chirurgie radicale a ete realisee dans 5 cas, une metastasectomie dans 10 cas et une biopsie seule dans un cas. La survie cumulee moyenne etait de 12 mois avec des extremes de 2 a 120 mois. Elle etait en moyenne de 8 mois lorsque la decouverte de la metastase etait synchrone au diagnostic de la lesion primitive. Conclusion : La mediane de survie apres l’apparition d’une metastase surrenalienne a ete de 12 mois. Lorsque la decouverte de la metastase etait synchrone au diagnostic de la lesion primitive la survie moyenne etait de 8 mois. La prise en charge chirurgicale depend de la neoplasie primitive et de son evolution metastatique globale.

Biliary cysts are frequent hepatic manifestations. They are benign, single or multiple congenital lesions, with a female predominance. In more than half the cases, they remain asymptomatic; fortuitously detected during abdominal investigations, they are observable either by imaging (ultrasonography, CT scanning, MRI), either by surgery (laparoscopy or laparotomy). However, they may evolve and induce various complications: congestive attacks, intracystic hemorrhage, ruptures, infection, compression of the surrounding intra- or extrahepatic tissues. Treatment is indicated only in case of complication or pain. Although laparoscopic resection of the dome is the most frequently used treatment for about twelve years, the recurrence rate remains high. Besides, other therapeutic means exist, such as surgery (cystectomy, hepatic resection, hepatic transplantation) or non-surgical treatments (percutaneous radiological drainage, intracystic injection of sclerotic substances). All these methods have to be carefully discussed before selection, owing to various associated advantages, disadvantages and results.

Resume Nous rapportons un cas de fistule arterioportale mesenterique inferieure postchirurgicale. Les fistules arterioportales representent une pathologie rare. La semiologie est dominee par une hypertension portale et des signes cliniques lies au shunt, c'est-a-dire une ischemie d'aval. Le traitement de choix de ces fistules est l'embolisation. La chirurgie est neanmoins toujours possible par ligature ou excision de la fistule ; la vascularisation etant assuree par l'arcade de Riolan et les arteres hypogastriques a retro.

Purpose: The purpose of this study was to compare the outcome of stapled hemorrhoidopexy (SH group) performed using a circular stapler with that of the Milligan-Morgan technique (MM group). The goals of the study were to evaluate the efficacy and reproducibility of stapled hemorrhoidopexy and define its place among conventional techniques.

Resume Le caecum est, en frequence, la deuxieme partie du colon concernee par le volvulus apres le sigmoide et avant l’angle gauche et le colon transverse. Cette affection survient sur des caecums anormalement mobiles. Le mecanisme du volvulus est la torsion ou la bascule. Le tableau clinique est celui d’une occlusion intestinale aigue par strangulation. La radiographie de l’abdomen sans preparation permet de poser le diagnostic dans plus de la moitie des cas. Elle montre le caecum distendu, donnant l’image en « grain de cafe » ou en « goutte de larme », associee a des niveaux hydro-aeriques de l’intestin grele, et a une absence d’air dans le colon. Le lavement aux produits hydrosolubles montre une opacification colique totale, et une absence d’opacification caecale, avec un arret du produit en « bec d’oiseau ». Le scanner montre une image pathognomonique que l’on nomme le « tourbillon » caecal. Le traitement vise a reduire le volvulus et a traiter les complications evolutives. La resection ileo-caeco-colique est la meilleure option therapeutique. Les caeco-colopexies peuvent dans de rares cas constituer une alternative therapeutique chez les sujets âges, ou sur terrain debilite et en l’absence de necrose.

Resume But de l’etude : La chirurgie laparoscopique du foie en est encore a ses debuts. Le but de cette etude etait de rapporter une serie de tumeurs solides et kystiques du foie traitees par voie laparoscopique. Patients et methodes : Entre avril 1991 et decembre 1999, 32 patients porteurs de lesions hepatiques ont ete operes par voie cœlioscopique. Il s’agissait de 15 patients ayant des lesions kystiques non parasitaires (kystes biliaires volumineux [ n = 11], polykystoses [ n = 4]), et de 17 patients ayant 18 tumeurs solides : hyperplasie nodulaire focale ( n = 8), angiome ( n = 6), adenome ( n = 2), metastase d’un cancer colique gauche ( n = 1) et carcinome hepatocellulaire ( n = 1). Quinze fenestrations simples ou multiples et 18 exereses hepatiques ont ete realisees par laparoscopie : une hepatectomie droite, cinq lobectomies gauches, deux sous-segmentectomies IVb, une segmentectomie III et neuf tumorectomies. Resultats : Une conversion a ete necessaire (3 %) en fin d’intervention (lobectomie gauche pour carcinome hepatocellulaire) pour confirmer la marge de securite au niveau de la tranche de section. Le diametre moyen des tumeurs solides etait de 6,5 cm et celui des lesions kystiques solitaires de 15,7 cm. La duree operatoire moyenne des exereses hepatiques a ete de 232 minutes. La mortalite postoperatoire a ete nulle. La morbidite a comporte dans chaque groupe un cas d’occlusion de l’intestin grele par hernie interne au niveau d’un orifice de trocart survenue a j5 et a j7, ayant necessite dans les deux cas une resection intestinale segmentaire. La duree moyenne de sejour postoperatoire a ete de 5,6 jours dans les tumeurs solides et de 7,5 jours dans les lesions kystiques. Dans le groupe des lesions kystiques, le taux de recidive etait de 50 % apres un suivi moyen de 5,5 mois. Conclusion : La chirurgie laparoscopique du foie semble realisable en toute securite mais necessite au prealable une experience de la chirurgie hepatique classique et une parfaite maitrise de la chirurgie cœlioscopique. Seules les lesions de siege anterieur, qu’il s’agisse de tumeurs benignes symptomatiques ou atypiques, de kystes, ou de polykystoses de type I, peuvent etre traitees par l’abord laparoscopique. Pour les lesions malignes, les indications restent a preciser.

La TEP apparait aujourd'hui comme une technique incontournable en cancerologie. Associee aux autres modalites d'imagerie, elle permet des bilans tres precis dans la stadification initiale et les recurrences d'un grand nombre d'affections malignes. Sur le plan medico-economique, elle permettra probablement, comme le demontre un certain nombre de publications americaines, des economies substantielles obtenues essentiellement en evitant des chirurgies inutiles. En cas de chirurgie possible, on pourra utiliser des sondes per-operatoires dans le but d'obtenir une exerese complete. L'importance de la fixation du18FDG etant directement liee a l'evolutivite des lesions, la TEP apparait egalement comme un excellent moyen de controle de l'efficacite d'une chimiotherapie et ceci des la premiere ou deuxieme cure [25].

Resume But de l'etude : La rupture spontanee d'un carcinome hepatocellulaire (CHC) est un accident grave entrainant un hemoperitoine abondant mettant en jeu le pronostic vital. Le but de ce travail etait de rapporter une serie retrospective de 22 cas observes dans le meme centre. Patients et methodes : De 1978 a 1998, 22 patients (18 hommes et quatre femmes, âge moyen : 63 ans, extremes : 18–83 ans) ont ete traites pour un CHC rompu sur foie cirrhotique dans 17 cas, et sur foie sain dans cinq cas. Dans 14 cas, le diagnostic d'hemoperitoine aigu a conduit a une laparotomie en urgence. Le siege de la rupture predominait au niveau du lobe gauche (huit cas). L'operation realisee a consiste en une lobectomie gauche ( n = 7), une hepatectomie droite ( n = 2), une exerese tumorale ( n = 4), une ligature de l'artere hepatique ( n = 5), et une hemostase directe ( n = 4). Resultats : La mortalite postoperatoire globale a ete de 45,4 % ( n = 10). Sur les 12 survivants, neuf sont decedes dans un delai de 6 a 29 mois. Trois patients etaient vivants au moment de la realisation de ce travail avec un recul de 32, 40 et 66 mois. Conclusion : La rupture aigue d'un CHC impose le plus souvent une intervention en urgence avec une mortalite elevee. La resection tumorale est le procede le plus efficace mais n'est pas toujours realisable en urgence. La fissuration permet de realiser des examens complementaires et une eventuelle embolisation arterielle preoperatoire avec des resultats immediats meilleurs.

Resume But de l'etude : Le but de cette etude prospective multicentrique a ete d'evaluer les resultats a court terme de la technique de Longo dans le traitement chirurgical des hemorroides. Patients et methode : Du 1er avril 1998 au 31 juillet 1998, 94 patients (60 hommes et 34 femmes, d'âge moyen 47 ans) ont ete operes selon la technique de Longo d'un prolapsus hemorroidaire (12 stade II, 63 stade III et 19 stade IV). Chaque patient a ete revu au 2e et 6e mois postoperatoire. La technique consiste a confectionner une bourse circulaire a la partie basse du rectum et a resequer la muqueuse procidente avec ligature des pedicules hemorroidaires internes par un agrafage mecanique circulaire. Resultats : La morbidite postoperatoire a ete de 6,3 % (n = 6). Cinq patients ont eu une rectorragie dans les 12 heures, necessitant un decaillotage. La duree moyenne d'hospitalisation postoperatoire a ete de 36 heures (extremes: 24–72 heures). Le seul antalgique prescrit a ete du paracetamol. Tous les patients sont sortis sans soins locaux. A six mois, les patients se disaient tres satisfaits de leurs resultats dans 89 cas (94,7 %), moyennement satisfaits dans trois cas (3,2 %) (abces rectal intramural dans un cas, troubles fonctionnels dans deux cas) et insatisfaits dans deux cas (2,1 %) (persistance d'un prolapsus hemorroidaire). Conclusion : Ces resultats preliminaires sont satisfaisants mais demandent a etre confirmes par une etude prospective randomisee comparant l'operation de Milligan Morgan a celle de Longo.

Resume Un homme de 52 ans, sous traitement antidepresseur etait victime d’un encornage du triangle de Scarpa droit. L’exploration chirurgicale initiale a permis d’eliminer une lesion des gros vaisseaux femoraux. Une hemostase des vaisseaux superficiels etait realisee. Trois jours apres, il presentait une occlusion du grele. La laparotomie a permis de decouvrir un etranglement ileal dans une breche musculaire parietale. La physiopathologie de cette occlusion est expliquee ici.

Focal nodular hyperplasia is a rare hepatic tumor in children representing only 2% of all pediatric hepatic tumors. We report a case in teen-ager who had a symptomatic portal cavernoma at 9 years of age, and had been treated by porto-mesenteric surgical shunt. At 16 years, liver ultrasounds revealed multiple hepatic nodules. Focal nodular hyperplasia was suggested by CT scan and magnetic resonance imaging. Given the symptoms and the unusual and multiple lesions, diagnosis was confirmed by surgical biopsy. FNH pathogeny is discussed in this context.

Resume Nous nous proposons, a travers ce cas clinique, d’etudier les aspects, cliniques, iconographiques, anatomopathologiques et therapeutiques des tumeurs neuroectodermiques primitives peripheriques (PNET). Cette tumeur (PNET) est un neoplasme appartenant a la famille des tumeurs d’Ewing dont l’histologie est tres voisine, qui atteint habituellement les os ou les tissus mous. Son diagnostic necessite l’apport de l’histopathologie, de l’immunohistochimie et de l’etude cytogenetique. La localisation mesocolique primaire de cette tumeur rare (notre cas) n’a jamais ete rapportee. Le traitement, similaire a celui du sarcome d’Ewing, est complexe, et non encore codifie, ce qui en fait un autre aspect decevant de cette maladie dont le pronostic reste sombre.

A 37 year old-woman complained about persistant pain of right abdominal quadrant. We discovered many hepatic lesions. Histology revealed benign processus. Evolution was marked by peritoneal carcinomatosis. After reexamination of histology we discovered hepatic haemangioendothelioma. The patient died 18 month after diagnosis although chemotherapy.

L'examen par IRM nous parait interessant dans l'approache diagnostique des instabilites sous-taliennes. Cette technique non invasive devrait permettre une meilleure evaluation de l'atteinte sous-talienne dans le cadre des entorses de cheville. Le test “en inversion tenue” introduit le concept d'une IRM fonctionnelle qui tend a realiser une imagerie “sous contrainte” des structures ligamentaires qui optimise de facon significative leur lesion eventuelle.

A 47-year old man complained about persistant pain and cholestasis 12-years after a cholescystectomy. In his family, all his brothers and sisters had cholecystectomy. Genetic explorations revealed a MDR3 gene mutation. All symptoms disappeared with a treatment by ursodesoxycholic acid. MDR3 gene mutation is to be researched in all cases of familial cholestasis.

An 80-year-old woman with sigmoid diverticula was treated by corticosteroid for Horton disease. She presented abdominal pain, and abdominal mass in left iliac fossa. Radiological examinations revealed a colo-jejunal fistula. At laparotomy it was a giant diverticulum of colon sigmoid with fistula in the jejunum. The pathogeny of giant diverticulum and the role of corticosteroid are discussed.

We herein report five cases of heterotopic pancreas localized on common bile duct, gastric antrum, duodenum (two cases including one with cystic dystrophy), and jejunum. The choledocal localization was revealed by jaundice. The duodenal localization with cystic, diagnosed by endoscopic ultrasound, was revealed by onsets of acute pancreatitis. All localizations were treated by resection: antrectomy, bowel resection, and pancreaticoduodenectomy. Postoperative course was uneventful. Review of the literature shows that, even in uncomplicated cases, resection is usually performed.

A patient underwent at his birth, an ureterosigmoidostomy for exstrophic bladder. Fifty-six years later, she presented a carcinoma on the right ureterosigmoidostomy associated with chronic urinary infection. She underwent a right ureteronephrectomy and sigmoidectomy. Chronic alterations of the colic mucin by urines lead to carcinoma.

Yves Denizot*, Bernard Descottes, Veronique Truffinet, Denis Valleix, Francois Labrousse and Muriel Mathonnet UMR CNRS 6101, Laboratoire d’Immunologie, Faculte de Medecine, Limoges, France Service de Chirurgie Viscerale et Transplantations, CHU Dupuytren, Limoges, France Service d’Anatomo-Pathologie, CHU Dupuytren, Limoges, France Chirurgie Digestive, Endocrinienne et Generale, CHU Dupuytren, Limoges, France

Resume Les auteurs rapportent une observation d’agenesie du foie droit. Cette anomalie rare a ete suspectee en postoperatoire sur des anomalies du cholangiogramme peroperatoire au decours d’une cholecystectomie et diagnostiquee par une tomodensitometrie abdominale. Cette anomalie congenitale peut etre associee a une pathologie des voies biliaires, une hypertension portale et d’autres anomalies congenitales.

Resume Les metastases intrathyroidiennes sont sous estimees en pratique car elles sont pour la majorite « silencieuses ». L'origine renale represente plus de 50 % des cas dans les series cliniques. Nous rapportons deux observations de localisations metastatiques thyroidiennes d'origines renales survenues, trois ans et huit ans, apres la cure du foyer primitif. La notion de neoplasie dans les antecedents doit faire evoquer le diagnostic de metastases devant tout nodule thyroidien. La cytologie par ponction a l'aiguille fine ne fait pas l'unanimite. Enfin, la survenue des metastases essentiellement sur des terrains de dystrophie thyroidienne meriterait d'effectuer des etudes plus poussees.

We describe a case of ruptured mesenteric artery branch aneurysm. Since it is characterized by nonspecific clinical manifestations, aneurysm in this uncommon location is usually diagnosed following complications. Definitive diagnosis requires Doppler ultrasound followed by arteriography. The purpose of this report is to describe the pitfalls of diagnosis and define an appropriate management strategy. Unlike abdominal aortic aneurysm, isolated aneurysms of the superior mesenteric artery (SMA) branches are rare. Most cases are diagnosed after the occurrence of complications. Early diagnosis would be useful, since the natural course can be tragic without timely treatment. In this report, we describe one case of ruptured mesenteric artery branch aneurysm and review the literature for relevant data on the circumstances of discovery, methods of investigation, and appropriate management of these lesions.

A 67-year-old man with anti-HCV positive serum, was admitted for hematemesis by variceal bleeding. Portal hypertension, which initially was thought to be caused by a post-hepatitis C cirrhosis, was due to a fistula between a right hepatic artery and a right branch of the portal vein. The fistula located under the right liver and the adjacent atrophic hepatic segments, were resected by a bi-segmentectomy VI-VII. The postoperative course was simple. The pathological study of the resected liver showed no cirrhosis but active hepatitis. This arterioportal fistula was probably iatrogenic. Sixteen years before, this patient had undergone a total gastrectomy for cancer, followed by a serious haemorrhage requiring a massive transfusion, which was responsible for the transmission of hepatitis C.

Focal nodular hyperplasia is a rare hepatic tumor in children representing only 2% of all pediatric hepatic tumors. We report a case in teen-ager who had a symptomatic portal cavernoma at 9 years of age, and had been treated by porto-mesenteric surgical shunt. At 16 years, liver ultrasounds revealed multiple hepatic nodules. Focal nodular hyperplasia was suggested by CT scan and magnetic resonance imaging. Given the symptoms and the unusual and multiple lesions, diagnosis was confirmed by surgical biopsy. FNH pathogeny is discussed in this context.

Quantitative analysis using ELISA of vascular endothelial growth factor and basic fibroblast growth factor in human colorectal cancer, liver metastasis of colorectal cancer and hepatocellular carcinoma

http://www.wjgnet.com/1007-9327/12/2773.asp; AIM: Platelet-activating factor (PAF) is a pro-inflammatory and angiogenic lipid mediator. Here we aimed to investigate levels of PAF, lyso-PAF (the PAF precursor), phospholipase A(2) (PLA(2), the enzymatic activity generating lyso-PAF), acetylhydrolase activity (AHA, the PAF degrading enzyme) and PAF receptor (PAF-R) transcripts in cirrhotic liver and hepatocellular carcinoma (HCC). METHODS: Twenty-nine patients with HCC were enrolled in this study. Cirrhosis was present in fourteen patients and seven had no liver disease. Tissue PAF levels were investigated by a platelet-aggregation assay. Lyso-PAF was assessed after its chemical acetylation into PAF. AHA was determined by degradation of [(3)H]-PAF. PLA(2) levels were assessed by EIA. PAF-R transcripts were investigated using RT-PCR. RESULTS: Elevated amounts of PAF and PAF-R transcripts 1 (leukocyte-type) were found in cirrhotic tissues as compared with non-cirrhotic ones. Higher amounts of PAF and PAF-R transcripts 1 and 2 (tissue-type) were found in HCC tissues as compared with non-tumor tissues. PLA(2), lyso-PAF and AHA levels were not changed in cirrhotic tissues and HCC. CONCLUSION: While the role of PAF is currently unknown in liver physiology, this study suggests its potential involvement in the inflammatory network found in the cirrhotic liver and in the angiogenic response during HCC.

The cecum is the second most common site of colonic volvulus after the sigmoid. The mechanism is torsion or hyperflexion of the enlarged, poorly-fixed, and hypermobile cecum. It presents clinically as an acute bowel obstruction with strangulation. Diagnosis can be made by plain abdominal X-ray in more than half the cases on the basis of cecal distention (with a classical "teardrop" or "comma" appearance), proximal small bowel distention with air-fluid levels, and a gasless distal colon. Barium enema shows lack of filling of the cecum, often with a "beaked" termination of the column of contrast. CT images are pathognomonic when they reveal a cecal "vortex". After surgical reduction of the torsion, ileo-cecal resection is usually the best therapeutic alternative. Cecopexy may be aDDrouriate in older and debilitated Datients if there is no concomitant cecal necrosis.

A 37 year old-woman complained about persistant pain of right abdominal quadrant. We discovered many hepatic lesions. Histology revealed benign processus. Evolution was marked by peritoneal carcinomatosis. After reexamination of histology we discovered hepatic haemangioendothelioma. The patient died 18 month after diagnosis although chemotherapy.

A 47-year old man complained about persistant pain and cholestasis 12-years after a cholescystectomy. In his family, all his brothers and sisters had cholecystectomy. Genetic explorations revealed a MDR3 gene mutation. All symptoms disappeared with a treatment by ursodesoxycholic acid. MDR3 gene mutation is to be researched in all cases of familial cholestasis.

We report the case of a patient who underwent splenectomy for spontaneous rupture of the spleen due to splenic metastasis. Pathologic examination revealed diffuse infiltration by carcinoma. Chest X-ray revealed a right lung superior lobe tumor, related to poorly differentiated carcinoma. Total splenectomy is a good option for diagnosis and treatment of splenic metastases.

We report a case of postoperative inferior mesenteric arteriovenous fistula. Arteriovenous fistula represents a rare disease. Symptoms are due to portal hypertension and distal ischemy. Treatment of these fistulas is embolization. Surgery is possible by ligature or excision of the fistula because vascularisation is obtained by Riolan arcade and hypogastric artery.

We herein report a case of axillary localization of supernumerary breast. It is a matter of axillary bilateral masses mistaken as lipoma at clinical examination and ultrasonography. We here explain this confusion between lipoma and supernumerary breast. The aim of this work is to specify clinical characters of an axillary mass that must lead to suspect a supernumerary breast.

But: Elaborer une technique chirurgicale dans les peritonites par perforation diverticulaire sigmoidienne permettant, dans un second temps operatoire, un retablissement de continuite systematique et precoce par une technique associant la celioscopie et l’endoscopie. Patients et Methodes: Entre decembre 2001 et mai 2002, 5 patients ont ete admis en urgence pour peritonite sur perforation diverticulaire sigmoidienne. Le premier temps operatoire consistait a realiser une sigmoidectomie par laparotomie avec anastomose colorectale latero terminale a muqueuse fermee protegee par une colostomie en fosse iliaque gauche. Le second temps operatoire, precoce chez les 5 patients, consistait a retablir la continuite par l’action conjuguee de la celioscopie et de la coloscopie. Un controle endoscopique de l’anastomose etait realise a 1 an. Resultats: Le retablissement de continuite a ete systematique chez les 5 patients sans recours a la laparotomie. Le delai entre l’intervention initiale et le retablissement etait de 55 ± 23 jours. La duree de l’intervention de retablissement etait de 65 ± 7 min. La duree d’hospitalisation apres le retablissement etait de 6,5 ± 2 jours. Aucune complication post operatoire et aucun deces n’ont ete observes. La coloscopie a un an ne decelait aucune stenose anastomotique. Conclusion: La technique chirurgicale que nous avons developpee permet d’eviter les inconvenients de la technique de Hartmann classique (pourcentage eleve de colostomie definitive, delai de retablissement de continuite superieur a quatre mois, difficultes a dissequer le moignon rectal restant lors du retablissement de continuite) mais egalement ceux de l’anastomose colorectale protegee (necessite de conditions locales satisfaisantes, risque de fistule anastomotique ou de dehiscence post operatoire). Par ailleurs, cette technique a ses propres avantages: retablissement de continuite precoce, protection de l’anastomose vis a vis de la contamination fecale par le maintien d’une interface muqueuse, duree d’hospitalisation plus courte lors du retablissement de continuite, absence de stenose tardive de l’anastomose, controle endoscopique de la longueur du moignon colique.

An 80-year-old woman with sigmoïd diverticula was treated by corticosteroid for Horton disease. She presented abdominal pain, and abdominal mass in left iliac fossa. Radiological examinations revealed a colo-jejunal fistula. At laparotomy it was a giant diverticulum of colon sigmoid with fistula in the jejunum. The pathogeny of giant diverticulum and the role of corticosteroid are discussed.

The authors report a case of right liver atrophy. This rare anomaly was suspected during post-operative period on abnormalities of cholangiogram. This biliary tract anomaly was diagnosed by CT scan. This congenital abnormality may be associated with biliary tract abnormalities, portal hypertension and other congenital abnormalities.

A patient underwent at his birth, an ureterosigmoidostomy for exstrophic bladder. Fifty-six years later, she presented a carcinoma on the right ureterosigmoidostomy associated with chronic urinary infection. She underwent a right ureteronephrectomy and sigmoidectomy. Chronic alterations of the colic mucin by urines lead to carcinoma.

A 16-year-old male riding as a passenger on a personal watercraft fell behind the jet nozzle while jumping waves. An unusual rectal injury caused by the accident and resulting in the death of the patient is presented. The surgical management and postoperative course is discussed. Attention is drawn to the need for adequate protective clothes for all passengers of personal watercraft and to the necessity of a complete examination for correct diagnosis and treatment.

Background/Purpose. Portal triad clamping and total or intermittent hepatic vascular exclusion are usually used to reduce blood loss during major liver resections. We report, in this retrospective study, the results of right hepatectomy without vascular clamping. Methods. From January 1986 to July 2001, 87 right hepatectomies, including 14 extended right hepatectomies, were performed without vascular clamping. There was 53 men and 34 women, with a mean age of 60.2 ± 12.5 years. Indications were 58 metastases, 16 hepatocellular carcinomas, 5 cholangiocarcinomas, 4 adenomas, 3 angiomas, and 1 carcinoid tumor. All the procedures were carried out using an ultrasonic dissector and intraoperative ultrasonography with only vascular control (looping of the hepatic pedicle and supra; and infrahepatic vena cava). Results. There were four postoperative deaths and 23 complications (26%), including hepatocellular failure (6), pulmonary complications (6), transient bile leakage (5), digestive bleeding (2), subphrenic abscess (1), inferior vena cava (IVC) thrombosis (1), disseminated intravascular coagulation (DIC; 1), and evisceration (1). Forty-two patients (48%) had no blood transfusion. The mean blood transfusion requirement was 1.5 ± 2.7 units. The mean operative length was 280 ± 60 min and the mean hospital stay was 12.8 ± 8.1 days. Liver function test results were similar to those in other studies on days 1, 4, and 7 postoperatively, with a return to normal values after 1 week. Conclusions. In our experience with major liver resections, vascular clamping is not necessary.

We herein report five cases of heterotopic pancreas localized on common bile duct, gastric antrum, duodenum (two cases including one with cystic dystrophy), and jejunum. The choledocal localization was revealed by jaundice. The duodenal localization with cystic, diagnosed by endoscopic ultrasound, was revealed by onsets of acute pancreatitis. All localizations were treated by resection: antrectomy, bowel resection, and pancreaticoduodenectomy. Postoperative course was uneventful. Review of the literature shows that, even in uncomplicated cases, resection is usually performed.

A role for laparoscopy in the management of selected trauma patients is now possible. We report a case of a patient with a stab wound and a bowel perforation who underwent diagnostic and laparoscopic treatment.