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In front of a colonic tumor, the diagnosis of a pseudotumoral form of Crohn's disease must be considered. However, it is a rare form, especially when inaugural and a neoplasia must be eliminated before retaining the diagnosis.

Gallbladder polyps (GBP) are defined as developed masses inside the wall of the gallbladder; most of them (90%) are nontumor lesions. Abdominal ultrasound is the main and the first line radiological modality for their diagnosis and their risk lamination. We conducted a 12 year retrospective study between 2009 and 2020, which included patients who had preoperative transabdominal ultrasonography showing gallbladder polyps and had undergone cholecystectomy, and for whom postoperative pathology results were available, as well as patients who had at least one polyp discovered on the histopathological exam and who were not determined preoperatively. A total of 70 patients were identified. Preoperative diagnosis of vesicular polyp by ultrasound was carried in 82.9% of patients. The number of ultrasounds performed per person was 1.2 ± 0.47. The polyps’ size in mm was on average 6.14 ± 2.6 with extremes between 3 and 13 mm. On anatomopathological examination, a polyp was objectified in 33.3% of cases. In our series, abdominal ultrasound had a low sensitivity at 36.4%. We aim to provide the accuracy of abdominal ultrasound for the diagnosis of GBP, as a low-cost modality, and to evaluate the concordance of preoperative ultrasound imaging with postoperative pathology.

Background: Ambulatory surgery is defined as surgery without an overnight hospital stay, which allows the patient to return home on the same day of admission after the surgical procedure. It is increasing countinuously in the world because of its several advantages. This study aimed to describe the experience of our department in outpatient hernia surgery, evaluate its feasibility and safety, and determine the predictive factors for failure of this surgery. Results: We collected 1294 patients. One thousand twenty patients underwent groin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3%) had an unplanned admission (UA) and 7 patients (0.7%) had an unplanned rehospitalisation (UR). Morbidity rate was 2.4% (24 patients) and mortality rate was zero. In multivariate analysis, we did not identify any variable predicting discharge failure in the GHR group. Two hundred and seventy-four patients underwent ventral hernia repair (VHR). The failure rate of ambulatory management of VHR was 5.5%: 11 patients (4%) had a UA and 4 patients (1.5%) had an UR. Morbidity rate was 3.6% (10 patients) and the mortality rate was zero. In multivariate analysis, we did not identify any variable predicting discharge failure in the VHR group. Conclusions: Our study data suggest that ambulatory hernia surgery is feasible and safe in well-selected patients. The development of this practice would allow for better management of eligible patients and would offer many economic and organisational advantages to healthcare structures.

A 33-year-old man was admitted to the hospital for bowel obstruction secondary to fistulizing and stenosing Crohn's disease. A computerized tomography scan of abdomen showed a duplication of the inferior vena cava.

Les myelolipomes surrenaliens(MS) sont des tumeurs benignes non secretantes du cortex surrenalien. Elles representent 2 %des tumeurs surrenaliennes. Elles sont desormais classees dans le groupe des tumeurs mesenchymateuses et stromales du cortex surrenalien selon la derniere classification de l’OMS(2017). Notre objectif etait d’etudier, a travers un cas, les caracteristiques clinico-anatomopathologiques de ces tumeurs. Observation Patiente âgee de 56 ans qui presentait depuis un an des douleurs isolees de l’hypochondre droit. L’IRM avait montre une masse surrenalienne droite de16 cm a composante majoritairement adipeuse. Elle a eu une resection de la masse et l’examen anatomopathologique avait revele une proliferation adipocytaire mature bien circonscrite lobulee de21 cm avec de nombreux foyers d’hematopoiese extramedullaires entre les adipocytes concluant ainsi a un MS. Discussion Les MS surviennent entre la cinquieme et la septieme decennies sans predilection pour le genre. Effectivement, notre patiente avait 56 ans. Pres de 440 cas ont ete rapportes dans la litterature. Ils sont unilateraux dans 90 % des cas et touchent deux fois plus la surrenale droite que la surrenale gauche comme c’etait le cas pour notre patiente. Ils sont generalement encapsules bien limites et leurs taille peut varier de quelques millimetres a des dizaines de centimetres avec une taille moyenne de 10 cm. Microcopiquement, ils sont constitues de tissu adipeux mature auquel sont meles des elements hematopoietiques. Le diagnostic differentiel peut se poser avec les teratomes, les angiomyolipomes et les liposarcomes. Elles sont d’evolution lente et de bonpronostic. A notre connaissance, aucun cas de transformation maligne n’a ete rapporte. Le traitement chirurgical est reserve aux formes symptomatiques et aux MS geants.

Background Since the advent of immunohistochemistry for the diagnosis of stromal tumours, the incidence of leiomyosarcomas has significantly decreased. Nowadays, gastric leiomyosarcoma is an exceptionally rare tumour. We report the second case in the English literature of gastric leiomyosarcoma revealed with massive bleeding and hemodynamic instability and diagnostic pitfalls that we encountered. Case presentation A 63-year-old woman, with 2 years’ history of dizziness and weakness probably related to an anaemic syndrome, presented to the emergency room with hematemesis, melena and hemodynamic instability. On examination, she had conjunctival pallor with reduced general condition, blood pressure of 90/45 mmHg and a pulse between 110 and 120 beats per minute. On digital rectal examination, she had melena. Laboratory blood tests revealed a haemoglobin level at 38 g/L. The patient was admitted to the intensive care department. After initial resuscitation, transfusion and intravenous Omeprazole continuous infusion, her condition was stabilized. She underwent upper gastrointestinal endoscopy showing a tumour of the cardia, protruding in the lumen with mucosal ulceration and clots in the stomach. Biopsies were taken. Histological examination showed interlacing bundles of spindle cells, ill-defined cell borders, elongated hyperchromatic nuclei with marked pleomorphism and paranuclear vacuolization. Immunohistochemistry showed positivity for Vimentine, a strong and diffuse immunoreactivity for smooth muscle actin (SMA). Immunoreactivities for KIT and DOG1 were doubtful. Computed tomography scan revealed a seven-cm tumour of the cardia, without adenopathy or liver metastasis. The patient underwent laparotomy. A total gastrectomy was performed without lymphadenectomy. Post-operative course was uneventful. Histological examination of the tumour specimen found the same features as preoperative biopsies with negative margins. We solicited a second opinion of an expert in a reference centre for sarcomas in France, who confirmed the diagnosis of a high grade gastric leiomyosarcoma. Conclusion Gastric leiomyosarcoma is a rare tumour. Diagnosis is based on histological examination with immunohistochemistry, which could be sometimes confusing like in our case. The validation of a pathological expert is recommended.

Introduction: Unintentional post-operative open abdominal wall (UPOAW) is a postoperative complication that consists of the early separation of the fascial layer after a primary closure of a laparotomy incision. This complication is associated with great morbidity and mortality. In this article, we studied the frequency of some of these known factors in our series and we briefly discussed the management of this complication.Methods: It was a monocentric retrospective and descriptive study. We enrolled patients with UPOAW, admitted in the department of surgery in Habib Thameur hospital in Tunis (Tunisia), between January 2010 and December 2015.We did not include traumatic patients. We excluded patients with missing data from medical records.Results: The study was conducted on fifteen patients. Eight out of fifteen were men. Patients were aged between 41 and 76 years, with a mean age of 66.6 ± 11.4 years. In the past medical history, chronic obstructive pulmonary disease was noted in three patients, cirrhosis in three patients, diabetes in one patient and a history for laparotomy in one patient. Eight out of fifteen underwent emergent surgeries. Two out of these eight patients had haemodynamic instability throughout surgery. In the postoperative course, coughing was noted in three patients, abdominal distension from ileus in three patients, vigorous postoperative ventilation in two patients and vomiting in one patient. UPOAW was diagnosed between postoperative day zero and postoperative day twenty-one, with a mean time of diagnosis of 10.1 ± 6.6. All patients had immediate closure of the fascial layer. The surgeon used retro-fascial polyglactin mesh in three patients. Relaxing incisions were used in 5 patients. Morbidity after reoperation was 46.7 % (7/15) and mortality was 33.3 % (5/15).Conclusion: UPOAW is a serious complication with high morbidity and mortality. Many factors can contribute to this complication. Every visceral surgeon is confronted with this problem at some point of his carrier and should apply the adequate treatment to his patients depending on his decision and experience. Strong level of evidence is needed to establish clear guidelines for the management of this heterogenous complication.

Collision tumors of adenocarcinoma and MALT (Mucosa-associated lymphoid tissue) lymphoma are often rare findings of resection specimens of gastric carcinomas. The fact that these two histological lesions are contiguous may suggest a common oncogene. As it is widely known, Helicobacter pylori (H. pylori) plays a leading role in gastric oncogenesis. Could it be responsible for these tumors? As of today, the exact mechanism is still unclear. However, some histological findings may suggest that H. pylori promotes the formation of MALT lymphoma which increases the risk of carcinomatous changes. Prognosis of collision tumors is tightly linked to the carcinoma lesion, which is generally poor due to diagnostic delay. Large scale strategies to eradicate H. pylori and detect early lesions could reduce the mortality of this disease.

Sclerosing encapsulating peritonitis (SEP) is a very rare entity characterized by encasement of small intestine by a fibrocollagenous membrane. It is divided into primary (idiopathic) which is named as abdominal cocoon and secondary forms. The preoperative diagnosis is difficult and most cases are diagnosed intraoperatively. A conservative treatment approach is the most suitable management strategy in asymptomatic idiopathic SEP. In this paper, we aimed to present a case of idiopathic SEP revealed by intestinal obstruction.

Background Gastroduodenalartery (GDA) pseudo-aneurysms are very rare. Their clinical importance lies in the eventuality of rupture, causing bleeding and ultimately exsanguination. Case presentation We report the case of a man, with prior history of biliary surgery, presenting with haemobilia secondary to a rupture of GDA pseudo-aneurysm eroding the main bile duct. The patient was treated with coil embolization. This technique is considered to be safe. However, on the long term, some complications may occur. In our case, the patient presented with cholangitis subsequent to coil migration in the lower bile duct. This situation was managed using endoscopic retrograde cholangiopancreatography (ERCP) allowing coil extraction with favorable evolution. Conclusions GDA pseudo-aneurysms are very rare. Bleeding, secondary to the rupture of these lesions, is a serious complication that could lead to death. Diagnosis and treatment of ruptured GDA pseudo-aneurysms rely on angiography. This method is considered to be safe. Cholangitis secondary to coil migration in the main bile duct is exceedingly rare,but remains an eventuality that physicians should be cognizant of.