Insulinoma is a rare neuroendocrine tumor, occurring almost exclusively in the pancreas. Most oft... more Insulinoma is a rare neuroendocrine tumor, occurring almost exclusively in the pancreas. Most often unique and benign in 90% of cases. Usually sporadic, 10% of lesions become part of type 1 multiple endocrine neoplasia. The main manifestation of insulinoma is hypoglycemia, which is a life-threatening metabolic emergency. The hypoglycemia occurring in this context are particularly serious and frequent with sometimes harmful cerebral consequences. Topographic diagnosis remains difficult due to the small size of the lesions justifying the importance of the preoperative imaging required for the location of the tumor. Enucleation is the surgical indication of choice in the presence of a sporadic insulinoma that is presumably benign. Pathological and immunohistochemical examination confirms the diagnosis of neuroendocrine tumor. Our observation is particular by the circumstances of discovery of the insulinoma, the severe nature of the symptoms.
The left para-duodenal hernia or mesocolic hernia is a rare cause of occlusion for young adults, ... more The left para-duodenal hernia or mesocolic hernia is a rare cause of occlusion for young adults, its association with a peritoneal bridle is exceptional. We reporting a case of a 20-year-old young man with a history of appendectomy presenting with occlusion syndrome. Abdominal CT scan with contrast suggests the diagnosis of left para-duodenal hernia, with intraoperative discovery of a bridle in the right iliac fossa. In view of the non-specific clinical presentation, internal hernias is a challenging diagnostic. Intestinal obstruction by bridles remains the main differential diagnosis, however a possible association should not be overlooked.
Supravesical hernias are very rarely seen and reported as a possible cause of small bowel obstruc... more Supravesical hernias are very rarely seen and reported as a possible cause of small bowel obstruction. The proper diagnosis of which is usually made intra-operatively as the preliminary diagnosis despite the availability of advanced radiological investigations which are not very helpful. We report the case of a patient without previous abdominal surgery with an acute abdominal obstruction in which laparotomy exploration revealed a strangulatedinternalsupravesicalhernia. The defect was repaired after reducing the bowel and the patient made an uneventful recovery.
Primary mucinous adenocarcinoma is a rare malignancy of the anus (3% of anal cancers), the pathog... more Primary mucinous adenocarcinoma is a rare malignancy of the anus (3% of anal cancers), the pathogenesis of which is better understood by immunohistochemistry. We reviewed cases of primary mucinous adenocarcinoma of the anus from 2000 to 2009 in the Hepatogastroenterology Department of the University Hospital Centre of Marrakech. Three cases were identified who were males with the mean age of 68 years, and presented with a chronic anal fistula. Two cases had anal pain. Clinical examination revealed multiple fistulae in two cases with a secretion simulating 'cooked grains of tapioca'. Diagnosis was confirmed by histopathology and immunohistochemical profile (CK7 positive/CK20 negative). Imaging revealed a retro-rectal collection with thickening of the anal wall without metastasis (two cases). One patient underwent abdominoperinal resection without recurrence.
Les perforations greliques post traumatique plus frequents chez les jeunes sont de complications ... more Les perforations greliques post traumatique plus frequents chez les jeunes sont de complications tardives et rare dans les traumatismes de labdomen fermees. La disponibilite dun plateau technique performant constitue classiquement une des principales conditions pour la reussite de cette attitude. Nous essayons detudier les differents aspects epidemiologiques, diagnostiques et therapeutiques de cette affection a travers les resultats dune serie de 50 malades. Une serie de 50 patients est prise en charge par le traitement operatoire. La gravite des lesions est appreciee par les donnees cliniques et paracliniques, ainsi que la morbidite et la mortalite sont analysees. Les accidents de la circulation etaient la premiere cause des perforations greliques, suivi par les plaies par arme blanche (34 % cas) dans notre contexte. Les epanchements intraperitoneaux etaient les plus frequentes (30% des cas). La notion de polytraumatisme etait tres frequente. La duree moyenne de surveillance etait ...
Splenic rupture is a potentially life-threatening condition, often associated with chest or abdom... more Splenic rupture is a potentially life-threatening condition, often associated with chest or abdominal trauma. Spontaneous rupture is very rare and is usually reported as being secondary to underlying pathological conditions. We report a case of atraumatic splenic rupture in a patient with no underlying disease pathology. This case should remind the emergency physician spontaneous splenic rupture should be considered in the differential diagnosis of unexplained acute abdominal pain.
Up to the 20th century, colorectal cancer used to be quite scarce and its incidence has increased... more Up to the 20th century, colorectal cancer used to be quite scarce and its incidence has increased at the same rate as the economic development. Currently it is considered amongst the most frequent and the most acute malignant tumors. In Morocco, that cancer remains underestimated because of the lack of screening and the delayed diagnosis. We have made this study to evaluate the different epidemiological as much as the anatomopathological aspects of colorectal cancer in Marrakech. This is a retrospective descriptive study of the different cases of colorectal cancer collected in Marrakech between 1997 and 2015. We could identify 2584 cases of colorectal cancer, 44% of whom have colonic cancer and 56% with rectal cancer. The male gender is predominant with a ratio of 1.34. The mean age in our series was 55.4 years with extreme ages ranging from 18 to 100 years. Polyps and adenomas were the major risk factor in the development of colorectal cancer. The sigmoid colon represented 44% of t...
Retro-peritoneal liposarcoma is a rare tumor which preoperative diagnosis and stagging are essent... more Retro-peritoneal liposarcoma is a rare tumor which preoperative diagnosis and stagging are essential for planning its management. Methods and results: Case 1: A 58-year-old woman complaining of abdominal distension. Computed tomography revealed voluminous right abdominal mass. Bloc removal of the tumor was achieved. The histological diagnosis was well-differenciated liposarcoma. Case 2: A 63-year-old man complaining of abdominal distension. Ultrasonography and Computed tomography revealed a huge tumor that involved all the right retroperitoneal space. At surgery, a right hemicolectomy and a right nephrectomy were performed for complete resection of the tumor. The final histopathological report showed welldifferentiated liposarcoma of the retro peritoneum. Conclusion: Total surgical resection provides the patient best chance for cure. It may extend to the adjacent organ for an R0 resection.
The authors report three cases of post-traumatic hemobilia. Hemobilia complicates about 0.5% to 2... more The authors report three cases of post-traumatic hemobilia. Hemobilia complicates about 0.5% to 2% of liver injuries. The diagnosis can be difficult because of its possible delay of appearance. The ultrasound and CT scan performed urgently are of great help in both positive diagnosis and monitoring of this pathology. Once the diagnosis is made-immediatly or a while after the trauma-a diagnostic and therapeutic arteriography must be carried out quickly.
Spleen-splenectomy-hydatid cyst Hydatid cyst disease is endemic in our country. The splenic invol... more Spleen-splenectomy-hydatid cyst Hydatid cyst disease is endemic in our country. The splenic involvement comes at the third rank following the liver and the lungs. 15 cases were evaluated, retrospectively, between 2002 and 2013. The gender distribution was 73% Females and 27% males. The mean age is 48 years. The pain was a frequent reason for consultation (40%). Splenomegaly was found in 46,7% of patients. The diagnosis is established by Ultrasound scan and computed tomography scan. The splenic hydatid cyst was solitary in 6 cases. Surgical treatment was performed in all cases. Deroofing was the most common method in 53%of cases, and total splenectomy in 47% of cases. The results were good with no mortality and morbidity consisting of one sub-phrenic abscess that required external drainage.
La place du traitement non opératoire des contusions abdominales dans les pays en voie de dévelop... more La place du traitement non opératoire des contusions abdominales dans les pays en voie de développement
Les pancréatites aiguës sont des maladies fréquentes et potentiellement mortelles. Les étiologies... more Les pancréatites aiguës sont des maladies fréquentes et potentiellement mortelles. Les étiologies sont nombreuses dominées par la lithiase de la voie biliaire principale et l'intoxication alcoolique (80 % des cas). D'autres causes plus rares peuvent être rencontrées. Dans ce cadre, nous rapportons le cas d'une pancréatite aiguë secondaire à un kyste hydatique rétropéritonéal par compression extrinsèque du wirsung, associé à des localisations hépatiques, chez un patient de 53 ans. Le traitement a consisté en une résection du dôme saillant de tous les kystes suivie d'un traitement médical par l'albendazole. Cette observation permet de rappeler les aspects diagnostiques de cette entité rare du kyste hydatique rétropéritonéal et ses modalités thérapeutiques.
L'actinomycose est une maladie suppurative subaiguë pseudotumorale due à un bacille Gram positif ... more L'actinomycose est une maladie suppurative subaiguë pseudotumorale due à un bacille Gram positif anaérobie, Actinomyces israelii. La localisation appendiculaire reste rare, et son diagnostic est le plus souvent fait en postopératoire sur l'analyse de la pièce chirurgicale, seule l'histologie confirme le diagnostic. Nous rapportons ici le cas d'une patiente présentant une localisation d'actinomycose diagnostiquée au décours d'une prise en charge chirurgicale, le but de ce travail est de souligner l'intérêt de penser à un tel diagnostic dans un contexte clinique évocateur, et de privilégier autant que possible le traitement médical par antibiothérapie seule durant six mois si le diagnostic est suspecté en préopératoire et de réserver la chirurgie à des situations particulières. Pour citer cette revue : J. Afr. Hépatol. Gastroentérol. 5 (2011).
Gastrointestinal tuberculosis is quite rare, representing only 3% of all extrapulmonary cases. In... more Gastrointestinal tuberculosis is quite rare, representing only 3% of all extrapulmonary cases. Involvement of the appendix is rare, only occurring in about 1% of cases. It is usually secondary to tuberculosis elsewhere in the abdomen. A prompt diagnosis depends on a high index of suspicion as clinical signs may be nonspecific and microbiological confirmation is difficult. Histopathologic examination is often the only way to reach a diagnosis and to establish specific antibiotic therapy. In these cases, due to the absence of specific symptoms and signs, the diagnosis is delayed until after surgery.
Fatal hypoglycaemia from IGF II hyperproduction as a complication of a mesenteric gastrointestinal stromal tumour
Arab Journal of Gastroenterology, 2011
... Abdennasser Finech: Affiliations. Surgery Department, King Mohamed VI Hospital, FMPM, UCAM, K... more ... Abdennasser Finech: Affiliations. Surgery Department, King Mohamed VI Hospital, FMPM, UCAM, King Mohamed VI University Hospital, Medical School of Marrakech, Cadi Ayyad University, Marrakech, Morocco. ,; Khalid Rabbani: Affiliations. ... Fadoua El Mansouri: Affiliations. ...
Calcified liver hydatid cyst compressing the gall bladder
Arab Journal of Gastroenterology, 2011
A 48-year-old male patient was admitted to suffering from hydatid disease located in the gall bla... more A 48-year-old male patient was admitted to suffering from hydatid disease located in the gall bladder. Although Morocco remains an endemic area for echinococcosis, this presentation of the disease was rare. The pericyst was tightly attached to the liver. Complete pericystectomy with cholecystectomy was done. Histopathology confirmed the presence of a calcified hydatid cyst of the gall bladder. Perioperative adjuvant
Insulinoma is a rare neuroendocrine tumor, occurring almost exclusively in the pancreas. Most oft... more Insulinoma is a rare neuroendocrine tumor, occurring almost exclusively in the pancreas. Most often unique and benign in 90% of cases. Usually sporadic, 10% of lesions become part of type 1 multiple endocrine neoplasia. The main manifestation of insulinoma is hypoglycemia, which is a life-threatening metabolic emergency. The hypoglycemia occurring in this context are particularly serious and frequent with sometimes harmful cerebral consequences. Topographic diagnosis remains difficult due to the small size of the lesions justifying the importance of the preoperative imaging required for the location of the tumor. Enucleation is the surgical indication of choice in the presence of a sporadic insulinoma that is presumably benign. Pathological and immunohistochemical examination confirms the diagnosis of neuroendocrine tumor. Our observation is particular by the circumstances of discovery of the insulinoma, the severe nature of the symptoms.
The left para-duodenal hernia or mesocolic hernia is a rare cause of occlusion for young adults, ... more The left para-duodenal hernia or mesocolic hernia is a rare cause of occlusion for young adults, its association with a peritoneal bridle is exceptional. We reporting a case of a 20-year-old young man with a history of appendectomy presenting with occlusion syndrome. Abdominal CT scan with contrast suggests the diagnosis of left para-duodenal hernia, with intraoperative discovery of a bridle in the right iliac fossa. In view of the non-specific clinical presentation, internal hernias is a challenging diagnostic. Intestinal obstruction by bridles remains the main differential diagnosis, however a possible association should not be overlooked.
Supravesical hernias are very rarely seen and reported as a possible cause of small bowel obstruc... more Supravesical hernias are very rarely seen and reported as a possible cause of small bowel obstruction. The proper diagnosis of which is usually made intra-operatively as the preliminary diagnosis despite the availability of advanced radiological investigations which are not very helpful. We report the case of a patient without previous abdominal surgery with an acute abdominal obstruction in which laparotomy exploration revealed a strangulatedinternalsupravesicalhernia. The defect was repaired after reducing the bowel and the patient made an uneventful recovery.
Primary mucinous adenocarcinoma is a rare malignancy of the anus (3% of anal cancers), the pathog... more Primary mucinous adenocarcinoma is a rare malignancy of the anus (3% of anal cancers), the pathogenesis of which is better understood by immunohistochemistry. We reviewed cases of primary mucinous adenocarcinoma of the anus from 2000 to 2009 in the Hepatogastroenterology Department of the University Hospital Centre of Marrakech. Three cases were identified who were males with the mean age of 68 years, and presented with a chronic anal fistula. Two cases had anal pain. Clinical examination revealed multiple fistulae in two cases with a secretion simulating 'cooked grains of tapioca'. Diagnosis was confirmed by histopathology and immunohistochemical profile (CK7 positive/CK20 negative). Imaging revealed a retro-rectal collection with thickening of the anal wall without metastasis (two cases). One patient underwent abdominoperinal resection without recurrence.
Les perforations greliques post traumatique plus frequents chez les jeunes sont de complications ... more Les perforations greliques post traumatique plus frequents chez les jeunes sont de complications tardives et rare dans les traumatismes de labdomen fermees. La disponibilite dun plateau technique performant constitue classiquement une des principales conditions pour la reussite de cette attitude. Nous essayons detudier les differents aspects epidemiologiques, diagnostiques et therapeutiques de cette affection a travers les resultats dune serie de 50 malades. Une serie de 50 patients est prise en charge par le traitement operatoire. La gravite des lesions est appreciee par les donnees cliniques et paracliniques, ainsi que la morbidite et la mortalite sont analysees. Les accidents de la circulation etaient la premiere cause des perforations greliques, suivi par les plaies par arme blanche (34 % cas) dans notre contexte. Les epanchements intraperitoneaux etaient les plus frequentes (30% des cas). La notion de polytraumatisme etait tres frequente. La duree moyenne de surveillance etait ...
Splenic rupture is a potentially life-threatening condition, often associated with chest or abdom... more Splenic rupture is a potentially life-threatening condition, often associated with chest or abdominal trauma. Spontaneous rupture is very rare and is usually reported as being secondary to underlying pathological conditions. We report a case of atraumatic splenic rupture in a patient with no underlying disease pathology. This case should remind the emergency physician spontaneous splenic rupture should be considered in the differential diagnosis of unexplained acute abdominal pain.
Up to the 20th century, colorectal cancer used to be quite scarce and its incidence has increased... more Up to the 20th century, colorectal cancer used to be quite scarce and its incidence has increased at the same rate as the economic development. Currently it is considered amongst the most frequent and the most acute malignant tumors. In Morocco, that cancer remains underestimated because of the lack of screening and the delayed diagnosis. We have made this study to evaluate the different epidemiological as much as the anatomopathological aspects of colorectal cancer in Marrakech. This is a retrospective descriptive study of the different cases of colorectal cancer collected in Marrakech between 1997 and 2015. We could identify 2584 cases of colorectal cancer, 44% of whom have colonic cancer and 56% with rectal cancer. The male gender is predominant with a ratio of 1.34. The mean age in our series was 55.4 years with extreme ages ranging from 18 to 100 years. Polyps and adenomas were the major risk factor in the development of colorectal cancer. The sigmoid colon represented 44% of t...
Retro-peritoneal liposarcoma is a rare tumor which preoperative diagnosis and stagging are essent... more Retro-peritoneal liposarcoma is a rare tumor which preoperative diagnosis and stagging are essential for planning its management. Methods and results: Case 1: A 58-year-old woman complaining of abdominal distension. Computed tomography revealed voluminous right abdominal mass. Bloc removal of the tumor was achieved. The histological diagnosis was well-differenciated liposarcoma. Case 2: A 63-year-old man complaining of abdominal distension. Ultrasonography and Computed tomography revealed a huge tumor that involved all the right retroperitoneal space. At surgery, a right hemicolectomy and a right nephrectomy were performed for complete resection of the tumor. The final histopathological report showed welldifferentiated liposarcoma of the retro peritoneum. Conclusion: Total surgical resection provides the patient best chance for cure. It may extend to the adjacent organ for an R0 resection.
The authors report three cases of post-traumatic hemobilia. Hemobilia complicates about 0.5% to 2... more The authors report three cases of post-traumatic hemobilia. Hemobilia complicates about 0.5% to 2% of liver injuries. The diagnosis can be difficult because of its possible delay of appearance. The ultrasound and CT scan performed urgently are of great help in both positive diagnosis and monitoring of this pathology. Once the diagnosis is made-immediatly or a while after the trauma-a diagnostic and therapeutic arteriography must be carried out quickly.
Spleen-splenectomy-hydatid cyst Hydatid cyst disease is endemic in our country. The splenic invol... more Spleen-splenectomy-hydatid cyst Hydatid cyst disease is endemic in our country. The splenic involvement comes at the third rank following the liver and the lungs. 15 cases were evaluated, retrospectively, between 2002 and 2013. The gender distribution was 73% Females and 27% males. The mean age is 48 years. The pain was a frequent reason for consultation (40%). Splenomegaly was found in 46,7% of patients. The diagnosis is established by Ultrasound scan and computed tomography scan. The splenic hydatid cyst was solitary in 6 cases. Surgical treatment was performed in all cases. Deroofing was the most common method in 53%of cases, and total splenectomy in 47% of cases. The results were good with no mortality and morbidity consisting of one sub-phrenic abscess that required external drainage.
La place du traitement non opératoire des contusions abdominales dans les pays en voie de dévelop... more La place du traitement non opératoire des contusions abdominales dans les pays en voie de développement
Les pancréatites aiguës sont des maladies fréquentes et potentiellement mortelles. Les étiologies... more Les pancréatites aiguës sont des maladies fréquentes et potentiellement mortelles. Les étiologies sont nombreuses dominées par la lithiase de la voie biliaire principale et l'intoxication alcoolique (80 % des cas). D'autres causes plus rares peuvent être rencontrées. Dans ce cadre, nous rapportons le cas d'une pancréatite aiguë secondaire à un kyste hydatique rétropéritonéal par compression extrinsèque du wirsung, associé à des localisations hépatiques, chez un patient de 53 ans. Le traitement a consisté en une résection du dôme saillant de tous les kystes suivie d'un traitement médical par l'albendazole. Cette observation permet de rappeler les aspects diagnostiques de cette entité rare du kyste hydatique rétropéritonéal et ses modalités thérapeutiques.
L'actinomycose est une maladie suppurative subaiguë pseudotumorale due à un bacille Gram positif ... more L'actinomycose est une maladie suppurative subaiguë pseudotumorale due à un bacille Gram positif anaérobie, Actinomyces israelii. La localisation appendiculaire reste rare, et son diagnostic est le plus souvent fait en postopératoire sur l'analyse de la pièce chirurgicale, seule l'histologie confirme le diagnostic. Nous rapportons ici le cas d'une patiente présentant une localisation d'actinomycose diagnostiquée au décours d'une prise en charge chirurgicale, le but de ce travail est de souligner l'intérêt de penser à un tel diagnostic dans un contexte clinique évocateur, et de privilégier autant que possible le traitement médical par antibiothérapie seule durant six mois si le diagnostic est suspecté en préopératoire et de réserver la chirurgie à des situations particulières. Pour citer cette revue : J. Afr. Hépatol. Gastroentérol. 5 (2011).
Gastrointestinal tuberculosis is quite rare, representing only 3% of all extrapulmonary cases. In... more Gastrointestinal tuberculosis is quite rare, representing only 3% of all extrapulmonary cases. Involvement of the appendix is rare, only occurring in about 1% of cases. It is usually secondary to tuberculosis elsewhere in the abdomen. A prompt diagnosis depends on a high index of suspicion as clinical signs may be nonspecific and microbiological confirmation is difficult. Histopathologic examination is often the only way to reach a diagnosis and to establish specific antibiotic therapy. In these cases, due to the absence of specific symptoms and signs, the diagnosis is delayed until after surgery.
Fatal hypoglycaemia from IGF II hyperproduction as a complication of a mesenteric gastrointestinal stromal tumour
Arab Journal of Gastroenterology, 2011
... Abdennasser Finech: Affiliations. Surgery Department, King Mohamed VI Hospital, FMPM, UCAM, K... more ... Abdennasser Finech: Affiliations. Surgery Department, King Mohamed VI Hospital, FMPM, UCAM, King Mohamed VI University Hospital, Medical School of Marrakech, Cadi Ayyad University, Marrakech, Morocco. ,; Khalid Rabbani: Affiliations. ... Fadoua El Mansouri: Affiliations. ...
Calcified liver hydatid cyst compressing the gall bladder
Arab Journal of Gastroenterology, 2011
A 48-year-old male patient was admitted to suffering from hydatid disease located in the gall bla... more A 48-year-old male patient was admitted to suffering from hydatid disease located in the gall bladder. Although Morocco remains an endemic area for echinococcosis, this presentation of the disease was rare. The pericyst was tightly attached to the liver. Complete pericystectomy with cholecystectomy was done. Histopathology confirmed the presence of a calcified hydatid cyst of the gall bladder. Perioperative adjuvant
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