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ABSTRACT: Panniculitis mesenteritis is a rare, benign, and chronic fibrosing inflammation disease with unknown aetiology that affects the mesentery of small bowel and colon.
To report a new case of this entity and to highlight its diagnostic difficulties especially when it affects the mesocolon.
A 37 years-old women presented with chronic abdominal pain; physical examination found mass of left ilaca fossa. Closcopy and abdominal CT scan showed a thickness of bowel wall with negative biopsies. The patient underwent a colectomy. Histologic examination concluded to the diagnosis of Mesenteric panniculitis without malignant lesion.
Mesenteric panniculitis is a rare pathology which diagnosis is difficult to establish. It can simulate malignancy. A better knowledge of its clinical and radiological features could ovoid unnecessary digestive resection.
La Tunisie médicale 12/2010; 88(12):950-3.
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Wael Rebai,
Montasser Kacem,
Mohamed Jouini,
Haykal Bedioui,
Fadhel Fterich,
Sofiene Ayadi,
Amin Daghfous,
Faouzi Chebbi,
Amin Makni,
Taieb Chouikh,
Rachid Ksantini, Zoubeir Bensafta
La Tunisie médicale 09/2010; 88(9):684-5.
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La Presse Médicale 03/2009; 38(9):e11-4. · 0.67 Impact Factor
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La Presse Médicale 03/2009; 38(5):848-50. · 0.67 Impact Factor
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La Presse Médicale 10/2008; 37(12):1821-4. · 0.67 Impact Factor
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ABSTRACT: Gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes. It is a diagnostic emergency and therapeutic challenge because in acute forms it may lead to gastric strangulation with a high risk of ischemia and necrosis. Organoaxial and mesentericoaxial volvulus are distinguished according to the direction of rotation. The most common cause of gastric volvulus is hiatal hernia, but the principal predisposing factor is ligamentous laxity. The diagnosis is suspected when erect chest radiograph images show a high air-fluid level in the chest. Moreover a barium swallow is essential to confirm the diagnosis. Nonetheless, a computed tomography (CT) scan now provides a comprehensive description of the thoracic lesion, including stomach vitality. Gastric volvulus requires surgical treatment, specifically volvulus reduction, reintegration of the stomach into the abdominal cavity in cases of intrathoracic migration, and correction of causal factors. Resection of the hernial sac and the role of gastropexy for preventing recurrence remain controversial. Advances in laparoscopic surgery have made possible a laparoscopic approach to most cases of chronic gastric volvulus.
La Presse Médicale 04/2008; 37(3 Pt 2):e67-76. · 0.67 Impact Factor
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Heykal Bedioui,
Amine Daghfous,
Rachid Ksantini,
Kais Nouira,
Faouzi Chebbi,
Fadhel Fteriche,
Wael Rebai,
Mohamed Jouini,
Montasser Kacem,
Emna Menif, Zoubeir Bensafta
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ABSTRACT: Internal hernias are a rare cause of acute intestinal obstruction. Herniation through the falciform ligament is rare and often diagnosed only during surgery. Abdominal computed tomography (CT), performed on an emergency basis, can help to diagnose this obstruction before surgery and select a therapeutic approach.
A 60-year-old man was hospitalized on an emergency basis for symptoms that had been developing for 3 days, including tympanites and epigastric pain (torsion), associated with vomiting and the cessation of both feces and flatus. Abdominal radiography showed multiple levels of air-fluid levels in the small bowel, some projecting towards the liver area, as well as the presence of a flat intestinal loop continuous with a distended small-bowel segment. Abdominal CT suggested a diagnosis of small-bowel herniation and obstruction, very probably through the falciform ligament. The patient then underwent emergency surgery after a brief resuscitation. Intraoperative exploration confirmed the diagnosis of internal hernia through the falciform ligament. The postoperative course was without problems.
Abdominal CT is the examination of choice in cases of a "new" acute intestinal obstruction. It makes it possible to diagnose the mechanism of the occlusion and especially the cause, especially for an internal hernia through the falciform ligament. It thus guides the choice of emergency surgical procedure and of appropriate approach. Once diagnosed, emergency surgery is essential to free the intestinal loop, with or without intestinal resection as a function of vitality.
La Presse Médicale 02/2008; 37(1 Pt 1):44-7. · 0.67 Impact Factor
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Heykal Bedioui,
Rachid Ksantini,
Kaies Nouira,
Amina Mekni,
Amine Daghfous,
Faouzi Chebbi,
Wael Rebai,
Fadhel Fteriche,
Mohamed Jouini,
Montasser Kacem,
Nabil Ben Mami,
Azza Filali, Zoubeir Bensafta
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ABSTRACT: Peritoneal tuberculosis and carcinomatosis are the most frequent etiologies of exsudative ascitis and require rapid diagnosis and treatment. The purpose of this study has been to evaluate the predictive value of clinical and complementary data for the etiologic diagnosis of exsudative ascites and to assess the results of laparoscopic surgery.
We report a prospective long-term study conducted over 10 years, having included all cases of exsudative ascites of unidentified etiology. We excluded patients with a history of anterior laparotomy and patients having a contraindication for laparoscopic surgery. Clinical signs, results of the cytochemical and bacteriological exam of the ascetic liquid and findings from radiological exams and endoscopic investigations were noted. Open laparoscopic exploration noted the macroscopic aspect and many peritoneal biopsies were obtained as well as a liver biopsy when possible. Statistical analysis was performed with SPSS10.0 software. The degree of statistical significance was set for P<0.05.
We included 90 cases of isolated exsudative ascites. There were 59 cases of tuberculosis and 31 of carcinomatosis. Mean patient age was 47 years with a sex ratio of 0.5. Bowel transit disorders were significantly in favor of a carcinomatosis (P=0.04) while fever and nocturnal sweats were suggestive of tuberculosis (P=0.04) but in both instances, the positive predictive value (PPV) of these two signs was weak, respectively 29% and 43%. Relative to chemical and cytologic study of ascitic fluid, hemorrhagic fluid, low white cell count, low lymphocyte differential and presence of atypical cells were significantly linked with the carcinomatosis (P=0.01) but with a PPV<85%. Radiological exams were not very contributive for the etiologic diagnosis. The laparoscopic peritoneal aspect was typical of tuberculosis in 90% of proved cases and in 29% of carcinomatosis cases, underlying the importance of peritoneal biopsies for histological study. Hepatic tuberculosis was associated with peritoneal localisation in 48% of cases. We had no surgical mortality and the morbidity was about 1%.
Etiological diagnosis of exsudative ascitis remains difficult to establish. Peritoneal biopsies under videolaparoscopy are currently the "gold standard" for diagnosis.
Gastroentérologie Clinique et Biologique 12/2007; 31(12):1146-9. · 0.80 Impact Factor
