Abbreviations and AcronymsCT = computed tomography EP = emphysematous pyelitis EPN = emphysematous pyelonephritis KUB = kidney, ureter, bladder ABSTRACT
A 42-year-old Tunisian man was presented to the emergency department with acute epigastric pain, nausea and vomiting. He was a smoker and had a past medical history of hypertension. On physical examination, there was no evidence of peritonitis and vital signs were normal.Laboratory data revealed leukocytosis with a white blood cell count of 11,000/ml. There was no evident pathology in the abdominal sonographic examination. An abdominal computed tomography scan with intravenous contrast showed a normal thoraco-abdominal aorta. However, dissection of both the celiac trunk and SMA was determined. SMA dissection was classified as Sakamoto type II b. There was no bowel oedema or free fluid. The dissection of the celiac artery was approximately 22mm long with aneurysmal dilatation [ ABSTRACTIsolated arterial dissection without aortic pathology has been rarely reported in mesenteric vessels. The natural history and appropriate treatment for this disease is uncertain because of the scarcity of literature which limits the data available to the clinician, resulting in management challenges. Herein, we report a rare case of a 42-year-old Tunisian man with spontaneous dissection and aneurysmal dilatation of the Celiac Artery (CA) and the Superior Mesenteric Artery (SMA) with partial thrombosis. This case was successfully managed conservatively with heparin infusion and blood pressure control and the patient remained symptom free at 15 months follow up. This case demonstrates that conservative management may be warranted in non-complicated isolated visceral arterial dissection.the method of choice. It was based on anticoagulation, pain and hypertension control. His abdominal pain resolved in 2 days. The patient was discharged home with warfarin and aspirin. Follow-up CT scan at 3 and 6 months demonstrated that the dissections and aneurysmal dilatation were both stable. The patient was continuing to do well on his 15 month clinical follow-up. Further follow-up CT examinations were planned.
Ewing's sarcoma family of tumors (ESFT) is a rare entity of mesenchymal tumors deriving from neural crest tissue with a variable degree of neuroectodermal differentiation and sharing common morphological and cytogenetic aberrations. 1 It includes extraosseous Ewing sarcoma (ES), primitive neuroectodermal tumor (PNET), Askin tumor, and atypical ES. PNETs were recognized for the first time by Arthur Purdy Stout in 1918 2 and constitutes approximately 1% of all sarcomas. ES was first described by James Ewing in 1921. 3 These tumors commonly occur in the young population as the majority of patients are younger than 30 years of age. In adults, ESFT arises in more than 50% of cases in soft tissues (trunk, retroperitoneum, intra-abdominal tissues, and viscera).The primary involvement of the liver is extremely rare, and only 11 cases have been reported. [4][5][6][7][8][9][10][11][12][13][14] These tumors are aggressive, with a high tendency to relapse and metastasize especially in the lungs, bone marrow, brain, and lymph nodes. 15 The present work aims to report a new case on primitive hepatic ES and review all cases of primitive hepatic ES/PNET reported in the literature and describe clinical, radiological, histological, cytogenetical, therapeutic, and prognosis features of this singular tumor site in the different cases. | CASE REPORTA 26-year-old man presented with paroxysmal right upper quadrant pain and progressive distension of his upper
Introduction ambulatory surgery is continuously expanding in global reach 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. Methods we conducted a monocentric retrospective cohort study on patients who had ambulatory groin hernia repair (GHR) and ventral hernia repair (VHR) in the general surgery department of the Habib Thameur Hospital in Tunis between January 1 st , 2008 and December 31 st , 2016. Clinicodemographic characteristics and outcomes were compared between the successful discharge and discharge failure groups. A p-value of ≤ 0.05 was considered significant. Results we collected data from the record of 1294 patients. One thousand and twenty patients had groin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3.0%) had unplanned admission (UA) and 7 patients (0.7%) had unplanned rehospitalization (UR). The morbidity rate was 2.4% while the mortality rate was 0%. On multivariate analysis, we did not identify any independent predictor of 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 (4.0%) had UA and 4 patients (1.5%) had UR. The morbidity rate was 3.6% and the mortality rate was zero. On multivariate analysis, we did not identify any variable predicting discharge failure. Conclusion 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 organizational advantages to healthcare structures.
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