The occurrence of acute appendicitis during pregnancy may pose diagnostic and therapeutic difficulties. In fact pregnancy can make the clinical diagnosis delicate and the use of morphological examinations is still subject to controversy. The debates concerning the ideal surgical approach during pregnancy continue. On the other hand, in some cases the occurrence of acute appendicitis, especially in its complicated form, which is frequent in pregnant women, exposes to obstetrical complications and an increased risk of premature delivery We aims to describe the clinical and management features of acute appendicitis in pregnant women and the maternal and neonatal outcomes and carry out a review of the literature on this topic. It is a retrospective analysis of a series of 33 cases of appendicitis in pregnant women who were diagnosed and managed, in collaboration between the departments of General and digestive surgery, Gynecology and Obstetrics and Anaesthesia at Farhat Hached Universitary Hospital Sousse Tunisia between January 2005 and December 2015. The average age of the patients was 29 (20-40). Fourteen patients were in the first trimester, twelve in the 2nd and seven in the third trimester. The main symptom was pain in the right iliac fossa. The mean delay between consultation and surgery was 2.7 days. Twenty five patients had a preoperative ultrasound. Eight of the 33 pregnant patients presented complicated appendicitis with localized or generalized peritonitis. Thirty patients underwent laparotomic appendectomy: 28 with a Mc Burney incision and 2 with a midline incision and only three patients underwent laparoscopy. Preventive tocolysis was given to 14 patients, maternal mortality was null. Twenty four pregnancies were followed until delivery: one case of premature birth and one case of preterm labor were observed. Pregnancy makes it difficult to diagnose appendicitis, which explains the high rate of complicated acute appendicitis in our series. An early treatment improves maternal and fetal outcome.

Small bowel diverticulosis represents an uncommon pathology that is often misdiagnosed, since it causes non-specific gastrointestinal symptoms. It is defined by the existence of multiple diverticula, which are located most frequently in the jejunum. Diagnosis often occurs following the presentation of related complications such as diverticulitis, haemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or the presence of enteroliths. Here, we report a case of multiple jejunal diverticula causing acute intestinal obstruction.

A pancreatic duct variation, as the ansa pancreatica, can be diagnosed during a severe acute pancreatitis. It is still not clear whether the presence of these two pathologies is a coincidence or if the ansa pancreatica is the cause of the acute pancreatitis. New studies are necessary to clarify these points.

Introduction: Ingestion of sharp objects is a rare event. We report our experience in the care of prisoners who ingested razor blades as well as the in-time evolution of our management. Material and Methods: This is a descriptive study including all detainees ingesting razor blade, transferred from the prison to Farhat Hached University Hospital of Sousse, from January first,2014 to December 31st ,2015. Thus, we have counted 19 cases of swallowed razor blades in 16 prisoners; indeed, one prisoner had ingested a razor blade thrice and another had ingested a blade twice. Results: Our study includes 19 episodes of swallowed razor blades. In two cases, these events were secondary to suicide attempts. In the other cases, it was an expression of discontent and rejection of the situation in the prison. Three patients had a psychiatric history. The mean age of patients is 24 years. The initial clinical examination had not objectified signs of gastrointestinal perforation. Thoraco-abdomino-pelvic CT had allowed specifying the blade location in all cases. It had objectified, also, a pneumo-mediastinum in two cases. The blade location was esophageal in one case, gastric in six cases and in the small bowel in the other cases. The first four patients had surgical removal of the blade. In subsequent cases, the surgical abstention was the rule, and the spontaneous blade expulsion was observed. The average time of expulsion was four days. Conclusion: In our experience, surgical removal of the sharp foreign bodies should not be performed systematically without complications.

Introduction: Lipomas of the colon are rare benign tumors. Colo-colonic intussusception caused by colonic lipoma is more rare. Case report: We report a case of a 52-year-old patient presenting with recurrent colonic obstruction which occurred in recent days. Colonoscopy revealed a large submucosal mass having benign appearance. Abdominal computed tomography scan diagnosed colo-colonic intussusception due to a large lipoma of the sigmoid colon. Diagnosis was confirmed during operative reduction and resection. He had segmental left colectomy. The postoperative course was uneventful. Conclusion: Computed tomography scan and colonoscopy seem important for diagnosing both lipoma and intussusception. The treatment may be surgical or endoscopic.