Syndrome de Budd-Chiari : complication rare du kyste hydatique du foie : �� propos de trois cas

Introduction

Hydatid disease is a parasitic infestation due to the development of Echinococcus granulosus in the organism. This disease is particularly frequent in Tunisia where echinococcosis is endemic. Liver is the most common organ to be affected by hydatidosis, and several complications have been described. Vascular complications secondary to hepatic echinococcosis such as Budd-Chiari syndrome have rarely been reported.

Case reports

We report three rare cases of hydatid cyst complicated by Budd-Chiari syndrome. The cyst occupied at least two segments of the hepatic dome in all patients, and its diameter was 12.5, 21 and 12.5 cm, respectively. According to the Gharbi classification, the cysts were type III in one case and type IV in the other two cases. The Budd-Chiari syndrome was chronic in one patient and asymptomatic in other cases. The diagnosis was established by abdominal ultrasound (US) in two cases, confirmed by Doppler US and CT angiogram in one patient and by CT angiogram in the other. The diagnosis was established only by CT angiogram in the third case. The Budd-Chiari syndrome was due to the compression of two hepatic veins in one case, compression of inferior vena cava in one case and compression of one hepatic vein and inferior vena cava in another case. Laparotomy was performed in all patients. The surgical procedure comprised the resection of the protruding hepatic tissue after puncture aspiration of the cyst in all the three cases. The postoperative period was complicated by abscess formation in residual cavity, requiring drainage, and by the development of ascites in one case.

Conclusion

Hydatid cyst should be suspected amongst the causes of Budd-Chiari syndrome in countries where the disease is endemic. Conversely, this vascular complication should be looked for routinely in patients with hydatid disease of the liver.     

Mégaduodénum: à propos de deux cas

Megaduodenum is a rare condition. It may be idiopathic or secondary to visceral myopathy or neuropathy. The clinical manifestations vary from total latency to severe pseudo-obstruction. Recurrent urinary infections are common. The diagnosis is easily made by radiology and manometry revealing a motor disorder of the esophagus, small intestine, and anorectum. Surgical treatment poses specific technical problems related to the presence of biliarypancreatic confluence and head of the pancreas. The aim of this study is to describe the clinical manifestations; radiological and manometric abnormalities observed during megaduodenum and discuss therapeutic modalities. We report two patients: the first a 27-year-old man, operated for upper gastrointestinal stricture in another center where a large gastric dilatation was observed with a permeable pylorus. A lateral side anastomosis was performed between the duodenum and the second jejunal loop. The patient was readmitted to our department 4 years later for recurrence of the same symptoms. The former intraoperative duodenojejunal anastomosis was permeable. A total duodenal diversion was performed. The second patient a 22-year-old man, had a brother who is dead in the first year.. This case is associated with ophthalmologic disorders, facial dysmorphism, and a Barrett’s esophagus. The patient received a total duodenal diversion with satisfactory results, the blood karyotype showed no chromosomal abnormalities.     

Le carcinome adénosquameux. Une tumeur méconnue et agressive du tube digestif : à propos de deux cas

The gastrointestinal adenosquamous carcinoma is a rare histological variety, with poor prognosis. It poses the problem of differential diagnosis with gastrointestinal stromal tumor.     

Perforation isolée du sigmoïde par ingestion de prothèse dentaire : à propos de deux cas

The authors relate two cases of acute stercoral peritonitis secondary to the perforation of sigmoid colon, by accidental ingestion of a dental prosthesis. Clinically, the patients presented symptoms of acute peritonitis. The antecedents of chronic smoking and repeated epigastric pain suggested the diagnosis of ulcer perforation in one patient. At laparotomy, we found a perforation of sigmoid colon, with a dental prosthesis wedged in the perforation in the two patients. The perforation was exteriorized on a stick, and the reestablishment of continuity made three months later. The prosthesis has been accidentally ingested during sleep.     

Allergie aux antipaludéens de synthèse : à propos de deux cas

Few cases of hypersensitivity reactions due to antimalarials are described in the literature. Chloroquine sulfate is a widely used antimalarial drug with a long elimination half-life. We report two cases of delayed hypersensitivity to chloroquine diagnosed by open oral challenge and programmed re-introduction of the drug over several days. These cases point out the possibility of false negative skin tests, from which it follows that there are few reports of chloroquine hypersensitivity syndrome in the medical literature. We recommend that the allergy work-up when these conditions suspected include open oral challenge and drug re-introduction over several days. This approach may help identify cases of possible hypersensitivity to chloroquine or other anti-malarial drugs with a long elimination half-life.     

Le kyste hydatique primitif de la vésicule biliaire : une entité exceptionnelle

The authors report a case of hydatid cyst developed at the wall of the gallbladder and try to discuss the pathogenesis and management of this exceptional original location.     

La maladie de Verneuil: à propos de 40 cas

The Verneuil’s disease or Hidradenitis suppurativa is a disease that affects the apocrine sweat glands. The diagnosis is often made after some chronic episodes. Search for other locations in the body must be systematic. The treatment is essentially surgical and constrained, consisting of large excisions, and sometimes repeated. Recurrence is common. Our study is based on 40 cases of Verneuil’s disease, all male, whose average age is 32 years. Clinical examination was dominated by the presence of several fistulas in the perianal region. Treatment was surgical, associated with large excisions, requiring daily local care. Results were satisfactory and the time for scar tissue development varied between 45 and 60 days. Thefollow-up was of one to ten years and we noted seven cases of recurrence, operated using the same technique and with good results.     

Syndrome platypnée-orthodéoxie secondaire à une pneumopathie : à propos de deux cas

IntroductionThe platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism.ObservationsWe report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound.ConclusionThis syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.     

Kyste hydatique du foie ouvert dans la vésicule biliaire : à propos d’un cas

The opening in the intra hepatic bile ducts is the most common complication of hepatic hydatid cyst. The opening in the gallbladder is unusual.We report the case of a 65-year-old woman with complaints of right upper quadrant pain and fever. Various explorations have found a hydatid acute cholecystitis due to an opening of a hydatid cyst of the liver in the gallbladder. Treatment was surgical.     

Faux anévrisme du ventricule gauche du sujet jeune : à propos de trois cas

Pseudoaneurysm of the left ventricle is a rare late complication of myocardial infarction. So-called non-coronary forms have been described in young people. In this context, we report three cases. Mr. M.B., aged 20, consulted for chest pain associated with palpitations. Cardiovascular examination found a pulsatile, expanding precordial bulging and a mesocardiac systolo-diastolic murmur. We noted a sinus rhythm with ventricular extrasystoles on ECG. The chest radiograph showed cardiomegaly and aneurysmal deformation of the left lower heart border. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mrs. O.B., aged 23, was admitted for biventricular heart failure and in whom the examination found a systolic murmur in the apical area. ECG showed a regular sinus tachycardia, left atrial and ventricular hypertrophy. The chest radiograph showed cardiomegaly and aneurysmal deformation of left middle and lower heart borders. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mr. I.S., aged 24, admitted for the management of congestive heart failure. The patient had non-specific laboratory inflammatory signs, a sinus tachycardia and extrasystoles on the ECG. Chest radiography showed a discontinuation at the posterior arch of the sixth rib, a cardiomegaly and a neurismal dilatation of the left lower heart border. Doppler echocardiography showed a large apical pseudoaneurysm of the left ventricle.     

Aspect IRM atypique du syndrome de tako-Tsubo : à propos d’un cas

Since the 1990s, a new entity cardiomyopathy is described: the Tako-Tsubo syndrome. The Mayo Clinics’ criteria have been defined by to help diagnose: LV dysfunction, electrical modifications, and complete recovery. It is a Caucasian woman aged 66 hospitalized for chest pain syndrome occurred during the funeral. In support, we note the presence of STEMI. The patient received the conventional treatment of acute coronary syndrome. Cardiac ultrasound, angiography is in favor of Tako-Tsubo syndrome. MRI shows an unusual location: a delayed enhancement in epicardial associated pericardial effusion mimicking myopericarditis.     

Tumeur d’Abrikossoff à localisation œsophagienne : à propos d’un nouveau cas

Granular cell tumors or Abrikossoff tumors are rare and usually benign tumors. The esophageal involvement was rarely described (2% of cases). Diagnosis is histological and treatment controversial. From a new observation of granular cell tumor of the esophagus, we discuss clinical, endoscopic, histologic and therapeutic characteristics of this rare entity through a literature review. The Observation reported was of a 65-year-old man in whom and through exploration of dysphagia, we discovered a granular cell tumor of the third lower esophagus. In the absence of criteria of malignancy, the therapeutic approach was conservative with a simple endoscopic and echo endoscopic monitoring.     

La tuberculose hépatique : à propos d’un cas de présentation échographique exceptionnelle

Objective

To report a rare case of extrapulmonary tuberculosis (hepatic tuberculosis) and demonstrate the role of the ultrasound in its early detection, its precise diagnosis and in the monitoring of its treatment.

Method

We performed an abdominal ultrasound to a 12-year-old, immuno-competent teenager, complaining about chronic abdominal pain evolving for 8 months, without any notion of tuberculous contagium and presenting signs of tuberculous impregnation. The ultrasound examination was performed by means of an echo-doppler ultrasound device (Logic 400) of General Electric, provided with 2 probes (3.5 MHz and 7.5 MHz).

Results

The abdominal ultrasound found, a multi-micronodular hepatomegaly. Micronodules were homogeneous hypoechogenics, measuring between 3 and 4 mm in diameter and were spread in all the hepatic parenchyma. An ascites located in the pelvis was objectivized. There were neither adenopathies nor peritoneal nodules. The diagnosis of hepatic tuberculosis was evoked and confirmed by a hepatic punch-biopsy under ultrasound guidance. The patient was treated and a monthly ultrasound monitoring was performed. The disappearance of nodules and the ascites was obtained at the end of the 4th month of the treatment. That of the hepatomegaly is obtained one month later.

Conclusion

Ultrasound examination plays a very important role in the early detection of the hepatic tuberculosis, its precise diagnosis and the surveillance of the treatment. During its realization in a context of chronic abdominal pain at the child, the diagnosis of hepatic tuberculosis should be evoked in front of a multi-micronodular hepatomegaly, even at the immuno-competent child.