Introduction: Fournier's gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality. Methods: We carried out a retrospective study of 72 patients treated for Fournier's gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and nonsurvivors and potential prognostic factors were analyzed. Results: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier's Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002). Conclusion: Fournier's gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.

BackgroundRetrorectal tumors in adults are very rare and little known condition. These tumors, often misdiagnosed or mistreated, should be completely excised because of the potential for malignancy or infection. A suitable operative approach is the key to the successful surgical management.Case presentationWe report the case of a 45-year-old Arab male who presented with chronic pelvic pain accompanied by straining to defecate and dysuria. The clinical examination showed a painless mass in the left perineal area. Pelvic magnetic resonance imaging and computed tomography scan demonstrated a huge and well-limited pelvic mass causing displacement and compression of the rectum and bladder. Although the large size of the mass (>7 cm in the greater diameter), it was successfully and completely excised through only perineal approach without undertaking coccygectomy or sacrectomy. The histopathological study revealed a low-grade leiomyosarcoma. The patient is currently in 4-years follow-up with no signs of recurrence or metastasis.ConclusionEven large retro-rectal tumors may be successfully excised by the perineal approach especially in carefully selected patients, but require extensive knowledge of pelvic anatomy and expertise in pelvic surgery.

Depuis la découverte de leur phénotype particulier, les tumeurs stromales gastro-intestinales représentent les tumeurs mésenchymateuses les plus fréquentes du tractus digestif et ne sont plus confondues avec les vrais léiomyosarcomes gastriques devenant ainsi exceptionnellement rencontrés dans la pratique médicale. Nous rapportons le cas d'une jeune femme de 32 ans admise pour une masse douloureuse de l'hypochondre gauche et chez qui le bilan radiologique objectivait une volumineuse tumeur occupant le hile splénique. Une résection monobloc emportant la masse, la rate, le grand épiploon et une collerette de la paroi gastrique a été effectuée et l'examen histologique a confirmé le diagnostic d'un léiomyosarcome gastrique. Il est extrêmement important de différencier les autres tumeurs mésenchymateuses du tractus digestif des léiomyosarcomes gastriques dont l'exérèse chirurgicale complète reste, jusqu’à présent, le seul traitement à visée curative.

Acute pancreatitis is a rare condition during pregnancy. Gallstones are the most common etiology.Its diagnosis should not suffer from delay because its evolution can jeopardize the vital maternal and fetal prognosis.We report the observation of woman, 27 years old, pregnant at 27 weeks of amenorrhea. She was admitted for epigastric pain evolving for four days, her lipasemia was at 360 IU / L. Abdominopelvic ultrasound showed a thin-walled lithiasic gallbladder, the non-dilated intra and extra hepatic bile ducts and an enlarged pancreas; Active pregnancy with presence of fetal heart activity. MRI performed immediately objectified a multilithiasic gallbladder with moderate dilation of the common bile duct, which is the site of 3 non-obstructive microlithiasis, the pancreas is enlarged. The patient was put on rest with a diet low in lipids, good rehydration (basic ration with electrolyte supplementation, symptomatic treatment. satisfactory check-up and she left after five days of hospitalization with a check-up and possible cholecystectomy after childbirth. Acute pancreatitis rarely occurs during pregnancy; the reported frequency ranges from 1 in 1000 to 3 in 10000 births. The most common etiology is cholelithiasis in 70% of cases. According to Pitchumoni, more than 50% of acute pancreatitis occurs, as in our patient, in the 3rd trimester. The clinical symptomatology and a high lipasemia allow us to make the diagnosis of acute pancreatitis. The abdominal ultrasound confirms the biliary etiology, however she does not appreciate the pancreas. The abdominal scanner cannot be performed due to the risk of irradiation, we performed a biliMRI whose sensitivity is 90% without risk either for the mother or for the fetus. The management of acute benign pancreatitis is done in collaboration with gynecologists and is based on the diet to put to rest the endocrine function of the pancreas and symptomatic treatment with a good prognosis. In severe forms or associated with cholangitis management is multidisciplinary with a prognosis reserved for the mother. A delay in diagnosis and treatment worsens the prognosis. The medical treatment is identical to acute pancreatitis outside of pregnancy, however there remains the specific treatment of acute pancreatitis secondary to cholelithiasis, because on the one hand we must consider the high rate of recurrences during pregnancy estimated at 70 %, and on the other hand consider both the maternal risk which depends on the anatomical type of acute pancreatitis and the gestational age of onset, and the fetal risk which depends on the severity of the clinical form.