If successful surgery is the primary quest of any surgeon, unintentionally leaving behind surgical items in the operative field remains his most feared obsession. This rare but dramatic accident can lead to potentially fatal complications and turn both lives of the surgeon and the patient upside down. We present the case of a 29-year-old female patient who presented to the ER with three days history of severe diffuse abdominal pain associated with fever, biological inflammatory syndrome and well-tolerated iron deficiency anaemia. She had no past medical history except for a lower segment cesarean section 5 months ago. Abdominal MRI allowed the diagnosis of two gossypibomas responsible for two intra-abdominal collections. An emergency laparotomy allowed the removal of these foreign bodies and the management of their serious complications of intestinal perforation by the construction of a double intestinal stoma. The patient made a post-operative uneventful recovery. This observation emphasizes the need to raise the practitioner´s awareness about this differential diagnosis in every case of any poorly localized abdominal pain occurring after surgery.

Stump appendicitis is a rare etiology of acute lower right quadrant abdominal pain often forgotten in the emergency room (ER). The Mac Burney scar or a previous laparoscopic appendectomy always rule out the eventuality of appendicitis and mislead management. Advanced imaging tools are more than compulsory to help correct the diagnosis. Computed tomography (CT) scan is the option of choice that may be replaced if unavailable by simple ultrasound examination. The treatment is mainly surgical. We report the case of a stump appendicitis occurring 12 years after laparoscopic appendectomy in an 18-year-old girl. The diagnosis was based on consistent clinical signs and conclusive radiological data. A successful completion appendectomy was performed with good outcome.

BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

Background This study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease. Methods This is a descriptive retrospective study carried out over a period of 7 years extending from January 2013 to December 2019 reporting eight cases of isolated primitive splenic hydatid cysts. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy. Results The diagnosis was incidentally made in 50% of cases. The main other revealing complaints are pain in the left upper quadrant of abdomen in 25% of cases and a painless renitent mass in the same quadrant in only 12,5%. None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay (9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. Conclusions The current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures. It seems to be the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

Due to the anatomical proximity of the last ileal loop and the bladder, Crohn’s disease can affect the urinary tract by the formation of an Enterovesical Fistula (EVF). Although rare, it represents a complication with a potential impact on the patient’s quality of life and it is often difficult to manage. In addition to the Computed Tomographic (CT) findings, several other examinations can contribute to the diagnosis of EVF, which calls for adequate management based on disconnection of the digestive tract from the bladder and maintenance of medical treatment. Despite therapeutic advances in the context of Crohn’s disease, the EVF remains a surgical indication. The present case reported is of a successfully managed EVF which was revealed by fecaluria aiming to emphasise the clinical aspects and various diagnostic tools with a special mention of the key role of medical imaging in the diagnostic process and the surgical management.