In this very particular moment through which we are living, it seems interesting to expose our own experience in taking digestive surgery patients. Emergency, oncological surgeries remained a priority. Functional surgery was deferred. On March 19, 2020, the Interior Ministry declares a state of health emergency and restricted traffic in Morocco from Friday (March 20.2020) until further notice, and declares this as the only inevitable way to keep the coronavirus under control. Therefore, The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. The Mohamed the VI university Hospital consists of 4 hospitals and two centers; during this period, Ibn Tofail Hospital was dedicated to surgical management (all specialties combined). In addition to public Hospitals and some Mohamed the VI University Hospitals were involved in the Covid patients care. This last had two poles of digestive surgery (two different hospitals), the first one was dedicated to Covid-19 patients, and latter one for non-Covid patients, the advantage of this second pole: different specialties with a surgical resuscitation and emergency intensive care unit. The precautions, taken, were given the large number of healthy carriers; it must be emphasized that protective measures must be used in the care of all personnel and patients. Surgical treatment of 625 patients (From 20 March to 10 June) was carried out in collaboration with the resuscitation department, radiology, gastroenterology, oncology, biological laboratory, anatomopathology, paramedical staff and mainly in responsibility sense of the university hospital direction and the ministry of health engagement. We detail the results below. The report purpose: there is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. Not only the Covid-19 caused death during this pandemic, also we must work hard to treat other pathologies which can be fatal.
Agenesis of the gallbladder and the cystic duct is one of the rarest congenital abnormalities of the biliary system. Almost half of the patients develop common duct stones and 23% of them manifest signs and symptoms that mimic biliary colic. We present two cases of gallbladder agenesis. The first case is of a woman presenting symptoms of biliary colic. Laparoscopy failed to reveal either gallbladder or cystic duct. The procedure was continued to further search for ectopic sites of gallbladder. A gallbladder agenesis was suspected and then confirmed via post-operative magnetic resonance cholangio-pancreatography, who also objectified a cystic dilatation and septum of the main bile duct. The second case is of a woman with symptoms of biliary colic. A first abdominal ultrasonography objectified a "scleroatrophic" gallbladder; on the second ultrasonography a gallbladder agenesis was suspected and later confirmed via magnetic resonance cholangio-pancreatography. We report through these cases our experience with regard to the challenges associated with the diagnosis and management, and a brief review of the literature of this rare pathology.
Isolated liver tuberculosis is still considered a rare condition and atypical clinical presentation challenges the clinical acumen of the treating physician. Hepatic tuberculosis is usually associated with an active pulmonary or miliary tuberculosis. Liver involvement in tuberculosis is usually clinically silent. A lady presented with fever, pain in right hypochondria, radiate to the right shoulder or scapula nausea and weight loss. CT scan of abdomen showed acute cholecystitis and multiple small hypodense non-enhancing lesions and a heterogeneous texture of liver. Biopsy confirmed the diagnosis of hepatic tuberculosis. It was concluded a case of isolated hepatic tuberculosis without evidence of other primary sites involvement. It is important to consider tuberculosis in the differential diagnosis when suspecting metastatic diseases in a patient with vague symptoms and abnormal hepatic texture on CT.
Gallstone ileus is an unusual and peculiar complication of biliary lithiasis. Less than 1% of gallstones migrate into the gut, causing 25% of non-strangulated small bowell obstructions in elderly population. Diagnosis is difficult, leading to late operation. Considering the median age of the patients and the fact that in most cases surgery is delayed, there is a lot of dispute regarding the best approach. Recent technical facilities in diagnostic and surgical practice seem to be irrelevant for the general outcome. We report a case of a wonan, 70 years-old, diabetic with old history of gallbladder cancer (old abdominal scan 2 years ago). She was admitted to hospital for after 3 days of worsening abdominal pain and subboclusion. The scanner showed an occlusion on an ileal discrepancy with parietal calcifications. The gallblader was unseen. Particular elements suggesting the ethiology were absent. The surgical exploration: very large gallstones occluding the ileon. Enterolithotomy was practiced with gallstone extraction and suture. The cholecystectomy was impossible cause the hepatic mass. The patient died two days later because of pulmonary embolism.
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