Introduction: Post-traumatic diaphragmatic hernia is defined as the passage of abdominal viscera into the thorax through a post-traumatic diaphragmatic breach. They are rare and may be unrecognized in 10-30% of cases at initial management. Materials and Methods: A retrospective descriptive study including all the patients taken in charge for post-traumatic neglected diaphragmatic lesions over two years between December 2018 and January 2021 within the service of visceral emergencies of the universitary hospital center Ibn Rochd of Casablanca. Our work aims to define the epidemiological, clinical, and therapeutic characteristics of patients admitted for post-traumatic diaphragmatic lesions. Results: The average age of the patients was 30 years (range 18 to 43 years). All patients were male. They were due to a closed trauma in 11 patients (32%) and a penetrating trauma in 58%. The diagnosis was guided preoperatively by the different imaging techniques, in particular chest radiography and CT scan. Treatment was mainly by laparotomy and consisted of closure of the diaphragmatic breach by simple sutures. Conclusion: Post-traumatic diaphragmatic hernias can go unnoticed and can be life-threatening in case of associated lesions or complications.
Introduction Small bowel adenocarcinoma is a rare but increasing disease. It poses both a diagnostic and therapeutic challange. Small bowel adenocarcinoma is a rare cause of small bowel obstruction. We present the case of a patient admitted to our emergency department for a bowel obstruction due to a mass of the jejunum and whose anatomopathological diagnosis was adenocarcinoma. Patient and method It is a 62-year-old woman with unparticular history, admitted to the emergency of visceral surgery of Ibn Rochd University Hospital for subocclusive syndrome evolving for one year, with early postprandial vomiting becoming stenosing two months ago. The abdominal CT scan showed thickening jejunal wall of 46 mm with upstream distension. She underwent a segmental bowel resection of 50 cm of small bowel with 3 cm stenotic mass located at 40 cm from the duodenojejunal angle. The pathophysiology revealed an invasive liberkhunian adenocarcinoma. The postoperative follow-up was simple, feeding allowed at D4 with discharge allowed at D6 and functional improvement at the time of the control performed three months after the intervention. Discussion Small bowel adenocarcinoma is rare and represents only 1–3% of all gastrointestinal cancers. The incidence of SBA is 24 to 66 times lower than that of colorectal cancer (CRC). Due to its non-specific clinical manifestation and less accessible location, SBA is diagnosed at an advanced stage, and often at specimen analysis. The treatment is resection and the overall survival is increased when diagnostic is early made. Conclusion Small bowel adenocarcinoma is a rare but increasing cause of gastrointestinal malignancy, being both a diagnostic and therapeutic challenge. In front of the occlusive syndrome of small bowel appearance, adenocarcinoma must be ruled out.
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