La rate voyageuse est une anomalie congénitale ou acquise caractérisée par un défaut de fixité anatomique de la rate avec les organes avoisinants ; appendue à un long pédicule, la rate se trouve en dehors du quadrant supérieur gauche de l'abdomen. Parfois asymptomatique, cette rate en position ectopique peut se manifester par une masse abdominale ou pelvienne, des douleurs abdominales chroniques intermittentes ou aiguës, en rapport avec des épisodes de torsion/détorsion du pédicule vasculaire splénique. Le diagnostic préopératoire des rates voyageuses est facile grâce à l'apport de l'imagerie qui montre l'hypochondre gauche déshabité, situe la rate dans un autre quadrant de l'abdomen et peut détecter des complications dont la principale est la torsion du pédicule splénique. Nous rapportons un cas de rate voyageuse compliquée de volvulus du pédicule splénique chez une jeune femme qui a été traitée par une splénectomie. Pour citer cette revue : J. Afr. Hépatol. Gastroentérol. 5 (2011).Mots clés Rate ectopique · Volvulus de rate · Splénopexie · Splénectomie · Chirurgie laparoscopique Abstract Wandering spleen is an acquired or congenital anomaly characterized by a defect of the anatomical strictness of the spleen with neighboring organs owing to its long pedicle, the spleen is located on the outside of the upper left quadrant of the abdomen. Sometimes asymptomatic, the spleen in ectopic position may manifest itself by an abdominal or pelvic mass, chronic or acute abdominal pain, in relation to infarction from the torsion of splenic pedicle. Preoperative diagnosis of wandering spleen is easy, thanks to the contribution of non-invasive imaging procedures. We report a case of a wandering spleen complicated by the torsion of splenic pedicle in a young woman who was treated by splenectomy. To cite this journal: J. Afr. Hépatol. Gastroentérol. 5 (2011).
Isolated corrosive gastric stricture is relatively rare. Surgery tailored according to the extent of gastric stricture provides excellent results.
Introduction: Right ventricular dysfunction is a cause of morbidity and mortality after surgical correction of tetralogy of Fallot. The transatrial-transpulmonary approach allows preservation of right ventricular function. Aim: To report the immediate and long-term results of surgical treatment of tetralogy of Fallot using the transatrial-transpulmonary approach. Material and methods: This is a retrospective study including cases of tetralogy of Fallot operated on by the transatrial-transpulmonary approach between April 2009 and October 2010 in our institution. Results: There were 19 patients including 10 girls and 9 boys with a mean age of 7.4 years (extremes: 3 and 19 years). All our patients benefited from closure of the ventricular septal defect by a right atrial approach and enlargement of the pulmonary pathway. In the immediate postoperative period, the pressure gradient between the pulmonary artery and the right ventricle was 18.77 mm Hg. We had 2 deaths (10.5%). Complications were dominated by conduction disorders (100%) such as right bundle branch block and pleuropulmonary complications (41.20%). After a mean follow-up of 11.43 ±0.81 years, no patient died and all were asymptomatic, without significant residual lesion. Conclusions: Complete cure of tetralogy of Fallot by the transatrial-transpulmonary route is associated with low morbidity and mortality in our experience. The long-term results are satisfactory.
The authors relate on the outcomes of traumatic diaphragmatic injuries unknown early. The files of three patients have been reviewed retrospectively. All of them presented early undiagnosed injuries. The first patient had a left diaphragmatic injury consecutive to a stab wound to the left hypochondrium. The diagnosis was made 18 days later. He died 2 days after operation because of septicaemia. The second patient presented a colonic strangulation through a left diaphragmatic rupture consecutive to a stab wound three years before. A resection and anastomosis to the colon was performed. The patient left the hospital with a definitive pachypleuritis. The third patient was admitted for blunt trauma to the chest with dyspnoea. The chest X-ray showed the diaphragmatic rupture. The peri-operative exploration showed an old rupture with fibrosis banks. The lesion had been respected. The outcomes of early missed traumatic diaphragmatic rupture are various. Their treatment is sometime difficult and dangerous.
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