The management of penetrating wounds of the abdomen is still, at present, a subject of controversy. The aim of this study was to analyse the results of the management of penetrating abdominal wounds. This retrospective study was carried out over a period of 5 years, from January 2017 to January 2021. It covered 90 cases of penetrating abdominal wounds collected at the level of the Surgical Emergency Department of the Mohammed VI University Hospital of Marrakech. It involved 88 men and 2 women, with an average age of 27 years. Two groups of patients were identified. A first group of 61 patients (group I) where the diagnosis of penetration was based on the following findings: epiplocele, evisceration, flow of abdominal fluid, and in which laparotomy was systematically performed. Group II included 29 patients, with no signs of severity, who received simple wound trimming under local anaesthesia with plane-by-plane closure and simple monitoring. Age, gender, causative agent and circumstances of injury were comparable in both groups. The overall mortality was 2.2% (2 cases) and concerned only group I patients. The overall morbidity was 13.3% and consisted of: - 6 cases of peritonitis of which 5 cases were in group II, giving a secondary intervention rate of 17.2%; the other cases of morbidity concerned only group I patients with 3 cases of parietal suppuration, 2 cases of delayed transit resumption and 2 cases of evisceration. The rate of unnecessary or blank laparotomies was 25% in Group I. Laparotomy from the outset in the case of any penetrating wound of the abdomen has the advantage of making a precise assessment of the injury, hence its medico-legal interest, especially in the case of an assault. However, "selective abstentionism" has the advantage of avoiding unnecessary laparotomies. In short, there is no dogma in this matter.
Acute intestinal intussusception is a pathology of infants and small children. Its occurrence in adults is very unusual. It is of various etiologies. In the vast majority of cases, it is secondary to a tumour which may be benign or malignant. A benign fibrous tumour of Meckel’s diverticulum revealed by intestinal intussusception is a very rare entity. We report the case of a 42-year-old female patient admitted to the emergency department of the Mohammed VI University Hospital in Marrakech, Morocco, for an intestinal obstruction. Abdominal CT scan showed an acute ileocecal intestinal intussusception, associated with a tumor lesion of 25 cm in diameter. Treatment was open surgical carcinological resection. Pathological and immunohistochemical examination of the surgical specimen concluded that the tumour was benign Meckel’s diverticulum. Intestinal intussusception is a rare condition in adults. It most often leads to the discovery of an organic cause which may be tumour. From this new case and after analysis of the literature, we discuss the clinical and diagnostic characteristics and the therapeutic possibilities of this rare pathology.
Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity. Lipoma may develop as a benign tumor in all organs and rarely in large or small intestine ileal and colic lipoma. We reported two rare cases of bowel intusssception in adults. The invagination was diagnosed by computed tomography scan. Exploratory laparotomy revealed the intussusceptions secondary to a lipoma which was successfully treated with segmental intestinal resection. Since adult intussusception is frequently associated with malignant organic lesions, being aware of the differential diagnosis is important and timely surgical intervention paramount. The anatompatholy is essential for the diagnosis defintive and the search of malignitis signs.
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