Publications by authors named "Khalid Ait Taleb"

51 Publications

[Epiploic appendagitis: a rare cause of acute abdomen].

Pan Afr Med J 2020 3;36:149. Epub 2020 Jul 3.

Service de Chirurgie Viscérale, CHU Hassan II, Faculté de Médecine, Fès Maroc.

Epiploic appendagitis is a rare cause of acute abdomen. It can mimic other inflammatory processes such as diverticulitis or appendicitis. Diagnosis is based on CT scan. Medical management is the approach of choice in the absence of complications.
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http://dx.doi.org/10.11604/pamj.2020.36.149.21033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436646PMC
December 2020

The Effect of Lymph Nodes' Histologic Response on Survival Outcomes in Moroccan Patients with Rectal Cancer.

Int J Surg Oncol 2020 6;2020:8406045. Epub 2020 Jan 6.

Laboratory of Biomedical and Translational Research. University of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah of Fez, 30070 Fez, Morocco.

Prognosis for patients with locally advanced rectal cancer remains controversial. The purpose of this study was to elucidate possible association between therapeutic effect on lymph nodes (LNs) and patient prognosis. Overall, 149 patients with rectal cancer received preoperative radiotherapy in concomitance with chemotherapy or exclusive radiotherapy before rectal excision. Microscopic examination of formalin-fixed lymph nodes was assessed for therapeutic effect. The establishment of groups combined reaction tissue types of fibrosis, colloid, and necrosis after neoadjuvant treatment was assigned. The average age was 56.38 years, ranged between 22 and 88 years, 53% were female, and 47% were men, with a sex ratio of 1 : 12. In the present study, we noticed that after a median follow-up time of 40.67 months (0-83; SD: 21.1), overall survival was statistically significant depending on age groups. Kaplan-Meier analysis showed significant differences in the rate of patients with an age under 65 years (70.64%) versus those with an age over 85 years (36.5%) ( < 0.001). Also, the OS was statistically significant depending on therapeutic effect groups composed of 0TE (No Therapeutic effect), C+ (presence of only colloidal effect), F+ (presence of only fibrosis tissue), and ME+ (mixture of 2 or 3 types of therapeutic effect) group. Indeed, we observed a significantly higher OS rate in the ME + group (86%) compared with the OS rate of LNs group with no therapeutic effect (57%) (=0.028). Additionally, there was a significant association between the presence of fibrosis on LNs and an extended delay of more than 8 weeks to neoadjuvant treatment completion and surgery. Our study indicates that the best patient prognosis could be predicted based on tumor presenting a best pathologic effect on lymph nodes, and that delaying surgery for more than 8 weeks to neoadjuvant treatment completion improves therapeutic response on LNs.
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http://dx.doi.org/10.1155/2020/8406045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183526PMC
December 2020

Analysis of Molecular Pretreated Tumor Profiles as Predictive Biomarkers of Therapeutic Response and Survival Outcomes after Neoadjuvant Therapy for Rectal Cancer in Moroccan Population.

Dis Markers 2020 11;2020:8459303. Epub 2020 Jan 11.

Laboratory of Biomedical and Translational Research, University of Medicine and Pharmacy of Fez, Morocco.

Pathologic features depending on tumor response to preoperative chemoradiotherapy are important to determine the outcomes in patients with rectal cancer. Evaluating the potential predictive roles of biomarker expression and their prognostic impact is a promising challenge. We reported here the immunohistochemical staining of a panel marker of mismatch repair protein (MMR), Ki67, HER-2, and p53. Additionally, identification of somatic mutations of KRAS, NRAS, and BRAF genes were performed by direct sequencing and pyrosequencing in pretreated biopsy tissues from 57 patients diagnosed for rectal cancer. Clinical features and pathological criteria for postneoadjuvant treatment surgical resection specimen's data were collected. Immunohistochemical expression and mutational status were correlated with therapeutic response, overall survival, and disease progression. The mean age of patients was 56 years. Seven (12.3%) out of 57 patients had a complete therapeutic response. Our analysis showed that when using complete therapeutic response (Dworak 4) and incomplete therapeutic response (Dworak 3, 2, and 1) as grouping factor, high p53 expression at the pretreatment biopsy was significantly associated to an incomplete response ( = 0.002). For 20 and 2 out of 57, KRAS and NRAS mutations were detected, respectively. The majority of these mutations affected codon 12. KRAS mutations detected at codon 146 (A146T, A146V) was associated with the appearance of recurrence and distant metastasis ( = 0.019). A high expression of HER-2 corresponding to score 3+ was observed in 3 pretreatment biopsy specimens. This class was significantly associated with a short relapse-free survival ( = 0.002). Furthermore, the high expression of Ki67 was moderately correlated with an older age ( = 0.016, = 0.319). In addition, this shows that high p53 expression in the pretreatment biopsy was associated with an incomplete response in surgical resection specimens after neoadjuvant treatment, and a HER-2 score 3+ can be a predictive factor of distant metastasis and local recurrence. Larger, prospective, and more studies are needed.
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http://dx.doi.org/10.1155/2020/8459303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977322PMC
September 2020

Implication of Microsatellite Instability Pathway in Outcome of Colon Cancer in Moroccan Population.

Dis Markers 2019 7;2019:3210710. Epub 2019 Dec 7.

Department of Pathological Anatomy, Hassan II University Hospital, Fez, Morocco.

Background: Tumors with microsatellite instability (MSI tumors) have distinct clinicopathological features. However, the relation between these tumor subtypes and survival in colon cancer remains controversial. The aim of this study was to evaluate the overall survival (OS) in patients with MSI phenotype, in FES population.

Methods: The expression of MMR proteins was evaluated by immunohistochemistry for 330 patients. , , and mutations were examined by Sanger sequencing and pyrosequencing methods. The association of MSI status with a patient's survival was assessed by the Kaplan-Meier method and log-rank test.

Results: The mean age was 54.6 years (range of 19-90 years). The MSI status was found in 11.2% of our population. MSI tumors were significantly associated with male gender, younger patients, stage I-II, right localization, and a lower rate of lymph node and distant metastasis. The OS tends to be longer in MSI tumors than MSS tumors (109.71 versus 74.08), with a difference close to significance ( = 0.05).

Conclusion: Our study demonstrates that MSI tumors have a particular clinicopathological features. The results of survival analysis indicate that the MSI status was not predictive of improved overall survival in our context with a lower statistical significance ( = 0.05) after multivariate analysis.
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http://dx.doi.org/10.1155/2019/3210710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925747PMC
May 2020

[Voluminous colorectal foreign bodies inserted voluntarily: about a case].

Pan Afr Med J 2019 13;34:142. Epub 2019 Nov 13.

Service de Chirurgie Viscérale, CHU Hassan II, Fes, Maroc.

Insertion of foreign bodies is a curiosity and a taboo in our country. It is characterized by the severity of possible complications and the different therapeutic opportunities. We report the case of a patient with rectal incarceration of a vouminous object introduced voluntarily. He underwent manual extraction. Extraction, when possible, allow to avoid surgery that is necessary in the case of failure or complications.
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http://dx.doi.org/10.11604/pamj.2019.34.142.20793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906543PMC
March 2021

[Acute intestinal intussusception revealing intestinal T-cell lymphoma in adults].

Pan Afr Med J 2019 1;33:153. Epub 2019 Jul 1.

Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.

Acute intestinal intussusception occurs primarily in infants and young children. It uncommonly occurs in adults. It can have various causes. In the vast majority of cases, it is secondary to a benign or malignant tumor. Intestinal T-cell lymphoma revealed by intestinal intussusception is very rare. We report the case of a 43-year old patient admitted with intestinal occlusion to the Emergency Department at the University Hospital Hassan II, Fes, Morocco. Abdominal CT scan showed acute intestinal intussusception associated with incarcerated bowel loop with bowel wall thickening. Treatment was based on open carcinological resection. Anatomopathological and immunohistochemical examination of the surgical specimen showed large T-cell anaplastic lymphoma. After surgery, chemotherapy was indicated to improve prognosis and to avoid a potential relapse. Intestinal intussusception rarely occurs in adults. It most often leads to the detection of an organic cause such as a tumor. This study and literature review aim to highlight the clinical and diagnostic features as well as the therapeutic approaches for this rare disease.
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http://dx.doi.org/10.11604/pamj.2019.33.153.18758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754853PMC
October 2019

[Internal hernia through the falciform ligament: a rare cause of intestinal obstruction].

Pan Afr Med J 2019 28;32:48. Epub 2019 Jan 28.

Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.

Internal hernias are a rare cause of acute intestinal obstruction. Hernias through the falciform ligament is uncommon. Diagnosis is often made intraoperatively. Abdominal CT scan, performed in an emergency situation, can enable preoperative diagnosis and guide the therapeutic approach. In this respect, we here report a case whose data were collected in the Department of Visceral Surgery at the University Hospital Hassan II in Fez. The study involved a 48-year old patient, with no particular previous history, admitted to the Emergency Department with occlusion evolving over 4 days. Abdominal x-ray without treatment objectified multiple hydroaeric levels in small bowel some of which projected towards the hepatic region as well as the presence of a flat intestinal loop in continuity with distended intestinal segment. Abdominal CT scan was not performed due to altered renal function. The patient then underwent emergency surgery after stabilization of his condition and the diagnosis of internal hernias through the falciform ligament was made intraoperatively. In adults, internal hernia through the falciform ligament is a rare cause of acute intestinal obstruction in our daily practice. The diagnosis is most often made intraoperatively. It is necessary to suspect it in young patients with no history of abdominal surgery or intraperitoneal infectious process and with hydroaeric levels in the right upper quadrant.
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http://dx.doi.org/10.11604/pamj.2019.32.48.17845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522209PMC
June 2019

Transverse colon volvulus presenting as bowel obstruction: a case report.

J Med Case Rep 2019 May 25;13(1):156. Epub 2019 May 25.

Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.

Background: Transverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco.

Case Presentation: We report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a "U-shaped" loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function. He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis. Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies.

Conclusion: This case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial. It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. Prompt recognition with emergency intervention constitutes the key to a successful outcome.
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http://dx.doi.org/10.1186/s13256-019-2080-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534884PMC
May 2019

Applicability and outcome of laparoscopic adrenalectomy for large tumours.

Pan Afr Med J 2018 11;31:23. Epub 2018 Sep 11.

Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco.

Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy. In our department, from 2011 to 2016, a total of 28 patients with 31 adrenal tumours underwent laparoscopic adrenalectomy regardless of tumour size. Our policy in the department is to exclude adrenal tumours that are potentially malignant or metastatic adrenal tumours for laparoscopic resection. In this a retrospective study, we divided patients into two groups according to tumour size: < 5 or ≥ 5 cm, which was considered as the definition of large adrenal tumours. We compared demographic data and per- and postoperative outcomes. There was no statistical difference between the two groups for per-operative complications (16,6% vs 18,75% , P = 0.71), postoperative complications (16,6% vs 18,75% , P = 0.71), postoperative length of hospital stay (5 vs 8 days P = 0.40), mortality (0% vs 0%) or oncologic outcomes: recurrence and metastasis (8.3% vs 6.25% P = 0.70). The only statistical difference was the operating time, at a mean (SD) 194 (60) vs 237 (71) min (P = 0.039) and the conversion rate (0% vs 12.5% P < 0.01). Laparoscopic adrenalectomy can be done for all patients with adrenal tumours regardless of tumour size, even it needs more time for large tumour but appears to be safe and feasible when performed by experienced surgeons.
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http://dx.doi.org/10.11604/pamj.2018.31.23.15153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430842PMC
April 2019

[Gastroduodenal trichobezoar: about a case].

Pan Afr Med J 2018 15;30:25. Epub 2018 May 15.

Université Sidi Mohamed Ben Abdellah, Service de Chirurgie Viscérale A (C3), CHU Hassan II Fes, Maroc.

Gastroduodenal trichobezoar ulcer is rare. Its diagnosis is easy in the presence of an evocative context. We report the case of a 21-year old patient followed up for schizophrenia, admitted with acute abdominal pain, vomiting and epigastric mass. Abdominal CT scan suggested the diagnosis of bezoar on the basis of heterogeneous, non-enhanced lesions occupying the entire stomach and appearing to be separated from the gastric wall. Surgical removal of trichobezoar by gastrotomy was performed without complications. The patient was referred to the Department of Psychiatry.
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http://dx.doi.org/10.11604/pamj.2018.30.25.12239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110540PMC
September 2018

[Volvulus of the cecum: a rare cause of intestinal occlusion: about two cases].

Pan Afr Med J 2017 19;28:162. Epub 2017 Oct 19.

Service de Chirurgie Viscérale A(C3), CHU Hassan II, Fès, Maroc.

The cecum is the second part of the colon that is most commonly affected by the volvulus after sigmoid colon and before left corner and the transverse colon. This condition occurs in patients with abnormally mobile cecum. Volvulus is characterized by torsion or tilt. Clinically, it appears as bowel obstruction due to acute strangulation. Abdominal x-ray without treatment and abdominal CT scan are the radiological procedures of choice in the diagnosis of volvulus of the cecum. Treatment is based on emergency surgical excision of the cecum and of the terminal ileum. We report two cases of patients with volvulus of the cecum admitted to the emergency department with acute intestinal obstruction. In both patients, the diagnosis was confirmed by abdomino-pelvic CT scan and the treatment was based on ileocolic resection with immediate restoration of the intestinal continuity. The postoperative course was uneventful.
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http://dx.doi.org/10.11604/pamj.2017.28.162.12237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847055PMC
March 2018

[High grade insulinoma detected in a patient with a 5-year history of severe hypoglycemias].

Pan Afr Med J 2017 4;27:250. Epub 2017 Aug 4.

Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.

Functional endocrine tumors of the pancreas are rare. Among them insulinomas are the most common types. The majority of the patients with insulinoma are between 30 and 60 years of age and 59% of them are women. Most insulinomas are sporadic tumors while 10% of them develop in patients with multiple endocrine neoplasia (MEN). Diagnosis is based on clinical examination and laboratory tests. Preoperative imaging assessment (echo-endoscopy, CT, MRI) is essential for tumor localization in more than 80% of cases. Surgical excision is the treatment of choice. We here report the case of a 50-year old patient with high grade insulinoma developed on the anterior surface of the pancreas tail.
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http://dx.doi.org/10.11604/pamj.2017.27.250.13144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622836PMC
October 2017

[Colonic gallstone ileus: a rare cause of colonic obstruction].

Pan Afr Med J 2017 11;27:187. Epub 2017 Jul 11.

Service de Chirurgie Viscérale A (C3), CHU Hassan II Fès, Maroc.

Bile ileus with migration of the gallstone into the colon through cholecystocolonic fistula is rare. The diagnosis is difficult and often late. We here report the case of a 89-year old patient with a history of sigmoid diverticular disease presenting with colonic obstruction associated with bile ileus caused by migration of a large gallstone through cholecystocolonic fistula. Abdominal CT scan allowed the diagnosis. The patient underwent surgical extraction of the gallstone with sigmoidotomy followed by sigmoidostomy with subsequent recovery of the digestive continuity. The cholecystocolonic fistula wasn't identified.
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http://dx.doi.org/10.11604/pamj.2017.27.187.12238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579432PMC
September 2017

Epigenetics could explain some Moroccan population colorectal cancers peculiarities: microsatellite instability pathway exploration.

Diagn Pathol 2015 Jun 24;10:77. Epub 2015 Jun 24.

Department of pathology, University hospital Hassan II of Fez, Fez, Morocco.

Background: Colorectal Cancers (CRC) are one of the most common malignancies in the world. Their incidence in Morocco, between 2005 and 2007, was 5.6 for 100000 inhabitants, which is very low compared to what found in developed countries. In addition, CRCs show a high frequency of rectal localizations, and occurs in a younger population in Morocco compared to what found in developed countries. The purpose of this study is to confirm these CRC peculiarities in Morocco and try to explain them by exploring the microsatellite instability molecular pathway.

Methods: This is a prospective observational study conducted since January 2010, including 385 patients admitted in Hassan II University Hospital of Fez. We collected clinical, radiological and pathological data. We investigated the expression of mismatch repair (MMR) proteins in 214 patients and BRAF gene mutations in 159 patients.

Results: Mean age was 55.08 +/- 15.16 years. 36.5% of patients were less than 50 years old and 49.3% of tumors were localized in the rectum. Loss of MMR protein expression was observed in 11.2% of cases. It was independently associated with individual or family history of cancer belonging to Hereditary Non-Polyposis Colorectal Cancer (HNPCC) spectrum (p = 0.01) and proximal localization (p = 0.02). No BRAF mutation was detected in all cases.

Conclusions: These results confirm the high occurrence of CRCs to young patients and the high frequency of rectal localizations in Moroccan population. They mostly show an absence of BRAF mutation, supposing a rarity of MLH1 promoter hypermethylation pathway, which may even partially explain the CRC peculiarities in our context.

Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5868184711716884.
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http://dx.doi.org/10.1186/s13000-015-0326-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477595PMC
June 2015

[Large intra-rectal foreign body : a case report].

Pan Afr Med J 2014 4;18:273. Epub 2014 Aug 4.

Service de Chirurgie Viscérale, CHU Hassan II - Fès, Université Sidi Mohamed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2014.18.273.4226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258213PMC
July 2015

[Extrathoracic solitary shwannoma of the intercostal nerve: a rare localization].

Pan Afr Med J 2014 24;18:178. Epub 2014 Jun 24.

Service de chirurgie digestive C3, CHU Hassan II de Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2014.18.178.315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236917PMC
July 2015

[Small bowel volvulus on peritoneal hydatid disease: a rare cause of obstruction].

Pan Afr Med J 2014 24;18:79. Epub 2014 May 24.

Service de Chirurgie Viscérale, CHU Hassan II - Fès, Université Sidi Mohamed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2014.18.79.4205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231250PMC
July 2015

Pedunculated lipoma causing colo-colonic intussusception: a rare case report.

BMC Surg 2013 Oct 30;13:51. Epub 2013 Oct 30.

Surgery Departement, University Hospital Hassan II, BP 1893; Km 2,200, Sidi Harazem Road, Fez 30000, Morocco.

Background: Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy.

Case Presentation: A 55-year old man visited our emergency department with severe abdominal pain, multiple episodes of vomiting, abdominal distension. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign, suggestive of intussusception. Surgery revealed a hard elongated mass in the right colon wihch telescoped in the transverse colon and caused colo-colonic intussusception. Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.

Conclusion: A large submucosal lipoma is a very rare cause of colon intussusception that presents as intestinal obstruction in patients without malignancy. CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall. Surgical resection remains the treatment of choice and produces an excellent prognosis.
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http://dx.doi.org/10.1186/1471-2482-13-51DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818566PMC
October 2013

Benign cystic mesothelioma of the peritoneum: a case report and literature review.

World J Emerg Surg 2013 Oct 13;8(1):43. Epub 2013 Oct 13.

Department of Surgery, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdallah University, University hospital HASSAN II, BP: 1893, Km2,200, Route de Sidi Hrazem FEZ 30000, Morocco.

Benign cystic mesothelioma of the peritoneum (BCM) is an uncommon lesion with some 130 cases reported since the first case described by Smith and Mennenmeyer in 1979. It is a rare intra abdominal tumor occurring predominantly in women of reproductive age. Due to the rarity of this tumor, similarity of patient presentation, and comparable features on imaging, the diagnosis of this pathology is difficult, and is based on histological findings. This tumor is known for local recurrence. It's agreed that surgery is the only effective treatment, but there are no evidence-based treatment strategies for BCM.
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http://dx.doi.org/10.1186/1749-7922-8-43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853709PMC
October 2013

Traumatic appendicitis: a case report and literature review.

World J Emerg Surg 2013 Aug 9;8(1):31. Epub 2013 Aug 9.

School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893; km2,200, route de sidi Hrazem, Fez 30000, Morocco.

Appendicitis and trauma may exist together, which causes an interesting debate whether trauma has led to appendicitis. We report a case of appendicitis after an abdominal trauma. Our patient developed acute appendicitis following a stab wound in the right iliac fossa. Surgical exploration confirmed the traumatic origin of appendicitis, appendectomy was performed and our patient made an excellent recovery. In non operative management of abdominal trauma, physical examinations and radiological explorations should be repeated in order to diagnose traumatic appendicitis.
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http://dx.doi.org/10.1186/1749-7922-8-31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750490PMC
August 2013

Acute intraperitoneal rupture of hydatid cysts: a surgical experience with 14 cases.

World J Emerg Surg 2013 26;8:28. Epub 2013 Jul 26.

Surgery Department, Hassan II Hospital, University Sidi Mohamed Ben Abdellah, BP 1893; Km 2.200, Sidi Harazem Road, Fez 30000, Morocco.

Introduction: Hydatidosis is endemic in the Mediterranean region including morrocco, the Middle and Far East, Australia, New Zealand, and South America-all areas where animal husbandry is common. Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention.

Methods: Fourteen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 5 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively.

Results: Eight of the patients were men and six were women. All of the patients had signs of peritoneal irritation. One patient (7,14%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases, intraperitoneal multiple cysts in 11 cases and heterogeneous cavity or cystic structures in the liver in 12 cases. Computed tomography showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. The ruptured cysts were located in the right lobe of the liver in seven patients, in the left lobe in six patients and in both lobes in one patients. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Partial pericystectomy and drainage was the most frequent surgical procedure. No patients died in the early postoperative period. A total of seven morbidities developed in six patients (35.3%). Median hospital stay was 08 days and median follow-up was 12 months. Intra-abdominal recurrence occurred in one case (7.7%).

Conclusions: Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. The operative procedures, either radical or conservative, should be based on the patient's condition, the regional characteristics, and the surgeon's experience. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.
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http://dx.doi.org/10.1186/1749-7922-8-28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725171PMC
May 2014

A large gastrointestinal stromal tumor of the duodenum treated by partial duodenectomy with Roux-en-Y duodenojejunostomy: a case report.

J Med Case Rep 2013 Jul 15;7:184. Epub 2013 Jul 15.

Surgery Department, University Hospital Hassan II, Fez, Morocco.

Introduction: Duodenal gastrointestinal stromal tumors are uncommon and a relatively small subset of gastrointestinal stromal tumors whose optimal surgical procedure has not been well defined. Because submucosal spread and local lymph node involvement are infrequent in gastrointestinal stromal tumors, wide margins with routine lymph node dissection may not be required. Various surgical procedures for duodenal gastrointestinal stromal tumor, pancreatoduodenectomy, pancreas-sparing duodenectomy, segmental duodenectomy, or local resection, have been described depending on the size and exact site of the lesion.

Case Presentation: We present the case of a 65-year-old African woman with a giant gastrointestinal stromal tumor involving the second and third portion of the duodenum successfully treated by partial duodenectomy with duodenojejunostomy. This surgical technique is ideal when a gastrointestinal stromal tumor does not involve the ampulla because it avoids a pancreatoduodenectomy, and has not been previously described for the management of this malignancy. Duodenal gastrointestinal stromal tumor should be suspected in any patient with a duodenal wall mass.

Conclusions: Gastrointestinal stromal tumors of the duodenum should be suspected in any patient with a duodenal wall mass. Extramural growth and central ulceration with or without bleeding should alert the endoscopist to the possibility of a duodenal gastrointestinal stromal tumor diagnosis.
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http://dx.doi.org/10.1186/1752-1947-7-184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726472PMC
July 2013

Fournier's gangrene: our experience with 50 patients and analysis of factors affecting mortality.

World J Emerg Surg 2013 Apr 1;8(1):13. Epub 2013 Apr 1.

Department of surgery, University hospital Hassan II, Fez, Morocco.

Introduction: Fournier's gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier's gangrene and to identify risk factors that affect mortality.

Methods: The medical records of 50 patients with Fournier's gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality.

Results: Ten males and five females were enrolled in the study. The mean age was 54 years (range 23-81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality.

Conclusions: Fournier's gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices.
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http://dx.doi.org/10.1186/1749-7922-8-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616831PMC
April 2013

Squamous cell carcinoma associated anal fistulas in Crohn's disease unique case report with literature review.

J Crohns Colitis 2013 Jul 12;7(6):e232-5. Epub 2012 Oct 12.

Department of surgery, University hospital Hassan II. Fez., Morocco.

Squamous cell carcinoma arising from perineal fistula in patients with Crohn's disease (CD) is a rare entity, with few reported cases in the literature making its clinical characterization troublesome. The outcome is poor following operative treatment as the malignancy of chronic perineal fistula in Crohn's disease is usually overlooked and tardily diagnosed. We present a unique case of a 47-year-old man with a 20-year history of chronic perineal fistula that was diagnosed with extensive perineal squamous cell carcinoma extending down to the right thigh. Computer tomography showed locally advanced disease with inguinal and lung metastasis. Treatment was consisted of diverting colostomy and palliative care. The patient died 3 months later. The clinical data and clinicopathological features of reported cases in the literature were reviewed.
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http://dx.doi.org/10.1016/j.crohns.2012.09.015DOI Listing
July 2013

Adult intussusceptions caused by a lipoma in the jejunum: report of a case and review of the literature.

World J Emerg Surg 2012 Aug 22;7(1):28. Epub 2012 Aug 22.

Surgery Department, University Hospital Hassan II, Fez 30000, Morocco.

Intussusceptions in adults is rare. Gastrointestinal lipomas are rare benign tumors and intussusceptions 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. The present report describes a case of jejunojejunal intussusceptions in an adult with a history of colicky upper abdominal pain. Ileo-ileal invagination was diagnosed by computed tomography scan. Exploratory laparotomy revealed jejunojejunal intussusceptions secondary to a lipoma which was successfully treated with segmental intestinal resection. A review of the literature is also performed regarding this rare association revealing the diagnostic and therapeutic debates that exist. ABSTRACT (FRENCH): L'invagination chez les adultes est rare. Les lipomes gastro-intestinaux sont de rares tumeurs bénignes et l'invagination intestinale due à un lipome gastro-intestinal constitue une entité clinique trés rare. Le lipome peut se développer comme une tumeur bénigne dans tous les organes et rarement dans l'intestin grêle ou le colon. Le présent rapport décrit un cas d'invagination jéjunojéjunale chez un adulte avec une histoire de douleurs abdominales. Iléo-iléale invagination a été diagnostiquée par tomodensitométrie. Une laparotomie exploratrice a révélé l'existence d'une invagination jéjunojéjunale secondaire à un lipome qui a été traitée avec succès par une résection intestinale segmentaire. Une revue de la littérature est également effectuée au sujet de cette association rare révélant les débats diagnostiques et thérapeutiques qui existent.
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http://dx.doi.org/10.1186/1749-7922-7-28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502287PMC
August 2012
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