Publications by authors named "Youssef Chaker"

15 Publications

  • Page 1 of 1

Primary duodenal tuberculosis complicated with perforation: A review of literature and case report.

Ann Med Surg (Lond) 2021 Jun 12;66:102392. Epub 2021 May 12.

Department of Digestive Surgery 'A', La Rabta Hospital University, Faculty of Medicine of Tunis, Tunisia.

Tuberculous (TB) disease remains an endemic pathology in Tunisia. the ileocecal region is the predominant site of involvement while gastroduodenal tuberculosis is very rare, this form is often presenting as one of the complications, mainly upper gastrointestinal stenosis or exceptionally as a perforation. We describe a case of female patient aged 33 years-old presented with a 2-day history of acute abdominal pain, with a tenderness of the right hypochondrium and the epigastrium, ultrasound of the abdomen revealed gallbladder distension with a wall thickening. The diagnosis of acute cholecystitis was suspected and the patient had an exploratory laparoscopy that revealed the presence of a perforated duodenal ulcer which was blocked by the gallbladder and several peri-duodenal lymph nodes. Cholecystectomy was performed and the edges of the ulcer were resected and the ulcer was sutured. Histological examination revealed duodenal tuberculosis and the patient was referred to the TB eradication program.
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http://dx.doi.org/10.1016/j.amsu.2021.102392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141517PMC
June 2021

A rare association of caecal volvulus and intestinal malrotation causing an acute abdomen: Case report.

Ann Med Surg (Lond) 2021 May 30;65:102357. Epub 2021 Apr 30.

Department of Surgery A La Rabta, Tunis, Tunisia.

Introduction: and importance: Caecal volvulus represents 30% of colonic volvulus. It happens due to torsion or hyperflexion of a hypermobile caecum. Usually it is secondary to an axial rotation of the caecum and the ileum around the mesentery. On the other hand Intestinal malrotation occurs due to incomplete or faulty rotation and fixation of the gut during fetal life. The occurrence of these two anomalies together is scarse which makes this case report interesting.

Case Presentation: A 75 year old man with medical history of terminal kidney failure, presented to the emergency room with an intestinal obstruction syndrome. On examination the patient had a distended abdomen with tenderness in the left upper quadrant. Biology found an important biological inflammatory syndrome with hyperleukocytosis and elevated CRP. Plain X-ray of the abdomen in erect posture showed an air fluid colonic level in the left hypochondrium. CT scan showed signs of caecal volvulus with intestinal malrotation. A brief reanimation and nasogastric aspiration couldn't solve the problem therefore emergency laparotomy was needed ileocaecal resection was performed associated with LADD's procedure in order to treat both anomalies and prevent further gut volvulus.

Clinical Discussion: Despite it's rareness, caecul volvulus represents the second cause of large bowel volvulus just behind sigmoid volvulus. Intestinal malrotation in adults subjects is estimated to occur in 0.2-0.5%.The uniqueness of our case is that these two anomalies were associated in such a way that it made both the diagnosis and the therapy even more difficult. Abdominal CT has become mandatory for pre-operative diagnosis of intestinal volvulus. Surgery is the gold standard treatment for caecal volvulus. The usual options are manual detorsion, carcopexy, caecostomy and colectomy.

Conclusion: This case reports a rare association of a caecum volvulus with intestinal malrotation that emphasis the place of modern technologies such as CT scan in order to achieve correct preoperative diagnosis. We also describe our approach to this uncommon surgical emergency in order to provide an efficient treatement.
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http://dx.doi.org/10.1016/j.amsu.2021.102357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121876PMC
May 2021

Endoscopic removal of a migrating intrauterine device perforating the sigmoid.

ANZ J Surg 2021 Mar 23. Epub 2021 Mar 23.

Department of Surgery "A", La Rabta Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1111/ans.16781DOI Listing
March 2021

Pancreatic Metastasis of Renal Cell Carcinoma: A Surgical Indication for a Disseminated Disease.

Case Rep Med 2021 6;2021:5579385. Epub 2021 Mar 6.

General Surgery Department, La Rabta Hospital, 1002 Bab Saadoun, Tunis, Tunisia.

Pancreatic metastasis (PM) of renal cancer is a rare condition. It is characterized by a long period after initial nephrectomy and a favorable prognosis compared to other pancreatic malignancies. Its diagnosis may confuse clinicians if the medical history is not known. In the era of targeted therapies for metastatic renal carcinoma, surgery stands as the best treatment option for PM of renal cancer. We report the case of a woman who underwent successfully left splenopancreatectomy for corporeal PM of renal cancer treated seven years ago. This case underlines the necessity of long-term follow-up of patients treated for kidney cancer.
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http://dx.doi.org/10.1155/2021/5579385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960060PMC
March 2021

Presentation with perforation of the terminal ileum and acute limb ischemia in Crohn's disease: A case report.

Int J Surg Case Rep 2021 Mar 9;80:105626. Epub 2021 Feb 9.

Department of Surgery A, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.

Introduction And Importance: Crohn's disease is a chronic inflammatory bowel disease with complex pathophysiology and multiple complications, some of which can be fatal. We report herein the management of an unusual case of Crohn's disease revealed by two life-threatening complications.

Case Presentation: A 59-year-old patient presented with an acute abdominal pain evolving for one day with a clinical presentation in favor of peritonitis by perforation of the last ileal loop and acute limb ischemia. At emergency laparotomy, we found a fecal peritonitis by perforation of the last ileal loop. The patient underwent an ileo-caecal resection with rifle barrel ileo-colostomy associated with embolectomy using a Fogarty catheter of the femoral artery. Pathological examination of the specimen showed an aspect consistent with an ileo-caecal Crohn's disease and blood clot embolus of the femoral artery. Postoperative course was uneventful and the patient was kept in remission with immunosuppressants.

Discussion: Several complications may arise during the evolution of the disease. However, Life-threatening complication scarcely inaugurate crohn's disease like in our patient. Free perforation of the small intestine in crohn's disease occurs rarely, which makes its statistical study difficult. Risk factors for perforation are still poorly identified. Patients diagnosed with crohn's disease have a higher risk of thromboembolic complications. Indeed, there is an association between the activity of the disease and thromboembolic events. In our case, the severity of the clinical presentation as well as its inaugural character are unique.

Conclusion: The management of inaugural two uncommon acute conditions in Crohn's disease is challenging.
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http://dx.doi.org/10.1016/j.ijscr.2021.02.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898057PMC
March 2021

Management of a primary retroperitoneal hydatid cyst ruptured in the abdominal wall: A case report.

Int J Surg Case Rep 2020 28;76:69-72. Epub 2020 Sep 28.

Department of General Surgery A, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia. Electronic address:

Introduction: Hydatid disease is a global zoonosis. Any organ of the human body can be involved. Single or multiple locations are reported. However, retroperitoneal hydatid cysts are uncommon. Furthermore, parietal complications are rarely reported in literature. Therefore, the management of hydatid cysts ruptured in the abdominal wall remains challenging.

Presentation Of Case: In this case report, we aim to describe our experience in treating a primary retroperitoneal hydatid cyst with rupture into abdominal wall in an 87-year-old woman who presented with a 15-centimeter mass of the right flank. Hydatid serology test was positive. An abdominal CT scan showed a 20-centimeter cystic mass of retroperitoneum extended to the abdominal wall with several septa within and enhanced thick wall. The patient underwent a surgical elective drainage with perioperative antiparasitic chemotherapy. Follow-up showed no recurrence.

Discussion: Primary retroperitoneal hydatid cyst with parietal complications is scarce and barely described in literature. We performed a review of the recent relevant literature that deals with this subject. None of the hydatid cysts reported in 55 cases was located in retroperitoneum. The top seven countries of origin are located in Mediterranean region except for India. Imaging is compulsory for the diagnosis along with patient's history, physical examination and hydatid serology. The treatment is surgical and must be must be covered by antiparasitic chemotherapy.

Conclusion: Primary retroperitoneal hydatid cyst extended to the abdominal wall remains a rare and challenging diagnosis that must be considered in endemic countries.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530222PMC
September 2020

Surgical Management of Bleeding Duodenal Stromal Tumours with Shock.

J Gastrointest Cancer 2020 Mar;51(1):347-350

Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007, Tunis, Tunisia.

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http://dx.doi.org/10.1007/s12029-019-00288-9DOI Listing
March 2020

Laparoscopic cholecystectomy decreases extra surgical site morbidity compared with open cholecystectomy: A propensity matched analysis.

Tunis Med 2015 Aug-Sep;93(8-9):500-6

Background: The ideal way to show treatment effectiveness is through randomized controlled trials the 'gold standard' in evidence-based surgery. Indeed, not all surgical studies can be designed as randomized trials, sometimes for ethical and otherwise, for practical reasons. This article aimed to compare laparoscopic cholecystectomy to open cholecystectomy, according to data from an administrative database, managed by a propensity matched analysis.

Methods: Were included all patients with cholelithiasis admitted in Department B between June 1st, 2008 and December 31st, 2009. In this study, the propensity score represented the probability that a patient would be treated by a procedure based on variables that were known or suspected to influence group assignment and was developed using multivariable logistic regression used here to match patients who had laparoscopic cholecystectomy to a control patient who had open cholecystectomy. The main outcome measure was morbidity. This was expressed as the number of patients with 1 or more complications occurring during the hospital stay or within 30 days following discharge.

Results: According to intention to treat, 535 patients had a laparoscopic approach (LC group) and 60 patients had a traditional open approach (OC group) regarding associated cardiac disease, previous laparotomy or when choledocholithiasis was suspected, however intra operative cholangiography showed that there was no choledocolithiasis. According to the propensity score, 28 patients in OC were matched with 58 in LC. Comparison between OC and LC before and after propensity matched analysis showed that OC was associated with a higher rate of Extra Surgical Site morbidity (p= 0.010), a longer median duration of intervention, post-operative stay and overall hospital stay (p= 0. 0001).

Conclusion: LC should be considered as first-line therapy to treat cholelithiasis surgically even if it becomes necessary to convert to OC because of intra operative findings.
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March 2016

[Stromal gastrointestinal tumors: retrospective study of 24 cases].

Tunis Med 2013 Nov;91(11):661-7

Background: Gastrointestinal stromal tumors (GIST) are the most common digestive sarcomas. They develop in most cases in the stomach and small intestine, more rarely rectum, colon, esophagus or mesentery. These tumors typically express the phenotype CD117/KIT + and CD34 +.

Aim: To evaluate epidemiologic, clinical, pathologic, therapeutic, characteristics and evaluative pattern of gastrointestinal tumor treated in our surgical department.

Patients And Methods: We collected 24 cases of GIST (confirmed by the positivity of CD 117 and/or CD 33) treated between 1997 and 2010 in the department of surgery B of Charles Nicolle's Hospital. We analyzed demographic characteristics, clinic pattern, investigations treatment and therapeutic variables of our patients. We calculated the survival rate and identified prognostic predictive factors of survival.

Results: Our retrospective study interested, during 13 years, 24 patients presenting GIST with a median age of 66 years and a sex ratio of 0.8. The median time for diagnosis was two months (3 days to 24 months). Abdominal pain, gastrointestinal bleeding and vomiting were the most common symptoms. The endoscopic appearance was tumor arising from muscular layer found in the stomach (13/24 cases; 54%), small bowel in four cases (16.5%) and duodenal or rectum three patients (12,5 %). Twenty three within 24 patients underwent surgical resection with R0 in 20/23 cases. Three patients were treated with neoadjuvant imatinib for an average of 12 months, one patient had adjuvant treatment and four patients in locoregional evolutive tumor and / or metastatic. The overall survival was 70% at one year and 65% at two years with a pejorative impact, in univariate analysis of abdominal pain, asthenia, anorexia, weight loss, cytonuclear atypia, tumor size ≥ 10 cm and a mitotic index ≥ 5/50. Multivariate analysis showed that tumor size (Hazard Ratio = 6 if size ≥ 10 cm 95% CI [1,539-24,017]) and weight loss (Hazard Ratio = 7 95% CI [1,664-29,100]) were influential factors on overall survival and recurrence-free survival.

Conclusion: The prognostic predictive factors identified were the size of tumor ≥ 10cm and the mitotic index.
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November 2013

[Spinal anesthesia versus general anesthesia for inguinal hernia repair: propensity score analysis].

Tunis Med 2012 Oct;90(10):686-91

Hopital Charles Nicolle, Tunis, Tunisie.

Background: Administrative database, used previously for control of cost, patient flow and invoicing, offer to researchers a large sample of patients representative of population providing interesting information's in the field of descriptive and analytic epidemiology with less cost.

Aim: To compare spinal to general anesthesia for inguinal hernia repair concerning a population extracted from administrative database after propensity matched analysis.

Methods: Prospective study concerning 4690 hospitalizations in Department B of General Surgery of Charles Nicolle hospital during a period of 18 months, between June 1st, 2008 and December 31st, 2009. A descriptive analysis followed by a comparison between spinal and general anesthesia according propensity matched analysis were performed. Résultats: 595 inguinal hernias were operated on. Mean age was 55±15.We mentioned a male predominance: 326 men (84.2%) and 61 women (15.8%). 137 patients had previous medical diseases(35.4%). 47(12.1%) patients were operated on in emergent situation on the other hand 340(87.9%) had elective surgery.264(68.2%) were ASA I, 110(28.4%) ASA II, 13(3.4%) ASA III. Post operative course were uneventful in 96.1% (372) and complicated in 11 patients (2.9%).Four deaths were observed (1%). Comparison before and after propensity matched analysis showed a statistical difference regarding postoperative stay and all hospital stay in favor of spinal anesthesia (p=0.007).

Conclusion: Postoperative stay is significantly shorter in the group of spinal anesthesia (p=0.007). A randomized clinical trial comparing spinal anesthesia to general anesthesia is needed.
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October 2012

[Assessment of care quality in department of general surgery : usefulness of administrative database].

Tunis Med 2012 Jun;90(6):435-41

Hopital Charles Nicolle, Tunisie.

Background: Administrative database, used previously for control of cost, patient flow and invoicing, offer to researchers a large sample of patients representative of population providing interesting informations in the field of descriptive and analytic epidemiology with less cost.

Aim: To assess the usefulness of administrative database for quality of care and research.

Methods: It was a prospective study concerning 4690 hospitalisations in Department B of General Surgery of hôpital Charles Nicolle during a period of 18 months, between June 1st, 2008 and December 31st, 2009. A descriptive analysis followed by a pronostic study with a univariate and multivariate analysis was performed. RÉSULTATS : Our study showed the usefulness of an administrative database in assessing the quality of care, it allowed us to determine postoperative mortality rate (2.7%), deep morbidity (2.5%), parietal morbidity (1.2%), medical complications (6%), nosocomial infections (3.6%) and re intervention (2.7%), with independent predictive factors of these events. To reduce the incidence of these events we should reduce length of pre-operative stay, prevent intra operative accidents, avoid intra operative bleeding in order to reduce intra operative transfusions and avoid as far as possible the stay in ICU Independent predictors of post trauma death are multiple trauma [OR: 6.14, 95% (from 1.68 to 16.94), p = 0.002], a traumatized patient in distress on arrival [OR: 8.74, 95% (3.59 -27.77), p = 0.000] and overall medical complications [OR: 13.18, 95% (from 4.01 to 31.25), p=0.000]. The ISS is a good discriminative indice to assess the severity and life-threatening risk.

Conclusion: Administrative databases provide information on the efficiency of care, it helps to realise observational studies on large samples representative of the population at low cost. They are very useful in the research, despite the lack of clinical data.
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June 2012

Sister Mary Joseph's nodule showing adenocarcinoma of pancreas.

Tunis Med 2011 Oct;89(10):790-1

Service de Chirurgie B, Hopital CHarles Nicolle, Tunis, Tunisie.

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October 2011