Sousse, Tunisia
Sousse, Tunisia

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Bouguila J.,Hospital Farhat Hached | Mabrouk S.,Hospital Sahloul | Tilouche S.,Hospital Farhat Hached | Bakir D.,Hospital Farhat Hached | And 3 more authors.
World Journal of Hepatology | Year: 2013

Giant cell hepatitis (GCH) with autoimmune hemolytic anemia is a rare entity, limited to young children, with an unknown pathogenesis. We report the case of 9-mo old who presented with fever, diarrhea and jaundice four days before hospitalization. Physical examination found pallor, jaundice and hepatosplenomegaly. The laboratory workup showed serum total bilirubin at 101 μ mol/L, conjugated bilirubin at 84 μ mol/L, hemolytic anemia, thrombocytopenia and immunoglobulin G (IgG) and anti-C3d positive direct Coombś test. The antinuclear, anti-smooth muscle and liver kidney microsomes 1 non-organ specific autoantibodies, antiendomisium antibodies were negative. Serological assays for viral hepatitis B and C, cytomegalovirus, herpes simplex and Epstein Barr virus were negative. The association of acute liver failure, Evańs syndrome, positive direct Coomb́s test of mixed type (IgG and C3) and the absence of organ and non-organ specific autoantibodies suggested the diagnosis of GCH. The diagnosis was confirmed by a needle liver biopsy. The patient was treated by corticosteroids, immunomodulatory therapy and azathioprine but died with septicemia. © 2013 Baishideng.

PubMed | Hospital Sahloul, Hospital Ibn Jazzar, Hospital Farhat Hached and CARE Hospital
Type: | Journal: Surgical and radiologic anatomy : SRA | Year: 2016

Cystic plate is easily visible while right anterior portal pedicle (RAPP) is a difficult to identify due to its intrahepatic location. This study aims to determine the relation between these two structures so as to facilitate rapid identification of RAPP during the operation.Thirty-seven cadaveric liver dissections were carried in the Forensic Department at the Charles Nicolle Hospital, Tunisia.The cystic plate was thin (1mm), medium (1-3mm), and thick (3mm) in 14 (37.8%), 17 (46%), and 6 cases (16.2%), respectively. RAPP was found to be originating from right, main, and left portal trunk in 29 (78.3%), 6 (16.3%), and 2 (5.4%) livers, respectively. The origin of RAPP was extrahepatic in nine cases (24.3%). RAPP was located underneath the cystic plate in 21 livers (56.8%). Thirteen RAPPs (35.1%) were located to its right at the mean distance of 1.4cm (range 0.4-2.5). Three RAPPs were present to the left of cystic plate (8.1%) at the mean distance of 0.9cm (range 0.7-1.3).Rapid identification of RAPP is possible by knowing its anatomic variations and its relation with cystic plate.

PubMed | Hospital Sahloul, CARE Hospital and Farhat Hached Hospital
Type: | Journal: International journal of surgery case reports | Year: 2016

Gastrointestinal stromal tumors (GIST) are tumors of mesenchymal origin commonly detected in stomach and small bowel. GIST arising primarily from the anal canal is extremely rare. Due to the malignant potential, these tumors are treated with radical surgery like abdominoperineal resection. But with the advent of imatinib therapy and a better understanding of the tumor biology, some cases have been successfully treated with wide local excision.We describe a case of a 70-year-old lady presenting with a 2cm mass in the anal canal. Endoanal ultrasound revealed a well-circumscribed solid nodule in the intersphincteric space. The patient was successfully treated by wide local excision and adjuvant therapy with imatinib mesylate.Only 14 confirmed cases of primary anal GIST have been reported in the literature. It appears as a well circumscribed hypoechoic mass arising from the intersphincteric space encroaching into the lumen on endorectal ultrasound. Lymphadenopathy is absent. Anal sphincters get involved as the lesion increases in size. Treatment is often planned based on the extent of the disease, the mitotic rate, patients general condition and willingness for a permanent colostomy.Small lesions (<2cm) with low mitotic rate may be successfully managed by local excision. Radical surgery should be reserved for large, aggressive tumors.

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