Physiology and Anatomy

Tuberculosis and HIV co-infection is a major public health problem worldwide. Tuberculosis in HIV-infected patients presents clinical and paraclinical atypicalities making the diagnosis of this pathology difficult.We report in this manuscript the observation of a patient with multifocal tuberculosis revealing HIV infection.

Intestinal phytobezoars are rare causes of small bowel obstruction. Treatment consists of surgical extraction by enterotomy. We report a case of small bowel obstruction on a phytobezoar in a 66-year-old woman treated by enterotomy followed by manual extraction.

Primary retroperitoneal hydatid cysts of the psoas muscle are rare. We report the case of a recurrent hydatid cyst of the psoas muscle in a 57-year-old patient with a left lumbar-iliac mass. Ultrasound and computed tomography contributed to preoperative diagnosis. The mass was completely removed via a retroperitoneal approach. We will discuss in this article the diagnostic and therapeutic aspects of the psoas hydatid cyst.

The advancements in surgical nephrology in the management of numerous renal pathologies in the form of vascular reconstruction, renal transplants, nephron sparing surgeries, etc and the indispensable use of non invasive MDCT technology in detecting the variations in renal arteries anatomy has validated the study. Assessment of the anatomical variants of bilateral renal arteries in Indian population cohort on MDCT angiography and its clinical implications. 110 subjects were included in the study. The subjects were in the age group of 20 to 50 years. There were 60 (55%) male and 50(45%) female subjects. Normal and variant anatomy of renal arteries was studied using a 40 slice multidetector CT scanner. 76(69%) patients had single renal artery on right side, two renal arteries in 32(29%) patients and three renal arteries in 2(1.8%) patients. On the left side 87(79%) patients have single renal artery, 19(17%) patients have two renal arteries and 4(3.6%) patients have three renal arteries. No correlation with respect to the sex of the subjects was found. Knowledge of the renal artery anatomy is crucial in attaining the precision in renal related surgeries and MDCT renal angiography is the ideal modality of choice as it is not only accurate but also provides a detailed anatomical road map of the vascular anatomy.

Krukenberg tumors are defined as ovarian metastasis of digestive tract cancer. They represent only 1% to 2% of all malignant ovarian tumors [1]. Stomach is the most common primary site. We report an observation of Krukenberg tumor arising from a gastric cancer, discovered during the exploration of chronic abdominal pain in a 48-year- old women. The call signs were mainly digestive. Ultrasonography and pelvic MRI played a key diagnostic role. The aim of our article was to give an overview of the imaging features of typical Krukenberg tumor.

Blue rubber nevus syndrome also known as Bean syndrome, is a rare vascular congenital condition responsible for multiple venous malformations that usually concern the skin and the gastrointestinal tract, rarely reported affecting the central nervous system, lung or the thyroid gland. We herein present a case of an 80-year-old male, diagnosed with Biermer’s disease since 2006, he latter on was subject to an aggravation of his anemia leading the investigations to discover multiple gastrointestinal (GI) ‘blebs’ causing recurrent haemorrhages.

Laparoscopy (or laparoscopy) is considered in surgery as a non-invasive elective approach. It allows a shorter duration of hospitalization, fewer scarring sequelae, an improvement in morbidity and a reduction in the cost of the intervention. In our case study, we propose a retrospective study of about 113 patients, the aim of which is to underline the interest of laparoscopy in the discovery and/or confirmation of the diagnosis, in situations where the etiological diagnosis could not be established, despite morphological examinations.

Dysphagia is a frequent reason for consultation. High-resolution esophageal manometry (HREM) is the current reference examination for the exploration of dysphagia when endoscopy is normal with negative esophageal biopsies. This is a retrospective single-center study including 231 patients presenting dysphagia with normal upper digestive endoscopy and negative esophageal biopsies benefited from HRM. The diagnosis was retained based on the Chicago 3.0 classification. We used a HRM unisensor catheter and the MMS 9.5 sofware for interpretation. Our study included 231 patients, 126 (54.54%) of whom were women. Mean age was 43.9 years (extremes 18- 94 years). MHR was pathological in 186 cases (80.51%). It revealed achalasia in 121 patients (65.05%): achalasia type I in 25 patients (20.66%), type II in 86 patients (71.07%) and type III in 10 cases (8.26%). HRM showed others esophageal motility disorders corresponding to scleroderma in 20 patients (10.75%), ineffective motricity in 33 patients (17,7%), oesogastric junction obstruction in 7 cases (3.7%), jackhammer oesophagus in 2 cases (1,07%), oesophageal spasm in 3 cases (1.61%). HRM was normal in 45 patients (19.48%).High-resolution esophageal manometry represents an undeniable advance in the diagnosis of esophageal motor disorders in patients with dysphagia and normal endoscopy. The most common primary motor disorder is achalasia type II.

The incidence of coronary spasm appears to be decreasing, probably due to the widespread use of bradycardia calcium channel blockers, statin, and reducing smoking also. Many studies have shown the pathological association of atheroma plaque and coronary spasm. The new imaging techniques: Optical coherence tomography (OCT) and Intravasculaire ultrasound (IVUS), allows accurate analysis of arterial tunnels. In this article, we report a case of a patient who presented with refractory spastic angina, wich was complicated by acute coronary syndrome many month later.

Contrary to the primitive forms of the infant Acute intestinal intussusception is a rare entity in children. Adult, showing 10% of all intussusceptions and 4% of intestinal obstructions in adults. And an organic lesion is often found at the point of weakness of the intussusception in 80% of the cases at the adult. Malignant tumors represent the first etiology of intussusceptions, especially in the colon, whereas they are secondary to a benign lesion (especially in the hail) in 25% of cases. Treatment is always surgical in adults and leaves no room for reduction by hyperpressure under radiological control.