A spontaneous rupture of the urinary bladder (SRUB) is an exceedingly rare surgical emergency that might be misdiagnosed, resulting in a high mortality risk. Clinicians should be mindful that secondary peritonitis can occur as a result of a ruptured urinary bladder, which is frequently misdiagnosed and undertreated. The majority of cases are identified during laparotomy. We report a case of a 70 -year -old woman who had irradiation for endometrial cancer 25 years ago and had a history of hypertension, diabetes, and recurring urinary tract infections. The current study sought to determine the etiology of SRUB as well as clinical aspects and diagnostic strategies. She was diagnosed with generalized peritonitis. An exploratory laparotomy discovered a perforated urinary bladder. Following further care, the patient was released with no further complaints.

Background: Seatbelts have reduced the number of fatal head, chest and abdominal injuries. They have, however, introduced a set of injuries comprising abdominal wall bruising, Intra-abdominal injuries, and lumbar spine fractures collectively termed the seat belt syndrome. Case presentation: A 60-year-old man who was transferred to our emergency department after sustaining a blunt abdominal trauma after a road traffic accident. An exploratory laparotomy was performed revealed a sigmoid transection that was treated by an Hartmanns pouch procedure. After further management, the patient was discharged with no further complaints. Conclusion: The presence of a seatbelt sign should raise the suspicion of a significant intra-abdominal injury. Responding to clinical signs is critical and early diagnosis and management reduces morbidity and mortality.

Emphysematous cholecystitis is a rare but serious condition that requires early diagnosis and prompt treatment. We present a case of an 82-year-old patient with a history of hypertension and diabetes who was admitted with septic shock and acute renal failure secondary to emphysematous cholecystitis confirmed on CT scan. After resuscitation and antibiotic therapy, the patient underwent cholecystectomy with favorable outcomes.

Background: With the introduction of the use of seatbelts in cars, mortality following motor vehicle collisions has decreased significantly. They have, however, introduced a set of injuries comprising abdominal wall bruising and intra-abdominal injuries. Injuries may consist of traumatic abdominal wall disruption. Closed rupture of rectus abdominis following seatbelt related trauma is rare. Case Presentation: We present the case of a 68 years old male who presented with a closed rupture of the rectus abdominis without other intra abdominals injuries, following a high velocity road traffic accident. He was brought in with an acute abdomen and a seatbelt sign upon which the decision was made to perform emergency laparotomy. After further management, the patient was discharged with no further complaints. Conclusion: Our case highlights the need for suspicion, investigation and subsequent surgical management of intra-abdominal injury following identification of this rare consequence of seat belt trauma.

Distal intestinal obstruction syndrome is one of the frequent digestive complications of cystic fibrosis; due to a more or less complete small bowel obstruction. Proximal intestinal obstruction syndrome is a rarer variant, but has been more often described since the improvement of the management of CF that has led to enhance CF patient survival. We described a 19-year-old male followed in the pediatrics department of the HMIMV for cystic fibrosis complicated by exocrine pancreatic insufficiency and type 1 diabetes, who presented an intestinal obstruction syndrome for two days, consisting on abdominal pain, bloating, bilious vomiting and cessation of stool and gas. Imaging has suspected a mechanical obstruction of the small bowel however no transitional zone could be identified. A conservative treatment was start and because of the inefficiency of this first approach, the decision was made to proceed with a laparotomy. Intra-operatively, a mid-jejunum point with inssipationed stool was noticed to be the transitional aera of the obstruction and conducted us to proceed for an entrotomy and digitaly empty the proximal bowell. PIOS is a more rare intestinal complication but should be considered when the ileo cecal clinical location is absent in an obstruction syndrome. Its treatment is based on laxatives however surgery should wisely be considered in front of failure of the conservative approach or critical condition.

A 26-year-old male patient, with a 3-days history of peri-umbilical pain which had localized to the right iliac fossa by the time he attended the hospital, was admitted to the emergency department of our hospital. The abdominal examination revealed a soft abdomen, rebound tenderness in the right iliacfossa, and a positive psoas sign. He was not peritonitic and had a negative Rosving's sign and absenthernias. Blood tests showed a mild leucocytosis of 12.5×109/l (range, 4.0–11.0×109/l) with a neutrophilia of 10.5×109/l (range. 2.0–7.5×109/l) and a CRP of 90mg/l. Ultrasonography confirmed a diagnosis of appendicitis by the presence of free fluid within the RIF and within the 10mm appendix which was incompressible. Under general anesthesia, the surgical exploration by laparotomy revealed the presence of acute appendicitis, but the meticulous investigation of the area around the cecum detected a second appendix with a definite mesoappendix and obvious signs of inflammation (Figure 1). Formal appendectomy was then performed for both processes (Figure 2).

Solid and Pseudopapillary Tumors (SPT) of the pancreas are a rare entity, occurring essentially in young women, radiological examinations lead to the diagnosis while the positive diagnosis is based on immunohistological study. The primary treatment modality for SPTs condition is surgical intervention. Our case aims to recall, when encountering a pancreatic mass in a young woman, that it is crucial for surgeons, radiologists, and pathologists to take into account the possibility of solid and pseudopapillary tumor. This is due to the favorable prognosis and unique treatment approaches associated with SPT, as opposed to other types of pancreatic tumors.

Acute appendicitis associated with acute adnexal pathology is very rare with a few cases reported in the literature. To illustrate this unusual association, we report a case of a 53-year-old female patient admitted to the emergency department with diffuse abdominal pain and hyperleucocytosis. The abdominal CT scan showed appendicular peritonitis and a pelvic mass. The patient underwent surgery, and we kept the diagnosis of appendicular peritonitis associated with torsion of a right ovarian tumor. Appendectomy and right salpingo-oophorectomy were performed with satisfactory postoperative outcomes. Systematic exploration of the genital tract in female patients with appendicitis is indispensable to eliminate an associated ovarian torsion or other adnexal pathologies.

Splenic cysts are rare tumors, grouped into parasitic and non-parasitic cysts, no-parasitic cysts are further classified into primary and secondary cysts depending on the mucous membrane of the cyst, radiological imaging allows the diagnosis to be made but confirmation of the diagnosis is based on an atom-o-pathological examination of the part. surgical treatment is the cornerstone of symptomatic and complicated splenic cysts. The conservative treatment is a reference for splenic cysts. We report the case of a young woman who was presented with a simple cyst of the spleen.

Abstract Background Our review discuss (i) the findings from analyzed data that have examined KRAS, NRAS and BRAF mutations in patients with colorectal cancer (CRC) in North Africa and to compare its prevalence with that shown in other populations and (ii) the possible role of dietary and lifestyle factors with CRC risk. Methods Using electronic databases, a systematic literature search was performed for the KRAS, NRAS, and BRAF mutations in CRC patients from Morocco, Tunisia, Algeria and Lybia. Results Seventeen studies were identified through electronic searches with six studies conducted in Morocco, eight in Tunisia, two in Algeria, and one in Libya. A total of 1843 CRC patients were included 576 (31.3%) in Morocco, 641 (34.8%) in Tunisia, 592 (32.1%) in Algeria, and 34 (1.8%) in Libya. Overall, the average age of patients was 52.7 years old. Patients were predominantly male (56.6%). The mutation rates of KRAS, NRAS and BRAF were 46.4%, 3.2% and 3.5% of all patients, respectively. A broad range of reported KRAS mutation frequencies have been reported in North Africa countries. The KRAS mutation frequency was 23.9% to 51% in Morocco, 23.1% to 68.2% in Tunisia, 31.4% to 50% in Algeria, and 38.2% in Libya. The G12D was the most frequently identified KRAS exon 2 mutations (31.6%), followed by G12V (25.4%), G13D (15.5%), G12C (10.2%), G12A (6.9%), and G12S (6.4%). G12R, G13V, G13C and G13R are less than 5%. There are important differences among North Africa countries. In Morocco and Tunisia, there is a higher prevalence of G12D mutation in KRAS exon 2 (≈50%). The most frequently mutation type in KRAS exon 3 was Q61L (40%). A59T and Q61E mutations were also found. In KRAS exon 4, the most common mutation was A146T (50%), followed by K117N (33.3%), A146P (8.3%) and A146V (8.3%). Conclusion KRAS mutated CRC patients in North Africa have been identified with incidence closer to the European figures. Beside established anti-CRC treatment, better understanding of the causality of CRC can be established by combining epidemiology and genetic/epigenetic on CRC etiology. This approach may be able to significantly reduce the burden of CRC in North Africa.

Introduction: SFT is an uncommon tumor representing 3, 7% of all soft tissue sarcomas and mesenchymal tumor. The most common location is pleura followed by the abdomen. Case Report: A 68 years old male patient was admitted to our department with abdominal pain and a mobile masse in his abdominal hypogastric area. CT-scan showed a well-defined mass with vividly homogenous enhancing features in both the arterial and venous phases. A complete resection of the tumor was performed thought a median sub-ombilical laparotomy. The histological examination showed a fibroblastic mesenchymal tumor with expression of CD34, CD99 and Bcl2 in the immunohistochemical study that is specific of the solitary fibrous tumor. Discussion: SFT are anatomically ubiquitous mesenchymal tumors developed from fibroblasts. It is an uncommon tumor represents 3, 7% of all soft tissue sarcomas and mesenchymal tumors. The most common location is the pleura followed by the abdomen. Clinically, abdominal SFT is usually manifest as abdominal fullness, gastrointestinal obstruction, weight loss, jaundice, fever, or hypoglycemia. Immunohistochemistry, the cell of the SFT typically express the following markers: CD34, CD99 and Bcl2. Complete surgical removal of the tumor is the gold standard treatment which can be completed by adjuvant radiotherapy. Conclusion: Primary SFTs in the peritoneum are extremely uncommon. Clinical symptoms and imaging manifestations are nonspecific whish make the diagnosis difficult. Treatment includes surgical resection, embolization therapy, radiation therapy, chemotherapy and anti-angiogenic agents.

Introduction: Hydatid disease is a zoonosis caused by an infection with the larvae of the tapeworm echinococcus granulosus, it mostly involves liver and lungs but it may exceptionally affect muscle. Case Report: we report the case of a 22 years old man who was admitted to our surgical clinic with a primary hydatid cyst in gluteal muscle diagnosed by clinic examination, imaging and serological testing. The treatment was a complete pericystectomy and chemotherapy by antiparasit drugs. Discussion: Hydatid disease it‘s an endemic disease in sheep-producing regions, In human, this disease involves usually the liver and the lungs and exceptionally the muscle. The diagnosis may be challenging, as it should consider arguments such as history, physical examination, imaging and serological testing. The best treatment is pericystectomy with perioperatory chemotherapy to reduce risk of occurrence. Conclusion: The hydatid cyst of gluteal muscle is exceptional even in endemic area, the diagnosis may be challenging and the surgery is the gold standard of treatment.

Background: Amyand hernia is defined as the presence of an appendix within the hernial sac with or without appendicitis. It is an extremely rare condition seen in approximately 1% of all hernias, whereas associated complications like acute appendicitis, or perforated appendicitis, are even rarer. Case presentation:We describe a case of a 50-year-old male patient, who presented to the Department of Surgery with an incarcerated right-side inguinal hernia without any signs of ischemic complications. He was admitted and a hernioplasty was performed. As an incidental finding, an Amyand hernia was encountered that was treated without appendectomy and placement of a prosthetic mesh without any complications. Conclusion: Amyand's hernia is a rare presentation of inguinal hernias and the preoperative diagnosis of Amyand's hernia remains a challenge. CT scan and ultrasonography are helpful for the diagnosis but the definite diagnosis should be made by laparoscopy.