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Aortodigestive Fistula: A Rare Cause of Digestive Bleeding

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Case Reports in Clinical Medicine 2021年第4期10卷 126-132页

作者： Nada Lahmidani Mouna Figuigui Hakima Abid Mounia El Yousfi Mohammed El Abkari Sidi Adil Ibrahimi dafr allah benajah Department of Gastroenterology University Hospital Hassan II Sidi Mohammed Ben Abdallah University Fez Morocco

Backgound: Aorto-digestive fistulas remain a fatal disease entity often occurring after vascular surgeries. Eso-gastro-duodenal endoscopy is essential to explore the upper digestive bleeding. The negativity of morphological examinations should not exclude the diagnosis. Diagnosis has benefited in recent years from developments in cross-sectional imaging: computed tomography (CT) and magnetic resonance imaging (MRI). The severity of bleeding is linked to the vital consequences (mortality close to 50% up to 100% in the absence of treatment), functional (30% amputation), and to the underlying infection itself correlated with the attack of the stent and the anastomosis. Patients: We report three cases of aorto-digestive fistulas treated at The University Hospital Hassan II to show the challenging diagnosis and therapeutic of such rare causes of upper digestive bleeding. Results: three patients were admitted to the emergency endoscopy unit for upper digestive bleeding, 2 of them had a medical history of Behcet Disease and two had past aortic aneurism surgery. The couple’s upper endoscopy and CT scan angiography made the diagnosis. Unfortunately, 2 patients died from fatal bleeding. Conclusion: Aortodigestive fistula is an extremely serious complication of aortic aneurisms and a rare cause of gastrointestinal bleeding. This diagnosis should be considered in any patient presenting with digestive bleeding with vascular disease or previous history of vascular stent.

关键词： Aorto Digestive Fistula Bleeding Endoscopy Primary

A Rare Cause of Gastrointestinal Bleeding: Cholecystoenteric Fistula

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Case Reports in Clinical Medicine 2014年第9期3卷 521-523页

作者： Iliass Charif Hossam Benhammane dafr-allah benajah Said Ait Laalim Khalid Mazaz Adil Ibrahimi Mounia El Yousfi Department of Gastroenterology Hassan II University Hospital Faculty of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdellah University Fez Morocco Department of Surgery Hassan II University Hospital Faculty of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdellah University Fez Morocco

A 60-year-old woman presented to the emergency department of our university hospital for several episodes of upper gastro-intestinal bleeding (hematemesis and melena). The endoscopic examination (Figure 1) showed a large ulcer at the front of the bulb, with a calculation within it and a visible vessel on the banks of the ulcer treated by putting two clips. Computer tomography (CT), demonstrated a sclerotic, atrophic and multi gallstone gallbladder, with a calculation protruding in the duodenum. The patient underwent surgery which consisted on partial cholecystectomy with duodenal suture and closing of cystic duct.

关键词： Gastrointestinal Bleeding Cholecystoenteric Fistula

Peripheral Neuropathy under Infliximab Therapy: About One Case

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Open Journal of Gastroenterology 2020年第9期10卷 242-246页

作者： Fatima-Zahra Hamdoun Hakima Abid Nada Lahmidani Mounia El Yousfi dafr-allah benajah Mohammed El Abkari Adil Ibrahimi Department of Hepato-Gastroenterology Hassan II University Hospital of Fez Faculty of Medicine University Sidi Mohammed Ben Abdelalh Fez Morocco

A-TNF inhibitors are increasingly used in various inflammatory disorders. Multiple side effects have been reported in recent years, particularly peripheral neuropathies. We report a case of axonal neuropathy occurring after the start of treatment with Infliximab. This is a 47 years old patient, followed for Crohn’s disease requiring treatment with Infliximab. Twenty-two weeks later, the patient presented a grade 4 of axonal neuropathy. We concluded to a medicinal sensitive neuropathy after elimination of other etiologies. Given the severity of the neurological symptoms, we decided to change the therapeutic class.

关键词： Crohn’s Disease Infliximab Peripheral Neuropathy

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

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Open Journal of Gastroenterology 2018年第3期8卷 107-117页

作者： Hakima Abid Fatima Babakhouya Ihssane Mellouki Mounia El Yousfi Noureddine Aqodad dafr allah benajah Adil Ibrahimi Mohamed El Abkari Hepatogastroenterology Department Hassan II University Hospital of Fez Univesity Sidi Mohamed Ben Abdellah Fez Morocco

Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency;its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005-2015). We included all patients admitted for severe acute colitis;all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 - 70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma;totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively;it is due to the delayed admission of pati

关键词： Acute Severe Ulcerative Colitis Infliximab Cyclosporine Colectomy

What Is the Role of Endoscopic Retrograde Cholangio-Pancreato-Grahy in the Management of Hepatic Hydatid Disease Complications?

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Open Journal of Gastroenterology 2020年第5期10卷 107-117页

作者： Hakima Abid Ghita Ousseur Nada Lahmidani Mounia El Yousfi Noureddin Aqodad Mohammed El Abkari Adil Ibrahimi dafr allah benajah Department of Hepato-Gastro-Enterology University Hospital Hassan II Fez Morocco Faculty of Medicine Sidi Mohamed Ben Abdellah University Fez Morocco

Liver hydatid cyst is a parasitic disease that is endemic in Morocco. Its gravity is essentially due to its complications, such as Intrabiliary rupture. The aim of our study was to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in the management of intrabiliary rupture of hydatid disease of the liver. Materials and Methods: This is a retrospective study in the department of Gastroenterology in the University Hospital Hassan II of Fez over a period of 12 years from March 2005 to October 2017. All patients admitted for hepatic hydatid disease and who received ERCP were included. We analyzed the success rate of catheterization of the common bile duct (CBD), the successful clearance of the bile duct and the complications. Results: 2860 patients had received therapeutic ERCP, 151 patients (5.3%) had hepatic hydatid disease, 112 of which had intrabiliary disruption of hepatic hydatid and 39 patients were admitted for sphincteromy for reversal of the flow after surgery of hydatid cyst. The average age of our patients was 41 years old [12 - 85]. The sex ratio F/H = was 1.12. 74% (N = 112) patients were admitted to a table cholangitis and 26% of cases were operated for KHF fistulized in the bile ducts with persistence of a large biliary flow in post-operative (39 cases). The success of initial catheterization of the commun bile duct was achieved for 138 patients (91%) or obtained secondarily after precut for 13 patients. The evacuation of hydatid membranes was carried out in 51% of them (N = 78);twenty two (14.5%) patients had one or more calculations with or without hydatid membranes. A case of gastrointestinal bleeding post ERCP was observed. All the patients followed evolved well in the long term except for two patients who presented in few months after the first ERCP severe cholangitis which required the use of a second ERCP with successful evacuation of membranes. Conclusion: In our study, endoscopic management o

关键词： Hydatid Cyst Intrabiliary Rupture Complications Endoscopic Retrograde Cholangiopancreatography Endoscopic Sphincterotomy

Predictors of early rebleeding and mortality after acute variceal haemorrhage in patients with cirrhosis

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Open Journal of Gastroenterology 2013年第7期3卷 317-321页

作者： Iliass Charif Kaoutar Saada Ihsane Mellouki Mounia El Yousfi dafr allah benajah Mohamed El Abkari Adil Ibrahimi Nourdin Aqodad Department of Hepatology and Gastroenterology Hassan II University Hospital Faculty of Medicine and Pharmacy Sidi Mohammed Ben Abdellah University of Fez Fez Morocco

The upper gastrointestinal bleeding from esophageal or gastric varices is the most dangerous complication of portal hypertension. The purpose of this study was to identify the predictors of early rebleeding and mortality after a bleeding episode. Patients and Methods: It was a retrospective study including 215 patients admitted in our department of hepatology and gastroenterology at the Hassan II University Hospital of Fez, from January 2001 to January 2010. Results: The mean age of our patients was 51 years. Thirty percent of patients had cirrhosis due to virus (B or C). The majority of patients (79%) had only esophageal varices. Fifty patients (23%) had a bleeding recurrence. Twenty-five patients (11.5%) died during the first ten days, of which 52% had presented rebleeding (p = 0.01). In 30% of cases, the rebleeding was secondary to a fall of pressure ulcers. Univariate analysis showed that early mortality of patients was significantly associated with advanced age (p = 0.018), low prothrombin time (PT) (p = 0.022), low serum sodium (p = 0.03), low platelet count (p = 0.05), and elevated transaminases (p = 0.02). Conclusion: The survival of cirrhotic patients after a bleeding episode was influenced by advanced age, a low rate of PT, of serum sodium, and of the platelet count, and elevated transaminases.

关键词： Cirrhosis Portal Hypertension Gastrointestinal Bleeding Esophageal Varices

Update on Gastric Cancer Epidemiology and Risk Factors

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Journal of Cancer Therapy 2018年第3期9卷 242-254页

作者： Nada Lahmidani Mounia El Yousf Nourdine Aqodad dafr allah benajah Mohammed El Abkari Adil Ibrahimi Adil Najdi Zineb Benbrahim Naoufal Mellas Department of Gastroenterology University Hospital Hassan II School of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdallah University Fez Morocco Department of Epidemiology and Biostatistics School of Medicine and Pharmacy of Tangier Tangier Morocco Department of Medical Oncology University Hospital Hassan II School of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdallah University Fez Morocco

Gastric adenocarcinoma is the most common gastric tumor. It is the fifth most common cancer worldwide after lung cancer, breast, colo rectal and prostate cancer. Long considered enigmatic, its epidemiology has changed over time. In fact, the incidence of distal gastric cancer has declined while that of the cardia was stable or increased. This cancer is multifactorial but reducing the incidence of distal cancer is particularly attributed to advances in the treatment of H. pylori infection. In this review, we analyzed the available data concerning the changing epidemiology of gastric cancer and the main risk factors. The incidence of distal cancer is definitely declining due to the control of Helicobacter pylori infection. Proximal gastric cancer and cardia cancer is particularly due to smoking, overweight.

关键词： Adenocarcinoma Gastric Incidence Risk Factors Helicobacter pylori

Portal Vein Thrombosis in Non Cirrhotic Patients: Experience of Gastroenterology and Hepatology Department University Hospital Hassan II

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Open Journal of Gastroenterology 2020年第12期10卷 349-356页

作者： Nada Lahmidani Mariam El Khayari Maria Lahlali Asmae Lamine Hakima Abid Mounia El Yousfi dafr allah benajah Sidi Adil Ibrahimi Mohammed El Abkari Department of Gastroenterology and Hepatology School of Medicine and Pharmacy of Fez University Hospital Hassan II University Sidi Mohammed Ben Abdallah Fez Morocco

Portal thrombosis (PT) is a rare condition of heterogeneous etiologies. The aim of our work is to study the epidemiological and etiological profile of portal thrombosis in non cirrhotic patients through the experience of our department. Patients and Methods: This is a retrospective study over a 9-year period (January 2009-July 2018), 54 cases of PT in non cirrhotic patients were collected in the department of Hepato-Gastro-Enterology of the HASSAN II Fez Hospital, 73 cases of PT were excluded among cirrhotic patients. Results: We collected 54 cases of PT cases;the average age was 45 years, with an F/M ratio of 1.42. PT was revealed by abdominal pain in 20 cases, complications of portal hypertension in 24 cases, and ultrasound discovery in 10 asymptomatic cases. Main underlying causes of PT were: A proteine S deficiency in 7 cases, Acute pancreatitis in 5 cases, colonic cancer in 4 cases, pancreatic cancer in 4 cases, Hydatic liver Echinococcoses (3 cases), anti phospholipid syndrom (3 cases), myeloproliferative syndrom (2 cases) and jak mutation 2 in 1 case, non identified etiology was reported in 20 cases (37%). Treatment was based on anticoagulation, treatment of portal hypertension complications, and etiological treatment in cases where etiological diagnosis was certainly posed. Conclusion: PT is a rare but serious condition, according to our study neoplastic causes are predominant followed by protein S deficiency. Etiological investigations have to be wide and early treatment is the best option to avoid extension and complication.

关键词： Portal Thrombosis Etiology Anticoagulant Non Cirrhotic

A Biliary Recurrence of a Breast Cancer: Case Report and Review of the Literature

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Journal of Cancer Therapy 2017年第3期8卷 296-301页

作者： Fatima Zahra El M’rabet Hanae Bedoudou Adil Mai Amina Arramdani Boubacar Efared Laila Chbani Ihssane Mellouki dafr allah benajah Youssef Alaoui Lamrani Nawfel Mellas Oncology Department University Hospital Hassan II Fez Morocco Radiology Department University Hospital Hassan II Fez Morocco Hepatogastroenterology Department University Hospital Hassan II Fez Morocco Anatomical Pathology and Cytology Laboratory University Hospital Hassan II Fez Morocco

A 51-year-old female with a history of radical mastectomy with axillary lymph node dissection, adjuvant chemotherapy and radiation for a breast cancer was referred to the emergency room due to cholangitis. A CT scan showed a common bile duct mass invading the duodenum. After bile draining, the investigations led to an undifferentiated carcinoma with positive hormonal receptors. The diagnosis of a breast cancer recurrence was established and the patient was commenced on taxane therapy.

关键词： Breast Cancer Recurrence Cholangitis Biliary Tumor Metastasis Hormonal Receptors Chemotherapy