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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

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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

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The endoscopic pneumatic balloon dilation in treating achalasia in a Moroccan center

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Open Journal of Gastroenterology 2012年第4期2卷 172-176页

作者： Mounia El yousfi Nada Lahmidani Adil Ibrahimi Dafr-Allah Benajah Department of Hépato-Gastroenterology University Sidi Mohammed Ben Abdillah Fez Morocco

Aim of the work: Achalasia is a rare pathology whose physiopathogenesis is mysterious. The treatment is based on endoscopic pneumatic dilation (PD) and surgery. The aim of our work is to show our experiment about endoscopic pneumatic dilation as the principal treatment suggested for patients presenting achalasia. Material and method: It is a retrospective study relating 21 cases of achalasia indexed between 2002 and 2007. The remission was judged on Eckardt’s clinical criteria. If the symptoms persist after three episodes of PD, there’s a therapy failure and the patients were then proposed to surgery or recurrent DP. The results: The Middle Age at the time of diagnosis was of 44 ± 10, 66 years (20 to 76). The sex ratio was 1, 3 (12M?9F) (p = 0.5). The diagnosis of achalasia is based on imaging, endoscopy and manometric arguments. The PD of the cardia was proposed in first intention, except two patients who were treated 6 and 15 years before by surgery. 38 dilations were performed for 21 patients with an average of 1.8 PD per patient [1-6]. The rate of good answers after the third episode of PD was about 90.47% (19 patients). There was no complication of the PD. In plain-varied analysis, no predictive factor of good answers to PD was retained. Conclusion: PD is an effective cure with a negligible morbidity and no mortality. The surgery is reserved for the failures of pneumatic dilation.

关键词： Achalasia Esophagus Treatment Pneumatic Dilation

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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

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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

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Viral Hepatitis B during Chronic Inflammatory Bowel Diseases at Fez University Hospital: Prevalence and Risk Factors

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Open Journal of Gastroenterology 2018年第1期8卷 17-26页

作者： H. Abid H. Meyiz O. Laalaj I. Mellouki M. El yousfi N. Aqodad D. Benajeh A. Ibrahimi M. El Abkari Department of Hepato-Gastroenterology University Hospital Hassan II Fez Morocco Faculty of Medicine-Fez University Sidi Mohammed Ben Abdelalh Fez Morocco

Patients with chronic inflammatory bowel diseases (IBD) have long been considered at risk for viral hepatitis B. However, recent epidemiological studies have found similar prevalence, or even lower than in the general population. The objective of this work is to determine the prevalence of viral hepatitis B (HVB) during IBD, to determine the risk factors in the service of Hepato-gastroenterology of university hospital Hassan II-Fez, and of evaluate the impact on therapeutic management. PATIENTS AND METHODS: This is a retrospective study, spread over a period of 17 years and a half (January 2001-June 2017). All patients treated for IBD who are tested for Hbs Ag and anti Hbcwere included. The HVB DNA levels were tested in case of positivity of HbsAgor anti Hbc. Results: Over the study period, 755 patients were included. The average age of our patients was 35 years [14 - 87] with a sex-ratio H/F of 0.67. We had 391 cases (51.8%) of Crohn’s disease (CD) and 364 cases (48.2%) of ulcerative colitis (UC). Anti HBctest was positive in 1.98% of cases (N = 15). In these patients, HBsAg was positive in 1.19% of cases (N = 9). The prevalence of HVB was 2.55% in CD (N = 10) versus 1.37% in UC (N = 5). In our work, no history of surgery, digestive endoscopy or transfusion has been shown to be a risk factor for viral transmission. CONCLUSION: The prevalence of HVB in IBD is similar to that of the general population. The safety of blood transfusions and the improvement of asepsis probably explain these results. However, the risk of viral reactivation during HVB, sometimes fatal under immunosuppressive treatment, requires systematic screening.

关键词： IBD UC CD Hbs Ag Ab Hbc HVB DNA Levels Prevalence Viral Hepatitis

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The Elastic Ligation of Internal Hemorrhoids: Where Are We Now?

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Open Journal of Gastroenterology 2019年第1期9卷 28-35页

作者： H. Abid G. Ousseur R. Benjira M. Lahlali A. Lamine N. Lahmidani M. El yousfi N. Aqodad D. Benajah A. Ibrahimi M. El Abkari Hepato-Gastroenterology Department Hassan II University Medical Center Fez Morocco Faculty of Medicine Sidi Mohammed Ben Abdellah University Fez Morocco

Hemorrhoidal disease requires different means of treatment: medical, surgical and instrumental. Among these, the elastic ligature seems to be an effective and widespread technique in the world. The aim of our study is to report our experience in methodology and short and medium term results of ligation in a population that strongly fears surgery. Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids. These patients were collected over a period of 15 years (October 2003-April 2018) at the gastroenterology department of Hassan II CHU in Fez. Results: The average age of our patients was 50.3 years [20 - 82 years] with a sex-ratio M/F of 2.85. The clinical signs were dominated by rectorrhagia (99%) complicated by anemia in 116 cases requiring blood transfusion in 72 cases, followed by proctalgia (27.4%). Transit disorders were noted in 65 patients (31.2%). Indications for elastic ligation were symptomatic internal hemorrhoids Grade 3 (65.4%) and Grade 2 (34.6%). The average number of ligation sessions that achieved the therapeutic goal was 2.30 sessions [1 - 4]. The average number of rings per session was 3.1 rings [1 - 6]. Moderate to severe pain was reported by 20 patients (9.6%) mostly within 6 hours of ligation. Minimal rectorrhagia was reported in 33 cases (15.8%). There were no major complications who required a hospitalization. The success rate was 80.7% (n = 168). Surgery was performed in 31 patients (14.9%) and sclerosis in 7 patients (3.3%). Conclusion: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3. The results obtained in our study were very reassuring and motivating.

关键词： Internal Hemorrhoids Elastic Ligature Evolution

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