Laparoscopic treatment of a gastric outlet obstruction caused by a gallstone (Bouveret's syndrome).

Duodenal impaction of a gallstone after its migration through a cholecystoduodenal fistula is an uncommon cause of gallstone ileus described as Bouveret's syndrome. Surgical treatment is recommended, but the morbidity and mortality rates are nearly 60% and 30%, respectively. To reduce these rates using improved endoluminal surgery, a laparoscopically assisted intraluminal gastric surgery could be considered.

[Emphysematous pyelonephritis in a diabetic patient. Literature review apropos of a case].

We report the history of a 65-year-old woman, diabetic for 25 years who presented progressive alteration of consciousness with hyperthermia, right upper quadrant pain and vomiting. Bacteriological and radiographic investigations, especially computerized tomography scan of the abdomen, led to the diagnosis of emphysematous pyelonephritis caused by Escherichia coli. Despite a large spectrum antibiotic therapy and surgical drainage of the gas collection, the patient remained septic.

[Cholestatic jaundice complicating lipomatous pseudo-hypertrophy of the pancreas].

The authors describe a major pancreatic lipomatous infiltration, causing a "pseudo-hypertrophy" of the pancreas, in a 70-year-old man. This lesion was responsible of a hyperechogenic area at ultrasonography and of an empty pancreatic bed ("vanishing pancreas") at computed tomography, suggesting lipomatosis. This entity is a special modality of senescence of pancreatic tissue whose origin remains obscure.

[Acute pancreatitis caused by a voluminous umbilical hernia. Case report].

A 65 year old woman, who had a giant umbilical hernia since more than 30 years, was admitted for a transitory cerebrovascular ischemia. During her stay, she presented an episode of acute pancreatitis localized in the head of the pancreas. All current causes of acute pancreatitis were ruled out, especially alcoholism and gallstones.

[Is jaundice a cause of error in the interpretation of CA 19-9 blood levels?].

Serum CA 19-9 has been proposed as a tumour marker for pancreatic cancer (PC). However, false positive results are seen in sera of patients with benign jaundice. The CA 19-9 assay was performed by a solid state radioimmunoassay in 86 icteric patients (total bilirubin greater than 2 mg/dl).