Official websites use .gov
A
.gov website belongs to an official
government organization in the United States.
Secure .gov websites use HTTPS
A lock (
) or https:// means you've safely
connected to the .gov website. Share sensitive
information only on official, secure websites.
Gallstone ileus is a rare cause of the bowel obstruction observed in older persons.The diagnosis is based on computed tomography.Theenterolithotomy with or without cholecystectomy and the repair of fistula is the treatment.The aim of our study is to report two cases of gallstone ileus and to describe the particularities of the epidemiology,the diagnosis and the therapy of the gallstone ileus.
gallstone ileus, obstruction,computedtomography,enterolithotomy, fistula.
To determine the hospitalfrequency of acute intussusception in adults, to describe diagnostic, therapeutic and analytical aspects of surgicalprocedures.
This wasaretrospectiveanalyticalstudyextendingfromJanuary 2001 to December 2013 and prospectivelyextendingfromJanuary 2013 to April 2014, a total of 13 years.
Wecollected 33 cases involving acute intussusception in adults. This pathologyaccounted for 0.26% of surgicalprocedures, 2.41% of intestinal occlusions. The sex ratio was 0.65. The averageagewas 31.85 yearswithextremes of 16 and 70 years. The average time of consultation was 4.79 hourswithextremes of 1 to 8 days. Signsrecoveredwere: abdominal pain 100%, meteorism 69.7%, peristalticripples 42.4%, tympanism 72.7%, defense 90.9%, increase in hydroaeric noise 30.3%, A rectal bleeding 12.1%. The SPA showedhydroaericlevelsin 81.8% (27 cases). The abdominal ultrasound has objectified the typical image in cockadein 45.45% (15 cases). The ileo-ileal invaginations were the mostfound in peroperativewith 51.51% (17 cases). There werenecrosisin 45.4% (15 cases). Weperformed the invagination rodresectionin 78.8% (26 cases) withanastomosis, astoma 12.1% (4 cases) and a manualdisinvagination 9.1% (3 cases). The etiologiesfoundwere the malignanttumors 24.2% (8 cases), benign 12.1% (4 cases) and idiopathicin 63.6% (21 cases). Morbiditywas 27.3% (9 cases) and mortalitywas 9.1% (3 cases).
Acute intestinal intussusception of the adultis a relatively rare condition. The prognosisdepends on the ischemia, whichis all the more serious as the diagnosisisdelayed.
Acute intestinal intussusception - Adult - surgery - tumor - Mali.
Described by Claudius Amyandin 1735. This is an inguinal herniacontaining the vermiformappendixinflamed or not. It is a rare entity, whichaccounts for about 1% of inguinal hernias. The authors report four cases in an 11-month-old boy, 13 yearsold, and two 14-year-old boys. The diagnosiswas made in per-operative in all cases. The management hadconsisted of an appendectomy in two cases and a dischargeappendix in the abdomen in two cases. In all cases, ligationvaginaliswascarried out at the deep inguinal ring. The operativesequenceswere simple. Amyand of hernia The namesakeisgiven to any type of hernia of the abdominal wallcontainingAppendixexcept in a femoralhernia. In this case, wespeak of hernia of De Garengéot. The diagnosis of herniaAmyandisoftendoneduringsurgery as observed in our four cases. If inflammation of the appendix in the herniaAmyand the clinicalpicturebecomes an emergency involving an inguinal swelling inguinal or scrotal pain withfever, leukocytosis. Shemakes the differentialdiagnosiswith a strangulatedhernia or twisting of the spermaticcord. In these situations, the explorations of imagingmakeit possible to make the diagnosis in preoperative. Whetheritislaparoscopic or conventionalsurgery, the therapeutic attitude isbased on the recommendations of Losanoff and Basson. The operativesequences are generally simple.
Hernia ,Amyand, child, Lomé
Peritonitis is the third most common emergencies in digestive surgery in Africa after occlusions and appendicitis. It presents a diagnostic and therapeutic problem with high mortality and morbidity. The aim of this study is to determine the etiologies and the operative outcome of peritonitis in a context of limited technical equipment.
This was a prospective study over a period of 15 months (May 2015-July 2016). Included were all patients admitted to the general surgery department of the HZB and in whom the diagnosis of acute generalized peritonitis was confirmed at laparotomy.
Fifty-three patients had been screened. The mean age of the patients was 19.8 ± 16.9 years with extremes of 4 and 71 years. The male sex was predominant with a sex ratio of 2.3. The main etiologies were the non-traumatic ileal perforation of typhoid origin (52.83%), gastric perforation (11.32%), appendicular origin and trauma (9.43%). %) Had postoperative complications of which 15 (71.43%) were parietal suppurations. The mortality rate was 11.32%. The delay in consultation and self-medication were factors of poor prognosis. The mean hospital stay was 22.5 ± 4 days.
In Northern Benin, peritotis remains dominated by the complications of typhoid fever. The mortality rate remains high. Prevention requires good hygiene and awareness of early consultations.
peritonitis, etiology, area hospital, Bembéréké
The non-operative treatment is a treatment option abdominal contusion, including those of a certain severity. Its effectiveness in medically under-equipped environment remains to be established.
Describe the management of abdominal contusions and results of non-operative treatment in a resource-constrained environment.
This is a prospective study in CHU-SO (Togo) over 6 months. All patients admitted for abdominal contusion were included in the study. The treatment was surgical in case of persistent hemodynamic instability after resuscitation and in case of a hollow organ perforation is suspected. Treatment was initially nonoperative in other cases.
32 patients were collected, including 26 men and 6 women. The mean age was 30 years. 10 patients had stable hemodynamic status at admission, 19 reversible shock to the establishment of resuscitation measures and 3 persistent hemodynamic instability. Nonoperative treatment was initially performed in 27 patients and was eventually conducted in 25 patients. 3 patients underwent surgical treatment.
The initial shock should be an indication for surgery in the treatment of abdominal contusions. The non-operative treatment in selected patients can be effective even in a resource-constrained environment.
abdominal contusion, non-operative treatment.
Pneumoperineum usually is a consequence of digestive tract perforation and need emergent surgery. Spontaneous pneumoperineum is uncommon situation leading to diagnostic and therapeutic dilemma. We report such a case in a 77 years old male that has been successfully managed with conservative measures.
spontaneous pneumoperitoneum, tomodensitometry, conservative treatment
The objectives were to determine the frequency, to describe the clinical and therapeutic aspects of band / adhesion occlusions.
This was a descriptive study of the patients in the bite / adhesion occlusion service from 2010 to 2016.
We collected 54 cases of intestinal occlusions on band and / or adhesions which constituted 2.7% of the abdominal emergencies and 36.7% of the causes of intestinal occlusions. Fifty patients had a history of laparotomy. The symptoms were marked by abdominal pain in all patients, vomiting (75.9%) and cessation of materials and gases (68.5%). Radiography of the abdomen without preparation performed in all the patients allowed to objectify images of hydro-aerial levels wider than high and central in 98.14%. Fifty one patients were operated on and three treated medically. There was intestinal necrosis in 17.64%, a perforation in 5.88%. Surgical treatment consisted of resection of the flange in 27.45% associated with adhesiolysis in 45.09% or simple adhesiolysis in 5.88%. Intestinal resection was performed in 11 patients followed by immediate anastomosis (8/11, 72.72%) or ileostomy (3/11, 27.27). Postoperative morbidity was 13.7%. Postoperative mortality was 3.9%
occlusion on band and / or adhesions is mainly due to laparotomy. Any laparotomy constitutes a permanent risk of occlusion on flanges / adhesions. For its treatment, the surgical sanction must not be systematic.
occlusion - intestinal - band- adhesions - surgery
Membranous subaortic stenosis (MSAS) is a half-moon membranous inserted both in the septum of left ventricular inducing subaortic stenosis. The aim of this study is to assess surgical results of MSAS.
This is a retrospective study of 11 years, on 20 patients’ sheets. The mean age was 13 years old [4-51 years]. Grade 2 dyspnea was the main symptom (85%). Trans thoracic echography found circular subaortic membranous (60%), or half-moon membranous (40%). The mean trans-aortic gradient was 56 mmhg. All patients underwent surgery through median sternotomy under cardiopulmonary bypass using 2 vena cava cannulations in 70% and one cava cannulation in 30%.
Membranous resection was done with conservation of aortic valve in 90% of cases. Associated surgical gesture were muscular resection in 35%, interventricular communication closure in 15%, aortic valve replacement in 10%, and one coarctation repair. Recurrence was noted once with redo surgery 10 years later.The evolution was good in 85% of cases. The complications were atrial fibrillation and fluttering medically treated.
Surgery is the best treatment of membranous subaortic stenosis in Senegal.
cardiac surgery, membranous subaortic stenosis
The implantable catheter chamber (ICC) is a long-lasting central venous portal (longer than 3 months) used most often for cancer chemotherapy, parenteral nutrition, transfusion, long-term treatments. Commonly used in the West, CCIs are a recent introduction in our practice.
to make a preliminary assessment of this activity in our practice in terms of indications, techniques and monitoring.
This was a retrospective and descriptive study that took place at the CHU-Hôpital du Mali from January 2012 to November 2016, in the Department of Thoracic Surgery. We included all patients who benefited from CCI.
During the study period we performed 41 procedures (37 poses and 4 ablations) for implantable chamber catheters in 37 patients. There were 22 women (53.7%) and 19 men (46.3%). Anti-cancer chemotherapy was the indication in all patients. The veins used were respectively: the cephalic vein in 20 (54.1%) cases, the subclavian vein in 9 (24.3%) cases, the internal jugular in 5 (13.5%) cases, the external jugular in 3 (8.1%) cases. The right side was the most used, with 35 cases (94.6%). An intraoperative control of the position of the catheter by gloss enhancer was performed in 26 patients (70.27%). Two cases of complications (5.40% of cases) were recorded.
ICC is a venous access device offering better quality and comfort to patients and caregivers. Its use must be more widespread in low-income countries.
CCI, Indications, Techniques, Results.
Chronic kidney disease (CKD) is a public health problem in the world. Its management in the terminal stage necessarily requires an extra renal treatment which requires a vascular approach.
The purpose of this study was to analyze the results of the Vascular Approach for Chronic Hemodialysis in the surgical department "B" of the "G" Point Hospital in Bamako.
This was a retrospective study over a 30-month period. All patients with renal insufficiency who had consulted and benefited from a native venous arteriovenous fistula (FAV) were identified.
We constructed native FAV in 171 patients. Patients were at the terminal CRI stage in 69% hemodialysis. HTA was observed in 84.7%. The intraoperative aspect of the veins and arteries was considered normal in 60.8% and 81.3%, respectively. FAV were radio-cephalic in 72.5%, brachiocephalic in 24.6% and brachio-basilic in 2.9% of cases.
The immediate result was satisfactory for 94.7% of the patients. The rate of early complications was 14% mainly dominated by thrombosis. After a first puncture of the FAV, the rate of late complications was 14% dominated by thrombosis and aneurysm.
The native FAV remains the choice of 1st intention in our practice. The training of patients and medical staff in the care and surveillance of VFDs could improve the quality of life of these patients.
chronic renal failure - hemodialysis - arteriovenous fistula
Arterio-venousfistula (AVF) creation is one of the modalities for the surgical management of end-stage renal disease (ESRD). In our environment, majority of patients require some form of vascular access for diaylsis prior to referral for AVF creation due to late presentation.
To review all cases of AV-fistula that has been created for ESRD patients at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria over the last 10-years (January 2006 to December 2015).
A retrospective review of all cases of AV Fistula recording the demographic characteristics, clinical and intra-operative findings, operative complications and outcome of in our hospital during the study period.
A total of 80 cases were reviewed. Age range was 17 to 80yrs, with a mean of 49.03+/- 16.34 years. Males (68,85%) were commoner than females (12,15%). The left upper limb(non-dorminant) was used in 74 patients (88.1%) and 11.9% on the right upper limb. The distal radio-cephalic AVF (76.3%) was most commonly performed. With either the end (vein) to side (artery) (68.8%) or side to side (31.2%) anastomotic techniques employed. Other techniques include the brachio-cephalic and radio-basilic techniques.There was primary failure in 6 patients hence a primary failure rate of 7.5%.Primary failure was more common in diabetics and inadequately dialysed patients. Thrombosis (7.1%) was the commonest cause of primary failure. Fifty four (67.5%) had some form of vascular access for dialysis prior to AV fistula creation.
AV-fistula creation has very good outcome in well selected patients. Early presentation and diagnosis of ESRD patients will obviate the need for other forms of vascular access and increase AVF creation in our facility.
Arterio-venous fistula, End stage renal Disease, Haemodialysis, Ile-Ife
The challenge of commencing cardiac surgery in developing countries is onerous. The National Cardiothoracic Centre in Accra in Ghana is currently the only independent centre, which serves as one of the training centres and the main examination centre for the subregion
We present ourexperience of cardiac surgeries at the Komfo Anokye Teaching Hospital in Kumasi in Ghana, the second largest teaching hospital with separate cardiac surgery missions between 2007 and 2016. We share our challenges of starting open heart surgery in a resource limited environment like ours
Over the 10 year period, 207 cases including 157 Cardiac Surgical Cases and 50 pacemakers implantationwere carried out. This includes 122 pediatric and 35 adult cardiac surgicalcases and the first series of AICDS (Automated Implantable Cardioverter Defibrillator) implantation in Ghana and in West Africa.
We conclude that owing to the huge financialinvestment and the highly skilled training needed to establishCardiothoracic and vascular centres in Africa, governmental commitment for sponsorship as well as collaboration with overseas based and local non-governmental agencies is mandatory. Though local staff training opportunities are provided by such missions, this needs to be complemented by overseas or regional exposure in areas of need for capacity building.
Pericardiectomy is the standard treatment for patients with constrictive pericarditis. Outcome following the procedure can be influenced by multiple factors. These factors include the etiology of the constriction,New York Heart Association class, presence of comorbidity and several other factors
To study the post-operative outcome of pericardiectomy and analyze factors that determine the outcome
This is a retrospective study of all cases of pericardiectomy done between 2008-2015, a period of 8 years.The available medical records were reviewed and relevant pieces of information were entered into a structured questionnaire
A total of 11 patients had pericardiectomy during the study period. Mean age was 34 years with a male to female ratio of 4.5:1. Diagnoses were effusive-constrictive and constrictive pericarditis. Pericardiectomy was achieved via median sternotomy in all patients. Mortality rate was 36% and all mortalities occurred within 24 hours of surgery. Median follow up period was 6 months.Outcome was better in the second half of the study period
Pericardiectomy is life saving, but can be associated with significant morbidity and mortality. Results improve with surgical experience
About which little is said, the fracture of the penis is a painful and traumatic accident coming after abnormaland brutal movement on erected penis. It’s a rare affection and throughout unknown by his anatomopathologist forms. The management of fractures of the penis in our context remains not codified. We report the case of a divorced about 42 years with a fracture of the penis posterior seat with penile rupture of the corpus cavernosum and the tunica.
Fracture of the penis, breaking the albuginea of the corpora cavernosa
To report the epidemiological, diagnosis, therapeutic and evolutionary aspects of the enlarged and painful scrotum in the department of generalsurgery at the TeachingHospital of Kara, Togo.
It was a retrospective, descriptive study of 42 cases of enlarged and painful scrotum treated in the department of generalsurgery at the TeachingHospital of kara, betweenJanuary 1st, 2011 and December 31th, 2015.
The enlarged and painful scrotum constitued 1,06% of the pattern of urological consultation. The meanagewas 33 yearswithextrem (02 months, 85 years). The time of consultation waslowerthan 48 hoursin 14.3% of the cases, while 54.8% of the patients hadconsultedbeyond 72 hours. The etiologiesweredominated by orchiepididymitis (52.4%) followed by the torsion of spermaticcord (35.7%).The majority of patients (63.64%) withorchiepididymitisweremanagedconservatively.A torsion of the spermaticcordwasevokedamong 15 patients (37.7%) and confirmedwith the scrototomyamong 12 patients (28.57%) of all the patients, the positive predictive value was 80% of physicalexamination and ultrasonography. The scrototomycarried out in 28 cases (66.67%) hadfound 42.86% viable testis and 11.9% of necrosed testis havingprofitedfrom a orchidectomy. The operative continuations were simple in the majority of cases (89.3%). Wenotedtwo cases of testicularatrophyafterorchidopexiaincluding one case of infertility of the couple withazoosperm.
The enlargedpainful scrotum are frequent and of various causes. The orchiepididymitiswas the mostcommonetiology in ourstudy. Majority of our patients with acute scrotum presented to hospitallate. The diagnosis and the treatment must beprecocious in the acute scrotum in order to avoid the risk of necrosis testis.
acute scrotum ; orchiepididymitis ; spermaticcord torsion, scrototomy ; orchidectomy.
To assessmorbidity and mortalityafter open prostatectomy for benign prostate hypertrophy by the transvesicalapproach in the department of generalsurgery at the teachingHospital of Kara, Togo.
We performed a prospective, descriptive studycovering a period to November 1st, 2014 to April 30th, 2016.During this period 76 patients underwent to open prostatectomy for benign prostate hypertrophy with Hrynstchak method. All patients were evaluated clinically by using the International Prostate Symptom Score (IPSS), by rectal touch. They have all benefiteda dosage of Prostate Specific Antigen (PSA), asuprapubicultrasonography and preoperative investigation.The incidents and accidents were noted.
The meanage was 69.3 years (range to 42 – 98 years). In all, 52 (68.42%) patients presented with obstructive symptoms and 37 (48.68%) presented with acute urinary retention. The average volume of the prostate as measured by suprapubicultrasonographywas 104.7 cm3 (range to 35 – 285 cm3).Beforeoperation 48 (63.16%) patients hadtransurethralcatheterization. A simultaneous repair of inguinal hernia was done in 26.3% of cases. The average operating time was 61.5 ±12.09 minute. The average eblood loss after surgery was500 ± 115 ml.Fifteen (19.74%) patients have benefited of blood transfusion. The average time for transurethral catheterization in postoperative was 07 days (range to 04 – 15 days). Postoperative complications include wound infection (13.16%), vesicocutaneous fistula (7.9%) and orchiepididymitis (15.8%). There were also urinary incontinence in 9.21% of patients and globaly IPSS scores wereunder07 in 95% of patients, three months after surgery.The overallmortality rate was 2.63%.
The open prostatectomy in ourenvironmentisstill the commonestsurgical option for benignprostatic hyperplasia. Therefore, wehad good resultswith few complications. There isaneed for the development of transurethralresection of prostate to minimize the rate of morbidity.
open prostatectomy, transvesicalapproach, benign prostate hypertrophy, complications, Kara, Togo.
Post traumatic penile amputation is a urological emergency, which can be self inflicted accidental, assaults or circumcision mishaps.¹’²’³ The anatomical location of the penis and the men exposure to industrial accidents one third of the two third cases of genitor-urinary trauma affects the penis.4’5’6’7 The first penile reimplantation was reported by Ehrlich in 1929, with different outcomes.7’8 Grinding machine injury is rare and occurs while the patient operates the machine as it happens to our patient.¹0
To report a rare case of traumatic penile amputation with delayed presentation
15 years old boy who presented 34 hours late with a history of penile amputation following trauma from a grinding machine. He had split thickness skin grafting and scrotoplasty was done. Four weeks post operatively patient did well and was passing urine with good flow.
Traumatic penile amputation is a urological emergency with devastating effects to the patient, his relatives and very tasking to the urologist, especially when the patient presents late as in the case of our patient.
The best modality for bladder decompression in chronic urinary retention (CUR) remains a controversy.
To compare gradual and rapid bladder decompression in relation to the development of haematuria in patients with CUR
This prospective study was carried out between July 2013 and June 2016 in our university teaching hospital. Consecutive patients with CUR were randomized into two groups (A & B) after excluding those with increased bleeding risk. Group A patients had gradual bladder decompression (125mls/hour) while group B patients had rapid drainage. Rebound haematuria complicating drainage was compared between both groups using student’s t-test (p<0.05).
A total of 123 patients were studied (61 in group A, 62 in group B). All were males, with mean age of 57 and 59 years in groups A and B respectively. Average duration of symptom was 18 months for group A and 20 months for group B. Aetiology of CUR was similar across both groups. Urine drained was 1.7-4.0L and 1.5-3.9L in groups A and B respectively. In group A, 14 patients (23.0%) had mild haematuria (0-1% PCV drop) which was self-limiting. In group B, 13 patients (21.0%) had haematuria which was mild & self-limiting in 10 patients (16.1%) but prolonged (>24hrs) in remaining 3 patients (4.8%), necessitating blood transfusion.
The incidence of haematuria after rapid and gradual bladder drainage is similar. However, the haematuria is more severe and prolonged following rapid decompression. There is need for more studies to validate this result.
Chronic urinary retention, rapid bladder decompression, gradual bladder decompression, Nigeria
present the clinical, paraclinical and ensure the management of the hematocolpos due to imperforate hymen revealed by the acute urinary retention in teenage girls.
it is a descriptive retrospective study with a sample of 16 teenage girls who were received in emergency for acute urinary retention. The diagnosis of hematocolpos by imperforate hymen was retained and its management was ensured in the urology department of the National General Referral Hospital of N’Djamena in Chad. Clinical, paraclinical, therapeutic and evolutionary were the variables studied.
in a period of 6 years, we have diagnosed and managed for 16 cases of teenage hematocolpos due to the imperforate hymen reveled by acute urinary retention. The mean age was 14.75 years with extremes of 12 and 18. The main consultation motive which was also the emergency was the acute urinary retention for the 16 teenage girls. An emergency urine evacuation was done before looking for its etiology. The cyclic pelvic pain, absence of menarches and acute urinary retention were the most symptoms found in all patients. The sonography confirmed the presence of the hematocolpos. The hymenotomy was successfully performed in all patients. The menses appeared in the first 30 days.
Acute urinary retention in teenage girls with notion of absence of menarches should suggest a hematocolpos by hymenal imperforation. Once diagnosed, the hymenotomy is the only surgical procedure to achieve.
hymen;hematocolpos;menarche;hymenotomy
To contribute to the study and a better management of the hypospadias in the urology department of general referral hospital of N’djamena.
It was a descriptive prospective study involving 34 patients with hypospadias over a 3-year period from October 2011 to September 2014. The variables studied were sociodemographic, clinical, para clinical, therapeutic and evolutionary.
During 3 years, 34 patients were cared for. The mean age was 3.65 with extremes of 6 months and 22 years. The majority of our patients were over 5 years old with 52.9% (n=18).The circumstances of discovery were:fortuitous (n = 8),staining of the clothes during micturition (n = 6),possible urination when sitting (n = 4),dysuria (n = 2),malformations of the external genitalia observed by parents (n=14).
The previous forms were predominant with 50%. The surgical management required the use of three techniques of urethroplasty: DUCKET, DUPLAY and MATHIEU.
Hypospadias is relatively rare in the urology department of N'Djamena. The earlier forms were predominant. Management is surgical and multidisciplinary.
penis, urethra, hypospadias, urethroplasty
Urinary tract infections are veryfrequentespecially in hospitals. Enterobacteriaceae, the germsfrequentlyresponsible for these infections, developincreasingresistance to antibiotics
Determine the epidemiological profile of the causative germs of urinary tract infections and describetheirsusceptibility to antibiotics
Retrospective and descriptive studycarried out at the CNHU-HKM of Cotonou in 6 Hospitaldepartment: Urology, VisceralSurgery, Traumatology-Orthopedics, InternalMedicine, Nephrology, Rheumatology
196 patients werecollected. 2/3 of patients werefrom the UrologyDepartment. The incidence of infections was 5.5%. A male predominancewith a sex ratio of 2.2. The meanagewas 57.4 ± 16.2 years. Urethro-vesical probe was a favorable factor. Sixty-one percent of the patients had a bladdercatheter. Prostatitispredominatedclinicalforms. Gram-negativebacilliconstituted 85.1% of the bacterialstrainsisolatedwith Escherichia coli as the main germ (47.73%). Thesestrainswere susceptible to Imipeneme, Fosfomycin and Cephalosporins. Theywereresistant to aminopenicillins and fluoroquinolones.
Knowledge of bacterialecology and the profile of susceptibility to antibioticsis essential to improve the management of urinary tract infections.
the renal acute obstructive insufficiencyisfrequent and serious. It iscaused by an obstacle on the upperexcretoryurinary tract. It involvesbothkidneys or a single anatomical or functionalkidney. We report the results of a studyconducted in the Northern Benin. The aim goal was todetermine the hospitalfrequency of renal acute obstructive insufficiency, to describeclinical and epidemiological aspects, and to evaluatetheir management.
It was a retrospective descriptive and analyticstudy of 75 collectedcases in Tanguiétaarea hospitalconductedduring 5yearsfromJanuary 1, 2010 to Decembre 31, 2015. All the cases of renal acute obstructive insufficiencytreated and monitoredin the unit duringthe studyperiodand meeting our diagnosticcriteriahad been included in the study.
During the studyperiod, 608 cases of d’IRA had been collected and 84(13,81%) was obstructiveinsufficiency. The middle age of patients was51,95±19,69years. The male patients had the majority of 62 (82,67%). The sex-ratio was4,77. The twoaimcircumstances of discoverywerelumbar pain and dysuria.The main time elapsedbetween the diuresisanomaly and the bypass was 24,91 days. The first twoetiologieswereprostatichypertrophy33 (44%) cases and lithiasis 23 (30,67%) cases.Open surgery of urinary diversion wasperformedin37 cases(49,33%) with or without obstacle lift. The recovery of the diuresis and the elevation of the creatinine clearance werenoted in most cases from the first postoperativeday.Wedeplored 7deaths (9,33 %).
the renal acute obstructive insufficiencyisfrequent and serious. The best treatmentremainspreventionwhichinvolvesearlierdiagnosis and etiologiestreatment.
renalinsufficiency, obstructive, pyelocalicial dilatation.
Ambulatory surgery is regaining interest with the concern to reduce the cost of health care to the community and to the individual
Evaluate the place of ambulatory surgery activities at the University Clinic of Urology and Andrology
This was a retrospective 5-year study from 1 January 2010 to 31 December 2014 conducted at the urology andrology clinic of the Hubert KOUTOUKOU MAGA National University Hospital Center in Cotonou. The parameters studied were age, sex, indication, type of surgery
We observed 230 ambulatory surgical activities, ie 22.4% of surgical activity. The mean age of the patients was 48.68 ± 18 years (12-93). Patients were male in 80.4% versus 19.6% for females. The indications were for male patients, condyloma cauterization, circumcision recovery, testicular pulpectomy (22.2%), JJ probe ablation, testicular biopsy, hydrocele cure. In the female sex, it was an ablation of JJ probe. The anesthesia was local in all cases. Finally the immediate operative follow-ups were simple for all the cases.
Ambulatory surgery in urology is a small proportion of our operative activity, dominated by condyloma cauterization and bilateral testicular pulpectomy. A better organization with a dedicated staff and the creation of an ambulatory surgery unit would allow its development.
Urolithiasisis a commonurologic affliction. It affects all parts of the urinary tract. Treatment of renal stones has evolvedfrom the traditionalcutting to the stone to technologicallydriventreatment minimal access options. Choice of treatment options depends on stone location, stone density, pelvicalycealanatomy, patients’ comorbidstatus, expertise of the urologist and patients’ preference.
To determine the minimal accessmethodemployed in the treatment of renal stones, their main differences and short termoutcomes.
This was a prospective, longitudinal, comparative study over a 6 monthperiod. Ethical clearance was obtained. All patients had a written informed consent. All renal stones ≥ 1cm were included. Renal stones logy, Department of Surgery, Ahmadu Bello UniversityTeachingHospital, Zaria-Nigeria.
to evaluate the frequency of swollen scrotum in children, to identify the main etiologies and to discuss management in a semi-urban region of Togo.
It was a retrospective study of patients less than 15 years of age treated for swollen scrotum at Regional Hospital of Dapaong during a period of five years, from 1st January 2009 to 31 December 2013.
Five hundred and eighty four patients had been treated for swollen scrotum. Patients under 15 years of age were 21.4% (125 cases) and had an average age of 9 years. Inguino-scrotal hernia was the most frequent cause, followed by hydrocele in respectively 49.9% and 32.8%. Treatment was surgical in 96% of cases and surgical morbidity was 2.5%.
The scrotal swelling at Dapaong is dominated by inguino-scrotal hernias and hydroceles by persistent processus vaginalis.
scrotal swelling, hernia, hydrocele, spermatic cord.
present the clinical and paraclinical aspects of chronic prostatitis and report the management in urology.
We conducted a retrospectivedescriptive study of 47 patients referred to the urology department from January 2011 to December 2013. Analysed variables were epidemiological (age, marital status, place of residence, occupation, education level, taking stimulants), clinical, paraclinical (CBC, chlamydia, syphilis and HIVserologies, urine culture susceptibility testing, semen analysis, ultrasound of urinary tree, radiographs, UCR, IVU), treatment and results.
The mean age was 44.6 years. The main reasons for consultation were dysuria (55.3%), prostatorrhea (29.8%) and sexual asthenia (12.8%). The general condition was satisfactory (80.9%), purulent drop was objectified in the urethral meatus in 10.6% of cases, and the DRE was painful at 44.68%. Escherichia Coli was the main isolated germ (23.4%). In 55.3%, calcification of the prostatic area was objectified to ultrasound of the urinary tract. The UCR had objectified bilharzia in 8.5% of calcifications of the bladder area and 19.14% of urethral stricture. The medical treatment was completed in all patients according to the etiology and complications by an instrumental or surgical treatment, offline or emergency. The outcome was favorable in 25 patients, symptoms were improved in 12 others and a failure for the ten remaining.
Chronic prostatitis is relatively frequent in urology. Clinical manifestations are diverse and varied. Treatment is difficult with a significant failure rate.
prostate, infection, calcification, chlamydiae, schistomiasis.
Kidney cancer is the third urological cancer in humans. It is nowadays increasingly discovered fortuitously and can take various aspects. We report in this case a tubulo-papillary carcinoma revealed by a renal abscess.
A 46 year old patient immunocompromised with HIV and treated by triple antiretroviral therapy was admitted for a severe infectious syndrome with a painful right lumbar mass. The abdominal scan had found a fluid collection of the right kidney in favor of a large abscess. A management in two stages of which a drainage of the collection by open way first, and then a total nephrectomy had been performed. Histological examination revealed tubulo-papillary carcinoma. The surgical follow-up had been simple and no complementary treatment had been done. Any complications had been detected on a three-year follow-up.
Kidney cancer is polymorphous and should be suspected on any renal mass.
renal cancer, abscess, nephrectomy, drainage.
Penile cancer is uncommon malignancy in western world accounting for less than 1% of adult male cancers but account for 10-20% of malignancies in men in Africa and other developing countries. Penile cancer is uncommon in Sokoto with only 2 cases recorded in 10 years.
Is to report a case of multimodal management of locally advance penile cancer in Sokoto with Surgery and radiotherapy
A 67 year old man who presented with mobile malignant penile ulcer on the ventral aspect of the root of penis which excision biopsy revealed well differentiated squamous cell carcinoma. He developed hard matted left inguinal lyphadenopathy 6 weeks after the excision. A diagnosis of stage III (T1aN2M0) was made after relevant imaging investigations. He had conformal external beam radiotherapy to the penis and groin bilaterally. There was resolution of the left inguinal lymphadenopathy. He is on regular follow-up.
Combination of surgery and radiotherapy as multimodal therapy can be used to treat locally advanced low risk squamous cell carcinoma of the penis with good outcome without inguinal lymphadectomy. This avoids the morbidity of lymphadectomy and allow patient to have better quality of life.
penile cancer, squamous cell carcinoma, multimodal therapy
To determine the outcome of paediatric day-case surgery in a community hospital based setting.
Paediatric day case surgery is a common practiceespecially during surgical outreaches, however the need to ensure acceptable levels of safety and quality of care is a major concern to paediatric surgeons. This is more so when there are no effective means for follow up and management of post-operative complications that may arise at the community level.
A prospective study of all paediatric patients who had surgery during Surgical outreach program held on 28th February, 2016. All patients were evaluated clinically and also had basic blood investigations. Patients requiring major surgeries or with acute conditions or deranged investigations results were excluded and referred to the Paediatric surgical clinic of the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Patients were reviewed 7th day after surgery. Subsequent follow upwas via phone calls.
Children constituted 48.2% of the total number of 56patients who had surgery during the outreach. In all 62 paediatric surgical patients were seen, 28(45.2%) of which had diagnoses considered not appropriate for day-care surgery, while 7(11.3%) had deranged investigation results. A total of 30 surgical procedures were performed on 27 eligible children.They were ranged between 6months-15years (median age=4.5years). Twenty-six(96.3%) of the patients were boys. Right inguinal hernia was the most common diagnoses, observed in 40%(12) patients. Herniotomy(12, 40%) and herniorrhaphy(13, 43.3%) were the common surgeries done. Only 1(3.3%) patient had superficial surgical site infection and two(6.7%) patients had associated post-operative scrotal edema.The average follow up period was 6months and all were doing well.
Paediatric day case surgery in well selected patients is safe and is associated with low morbidity even when the surgeries were performed in a community hospital.
paediatric, day case surgery, surgical outreach
Currarino’s syndrome is part of the rare syndromicforms of anorectal malformations (ARM). This isaclinical case of a male newbornwithin high ARM admitted at 3 days of life in the pediatricsurgerydepartment of the UniversityTeachingHospital of the Mother and Child Lagune in Cotonou. Colostomywasperformed in emergency. Subsequently, complementary investigations and posterior sagittal anorectoplasty (PSARP) with abdominal approach by Peñawere made.
pelvicopacityobscuring the sacrum. The PSARP stage could not identify the blend end of the rectum. So the reconstruction of sphinctéro-muscularcomplexwas made on atracheal tube. The abdominal stage led to the discovery and resection of a presacral mass. Founded rectal blind end wasthenlowered. The postoperative course wasuneventful. Postoperative X rays revealed a partial sacral agenesis. Histology of the presacral mass revealed a cysticlipoma. The diagnosis of Currarino syndrome wasthenretained. The search for a HLXB9 mutation has not been undertaken.
The lack of a social security and inadequatetechnicalfacilities in Benin limit the fields of investigation to complex pathologies likeCurrarino syndrome.
Malformation, anorectal, Currarino syndrome, child.
To determine the effectiveness and safety of oral ketamine as an analgesic in neonatal circumcision using Plastibell®
One hundred and twenty-one (121) neonates were sequentially recruited, and randomized into two groups of 55 each, with those in group A receiving oral ketamine and while those in group B received placebo (plain sucrose syrup). Each neonate was placed on continuous pulse oximeter monitoring before, during and immediately after the procedure. The procedure was carried out 30minutes after administration of the oral syrups. The pre-procedural percutaneous oxygen saturation (SpO2) and pulse rate (PR); the SpO2, PR, and neonatal infant pain scale (NIPS) score at the stages of adhesiolysis, dorsal-slit, tying and excision were recorded and analyzed for significant difference in the mean values between the two groups.
Sixty-one (61) neonates in group A received oral ketamine, while sixty (60) neonates in group B received placebo. The mean ages and weight of the two groups were 15.2 days and 15.0 days, 3.67Kg and 3.63Kg, respectively. There was no statistical differences between these two groups in their age and weight (P= .509 and .692). The mean SpO2 (95.5 vs 95.6, 95.3 vs 94.4, 94.6 vs 93.5, 95.9 vs 94.8) was lower in the placebo group and was statistically significant at the tying stage with P= .022. The mean PR (158.1 vs 162.8, 165.5 vs 175.0, 179.6 vs 192.6, 161.5 vs 178.2) was higher in the placebo group and was statistically significant in a Mann-Whitney U test at dorsal-slit, tying and excision stages (P < .05). The mean NIPS scores (3.8 vs 4.9, 3.8 vs 4.9, 4.4 vs 4.9, 3.7 vs 4.8) were higher in the placebo group and significant in all the stages. These imply that oral ketamine produced significant analgesic effect during Plastibell® circumcision in the neonates in comparison to placebo. However a paired t-test of the mean pre-procedural and intra-procedural SpO2 and PR within the oral ketamine group shows significant difference. This points out that the analgesic effect produced by oral ketamine for this procedure is not yet ideal.
There were no statistically significant side effects noticed in the neonates who received oral ketamine. The noticed side effects required no intervention and were not life threatening.
Oral ketamine has significant analgesic effect during neonatal circumcision. Oral ketamine produced significant analgesic effect during Plastibell® circumcision in the neonates in comparison to sucrose and it is safe for use in neonates for procedures. Further research is necessary in order to explore the full benefits of orally administered ketamine in paediatric surgical practice.
Oral ketamine, neonatal circumcision, Efficacy, Safety.
Nicolau syndrome also known as Emboli cutis medicamentosa is a very rare iatrogenic complication happened mostly after intramuscular injections. After few hours skin, subcutaneous fats andmuscles become necrosis. The exact pathogenesis of this syndrome still remains unclear. Perhaps Drugs micro crystals cause vascular damages or vessels traumatism . Its clinical presentation varies from simple pain with cutaneous ulceration at the site of intramuscular injection on the limb to ischemic necrosis of the entire limb. The authors report three cases of advanced ischemic necrosiss of lower limb after intramuscular injection in patients of 14 days, 11 months and 17 months. The obliteration of the vessels was confirmed by echo Dopplerh and angio-scan of lower limb. The management consisted of amputation of a segment of lower limb.
Nicolau syndrome, ischemic necrosis, intramuscular injection, lower limb, children
In sub-Saharan Africa, the growing awareness of the burden of paediatric surgical diseases highlights the enormous challenges in the access to adequate paediatric surgical care in this setting. This is more profound in the large discrepancy between the capacity to treat and the ability to afford treatment. This systematic review focuses on the sources and challenges of funding paedaitric surgical procedures in sub-Saharan Africa.
We undertook a search for studies published between January 2007 and November 2016 that reported funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review, and data abstraction were completed and analyzed with the Statistical Package for Social Sciences (SPSS).
Out of 401 abstracts, 83 were selected for textual review, and 35 underwent complete data abstraction. Countries predominantly emphasized in the publications were Nigeria, South Africa, Kenya, Ghana, and Uganda. The paediatric surgical procedures covered general paediatric surgery/urology, cardiac, neurosurgery, oncology, plastic, ophthalmology, orthopaedics, and ENT. The cost of the procedures ranged from US$7 to US$8,000 and was initially borne by the patients’ families in 91.4% of cases, which substantially limited access to mostly cardiac and neurosurgery procedures. However interventions through charity/ medical missions health insurance, and free healthcare services reduced out of pocket funding to 37.1%.Involvement of international organizations/charity and local government, effective health insurance scheme, and active intervention by World Health Organization, were the suggested solutions to funding challenges. These might require coordination, and monitoring to ensure they are sustainable.
The costs of paediatric surgical procedures in sub-Saharan Africa are borne mostly by the families of the patients. Coordinated collaboration of local government and international agencies may reduce out of pocket funding and improve access to the procedures.
Paediatric wound dressing changes are different from that in adults.Anxiety, imprecision about pain and the child’s failure to participate in the whole process make it challenging. Nursing staff are responsible for mostwound dressings. We therefore aimed to surveythe knowledge about pain control and practices of nurses during paediatric wound dressings. This would be a first step in the development of appropriate pain control protocols for such exercises.
A 17-item questionnaire was administered to 50 nurses of varying ranks on surgical wards involved with the care of children. This study was undertaken at the KomfoAnokye Teaching Hospital, Kumasi. Data was analyzed using SPSS 23.0
Twenty-four respondents were senior nurses. Most of the nurses were female (43). Length of years in practice ranged from 1 to 34years with a median of 4years. Most (26) were aged between 30-39 years. Some 29 (58%) nurses thought that children would cry during change of wound dressing, with or without pain control. While most respondents (86%) did not think that pacification and/or paracetamol were sufficient pain control measures on their own, 24 (48%) felt that Diclofenac alone was sufficient. Only 19 (38%) nurses agreed that oral midazolam was a good pre procedure analgesic. Seventeen(34%) respondents actually thought the doctors on their ward were not advocates for pain control during wound dressings.
Unambiguous pain control protocols are required on paediatric surgical wards and surgeons should lead the advocacy for pain control during paediatric wound dressings.
The global goal of ANC to ensure a healthymother and baby duringpregnancy has not been achieveddespitecurrent ANC strategies.A positive pregnancyexperienceis the focus of the 2016 WHO ANC model and itisdefined as maintainingphysical and socioculturalnormality, maintaining a healthypregnancy for mother and baby (includingpreventing or treatingrisks, illness and death), having effective transition to positive labour and childbirth, and achieving positive motherhood (includingmaternal self-esteem, competence and autonomy).
To enablehealthworkersunderstand the role of positive pregnancyexperience; and how best to implement ANC to achieveitsdesired goal.
This is a criticalanalysis of the 2016 WHO ANC model
The traditional ANC isbased on the riskapproach and13 or more visits. The focused ANC (FANC) isbased on birthpreparedness and complication readiness and 4 visits.The 2016 WHO ANC model isbased on evidence to improveoutcomes to ensure a positive pregnancyexperience and 8 contacts.
The journey to achieve the main goals of ANC has been elusive; necessitating the adoption of differentstrategies. The 2016 WHO ANC model wasdesigned to address the gaps observedwith FANC but whetheritwillachieve the ultimate goal of ANC isyet to beverified.
ANC Models
PDF (1.0 MB)
