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Journal of the West African College of Surgeons logoLink to Journal of the West African College of Surgeons
. 2017 Jul-Sep;7(3):137–170.

Peer-Reviewed Abstracts of Scientific Paper Presentation at The 57th Annual Conference Of The West African College Of Surgeons at Ougadougou, Burkina Faso 26th February – 4th March 2017.

PMCID: PMC6237410  PMID: 30525008
J West Afr Coll Surg. 2017 Jul-Sep;7(3):137.

orificiel syndrome in gastric cancers in general surgery

BT Dembélé 1, A Traoré 1, A Togo 1, L Kanté 1, AA Traoré 1, T Koné 1, Y Sidibé 1, A Bah 1, M Konaté 1, I Tounkara 1, B Karembé 1, I Diakité 1, DM Diango 1, G Diallo 1

introduction

The orificiel syndrome occurs very frequently in the stomach cancer.

Objectives

The objectives of this work were to study the epidemiological, clinical and therapeutic aspects of the orificiel syndrome in gastric cancer.

Methodology

This was a 15-year retrospective study from 1999 to 2014, including any patient with confirmed gastric cancer in the anatomical pathology with orifice syndrome in the department.

Result

We have collected over a period of15 years(1999-2014),372 orificiel syndrome cases, representing 53.3% of stomach cancers, 29.6% of digestive cancers and 2.1% of hospitalizations. The sex ratio was 1.5; the average age was 56 years with extremes of 27 and 84 years and a standard deviation of 13.3. The average time of evolution of orificiel syndrome was 3.5 weeks with extremes of1 and 6 weeks and a standard deviationof 5.2. 75(seventy five) patients (20.2%) were admitted in emergencies.The main signs found were: vomiting 335/335 cases (100%), dysphagia 37/37 cases (100%) weight loss 364 cases (97.8%), epigastric mass 172 cases(46.5%), fastinglapping 168 cases(45.2%) and ascites105 cases(28.2%). 192 patients were classified as WHO grade III(78.5%); WHOII45 cases(12.1%) and WHOIV 35 cases(9.4%). A large majority of our patients,267 (71.8%), had an ASA score III or more. The pyloricantrum-seat was the most represented 335 cases(90.1%), cardia location in 37cases. Adenocarcinoma was the most common histological type351(94.4%). The operability rate was 75% (282 patients): 46 patients (16.3%) had agastricre section; 184 cases(65.3%) of gastro-enteroanastomosis; 32 cases(11.3%) of feeding stoma; 90patients (24.2%) were not operated. Morbidity was 25.6% and mortality 14.5%. Thefore cast is very poor with a 3-year survival of 4,3%.

Keywords

stomach cancer syndrome orificiel, Bamako Mali.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):137–138.

SCROTAL SQUAMOUS CELL CARCINOMA: A CASE REPORT AND LITERATURE REVIEW

TA Badmus 1, AA Salako 1, MC Igbokwe 1,✉, RA David 1, A Laoye 1, IA Akinbola 1, E Aigbe 1

Background

Squamous cell carcinoma (SCC) of the scrotum is very rare in clinical practice. It is linked with occupational exposure to certain industrial carcinogens. Reports on the disease are still relatively rare in world literature.

Objectives

To present the clinical presentation, management challenges and outcome of scrotal SCC treated in our university teaching hospital.

Case Report

Our index patient is a 65-year old man referred to us with a two year history of progressive scrotal swelling which ulcerated after it was incised in the referral hospital. He had worked as a welder all his life and was already totally blind in both eyes from chronic exposure to various dangerous products during his career.There was no evidence of metastasis.

Examination revealed a huge, fungating mass with raised edges taking up the whole of both hemi-scrotum and actively discharging sero-purulent effluent. There were no palpable inguinal lymph nodes and incisional wedge biopsy was compatible with scrotal SCC.

He had wide local excision of the mass. The right testis was morbidly adherent to the tumour hence a right orchidectomy. Advancement flap closure of the resultant scrotal defect was done. He developed surgical site infection post-operatively, but treated successfully with topical antibiotics and dressings. Histopathology confirmed tumour free margins and he has remained stable, 18 months after the procedure.

Conclusion

Although rare, SCC is the most common malignancy, affecting the scrotum worldwide. Surgery remains the mainstay of treatment and early intervention improves results.

Keywords

Scrotum, Squamous cell carcinoma, Case report, Nigeria

J West Afr Coll Surg. 2017 Jul-Sep;7(3):138–139.

ADENOCARCINOMA OF THE DUODENUM: About a case observed at the Sylvanus Olympio University Hospital of Lomé-Togo

K BIGNANDI 1,✉, K SIMLAWO 1, A AMAVI 1, EJ AMETITOVI 1, T DARRE 1, D DOSSEH 1

Summary

Cancers of the small intestine are rare and represent between 1% and 5% of digestive cancers according to the authors. Adenocarcinoma of the duodenum is the most common histological type. The symptomatology most often silent, leads to a late diagnosis at an inoperable stage in most cases, despite advances in digestive exploration. The prognosis with or without adjuvant or neo adjuvant chemotherapy after or without surgery is reserved. Few studies in the literature and particularly in Africa have addressed this type of cancer. No case has been published in Togo in the past 20 years.

This case is a 50 - year - old patient with no previous history or risk factors admitted for intermittent epigastric abdominal pain with minimal abnormal hematemesis. It had a progressive alteration of the general state. A digestive endoscopy allowed to objectify a chronic bulbous ulcer stenosing at the bulbar tip associated with a chronic bulbite with large mucous folds. He did not have any biopsies. Intraoperative exploration revealed a tumor mass developed at the expense of the first duodenal segment without ganglionic invasion or distant metastasis. The patient received cephalic duodeno-pancreatectomy. Histological examination of the surgical specimen revealed a well differentiated adenocarcinoma of the duodenum classified T2NxMx.

We will discuss from this rare case of digestive cancer diagnostic, therapeutic and scaling options.

Keywords

Digestive cancer, duodenal adenocarcinoma, cephalic duodeno-pancreatectomy, Togo.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):139.

CHANGING TREND OF TRANSITIONAL CELL CARCINOMA OF THE BLADDER IN A NIGERIAN PEOPLE

AA Salako 1, TA Badmus 1, Akinbola IA 1,✉, MC Igbokwe 1, RA David 1, A Laoye 1

Background

Squamous cell carcinoma from Bilhaziasis is the more common form of histologic bladder cancer in sub-Saharan Africa. Recent studies however show a rising pattern of transitional cell carcinoma (TCC) in our practice as in other developed parts of the world.

Objectives

To report the changing trend of TCC in a semi-urban population of southwestern Nigeria.

Methods

A retrospective review of clinical and pathological records of all bladder cancer cases managed between January 2006 and December 2015 in our university teaching hospital was done. Cases of TCC were identified, extracted and analyzed.

Result

A total of 38 histologically confirmed bladder cancers were diagnosed during the study period. TCC accounted for 61%, Squamous cell carcinoma 16%, Adenocarcinoma 13%, while secondary bladder tumour from prostate cancer accounted for 10%. Of the patients with TCC, mean age was 60 years ±13.4SD while the male to female ratio was 4:1. Ninety-five percent of them presented with haematuria. Identified risk factors include smoking (43%) and industrial exposure to carcinogens (14%). Only 26% of the TCC cases were non-muscle invasive while the remaining 74% were muscle invasive. Eighty-seven percent were treated while 13% defaulted further treatment in our hospital after diagnosis. Among those treated in our centre, 7 (30%) had combinations of radical cystectomy, intravesical chemotherapy using Mitomycin C and chemotherapy and are presently on follow-up. Two patients (9%) have died, while 6 (26%) are still on treatment with either intravesical chemotherapy or chemotherapy. The remaining 8 patients (35%) have been lost to follow-up.

Conclusion

TCC is on the increase possibly due to cigarette smoking, increasing urbanization, industrialization and eradication of schistosomiasis in our environment.

Keywords

Transitional cell carcinoma, Changing trend, Ile-Ife, Nigeria.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):140.

COLON CANCER: Diagnostic and therapeutic aspects

A Togo 1,✉, BT Dembélé 1, A Traoré 1, M Diassana 1, I Diakité 1, L Kante 1, Y Sidibé 1, S Pamateck 1, G Diallo 1

Objectives

To describe the diagnostic aspects and to analyze the results of the surgery.

Methodology

we performed a retrospective study (2000-2014), a period of 15 years. We include all patient admitted to our department for colon cancer were confirmed by histological examination. The data carriers were register of consultation, hospitalization, operating roum register, pathological examinations and anesthesia register. Convocations and telephone calls were conducted to determine patient survival.

Result

In 15 years, 175 cases of colon cancer were include, accounting for 12.04% of digestives cancers and 51.2% of colorectal cancers. The average age of patients was 52.19 years with extremes of 19 years and 90 years. The sex ratio was 1.33. The most important functional signs were abdominal pain (92.6%, n = 162), rectorragie (39.4%, n = 69), melena (8%, n = 14) and the alternation of diarrhea and constipation (26.9%, n = 47). Abdominal mass (42.9%, n = 75) and abdominal distention (34.9%, n = 61) were the most frequent physical signs. Colonic occlusion was the mode of revealing the tumor in 38.9% of the cases (n = 68). For diagnostic we performed abdominal radiography with colon opacification (53%, n = 93) and colonoscopy was performed (45.7%, n = 80).) Left colon cancers were found in 63.6% (n = Stage III was found in 63.6% (n = 111), 93.7% adenocarcinoma (n = 164), and surgery was performed in 92.6% (N = 162), colectomy was performed in 75.3% (n = 132), and immediate postoperative morbidity was 24.6% and the postoperative mortality was 9.9%. Survival at 5 years was 21.5%. Prognostic factors were: TNM stage, quality of surgery and adherence to chemotherapy.

Conclusion

Colon cancer is common in our practice. The most frequent complication is bowel obstruction. Chemotherapy and adequate surgery must be performed to improve the prognostic.

Keywords

Colon cancer Surgery prognostic.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):141.

Management of breast cancer in the surgical department B of Point G University Hospital since the advent of chemotherapy in Mali

O Siby 1,✉, B Bengaly 1, D Traoré 1, B Coulibaly 1, B Togola 1, S Diallo 1, D Ouattara 1, G Timbely 1, B Ba 1, S Sanogo 1, M Coulibaly 1, B Dena 1, N Ongoiba 1, F Sissoko 1

Summary Introduction

The objective was to study the management of breast cancer in our department since the advent of chemotherapy.

Methods

This was a descriptive study with a retrospective collection over 6 years (January 2005 to December 2010) in the surgical department "B" at the Point G hospital.

Result

76 patients representing 0.9% of service visits during the period indicated. 75 women and 1 man were recruited, with an average age of 47.17. At the time of diagnosis, 89.4% of patients were in stage III or IV

Surgical treatment was performed to 64 patientsincluding 57 curative surgeries and 7 palliative surgeriesSurgery was associated with chemotherapy in 70.7% (50/76) and radiotherapy in 3 patients.

Overall survival was 22.4% (17/76) at 5 years, 31 patients died, 28 patients were lost to follow-up5-year survival was higher in patients who received surgery followed by adjuvant chemotherapy with a statistically significant difference (p = 0.04).

Conclusion

The prognosis of breast cancer remains poor despite the advent of chemotherapy. This is partly due to the delay in diagnosis.

Keywords

breast cancer, chemotherapy, survival

J West Afr Coll Surg. 2017 Jul-Sep;7(3):141.

PAPILLARY RENAL CELL CARCINOMA REVEALED BY RENAL TRAUMATISM: A CASE REPORT IN LOMÉ

Tchilabalo Matchonna Kpatcha a,✉, Kodjo Tengué a, Gnimdou Botcho a, Kossi Akomola Sabi c, Komi Hola Sikpa a, Essomendedou Léloua a, Edoé Viyomé Séwa a, Obube Amegayibor a, Tsipa Anoukoum a, Tchin Darré b, Koffi Amégbor b, Ekoue David Dosseh d

Abstract

This study is a report on a case of papillary carcinoma of the kidney revealed by an abdominal contusion. The results of radiological investigations were discordant with the low intensity of the shock. The treatment consisted of radical nephrectomy because of the suspicion of a pre-existing malignancy. Histological analysis revealed a papillary carcinoma pT3N0M0. We focus on the need for performing diagnostic tests in order to avoid missing a pre-existing anomaly to the kidney trauma.

Keywords

renal papillary carcinoma; renal trauma; nephrectomy; Lomé.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):142.

BONE TUMOR CELL GIANT WRIST: ABOUT 01 CASES IN CHU SYLVANUS OLYMPIO.

A Sogan *,✉, A Walla 1, K Adabra 2, K Amavi 2, A Dossim 1

ABSTRACT

The bone giant cell tumors (GCT) are benign tumors with aggressive potential usually localized to the epiphysis of long bones. Their evolution is dominated by the unpredictable risk of local recurrence. We report 01 cases of wrist TCG whose evolution has been marked by relapses that led to the amputation of the forearm.

Keywords

bone giant cell tumors, wrist

J West Afr Coll Surg. 2017 Jul-Sep;7(3):143.

Injury severity in patients with facial fracturesand concomitant injuries

R Béogo 1,✉, TA Coulibaly 1, I Traoré 1, HM Kohoun 1, WH Dakouré Patrick 2

Introduction

Facial fractures in combination with other serious injuries occur in a significantproportion of trauma patients. The objective of this study was to evaluate injury severity and its determinants infacial fracture patients presenting with associated injuries.

Patients and Methods

A retrospective study was carriedout in 110 patients, in a university hospital in Burkina Faso.

Result

Two-wheel motor vehicle collisions were byfar the main aetiology. Cranial injuries and limb fractures were the most common associated injuries. The injuryseverity score (ISS) ranged between 5 and 75 (mean 11.1, SD 8.3). Severe injury, defined as ISS above 15, wasrecorded in 13.6% of the patients. Death was recorded in two patients, giving a mortality rate of 1.8%. There wasa statistically significant association between the ISS and multiple facial fractures (p = 0.001).

Conclusion

Giventhe retrospective character and the limited sample size of this study, the IS and its determinants could have beenunderestimated. However this work provides knowledge on the IS in patients presenting with facial fractures andconcomitant injuries, in Burkina Faso. The findings of this study indicate the need for special attention in patientspresenting with multiple facial fractures in the emergency room.

Keywords

Facial Fracture; Associated Injury; Injury Severity Score

J West Afr Coll Surg. 2017 Jul-Sep;7(3):144.

DIAGNOSIS AND TREATMENT OF CRANIO-FACIAL MUCORMYCOSIS: A CASE REPORT AND REVIEW OF LITERATURE

R Béogo *,✉, I Traoré *, TA Coulibaly *, HM Kohoun *, BV Ili †, D Ouédraogo †

Background

Head is the most common localization of mucormycosis, a very rare fungal infection with challenging diagnosis and treatment.

Case report

A 65-year-old immunocompetent woman presented with a six-month history of headaches, nasal obstruction and facial pseudo tumoral swelling. Histopathological examination of a biopsy of the facial swelling schew vascular thrombosis and tissue invasion by aseptate hyphae suggestive of mucormycosis. The patient was diagnosed as having cranio facial mucormycosis. Treatment was possible only with fluconazole given intravenously during 3 weeks. After an initial satisfactory clinical remission,the patient died. On the basis of this experience and a review of the literature, the approaches of diagnosis and treatment of cranio facial mucormycosis are discussed.

Conclusion

Rhinosinusal symptoms, headaches and a facial pseudo tumoral swelling should lead to suspect cranio facial mucormycosis. Histopathological proof should be sufficient for the diagnostic. Treatment should combine antifungal therapy with a polyene otherwise posaconazole, surgery of the tissue necrosis and an eventual predisposing factor control.

Keywords

Mucormycosis; Diagnosis of mucormysis; Treatment of mucormycosis ; Prognostic of mucormycosis.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):144.

ENDODONTIC PRACTICE AMONGST NIGERIAN RESIDENT DOCTORS

SO Gbadebo ✉, IMF Abiodun-Solanke , DM Ajayi

Background

Endodontics is widely practiced across the globe in alleviating pulpal pain and pathologies in order to maintain the affected teeth as a functional unit of the arch. This study was aimed at understanding the practice of endodontics amongst Nigerian doctors and to see if the practice is done according to recommended standard protocol.

Methodology

A cross sectional study that employed self administered questionnaire to resident doctors during an update course. The protocol for endodontic treatment, materials employed and were amongst the information obtained.

Result

Ninety (57 males and 33 females) respondents filled the questionnaire. The mean age of participants was 34.81 ± 5.9. The Majority of respondents perform an average of,5 root canal treatment (RCT) per week and only about 15%perform the procedure on multi rooted teeth. Rubber dam was never used as claimed by 72.2% of respondents, (92.9%) still use conventional radiographs, and 69% of respondents use stainless steel files. Step down technique of biomechanical preparation was employed by majority (53.9%) and sodium hypochlorite was major irrigant of choice (80%) while cold lateral condensation was the most employed technique of obturation (95.5%). A high proportion (69.2%) still use amalgam for restoration of access cavity in the posterior region and majority (52.4%) delay the placement of the definitive restoration of access cavity.

Majority were not satisfied with their current knowledge and practice of endodontics and most of these respondents were those that felt they did not have good undergraduate training on endodontics. (p = 0.04).

Conclusion

There is need to standardize endodontic protocol across the nation as it is being done in some other countries, to improve practice for success of the procedure and effective management of the patients.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):144.

Wire internal fixation: an obsolete, yet valuable method for surgical management of facial fractures

Béogo Rasmané 1, Bouletreau Pierre 2, Konsem Tarcissus 3, Traoré Ibraïma 1, Antoine Toua Coulibaly 1, Dieudonné Ouédraogo 3

Background

In some developing countries wire is still widely used in facial fractures internal fixation. This study presents the results of wire osteosynthesis in a university teaching hospital in Burkina Faso and discusses its benefits and disadvantages.

Methods

Notes of 227 patients with facial fractures treated by wire internal fixation between 2006 and 2010 are reviewed retrospectively.

Results

A satisfactory treatment outcome was recorded in 91.2% of the 227 patients. Complications occurred in 8.8% of the patients who had operative site infection (3.1%), malocclusion (1.8%), sensory disturbance (1.8), facial asymmetry (1.3%), delayed bone union (0.9%) or enophtalmos (0.4%). The overall complications rate was 7.4% after mandibular osteosynthesis, 6.9% after Le Fort osteosynthesis and 6.5% after zygoma osteosynthesis. Post operative infections occurred irrespective to the surgical site. The other complications were more specific to the surgical site.

Conclusion

Wire internal fixation may be a reasonable alternative for the surgical treatment of facial fractures in setting of limited resources.

Keywords

Facial fracture; Wire internal fixation; Outcome

J West Afr Coll Surg. 2017 Jul-Sep;7(3):146.

MANAGEMENT OF FACE BONES FRACTURES. THERAPEUTIC DIFFICULTIES. Our experience at the Niamey National Hospital from February to November 2016

AKO KADRE 1,✉, S ILLE 1, N TIMI 1, H MAYAOU 1

Summary: Context

The management of face bones fracture is a real challenge for the maxillofacial practitioner in a country such as Niger where the specialty is still little known.

Objectives

Report our experience on the management of face bones fractures in the Department of Stomatology and Maxillofacial Surgery at the Niamey National Hospital.

Methodology

This is a prospective study from February to November 2016 during which: 94 patients consulted for a face bone fracture. 52 patients had a displaced mandibular fracture, 6 had a non-displaced mandibular fracture. 18 patients had a fracture of the facial and mandibular massive. 15 patients had fracture of the facial massive, and 3 had an orbito-frontal fracture.

Results

65 patients benefited of maxillo-mandibular blockage, 4 benefited of osteosynthesis with steel wire, 5 had mini-plate osteosynthesis, 15 had mixed osteosynthesis, and 5 had functional therapy. Our results were satisfactory in 95.75% of the cases.

Conclusion

The management of face bones fractures constitutes a real therapeutic stake considering insufficient technical platform and lack of knowledge of the specialty.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):146–147.

RECONSTRUCTION OF LOSS OF BONE SUBSTANCE AFTER SURGERY IN MAXILLO-FACIAL SURGERY. OUR EXPERIENCE AT NIAMEY NATIONAL HOSPITAL.

AKO KADRE 1,✉, S ILLE 1, N TIMI 1, H MAYAOU 1

Oral communication Summary: Context

Reconstruction of bone loss is a real surgical problem for the maxillofacial practitioner in a country such as Niger where the specialty is still poorly known with very limited means.

Objectives

To Bring out Our experience on the reconstruction of bone loss following surgery at the Department of Stomatology and Maxillofacial Surgery at the Niamey National Hospital.

Methodology

This is a prospective study from February to November 2016. During this study: 17 patients were consulted for maxillofacial bone tumor, 3 patients had maxillo-malar tumor and 14 had mandibular tumor. The management consisted of interrupter resection with costal and iliac graft reconstruction.

Results

2 patients benefited from an orbital reconstruction by costal graft and 1 by iliac graft for the loss of maxillo-malar bone. 14 patients benefited from costal graft reconstruction for loss of mandibular interrupter substance. 2 cases of osteitis and 1 fracture on costal graft were recorded. We recorded 2 cases of disappearance.

Conclusion

The reconstruction of loss of bone substance in maxillofacial surgery underlines a real problem restoration with need of micro-surgery intervention.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):147.

MAIDEN PAEDIATRIC LAPAROSCOPIC CHOLECYSTECTOMY IN A NIGERIAN HOSPITAL- A WORTHWHILE ADVENTURE Case report

A Adebayo Adedayo 1,✉, S Oguntola 1, Adetunji 1, N Adedamola Idowu 1

Background

Minimal access surgery has evolved for quite sometime now. Advantages of this technique abound, with quite a number of open surgical techniques virtuallybeing replaced by it. Laparoscopic cholecystectomy is currently accepted as a gold standard in the definitive treatment of symptomatic cholilithiasis. In our setting however, paediatric laparoscopic cholecystectomy is still erupting. This might be attributed to non-availability of appropriate equipment, inadequate training and training facilities and previous un-encouraging and unrewarding attempts.

Case report

We report the first case of laparoscopic cholecystectomy in our institution in a 14yr old boy with symptomatic cholilithiasis previously managed conservatively for recurrent cholecystitis. The recovery was not adversely eventful. We narrate our challenges and potential pitfalls encountered during the procedure.

Conclusion

Paediatric laparoscopic cholecystectomy is quite rewarding. Its merits out rightly outweigh its numerous challenges. There is always a room for improvement with new starters and experience is still the greatest teacher. We sincerely hope that our experience will add up to greater future achievements to us and clinicians in settings similar to ours.

Keywords

Cholecystectomy, cholelithiasis,laparoscopic, minimal access

J West Afr Coll Surg. 2017 Jul-Sep;7(3):148.

NEONATAL GASTROINTESTINAL PERFORATION PERITONITIS

Oumarou Habou 1,✉, Harissou Adamou 1, Magagi Ibrahim Amadou 1, ada Omid Ali 1, Hellé Moustapha 1, Magagi Amadou 1, Habibou Abarchi 1

Objective

To describe the etiological and prognostic aspects of the newborn's gastrointestinal perforations.

Patients and Methods

This is a retrospective review of all cases of neonates treated for gastrointestinal perforation between 2008 and 2015 in the pediatric surgery departments of Niger.

Result

This study involved 17 patients, 6 girls and 11 boys with an average age of 7 days. The median intake weight was 2753 grams. Prematurity was found in 5 patients and 3 showed meconium delay. The average time of diagnosis was 31.25 hours (extreme 14 hours and 4 days). All patients had abdominal distension on admission, 11 had an altered general condition and pneumoperitoneum was found on all abdominal X-Ray. The perforation was located on the stomach in 2 cases, the small bowel in 6 cases, the cecum in 3 cases, the ascending colon 1 cases, the transverse colon 1 cases, the sigmoid colon in 2 cases and the rectum in 2 cases. The perforation was iatrogenic in 5 cases and in 7 cases, an ulcerative necrotizing enterocolitis was identified. A digestive stoma was performed in 12 patients, resection-anastomosis in 3 cases and gastric suture in 2 cases. The overall mortality was 70.59% (12/17).

Conclusion

Neonatal peritonitis is responsible for a high death rate. The absence of a neonatal resuscitation unit and delay in diagnosis are the main factors of gravity.

Keywords

neonatal peritonitis, gastrointestinal perforation, necrotizing ulcerative enterocolitis, iatrogenic perforations.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):149.

Management of child hernia as a day care surgery

Oumarou Habou 1,✉, Harissou Adamou 1, Magagi Ibrahim Amadou 1, Magagi Amadou 1, Habibou Abarchi 1

Aim

Report our experience ofchild congenital hernia as a day case surgery.

Patients and Methods

This is a prospective study conducted in the Department of Pediatric Surgery of the Zinder National Hospital between March 2014 and April 2016 in children with congenital hernia. Informed consent from parents was collected and assessed prior to surgery and during the first return visit.

Results

The mean age of patients was 7.35 months. 227 surgical procedures were performed in 212 patients, including 189 boys and 23 girls. The umbilical hernia accounted for 59.9% of cases (n = 127), groin hernia 33.02% (n = 70) and hernia of the white line 7.08% (n = 15). The hernia of the groin was unilateral in 78.57% (n = 55) and bilateral in 21.43% (n = 15) and in 8.57% (n = 6) cases it was an ovarian hernia No per-operative incidents were observed. Morbidity was 8.96%. The failure rate was 0.94% (n = 2). We did not record any deaths. Before the intervention 21.7% (n = 46) of the parents expressed their fear that the patient would be discharged on the day of the intervention. However, 97.16% (n = 206) of parents were satisfied with the procedure at the first return consultation.

Conclusion

The congenital parietal hernia of the child is a frequent pathology. Its treatment in an outpatient setting presents a low morbidity and constitutes a sure solution, appreciated by the parents in our context.

Keywords

parietal hernia, children, day care surgery, ambulatory surgery, Niger

J West Afr Coll Surg. 2017 Jul-Sep;7(3):150.

Pediatric laparoscopy at University Hospital of the Mother and Child Lagune (CHU-MEL) in Cotonou

AS Gbenou 1, I Lawani 2, J Bonou 1, MA Fiogbe 3, Tristan J Uroz 4

Introduction

Laparoscopy is part of the new operative techniques in pediatric surgery.

Purpose

The purpose of this study was to report the conditions of its initiation in the pediatric surgery department at the CHU-MEL in Cotonou, with the results obtained and perspectives.

Material and Method

Learning with laparoscopic techniques began during the foreign surgical missions and was reinforced by courses on simulator. The laparoscopy was performed for diagnostic and therapeutic purposes.

Results

A total of 48 children were operated, 15 of them outside the missions from January 2013 to august 2016. The sex ratio was 7. The average age of the children was 11.5 (± 5.5) years. The cases of inguinal hernias concerned 03 girls and 02 boys The varicoceles (33) were of grade III and operated by the technique of Palomo. Of the testicular ectopias (07), two were testicular agenesis. One case of intraoperative diagnosis of ovotestis was noted. There were 3 cases of appendectomy, and an ovarian cyst resection. The recto-urethral fistula in a case of anorectal malformation was explored. The mean duration of the intervention was 50 minutes (22 min -120 min) for a varicocele, 78 minutes (65 min -80 min) for an inguinal hernia and 31 minutes (16 min- 60 min) for ectopia. The surgery was simple. The duration of hospitalisation was 2 days in 47 cases.

Conclusion

Learning and continuous practice of surgical laparoscopy has made it possible to carry out explorations and treatments of various digestive and urological affections of the child with good results.

Keywords

laparoscopy, child, Benin.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):152–153.

Presentation of children with rectal prolapsed in an African setting- a myth or a fallacy- preliminary review

A Adedayo Adebayo 1,✉, David Onilede 2

Background

Rectal prolapsed is found commonly in extremities of age. In children, it is commonly seen in less than 3 years of age. In majority of cases a spontaneous resolution occurs after addressing the underlying pathologies and predisposing factors. The aetiopathogenesis often guides further treatment if need be. On the contrary, in our setting several pathologies affecting the lower gastro-intestinal tract are erroneously classified as one. And often, the treatment is generalized. Presentation at the hospital sometimes depicts some of these treatment modalities. We narrate our experience in the management of 5 children seen in our hospital with pre-hospital treatment of rectal prolapsed over 18month period (February 2015- December 2016).

Aims and Objectives

To share our experience of children with rectal prolapsed following local treatment

Methods and Materials

This is a prospective study. Proforma was filled for patient at presentation and updated as necessary. The subjects’ biodata, pre-hospital treatment, presentation and treatment given were analyzed. Complications with previous therapy were noted. Period of relief of symptoms and complete resolution were also noted.

Result2

Five cases were reviewed over the set period. Four were female and 1 was male (age range; 1year-4years). Four were simple prolapsed while 1 was complete. All the simple prolapsed were reducible. All had received one or more form of home treatment e.g traditional oral herbal concoction, hot concoction sitz bath, locally applied ointment etc. Two subjects had complications following hot concoction sitz bath; one of whom had gluteal burns with natal cleft contracture and fusion and the other had full thickness anorectal burns. The latter required an emergency divided sigmoid colostomy.

Conservative treatment with stool softener improved prolapsed in 3 patients. The patient with natal cleft contracture had contracture release and gluteal fold reconstruction. Her rectal prolapsed had improved at the time of the reconstruction. The child with anorectal burns had an emergency diverting sigmoid colostomy and rectopexy. a distal colostogram confirmed complete rectal stenosis. She will later benefit from a definitive pull-through and colo-anal anastomosis.

Conclusion

Rectal prolapsed has been since antiquity. Late presentation and presentation of children with complicated conditions following traditional attempt at treatment is still common in our setting. This can be linked to wrong believes and poorly understood aetiopathogenesis of this conditions in our setting.

Keywords

aetiopathogenesis, anorectal, colo-anal anastomosis, hot sitz bath, reconstruction, rectopexy

J West Afr Coll Surg. 2017 Jul-Sep;7(3):153.

Surgical outreach: A safe and effective method for Paediatric surgical day case surgery

Tunde T Sholadoye 1,✉, Halima O Aliyu 2, Philip M Mshelbwala 3

Aim

To determine the outcome of paediatric day-case surgery in a community hospital based setting.

Background

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.

Method

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.

Results

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 considerednot 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.

Conclusion

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.

Keywords

paediatric, day case surgery, surgical outreach

J West Afr Coll Surg. 2017 Jul-Sep;7(3):155.

THORACIC WOUNDS BY BLAST TO GAO " REVIEW BY 5 CASES RECEIVED IN THE UNIVERSITY HOSPITAL - HOSPITAL OF MALI "

M Bazongo 1, J Saye 1, IB Maiga 1, Ombotime A 1, CAS Toure 1, A Sanou 2, S Togo 1, MA Ouattara 1, S Yena 1

Introduction

thoracic blast trauma is severe.

Objective

To describe the diagnostic, therapeutic and evolutive aspects of induced lesions.

Patients and Methods

This is a prospective and descriptive study carried out in the department of thoracic surgery at the university hospital-Hôpital of Mali following a suicide bombing in Gao on 18 January 2017. The survivors victims referred to Bamako and with thoracic blast lesions were included. Their diagnostic, therapeutic and monitoring data were analyzed.

Result

A total of 5 patients were included, including one woman. Patients were aged 22 to 46 years. The thoracic trauma was closed in all cases. In two cases, a thoracic parietal wound was associated. Thoracic CT was performed in all cases. Pleural effusion was found in three patients. Pulmonary contusion was noted in two cases. A tracheal wound associated with a gaseous effusion of the mediastinumwas noted in one patient. The associated lesions were subcutaneous emphysema in three cases, a fracture of the scapula in one case. From a therapeutic point of view, thoracic drainage and trimming were performed in three and two patients, respectively. A tracheotomy was performed in a patient. All patients received a vaccine and a anti-tetanus serum, a analgesia and a antibiotic therapy. The evolution was simple in all cases.

Conclusion

Thoracic trauma following a blast is severe, multiple and varied. Thoracic CT allows mapping of the lesions caused and thoracic drainage constitutes the essential part of the surgical treatment.

Keywords

Thorax, Trauma, Blast effect, Treatment

J West Afr Coll Surg. 2017 Jul-Sep;7(3):156.

THE FIRST CASE OF RHEUMATIC POLYVALVULOPATHY OPERATED IN BAMAKO

S Togo 1, CAS Touré 1, A Ombotimbe 1, IB Maiga 1, J Saye 1, AA Maiga 1, N Ouologuem 1, M Konaté 1, J Dackouo 1, M Coulibaly 1, O Fomba 1, MA Ouattara 1, S Yena 1

Abstract

Mitral insufficiency (MI) is valvular heart disease characterized by regurgitation of left ventricular (LV) blood in the atrium (OG) during some or all of the systole secondary to mitral valve incontinence. Rheumatic etiology is most frequently found in developing countries. Valvular Plasty is the ideal surgical treatment in a child. To illustrate this assertion we report the case of the first open heart valvular plasty performed in Mali since independence.

It was a young child of 12 years old, student, with a history of angina of rheumatic origin, followed in ambulatory one year. He had a NYHA stage III dyspnea on a rheumatic polyvalvulopaty with a major IM. Echocardiography resulted in dilation of OG and the triscupid ring, grade IAo II and PAH. We performed a mitral and tricuspid plasty of DEVEGA. The evolution was simple and a post-operative cardiac ultrasound confirmed the absence of mitral and triscupid leaks. In light of this observation and a review of the literature, we insist on the indications and advantages of a valvular plasty in the management of cardiac complications of the RAA and its feasibility in a local hospital structure.

Keywords

Mitral insufficiency, Gravity, Open heart surgery

J West Afr Coll Surg. 2017 Jul-Sep;7(3):160.

THE WOUNDS OF THE ABDOMEN BY FIREARM AT THE CHU-YO

E Ouangré 1,✉, M Zida 1, PG Bonkoungou 1, RN Doamba 1, A Ouedraogo 1, M Bazongo 1, E Sawadogo 1, R Kafando 1, N Zongo 1, A Sanou 1, SS Traoré 1

Introduction

The wounds of the abdomen by gun are traumas with rupture of the abdominal parietal continuity.

Objective

To describe the epidemiological, clinical, paraclinical, therapeutic and evolutive aspects of wounds of the abdomen by firearm in the general surgery department of CHUYO.

Material and Method

This was a 5-year cross-sectional study (2011-2015) that included patients over the age of 15 admitted to the CHUYO for abdominal wounds by firearm.

Results

We collected 50 cases of abdominal wounds per gun or 29.23% of abdominal trauma. The sex ratio was 7.33 with an average age of 31.6 years. Patients came from urban areas in 74% of cases. The informal sector accounted for 39.4%. The circumstances of the occurrence were an aggression in 46%. The pistol was involved in 34.37%. The majority of patients were 84% consulted within a period of less than six hours. The peri-umbilical region was reached in 26%, hail was affected in 32.43%. Hemoperitoneum was the clinical picture in 47.91%. A laparotomy was performed within a period of less than six hours in 91.66%. The average hospital stay was 10.57 days. Morbidity was 22.91% and mortality was 12%.

Conclusion

The wounds of the abdomen by firearm is in marked increase in our country. Regulating the weapon will reduce its impact.

Keywords

Abdomen, gun, CHU-YO

J West Afr Coll Surg. 2017 Jul-Sep;7(3):161.

Laparoscopy in a Semi-urban Nigerian Hospital: an Outcomes-focused Comparative Analysis of Laparoscopic and Open Surgery

Katherine E Smiley 1, Funmilola Wuraola 1,✉, Bolanle O Mojibola 1, Adewale Aderounmu 1, Raymond R Price 1, Adewale O Adisa 1

Background

Patient benefits and cost savings of laparoscopic surgery are well described in surgical literature. However, laparoscopy is rare in some regions. Few studies have characterized its impact in low-income settings. We present one of the largest case series in sub-Saharan Africa.

Objectives

To describe patient outcomes and costs of laparoscopic vs open general surgery cases at one semi-urban Nigerian hospital.

Methods

A retrospective chart review identified 261 patients who underwent open or laparoscopic cholecystectomy, appendectomy or biopsy of intra-abdominal mass at the Obafemi Awolowo Hospital in Ile Ife, Nigeria. Primary outcome was length of stay; secondary outcomes included mortality, wound complications, analgesic use, and cost. Patient medical record data was limited, but included age, gender, and pre-operative diagnosis. Univariate comparison of laparoscopic versus open outcomes were assessed for statistical significance using Student’s t-test, Wilcoxon rank-sum test, and chi-squared test.

Results

Of 261 cases, 151 were laparoscopic; 7 (4.6%) converted to open. Average age for laparoscopic was 39.1 years (SD 15.4), vs 37.9 (SD 15.0) for open. Length of stay was lower in the laparoscopic group, 4.7 days vs 11.5 for open (p <0.001). Overall complication rates were 19.9% for laparoscopic vs 22.7% for open (p = 0.576). Overall mortality was low (8 deaths), with significantly more in the open group (6.4% vs 0.7%; p = 0.008). Total costs were lower with laparoscopy: 32,000 Naira vs 44,700 (p <0.001).

Conclusion

Laparoscopic general surgery allows for shorter length of stay, significant cost savings, and equivalent complication rates in the Nigerian population.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):162.

Laparoscopy in Nigeria: A Countrywide Survey of Current Training Paradigms and Practice Patterns

Katherine E Smiley 1, Funmilola Wuraola 1,✉, Raymond R Price 1, Adewale O Adisa 1

Background

Laparoscopy allows for swifter recovery with fewer complications; these benefits translate to the developing world. Laparoscopic training, however, remains a challenge in low- and middle-income countries. Nigeria is among the more medically advanced nations in Sub-Saharan Africa, yet is estimated to have fewer than thirty laparoscopic general surgeons. Little is known about their training pathway.

Objectives

To better understand the training experiences and current practice of Nigerian laparoscopic surgeons, we conducted a survey at the annual meeting of the Laparoscopic Surgical Society of Nigeria (LASSON).

Methodology

A 24-question survey captured surgeons’ experiences, including residency exposure, case volume, and equipment availability. The survey was emailed to LASSON members two weeks before the meeting. Paper copies were available at the meeting. Data was collected in REDCap and extracted with Microsoft Excel.

Results

The survey was distributed to 68 surgeons. Twenty-six surveys were completed by 24 consultants and 2 senior registrars. Twenty (77%) participated in training abroad: 13 (65%) in India, 5 (25%) in the United Kingdom, 4 (20%) in South Africa, and one each in nine other nations. Twenty-three (88%) trained in general surgery and 1 each in urology, paediatric surgery, and obstetrics/gynaecology. None had laparoscopic exposure in medical school. Less than half (46%) had any during residency, with most residents performing less than 5 cases total.

Conclusions

Laparoscopic training experience in Nigeria is limited, leading most to seek advanced training abroad. Improving local facilities may reduce the burden of training and increase the number of surgeons proficient in laparoscopy.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):163.

Post-traumatic acute generalized peritonitis (AGP) at the CHU-YO in Burkina Faso: epidemiological, clinical, therapeutic and evolutive aspects

C Zaré 1, E Ouangré 2, H Belemlilga 1, RM Daboué 2, IA Traoré 1, SS Traore 2

Objective

To study post-traumatic AGP in the general and digestive surgery department of CHU-YO in order to improve management.

Methodology

This was a longitudinal observation and descriptive study over a five-year period from March 1, 2011 to February 29, 2016.

Result

101 cases of post-traumatic AGP were collected, 6.6% of AGP and 2.4% of abdominal emergencies. The sex ratio (M / F) was 6.8 with an average age of 30.1 years. 63.4% of the patients came from urban areas and 73.8% were surgically treated within 24 hours of admission. In 76.2% of cases, abdominal bruises were causal trauma. The circumstance of occurrence was a public road accident in 63.4% of the cases. The X-ray of the abdomen without preparationwere the most used medical imaging examination in 47.5% of the cases. All patients benefited from laparotomy. The small intestine was the most affected organ in 87 cases. Parietal suppuration was the major complication in 17.8%. Mortality was 2%.

Conclusion

Early management of post-traumatic AGP improves the patient's prognosis.

Keywords

peritonitis, post-traumatic, management, CHU-YO

J West Afr Coll Surg. 2017 Jul-Sep;7(3):163.

"Handlebar" hernia: a rare type of traumatic parietal hernia

Ousseini Adakal 1,✉, Harissou Adamou 1, Ibrahim Amadou Magagi 1, Moussa Koini 1, Maazou Halidou 1, Oumarou Habou 1

Abstract

We report the case of a 20-year old patient with a personal history of fall over his motorcycle handlebar occurring 28 days earlier. He was admitted in emergency surgery with abdominal pain. Clinical examination showed a circular impact area at the level of the left hypochondrium associated with painful swelling, irreducible and with no impulse on coughing The diagnosis of traumatic parietal strangulated hernia was established. The patient underwent surgical treatment using midline laparotomy revealing parietal breach associated with incarceration of a portion of the omentum which was necrotic. The necrotic omentum was resected and the breach was sutured. The postoperative course was simple and the patient was discharged on d5.

Keywords

Traumatic parietal hernia, handlebar hernia, omental incarceration

J West Afr Coll Surg. 2017 Jul-Sep;7(3):164.

SAFETY AND PRACTICALITY OF EARLY POST-MASTECTOMY DISCHARGE AND DOMICILIARY DRAIN CARE IN ILE-IFE, NIGERIA: A PRELIMINARY REPORT.

O Olasehinde 1,✉, OI Alatise 1, OA Arowolo 1, AO Adisa 1, C Boutin Foster 1, TP Kingham 1

Background

Early post-mastectomy discharge with home drain care is the practice in most developed countries. The safety and practicality of this has not yet been evaluated in our setting.

Aim

To evaluate the practicality of early post-mastectomy discharge and home drain care and compare its outcome with the traditional long stay practice.

Method

Consenting patients undergoing mastectomy with favourable home circumstances, were discharged on the 3rd post-operative day after having been taught how to operate and empty the wound drains. Jackson Pratt drainage tubes connected to a 100milllilitre bottle were utilized for the study. Those who for reasons of consent, social concerns and anticipated post-operative challenges remained on admission for drain removal served as the comparative group.

Socio-demographic data, tumour characteristics and post-operative wound complications, primarily seroma were compared between the two groups. Those in the early discharge group were further interviewed using a seven item study specific questionnaire to assess their experience.

Result

Overall, there were 38 patients, 19 in each group with a mean age of 51±8.7 years, and a mean BMI of 26.9±6.2kg/m². The majority (52.6%) had stage 3B disease while 18.4% presented with ulcerated masses. These characteristics did not significantly differ between the two groups.

By design the early discharge group had shorter post-operative stay (3 days versus 11 days, p< 0.01). Seroma rate did not differ between the two groups, 5/19 in the early discharge group and 7/19 in the long stay group (p=0.485). Flap necrosis and wound infection rates were also comparable(p=0.461, 0.703 respectively).

All 19 patients in the early discharge group, despite less than half (42.1%) of them having tertiary education all felt confident operating the drain. None of the patients would have preferred a longer hospital stay with dislike for the hospital environment and reduced cost being the commonest reasons cited for their preference. They were all willing to recommend early discharge to other patients.

Conclusion

Early post-mastectomy and home drain care is practicable in our setting, acceptable to our patients and is not associated with higher complication rate compared to the traditional long stay.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):164–165.

Spectrum Of Colononoscopic Findings In Sokoto, Northwest Nigeria

Bashir Bello 1, Umar Muktar 1,✉

Background

Colonoscopy is considered as safe and effective diagnostic and therapeutic modality for colorectal diseases. It gives an excellent view of the colonic mucosa and is considered as the gold standard for the diagnosis of colorectal diseases. In the study area (Sokoto), the facility for performing colonoscopy is not commonly available.

Objective

To evaluate the spectrum of colonoscopic findings in our environment.

Methodology

A three year retrospective study of all patients referred for colonoscopy and done at UsmanuDanfodiyo university teaching hospital (UDUTH) Sokoto, from January 2014 to October 2016 were included in the study.Their case notes were retrieved and examined. A profoma was used to record the biodata and colonoscopic findings.

Result

There were 204 patients, comprising of 131 (64.2%) males and 73(35.8%) females with a male: female ratio of 1.8:1. The most common age group was 40-55years. The mean age of patients was 46.9 +/- 14.8years and a range of 19-85years. The most common pathologies detected were Haemorrhoids 53(26%) patients, diverticular disease 17(8.3%) patient, rectal tumors 17(8.3%) patients and colitis 9(9.3%) patients. Polyps detection rate was 5%.

Conclusion

Colonoscopy is a safe and effective method of detecting colonic abnormalities in our setting and in contrast to previous believe, diverticular disease and rectal tumors are common in the study area.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):165–166.

CAUSTIC ESOPHAGEAL STENOSIS: EPIDEMIOLOGICAL, DIAGNOTIC AND THERAPEUTIC ASPECTS IN VISCERAL SURGERY AT TEACHING AND HOSPITAL CENTER HUBERT KOUTOUKOU MAGA OF COTONOU

KC VIGNON 1,✉, DK MEHINTO 1, P SODONOUGBO 1, DOSSOU P SOSSOU 1, EOF CHABI 1, NATTA N’TCHANH 1

Aims

Study its epidemiological, diagnostic and therapeutic aspects

Method

About a retrospective study in visceral surgery at CNHU-HKM of Cotonou, from January 1st, 2001 to March 31th, 2011; 24 cases of esophageal caustic stenosis were analyzed

Results

The frequency was 2.3 cases /year and this pathologie represents 0.33% of hospitalized patients. The average age of patients was 31.2 years; the sex-ratio was 1.6. They were essentially married persons (15/24) and Christians (19/24). Dysphagia only or not was present in all the patients, caustic soda was especially involved (13/24) andattempted autolysis the first etiological circumstance (23/24). There was good general condition (15/24), patients without oral hurts(19/24) and patients without abdominal pain (20/24). Were realized: duodenal gastro esophageal endoscopy (17/24), duodenal gastro esophageal transit (12/24), both examinations (5/24). Stenosis position on esophagus was: cervical (3/24), thoracic (9/24), abdominal ((5/24), staged (1/24), gastro esophageal portion (4/24), pyloro gastro esophageal portion (1/24), esophagus and pylorus (1/24). Treatment was: endoscopic dilatation (22/24) successfully in 9 cases, definitive feeding jejunostomy in other cases including cases of failure of dilation (15/24). The morbidity was 2 cases of parietal suppuration (2/15), the mortality was 1/24. The evolution at 4 months was favourable.

Conclusion

Caustic stenosis of the esophagus was observed mostly in young men who attempted suicide. The treatment was mainly endoscopic dilation with a high failure rate.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):167.

NO TUMORAL PYLORO-DUODENAL STENOSIS: THERAPEUTIC ASPECTS IN VISCERAL SURGERY AT TEACHING AND HOSPITAL CENTER OF COTONOU

KC VIGNON 1,✉, DK MEHINTO 1, BA CODO 1, DOSSOU P SOSSOU 1, P SODONOUGBO 1, NATTA N’TCHANH 1

Aims

To describe its therapeutic aspects.

Method

About a retrospective study from January 1st, 1990 to March 31th, 2012 (22 years 3 months) in visceral surgery at the CNHU of Cotonou, 124 cases of non-tumorous pyloroduodenal stenosis were analyzed.

Results

The frequency was 5.6 cases / year, average age 41.5 years, sex ratio 2.3. During an adapted preoperative medical resuscitation, 6 patients (4.8%) had died. The etiology was ulcerous (116 cases, 98.3%) and caustic (2 cases, 1.7%). After median laparotomy a stenosis was found: bulbar (68 cases, 57.6%), pyloric (35 cases, 29.7%) and pylorobulbar (15 cases, 12.7%). Surgical procedures for ulcerative stenosis were: bilateral truncular vagotomy with pyloroplasty (71 cases/116, 61.2%) or gastrojejunostomy (3 cases, 2.6%) or antrectomy and gastroduodenostomy type Pean (8 cases, 6.8%) or lower polar gastrectomy and gastrojejunostomy type Finsterer (5 cases, 4.3%); Isolated pyloroplasty (15 cases, 13%); Isolated gastrojejunostomy (5 cases, 4.3%); Antrectomy and gastroduodenostomy type Pean isolated (3 cases, 2.6%); Lower polar gastrectomy and gastrojejunostomy type Finsterer Isolated (6 cases, 5.2%). The eradication of helicobacter pylori was systematic. Isolated pyloroplasty was performed in both cases of caustic stenosis. Postoperative complications (8 cases, 6.8%) were dominated by parietal suppurations (6 cases, 5.1%) and any patient died after operation.

Conclusion

Appropriate preoperative medical resuscitation was systematic. The ulcerative etiology predominated and the postoperative evolution was mainly favorable.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):167–168.

Transplant ileocolic right for causticesophagealstenosis: about two cases at the Benin

Y IMOROU SOUAIBOU 1, FM DOSSOU 2, I LAWANI 2, DG GBESSI 1, AT DIALLO 4, FHR GNANGNON 1, G ATTOLOU 3, DK MEHINTO 3, J-L OLORY-TOGBE 1, KO BAGNAN 3

Introduction

the causticstricture of the esophagus, due to itss everity and its frequency underestimated, is currently recognized as a neglected public health problem. It is all the more seriousitis associated with stenosis pyloroduodenale. The therapeutic indications are variable. The objective of our work is to report ourtherapeuticstrategy and the results of the support of two cases of causticstricture of the esophagus which one is associated with stenosis pyloroduodenale stenosis.

Case Report

Two patients underage 15 (Mr MF) and 37 (Mr HF) have been supportedrespectively to the Cotonou CHNU and at the Porto Novo CHDU-OP in 2013 and 2016 for causticstricture of the esophagus secondary to ingestion of water from battery. The youngesthad no psychiatric history while the second had a psychiatric instability. Theywere all associatedwithdysphagia of incoercibles vomiting. An oesogastroduodenal transit had objectified tiered thoracic esophageal stenosis associated pyloroduodenale complete stenosis at the youngest and a short tight stenosis of the middle third of the esophagus in the other. Initial treatment of Mr MF had been to an esophageal dilation to Savary candle and a pyloroplastieaccording to HeineckeMiculitzfollowed by three sessions of esophageal dilatation without success. The oesophagoplastie was made in both cases with a sternal retro right ileocolique transplant by ways of xipho-umbilical first and cervical left. The appendectomywassystematic. Our anastomoses weremanual, oeso-ilealtermino-Terminal, colo-gastrictermino-lateral and ileo-colictermino-lateral. The postoperativewereinitially simple. But Mr HF wasreadmitted to the 55th day post-op for a cervical fistulathat has dried up aftertwoweeks.

Conclusion

the double causticesophagealstenosis and pyloroduodenalerequires a sequentialsupported. Esophageal dilatation isfeasible, reproducible, and avoids a stoma of power. Our results are satisfactoryafterascendingoesocoloplastie.

Keywords

causticstricture, esophagus, oesophagoplastie, right ileocolique transplant.

J West Afr Coll Surg. 2017 Jul-Sep;7(3):168–169.

GALLBLADER TUBERCULOSIS MIMICKING TUMOR : A CASE REPORT.

AO TOURE 1,✉, M FAYE 1, O THIAM 1, ML GUEYE 1, M CISSE 1, O KA 1, M DIENG 1

Introduction

Tuberculous involvement of the gallbladder is rare.The pseudo-tumorform poses a differential diagnosis problem with gallbladder cancer. Diagnosis is usually post operative with the histological analysis of the gallbladder.

Observation

A 51-years-old male patient presenting episodes of hepaticcolic with nocturnal vesper of ever. Abdominal examination objectified an ovoid painfull mass of the right hypochondrium, evoking a dilated gallbladder. Biological exams showed no inflammation and hepatictests were normal. Hepatobiliary MRI was in favor of multi-lobularcystic mass of the gallbladder evoking a cysticvesicular tumor or hydatidcyst. On sub-costalsurgical exploration there was a tumor of the bottom of gallbladder measuring about 4 cm, without extension on liver. Cholecystectomy was performed. After removal, we noticed a milkyliquid issue from the gallblader, with many little stones. The post-operative course was marked with skin infection treated by local care and antibiotic. Histological analysis showed a gallbladder tuberculosis. An anti-tuberculous treatment Rifampicin + Isoniazid + Ethambutol + Pirazinamide) was instituted during 6 months.Two months later, the patient presented an incisional hernia treated with prothesis. There was no further complication after.

Conclusion

Pseudo-tumortuberculosis of the gallbladder is exceptional, even in tuberculous endemic countries. Clinical, imaging and biology are not specific. The diagnosis is made by pathological analysis. A well-conducted antituberculosis treatment can lead to healing.

Keywords

tuberculosis, gallbladder

J West Afr Coll Surg. 2017 Jul-Sep;7(3):169.

FREQUENCY OF HIV IN SURGICAL ENVIRONMENT OF BAMAKO : DEPARTMENT GENERAL SURGERY CHU GABRIEL TOURE

I Tounkara 1,✉, L Kanté 1, A Togo 1, BT Dembélé 1, A Traoré 1, M Konaté 1, I Diakité 1, M Sagara 1, A Bah 1, A Koné 1, T Koné 1, G Diallo 1

Objectives

To determine the hospital frequency of HIV / AIDS in operated patients, surgical indications, postoperative complications and factors influencing the duration of hospitalization.

Methodology

This was a retrospective study of 1999-2012, ie a period of 12 years. The 36 HIV-positive patients operated in the general surgery department were included. HIV serology and viremia were performed in collaboration with biologists. The data carriers were records of consultation, hospitalization, operational report, biological check-up and anesthesia records. The postoperative follow-up was done by convocation and by telephone call.

Results

Our sample of 36 patients operated showed a predominance of female (58.3%), male 41.7% for an average age of 32 years. The age group of 16-45 was the most represented. Of our patients, 88.1% of our patients lived in urban areas (Bamako and the regional capitals); Housewives were the most represented with 25%. Of our 25,734 patients, 447 were tested for HIV, a screening rate of 1.7% ; 36 HIV-positive people were detected, an HIV prevalence of 8%. The surgical interventions were represented by generalized peritonitis (19.44%), anal suppurations (22.22%), appendicitis (11.11%). Morbidity was dominated by surgical site infection (22.22%). The mortality was (8.33%).

Conclusion

HIV infection is a public health problem in Mali. The association of human immunodeficiency virus and surgical pathologies is common in Mali. Patients are most often received in an acute abdomen emergency setting. Specific antiretroviral therapy and improvement of certain indicators (CD4, viremia) before and after surgery would help reduce the risk of perioperative morbidity and mortality in patients.

Keywords

HIV / AIDS, General Surgery, Gabriel Touré Hospital

J West Afr Coll Surg. 2017 Jul-Sep;7(3):170.

Skin transplant in the surgical department "B" of the "G" Point Hospital in Bamako

D Ouattara 1,✉, B Togola 1, B Bengaly 1, O Dienta 1, H Dicko 1, B Coulibaly 1, Babou Ba 1, M Coulibaly 1, S Sanogo 1, O Siby 1, S Diallo 1, B Dena 1, D Traoré 1, N Ongoiba 1, F Sissoko 1

Introduction

The lesions requiring a skin graft are increasingly varied.

Objective

The purpose of this work was to determine the indications and to analyze the results of the skin graft.

Methods

This was a prospective retrospective study performed in surgery department "B" over a period of 34 years (1980 - 2104). All the patients who had a skin transplant and whose record was exploitable were recorded.

Results

We identified 50 patients who underwent a skin transplant. The lesions to be grafted were in the lower limbs in 60%. The average duration of lesions was 1 year. The indications of the graft were essentially the losses of substance following the resection of the cicatricial flanges 40%, an ulcero-necrotic wound in 32%, malignant tumors in 14%.The average grafted surface was 13.2 cm 2. The techniques performed were mainly thin skin graft in 68%, a total skin graft in 30% and a mixed graft in 2% of the patients. The surgical sequence was complicated with infection in 6% of cases. Average hospital stay was 28 days. Aesthetic quality was considered good for 84% and satisfactory for 16% of patients.

Conclusion

The lesions to be grafted are dominated by the flanges, the infectious ulcero-necrotic wounds and the excision of malignant tumors.

Keywords

wound - ulcer-necrotic - loss of substance - skin graft

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