[Breast abscess: epidemiological, diagnostic and therapeutic features in patients hospitalized in the Main Hospital in Dakar]. / Abcès du sein: aspects épidémiologiques, diagnostiques et thérapeutiques à l'Hôpital Principal de Dakar.

Breast abscesses are neoformed collections of purulent matter occupying the mammary gland and the periglandular tissue. They can occur both in lactating or non-lactating women. The purpose of our study was to describe the epidemiological, diagnostic and therapeutic features of breast abscesses in patients hospitalized in the Division of General Surgery at the main hospital in Dakar. We conducted a retrospective, descriptive study involving all patients treated for breast abscess over a 4-year period. We collected data from 41 medical records of female patients. The average age of patients was 31 years. The main risk factor was mastitis during lactation (27%). The average time of progression was 12 days, ranging from 1 to 30 days. Left abscesses were reported in 61% of cases and mostly manifested as an inflammatory swelling (88%). Upper quadrants were mainly involved (43.9%). Breast ultrasound was performed in 51.2% of female patients. Surgical drainage under general anesthesia was performed in all female patients. The mean quantity of pus was 119 cc. Staphylococcus aureuswas the most commonly isolated germ (79.5%). The average length of stay in hospital was 7 days and operative morbidity was 31.7%. Mortality was zero. Prevention of abscesses during lactation is based on improving breastfeeding practices and on early antibiotic treatment in patients with mastitis.

[Clinical, epidemiological and therapeutic features of biliary tract cancers: about 20 cases]. / Cancers biliaires: aspects épidémiologiques cliniques et thérapeutiques à propos de 20 cas.

Biliary tract cancers mainly occur in two sites: gallbladder cancer which are adenocarcinomas and intra- and extrahepatic cholangiocarcinomas. We conducted a retrospective study of 20 cases with biliary tract cancer in the Department of Surgery at the General Hospital in Grand-Yoff between January 2006 and October 2014. 40% of patients had gallbladder cancer, 60% of patients had common bile duct cancer. Sex ratio was 1. The average age of patients was 58.1 years. The average time to diagnosis was 3.77 months. Symptomatology was dominated by icteric syndrome and right hypochondrium pain. All patients had biological manifestation of cholestatic syndrome. Abdominal ultrasound was performed in 65% of patients, while abdominal CT scan in 85% of cases and MRI in 35% of cases. Advanced cancers were predominant in our case series (n=19). The majority of patients underwent palliative surgery. The most practiced treatment was biliary diversion (50% of patients). There was a predominance of cholangiocarcinomas. The overall operative morbidity rate was 43.75%. The overall mortality rate in our patients with biliary tract cancers of any site was 31.25%. Median survival was 4 months and a half. Biliary tract cancers have multifaceted features and can be differentiated essentially among intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, gallbladder adenocarcinoma whose evolution is globally different but the prognosis is spontaneously poor.

[Acute intestinal occlusion revealing abdominal pregnancy: a case study]. / Occlusion intestinale aiguë révélant une grossesse abdominale: à propos d'un cas.

Abdominal pregnancy (AP) is defined as the implantation and the development of the fertilized egg in the peritoneal cavity. It is a rare type of ectopic pregnancy, whose detection can be fortuitous, mimicking surgical emergency. We report a rare case of acute febrile bowel obstruction revealing abdominal pregnancy in a 27-year old patient, with no particular past medical history, admitted to hospital for the treatment of occlusive syndrome evolving over the last week. Physical examination showed shiny, distended, meteoric, completely sensitive abdomen. Laboratory tests showed white blood cell count 20300, haemoglobin 7,2g/dL. Surgical exploration showed hemoperitoneum 2000ml, retrouterine encapsulated mass, strongly adherent to the mesosigmoid and to the sigmoid, responsible of a stenosis of the descending colon. The patient underwent monobloc exeresis, which showed a portion of placenta next to the mesosigmoid attached to the fetus, right annexectomy and colostomy.