Myomectomies for massive hemoperitoneum from spontaneous bleeding of a uterine myoma.

Massive hemoperitoneum from spontaneous bleeding of uterine myoma is an extremely rare condition, that needs urgent surgical exploration. We report a 40-year-old woman, admitted for acute onset of abdominal pain. Physical examination revealed hypovolemic shock. The hemoglobin level was of 5 g/dL. Ultrasonography revealed hemoperitoneum. Emergency surgical exploration was planned. There was hemoperitoneum of 3 L, uterine myomas with multiple subserous myomas, bleeding from superficial ruptured varice overlying the most largest subserous myoma, which measured 15 cm. Glove adapted as a tourniquet, was applied at the base of the uterus, and myomectomies were performed with removal of around twenty myomas. The postoperative course was uneventful. Myomectomies can be safely and effectively performed by using a tourniquet, for massive hemoperitoneum with precarious hemodynamic status due to subserous myoma bleeding, despite the number and the size of myomas.

[Anatomical study of pelvic colon]. / Étude anatomique du côlon pelvien.

OBJECTIVES: Identifying the different kinds of anatomical sigmoid colon in our environment and determine what exposes the most to the occurrence of pelvic colon volvulus. MATERIALS AND METHODS: This is a transverse prospective study from 1 January 2007 to 31 December 2012 on a series of 63 patients (33 men and 30 women) who underwent laparotomy for non-colonic pathologies. For all patients, the following parameters were recorded: C1: total length of the pelvic colon; C2: the length of the root of the meso-sigmoid; C3: the height of the meso-sigmoid; C4: maximum width of the meso-sigmoid. RESULTS: C1 through the entire series was 61,3cm. C2 average was 5.5cm. C3 height and maximum width C4 were on average 14,6cm and 7.6cm, respectively. Comparison of parameters in men and women showed no significant difference. CONCLUSION: This study allows us to know the different types of pelvic colons among the population of our operated patients. The measurements performed on the pelvic colon of patients presenting volvulus will help to attribute objectively the true authorship of this surgical emergency to an anatomical type of pelvic colon.

Management of peptic pyloroduodenal stenosis in Sylvanus Olympio teaching hospital in Lome (Togo).

This study's aim was to describe the management of ulcerous pyloroduodenal stenosis in Sylvanus Olympio teaching hospital of Lomé (Togo). It was a retrospective study of medical files of all patients managed for peptic pyloroduodenal stenosis at the visceral surgery department of Sylvanus Olympio teaching hospital in Lomé (Togo) from january 1(st), 2002 to december 31(th), 2011. Twenty-five patients were selected. Mean age was 38 ± 7.4 years. Sex-ratio was 5. Twenty four patients underwent upper digestive tract endoscopy, completed by upper gastrointestinal series in 18 cases. One patient had only an upper gastrointestinal series. Pyloroduodenal stenosis was improved by antisecretory therapy in 3 cases. Twenty two patients underwent laparotomy. Truncal vagotomy was performed in 15 cases associated with pyloroplasty in 8 cases, and gastrojejunostomy in 7 cases. An antrectomy was performed in 5 cases. Selective vagotomy was associated with pyloroplasty in 1 case, and a gastrojejunostomy in 1 case. One patient died in postoperative period. Functional results were classified Visick I (17 cases) and II (4 cases). Peptic pyloroduodenal stenosis affects young adults. Its tight nature requires association of upper gastrointestinal series and esophagogastroduodenoscopy for diagnosis. Its surgical treatment is exclusively performed by laparotomy at present. Mortality is low and functionnal prognosis is good.

[Diagnostic, therapeutic, and prognostic aspects of typhoid intestinal perforations in Dapaong, Togo]. / Aspects diagnostiques, thérapeutiques et pronostiques des perforations typhiques du grêle à Dapaong, Togo.

PURPOSE: This study's aim is to describe the diagnostic, therapeutic, and prognostic aspects of typhoid intestinal perforations (TIP) at the Dapaong regional hospital (Togo). MATERIAL AND METHODS: This retrospective study covered all patients with such perforations seen and managed in the Dapaong regional hospital's general surgery department during the 3-year period of 2009-2011. RESULTS: There were 110 patients with TIP during the study period, and they accounted for 67.9% of the patients treated for generalized peritonitis (162 cases). Their mean age was 10.2 years. The sex-ratio was 1.4. A single perforation was present for 69 patients (62.7%) and multiple perforations for the other 41 (37.3%). Sixty (54.5%) patients underwent simple closure, 36 (32.8%) had an ileal resection and enteroanastomosis, and 14 (12.7%) had loop or double-barrelled ileostomy. The postoperative course was complicated in 26 cases (23.6%), most often by surgical site infection, seen in 19 patients (17.3%). Overall, 23 patients died during the postoperative period, for a mortality rate of 20.9%. CONCLUSION: Typhoid intestinal perforations are the most common cause of generalized peritonitis at the Dapaong regional hospital. Most patients have only a single perforation, which is repaired by excision-suture. Their morbidity and mortality rate are high.

[Management of surgical abdominal emergencies in Kara teaching hospital (Togo): 10-year retrospective study of 594 cases]. / Prise en charge des urgences abdominales chirurgicales au centre hospitalier universitaire de Kara (Togo): étude rétrospective à propos de 594 cas sur une période de dix ans.

PURPOSE: The aim of this study was to describe the epidemiologic, diagnostic, and therapeutic aspects of surgical abdominal emergencies in a teaching hospital in a developing country (Togo). MATERIAL AND METHOD: This retrospective study included the medical files of all patients managed for surgical abdominal emergencies from March 1, 2002, to March 1, 2012. RESULTS: The study included 594 patients, with a mean age of 30.3 years (range: 1 month to 80 years) and a 2.1 male:female sex ratio. The emergencies were acute generalized peritonitis (54.5%), intestinal obstruction (26.6%), acute appendicitis (14.5%), and abdominal trauma (4.4%). Plain abdominal radiographs were taken for 414 patients with acute generalized peritonitis (324 cases) and intestinal obstructions without a strangulated hernia (90 cases). Nine patients had abdominal ultrasounds for abdominal trauma (5 cases) and appendicular abscess (4 cases). No abdominal CT scan was performed. All patients underwent surgery, 316 (53.2%) by physician assistants and 278 (46.8%) by surgeons. Resuscitation and anesthesia were performed by nurse-anesthetists. The postoperative course was complicated in 182 cases (30.7%). These complications included parietal suppurations (18.2%), eviscerations (5.1%), ileal fistulas (4.4%), and postoperative peritonitis (3%). The death rate was 11.4%. CONCLUSION: Surgical abdominal emergencies at the Kara teaching hospital were both common and serious. Their particularly high morbidity and mortality might be reduced through the adoption of reasonably practicable measures: paramedical personnel training, public awareness, establishment of management protocols, and improvement of technical equipment (laboratory).

[Zuckerkandl's tubercle: incidence and relationship with the inferior laryngeal nerve]. / Le tubercule de Zuckerkandl: incidence et rapport avec le nerf laryngé inférieur.

UNLABELLED: The iatrogenal lesion of the inferior laryngeal nerve (ILN) during thyroid surgery is an incident, which can have greatest functional after-effects. Its research is recommended during cervicotomy for thyroidectomy and it can be easily found by the presence of Zuckerkandl tubercle, which is a postero-lateral excrescence of the thyroid gland. OBJECTIVES: The main objective of our study was the researching of the presence of this Zuckerkandl tubercle and appreciating the reports with the ILN. PATIENTS AND METHODS: From 1st October 2010 to 30th September 2012, we realized a continuous prospective study on a mono-operator series of 48 patients operated on for thyroidectomy. The Zuckerkandl tubercle has been researched from all the patients and classified according to the classification of Pelizzo et al. RESULTS: From 21 patients (43.75%), the Zuckerkandl tubercle has been well identified and it was grade 3 and grade 2. In those cases, the ILN was very closed to the tubercle. For the 27 other patients (56.25%), the tubercle was practically undetectable or reduced to a small glandular mound (grades 0 and 1). The connections with the nerve in this case were less evident. CONCLUSION: The zuckerkandl tubercle is comparatively frequent and is refound more than one time over 3 in our study. Its presence makes easier the identification of the ILN, which entertains a dangerous connection with the thyroid gland.

[Management of spinal cord compression in Togo]. / Prise en charge des compressions médullaires lentes au Togo.

PURPOSE: The aim of this study was to describe the epidemiologic, clinical, diagnostic and therapeutic aspects of spinal cord compression at the Lomé-Campus teaching hospital. MATERIAL AND METHOD: We retrospectively analyzed the files of all patients hospitalized for spinal cord compression at Lome-Campus teaching hospital from January 1, 1998, through December 31, 2007. RESULTS: 39 files were selected, mostly of men (77%). The mean age was 53 years (range: 22 to 79). Median time from the start of symptoms to hospital admission was 14.9 ± 24.5 weeks. The spinal cord compression was confirmed by myeloscan in 35 cases (90%), myelography in 2 (5%) and magnetic resonance imaging in 2 cases (5%). The thoracic spine was the most common site of involvement. The principal cause was malignant neoplasm (17 cases: 44%), followed by cervical spondylotic myelopathy (9 cases: 23%) and Pott's disease (7 cases: 18%). Only one patient underwent surgery. CONCLUSION: Spinal cord compression appears to be a rare condition in Togo. It is a true medical emergency and immediate intervention is required. Its management remains precarious and its prognosis poor.

[Management of secondary hyperparathyroidism in patients with chronic kidney disease undergoing dialysis in Togo]. / Prise en charge des hyperparathyroïdies secondaires chez des patients dialysés au Togo.

PURPOSE: To evaluate the means for diagnosis and treatment of secondary hyperparathyroidism in patients with end-stage renal disease undergoing regular hemodialysis. METHODS: This prospective investigation studied patients with chronic renal kidney disease requiring and receiving hemodialysis at the Tokoin University Hospital in Lomé, from January 21, 2008, through December 31, 2008. RESULTS: The study population comprised 42 patients: 24 men and 18 women ranging in age from 20-82 years (mean: 42.62 years). Hyperparathormonemia was found in 20 of 24 patients for whom parathormonemia was assayed. Two patients with hyperthyroidism received a phosphorus chelator, and another went to Egypt for renal transplantation. The various other treatments we applied were not efficacious. We noted three cases of pathological fractures and one case of sudden death. CONCLUSION: The risk of parathyroidism in patients receiving hemodialysis is unavoidable. Its course is marked by a risk of sudden death due to the cardiovascular damage it causes. Numerous factors impede its effective management in Togo.