[A rare triple combination of mesenteric panniculitis, acute appendicitis and König´s syndrome in a patient operated for acute febrile intestinal obstruction: a case report]. / Une rare triple association de panniculite mésentérique, appendicite aigüe et syndrome de Koenig chez un patient opéré pour une occlusion intestinale aigüe fébrile: à propos d'un cas.

Mesenteric panniculitis is a primary inflammation of the mesentery with variable necrosis, inflammation and fibrosis of the fatty tissue. It can be idiopathic (primary) or secondary (associated) to other diseases, asymptomatic and accidentally discovered or revealed by abdominal pain or complications (intestinal obstruction or peritonitis). We here report the case of a 53-year-old patient, admitted with acute abdominal pain, cessation of the transit of materials and gases, in a febrile context. Patient's history included chronic abdominal pain suggesting König´s syndrome and epigastralgia lasting several years. Physical examination showed sore face and abdominal examination revealed mild bloating, marked tenderness in the right iliac fossa (RIF) and in the periumbilical region, without guarding or rigidity and borygms heard on auscultation and with normal rectal examination. A diagnosis of bowel obstruction and fever was made, with suspicion of meso-celiac appendicitis. Abdominal X-ray without preparation and ultrasound confirmed the diagnosis of bowel occlusion. Exploratory laparotomy revealed functional stenosis of the ileum (König´s syndrome) at 1.20m from the ileocecal junction, with multiple adhesions. Adhesiolysis revealed hyperemic appendix measuring 15cm long, whose anatomo pathological examination showed a mucous membrane with inflammatory infiltrate and a wall rich in polynuclear cells. Infiltration of the ileal mesentery causing color change (reddish and greyish in some areas) and small nodosities with friability and tearing on simple handling led to suspicion of mesenteric panniculitis, then confirmed by anatomopathological examination, showing inflammatory reaction in the fatty tissue specimen with infiltration by macrophages, associated with necrotic patches and degeneration. Treatment was based on bowel emptying, anterograde appendectomy, and a combination of corticosteroid (Dexamethasone 24 mg/day) and chymotrypsin (10000 IU/day). The patient´s outcome was good and he was discharged in the 10th postoperative day. The patient underwent clinical and paraclinical follow-up (3 months) for another unknown associated pathology or a pathology that may have occurred early.

[Penile glans amputation during non-hospital circumcision: about two cases]. / Amputation totale du gland lors de la circoncision en milieu non hospitalier: rapport de cas.

Penile glans amputation during circumcision is a tragic operator-related complication. Standard treatment is based on microsurgical reimplantation with vascular and nerve anastomosis. We here report two cases of penile glans amputation in two children. The first patient was aged five years and was admitted urgently after circumcision. Penile glans was reimplanted without microsurgical anastomosis within one hour of the date of the accident. The other patient was aged 11 years and was received 3 years of the date of the accident. During these three years he had received psychological therapy. He was scheduled for plastic surgery. In the first patient, urinary, sensitivity and cosmetic results of the glans were good as well as erectile function.

[Mesenteric abscess due to Chryseobacterium meningosepticum revealing mesenteric Castleman´s disease in an immunocompetent young adult]. / Abcès mésentérique du au Chryseobacterium meningosepticum révélant la maladie de Castleman à localisation mésentérique chez un jeune adulte immunocompetent.

Mesenteric abscess caused by chryseobacterium meningosepticum is an extremely rare clinical entity, most often found in immunodeficient patients. Castleman disease can manifest as a mesenteric abscess. We here report the case of a 23-year-old patient admitted with generalized acute peritonitis evolving over the last 2 weeks. Abdominal ultrasound showed hypoechoic mass in the intestinal loops, without any further details. During laparotomy, pus was found in the large cavity, a mesenteric abscess was detected in the mesentery of the jejunum 35 cm from the angle of Treitz, without loop perforation and mesenteric adenopathy was found in corresponence with the abscess. Pyoculture isolated chryseobacterium meningosepticum. Histological analysis of mesenteric adenopathy biopsies showed structural anomalies, suggesting hyaline vascular type of Castleman disease. Treatment was based on incision and drainage of the abscess, with pyogenic membrane removal and abdominal cavity lavage with physiological saline solution. Chryseobacterium meningosepticum was only susceptible to Ciprofloxacin. The postoperative course was simple and the patient was discharged on postoperative day 10 after surgery. Clinical and paraclinical follow-up at 12 months did not show any other lymphadenopathy or recurrence. The purpose of this study is to show an extremely rare case of mesenteric abscess due to chryseobacterium meningosepticum associated with isolated mesenteric Castleman disease in an immunocompetent patient and management approaches.

[Conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: a case serie]. / Traitement conservateur des omphalocèles géantes par l'éosine aqueuse disodique 2%: une série des cas.

Primary surgical closure for the treatment of giant omphalocele is punctuated by the onset of unpleasant complications. Conservative treatment is an option in low-income countries where neonatal resuscitation is associated with high mortality rates. We conducted a prospective study of patients admitted to the University Clinics of Lubumbashi between January and April 2020 and receiving conservative treatment based on dissodic 2% aqueous eosin according to a defined protocol. Three patients were included in our series. The mean age was 24 hours (1 - 48); they were all full term newborns (38 - 39 SA), born vaginally and with no prenatal diagnosis. Mean birth weight was 2,800 grams (2,400 - 3,000). Mean amniotic sac diameter was 13.7 cm (11 - 15 cm); it contained the liver in all cases. The median time to enteral feed was 4.3 days (4 - 5 days), to granulation was 31.7 days (30 - 33 days) and to epithelialization was 71.7 days (60 - 90 days). No death was reported. These preliminary results encourage the use of disodium aqueous eosin for the conservative treatment of unbroken giant omphaloceles.

[Anorectal malformations: a 6-years review at the University Clinics of Lubumbashi]. / Malformations anorectales: revue de 6 ans aux Cliniques Universitaires de Lubumbashi.

Anorectal malformations (ARM) are developmental anomalies of the genitor anal elements, they represent a wide range of anomalies. An early diagnosis allows a better management as it reduces mortality associated with ARM, especially in developing countries. A prospective cross-sectional study has been carried, including patients from 0 to one year, admitted in our service for ARM. Twenty-four (24) patients have been considered. The median age was 2 days, the sex ratio 1/3 for female. Intestinal occlusions were the most frequent circumstances of diagnosis (50%), low ARMs were the most frequent, diagnosed in 11 patients (45.7%) of which 10 did not have any fistula. The most common associated malformation was intestinal atresia (3 patients). Anoplasty was done using abdominoperineal pull-through associated to anal dilatations in 13 patients (54.1%). Six patients died from unknown etiology and 6 were lost from the follow-up. Concerning the functional outcome, 12 of the 24 patients concerned by the study attended review and 3 of them presented signs of fecal incontinence, 9 of them were continents among whom 8 were diagnosed low ARM and one with high ARM. ARMs are encountered in our environment, nonetheless, the diagnosis is still made most of the time, during an intestinal occlusion. The mortality rate is still high and measures should be taken to allow long-term reviews, which will surely reduce the number of lost patients.

[Cystic hygroma of the neck in a young adult: about a case and literature review]. / Lymphangiome kystique du cou chez un adulte jeune: à propos d'un cas et revue de la littérature.

Cystic hygromas are congenital malformations affecting the lymphatic system. These are rare benign dyssembryoplastic lesions mainly affecting the head and neck, in particular the posterior triangle of the neck. They usually occur during childhood and exceptionally in adults. We here report a clinical case of cystic hygroma of the neck in a 22-year old subject.

[Delayed management of anorectal malformation with rectouretrobulbar fistula: a case study]. / Malformation anorectale avec fistule recto-uretro-bulbaire prise en charge tardivement: à propos d'un cas.

Ano-rectale malformations (ARM) are a spectrum of heterogeneous abnormalities in the development of the rectal canal. Its incidence is usually low and it is a little higher in some developing countries. Boys are more affected than girls and rectobulbar fistula associated with atresia of the anal canal is the most frequent disorder among them. We report the case of a 10-months old infant of male sex, whose mother lived in a mining area and had been complaining of fecaluria since the birth of her child. Physical examination showed fingerprint 1 cm below the intersection of the median raphe and the bi-ischiatic line. Paraclinical examinations showed no other associated malformation. Patient's management was based on anorectoplasty through abdominal and perineal approach with lower abdominoperineal reconstruction. In the post-operative period, the patient received antibiotic treatment and intravenous analgesia as well as dilations, which continued after discharge 2 weeks after surgery. No complications were observed and outcome was favorable.

[Recurrent invasive bladder urothelial carcinoma treated by cystectomy with substitutive ileal enterocystoplasty: case report]. / Carcinome urothélial invasif vésical récidivant traité par cystectomie avec enterocystoplastie iléale de substitution: à propos d'un cas.

We here report a case of bladder urothelial carcinoma, a rare tumor in subjects less than 40 years, as well as our therapeutic experience. The study involved a 37-year old patient with a history of urinary tract infection and of staying at a riparian area (bilharzia) presenting with hypogastralgia and total macroscopic hematuria. Clinical and paraclinical assessment showed voluminous bladder mass suggesting infiltrative tumor without local or distant lymph node or organic involvement. Surgical management was based on resection of bladder tumor and biopsy followed by total cystectomy with substitutive ileal enterocystoplasty. The postoperative course was uneventful. The patient also underwent adjuvant chemotherapy and vitamin B-12 therapy. Clinical and paraclinical assessment, performed after 6 and 12 months, showed no recurrence.

[Spontaneous neonatal gastric perforation: about a case]. / Perforation gastrique néonatale spontanée: à propos d'un cas.

Spontaneous neonatal gastric perforation is rare. We report the case of a full term 4-day old newborn who required resuscitation at birth. On the second day of life he had extensive abdominal distension. Abdominal x-ray without preparation showed pneumoperitoneum. Laparotomy showed a perforation at the level of the small gastric curvature, measuring 1,5 cm in diameter, treated by simple surgical suture. The patient dead on the first post-operative day.