Surgical management of pyelo-ureteral junction syndrome in a resource-limited setting: case of Zinder National Hospital, Niger.

BACKGROUND: Pyelo-ureteral junction syndrome (PUJS) is a frequent congenital malformation. We report the surgical management of PUJS by pyeloplasty according to Anderson-Hyne-Kuss's procedure at the Zinder National Hospital.. METHODS: This was a retrospective study from January 2013 to December 2016 (4 years), including patients who have undergone surgery for PUJS. RESULTS: Twelve (12) cases of PUJS had a surgery among which 66.7% were men with an average age of 32.5 ± 7.6 years. The clinical symptomatology was lumbar pain or renal colic in 92.3% of cases. This pain had evolved for more than 2 years for 58.3% of the cases. Ultrasound coupled with intravenous urography or CT-scan was performed to confirm the diagnosis of PUJS in 58.3 and 41.7% of cases. The average serum creatinine level at admission was 181.25 ± 67.3 µmol/L [Lab reference range: 53-97 µmol/L]. The Anderson-Hynes non dismembered pyeloplasty is used for all the patients. The release of a crossing lower pole vessel was performed in 25%, pyelolithotomy in 16.7%. The average surgery time was 118.3 ± 20.7 min. The average hospital length of stay was 10.8 ± 3 days. Immediate postoperative complications were recorded in 33.3% (n = 4). Postoperative outcomes were considered good by disappearance of clinical, biological and radiological signs. CONCLUSION: The Anderson-Hynes non dismembered pyeloplasty gives good results and provides a successful alternative in an environment where laparoscopy and robotic surgery are not developed.

Acute Abdomen Revealing an Unusual Case of Intra-Abdominal Testicular Torsion.

Introduction. Intra-abdominal testicular torsion is a rare event. We report hereby our experience of the management of a spermatic cord twist on intra-abdominal testis discovered during an acute surgical abdomen. Case Presentation. This was a 42-year-old patient admitted to the emergency department for abdominal pain that had been evolving for a week. The physical examination showed tenderness and guarding in the left iliac fossa with an empty ipsilateral hemiscrotum. Complementary examinations led to the discovery of an intra-abdominal left-lateral mass. The laparotomy found a whitish mass with areas of infarction, which was resected. Anatomopathological examination of the operative specimen identified it as a testis with atrophy of germ cells and necrotic areas without evidence of malignancy. Conclusion. Intra-abdominal testicular torsion should be considered in case of patients with an acute surgical abdomen with vacuity of one of the bursae.

[Peculiarities of anesthesia for the surgical treatment of pheochromocytoma: about a case]. / Particularité de l'anesthésie pour cure chirurgicale du phéochromocytome: à propos d'un cas.

This study decribes the treatment of a 37-year old female patient, with a history of poorly treated arterial hypertension (AH), referred to surgical consultation with right lower back pain, vertigo, headache, sweating and palpitations. During hospitalization, blood pressure (BP) ranged between 130/80 mm Hg and 190/120 mm Hg. The remainder of the clinical examination was normal. Thoracoabdominal scanner showed adrenal mass measuring 55x45x65 mm compressing the inferior vena cava and the right renal vein. The assay of urinary vanilmandelic acid (VMA) was 11.8mg/24hours. The assay of catecholamines in the blood was not performed. The diagnosis of pheochromocytoma was retained and surgical indication was determined. During pre-anaesthesia consultation, clinical examination showed good general condition, blood pressure (BP) to190/120 mmHg, normal cardiopulmonary auscultation and prediction criterion of easy intubation (Mallampati II). The patient underwent preoperative treatment with alpha-blockers and beta-blockers, and calcium channel blocker. Adrenalectomy was performed using midline laparotomy. The patient didn?t have hemodynamic instability during mobilization and tumor resection. The postoperative course was uneventful. She was discharged home on postoperative day 7. At 3 months? follow-up, the patient had no clinical signs and blood pressure was normal. Anesthesia for the surgical treatment of pheochromocytoma is feasible even in resource-limited settings. An adequate preoperative preparation of the patient helps prevent complications.

Pattern of Lower Intestinal Ostomies in a Low-Income Country: Case of Southeast of Niger Republic.

BACKGROUND: Intestinal ostomies are common surgical procedures performed in visceral surgery as part of management for several gastrointestinal diseases. This study aims to report the socio-demographic characteristics, indications and prognosis of intestinal ostomies in low-income country. METHODS: This was a 4-year retrospective study (January 2013 to December 2016) at Zinder National Hospital (Niger). All patients with a digestive ostomy on an ileum or colic segment were included in the study. RESULTS: During the study period, 2437 patients underwent digestive surgery, including 328 gastrointestinal stomas (13.5%). Patients classified ASA3 were 60.7% (n = 199). The median age was 12 years (IQ: 7-25). Children represent 64% (n = 210) of patients with ostomy. The sex ratio was 2.60. The stoma was performed in emergency in 96.3% (n = 316) of cases. Acute peritonitis was the main indication of the stoma in 70.73% (n = 232). The ileostomies accounted for 75.61% (n = 248). Ostomy was intended as temporary in 97.3% of cases (n = 319). Complications were observed in 188 patients (57.3%). Mortality was 14.02% (n = 46). The indigent status (OR: 4.15 [2.20-7.83], P = 000), ASA score 4 (OR: 2.53 [1.54-4.15], P = 0.0003), Altemeier class IV (OR: 4.03 [2.10-7.73], P = 0.0000) and ileostomy (OR: 2.7853 [1.47-5.29], P = 0.0018) were statistically associated with the occurrence of major complications. The mean time for stoma closure was 59.3 ± 14.5 days. CONCLUSION: Acute peritonitis was the main indication of digestive ostomy. The occurrence of major complications was associated with bad socioeconomic status, ASA4 score, Altemeier class IV and ileostomy.

["Handlebar" hernia: a rare type of traumatic parietal hernia]. / Hernie « guidon ¼: un type rare de hernie pariétale traumatique.

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.