Typhoid Intestinal Perforation Prognostic Score in Poor-Resource Settings.

Background: Mortality from peritonitis due to typhoid intestinal perforation (TIP) in sub-Saharan Africa is high. Objectives: This study aimed to determine the predictive factors of mortality, propose a prognostic score, and determine the appropriate surgical treatment for TIP in low-resource settings. Materials and Methods: This was a retrospective data collection of peritonitis due to TIP admitted at Zinder National Hospital from 2014 to 2021. To build a typhoid intestinal perforation prognostic score (TIPPS), patients were randomised into two groups: a score-building group and a validation group. Univariate and multivariate analyses were performed to identify risk factors of mortality. The value of P <0.05 was assigned significant for all analyses. Results: TIP accounted for 52.4% (n = 1132) of all cases of peritonitis (n = 2159). The median age was 12 years. Rural provenance represented 72.2% (n = 817). Deaths accounted for 10.5% (n = 119). The factors influencing mortality were respiratory rate ≥24/min (odds ratio [OR] = 2.6, P = 0.000), systolic blood pressure <90 mmHg (OR = 0.31, P = 0.002), serum creatinine >20 mg/L (OR = 2.6, P ≤ 0.009), haemoglobin (OR = 2.1, P = 0.000), comorbidity (OR = 3.5, P = 0.001), the American Society of Anesthesiologists score IV&V (OR = 3.3, P = 0.000), admission and management delay > 72 h (OR = 3.2, P = 0.001), and a number of perforations (OR = 2.4, P = 0.0001). These factors were used to build a "TIPPS" score, which ranged from 8 to 20. The risk of mortality was associated with increased TIPPS. The performance of this score was good in the two groups (area under receiver operating characteristic > 0.83). According to the severity and mortality risk of TIP, we classified TIPS into four grades: grade I (low risk: 8-10), grade II (moderate risk: 11-13), grade III (high risk: 14-16) and grade IV (very high risk: 17-20). Conclusion: The TIPPS is simple. It can describe the severity of the disease and can predict the risk of death. The study highlights the importance and impact of timely and adequate perioperative resuscitation in more complicated cases.

[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.

[Etiology and prognosis of acute mechanical intestinal obstructions at the National Hospital of Zinder: Cross-sectional study of 171 patients]. / Etiologies et pronostic des occlusions intestinales aigues mécaniques à l'Hôpital National de Zinder: étude transversale sur 171 patients.

Acute mechanical intestinal obstruction (AIO) is one of the most frequent pathologies in emergency digestive surgery. The objective of this study was to describe the etiologic and prognostic features of acute mechanical intestinal obstruction at the National Hospital of Zinder (HNZ), Niger. We conducted a cross-sectional study including all the patients operated for AIO over a period of 24 months (January 2013 - December 2014) Mechanical intestinal obstructions represent 24.50% (n=171) of digestive surgical emergencies (n=622). The median age was 25 years (range: 1 day-95 years). The sex ratio was 3.5 in favour of men. Children accounted for 38.60% (n=66). The seat of the obstacle was at the level of the small bowel in 60.82% (n=104), colonic in 21.63% (n=37) and mixed in 17.54% (n=30). The mechanism of strangulation accounted for 88,89% (n=152), among these strangulated hernias were detected in 49,70% (n=85) of patients and acute intestinal invaginations in 19,88% (n=34) of patients. Anorectal malformations and tumors were the main cause of obstruction in 7.02% (n=12) and 3.51% (n=6) of cases respectively. Intestinal resection was performed in 52 cases (30.41%). Septic complications prevailed (n=39/53); among these parietal suppuration (n=23). The average length of stay in hospital was 7.82 days. The overall mortality rate was 11.70% (n=20). This was statistically correlated to intestinal necrosis (p=0.01) and to delayed hospital admission (p=0.04). There are many causes of AIO which are dominated by strangulated hernia. The high morbidity and mortality rate from AIO might be prevented by early treatment performed before intestinal necrosis occurs.