[Scapulothoracic dissociation as a consequence of failure of traditional treatment in an adolescent girl: a case report]. / Désarticulation scapulo-thoracique, une conséquence d'un échec de traitement traditionnel chez une adolescente: à propos d'un cas.

Scapulothoracic dissociation due to a trauma is exceptional. The purpose of this study was to share our experience with a case of scapulothoracic dissociation and to explain the advantages of our approach. We report the case of a 12-year-old right-handed schoolgirl admitted to hospital with a blunt trauma to the right thoracic limb complicated by infection after a week of traditional treatment (massage, bandaging with reed splints). Surgical neck fracture of the right humerus complicated by wet gangrene of the entire limb and severe anaemia was diagnosed. Blood transfusion, triple antibiotic therapy and scapulohumeral disarticulation were required. Progressive excision of necrotic tissue followed by scapulectomy (day 24) for scapular necrosis made it possible to sterilise the site and to perform a skin graft (day 43). The patient was discharged after 2 months. Physiotherapy was combined with psychological treatment and the patient had a simple post-operative course during the 7-month follow-up period. Failure of conventional treatment for limb fractures can be life-threatening and cause severe sequelae.

Acute intestinal intussusception among children under five years of age admitted in an Ouagadougou hospital, Burkina Faso, 2008-2013: epidemiological, clinical and therapeutic aspects.

INTRODUCTION: acute intestinal intussusception is a life-threatening surgical condition. In some settings, rotavirus vaccines have been associated with a low-level increased risk of intussusception. We describe the epidemiology, clinical manifestations and management of intussusception in a tertiary referral hospital in Burkina Faso prior to the introduction of rotavirus vaccine in October 2013. METHODS: we retrospectively reviewed medical records of all children under 5 years of age treated at the Charles de Gaulle Pediatric Hospital for intussusception meeting the Brighton level 1 diagnostic criteria, from October 31st, 2008 to October 30th, 2013. We report the incidence of intussusception as well as descriptive characteristics of these cases. RESULTS: a total of 107 Brighton level 1 intussusception cases were identified, representing a hospital incidence of 21.4 cases / year. There were 69 males and 38 females (sex ratio of 1.8), with a median age of 8 months (range 2 months to 4 years). Sixty-two percent of intussusception cases occurred among infants (n = 67 cases). The average time from symptom onset to seeking medical consultation was 3.8 days +/- 2.7 (range 0 to 14 days). Treatment was mainly surgical (105 patients, 98.1%) with 35 patients (32.7%) undergoing intestinal resection. Thirty-seven patients (35.5%) experienced post-operative complications. The mortality rate was 9.3%. Intestinal resection was a risk factor for death from intussusception. CONCLUSION: in this review of intussusception hospitalizations prior to rotavirus vaccine introduction in Burkina Faso, delays in seeking care were common and were associated with mortality.