[Drainage of liver abscess by "mini-hepatotomy"]. / Drainage des abcès du foie par la technique de "l'hépatotomie a minima".

UNLABELLED: We have developed a a "mini-hepatotomy" technique to prevent rupture of large superficial liver abscesses. AIM: The purpose of this report is to describe our results using this technique. PATIENTS AND METHOD: Data was extracted from the files of 40 patients hospitalized in our department for liver abscess from January 2000 to June 2005. Antimicrobrial therapy including metronidazole was administered to all patients and was the sole treatment in two. Additional treatment included laparotomy for ruptured abscess in 4 cases, pleural drainage for rupture in the right pleural cavity in one, and "mini hepatotomy" in 33. This study includes the 33 patients who underwent mini-laparotomy. There were 30 men and 3 women with a mean age of 38 years. The mean delay for consultation was 51 days. RESULTS: Liver abscess was classified as amoebic abscess in 28 cases and pyogenic abscess in 5. The mean diameter of the abscess was 11.5 cm. The abscess was located in the right lobe in 21 cases and left lobe in 12. The mean quantity of liquid drained from the abscess was 1060 mL. Outcome was favorable in 28 cases (success rate: 84.8%). In the remaining 5 cases abscess persisted after drain removal including two that required a second drain procedure and three that resolved after medical treatment. The failure rate was 6% (2/33). No patient died. CONCLUSION: Large size and superficial location are risk factors for rupture of liver abscess. Drainage is warranted in patients at risk for this complication. The results of this study show that our "mini-hepatotomy" drainage technique has a high success rate and can achieve good results.

[Breast cancer screening in Dakar: knowledge and practice of breast self examination among a female population in Senegal]. / Dépistage du cancer du sein: connaissance et pratique de l'auto-examen des seins au sein d'une population féminine au Sénégal.

In front of the absence of a mammographic screening program and the late diagnosis of the breast cancers in Senegal, we wanted to evaluate the knowledge and the practice of the breast self examination (BSE) by feminine population in Senegal. During the period between July 10th to August 25th 2006, through five big hospitals in Dakar, we interviewed 300 patients coming from a medical or surgical consultation. For every patient we studied the social and demographic characteristics, the antecedents and arguments about the knowledge and practice of BSE. We found, in majority, a young population (the average age was 34 years), no sent to school (26.7%), without any financial income (58.7%), with a brief knowledge about BSE (42.7%) and a regular practice of BSE (29%). The information about BSE originated essentially from educational television (52.9%). This knowledge and practice were significantly influenced by the study level (p = 0.000) and the level of financial income (p = 0.02). Among these who presented certain factors of breast cancer risk, the knowledge and the practice of the BSE were however low. The authors insist on the need to encourage the women schooling and their socioprofessional insertion so to improve the knowledge and practice of the breast self-examination in our developing countries.

[Giant leiomyoma of fallopian tube: a rare aetiology of abdominal tumor]. / Léiomyome géant de la trompe utérine: une cause rare de tumeur abdominale.

Leiomyomas of the fallopian tube are extremely rare. They are often managed with autopsy or surgery. We report a revealed case by a voluminous-abdominal mass in a 35-year-old woman. Neither the tomodensitometry nor, even, the laparoscopy did not permit specifying the tubal origin of the tumor. The diagnosis has been finally carried to the laparotomy. An annexectomy had been achieved. The histological examination concluded to a leiomyoma without malignant-cellular atypia.

[Incarcerated procidentia due to giant cervical fibromyoma: a case report]. / Trachélocèle incarcérée à la suite d'un fibrome géant du col utérin: à propos d'un cas.

The authors report a sparse case of incarcerated procidentia due to cervical fibromyoma in a 43-year-old Senegalese woman. This is about the second case known around the world. Clinic was about a giant cervical mass, irreducible with haemorrhage and procidentia.

[Peritonitis from liver abscess: retrospective study of 5 cases]. / Peritonite par rupture d'abces du foie: etude retrospective a propos de 5 observations.

AIM: To report the clinical, paraclinical and therapeutic aspects of peritonitis from liver abscess and to study the risk factors of rupture MATERIAL AND METHOD: From January 2000 to March 2007, we retrospectively studied 5 cases of peritonitis secondary to ruptured of liver abscess at the surgery department of the University Teaching Hospital Le Dantec. These cases were selected among 48 cases of liver abscess managed during the same period. RESULTS: There were four men and one woman. The mean age was 40.5 years. In 4 cases the Peritonitis was generalised and it was localised in one case. Percutaneous needle aspiration was already performed in 2 cases in a medical department. The abscesses were located in the right hepatic lobe in 3 cases and in left hepatic lobe in 2 cases. The mean diameter of the collection was 10.6 cm with extreme of 8 cm and 15 cm. The right liver abscesses were larger than the left ones (12.3 cm versus 8 cm). There were 2 cases of amoebic liver abscess and 3 cases of pyogenic liver abscess. All our patients underwent resuscitation prior and after the surgical treatment which consisted of abscess evacuation, peritoneal lavage and drainage. We noticed one case of recurrence successfully treated with antibiotics and percutaneous drainage. No death was recorded. CONCLUSION: The big size of the abscess, the superficial location or on left hepatic lobe are risk factors of rupture. It justifies the necessity of instrumental evacuation of large hepatic abscess. Surgical drainage offer better results than other modalities in management of ruptured liver abscess.

[Postoperative peritonitis at the department of general surgery of Aristide le Dantec Hospital: report of 15 cases]. / Les peritonites post operatoires dans la Clinique Chirurgicale de l'Hôpital Aristide Le Dantec à propos de 15 cas.

INTRODUCTION: Post-operative Peritonitis (PPO) put some diagnostic and therapeutic problems to surgeons. The aim of the study was: first, to analyze the epidemiological, diagnostic, and therapeutic factors of post-operative peritonitis; then, to define a strategy to improve their prognosis. MATERIAL AND METHOD: We did a retrospective study carried out at department of general surgery of the Aristide Le Dantec hospital from January 2001 to March 2007 on cases of PPO. Fifteen cases were included. It was about 12 men and 3 women of middle age of 38.2 years with extremes of 17 and 70 years. RESULTS: Clinical signs were dominated by the abdominal pain (73.3%) and the fever (66.7%). Abdominal collections were multi-microbial. The digestive suture failure was the dominant reason. All patients have been managed in the 48 hours that followed the diagnosis of PPO. The treatment consisted, essentialy in temporary digestive derivation, washing and drainage of the abdominal cavity framed by an adequate resuscitation. The recovery was 67.7%. Morbidity rate is 33.3%. Mortality concerned 5 patient (33.3%) especially carriers of 2 or 3 visceral failings. Criteria of precocious re-laparotomy have been specified. CONCLUSION: The improvement of the prognosis passes indeed by a precocious diagnosis and a coherent multidisci lina a roach.

[What determines the sick leave of repair and rehabilitation of the hand flexor tendons injuries]. / Recherche sur les facteurs influençant la durée de l'arrêt de travail dans les réparations des tendons fléchisseurs de la main.

OBJECTIVES: The purpose of this study is to analyse the relationship between the social and economical consequences, after repair and rehabilitation of the hand flexor tendon injuries, and to prove that it is not related to local factors. METHOD: All the patients who underwent surgery for at least one flexor tendons injury of one or several long fingers, between the years 2003-2004 were included in this study. Information regarding the data was taken from the patient file. Statistical tests were used for analysing these data. RESULTS: Significant first rate factors related to the length of sick leave are the chaotic professional history (P=0.03), the type of occupation (P=0.01) and the age (P=0.0002). A significant second rate factor is represented by the type of mobilization/retraining (P=0.04). Sex, side of injury, finger injured, zone of injury, associated damages, did not significantly influence the results of this study. CONCLUSION: The environmental factors determine the length of sick leave more than the characteristic of injury in hand flexor tendons surgery.

[Diagnostic interest of Barr chromatin test in sex determination: about one case of male pseudohermaphrodism]. / Interet diagnostique du test chromatinien de Barr dans la determination de sexe: a propos d'un cas de pseudo- hermaphrodisme masculin.

INTRODUCTION: The Barr chromatin test is a medical cytogenetic test, very quick to make, consisting in determination of the percentage of Barr corpuscles that correspond to the condensation of the second X chromosome in female epithelial cells of mammal, which range between 20 and 50% the percentage of Barr corpuscles in male epithelial cells range between 2 and less than 5%). In the less developed countries where caryotype isn't realized, this test can give invaluable informations about individual sex. The aim of this study was to show the Barr chromatin test interest in the sexual ambiguity diagnosis orientation in some cases of these sexual ambiguities. PATIENT AND METHODS: To carry this study, we have done a Guard coloration on nude nucleus of epithelial cells taken on the cheeck internal side of our patient, a 19 years old woman that a gynaecologist had sent to us for sexual ambiguity. We have examinated the nude nucleus. RESULTS: None of the nude nucleus had showed a Barr corpuscle (0% of Barr corpuscles, corresponding to male chromatin sex). CONCLUSION: This rate has gived us a Morris syndrome diagnosis orientation; the diagnosis was confirmed later by the surgery and by the removal histological study. When caryotype or molecular biology are not available, the Barr chromatin test can represent a substitute biological test that can contribute to some sexual ambiguity diagnosis.

[Penetrating wound of the abdomen. Profile of the suffering patient at Dakar teaching hospital]. / Plaies penetrantes de l'abdomen. Profil du blesse admis au centre hospitalier universitaire de Dakar.

INTRODUCTION: In Senegal, the rate of penetrating wound of the abdomen seems to be in great progression. The purpose of this study was to make a descriptive analysis of the epidemiological data on the patient suffering from a penetrating wound of the abdomen. MATERIAL AND METHOD: It is about a retrospective study performed on a 5 years period from January 1997 to January 2002. This study covered 90 cases of penetrating wounds of the abdomen listed at the emergency department of Dakar teaching hospital. The rate, age, sex, responsible agent, circumstances of the wound, place of the injury, evacuation mode, time of admission and check-up injury were studied. RESULTS: The average absolute rate of the penetrating wounds of the abdomen was 18 cases per year. The average age was about 27 +/- 10 years with 88 men for 2 women. The responsible agent was a knife (87%), a firearm (6%), a broken glass (4%), a bullock horn (2%) and a piece of iron (1%). Circumstances of the injury was aggression (91%), accident (6%), self-mutilation (2%), suicide attempt (1%). Evacuation was done by firemen (60%), by the ambulances of the medical structures (22%), and by private individuals (18%). The average time of admission was 5 hours. Nearly 61% of the wounds were located in the umbilical, epigastric, left hypochondre and left side areas. Wound was single in 93,4% of cases and linear in 71,8% of cases. We noted an exit of epiploon (38 cases), peritoneal signs (13 cases) and a small bowel evisceration (9 cases). The treatment was a systematic laparotomy (68%) and a simple closure of the wound with a good follow-up for any further aggravation (32%). CONCLUSION: The patient admitted at the surgical emergency unit of Dakar teaching hospital for penetrating wound of the abdomen is generally a young man, victim of aggression by knife, evacuated by firemen within 5 hours, which present a single and linearwound in perish-umbilical area with exit of epiploon and/or small bowel evisceration, which would undertaken a surgical operation in 68% of cases.

[A case report of intrapelvic foetal osseous remains localization after clandestine caused abortion]. / A propos d'un cas de localisation intrapelvienne de debris osseux foetaux apres avortement provoque clandestin.

A 26 year old women, unmarried, second gesture, primiparous, had been hospitalized in our departement for the management of a hypogastric mass. Ultrasonography had shown: an uterus of normal size, a normal uterine vacuity line with presence of many osseous and fibrous constituents inside the inter-vesico-uterine area, including one femoral osseous of 18,6 mm corresponding to 15 weeks of amenorrhoea. A few months before, the patient had undergone a clandestine caused abortion on a progressive intrauterine pregnancy of 12 weeks of amenorrhoea certified by ultrasonography. It is an exceptional complication of clandestine caused abortion. It gives the opportunity to us to discuss its etiopathogenic mechanism. It also enables us to point out the complications of the clandestine caused abortion and to insist on the need for its prevention.

[Congenital choledocal cyst of adult: report of two cases]. / Kyste congenital du choledoque de l'adulte : a propos de deux observations.

INTRODUCTION: Congenital choledochal cyst is a congenital dilatation of the biliary tract often associated with a long common bilio-pancreatic duct without obstruction. PATIENTS AND METHOD: We report the case of two women who presented a congenital choledochal cyst. RESULTS: For the first patient, the diagnosis was effected during a laparoscopic cholecystectomy for a gall bladder lithiasis. The second one presented repeted access of angiocholitis. Echography and abdominal tomodensitometry found the congenital choledochal cyst. Percutaneous opacification of the cyst found a long common biliopancreatic duct in the second patient. A complete resection of the cyst with a cholangiojejunal anastomosis was performed for both patients. The treatment was successfull for the first one and the second one was deceased three days after the operation. CONCLUSION: This case report underlines the clinical polymorphysm, the morphologic anomaly and the treatment of congenital choledochal cyst which require total resection.

[Liver arterial ischemia after cephalic pancreatico-duodenectomy. A case report]. / Ischemie arterielle hepatique apres duodenopancratectomie cephalique.

Cephalic pancreaticoduodenectomy is the best treatment for cephalic pancreas cancers. A rare complication is the liver ischemia after the divison of gastroduodenal artery. This complication can occur when a celiac trunk stenosed by the median arcuate ligamentous is not recognised. We report the case of a 40 old woman who underwent cephalic pancreaticoduodenectomy for an adenocarcinoma of pancreas head. There was no complication immediatly. Two weeks later, she presented two episodes of angiocholitis. An abdominal tomodensitometry showed a liver arterial ischemia associated with a celiac trunk stenosis. There was a left hepatic artery wich came from the left gastric artery. Medical treatment of the angiocholitis was successful. Surgical revascularization was not necessary. Nine months after, arterial revascularization by the left hepatic artery and biological hepatic tests were restored. This case report talks about the importance of angioscanner before pancreatic surgery when celiac and mesenteric angiography is not available. Also, it underlines the importance of the gastroduodenal artery occlusion test before his ligation during pancreaticoduodenectomy.

Perforated mesenteric Meckel's diverticulum in an adult: a real variant?

A Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a real diverticulum that is usually located on the anti-mesenteric edge in the last meter of the ileum. Its location on the mesenteric edge has been rarely reported. It may lead to several complications including perforation that may be life-threatening for the patient. We report herein a case of perforated mesenteric Meckel's diverticulum in an adult patient. Upon surgical exploration by laparotomy, we found a perforated Meckel's diverticulum located on the mesenteric edge of the ileum 60 cm from the ileocoecal junction and 400 ml of seropurulent peritoneal fluid. The patient underwent a segmental ileal resection and an end-to-end anastomosis. The postoperative outcomes were marked by a persistent peritonitis that required successful revision surgery.

Endoscopic surgery in Senegal. Benefits, costs and limits.

BACKGROUND: Evaluating the introduction of endoscopic surgery in Senegal may be useful for assessing the role of this technology in developing countries. METHODS: The endoscopic surgery performed at the Hospital Principal and the Hospital Le Dantec, Dakar, from January 1995 to December 2000 was evaluated retrospectively. Operative time, postoperative stay, patients, and hospital costs were compared in samples of 100 patients treated endoscopically and 80 patients treated with open techniques. RESULTS: Altogether, 826 endoscopic procedures were performed (11.6% of elective surgical activity). Of these, thoracoscopic (34%) and laparoscopic (14%) vagotomy, cholecystectomy (21%), fundoplication (12%), and diagnostic laparoscopy (11%) were selected for comparisons. Operative time proved to be reduced by endoscopic surgery except for laparoscopic fundoplication (+40 min). After endoscopic surgery, postoperative hospitalization was 3.7 days shorter, and patient fees were consequently reduced. In 6 years, 87% of the hospital investment (36,000 Euro) was recovered. CONCLUSIONS: Developing countries can benefit from endoscopic surgery. First-world countries might supply staff training.

[Results of emergengy colectomy in the management of the colon volvulus in Dakar hospital]. / Résultats de la colectomie en urgence dans le traitement du volvulus du côlon au centre hospitalier universitaire (CHU) de Dakar.

PURPOSE: The aim of this study was to evaluate the results of emergency colectomies for the management of colon volvulus. PATIENTS AND METHODS: This retrospective study was undertaken on 50 cases of colon volvulus operated in the Surgical Department of the Aristide Le Dantec teaching hospital of Dakar from January 1994 to December 2000. It concerned 42 men and 8 women with an mean age of 42 years. All patients presented an occlusive syndrome suggestive of colon volvulus, which required a laparotomy, through a xypho-pubic incision. The patients were divided into two groups. Group I concerned 13 patients who underwent an ideal colectomy and group II, 37 patients in whom we performed a colectomy associated with a temporary colostomy with either Bouilly-Volkman procedure (n = 23) or Hartman procedure (n = 14) followed one month later by intestinal continuity restoration. Mortality and morbidity were compared in the two groups. RESULTS: The overall mortality rate was 12% (6/50). The mortality rate was 31% (4/13) in group I and 5 % (2/37) in group II. The overall morbidity rate was 14%. In group I, the morbidity rate was 15 % (2/13) and 13,5% (5/37) in group II. CONCLUSION: In our study the mortality rate was higher after colectomy with primary anastomosis than after colectomy with temporary colostomy followed by secondary anastomosis. We recommend colectomy without anastomosis for the emergency management of the colon volvulus in Africa.

[Televised education: experience in Senegal]. / Télé-enseignement: une expérience sénégalaise.

As a possible response to the shortage of qualified teachers in Africa, a promising pilot study using television is being carried out at the A. Le Dantec University Hospital in Dakar, Senegal. Trainees at the Dakar Medical School receive long-distance coaching mainly in video-assisted surgery from experts at several partner centers in Europe, namely: Rangueil Hospital in Toulouse, France, IRCAD in Strasbourg, France and Saint Peter's Hospital in Brussels, Belgium. Results support more widespread use of televised courses.

[Emergency care in tropical areas: status report based on surgical emergencies in Senegal]. / Urgences en milieu tropical: etat des lieux l'exemple des urgences chirurgicales au Senegal.

Management of surgical emergencies in Senegal is characterized by a mismatch between supply of facilities and demand for care. The situation has been complicated by runaway urban growth. Two situations can be distinguished in rural zones and in the major city of Dakar. The common features in both locations are chronic underfunding, absence of pre-hospital emergency and rescue services, and inadequacy of health care facilities to manage emergency situations. In urban and rural areas, hospital are oversollicited, poorly designed and managed in terms of infrastructure and equipment, and understaffed in terms of surgeons and qualified paramedical personnel. The main differences between urban and rural areas involve the volume and type of surgical emergencies with a constantly increasing number of trauma emergencies in cities. Solving these problems will require a specific national plan to develop emergency care services in general. This plan will require coordination of funding, re-organisation of hospital facilities, and hiring and training of qualified personnel (surgeons and paramedical staff).

[Complications of Meckel's diverticulum in Dakar (apropos of 2 cases)]. / Complications du diverticule de Meckel à Dakar (a propos de 2 observations).

Meckel's diverticula is the most common lesion among the abnormalities resulting from the persistence of the vitelline canal and its vessels. Studying it is interesting, on the one hand, because of the difficulty of detecting it, and, on the other, because of the possibility of accidents dominated by intestinal occlusions and digestive haemorrhages. Two observations on complications in Meckel's diverticula discovered in young men in the casualty unit are covered, and literature on the rare pathology is reviewed.

[Treatment of incisional hernias]. / Traitement des eventrations post-opratoires.

Several therapeutic processes were proposed in the repair of incisional hernia, on the basis of simple joining suture go to the installation of prosthetic mesh while passing by aponeurotic autoplasty according to Welti-Eudel technique. The aim of this study was to report the results of our experiment in the treatment of incisional hernias. It was a retrospective study carried out of January 11th 1996 to December 31, 2000, concerning 35 cases of incisional hernias operated during the study period. The following parameters were studied: age, sex, diameter, technique of repair, morbidty, mortality and the remote follow-up. Average age of our patients was 33 years with extremes of 13 and 53 years. It include 30 womens and 5 mens. The initial operation were dominated by Caesarean (57%). The diameter of incisional hernia varied between 3 and 5 cm in 22.9% of patients, between 5 and 10 cm in 62.8% of paitents, higher than 10 cm in 14.3% of patients. The simple joining suture was carried out in 22.9% of cases, the Welti-Eudel technique in 42.9% of cases and the installation of prosthetic mesh in 34.2% of the cases. Mortality was 5.1% and the morbidity was 34.2% made exclusively by suppuration including 5.1% on prosthetic material. We noted 14.3% of recurence which has occured after repair by simple joining. The Welti-Eudel procedure gives good results in the repair of incisional hernia with small and average dimensions. The installation of prosthetic mesh constitute the treatment of choice because the rate of recurence is weak even null.

[Vaginal hysterectomy for hysterocele (report of 36 cases)]. / Hystérectomie vaginale pour hystérocèles (à propos de 36 cas).

Vaginal total hysterectomy get to better qualily of lite to patients who have genital prolapse. It gives no abdominal scar. The feeding and rising are early. Among a serie of 36 total vaginal hysterectomies for hysteroceles we performed, we report few complications. One patient presented a plentiful peroperative haemorrhage : three others present a vesical wound. We report one case of releasing suture, one had setting of bladderand one case of vaginal infection. One patient died from a cause not reliable to the procedure. The mean duration of the hospital stay was 8.36 days. After 4 years following up, 2 patients have elytrocele recurrence, and one other presents a bad reducing of cystocele. We hope to pursue this serie strenghen then our results.