[Macrocystic serous cystadenoma of the pancreas, about a case]. / Cystadénome séreux macrokystique du pancréas, à propos d'un cas.

Serous cystadenomas of pancreas are unusual cystic tumour. The microcystic forms is more common and its radiological diagnosis is easy. However, the macrocystic unilocular form of serous cystadenoma can be mistaken with other malignant macrocystic lesions of the pancreas. We report the case of a 17 year-old girl, admitted to the National Hospital of Niamey (Niger), with abdominal pain and an unilocular macrocystic serous cystadenoma of pancreas, diagnosed after histological examination of the surgical specimen. The diagnostic tests, including ultrasound, CT scan, MRI, endoscopic ultrasonography are inconclusive. Challenge of its management is related to the preoperative diagnosis.

Les cystadénomes séreux (CS) du pancréas sont des tumeurs kystiques rares. La forme microkystique du CS est la plus fréquente et de diagnostic radiologique facile. Par contre la forme macrokystique du CS peut être confondue avec les autres lésions macrokystiques du pancréas à potentiel malin. Nous rapportons l'observation d'une jeune patiente de 17 ans admise à l'Hôpital national de Niamey (Niger) dans un tableau de douleurs abdominales, ayant un cystadénome séreux macrokystique uniloculaire du pancréas, diagnostiqué après l'examen histologique de la pièce opératoire. Les examens paracliniques réalisés, notamment l'échographie, le scanner, l'IRM, l'échoendoscopie ne sont pas concluants. La difficulté de la prise en charge réside dans le diagnostic préopératoire.

[Upper Digestive Endoscopy at Zinder National Hospital: Indications and Results]. / Endoscopie Digestive Haute a L'hopital National de Zinder: Indications et Resultats.

OBJECTIVE: to determine the indications and results of upper digestive endoscopy (EDH) at the Zinder National Hospital. MATERIALS AND METHODS: this is a retrospective analysis of EDH reports, from digestive endoscopy registers from January 1, 2020 to February 28, 2021, covering 667 examinations, or a monthly frequency of 48 EDH. RESULTS: the average age of patients was 38.98±14.84 (13-80 years) with a sex ratio of 1.02. Epigastralgia represents 42.8% (n = 363) of indication of EDH, dyspepsia 15.2% (n = 129), diffuse abdominal pain 11.9% (n = 101), vomiting 8.1% (n = 69), search for endoscopic signs of portal hypertension 5.1% (n = 43), dysphagia 4.9% (n = 42) and digestive hemorrhages 3.2% (n = 27Depending on the anatomical segment concerned, the stomach accounted for 55.51% (n=419), the esophagus 19.6% (n=148) and the duodenum 6.68% (n=50). Inflammatory lesions account for 63.04% (n=475), ulcers 6.65% (n=50), tumours 3.03% (n=23) and miscellaneous lesions 27.28% (n=205). The biopsy was performed in 22 patients (3.46%) and 10 histological reports were obtained, divided into 06 gastric adenocarcinomas, 02 chronic gastric with intestinal metaplasia, 01 epidermoidal carcinoma of the esophagus and 01 hyperplastic gastric polyp. CONCLUSION: Epigastralgia dominates the indications of HRE. Upper digestive pathology is certainly dominated by inflammatory lesons, but ulcers and tumors are increasingly diagnosed. These lesions would be better evaluated if systematic biopsies were performed in our patients.

OBJECTIF: déterminer les indications et résultats de l'endoscopie digestive haute (EDH) à l'Hôpital National de Zinder. MATÉRIELS ET MÉTHODES: il s'agit d'une analyse rétrospective des comptes rendus d'EDH, à partir des registres d'endoscopie digestive du 1er Janvier 2020 au 28 Février 2021, portant sur 667 examens, soit une fréquence mensuelle de 48 EDH. . RÉSULTATS: l'âge moyen des patients était de 38,98±14,84 (13-80 ans) avec un sex ratio de 1,02. Les épigastralgies représentent 42,8% (n=363) d'indication d'EDH, la dyspepsie 15,2% (n=129), les douleurs abdominales diffuses 11,9% (n=101), les vomissements 8,1% (n= 69), la recherche des signes endoscopiques d'hypertension portale 5,1% (n= 43), la dysphagie 4,9% (n=42) et les hémorragies digestives 3,2% (n=27). Selon le segment anatomique concerné, l'estomac comptait pour 55,51% (n=419), l'œsophage 19,6% (n=148) et le duodénum 6,68% (n=50). Les lésions inflammatoires représentent 63,04% (n=475), les ulcères 6,65% (n=50), les tumeurs 3,03% (n=23) et les lésions diverses 27,28% (n=205). La biopsie était réalisée chez 22 patients (3,46%) et 10 comptes rendus histologiques étaient parvenus, repartis en 06 adénocarcinomes gastriques, 02 gastriques chroniques avec métaplasie intestinale, 01 carcinome épidermoïde de l'œsophage et 01 polype gastrique hyperplasique. CONCLUSION: Les épigastralgies dominent les indications de l'EDH. La pathologie digestive haute est certes dominée par les lésons inflammatoires, mais les ulcères et les tumeurs sont de plus en plus diagnostiqués. Ces lésions allaient être mieux évaluées si des biopsies systématiques étaient réalisées chez nos patients.

[Pygomelus: a surgical case report from Nigeria]. / La pygomélie: à propos d'un cas opéré au Niger.

We report a case of pygomelus, a malformation characterized by the presence of supernumerary limb. The patient was a 3-month-old girl born full term in the Zinder area of Niger. The mother had not attended prenatal visits. No drug had been administered during pregnancy and the family was not inbred. The malformation consisted of an almost fully developed third lower limb, attached to the lumbosacral spine, and of a small fleshy mass at the base of the limb resembling a penis. The appendage was removed surgically without complications and the child has been developing normally since the intervention.

INJURIES OF BOKO HARAM INSURGENCY IN SOUTH-EAST NIGER REPUBLIC.

BACKGROUND: Currently, wounds of wars, terrorism and criminality are increasing and constitute major public health problem worldwide. AIM: To present the epidemiological, clinical and therapeutic characteristics of the wounds observed during the Boko Haram (BH) insurgency in the South-east of the Republic of Niger. METHODOLOGY: This was a cross-sectional study from December 2014 to December 2016 at Diffa Regional Hospital, Diffa, Niger of individuals whose injuries were as a result of Boko Haram insurgency. RESULTS: In the period of this study, 573 injuries from Boko Haram insurgency were managed at the Regional Hospital at Diffa. The majority, 513(89.5%), were males while females constituted 60(10.5%) with a male/female ratio of 8.55. The mean age was 30,94(SD24,91) years (range 1 to 97 years). Civilian victims accounted for 379 (66.1%) while Nigerien soldiers accounted for 160(27.9%) and 34 (5.9%) were Boko Haram fighters. Firearms and explosives accounted for injuries in 489 (85.3%) and 7(1.2%) of patients respectively; 42 (7.3%) suffered injuries from a variety of traditional weapons. Injuries to limbs accounted for 361(63%) of cases and polytrauma in 65(11.34%). The main surgical management included wound debridement in 409 (71.4%), external bone fixation in 38 (6.6%), laparotomy in 30 (5.2%), thoracic drainage in 27 (4.7%), and major limb amputations in 13 (2.3%) cases.Postoperative follow-up was uneventful in 460 (80.28%) of cases; there were 29 deaths, giving a mortality rate of 5.1%. Predictors of death after injuries of Boko Haram terrorism in this study included: being civilian patients (OR = 3.38 [1.15-9.85], p=0.018), injuries to head, neck, trunk or spine (OR 3.45[1.58-7.58], p= 0.001) or the presence of polytrauma on admission (OR = 17.30 [7.72-38.80], p<0.0001). CONCLUSION: This study has shown that injuries sustained in Boko Haram insurgency in Niger were mainly firearm injuries and injuries from the use of traditional weapons, affecting mostly young civilian males. The part of the body most commonly involved were the extremities, with mainly soft tissue injuries. Wound debridement was the commonest surgical procedure performed and the mortality rate was 5.1%. Predictors of mortality were being civilian patients, injuries of head, neck, trunk or spine and polytrauma. The ICRC has played a major role in strengthening our hospital for the task of caring for the victims, in terms of provision of material resources and in the further training of our personnel.

[Digestive surgical emergencies in Sub-Saharan Africa: a prospective study of a series of 622 patients at the National Hospital of Zinder, Niger]. / Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d'une série de 622 patients à l'Hôpital national de Zinder, Niger.

The purpose of this study was to describe the epidemiologic, therapeutic, and prognostic aspects of surgical acute abdomen at the National Hospital of Zinder (HNZ). This was a prospective study of patients undergoing digestive surgical emergencies in HNZ over 24 months (January 2013-December 2014). During the study period, 622 digestive surgical emergencies were operated. The mean age was 22.91 ± 18.14 years old, with a sex-ratio of 3:1. The average admission time was 64.31 ± 57.90 h. Abdominal pain was the main reason for admission in 61.90% (N = 385) of the cases, with or without fever throughout the course in 26.05% (N = 162) of the cases. The average time before surgery was 9.13 ± 5.97 h. Acute peritonitis accounted for 51.61% (N = 321) of cases, led by ileal perforation maybe from typhoid (N = 175). The acute intestinal obstruction and acute appendicitis accounted for 27.49% (N = 171) and 9.65% (N = 60) of the cases, respectively. Abdominal trauma had affected 53 patients (8.52%). The average length of hospital stay was 8.71 ± 5.29 days. Postoperative morbidity was 38.10% (N = 237). Septic complications (N = 187) were predominant. Overall lethality of 13.67% (N = 85), was associated with the delay of diagnosis and treatment (P < 0.001). The incidence and the high morbidity and lethality of digestive surgical emergencies in the Sub-Saharan context, could be avoided through prevention, early consultation, and adequate intra-hospital management.

Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger.

To report etiological and prognostic characteristics of acute peritonitis in children. This retrospective study reviewed the records for a 30-month period (January 2013-June 2015) at Zinder National Hospital (Niger) of all children between the ages of 0-15 years who underwent surgery for non-traumatic acute peritonitis. Statistical tests were performed, with significance defined by a P-value < 5 %. Acute peritonitis accounted for 62.12 % (226/358) of all emergency gastrointestinal surgery in children. Their median age was 10 years (range: 0-15 years), with almost two-thirds of them male (n=148). Ileal perforation, presumably due to typhoid fever, was the main cause (n=153), with acute appendicular peritonitis in second place, accounting for 25.22 % (n=57) of cases. Gastrointestinal ostomy was performed in 101 patients (44.7 %) and an appendectomy in 56 (24.8 %). The average length of stay was 10.9±3.6 days. Postoperative complications, defined by the Clavien-Dindo classification, occurred in 46.5 % of these procedures (n=105). Surgical site infections were recorded in 66 cases. Overall mortality was 13.7 % (n=31) and was statistically associated with an American Society of Anesthesiologists (ASA) score of IV (OR = 3,32 : 1,07-10,27 ; P = 0,037) and Mannheim Peritonitis Index (MPI) ≥ 26 (OR = 44,68 : 10,17 - 196,32 ; P = 0,000), time to admission (OR = 4,626 : 1,39 - 15,34, P = 0,012), and time to surgery in hours (OR = 4,59 : 1,60 - 13,18 ; P = 0,0046). In Niger, perforation apparently due to typhoid is the main cause of peritonitis in children. Mortality is associated with an ASA score of IV, Mannheim Peritonitis Index ≥ 26, time to admission, and time to surgery.

[Patient satisfaction, an important part of care: case of a surgical department in Niger]. / Satisfaction des patients, element important dans la globalite des soins: cas d'un service des urgences chirurgicales au Niger.

INTRODUCTION: The aim of this study was to assess patient satisfaction in the surgical emergencies department at the National Hospital of Zinder, Niger. MATERIALS AND METHOD: This was a cross-sectional study focusing on patients admitted to the surgical emergency department of the National Hospital of Zinder (NHZ). The study was conducted over a period of 2 month - from July 1st to August 31st, 2015. During a face to face interview, patients were asked a series of questions. RESULTS: Of the 227 patients surveyed, 54.62% (n=124) were satisfied with their experience of the surgical emergencies department. The main factors associated with high satisfaction scores were patient reception (OR: 0.27, 95% CI=0.14 to 0.52; p <0.001), and the management of symptoms (OR: 0.28, 95 % CI=from 0.14 to 0.58; p < 0.001). Dissatisfaction factors were: waiting time before receiving treatment (OR 16.57, 95% CI=8.52 to 32.23; P <0.0001), the environment (OR: 3.89, 95% CI=2.12 to 7.12; p <0.001), accessibility (OR: 5.85, 95% CI=2.54 to 13.46, p < 0.001) and poor staff-patient communication (OR, 13.76; 95% CI 6.54 to 28.98; P <0.0001). CONCLUSION: Despite the shortcomings of the surgical emergencies department of NHZ, a good welcome and prompt patient management have been the key components associated with patient satisfaction.

INTRODUCTION: Le but de cette étude était d'évaluer la satisfaction des patients pris en charge au service des urgences chirurgicales de l'Hôpital National de Zinder, Niger. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale portant sur des patients admis aux urgences chirurgicales de l'hôpital National de Zinder (HNZ). L'enquête a été réalisée sur une période de 2 mois du 1er juillet au 31 août 2015. Un questionnaire adressé aux patients était rempli à travers un entretien direct. RÉSULTATS: Sur les 227 patients retenus, 54,62% (n=124) étaient satisfaits des prestations au service des urgences chirurgicales. Les principaux éléments associés à une bonne satisfaction étaient l'accueil (OR: 0,27; IC95%= 0,14 ­ 0,52; p<0,001) et la prise en charge de la symptomatologie (OR: 0,28; IC95% = 0,14 ­ 0,58; p<0,001). Les facteurs incriminés dans l'insatisfaction étaient: le temps d'attente avant la prise en charge (OR: 16,57; IC95% = 8,52 ­ 32,23; p<0,0001), l'environnement (OR: 3,89; IC95%=2,12 ­ 7,12; p<0,001), l'accessibilité (OR: 5,85; IC95%=2,54 ­ 13,46; p<0,001) et la mauvaise communication soignant-patient (OR: 13,76; IC95% =6,54­28,98; p< 0,0001). CONCLUSION: Malgré les insuffisances du service des urgences chirurgicales de l'HNZ, un bon accueil et une prise en charge rapide, sont les éléments clés associés à la satisfaction du patient.

A CASE OF LITTRÉ'S HERNIA AT ZINDER NATIONAL HOSPITAL, ZINDER, NIGER.

The presence of a Meckel's diverticulum in a hernia sac is known as Littré's hernia. We report a case of Littré's hernia in an 18-year old young man because of the uncommon condition. An 18-year old young patient was admitted to the Emergency Surgical Department of Zinder National Hospital, Zinder, Niger with a painful inguinoscrotal swelling of three days duration. The diagnosis of strangulated right inguinoscrotal hernia was made. At surgery, a Meckel's diverticulum was found at the antimesenteric border of the ileum in the hernia sac, the bowel loop was not viable. Resection of the non-viable ileal loop with the Meckel's diverticulum attached to it was performed with an end-to-end ileal anastomosis. The hernia defect in the groin was repaired according to Bassini procedure. The postoperative recovery was uneventful and the patient was followed up for 5 months without symptoms. CONCLUSION: Littre hernia is uncommon and difficult to diagnose; it is often an incidental finding at surgery which should ensure complete resection of the Meckel's diverticulum in order to prevent future complications.

[The seroprevalence of human immunodeficiency virus infection (HIV) in the Touaregs and Peuls Bororo in Niger]. / Séroprévalence de l'infection par le virus de l'immunodéficience humaine (VIH) chez les Touaregs et Peuls Bororo au Niger.

A seroepidemiological study of endemic treponematosis (bejel) in Niger allows us to realise an anonymous non correlated screening of VIH infection in Nomads: Touaregs of Tchirozerine (Agadez), Peuls Boro of Bermo (Maradi). On the 424 Touaregs screened only one was seropositive to VIH2 infection confirmed with Western blot that means 0.23% of seroprevalency comparable to that 0.50% found in the general population. The seroprevalency of trepronematosis (VDRL + TPHA+) is 7% in the range of 5 to 15 years old (80%), period which corresponds to the transmission of Bejel. Moreover this population don't travel to the seaborder countries. Concerning the 213 of the Peuls Bororo screened we had only 3 undetermined reactions to Western blot 1 and 2, despite the high seroprevalence of the treponematosis (VDRL+ TPHA+): 22% mostly in the subjects of more than 15 years old (89.36%) which is the sexual intercourse and exodus period to the seaborder countries, where 66% of our VIH patients are infected.

[Comparison of colonic J-pouch and straight coloanal anastomosis after low anterior resection for rectal carcinoma: a meta-analysis of 8 randomized trails].

OBJECTIVE: To evaluate the effect of colonic J-pouch coloanal anastomosis after low anterior resection for mid or low rectal cancer on improving defecation and anorectal physiology. METHODS: To make a meta-analysis, prospective randomized controlled trial of with or without colonic J-pouch after low anterior resection for mid or low rectal cancer was conducted. The key words included rectal cancer, J-pouch (or J-pouch) and those randomized from selected reports. The data on bowel function and physiological function of the anal canal and (neo) rectum were meta-analyzed using fixed effect model and random effect model. RESULTS: Eight randomized trails including 378 patients entered this study. After one year follow-up, the functional results showed that there were significant differences in stool frequency per day, urgency and use of medication between colonic J-pouch group and straight coloanal anastomosis group. On physiological function of the anal canal and (neo) rectum, there was significant difference only in rectal compliance between the two groups. But there was no significant difference in other 4 items. CONCLUSIONS: The functional improvement gained from colonic J-pouch coloanal anastomosis continues to benefit the patient with mid or low rectal cancer for at least 12 months. It is necessary to further study about the effect of colonic J-pouch coloanal anastomosis on physiological function of the anal canal and (neo) rectum.