[Morgagni hernia: Concerning 2 pediatric cases in Sub-Saharan Africa]. / Hernie de morgagni: a propos de deux cas pediatriques en Afrique Sub Saharienne.

Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far, very limited data is available about them. We report two cases of repaired successfully Morgagni hernias using a transabdominal approach. The aim of this study is to illustrate the diagnostic difficulties and the excellent post operational prognostic observed following the transabdominal procedure. Both patients were female, one 8 months old and the other 3 months old. The presenting symptom was recurrent chest infection. Chest x-rays were carried out on both patients, which showed a pre-cardiac gas mass. A transabdominal surgical approach enabled surgeons to sow the defect with non resorbable suture material in one patient, and a prolene plate in the other. The patients fully recovered and no postoperative difficulties were reported.

La hernie de Morgagni ou hernie diaphragmatique congénitale antérieure est une entité peu décrite dans la littérature et est le plus souvent asymptomatique. Le but de cette étude est d'illustrer les difficultés diagnostiques et l'excellent pronostic après traitement chirurgical après abord trans abdominal sus ombilical de cette forme rare de hernie des coupoles diaphragmatiques. Nous rapportons deux cas simulant une pneumopathie chronique chez deux nourrissons de sexe féminin âgés respectivement de 8 mois et 3 mois. Les radiographies pulmonaires de face et de profil ont permis de poser le diagnostic par la mise en évidence d'une clarté gazeuse pré cardiaque. La laparotomie transversale sus ombilicale a permis la fermeture du défect par suture avec du fil non résorbable chez une patiente et une obturation à l'aide d'une plaque de prolène chez la deuxième patiente. Les suites opératoires ont été simples.

Ultrasound guided hydrostatic reduction of intussusception in children at Korle Bu Teaching Hospital: an initial experience.

Intussusceptions is the telescoping or invagination of a portion of intestine (intussusceptum) into an adjacent segment (intussuscipiens). It is one of the common causes of bowel obstruction in infants and toddlers.Sonography has now been accepted as a method for guiding hydrostatic reduction of intussusception with tap water, normal saline or Ringer's lactate solution. This method is currently being used at Korle Bu Teaching Hospital. It is a very simple, efficient, economical and quick method of managing intussusception. The duration of the procedure ranges between two minutes and thirty minutes, with the majority being under ten minutes. A total of twenty intussusceptions were managed in eighteen patients over a nine month period. In fifteen patients (75%) the intussusception was reduced successfully. In five patients (25%), the procedure failed to reduce the intussusceptions.

Inversion appendicectomy.

OBJECTIVES: (i) To emphasise that incidental appendicectomy has indications and, to highlight this indications. (ii) To teach that, even when indicated, this procedure should not convert a clean surgical wound into a clean contaminated or even less optimal wound. (iii) To recommend that if an incidental appendicectomy is to achieve (ii) above, inversion appendicectomy is the better option to choose. (iv) To prove that inversion appendicectomy is fast, easy and achieves a similar result as the more popular excision appendicectomy. PATIENTS AND METHODS: This study was carried out in the paediatric surgical unit of Korle-Bu Teaching Hospital Accra, Ghana - between March 2003 and May 2004. PATIENT SELECTION: Fifteen patients qualified for enrollment into this study. These were (i) Those who had clear cut indications for incidental appendicectomy, and had it done as an inversion appendicectomy. (ii) Cases of incidental appendicectomy. METHODS: Eleven of these cases were done for intussusceptions and four for malrotation. Only wounds that qualified as clean surgical wounds were included in this study. There was no age or sex discrimination. RESULTS: Follow up on these patients did not reveal any complications. CONCLUSION: Incidental appemdicectomy has well-defined indications. When indicated in clean wound, inversion appendicectomy is the procedure of choice.

The daily water, sodium and potassium excretion in urine of Ghanaian children aged 5 to 12 years.

AIM: The aim of the study was to determine the daily losses of water, sodium and potassium in the urine of Ghanaian children who presented to the paediatric surgery unit of the Korle-Bu teaching hospital. METHODS: The urine of 74 Ghanaian children (51 male, 23 female) who presented to the Paediatric surgery unit of the Korle-Bu teaching hospital between June 1997 and January 1999 was collected over a 24 hour period and analysed to determine the volume, sodium and potassium content. RESULT: 74 children between the ages of 5 and 12 years with a mean age of 9 years were involved in the study. The mean daily urinary volume was 1136.8ml (95% confidence interval 1097.7 to 1176.0) with a range of 400 to 2400ml. The sodium excreted was 108.6mmol per day (confidence interval 105.3 to 111.9) with a range of 39.8 to 231.9mmol per day while the potassium excreted was 24.7mmol (confidence interval 23.7 to 25.7mmol) and a range of 6.25 to 69.9mmol per day. CONCLUSION: This study showed that children between 5 and 12 years in a ward lose a mean of 1136.8ml of water per day, 4.6mmol per kilogram of sodium per day, and 1mmol per kg per day of potassium in their urine.