Penetrating chest wound of the foetus.

Traumas of the foetus caused by stabbings are rare but actually life-threatening for both the foetus and the mother. We report a case of penetrating chest wound on a baby taken from the obstetrics unit to the paediatric surgical department. His mother was assaulted by his father, a mentally sick person with no appropriate follow-up. The foetus did not show any sign of vital distress. Surgical exploration of the wound has revealed a section of the 10 th rib, a laceration of the pleura and a tearing of the diaphragm. A phrenorraphy and a pleural drainage were performed. The new-born and its mother were released from hospital after 5 days and the clinical control and X-ray checks 6 months later showed nothing abnormal. We insisted a medical, psychiatric follow-up be initiated for the father. As regards pregnant women with penetrating wounds, the mortality rate of the foetus is 80%. The odds are good for our newborn due to the mild injuries and good professional collaboration of the medical staff. Penetrating transuterine wounds of the foetus can be very serious. The health care needed should include many fields due to the mother and the foetus' lesions extreme polymorphism. In our case, it could have prevented by a good psychiatric followed up of the offender.

[Epidemiology of neonatal surgical emergencies in Ouagadougou]. / Épidémiologie des urgences chirurgicales néonatales à Ouagadougou.

OBJECTIVE: The purpose of this study was to determine the rate of neonatal surgery emergencies and to highlight the main causes and difficulties related to better handling of these emergencies. PATIENTS AND METHODS: We conducted a 1-year descriptive prospective study from September 2009 to September 2010 based on 102 cases collected. At admission, we studied the patients' age, the pathologies encountered, the related malformations, the terms for better management, and prognosis. FINDINGS: In 1 year, we registered 102 cases of neonatal surgical emergencies affecting the digestive tract (63.7%), the anterior side of the abdomen (24.5%), trauma (6.7%), and tumors (2%). Males comprised 60.8% of the cases. The sex-ratio was 1.55. The frequency of such cases was 3.94%. The average age of patients was 5 days with the 0- to 5-day-old age group presenting most frequently. The average hospitalization lasted 2.75 days and the admission method was the reference in 75.5%. Congenital pathology accounted for 95.5% of cases with anorectal malformations (ARM) (35; 95%) and omphaloceles (28.1%). Hirschsprung disease was the main cause of bowel obstruction other than ARM (50%). The average time to surgery was about 2.54 days. The overall mortality of neonatal surgical emergencies was 30.3% and postoperative mortality 32.35%. The late consultation, poverty, a shortage of qualified staff, prematurity, low birth weight, congenital disease, and related malformations were the leading factors of a poor prognosis. Acquisition of effective technical means, staff training, measures to combat poverty, and better prenatal care would improve the management of neonatal surgical emergencies. CONCLUSION: Neonatal surgical emergencies include conditions that require immediate and adequate support. The continuous training of healthcare workers at all levels in the detection of neonatal emergencies and equipping healthcare facilities are an absolute necessity to provide better management and reduce the mortality rate.

Child abdominal tumour in tropical context: think about schistosomiasis!

Schistosomiasis presenting as an abdominal mass with chronic pain in a child is not common. This report presents case of child presenting with schistosomiasis presenting as an abdominal mass with chronic pain. Abdominal ultrasonography did not particularly contribute to definitive pre-operative diagnosis. However, pathological examination of surgical specimen confirmed Schistosoma mansoni eggs in the biospy. A decrease in the mass volume was noticed under medical treatment (Biltricide). The aim of this report was to intimate clinicians on possible abdominal schistosomiasis as differential diagnosis of childhood abdominal mass. This is a clarion call for a high index of suspicion of childhood abdominal schistosomiasis in children presenting with abdominal mass in a tropical setting.

[Acute intestinal obstruction]. / Occlusion intestinale aiguë.

A 12-year-old boy is admitted for emergency surgery for acute abdominal syndrome. The intervention showed strangulation of the terminal ileum by the vermiform appendix. The pathology analysis showed bilharzial appendicitis by Schistosoma haematobium. The patient was treated with praziquantel. The literature is not plentiful on this subject. Because protozoiasis is endemic in this area, it should be looked for in all cases of appendicitis, as it requires medical treatment in addition to the appendectomy.

[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.

Hirschsprung's disease: management problem in a developing country.

BACKGROUND: The management of Hirschsprung's disease remains a problem in developing countries. Our aim is to identify the main epidemiological, clinical, and therapeutic characteristics of Hirschsprung's disease at the University Child Hospital Charles De Gaulle of Ouagadougou (CHUP-CDG). PATIENTS AND METHOD: It is a retrospective study carried out in the period from January 2001 to December 2007 in the Surgery Unit at CHUP-CDG, which is a reference centre for Paediatric Surgery in Burkina Faso. RESULTS: There were 52 patients (M: F=3.3:1). The annual incidence was seven cases. Age at presentation and diagnosis ranged from two days 10 years (median 20 months). Twenty five patients were from poor socio-economic conditions. Presentations were mainly intestinal obstruction, chronic constipation and enterocolitis. There were two cases of associated trisomy 21. Average age at operative intervention was 3.17 months. The rectosigmoidal form was the most frequently encountered. Over two-thirds (67.31%), with no complications at presentation, had benefited from nursing before their final treatment. A temporary colostomy was requested in case of complication. Swenson's technique was practiced for all the patients who underwent surgery operation. The assessment of functional results in eight patients after an average decrease of 3.5 years gave excellent results. Post-surgery complications were mainly enterocolitis in 12% of patients. Mortality rate was 16%. CONCLUSION: Management of Hirschsprung's disease is a problem in Burkina Faso. It is characterised by its late presentation and difficult diagnosis due to inaccessibility and the non-availability of some investigation services (barium enema, histochemistry, and histology), resulting in high morbidity and mortality rates. Effective technical capacities, adequate staff training, and public education will be necessary to improve care quality.

[Primary ileostomy for typhoid-related ileal perforation: a 62-case series in Ouagadougou, Burkina Faso]. / Iléostomie première des perforations iléales d'origine typhique: 62 cas à Ouagadougou (Burkina Faso).

OBJECTIVES: The purpose of this report is to evaluate the efficacy of primary ileostomy for treatment of typhoid-related ileal perforation based on our experience. METHODS: This retrospective study included all cases of typhoid-related ileal perforation treated by primary ileostomy in the Visceral Surgery Department of the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso from January 2006 to June 2008. Diagnosis was based mainly on peroperative findings revealing specific anatomical lesions. There were 45 men (72.6%) and 17 women (27.4%) with a mean age of 26 years (range, 14 to 68). Asthenic forms were observed in 41 cases (66.1%) and sthenic forms in 21 (33.9%). The mean delay for seeking treatment was 6 days (range, 1 to 30 days). RESULTS: Primary ileostomy was used for treatment of typhoid-related ileal perforation in 78.5% of cases. Most cases (80.6%) involved single perforations. A temporary ileostomy was performed in 55 cases (88.7%) and terminal ileostomy was performed in 7 (11.3%). Complications were observed in 18 patients (29.03%) including suppuration of wall in 8 cases. The mean duration for re-establishing continuity and of hospital stay was 34 and 41 days respectively. Four deaths occurred due to hypovolemic shock. CONCLUSION: In our department, primary ileostomy for typhoid-related ileal perforation reduced mortality despite high morbidity.

[Strangulated umbilical hernia in children (Burkina Faso): differences with developed countries]. / Hernies ombilicales étranglées chez l'enfant au Burkina Faso: différences avec les pays développés.

Umbilical hernias occur frequently in children but complications are rarely reported. This study assesses the incidence of complicated umbilical hernias in our patients, evaluates data for risk factors, and shows dissimilarities with those encountered in developed countries. This study reports all children operated for complications due to strangulated umbilical hernia over a period of 3 years. On the whole, 162 children had umbilical hernias treated during this period. Thirty (18.5%) of these had complicated hernias. The average age of the complicated group was 3(1/2) years. Twenty-nine cases had a painful irreducible umbilical mass. Twenty-four children had bowel obstruction, while stercoral fistula occurred in one child. The average diameter of the hernia ranged between 1 and 1.5 cm. Five patients had ischemic intestine that required resection. One patient died. When active observation and follow-up after 1 year is difficult or not feasible when the wall defect diameter is 1.5 cm or less, and in suspicion of incarceration (unexplained abdominal pain, and irreducibility), umbilical hernia should be operated.

[Accidents of circumcision in children in Abidjan, Côte d'Ivoire]. / Accidents de circoncision chez l'enfant à Abidjan, Côte d'Ivoire.

Circumcision is the most common surgical procedure carried out in boys in our countries. It is performed by medical members but also by traditional practitioners. Circumcision is considered as a benign operation but its complications are common, sometimes severe and the treatment delicate. Authors reported 35 cases of circumcision's complications in boys, aged of 2 days to 14 years old who were circumcised by traditional practitioners and by medical members. The most frequent complications were urinary meatus stenosis (17 cases), haemorrhage (5), total glans section (3), urethral fistula (3), and incomplete circumcision (3). These complications were caused by traditional practitioners in 19 cases, paramedical members in 11 cases, and 5 cases by physicians. Among these complications, fistula and amputation had required delicate surgical procedure. All the stenosis were treated by meatal plasty and fistula were sutured with one recurrence. Partial glans section underwent Mathieu's procedure and the total sections were referred to the plastic surgeon. Authors recommend surgical procedure for circumcision which must be performed in medical center or by well trained practitioners.

[Tuberculous spondylodiscitis with neurologic problems: results of surgical treatment]. / Spondylodiscite tuberculeuse avec troubles neurologiques: resultats du traitement chirurgical.

The purpose of this study is to describe the outcome of surgical treatment for tuberculous spondylitis in 29 patients. These patients were part of an overall series of 67 cases of tuberculous spondylitis treated at the Traumatology and Orthopedic Department of the Yalgado-Ouedraogo National Hospital Center (YONHC) in Ouagadougou, Burkina Faso. Almost 90% of the 29 patients that underwent surgical treatment of tuberculous spondylitis associated with neurological manifestations were from poor rural areas. Mean age was 48 years and most patients were men. The procedure consisted of corporectomy via the anterolateral approach. Resection of variable extent was followed by replacement with forced insertion of a fibular graft. Intraoperative complications included non-fatal cardiovascular arrest (n = 1), inadvertent incision of the peritoneum (n = 3), and technical error in exposure of the damaged vertebrae (n = 1). Postoperative complications included emphysema (n = 2), massive pleurisy (n = 1), chylothorax (n = 1), pneumonia (n = 1), worsening of neurological manifestations (n = 1), and subacute peritonitis (n = 1). Surgical mortality was 10.3% (n = 3). Bone fusion was achieved in all patients. Functional recovery ranged from 50 to 60% after surgical treatment, which is comparable to rates in previous African reports. Choice of therapeutic modalities must take into account cost within the national health care context, duration of hospitalization and invasiveness. Surgical treatment should be used only when absolutely necessary.

[Warm saline enema for reduction of intestinal invagination under the ultrasonographic guidance: preliminary results apropos of 2 cases]. / Désinvagination intestinale par lavement au sérum salé isotonique tiédi sous contrôle échographique: résultats préliminaires à propos de deux cas.

The authors describe the use of isotonic normal saline enema under US guidance in the treatment of acute uncomplicated intestinal intussusception in infants. The technique was successfully used in two patients aged respectively 18 and 16 months, with 11 and 9-month follow-up. The various steps of this technique and the results are analyzed and discussed. It is a valuable alternative to surgical treatment or hydrostatic reduction with opaque x-ray contrast under fluoroscopic guidance.

[Non-traumatic circumscribed myositis ossificans. Apropos of a bilateral localization]. / La myosite ossifiante circonscrite non traumatique. A propos d'une localisation bilatérale.

The authors report one case of a bilateral atraumatic circumscribed myositis ossificans (C.M.O.) developed from the triceps muscles with major equinism, in a 15 years old girl. One side presented a current tumor, the other was seen at the first episode. The authors obtained a good functional result after surgical treatment and advocate this treatment.