Etiological, therapeutic and prognostic particularities of primary biliary peritonitis in tropical environments.

To describe the etiological, therapeutic, and prognostic aspects of primary biliary peritonitis in Burkina Faso. This retrospective study reviewed records of all patients admitted for primary biliary peritonitis at Tenkodogo Regional Hospital (Burkina Faso) from 2010 through 2016. Cases of secondary biliary peritonitis have been excluded. Thirty patients were identified. Their average age was 26.5 years. Fourteen patients were under 12 years of age. The reasons for consultation were dominated by abdominal pain (in all cases) and bile-induced vomiting (in 22 cases). Seven patients had a general condition classified in stage 2 of the World Health Organization classification, 18 in stage 3, and 5 in stage 4. The etiologies of peritonitis were acute typhoidal cholecystitis, which predominated (27 cases), and gallstones (3 cases). The surgical approach was a laparotomy in all cases. Intraoperative observation showed an inflamed and perforated gallbladder in 24 cases; gangrene was noted in 6 cases. Treatment consisted of cholecystectomy and peritoneal lavage, associated with antibiotic therapy. The post-operative period was complicated by septicemia in 12 cases. Fourteen patients died, for a mortality rate of 46.7 %. In rural Burkina Faso, primary biliary peritonitis occurs in young subjects. Its cause is most often acute cholecystitis due to Salmonella typhi. Mortality is very high.

So-called "historical" necrotic breast cancers: a terrifying actuality in Africa. The case of Burkina Faso.

Study the epidemiological, diagnostic, and treatment features and outcomes of necrotic breast cancer in women. This observational, longitudinal, and descriptive study covered the period from January, 2011, to the end of May, 2016 at the Surgery and Gynecology Departments of Yalgado Ouedraogo University Hospital and Schiphra Medical Center. The study included all women with necrotic breast cancers. Survival was calculated by the Kaplan Meier method and survival comparison was possible with the log-rank method. À risk of error of 0.05 was allowed. Necrotic cancer accounted for 9.1% of all breast cancers. The median age of the patients was 46 years old. The median interval before consultation was 12.4 months. The histological type was invasive ductal carcinoma in 90.8% of cases. Surgery was performed in 51 patients (52%). It was a palliative (cleaning) procedure in 92.2% of cases. Chemotherapy was performed in 28 patients. Overall survival was 61.8% at 6 months, 39.5% at 1 year, and 9.2% at 3 years. Median survival was 10 months: 13 months for women with surgery and 6 months for those without it (p<0.001). Necrotic breast cancer is still common in Ouagadougou. Surgery is the mainstay of the treatment. Survival is mediocre. It therefore seems urgent to focus on raising population awareness and organizing screening campaigns.

[Results after surgical management of ileal perforation due to typhoid fever, about 29 cases in Ouahigouya (Burkina Faso)]. / Résultats de la prise en charge des perforations iléales typhiques : à propos de 29 cas à Ouahigouya (Burkina Faso).

The aim of this study was to determine the results of management of typhoid perforations. This was a descriptive cross-sectional study carried out from January 1, 2016 to December 31, 2016 in the General Surgery Department of the Regional Teaching Hospital Center of Ouahigouya (Burkina Faso). It involved 29 operated patients, in whom the diagnosis of typhoid perforation was confirmed at laparotomy: age, sex, admission time, clinical, therapeutic and prognostic aspects were analyzed. Typhoid perforations accounted for 20% of acute generalized peritonitis and 38.1% of digestive perforations. Twenty-three patients were males and six were females (sex-ratio: 3.8). The average age of patients was 19 years. The mean diagnostic time was 9.8 days. The excision-suture of the perforation was the most used technique with 62% of the cases. The treatment lead to complications in 10 cases with a morbidity of 34.5%. Four deaths were recorded, representing an overall mortality of 13.8%. Prognostic factors were diagnostic delay, age, number of perforations and resection-anastomosis.

Acute appendicitis due to schistosomiasis: four cases at the Yalgado Ouédraogo University Hospital of Ouagadougou.

Acute appendicitis is a frequent pathology with diverse causes. Although Burkina Faso is a tropical country with endemic schistosomiasis, bilharzial appendicitis remains rare. We report 4 cases of appendicitis due to schistosomiasis that we treated at the university hospital of Yalgado Ouédraogo to call attention to the need for routine review of appendectomy parts. Four male patients, aged 22, 26, 30, and 35 years old, were admitted for abdominal pains. Eosinophilia was observed in one case. The preoperative diagnosis was acute appendicitis in 2 cases and appendiceal peritonitis in 2 others. Appendectomy was performed in all cases. Pathological examination of the appendectomy piece observed acute suppurative appendicitis due to schistosomiasis, specifically, Schistosoma haematobium. All patients received praziquantel for antiparasite treatment. Clinical course was uncomplicated in all cases. Routine antiparasite treatment would make it possible to prevent these cases of bilharzial appendicitis. In addition, routine histologic examination of appendectomy parts would enable us to determine the real frequency of this disease in our country, where bilharziasis is endemic. The treatment is appendectomy and the prognosis is good.

Epidemiological, clinical, and therapeutic features of typhoid intestinal perforation in a rural environment of Burkina Faso.

The aim of this study was to describe the epidemiological, clinical, and therapeutic features of ileal perforation due to typhoid fever at the regional hospital of Tenkodogo (Burkina Faso). This cross-sectional study examined the records over a 5-year period of all patients treated for typhoid ileal perforation. Ileal perforation was diagnosed intraoperatively, and its typhoid origin determined according to the following criteria : background signs of typhoid fever, location of the perforation on the antimesenteric edge of the terminal ileum, and a positive Widal-Felix serology. The study included 216  patients. Their mean age was 13.8 years, and 63.4% were male. The average time to consultation was 11 days. Clinical signs were mainly abdominal pain, vomiting, and abdominal tenderness. Anemia was observed in 135 patients (62.5%). All patients underwent laparotomy. Three procedures for treating surgical perforation were used : excision and suture of the perforation in 86 patients (39.8%), ileal resection with anastomosis in 98 (45.4%), and ileostomy with subsequent recovery in 32 (14.8%). The average length of hospital stay was 16.1 days. Postoperative complications occurred in 156 patients (72.2%). Thirty-seven patients died, for a mortality rate of 17.1 %. Ileal perforations due to typhoid fever are the main cause of peritonitis in rural areas of Burkina Faso. Patients are relatively young, and most are anemic at admission. Morbidity and mortality are significant.

[Acute pancreatitis at the Yalgado Ouedraogo University Hospital in Burkina Faso]. / Les pancreatites aigües au centre hospitalier universitaire (CHU) Yalgado Ouedraogo au Burkina Faso.

AIMS: To study the epidemiological, diagnostic, etiologic, therapeutic and evolutionary aspects of acute pancreatitis in Burkinabe. MATERIALS AND METHODS: We conducted a cross-sectional descriptive study referred from records of patients hospitalized for acute pancreatitis in the Department of General and Digestive Surgery of the Yalgado Ouedraogo University Hospital in Burkina Faso from 1 January 2007 to 31 December 2012. RESULTS: We noted 30 cases of acute pancreatitis, a frequency of 0.46 % of hospitalizations and an annual incidence of 4.6 cases per year. There were 22 men. The average age was 42.7 years. Alcohol consumption was found in 56.7%. The clinical aspects were dominated by abdominal pain (100%). Lipasemia was more than three times normal values in 66.3% of cases. An abdominal ultrasound was performed in 26.7% of cases and an abdominal CT was carried out in 50% of cases. The Balthazar score was evaluated in 15 patients and was lower in stage C in 9 cases. The treatment was mainly medical. The evolution was marked by the occurrence of systemic complications in 40% of patients and one death was recorded. CONCLUSION: Patients suffering from financial hardships present a major handicap for the diagnosis and early treatment.

BUT: Etudier les aspects épidémiologiques, diagnostiques, étiologiques, thérapeutiques et évolutifs de la pancréatite aiguë dans le contexte Burkinabè. MATÉRIELS ET MÉTHODE: Il a été mené une étude transversale à visée descriptive à partir des dossiers des patients hospitalisés pour pancréatite aiguë dans le service de chirurgie générale et digestive du CHUYO du 1er Janvier 2007 au 31 décembre 2012. RÉSULTATS: Trente cas de pancréatite aiguë ont été colligé soit une fréquence de 0,46% des hospitalisations et une incidence annuelle de 4,6 cas par an. Il y avait 22 hommes. L'âge moyen était de 42,7 ans. La consommation d'alcool était retrouvée dans 56,7%. Le tableau clinique était dominé par la douleur abdominale (100%). La lipasémie était supérieure à trois fois la normale dans 66,3%. L'échographie abdominale n'a été réalisée que dans 26,7% et le scanner abdominal a été réalisé dans 50%. Le traitement était essentiellement médical. L'évolution a été marquée par la survenue de complications générales dans 40% et un décès a été enregistré. CONCLUSION: Les difficultés financières des patients sont un handicap important pour le diagnostic et la prise en charge précoce.

[The bacterial microflora of diabetic foot infection and factors determining its spectrum in Ouagadougou (Burkina Faso)]. / Écologie bactérienne et facteurs déterminant le profil bactériologique du pied diabétique infecté à Ouagadougou (Burkina Faso).

The aim of the study was to describe the bacterial microflora of diabetic foot infection and to identify the factors which determine the bacterial spectrum in order to increase empiric antibiotic prescription in Ouagadougou. The study was a cross-sectional one, carried from July 1st, 2011 to June 30, 2012 in the departments of internal medicine and general and digestive surgery in Yalgado Ouédraogo teaching hospital. Samples for bacteriological tests consisted of aspiration of pus through the healthy skin, curettage and swab of the base of the ulceration or tissue biopsy from foot lesions. The bacteria's sensitivity to antibiotics has been tested by the qualitative method (Kirby-Bauer). The frequency of diabetic foot infection was 14.45% and the monthly incidence 5.33. The mean age of patients was 56 years and the sex ratio 1.37. Foot ulcerations were chronic in 33 (51.56%), necrotic in 51 (79.69%) and associated with osteitis in 40 (62.5%) patients. Infection was grade 3 in 70.3% cases. Thirty-nine patients had received antibiotics before hospital admission. Among the 71 samples, 62 (87.32%) cultures were positive: 53 (85.48%) monomicrobial and 9 (14.52%) bimicrobial. Aerobic Gram-positive cocci (76%) were the most frequent from ulcerations: Staphylococcus aureus (32.39%), Streptococcus sp (18.30%). Negative coagulase staphylococci have been found in 23.94% cases. Aerobic gram-negative bacilli have been isolated from 24% ulcerations. No factor was associated with the type of bacteria. Gram-positive pathogen cocci showed a high sensitivity to amoxicillin-clavulanic acid and oxacillin. No methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum beta lactamase Enterobacteriaceae (ESBL) have been isolated. A better design is necessary to a clarification of bacterial flora in diabetic foot infections. Prevention of bacterial resistance is also needed.

[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.

[Urachal cyst: contribution of ultrasound (about a case at Sourou Sanou Sobo-Dioulasso university hospital)]. / Kyste de l'ouraque: apport de l'echographie (a propos d'un cas au centre hospitalier universitaire Sourou Sanou Bobo-Dioulasso).

Urachal cyst is difficult to diagnose and is a rare malformation and the authors report a case in a 10-month old boy. The malformation was associated with posterior urethral valve and simple surgical treatment was successful.The authors emphasize the contribution of perineal ultrasound in the diagnosis of associated posterior urethral valves.

Le kyste de l'ouraque est de diagnostic difficile et constitue une malformation rare dont les auteurs rapportent un cas chez un garçon de 10 mois. La malformation était associée à une valve de l'urètre postérieur et sa cure chirurgicale très simple a été couronnée de succès.Ils insistent sur l'apport de l'échographie par voie périnéale dans le diagnostic associé des valves de l'urètre postérieur.

[Surgical abdomen caused by traditional treatment. Five-case report in teaching hospital Yalgado Ouédraogo of Ouagadougou]. / Les abdomens chirurgicaux dus au traitement traditionnel. À propos de cinq cas au Centre hospitalier Yalgado Ouédraogo de Ouagadougou.

The traditional products used to treat some pains can cause serious complications of which surgical abdomen. We listed in two years five cases of surgical abdomen complicating a traditional treatment in the service of digestive and general surgery of the hospital complex Yalgado Ouédraogo. There were two men and three women with an average age of 34,4 years. These traditional products were used to treat constipation, sexual impotence, sterility and to "posses" her husband. Oral and rectal routes were used by one and three patients respectively, another patient used triple routes (oral, rectal and vaginal). The digestive lesions were in the upper tract in one case (gastric phytobezoar), two patients presented acute intestinal occlusion and two others acute generalized peritonitis. All the five patients underwent laparotomy. Two patients died in immediately post-operative course. The prevention of severe surgical complications of the digestive tract induced by traditional treatments has to be broadcasted through information, education and communication.