[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.

[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.

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.

[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.