[Torsion Of Meckel's Diverticulum, A Case Report At Paediatric Surgery Service Of CHU Gabriel Touré]. / Torsion D'Un Diverticule De Meckel : A Propos D'Un Cas Dans Le Service De Chirurgie Pediatrique Du C.H.U. Gabriel Toure.

Twist is the rarest complication of Meckel's diverticulum (DM). We did not find a case published in African literature. We report a case of twisted "giant" diverticulum occurred in a 15-year-old boy who had consulted for abdominal pain. Operated in emergency, the diagnosis was intraoperative. The diverticulum was 14 cm long and 5 cm in diameter. It was twisted at its base, totally necrotic and perforated at the top. We performed a resection carrying the diverticulum followed by a terminoterminal ileal ileal anastomosis. The postoperative course was simple.

La torsion est la plus rare des complications du diverticule de Meckel (DM). Nous n'avons pas trouvé de cas publié dans la littérature africaine. Nous rapportons un cas de diverticule « géant ¼ tordu survenu chez un garçon de 15 ans qui avait consulté pour douleur abdominale. Opéré en urgence, le diagnostic était per-opératoire. Le diverticule avait 14 cm de long et 5 cm de diamètre. Il était tordu à sa base, totalement nécrosé et perforé à son sommet. Nous avons réalisé une résection emportant le diverticule suivie d'une anastomose iléo-iléale termino-terminale. Les suites opératoires ont été simples.

[Neonatal Gastric Perforation]. / Perforation Gastrique Neonatale.

Neonatal gastric perforation (PGNN) is a rare and serious pathology when management is not early. We did not find a case published in African literature. . We report 2 cases of PGNN registered in pediatric surgery of C.H.U Gabriel TOURE. The clinical pictures were that of a neonatal occlusion. X-rays of the abdomen without preparation revealed pneumoperitoneum in both cases. Congenital origin was retained for both cases. Surgical treatment consisted of excision-suture of the perforation margins. The operative sequences were simple in both cases.

La perforation gastrique néonatale (PGNN) est une pathologie rare et grave lorsque la prise en charge n'est pas précoce. Nous n'avons pas trouvé de cas publié dans la littérature africaine. . Nous rapportons 2 cas de PGNN enregistrés en chirurgie pédiatrique du C.H.U Gabriel TOURE. Les tableaux cliniques étaient celui d'une occlusion néonatale. La radiographie de l'abdomen sans préparation a permis de mettre en évidence un pneumopéritoine dans les 2 cas. L'origine congénitale a été retenu pour les 2 cas. Le traitement chirurgical a consisté à une excision-suture des berges des perforations. Les suites opératoires ont été simples dans les 2 cas.

[Pathologies of peritoneo-vaginal canal in pediatric surgery at the teaching hospital Gabriel Touré]. / Les Pathologies du Canal Peritoneo-Vaginal en Chirurgie Pediatrique du CHU Gabriel Toure.

The closure anomalies of the peritoneal-vaginal canal include several clinical entities, which are at the origin of various symptomatology. OBJECTIVE: To study the anatomo-clinical and therapeutic aspects of pathologies of the peritoneal-vaginal canal. MATERIALS AND METHOD: This was a prospective study from January 1st to December 31st, 2015 carried out in the pediatric surgery department of University Hospital Gabriel Touré. It covered all children aged 0-15 years old with a pathology of the peritoneal-vaginal canal operating in the department during the study period. This study did not include cases that were not operated on or not seen during the study period. RESULTS: During the study period, 2,699 children were treated in pediatric surgery, of which 150 cases of pathology of the peritoneal-vaginal canal had a hospital frequency of 5.5%. The average age was 3.25 ± 9.63 years. The sex ratio was 14. The reason for consultation was intermittent or permanent inguinal or inguino-scrotal swelling in all children. The pathology was discovered by the parents during the pushing efforts in 46.7%. Inguino-scrotal swelling was found on physical examination in 40% of cases. The right side was reached in 60% of the cases. Hernia accounted for 80.6% of these pathologies. We recorded 31 cases of strangulation and 11 cases of craze. Immediate operative follow-up was simple in 92% of patients. This rate was 96% after 6 months. CONCLUSION: Pathologies of the peritoneal-vaginal canal are very common in pediatric surgical practice. The first place of these pathologies is occupied by hernia. They preferentially affect male infants.

Les anomalies de fermeture du canal péritonéo-vaginal (CPV) regroupent plusieurs entités cliniques qui sont à l'origine d'une symptomatologie variée. OBJECTIF: étudier les aspects anatomo-cliniques et thérapeutiques des pathologies du canal péritonéo-vaginal. MATÉRIELS ET MÉTHODE: il s'agissait d'une étude prospective du 1er Janvier au 31 Décembre 2015 réalisée dans le service de chirurgie pédiatrique du CHU Gabriel Touré. Elle a porté sur tous les enfants de 0-15 ans présentant une pathologie du canal péritonéo-vaginal opérés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les cas non opérés et ou non vus pendant la période d'études. RÉSULTATS: Durant la période d'étude 2699 enfants ont été pris en charge en chirurgie pédiatrique dont 150 cas de pathologies du canal péritonéo-vaginal soit une fréquence hospitalière de 5,5%. L'âge moyen était de 3,25± 9,63 ans. Le sexe ratio était de 14. Le motif de consultation était la tuméfaction inguinale ou inguino-scrotale intermittente ou permanente chez tous les enfants. La pathologie a été découverte par les parents lors des efforts de poussées dans 46,7%. La tuméfaction inguino-scrotale a été retrouvée à l'examen physique dans 40% des cas. Le côté droit était atteint dans 60% des cas. La hernie a représenté 80,6% de ces pathologies. Nous avons enregistré 31 cas d'étranglement et 11 cas d'engouement. Les suites opératoires immédiates ont été simples chez 92% des patients. Ce taux était de 96% après 6 mois. CONCLUSION: Les pathologies du CPV sont très fréquentes dans la pratique chirurgicale pédiatrique. La première place de ces pathologies est occupée par la hernie. Elles touchent préférentiellement les nourrissons de sexe masculin.

[Epidemiology and prognosis of childhood cancers at Gabriel-Touré Teaching Hospital (Bamako, Mali)]. / Épidémiologie et pronostic des cancers pédiatriques au CHU Gabriel-Touré de Bamako (Mali).

UNLABELLED: Cancer today is being treated as a public health problem in Africa, as in developed countries. OBJECTIVE: The aim of this retrospective study was to evaluate the epidemiology and outcome of children treated in the Pediatric Oncology Unit of Gabriel Touré Teaching Hospital in Bamako (Mali), six years after it opened. METHODS: Retrospective study of the files of all children aged 15 and younger diagnosed with cancer and treated by chemotherapy between January 1, 2005, and December 31, 2010. RESULTS: The study included 690 children. Their mean age was 24 months. The time from observation of first symptoms to consultation was less than 3 months in 200 cases (29%), from 3 to 10 months in 256 (37.1%), and more than 10 months in 234 (33.9%). The five most common childhood cancers were malignant non-Hodgkin's lymphoma (NHL) (n=231, 33.5%), retinoblastoma (n=170, 24.6%), nephroblastoma (n=102, 14.8%), acute lymphoblastic leukemia (n=54, 7%), and Hodgkin's disease (n=34, 4%). Six years after the unit opened and after a mean follow-up of 3 years, we recorded 272 deaths (39.4%); at least 238 children are still alive (34.5%), with 180 cases (26.1%) lost to follow-up. CONCLUSION: Childhood cancer survival is still low in Mali, and the rate of loss to follow-up quite high.

Acute sigmoid volvulus: results of surgical treatment in the teaching hospitals of Bamako.

OBJECTIVE: The aim was to evaluate the results of surgical treatment of occlusion of the sigmoid colon due to volvulus. PATIENTS AND METHODS: This was a retrospective study from 1996 to 2010 of all patients undergoing surgery for sigmoid volvulus in surgical wards of the University Hospital of Bamako. RESULTS: A total of 417 patients were identified including 379 men and 38 women. The mean patient age was 45.7 ± 18.3 years. The general condition of the patients was good in 70.5% and altered in 29.5% of cases. Colonic necrosis was present in 80 patients (19.2%). Single-stage resection with immediate anastomosis was performed in 149 patients (35.73%). Two-stage surgery was performed in 268 cases (64.27%). The initial stage of the two-stage procedure was colostomy in 167 cases and simple detorsion in 101 cases. The surgical approach had an impact on mortality in patients who were in poor general condition. Single-stage surgery resulted in higher mortality (12/149; 8.05%) than two-stage surgery (5/268; 1.87%), and the difference was statistically significant (P=0.0005). CONCLUSION: Single-stage surgery for sigmoid volvulus carries a high risk of death when it is performed in patients with poor general condition. Indications for surgery must take into account the patient's general condition and the viability of the torsed sigmoid colon.

[Complications of digestive ostomies in pediatric surgery]. / Complications des stomies digestives en chirurgie pediatrique.

AIMS: To determine the frequency and factors of complications of intestinal stomas. METHODS: This was a retrospective study over a 7 year period from January 2004 to December 2010, covering all children aged 0-15 years, who received a stoma and hospitalized in the period of study. Excluded from this study, alimentary ostomy and urological ostomy, and children whose medical records were incomplete. RESULTS: We examined 192 cases of stoma or 27 cases/year. We noted a complication in 91 (48%) of our patients. The average age was 3.64 ± 5.03 years ranging from 6 hours and 15 years. The complicating factors were: the indication for surgery, type of stoma, the variety of stoma, surgical technique and equipment. CONCLUSION: The achievement of good technique and appropriate equipment would be needed to reduce some complications of the stoma.

OBJECTIFS: Déterminer la fréquence et les facteurs de complications des stomies digestives. MATÉRIEL ET MÉTHODE: Il s'agissait d'une étude rétrospective de 7 ans allant de Janvier 2004 à Décembre 2010, portant sur tous les enfants âgés de 0­15ans, ayant bénéficié d'une stomie et hospitalisés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les stomies d'alimentations et urologiques, ainsi que les enfants dont le dossier médical était incomplet. RÉSULTATS: Nous avons colligé 192 cas de stomies soit 27 cas/an. Nous avons noté une complication chez 91 patients (48%) de nos patients. L'âge moyen a été de 3,64±5,03 ans avec des extrêmes de 6 heures et 15ans. Les facteurs de complications ont été: l'indication opératoire, le type de stomie, la variété de la stomie, la technique chirurgicale et l'appareillage. CONCLUSION: La réalisation d'une bonne technique et un appareil adéquat seraient nécessaires pour réduire certaines complications des stomies.

[Amoebic liver abscess in general surgery at the Gabriel Touré teaching hospital, Bamako, Mali]. / Abces amibien du foie en chirurgie generale du CHU gabriel toure, Bamako, Mali.

The objectives were to determine the frequency, and to describe the clinical and therapeutic aspects of amoebic liver abscess. This was a retrospective study in the general surgery department of the Gabriel Touré teaching hospital from 1 January 2004 to December 2008. Included in this study, were all patients hospitalized and treated for amoebic liver abscess. We collected 53 cases a frequency of 1.3%. This was 45 men (84.9%) and 8 women (15.1%). The sex ratio was 5.6. The average age was 39.5 years. The average consultation time was 3 weeks. The signs observed were fever 96.2% (51 cases), the hepatalgia 94.3% (50 case), hepatomegaly 90.6% (48 cases) and anorexia 88.7% (47 cases). Collections of objectified abscess in abdominal ultrasound were located in the right lobe in 79.2% (42 cases), unique in 92.5% (49 cases) and 100 mm in diameter on average. Pulmonary radiography found an elevation of the right diaphragmatic dome 66.7% (14 cases). Amoebic serology was performed in 60.4% of cases, was negative in 2 cases (6.2%). Medical treatment alone was effective in the majority of cases - 62.7% (32 cases), an ultrasound-guided paracentesis associated with medical treatment was required in 31.4% (16 cases). Surgical methods were very rarely recommended 5.9 % (3 cases). The average amount of pus was 637.6ml. Average duration of treatment was 11 days. We recorded three deaths, including one due to a sepsis on peritonitis from ruptured liver abscess and 2 cases due to HIV. CONCLUSION: The amoebic liver abscess is uncommon in our service. Negative serology does not exclude the diagnosis. Medical treatment is usually curative in the absence of complications.

Les objectifs étaient de déterminer la fréquence, de décrire les aspects cliniques et thérapeutiques de l'abcès amibien du foie.Il s'agissait d'une étude rétrospective réalisée dans le service de chirurgie générale du CHU Gabriel Touré du 1er Janvier 2004 au Décembre 2008. Ont été inclus dans cette étude tous les patients hospitalisés et traités pour abcès amibien du foie. Nous avons colligé 53 dossiers soit une fréquence de 1,3%. Il s'agissait de 45hommes (84,9%) et 8femmes (15,1%). Le sex-ratio a été de 5.6 et la moyenne d'âge 39.5 ans. Le délai moyen de consultation a été de 3 semaines. Les signes observés ont été la fièvre 96.2% (51cas), l'hépatalgie 94.3%(50cas), l'hépatomégalie 90.6% (48cas) et l'anorexie 88.7%(47cas). Les collections d'abcès objectivées à l'échographie abdominale étaient localisées dans le lobe droit dans 79.2%(42cas), uniques dans 92.5%(49cas) et de 100 mm de diamètre en moyenne. La radiographie pulmonaire de face a retrouvé une surélévation de la coupole diaphragmatique droite 66,7% (14cas). La sérologie amibienne effectuée dans 60.4% des cas, a été négative dans 2 cas (6.2%). Le traitement médical seul a été efficace dans la majorité des 62.7% (32cas), une ponction évacuatrice échoguidée associé au traitement médical a été nécessaire dans 31,4% (16 cas). Les méthodes chirurgicales ont été très peu recommandées 5,9%(3cas). La quantité moyenne de pus a été de 637.6ml. La durée Moyenne de traitement a été de 11 jours. Nous avons enregistré 3 décès dont l'un suite à une septicémie sur péritonite par rupture d'abcès du foie et les 2cas sur terrain VIH. CONCLUSION: L'abcès amibien du foie est peu fréquent dans notre service. La négativité de la sérologie n'exclut pas le diagnostic. Le traitement médical est habituellement curatif en l'absence de complication.

[Necrotic ulcer in a general surgery department at Gabriel Tour Hospital]. / Ulceres necroriques dans le service de chirurgie generale du CHU Gabriel Toure.

Our objectives were to determine the frequency, clinical, and therapeutic aspects and to evaluate the cost of care. PATIENTS AND METHOD: This was a retrospective, analytical study, , carried out in the general surgery department of the teaching hospital Gabriel Touré from 1 January 2000 to December 2008. Were included in this study all patients operated for necrotic ulcer in the service. RESULTS: Seventy -nine (79) patients were identified which represents 0.6 % of our admissions. There were 48 men (60.8%) and 31 women (39.2%) . The sex ratio was 1.5 . The average age was 33.6 years, with extremes ranging from 31-81 years and the standard deviation = 19.7. The diagnosis was based on clinical and paraclinical investigations in all patients (100 %). The average period of consultation was 1.2 months, with extremes ranging from 1 - 24 months and the standard deviation = 0.8. Traditional medications were given to 38 patients (48.1%). The ulcer was multiple in 20 patients (25.3%). In 57 cases (72.2%) it sat in the lower limb and in 22 cases (27.8 %) in the upper limb. The average diameter was 24.3 cm and the standard deviation = 15.1. Trauma and infection were, respectively, the main causes in 63 patients (79.7 %) and 10 patients (12.6%). The most frequent germs found were the Staphylococcus aureus in 40 patients (50.6%) and Proteus mirabilis in 10 patients (12.7%). The thin skin autograft was performed in 66 patients (83.5 %). Healing was complete in 52 patients (78.8%), with a morbidity of 21.2 % (14 cases) . Infection was observed on graft and edema, 5 cases each (7.6%), graft rejection 4 cases (6.1%). The average hospital stay was 2.3 months. The average cost was 237,450 with a range of 75,000 to 500,000 FCFA. CONCLUSIONS: Necrotic ulcer is an uncommon pathology in our department. The lack of consultation and the use of traditional medication are the main factors of seriousness.

Nos objectifs étaient de déterminer la fréquence hospitalière, de décrire les aspects cliniques, thérapeutiques et d'evaluer le coût de la prise en charge. PATIENTS ET METHODE: Il s'agissait d'une étude retrospective,analytique, réalisée dans le service de chirurgie générale du CHU Gabriel TOURE du 1er Janvier 2000 au Décembre 2008. Ont été inclus dans cette étude tous les malades opérés pour ulcère nécrotique dans le service. RÉSULTATS: Soixante dix-neuf (79) patients ont été repertoriés soit 0,6% de nos hospitalisations. Il s'agissait de 48 hommes (60,8%) et 31 femmes (39,2%). la sex- ratio a été de 1,5. La moyenne d' âge a été de 33,6 ans avec des extremes variant entre 31 - 81 ans et l'Ecart-type=19,7. Le diagnostic a été retenu sur des bases cliniques et paracliniques chez tous les malades (100%). le delai moyen de consultation a été de 1,2 mois avec des extremes variant entre 1 - 24mois et l'Ecart-type= 0,8. les médications traditionelles ont été effetuées chez 38 patients (48,1%). L' ulcère était multiple chez 20 malades (25,3%). Il siégeait dans 57 cas (72,2%) au niveau du membre inférieur et 22cas (27,8%) au membre superieur. Le diamètre moyen a été de 24,3cm et l'Ecart type= 15,1. Les traumatismes et l'infection ont été les principales étiologies respectivement chez 63patients (79,7%) et 10patients (12,6%). Les germes le plus frequement retrouvés ont été le Staphilococcus aureus chez 40 patients (50,6%) et le Proteus mirabilis chez 10 malades (12,7%). L'autogreffe de peau mince a été réalisée chez 66 malades(83,5%). La guérison a été complète chez 52 malades(78,8%) , avec une morbidité de 21,2% (14 cas). infection sur greffon et oedème 5cas chacun(7,6%), rejet de greffon 4cas (6,1%). Durée moyenne d'hospitalisation a été de 2,3 mois. Le coût moyen a été de 237450 avec des extrêmes de 75000 et 500000 FCFA. CONCLUSION: L'ulcère nécrotique est une patologie peu fréquente dans notre service. Le retard à la consultation et l'utilisation de la médication traditionnelle constituent les principaux facteurs de gravité.

[Peritonitis by perforation on gastric cancer at the Gabriel Touré teaching hospital]. / Peritonites par perforation sur cancers Gastriques au CHU Gabriel Toure.

OBJECTIVE: Describe the therapeutic and diagnostic aspects of gastric cancer perforations at the general surgery department of the Gabriel Touré teaching hospital. PATIENTS AND METHOD: A retrospective survey was conducted over 11 years (January 1999 to December 2010). It included all patients having had surgery for peritonitis by gastric cancer perforation at the service during that time frame. RESULTS: We found 14 cases of peritonitis due to gastric perforation, of which 9 were male and 5 female. The main clinical symptoms were abdominal pain (100%), weight loss (100%) and abdominal contraction (98.8%). Endoscopy allowed to note a pyloric antrum budding tumor in 4 patients before perforation. Radiography of the abdomen without preparation showed pneumoperitoneum in 8 cases. In all cases, the histological type recorded was adenocarcinoma. The antral seat was the most common (64.3%). Palliative surgery was immediately performed in all cases. We recorded two cases of fistula tract and 3 cases of infection of the lining, as well as 2 cases of postoperative mortality. CONCLUSION: Gastric cancer perforation is rare and of bad prognosis as it survives on advanced cancer.

OBJECTIF: Décrire les aspects diagnostiques et thérapeutiques de la perforation du cancer de l'estomac dans le service de chirurgie générale du CHU GABRIEL TOURE. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective s'étalant sur 11 ans (Janvier 1999 à Décembre 2010). Elle a concerné tous les malades opérés pour péritonite par perforation du cancer de l'estomac pendant la même période dans le service de chirurgie générale du CHU GABRIEL TOURE. RESULTATS: Nous avons trouvé 14 cas de péritonite par perforation gastrique parmi lesquels 9 étaient de sexe masculin et 5 de sexe féminin. Les principaux signes cliniques ont été la douleur abdominale(100%),l'amaigrissement (100%) et la contracture abdominale (98,8%).La fibroscopie a permis d'objectiver une tumeur bourgeonnante antro-pylorique chez 4 malades avant la perforation. La radiographie de l'abdomen sans préparation a révélé le pneumopéritoine dans 8 cas. L'adénocarcinome était le type histologique dans tous les cas. Le siège antral était le plus fréquent (64,3%). Le geste chirurgical à visée palliative a été effectué en urgence dans tous les cas. Nous avons enregistré 2 cas de fistule digestive et 3 cas d'infection de la paroi, 2 cas de mortalité postopératoire. CONCLUSION: La perforation de cancer gastrique est rare et de mauvais pronostic car elle survient sur le cancer avancé.

[Acute generalized peritonitis in Sominé Dolo's Hospital of Mopti: Epidemiologic and therapeutic aspects]. / Peritonites aiguës Generalisees a l'hopital Somine Dolo de Mopti: Aspects epidemiologique et therapeutique.

Acute generalized peritonitis requires precocious diagnosis and immediate treatment. MATERIALS AND METHODS: The purpose of this study is to determine hospital case frequency, to describe the clinical and therapeutic aspects and to evaluate the operating suites. We conducted a prospective study, lasting 16 months, from January 2005 to April 2006, looking at 40 cases of generalized acute peritonitis operated in several services, including a general surgery department, of the Sominé Dolo's hospital of Mopti. RESULTS: We noted a hospital admittance rate of 3.1% with an average age of 26.3 years old and a 1.66 men to women ratio. Peritonitis at the Sominé Dolo hospital was dominated by intestinal perforation. The diagnosis was essentially made using the clinical approach. The treatment was medico-surgical. Operative mortality was recorded in 7 cases (17.5%) with 7 cases of inner-wall abscesses. The delay of consultations and the Mannheim score were the main factors causing bad prognostics. Excision - sutures associated with a cleansing drainage of the abdominal cavity was the most practised surgical procedure. CONCLUSION: Mortality remains high. The two factors for a bad prognostic are the delay of consultation and the lack of means for reanimation.

INTRODUCTION: La péritonite aiguë généralisée est une urgence qui nécessite un diagnostic précoce et un traitement d'urgence. MATÉRIELS ET MÉTHODES: Nous avons réalisé une étude prospective de seize mois de janvier 2005 à avril 2006 portant sur 40 cas de péritonites aigues généralisées opérés à l'hôpital Sominé Dolo, qui est un hôpital de première référence de la région de Mopti avec plusieurs services dont un service de chirurgie générale. Les objectifs de cette étude étaient de déterminer la fréquence hospitalière, de décrire les aspects cliniques, thérapeutiques et évaluer les suites opératoires. RÉSULTATS: Nous avons eu une fréquence hospitalière de 3,1% avec un âge moyen de 26,3 ans et un sex-ratio de 1,66 pour les hommes. La péritonite à l'hôpital Sominé Dolo de Mopti a été dominée par la perforation intestinale. Le diagnostic a été établi essentiellement sur la clinique. Le traitement a été médico-chirurgical. La mortalité opératoire a été observée dans 7 cas (17,5%) avec 7 cas d'abcès de paroi (17,5%). Le retard de consultation et le score de Mannheim ont été les principaux facteurs de mauvais pronostic. L'excision ­ suture associée à un lavage drainage de la cavité abdominale ont été les gestes chirurgicaux les plus pratiqués. CONCLUSION: La mortalité reste élevée .Les deux facteurs de mauvais pronostic ont été le retard de consultation et le manque de moyens de réanimation.

[Typhoid peritonitis in children: Evaluation of morbi-mortality at the Gabriel Touré teaching hospital in Bamako]. / Peritonites typhiques chez l'enfant: Evaluation de la morbi-mortalité au CHU Gabriel Touré, Bamako.

AIMS: To determine related factors of complications typhoid perforations in the small intestine in children. MATERIAL AND METHOD: A retrospective study was conducted between June 1st, 2005 to June 30th, 2010 in all children aged 0 to 14 years treated for peritonitis by ileal perforations in the service of paediatric surgery at the Gabriel Touré teaching hospital. Traumatic perforations and patients with incomplete files were not included in this study. RESULTS: In 5 years time we gathered 105 cases of ileal typhoid perforation. After surgical treatment early outcomes were simple in 70 patients (66.6%), a parietal suppuration had been noted in 15 patients (14.3%) and fistula in 4 (3.9%). Sixteen patients (15.2%) died. Complications were related to patient's age, ASA Score, time frame of care, quantity of peritoneal fluid, number and site of perforation, surgical techniques and the duration of surgery P(<0.05). Sex, anaemia, surgeon, and perforation diameter did not significantly influence the rate of complications. CONCLUSION: Reduction of morbi-mortality happens through prevention, earlier diagnosis and appropriate management of typhoid fever.

OBJECTIFS: Déterminer les facteurs liés aux complications post-opératoires des perforations typhiques du grêle chez l'enfant. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude rétrospective réalisée du 1er juin 2005 au 30 juin 2010 chez tous les enfants âgés de 0 à 14 ans traités pour péritonite par perforation iléale dans le service de chirurgie pédiatrique du CHU Gabriel Touré. Les perforations traumatiques et les patients à dossier incomplet n'ont pas été inclus dans l'étude. RÉSULTATS: En 5 ans nous avons colligé 105 cas de perforations iléales typhiques. Après le traitement chirurgical les suites immédiates ont été simples chez 70 malades (66,6%), une suppuration pariétale a été notée chez 15 patients (14,3%) et une fistulisation chez 4 autres (3,9%). Le décès était survenu chez 16 malades (15,2%). Les complications ont été fonctions de l'âge du patient, du Score ASA, du délai de prise en charge, de la quantité du liquide intraabdominal, du nombre et siège de la perforation, de la technique chirurgicale et de la durée de l'intervention (P<0,05). Le sexe, la présence d'une anémie, le chirurgien et le diamètre de la perforation n'ont pas eu d'influence sur la survenue des complications. CONCLUSION: La réduction de la morbi-mortalité passe par la prévention, un diagnostic précoce et une prise en charge adéquate des fièvres typhoïdes.

[Penetrating abdominal wounds caused by weapons in the service of general surgery in the Gabriel Touré teaching hospital]. / Plaies penetrantes abdominales par armes dans le service de chirurgie generale du CHU Gabriel Toure.

INTRODUCTION: Providing care for penetrating abdominal wounds is a controversial subject. The aim of this project was to describe their epidemiological, clinical and therapeutic aspects. MATERIALS AND METHODS: This retrospective study conducted over 4 years, from January 2006 to January 2010 concerned 70 cases of penetrating abdominal injury in the general surgery department of the Gabriel TOURE teaching hospital. Non-piercing and animal horn related abdominal injuries were not included. RESULTS: We collated 70 cases of penetrating abdominal wounds; representing 1.2% of hospitalisations during the studied time frame. The patients were 12 to 59 years old with a mean age of 27.7 years and a sex-ratio of 9 to 1 for men. 27 patients (38.36%) came from districts I and II of Bamako. Criminal injuries was the main cause of injury encountered representing 70% cases. 3 of the patients had psychiatric antecedents and 45.7% of patients regularly consumed drugs. The epiploon and small intestine were the main eviscerated organs (51.4% cases). 17/53 patients received non-surgical treatment. The rate of laparotomia was of 30.2% and postoperative morbidity 15.1%. CONCLUSION: Treating penetrating abdominal injury remains difficult. A good selection of patients allow the service to lower the rate of laparotomia.

INTRODUCTION: La prise en charge des plaies pénétrantes de l'abdomen est encore sujet à controverses. Les objectifs de ce travail étaient d'étudier les aspects épidémiologiques, cliniques et thérapeutiques. MATÉRIELS ET MÉTHODE: Cette étude rétrospective de 4 ans, de janvier 2006 à janvier 2010 portant sur 70 cas de plaies pénétrantes de l'abdomen, a été réalisée dans le service de chirurgie générale du CHU Gabriel Touré. Les plaies non pénétrantes et les encornements ont été non inclus. RÉSULTATS: A l'issue de l'étude, nous avons colligé 70 cas de plaies pénétrantes abdominales;ce qui a représenté 1,2% des hospitalisations. L'âge moyen des patients a été de 27,7 ans(extrêmes 12 et 59 ans) avec un sex ratio de 9 pour les hommes. Vingt sept patients (38,36%) viennent de la commune I et II. L'agression criminelle a été la circonstance de survenue la plus fréquente (70%). Trois de nos patients avaient un antécédent psychiatrique et 45,7% consommaient des stupéfiants. L'épiploon et le grêle ont été les organes les plus éviscérés (51,4%).Dix sept patients sur 53 ont bénéficié du traitement non opératoire. Notre taux de laparotomie blanche a été de 30,2% et la morbidité post opératoire était de 15,1%. CONCLUSION: La gestion des plaies pénétrantes abdominales reste difficile. Une bonne sélection des patients permet de diminuer le taux de laparotomie blanche.

[Intestinal invagination occurring during pregnancy: 1 case]. / Invagination intestinale sur grossesse: 1cas.

Acute intestinal invagination is a rare pathology in adults; even more so on specific fields as in pregnant women. Therapeutic indications depend on the duration of the invagination. We noted a cases of acute intestinal invagination after 72 hours of evolution in a multiparous 35 year old woman, 27 weeks pregnant, successfully treated by surgery and tocolysis.

L'invagination intestinale aigue est une pathologie rare chez l'adulte, elle l'est encore plus sur des terrains particuliers comme chez la femme enceinte. Les indications thérapeutiques dépendent de la durée d'évolution de l'invagination. Nous rapportons un cas d'invagination intestinale aigue après 72heures d'évolution chez une multipare de 35ans enceinte de 27semaines traitée avec succès par chirurgie et tocolyse.

[Non-resecable gastric cancers at the department of general surgery at CHU Gabriel TOURE Bamako]. / CANCERS gastriques non resecables dans le service de chirurgie generale CHU Gabriel TOURE Bamako

UNLABELLED: Our objectives were to determine the frequency of non-resecable gastric cancers, to analyse its clinical, and therapeutic aspects, and to assess patients follow-up. METHOD: Our retrospective study has been from 1st January 2008 to 31st December 2009. It included all patients operated or not having non-resecable gastric cancers at general surgery at CHU Gabriel TOURE RESULTS: We have recorded 305 cases of advanced gastric cancers, accounting for 71.4% of gastric cancers (n=425), 47.8% of digestive cancers (n=766) and 2.2% of hospitalisations. The sex ratio was 1.6 in men favour; the average age was 57 } 12 with extremes of 25 and 90. The average evolution delay was 15.5 months with extremes of 5 and 7, and standard deviation 19.2. 14 patients have been admitted in an emergency context. (8 cases of gastric perforation related peritonitis, 6 cases d'haematemesis). The main found signs were: epigastric tumours 187 (61.3%) cases, lower limbs oedema 105 (34.4%) cases, ascitis 105(34.4%) cases, hepatomegaly 68(22.3%), lymphadenopathy ≪ ganglions de Troisier ≫21(7%), ≪ ecailles de Brumer ≫ (= Brumer's scales) from rectal touch 17(6%) cases More than half of patients have been classified ASA 4.105(34.4%) ASA 5, and 74(24.2%) ASA . The tumour location was antrum in 260(85.2%) cases Cardiac orifice in 17(5.5%) cases, fundus i n 11(3.6%), the gastric linitis in 17(5,5%) cases. The imaging has found the ascitis in 119(39%) cases, the hepatic metastases in 54(17.7%) cases, pulmonary in 36(19%) cases, pancreatic 5(1.6%) cases, splenic in 4(1.3%), and ovarian in 3(1%) cases 105(34.4%) patients had no surgery, 4(1.3%) had chemotherapy, and 200(65 %) had surgery. The mortality rate was at 16.5% and the one year survival at 15.5%.

[Comparaison between the association of chlorhydrate ketamin-magnesium sulfate ketamin chlorhydrate and in paracetamol aving in visceral surgery]. / Comparaison l'association chlorhydrate de ketamine-sulfate de magnesium au chlorhydrate de ketamine dans l'epargne en paracetamol en chirurgie viscerale.

AIM: To compare paracetamol saving followed by the association of ketamine chlorhydrate - magnesium sulfate to ketamine chlorhydrate and analyze cost after the 2 protocols administration. MATERIAL AND METHODS: We conducted this comparative study from June 2005 to January 2006 in the services of anesthesiology and resuscitation and visceral surgery of the teaching hospital Gabriel Touré, Bamako. 80 patients were split into 2 groups - group A receiving: 0,25mg/kg of ketamine chlorhydrate plus 50mg /kg of magnesium sulfate, group B receiving: 0,25mg/kg of ketamine chlorhydrate. RESULTS: The 2 groups were compared by anthropometrical and clinical data (age, sex, weight) and ASA. The reduction of paracetamol dosage was 57, 50 % of the 4 g actually used per day in A group against 48, 50% in B group. CONCLUSION: Ketamin chlorhydrate associated to magnesium sulfate insure a post-operative analgesic saving in visceral surgery. Cost of analgesia actually used is reduced.

OBJECTIF: Comparer les effets de l'association chlorhydrate de kétamine - sulfate de magnésium à ceux du chlorhydrate de kétamine dans l'épargne en paracétamol. MATÉRIEL ET MÉTHODES: Notre étude était comparative. Elle s'est déroulée dans les services d'anesthésie réanimation et de chirurgie viscérale de l'hôpital Gabriel Touré de Bamako de juin 2005 à janvier 2006. Les malades ont été randomisés en deux groupes: groupe A recevait: 0,25 mg /kg du chlorhydrate de kétamine plus 50mg /kg de sulfate de magnésium et le groupe B recevait: 0,25mg/kg du chlorhydrate de kétamine. RÉSULTATS: Pendant la période 80 patients ont été inclus. Les deux groupes étaient comparables par les données anthropométrique et cliniques (poids, le sexe, l'âge) et ASA. La réduction de la dose de paracétamol injectable était de 57,50 % sur les 4 g habituellement utilisés par jour pour les patients du groupe A contre 48,50% des patients du groupe B. CONCLUSION: Le chlorhydrate de kétamine associé au sulfate de magnésium assure une épargne analgésique postopératoire en chirurgie viscérale. Le coût du paracétamol habituellement utilisé est réduit.

A metastatic case of gastrointestinal stromal tumor (GIST) treated with imatinib mesylate (Glivec(®)) in Mali.

Gastrointestinal stromal tumors (GIST) usually showing a spindle cells pattern of cell proliferation have recently benefit from a molecular definition. Indeed imatinib mesylate (Gleevec(®)) treatment has dramatically improved the management of these tumors as they frequently express the c-kit oncogene. We report the first case of a metastatic gastric GIST in a man of 45 years diagnosed and treated in Mali. The gastric tumor was particularly aggressive with a large intra-abdominal and mesenteric spreading and liver metastases. The diagnosis was done on the CD117 and CD34 expression in the tumor sample obtained by laparotomy. After a 34 months 400mg/day imatinib mesylate (Gleevec(®)) treatment a dramatic tumor regression was obtained.

[Small bowel obstruction and adhesions in general surgery at Gabriel Toure University Hospital]. / Occlusions Du Grele Sur Brides Et Adherences En Chirurgie Generale CHU Gabriel Toure.

UNLABELLED: The objectives were to determine the frequency, to describe the clinical, therapeutic aspects and to evaluate the cost of the assumption of responsibility of occlusions by supports and or adherences. It was about a retrospective study carried out in the department of surgery general of the CHU Hôpital Gabriel TOURE from January 1st, 2002 to December 2008. Were included in this study all the patients operated for occlusion of hail on Brides and Adherence confirmed in per operational. We colligé 659 acute obstructions of the bowels whose 100 occlusions of hail on supports and adherences is a frequency of 17,8%. They were 55 men (55%) and 45 women (45%). The sex-ratio was of 1,2. The average age was 39,7 years with the extremes varying between 15ans and 80 years. Eighty eight of our patients had surgical antecedents including 14 (16%) of surgery known méso colic and 74 (84%) of surgery under méso colic. Twelve patients had antecedents of contusion and untreated abdominal infections. Among the signs of the occlusive syndrome, the abdominal pain was found at all the malades100 (100%), the vomiting (98), the stop of the matters (88) and the gases (80). The ASP was carried out at 98 of our patients and 74 (75,5%) presented radiological images in favor of the occlusion of hail. The leading cause of occlusion was the supports (67), the supports and adherences (18) and adherences (15). The small intestine was hyperhémié chez14 patient, was necrosed among 16 patients and normal in the 70 cases. The surgical treatment consisted with a section of the support among 60 patients Adhésiolyse among 15 patients, a Adhésiolyse section among 10 patients, a résection Iléostomie among 10 patients and a résection - immediate anastomosis among 5 patients. The rate of morbidity was of 28%, it related to the infection of the operational site 18cas, the digestive dent 6cas and the eventration 4cas. Mortality was of 8%. Intermediate duration of hospitalization 14,8 days. The average costs of the assumption of responsibility were of 156.900 francs CFA. CONCLUSION: Mortality and postoperative morbidity are not negligible. Gravity of this pathology underlines the interest of it's fast assumption.

[Adverse events of anesthesia in pediatric surgery scheduled at Gabriel Toure hospital]. / Evenements indesirables de l'anesthesie en chirurgie pediatrique programmee a l'hopital Gabriel Toure.

UNLABELLED: The occurrence of an event planned or unplanned during anesthesia is a concern for staff. This event may jeopardize the success of surgery gesture. Pediatric Surgery therefore has its own specific complications that it requires anesthesia. PURPOSE: To evaluate the incidence of adverse events during anesthesia in pediatric surgery scheduled. STUDY TYPE: Descriptive non-randomized study. PATIENTS AND METHODS: Descriptive non-randomized study on adverse events related to anesthesia in children over a period of seven months. It took place in the anesthesia and intensive care unit and the pediatric surgery unit of Gabriel Toure hospital in Bamako. It focused on patients aged 0 to 12 years scheduled for surgery under general anesthesia during the study period. RESULTS: Sixty six percent of patients selected was male gender with a sex ratio of 3 in favor of males. The average age was 2 years with extremes of 16 days and 12 years and a standard deviation of 2.93. The old history of premature was found in 36% of patients and 2% of asthmatic. The number of patients experiencing an adverse event is 42 on a total of 107 patients collected either 39.25%. When the children were younger than one year adverse events occurred with 30, 76%. The occurrence of adverse events was more frequent when the child was not intubated with P < 0.05. All adverse events have received support except tachycardia, late revival but all developed positively. CONCLUSION: This study estimates the incidence of adverse events in anesthesia during pediatric surgery. The overall rate of patients experiencing an adverse event is relatively high. Children age less than or equal to one year are most vulnerable.

[Stoma use in the general surgery service of CHU Gabriel Touré]. / Stomies digestives en chirurgie generale du CHU Gabriel Toure.

OBJECTIVES: Were to determine the frequency, to describe the clinical and therapeutic aspects digestive stoma. MATERIAL AND METHODS: It was about six months an exploratory study from January 1st to June 30th, 2008 in the department of surgery general of the CHU Gabriel Touré. Were included in this study all the patients carrying a enter stoma or a colostomy, old of more than 15 ans. The digestive dents, the other types of stoma and the patients old of less than 15 years, were excluded. The results were analyzed by the software Epi information version 6.4 Fr, the tests of Khi 2 and Student with a threshold of significance for P < 0.05. RESULTS: We college 32 patients are 7.4% of all digestive surgical operations, 13.3% of the abdominal urgencies; composed of 26 men (81.25%) and 6 women (18.75%). The sex ratio at summer of 4.3. The average age was 44, 8 years with a standard deviation 8, 13 and the extremes varying between 16-80 years. Twenty and one (65.6%) sick were operated in urgency. We carried out 29 cases (90.6%) of final stoma, 3 cas (9.4%) side, 21 cas (65.6%) of colostomy, 9 cas (28.1%) of ileostomies. They were temporary in 25 cas (78.1%) and final 7 cas (21.9%). The volvulus of the sigmoid colonist with necroses 10 cas (31.3%), the peritonitis by typhus perforation ilea 9 cas (28.1%), occlusions on tumor of the left colonist 8 cas (25%), the traumatic perforations ileales 2 cas (6.3%), the digestive dents post appendicectomies 2 cas (6.3%) and the congenital megacolon 1 cas (3%) was the indications of the stoma. the operational continuations were simple in 21 cas (65.6%). The principal found complications were: coetaneous irritation 7 cas (21.8%), the prolapsed stomiale 4 cas (12.5%), the suppuration peristomial 3 cas (9.4%), the releasing of Stoma 3 cas (9.4%), the retraction of the stoma 3 cas (9.4%),the psychological disorders 3 cases (9.4%), the hemorrhage 2 cas (6.3), necroses peristomial 2 cas (3.1%), septic shock 2 cas (6.3%), and 1 cas (3.1%) of evisceration, obstruction of the bowels, shock hypovolemic. The intermediate duration of hospitalization was of 37,5 jours with a standard deviation = 13.58 and extremes varying between 02-73 days. Death rate was of 9.4%. CONCLUSION: The assumption of responsibility of the stomies is difficult in the absence of stomatherapeutes, and of the high cost of the parenteral nutrition in our context .

[Epidemiologic and therapeutic factors of postoperative incisional hernia at CHU Gabriel Touré]. / Facteurs etiologiques et therapeutiques des eventrations postoperatoires au Chu Gabriel Toure.

INTRODUCTION: The incisional hernia is a frequent complication of the opened abdominal surgery. The objectives of this study were to determine the hospital frequency and the favoritizing factors, to analyze the therapeutic aspects. MATERIALS AND METHODS: We realized a retrospective study from January, 1999 to December, 2005 in the services of general and paediatric surgery of teaching hospital Gabriel Touré. It concerned 45 cases of incisional hernia. The hernias of the abdominal wall, the abdominal and traumatic hernia were not retained. RESULTS: The frequency was 0.52%; the average age of our patients was 37.8 years with a sex ratio of 2 in favour of the woman. The average delay of consultation was of 59 months with extremes going from 2 to 11 months. Favoritizing factors found were the parietal suppuration to 13 (28.8%) patients and the multiple interventions to 8 (17.8%) patients. The average dimension of the hernia was 9.5 cms ± 3.8 with extremes going from 5 to 14 cms. The 45 patients benefited from the cure of the hernia according to Mayo. We didn't lost any patient. 2 parietal suppurations happened post-operatively. CONCLUSION: Incisional hernia treatment consists for Mayo's method or prosthesis. The laparoscopic surgery can reduce complications.