[Late presentation of anorectal atresia: a case report]. / Atrésie rectale membraneuse: présentation tardive à propos d'un cas.

Anorectal atresia and rectal stenosis are rare types of anorectal malformations, accounting for only 1-2% of cases. We here report one case of anorectal atresia. The study involved a female newborn baby delivered at term via vaginal birth, weighing 3600g, who was admitted with failure to pass meconium, abdominal bloating and fever on day 6 of life. Clinical examination showed a temperature of 39ºC, distended abdomen, normal anal location and peremeability, with prolapsed pinkish mass and no signs of necrosis. A cannula trocar stylet was inserted between the mass and rectal mucosa and stopped at about 3cm from the anal margin. Abdominal X-ray without treatment showed distended bowels and air-fluid levels, with no evidence of hollow-organ perforation. Due to suspicion of complete anorectal atresia, 16 gauge needle was inserted into the membrane and meconium was collected abundantly with considerable abdominal deflation. Surgical excision of the membrane was then performed. The postoperative course was uneventful and newborn baby was discharged at postoperative day 3. Anal dilatations were performed to treat anal stenosis. At 6-months´ follow-up, functional outcome was satisfactory. Anorectal atresia manifesting as failure to pass meconium associated with mass protruding through the anus has not yet been described in the literature. Membrane puncture confirmed the diagnosis. Membrane was resected with good outcome.

Emergency treatment of a ruptured huge omphalocele by simple suture of its membrane.

BACKGROUND: The rupture of a huge omphalocele is an emergency that threatens the newborn baby's life. It constitutes a therapeutical concern in the absence of prosthesis especially in developing countries. METHODS: We are reporting herein the case of a newborn baby that we managed in emergency successfully thanks to a simple treatment. RESULTS: It was a huge omphalocele, ruptured during delivery, in a male newborn baby. We conducted a simple and conservative surgical treatment without prosthesis, which consisted of reconstruction of the omphalocele's membrane by closing it with absorbable suture materials. The suture of the omphalocele's membrane was followed by treatment with the Grob's method. This treatment saved the newborn baby's life. The total skinning was obtained after 3 months. CONCLUSIONS: In case of rupture of huge omphalocele in absence of prosthesis, it is better to suture the membrane, and continue the treatment according to the Grob's method; the residual disembowelment can be repaired later.

Locations of osteomyelitis in children with sickle-cell disease at Tokoin teaching hospital (Togo).

BACKGROUND: The sickle-cell children are particularly affected by osteomyelitis in specific locations. This study was done in order to point out the locations of osteomyelitis in children with sickle-cell disease. This direct clinical examination for a quick diagnosis. MATERIALS AND METHODS: This is a retrospective study done by examining files of 43 children (15 girls and 28 boys), aged from 0 to 15 years, treated for osteomyelitis between January 1998 and December 2006. Their phenotypes included 18 SS, 14 SC and 11 AS. Osteomyelitis was acute in 20 cases and chronic in 23 cases. The different localisations are classified according to the type of osteomyelitis and the kind of bones concerned. RESULTS: The 43 children presented 63 locations: 57 on long bones and 6 on short bones. The osteomyelitis was unifocal in 32 cases, and multifocal in 11 cases. The locations on long bones were humeral (18 cases), tibial (12 cases), femoral (9 cases), fibular (7 cases), radial (7 cases) and ulnar (4 cases). The 6 short bones included 3 metacarpus and 3 phalanxes. The 11 multifocal locations concerned 8 SS, 2 AS and 1 SC. In chronic osteomyelitis, 7 patients had sequestrum and 2 had pathological fracture. CONCLUSION: During examination of sickle-cell children with fever, particular attention must be shown, respectively to the arm, the leg and the thigh, in order to track down quickly, an acute osteomyelitis. Early diagnosis and quick treatment permit to avoid complications and heavy sequela in these children.

[Current bacterial causes of osteomyelitis in children with sickle cell disease]. / Bactériologie des ostéomyélites de l'enfant drépanocytaire au CHU de Tokoin (Togo) : tentative d'évaluation et thérapeutiques.

INTRODUCTION: Osteomyelitis in children with sickle cell disease has been caused mainly by salmonella species, but in recent years, greater variation has resulted in other bacteria sometimes heading this list. We conducted this survey to determine the present distribution of causative bacteria, to improve initial probabilistic antibiotic therapy. MATERIAL AND METHODS: This retrospective survey reviewed files of children hospitalised during the 8-year period from 1998 to 2005 for osteomyelitis who had haemoglobinopathy SS or SC. In all, we identified 32 patients (mean age: 6.5 years) - 22 boys and 10 girls, 18 with SS and 14 SC. Eleven children with haemoglobinopathy AS were not included. Thirteen children had acute osteomyelitis and 19 chronic osteomyelitis. Bacteriological research included blood cultures, needle aspiration or biopsy, and cytobacteriological examination of pus. RESULTS: Of 4 blood cultures, one was positive. Only one needle aspiration was performed, and it was positive. Pus was examined in 19 cases and positive in 16 (84%). No bacteriological research was performed in 8 of the cases (25%) of acute osteomyelitis. Staphylococcus accounted for 22% of the bacteria identified, salmonella for 19% and Pseudomonas aeruginosa for 6%. CONCLUSION: Initial probabilistic antibiotic therapy for osteomyelitis in children with sickle cell disease must target staphylococcus and salmonella, preferably by combining a third-generation cephalosporin and aminoglycoside. Systematic bacteriological testing will provide a more reliable selection and improve initial treatment.

[Aseptic osteonecrosis of the femoral head in children with sickle-cell disease]. / Les ostéonécroses aseptiques de la tête fémorale chez l'enfant drépanocytaire.

PURPOSE: To identify the epidemiological, clinical and therapeutic aspects of hip-joint disorders in children with sickle cell disease, to point out the diagnostic problems, and to stress the necessity of early diagnosis for optimal outcome. MATERIAL AND METHODS: This retrospective study, conducted from January 1987 through December 2006, included children with at least one haemoglobin S gene and hospitalised for osteonecrosis of the femoral head. Ficat staging was used. RESULTS: The study included 14 children (12 boys and 2 girls) with a mean age of 14 years, all hospitalised and treated for osteonecrosis of the femoral head during the study period 8 SS and 6 SC. Osteonecrosis of the femoral head was diagnosed at Ficat stage 3 in 8 cases and at stage 4 in 6. Ten children (8 at stage 3 and 2 at stage 4) had orthopaedic treatment (continuous traction for 30 days and then a Thomas's splint for a mean 14 months). Outcome was good for 6 of the stage-3 cases (mean follow-up period 9 years) and poor for the other patients with purely orthopaedic treatment (mean follow-up period 11 years). Four children at stage 4 underwent surgery (varus osteotomy, immobilization in a cast for 8 weeks, and then Thomas's splint for a mean 12 months) with good results (mean follow-up period 10 years). CONCLUSION: Early diagnosis, assisted by computed tomography, magnetic resonance imaging or scintigraphy, makes it possible to provide better treatment and preserve hip function.