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An 8-year-old boy was brought to the paediatric surgery department having amputated his penis and both testicles during a road traffic accident. Examination of the perinea showed a complete amputation of penis, scrotum and testicles. We performed debridement and skin suture initially. The urethral orifice was catheterized by a 10â¯F Foley's catheter. I the herein case report, we discuss the incidence, management and complications of genital amputation in a young boy. Moreover, the existing literature in this subject is reviewed.
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Introduction: Les urgences chirurgicales néonatales dans les pays en voie de développement sont caractérisées par une mortalité élevée. Le but de cette étude était de recenser les urgences chirurgicales néonatales et d'analyser leur pronostic dans notre environnement.Patients et méthode: Il s'agit d'une étude rétrospective portant sur 96 dossiers de nouveau-nés hospitalisés sur une période de 4 ans (janvier 2010 à décembre 2014) pour une urgence chirurgicale opérée ou non. Nous avons étudié les aspects étiologiques, thérapeutiques et évolutifs.Résultats: La fréquence des urgences chirurgicales néonatales était de 19,8%. Le délai moyen de consultation était de 6 jours extrêmes (1 et 14 jours). Les pathologies du tube digestif représentaient 58,3% (n=56) suivies des pathologies de la paroi abdominale antérieure dans 41,7% (n=40). Le délai thérapeutique moyen était 6 jours. Vingt-six (27,1%) nouveau-nés ont pu être opérés. Le taux de mortalité néonatale était de 58,2% (n=53). La mortalité préopératoire était de 49,4% (n=45) avec un délai moyen de 5 jours. La mortalité post opératoire était de 8,79% (n=8) avec un délai moyen de survenue de 5,2 jours. Les pathologies de la paroi abdominale étaient responsables de 54,7% (n=29) des décès.Conclusion: Les urgences chirurgicales du nouveau-né sont caractérisées par un retard de prise en charge avec une mortalité élevée. L'amélioration de leur pronostic passe par un diagnostic précoce (diagnostic anténatal) et une prise en charge adéquate
Subject(s)
Academic Medical Centers , Cote d'Ivoire , Emergency Service, Hospital , Infant Mortality , Infant, Newborn , Intensive Care Units, Neonatal , Surgical Procedures, OperativeABSTRACT
BACKGROUND: The surgical management of giant omphalocele is a surgical challenge with high mortality and morbidity in our country due to the absence of neonatal resuscitation. This study evaluates conservative management of giant omphalocele with dissodic 2% aqueous eosin. MATERIALS AND METHODS: In the period from January 1997 to December 2012, giant omphaloceles were treated with dissodic 2% aqueous eosin. The procedure consisted of twice a day application of dissodic 2% aqueous eosin (sterile solution for topical application) on the omphalocele sac. The procedure was taught to the mother to continue at home with an outpatient follow-up to assess epithelialization. We studied the duration of the hospital stay, the learning curve of the procedure by the mother, the complications, the duration and the percentage of complete epithelialization and the mortality. RESULTS: A total of 173 giant omphaloceles had a conservative treatment with dissodic 2% aqueous eosin. The average hospital stay was 21 ± 6 days. The learning curve by the mother of the procedure was 10 ± 3 days. Complications of treatment were intestinal functional occlusion 22% and omphalocele sac infection 18%. The complete epithelialization of the omphaloceles sac after application of dissodic 2% aqueous eosin was 68.5%. Mortality was observed in 25.5%. CONCLUSION: Conservative treatment of giant omphaloceles by dissodic 2% aqueous eosin is a simple, efficient and a good alternative to surgery. The mother can easily learn its procedure which reduces the duration of hospital stay.
Subject(s)
Eosine Yellowish-(YS)/administration & dosage , Hernia, Umbilical/diagnosis , Hernia, Umbilical/drug therapy , Cohort Studies , Cote d'Ivoire , Female , Follow-Up Studies , Humans , Infant, Newborn , Injections, Intralesional , Length of Stay , Male , Patient Safety , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Contexte. Dans les pays industrialises; les IoA sont prises en charge tres rapidement au debut des manifestations cliniques contrairement aux pays en developpement ou elles sont traitees tard au stade subaigu ou chronique. L'objectif de cette etude etait de decrire les IAo chez les enfants de moins de 3 ans afin de definir leurs particularites cliniques; d'identifier les bacteries en cause. Patients et methode. Sur une periode de 11 ans; de Decembre 2002 a Janvier 2013; nous avons collige des dossiers d'Infections osteo Articulaires (IoA) d'enfants au Centre Hospitalier Universitaire de Yopougon Abidjan Cote d'Ivoire. Les donnees cliniques concernaient; le delai de consultation; les portes d'entrees; la symptomatologie clinique (signes generaux; signes fonctionnels; signes physiques); Les parametres etudies etaient cliniques; biologiques; bacteriologiques; therapeutiques et evolutifs. Resultats. Au total; nous avons collige 105 dossiers d'Infections osteo Articulaires (IoA) d'enfants de 0 a 36 mois. Les resultats de l'hemoculture ont ete positifs dans 22%; ceux de la ponction articulaire ont ete positifs dans 51;5%; ceux de la ponction metaphysaire dans 22% et ceux du prelevement de la porte d'entree dans 60% . Les bacteries isolees etaient; le staphylococcus aureus dans 54%; Salmonella dans 23%; Klebsiella pneumoniae dans 19%; Pyocianique dans 4%. L'antibiogramme a montre une sensibilite des bacteries isolees dans 100% des cas aux Aminosides; aux Fluoroquinolones; a la Fosfomycine; aux Imipenemes et aux Glycopeptides. La sensibilite aux Betalactamines etait de 60%. Conclusion. Il faut eviter les betalactamines en mono antibiotherapie de premiere ligne au cours des IAo chez les nourrissons de moins de 3 ans. Nous suggerons l'utilisation d'une mono antibiotherapie avec amoxicilline acide clavulanique qui vise l'elimination du Kingella Kingae premiere bacterie en cause au cours des infections orL des nourrissons mais aussi a cause de l'acide clavulanique pour eliminer les staphylocoques dores producteurs de betalactamase
Subject(s)
Arthritis, Infectious , Bacteriology , Child, Preschool , Infant , OsteomyelitisABSTRACT
BACKGROUND: Supracondylar fractures are the most common elbow fractures in children and are usually treated on an emergency basis, using percutaneous pinning. However, the treatment is often delayed in areas where healthcare resources are scarce. HYPOTHESIS: Delaying treatment does not influence the perioperative complication rate. MATERIALS AND METHOD: We retrospectively reviewed the medical charts of 89 children aged 2 to 15 years in whom surgery for extension-type supracondylar elbow fractures was delayed by more than 48 hours. The 53 boys and 36 girls with a mean age of 6 years 9 months had severe fracture displacement (28 stage III and 61 stage IV according to Lagrange and Rigault classification scheme). Mean time to treatment was 4.5 days (range: 2-17 days). Open reduction and crossed K-wire fixation via the posterior approach were performed in all 89 patients. Postoperative complications and sequelae were collected. Functional outcomes were evaluated using Flynn's criteria. RESULTS: Outcomes were satisfactory in 74 (83.2%) of patients. Postoperative complications occurred in 13 (14.6%) patients and consisted of surgical site infection (n=7, 7.8%), iatrogenic nerve injury (n=3, 3.4%), and reoperation (n=3, 3.4%). At last follow-up after a mean of 5 months, three (3.4%) patients had cubitus varus and one had a recurrent fracture due to massaging. Elbow motion was limited in 11 (12.4%) patients. No case of compartment syndrome was recorded. DISCUSSION: Despite an average time to surgery of 4.5 days, the outcome was satisfactory in 83% of cases. Delayed treatment was not associated with an increased rate of perioperative complications. LEVEL OF EVIDENCE: Level IV, retrospective study.
Subject(s)
Bone Wires , Elbow Injuries , Fracture Fixation, Internal , Humeral Fractures/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Humeral Fractures/diagnosis , Humeral Fractures/physiopathology , Male , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
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.
Subject(s)
Circumcision, Male/adverse effects , Adolescent , Child , Child, Preschool , Circumcision, Male/statistics & numerical data , Cote d'Ivoire , Humans , Infant , Infant, Newborn , Male , Medicine, Traditional , Retrospective StudiesSubject(s)
Circumcision, Female/psychology , Behavior , Circumcision, Female/statistics & numerical data , Culture , Female , Humans , Nigeria , PrevalenceABSTRACT
BACKGROUND: In most children proximal humeral fractures are treated non-operatively with generally good results. This review discusses the indications of operative treatment and assesses the treatment results. MATERIALS AND METHODS: The charts of 20 patients (14 girls; mean age: 12.3+/- 2.8 years; range: 7-16 years) with proximal humeral fractures who were operated on at our institution were reviewed from 1992 to 2002. RESULTS: There were five metaphyseal fractures and 15 physeal injuries which were angulated according to Neer-Horowitz score as grade III in four cases and grade IV in 16 cases with a mean angulation of 47.8+/-39.1 degrees (range: 6-148 degrees). Associated lesions comprised open fracture and head trauma in two cases each. Patients with associated injuries were operated on primarily and the 16 others by secondary intention. All but one were reduced via an anterior approach with internal fixation. They were assessed for clinical and radiological healing at a mean follow up of 3.6 years ranging from 1.2 to 7.8 years. CONCLUSION: Based on our study, surgical option is indicated for severely displaced and unstable fractures in older children and adolescents.
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OBJECTIVES: Treatment of congenital clubfoot improved in occidental country. We have studied the epidemiology, clinical and therapeutic aspects of this malformation in the context of Africa. PATIENTS AND METHODS: This was a retrospective study. Two thousand five hundred and sixty-two patients were hospitalised and operated during 12 years, 362 of them were diagnosed with congenital clubfoot. This represented 14,1% of the surgical diseases, with an incidence of 30,2 cases per year. The male to female ratio was 1,6:1, and ages ranged from 4 months to 38 years old, 59% of which were less than 15 years old. Two hundred and four (56,3%) patients had bilateral disease, 93 (25,7%) had right side disease and 65 (18%) had left sided disease. Considering the classification types we noted in our patient population 82% type III, 5% type II, 3% type I and 10% were undefined. RESULTS: Posteromedial approach describe by Codivilla was used in 45,5% of cases. Codivilla approach associated with lateral access to the foot in 44,4% of cases, with dorsal access in 2,3%. Few patients (7,8%) have had another approach. One hundred and seventeen patients received physiotherapy prior, but all the patients operated have postoperative physiotherapy while wearing orthopaedic shoes. Results obtained were: good in 510 cases (92%), quite good in 35 cases (6,3%), fairly good in 7 cases (1,3%) and mediocre in 2 cases (0,4%). CONCLUSION: The surgical aspect is still only a fraction of the entire treatment. It is imperative that physiotherapy is started immediately and orthopaedic shoes be worn postoperatively.
Subject(s)
Clubfoot/surgery , Adolescent , Child , Child, Preschool , Clubfoot/classification , Clubfoot/epidemiology , Clubfoot/rehabilitation , Cote d'Ivoire , Female , History, 16th Century , Humans , Incidence , Infant , Male , Physical Therapy Modalities , Postoperative Care , Retrospective Studies , Shoes , Treatment OutcomeABSTRACT
A retrospective study about 80 cases of exomphalos treated in the digestive unit of the paediatric surgery department in Abidjan teaching hospital--Côte d'Ivoire had been performed to analyse the result of this malformation treatment during 8 years. Prenatal diagnosis was made in two cases on six antenatal ultrasounds. Prematurity involved 7% of newborn and their birth weight ranged from 2500 to 4000 grams in 70% of cases. Treatment began in 64% at birth, conservative treatment with merbromine tannage was systematic on the non disrupted exomphalos. Surgery was indicated in the disrupted exomphalos and in the complicated cases of conservative treatment. Intestinal occlusion was the main fatal complication observed in both treatments but most of the time it occurred with surgical closure. Total lethality reached 30%, influenced by exomphalos super infection and by neonatal resuscitation insufficient means. Authors think exomphalos lethality reduction implies antenatal ultrasonographic for early diagnosis which could indicate a possible caesarian section in case of the voluminous exomphalos in order to prevent disruption and neonatal resuscitation operation.
Subject(s)
Developing Countries , Hernia, Umbilical/therapy , Cote d'Ivoire , Female , Hernia, Umbilical/diagnostic imaging , Hernia, Umbilical/mortality , Humans , Infant, Newborn , Postoperative Complications , Pregnancy , Retrospective Studies , Surgical Procedures, Operative/mortality , Ultrasonography, PrenatalABSTRACT
Considering 901 files of in-patients (68% of boys and 32% of girls, mean of ages: 2 days to 16 years) and prescriptions at the hospital of Yopougon during a period of two years (1991-1992), the authors have made a retrospective and critical study of the use of antibiotics in this department. Antibiotics, either demanded by strong presumption of infection, either indicated as a prophylaxis, have been administered to 54% of the patients. When this antibiotic therapy has been curative (56% of the cases of first intention), it was considered correct in 97% of the cases. On the other hand, it was ill-done when it was a matter of antibioprophylaxis. An antibiotherapy of second intention has been prescribed when antibiotherapy of first intention had failed and also when the antibiotic reserve of the hospital was over. The average number of antibiotics given to a patient was 2.12, frequently associating aminoside and penicillin. The total cost of antibiotics was 78% of the whole drugs used to cure these patients and among them, the biggest cost was for cephalosporines of third generation.
