Evaluation of the Management of Gastroschisis in Aristide Le Dantec University Hospital Center in Dakar.

INTRODUCTION: The management of gastroschisis remains problematic in low- and middle-income countries with high perioperative mortality. The objective of this work was to make an initial assessment of our management of gastroschisis. MATERIALS AND METHODS: This was a monocentric and cross-sectional study including all newborns with gastroschisis between January 2017 and December 2021 in the Pediatric Surgery and Anesthesia Resuscitation Department of the Aristide Le Dantec University Hospital Center from Dakar. The socio-demographic, diagnostic, therapeutic and evolutionary parameters were studied. RESULTS: Were collected 18 cases of gastroschisis (11 males and 7 females). The mothers were on average 23.1 ± 5.7 years old. Only one antenatal diagnosis was made. The term of pregnancy was on average 36.5 ± 1.5 weeks. On admission, the mean age was 16.8 ± 6.3 h and the mean weight 2244 ± 260.3 g. Gastroschisis was complex in four patients. Primary bowel reintegration was performed in 8 cases (44.4%) and progressive reintegration using an Applied Alexis retractor in 9 newborns (55.6%). Complications were dominated by respiratory distress (28.3%) and sepsis (22.2%). The mean delay of oral feeding was 5.1 ± 1.9 days. Mortality was 94.4% (17/18). CONCLUSION: Reducing gastroschisis-related mortality in our low-income countries remains a major challenge.

Management of Umbilical Hernia in African Children: The Experience of 2146 Cases.

Aims: Umbilical hernia (UH) is common in African and African-descent children. In high-income countries (HICs), it is considered benign, which is not the case in Sub-Saharan ones. Through this study, we aimed to share our experience. Materials and Methods: A descriptive review was conducted from January 01, 2012 to December 31, 2017 at Albert Royer National Children's Hospital Center. Among the 2499 patients, 2146 cases were included in the review. Results: UH had a frequency of 6.5%, with patients having a mean age of 2.6 years, with a male preponderance of 63%. Emergency consultation occurred in 37.1%. The symptomatic hernia was present in 90.9%. The congenital type was found in 96%, a history of painful episodes was reported in 46%, and medical and surgical comorbidities were found in 30.1% and 16.4%, respectively. Multimodal anesthesia was used in 93.1%. A lower umbilical crease incision was made in 83.2%, the sac was not empty in 16.3%, and additional umbilicoplasty was performed in 16.3%. During a 14-month follow-up, a complication occurred in 6.5% and mortality in 0.05%. Conclusion: In our region, the pediatric UH was predominantly symptomatic, with its natural evolution leading to more complications than in HICs. Its management carried acceptable morbidity.

Fibromatosis Colli: About 26 Cases.

Aims: The aim is to identify the epidemiological, diagnostic, therapeutic, evolutionary aspects, and risk factors related to the occurrence of this condition. Subjects and Methods: It was a retrospective and descriptive study of a series of 26 cases of fibromatosis colli collected over a period of 3 years (from January 1, 2017 to December 31, 2019). We studied the following parameters: frequency, age, sex, delay of consultation, motive of consultation, gravidity, parity, type of delivery, notion of birth trauma, birth weight, examination findings, ultrasound results, type of treatment, and evolutionary modalities. The data were collected from patients' files. The analysis was done on Excel 2016. Results: The frequency was 6.5 cases/year. The mean age was 2.1 months. The average delay of consultation was 6.3 weeks. A notion of obstetrical trauma was found in 16 cases (61.5%). Primiparity was noted in 15 cases (57.5%). Associated torticollis was noted in 03 cases. Cervical ultrasonography was performed in all cases (n = 26/26) enabling diagnostic confirmation. Surveillance was the main treatment (84.6%). After a mean follow-up of 20.8 months, evolution was favorable in the majority of patients. The average time of complete regression of the mass was 3.8 months. Conclusions: Rare condition of the newborn and infant for which the diagnosis is clinical and the confirmation is based on ultrasound. The management is simple and based on surveillance. The evolution is most often toward spontaneous regression.

Congenital malformations of the gastrointestinal tract in neonates at aristide le dantec university hospital in Dakar: Concerning 126 cases.

Objective: Congenital malformations of the gastrointestinal tract are one of the major causes of neonatal mortality, especially in developing countries. The aim of this study is to assess the overall management of gastrointestinal malformations. Patients and Methods: The study design is monocentric and retrospective. It includes all newborns aged 1-28 days with malformations of the gastrointestinal tract between 1st January 2014 and 31st December2018, at the Paediatric Surgery Department of Aristide Le Dantec University Hospital in Dakar. Data were collected by studying patient's records and surgical procedures. Results: During the five-year study, 405 newborns with congenital anomalies were admitted to our hospital. A total of 126 newborns were diagnosed with gastrointestinal tract malformations. The incidence was 25.2 cases a year. The sex distribution was 74 boys (58.7%) and 52 girls (41.2%). The mean age at diagnosis was 7.4 ± 3.2 days. Two cases were diagnosed antenatal (1.59%). The mean time to post-natal diagnosis was 6.5 ± 2.1 days. The most common malformation was oesophageal atresia with 43 cases (34.1%). The average time between diagnosis and surgery was 48 h. Out of the 126 cases, 77 (61.1%) received surgery and 49 (38.9%) died before surgery. The main causes of pre-operative death were intricate and dominated by lung infections (42.9%). Among the 77 newborns, who received surgery, 38 (%) had a simple post-operative course, 39 (50.6 %) died. Post-operative deaths were dominated by anaesthetic complications (30.8%), lung infections (46.1%). The overall mortality was 69.8% (n = 88). Conclusion: The low socio-economic status, poor pre-natal diagnosis, prematurity, post-natal diagnostic delay, obsolete medical equipment and the lack of neonatal intensive care units were identified as the major factors for high mortality in neonates with gastrointestinal tract malformations in a developing country.

[Management of congenital diaphragmatic hernia in sub-Saharan Africa: experience in the Albert Royer National Children's Hospital Center, Senegal]. / Prise en charge de la hernie diaphragmatique congénitale en Afrique sub-Saharienne: l'expérience du Centre Hospitalier National d'Enfants Albert Royer au Sénégal.

Introduction: congenital diaphragmatic hernia has been rarely reported in Africa. It can manifests early or late. Prognosis mainly depends on associated malformations. The purpose of this study is to report our experience in the Albert Royer National Children's Hospital, Dakar, Senegal. Methods: we conducted a retrospective study of patients treated for congenital diaphragmatic hernia between January 2010 and December 2019. Results: twelve patients were enrolled, with an average age of 8.9 months. Bochdalek hernias were detected in 10 patients. The most common symptoms were respiratory symptoms (83.3%), followed by digestive symptoms (41.6%). Thoraco-abdominal X-ray was used to make a diagnosis in all patients. Three patients underwent preoperative stabilization. All patients underwent laparotomy. Hernia sac was found in 10 patients, and 50% of patients had a defect measuring between 5 and 10 cm. The postoperative course was simple in 10 patients; a polymalformed patient died. Conclusion: congenital diaphragmatic hernia is a reality in our environment; it most often manifests beyond the neonatal period. Prognosis is generally good in our context.

Acute appendicitis revealing a giant mesenteric pseudocyst: case report.

Mesenteric pseuodycst is a very rare benign childhood tumor, accounting for less than 1 out of 250,000 hospital admissions. We here report a case of giant mesenteric pseudocyst incidentally detected in a 11-year-old boy with acute appendicitis. He complained of persistent abdominal pain for the past 48 hours. He had a history of intermittent pain for several months. Physical examination showed fever and abdominal pain. Ultrasonography showed large peritoneal fluid related to peritonitis probably of appendicular origin. The patient underwent exploratory laparotomy revealing giant abdominal mesenteric cyst and acute appendicitis. Open resection of the cyst and appendectomy were performed. The diagnosis of uncomplicated acute appendicitis associated with mesenteric pseudocyst was made. Preoperative diagnosis of pseudomesenteric cysts is a clinical challenge. Knowledge is essential and suspicion should be maintained in patients with nonspecific symptoms.

Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal.

Objective: Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department. Methods: We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression. Results: Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425). Conclusion: The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.

[Epidemiological and lesion aspects of hand fractures in children in the Pediatric Surgery department of the Aristide Le Dantec Hospital in Dakar]. / Aspects epidemiologiques et lesionnels des fractures de la main chez l'enfant au service de Chirurgie Pediatrique du chu Aristide Le Dantec de Dakar.

PURPOSE: Report the epidemiological and lesion aspects of hand bone fractures in children. PATIENTS AND METHOD: We did a retrospective and descriptive study over a 10-year period. This study involved 222 childre nunder the age of 16 with 261 fracture cases. The parameters studied were frequency, age, sex, mechanism, circumstances of fracture, consultation time, data from standard physical examination and x-ray of the hand, and associated lesions. RESULTS: Hand bone fractures accounted for 6.4% of all fractures in children in our service. The average age of the children was 8.5 years with a standard deviation of 4. There was a male predominance with a sex ratio of 2. Domestic accidents led the way with 44.3% of cases. They were followed by playful accidents with 33.94% of cases. Receiving heavy objects and fallingwith hand reception were the most common mechanisms. 62.8% of patients consulted within the first 24 hours. All fractures were in the metacarpals and phalanxes with 31% and 69% of cases, respectively. Head and diaphysis fractures each accounted for 28.1% of cases followed by cervical fractures with 27.8%. Non-displaced fractures accounted for 65% of cases. Associated lesions were found in 10 patients. CONCLUSION: Hand bone fractures are quite common. They often interest the bigchild in the decoy of a domestic or playful accident, by crushing the hand or falling with reception on the hand. Fractures of the phalanxes are the most common while those of carp are absent.

BUT: Rapporter les aspects épidémiologiques et lésionnels des fractures des os de la main chez l'enfant. PATIENTS ET MÉTHODE: Nous avons fait une étude rétrospective et descriptive sur une période de 10 ans. Cette étude concernait 222 enfants âgés de moins de 16 ans et ayant présenté 261 cas de fracture. Les paramètres étudiés étaient la fréquence, l'âge, le sexe, le mécanisme, les circonstances de survenue de la fracture, le délai de consultation, les données de l'examen physique et de la radiographie standard de la main ainsi que les lésions associées. RÉSULTATS: Les fractures des os de la main représentaient 6,4% de l'ensemble des fractures chez l'enfant dans notre service. L'âge moyen des enfants était de 8,5 ans avec un écart-type de 4. On notait une prédominance masculine avec un sexe ratio de 2. Les accidents domestiques arrivaient en tête avec 44,3% des cas. Ils étaient suivis des accidents ludiques avec 33,94% des cas. La réception d'objets lourds et les chutes avec réception sur la main étaient les mécanismes les plus fréquents. 62,8% des patients ont consulté dans les 24 premières heures. Toutes les fractures siégeaient au niveau des métacarpes et des phalanges avec respectivement 31% et 69% des cas. Les fractures de la tête et de la diaphyse représentaient chacune 28,1% des cas suivies des fractures du col avec 27,8%. Les fractures non déplacées représentaient 65 % des cas. Des lésions associées ont été retrouvées chez 10 patients. CONCLUSION: Les fractures des os de la main sont assez fréquentes. Elles intéressent souvent le grand enfant au décours d'un accident domestique ou ludique, par écrasement de la main ou chute avec réception sur la main. Les fractures des phalanges sont les plus fréquentes alors que celles intéressant le carpe sont absentes.

[Meckel's diverticulitis by ascaris in children: about a case]. / Diverticulite de Meckel d´origine ascaridienne chez l´enfant: à propos d´un cas.

We here report the case of a 4-year-old male child presenting with congenital umbilical bud that, recently, had begun to bleed. Physical examination showed pinkish umbilical bud with blood stains but without any fistula, measuring about 1,5 cm in diameter. Abdominal ultrasound was performed, which suggested urachal sinus. Surgery revealed umbilical bud communicating, in the abdominal portion, with hyperemic, inflammatory Meckel´s diverticulum placed 90 cm away from the ileocaecal angle in which many ascaris were detected. Anatomo-pathological examination of the surgical specimen showed diverticulitis. Thus, the diagnosis of Meckel´s diverticulitis by Ascaris was retained. Resection and anastomosis with bud excision were performed. The postoperative course was simple even after a 6-month follow-up period.

[Cryptorchidism in Prune Belly syndrome]. / La Cryptorchidie dans le Syndrome de Prune Belly.

PURPOSE: To analyze the epidemiological, diagnostic, therapeutic and evolutionary aspects of cryptorchidism in Prune Belly syndrome. PATIENTS AND METHOD: This is a retrospective and descriptive study over an 11-year period involving 24 cases of children admitted for cryptorchidism that is part of Prune Belly syndrome in the paediatric surgery department of the Aristide Le Dantec University Hospital in Dakar. We were interested in epidemiological, diagnostic, therapeutic and evolutionary aspects. RESULTS: The incidence of cryptorchidism in Prune Belly syndrome was 2.4 cases per year. The average age of discovery was 1 year and the age of testicular lowering was 20 months. The bilateral form predateed with 91.7% of cases. Simple orchidopexia was practiced in 50% of cases. An orchidopexia using the Fowler-Stephens technique in one time was practiced in 45.8% of cases. A right orchidectomy was needed in 4.2% of cases. Surgical procedures were simple in 47.8% of the lowered testicles. The most common complication was testicular atrophy noted primarily in the Fowler-Stephens technique in a single time. CONCLUSION: Cryptorchidism in Prune Belly syndrome is most often bilateral and the testicle was frequently palpable. His diagnosis remains very late in our context. Given the number of testicular atrophies driven by the Fowler-Stephens technique in one time, it should be abandoned in favour of the Fowler-Stephens technique in two stages.

BUT: Analyser les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la cryptorchidie dans le syndrome de Prune Belly. PATIENTS ET MÉTHODE: Il s'agit d'une étude rétrospective et descriptive sur une période de 11 ans portant sur 24 cas d'enfants admis pour une cryptorchidie qui entre dans le cadre du syndrome de Prune Belly au service de chirurgie pédiatrique du centre hospitalier universitaire Aristide Le Dantec de Dakar. Nous nous sommes intéressés aux aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs. RÉSULTATS: L'incidence de la cryptorchidie dans le cadre du syndrome de Prune Belly était de 2,4 cas par an. L'âge moyen de découverte était de 1 an et celui de l'abaissement testiculaire était de 20 mois. La forme bilatérale prédominait avec 91,7% de cas. Une orchidopexie simple a été pratiquée dans 50% des cas. Une orchidopexie selon la technique de Fowler-Stephens en un temps a été pratiquée dans 45,8% des cas. Une orchidectomie droite était nécessaire chez 4,2% des cas. Les suites opératoires étaient simples chez 47,8% des testicules abaissés. La complication la plus fréquente était l'atrophie testiculaire notée essentiellement dans la technique de Fowler-Stephens en un seul temps. CONCLUSION: La cryptorchidie dans le cadre du syndrome de Prune Belly est le plus souvent bilatérale et le testicule était fréquemment palpable. Son diagnostic reste très tardif dans notre contexte. Au vu du nombre d'atrophies testiculaires entraîné par la technique Fowler-Stephens en un temps, elle devrait être abandonnée au profit de la technique de Fowler-Stephens en deux temps.

[Omphalomesenteric fistulas; epidemiological diagnostic and therapeutic features: study of four cases in the Department of Pediatric Surgery at the Aristide Le Dantec University Hospital in Dakar]. / Fistules omphalo-mésenteriques; aspects épidémio logiques, diagnostiques et thérapeutiques: à propos de quatre observations au Service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar.

This study aims to determine the epidemiological, therapeutic and diagnostic features of omphalomesenteric fistulas (OMF). We conducted a study of four cases over a period of 10 years, from January 2004 to December 2013. The parameters studied were: frequency, age, sex, clinical and radiological signs, therapeutic and evolutionary features. Frequency was 0.4 cases per year. Patients were aged 11 days, 40 days, 45 days and 3 years respectively (three girls and one boy). Clinical examination showed intestinal fluid discharge from the belly button and belly button bud catheterisable in all the cases. The bud was prolapsed in the patient aged 45 days. Fistulography performed in two cases helped to confirm the diagnosis by showing a communication between the fistula and the small intestine. The assessment of malformations revealed congenital cyanogen heart disease with interventricular communication in the newborn aged 45 days, anorectal cloacal malformation associated with urachus fistula in the newborn aged 11 days. All patients underwent surgery. Semicircular periumbilical incision was performed in the absence of associated abdominopelvic malformations. A communication between the fistula and the ileum was found in the majority of cases. Bowel resection with termino-terminal anastomosis was performed in three cases. Cuneiform resection was performed in one case and was completed by complete resection of the urachal fistulous tract and bladder suture, with colostomy in newborn with urachal fistula and anorectal cloacal malformation. The postoperative course was marked by non-febrile seizures in the first child with good evolution and by superficial parietal suppuration followed by death due to cardiac decompensation in the third case. Omphalomesenteric fistula is rare. Diagnosis is based on clinical examination complemented by the fistulography. Surgical treatment using semicircular periumbilical incision gives good results. However, the assessment of malformations is necessary.

[Accidents of the everyday life (AcVC) in children in Dakar: about 201 cases]. / Les accidents de la vie courante chez l'enfant à Dakar: à propos de 201 cas.

Accidents of everyday life (AcVC) are common in children and can led to disabling injuries and death. This study aimed to analyze the epidemiological aspects of AcVC and the related injury mechanisms in Dakar. We conducted a descriptive, cross-sectional study conducted from 1 January 2013 to 30 June 2013. All the children victims of domestic accidents, sport and leisure accidents or school accidents were included. We studied some general parameters and some parameters related to each type of AcVC. Two hundred and one children were included, accounting for 27% of emergency consultations. There were 148 boys and 53 girls. Children less than 5 years of age were most affected (37.8%). Football and wrestling game were the main causes of AcVC. AcVC occur mainly at home (58.2%) and in the areas of sport and recreation (31.8%). The fractures predominated in the different types of AcVC: 54.9% of domestic accidents, 68.8% of sport and recreation accidents and 40% of school accidents. From an epidemiological perspective, our results are superimposable to literature. Fractures predominated contrary to literature where bruises were preponderant. Wrestling game is the main cause of these fractures, after football. The acquisition of knowledge about the epidemiological aspects of AcVC and the related injury mechanisms will allow for prevention campaigns in Dakar.

Wrestling game injuries among children in Dakar: a report on 172 cases.

INTRODUCTION: The objective was to report epidemiological and lesional features among children practicing wrestling as a game in Dakar, Senegal. METHODS: It was a retrospective study including all patients under 16, victims of wrestling game injuries. We studied epidemiological and lesional aspects in children: frequency of wrestling game injuries among all games, age, sex, geographic origin, place of injury, parent's socioeconomic status, nature of the injury and location. RESULTS: Wrestling game injuries represented 19.9% injuries in all games. Sex-ratio was 33.4. The most affected age group was the 6-10 years old age group. The majority of children are from suburban Dakar (64%). Injuries occurred most often at home and in the street. Most children are from low socioeconomic status (64%). Fractures predominated and were localized almost exclusively on the elbow. CONCLUSION: Wrestling game injuries in Dakar occur among older children from the suburbs, living in the neighborhood of great wrestling champions' districts of residence. Wrestling game cause injuries, consisting mostly of elbow fractures.

Pyloric atresia: a challenge in an underdeveloped country.

Pyloric atresia is a rare congenital malformation. We report a case in a 5-day newborn with pyloric atresia type C. Authors emphasize the diagnostic difficulties and therapeutic challenges in a resource-limited country.

[Volvulus of the small bowel due to ascaris lumbricoides package: about a case]. / Volvulus du grêle sur paquet d'ascaris: à propos d'un cas.

We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.

Oesophageal atresia: Diagnosis and prognosis in Dakar, Senegal.

BACKGROUND: Oesophageal atresia is a neonatal emergency surgery whose prognosis has improved significantly in industrialised countries in recent decades. In sub-Saharan Africa, this malformation is still responsible for a high morbidity and mortality. The objective of this study was to analyse the diagnostic difficulties and its impact on the prognosis of this malformation in our work environment. PATIENTS AND METHODS: We conducted a retrospective study over 4 years on 49 patients diagnosed with esophageal atresia in the 2 Paediatric Surgery Departments in Dakar. RESULTS: The average age was 4 days (0-10 days), 50% of them had a severe pneumonopathy. The average time of surgical management was 27 h (6-96 h). In the series, we noted 10 preoperative deaths. The average age at surgery was 5.7 days with a range of 1-18 days. The surgery mortality rate is 28 patients (72%) including 4 late deaths. CONCLUSION: The causes of death were mainly sepsis, cardiac decompensation and anastomotic leaks.

Laparoscopic Appendectomy in Children: Preliminary Study in Pediatric Hospital Albert Royer, Dakar.

Appendiceal pathology's management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were not founded. An abscess of Douglas pouch is noted in 2 patients with complicated appendicitis undrained. These Douglas abscesses were treated medically. No conversion of laparotomy was performed in the series. After an average of 8 months no other problems were noted.