Miliary abscess of the liver: unusual complication of intestinal perforation.

Miliary abscess of the liver represents a rare presentation of multiple liver abscesses. They often occur in immunosuppressed patients, or those with underlying liver disease. We report the case of a 22-year-old patient, without known immunodeficiency factors, surgical history or notion of tuberculous contacts, who was admitted for generalized peritonitis and ileal perforation. An ileostomy was performed. The infectious syndrome persisted in post-operative period, associated with painful hepatomegaly. An contrast-enhanced abdominal CT scan led to the diagnosis of miliary abscess of the liver. A blood culture isolated Escherichia coli. The treatment included antibiotics and the clinical evolution was favorable. The follow-up abdominal CT scan was normal. Intestinal continuity was restored without complications. Miliary abscess of the liver is rare and requires rapid diagnosis. The treatment is based on antibiotic therapy.

Duodenocolic fistula by nail ingestion in a child.

Unintentional foreign body ingestion is common among children. Normally, these ingested foreign bodies pass spontaneously. Only few of them may lead to complications such as fistula, which requires surgical intervention. We are reporting a case of accidental construction nail ingestion in a 3-year-old male child, for 30 days, without any symptoms. Diagnosis of duodenocolic fistula by construction nail was made on clinical examination and abdominal radiography features. He underwent surgical intervention, with nail removal, dudenal and colic primary closure. The follow-up was uneventful. We recommend emergently retrieval of sharp-pointed and long-ingested foreign bodies like a construction nail. Conservative outpatient management by clinical observation is not appropriate for this kind of foreign bodies. It may lead to complications such as perforation and fistula.

Severe snakebite envenomation revealed by an acute abdomen.

Acute abdomens are common conditions, with many aetiologies in developing countries. Abdominal bleeding due to snake envenomation is an extremely rare aetiology. A 11-year-old girl was admitted for acute abdominal pains. She had a history of foot bite of unknown origin. Physical examination revealed palor and abdominal tenderness. At laparotomy, there were peritoneal and retroperitoneal diffuse hematomas. Laboratory studies revealed abnormal coagulation profile. Retroperitoneal and peritoneal hematomas' diagnosis, by consumptive coagulopathy, due to snakebite envenomation, was made. Polyvalent antivenom administration permitted a normalization of coagulation profile, however, with persistent surgical site bleeding. Whole blood transfusion was administered with bleeding stop. Sudden abdominal pain, palor and signs of peritonism suggest an acute abdomen. However, abdominal bleeding due to snakebite envenomation should be considered, especially in child with unidentified bite history. Imaging modalities may helpful to confirm the abdominal bleeding. Antivenom is the mainstay of the treatment.

Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases.

The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiology (ultrasound and mammography), correlating them with the histopathology findings and the bacteriological profile of the isolated germs.

Evolution of the Histo-Epidemiological Profile of Urological Cancers in Togo

Background: Urological cancers are an important public health issue and pose problems with diagnosis and adequate management in developing countries. Our aim was to determine and report epidemiological and histological features of urological cancers in Togo. Materials and methods: A retrospective descriptive study was conducted of cases of urological cancers observed in the laboratory of pathological anatomy of the CHU Tokoin over the last 4 years (2012-2016). The parameters studied were frequency, age, sex, sites of development and histological type. Results: Epidemiological data were collected for 182 cases, representing 16.4% of all cancers (1108 cases). The annual frequency was 45.5±1.1 cases on average. The male:female sex ratio was 8.6 with a mean age of 60.2 years. Regarding location, in decreasing order of frequency, the tumors were found in the prostate (n=121 cases; 66.5%), bladder (n=28; 15.4%), kidney (n=19; 10.4%), testis (n=10; 5%), penis (n=3; 1.7%) and scrotum (n=1; 0.5%). Histologically, prostate cancers were predominantly adenocarcinomas (n=116 cases; 95.8%) with a Gleason score of 6 (n=46; 39.7%) predominant. Bladder cancers were mainly squamous cell carcinomas (n=11; 39.3%) followed by transitional carcinomas (n=9 cases; 32.1%) and adenocarcinomas (n=7; 25%). Kidney cancers were predominantly nephroblastomas (n=10, 52.6%) in children and clear cell carcinomas (n=8 cases; 42.1%) in adults. Testicular cancers were Burkitt lymphomas in 5 cases. The cases of penis and scrotum cancers were all squamous cell carcinomas. Conclusion: Urological cancers are experiencing an upsurge in frequency in Togo, dominated by prostate cancer, with a high frequency of squamous cell carcinoma of the bladder due to endemic bilharziasis.

Acute cholecystitis from typhic origin in children.

BACKGROUND: To evaluate the particularities of typhoid cholecystitis in children. MATERIALS AND METHODS: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings, confirmed by operative findings at cholecystectomy. RESULTS: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females). Their ages ranged from five to 13 years (median 8.8 years). The mean duration of symptoms was six to 21 days. The clinical signs were fever, abdominal pain, which predominated at the right upper abdominal quadrant, and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal's test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3), perforation (2) and empyema (1). All the patients made an uneventful recovery, and have remained symptom free one and three months on follow-up. CONCLUSION: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice.