[Nontraumatic digestive surgical emergencies in elderly patients at the Cocody University Hospital Center in Abidjan, Côte d'Ivoire: etiology and outcome]. / Urgences abdominates digestives non traumatiques chez les sujets âgés au CHU de Cocody à abidjan, Côte d'Ivoire: étiologies et résultats thérapeutiques.

OBJECTIVES: The purpose of this retrospective report is to describe etiologies and therapeutic outcomes of nontraumatic abdominal surgical emergencies in elderly patients. MATERIAL AND METHODS: The charts of patients aged 60 years or more who underwent emergency surgery for nontraumatic abdominal disorders at a Teaching Hospital in Abidjan, Cote d'Ivoire from August 1998 to July 2008 were reviewed. Demographic data, clinical findings, operative protocols, and postoperative outcomes were noted. RESULTS: A total of 137 patients with a mean age of 68.3 years (range, 60-93 years) underwent emergency surgery for nontraumatic abdominal disorders during the study period. The underlying etiologies were strangulated hernia (n = 40), abdominal parietal abscess (n = 6), bowel obstruction (n = 32), acute diffuse peritonitis (n = 29), acute appendicitis (n = 23), acute cholecystitis (n = 6) and massive rectorragy from colonic diverticulitis (n = 1). Coexisting medical problems (n = 84) were noted in 69 patients. Surgical procedures were tailored to operative findings. Twenty-seven patients were admitted to the intensive care unit in the immediate postoperative period. Mean hospital stay was 7.7 days (range, 2-23 days). Surgical complications included wound infection (n = 14), stoma-related complications (n = 7), digestive fistula (n = 4), scrotal hematoma (n = 5) and postoperative evisceration (n = 2). The mortality rate was 10.21% (n = 14) mainly due to postoperative peritonitis. CONCLUSION: The findings of this study indicated that most nontraumatic abdominal surgical emergencies in elderly patients were related to complications of neglected or undiagnosed preexisting disease. Prognosis was related to the stage of the disorder, initial surgical management, and deterioration of the coexisting medical problems.

[Colonoscopic perforation: 6 cases in Abidjan, Cote d'Ivoire]. / Plaies coliques per coloscopiques: 6 observations à Abidjan (Côte d'lvoire).

OBJECTIVES: The purpose of this report is to describe diagnostic and therapeutic management of colonoscopic perforation and identify risk factors. MATERIAL AND METHODS: The charts of 6 patients who underwent surgery for colonoscopic perforation between January 2003 and December 2008 were reviewed. Study data included patient age, indication for colonoscopy, operative findings, repair technique, and outcome. RESULTS: All 6 perforations occurred during diagnostic colonoscopy. There were 5 females and 1 male. Endoscopy was performed by an experienced operator in 5 cases and by a training fellow in 1. Preparation of the colon was considered as good in 5 cases. The operator reported procedural problems in only 1 case. Diagnosis of perforation was immediate in 5 cases and delayed for 30 hours in 1. The lesion was located in the sigmoid colon in 5 cases and transverse colon in 1. All patients underwent laparotomy. The repair technique consisted of simple closure in 2 cases, closure with colostomy in one, and bowel resection with anastomosis (n=2). Two deaths occurred intraoperatively in I case and postoperatively in 1. The patient who died intraoperatively had not yet undergone repair when death occurred. In both patients who died, laparotomy was performed late in the presence of co-morbidity. CONCLUSION: Colonic perforation is a rare but severe iatrogenic complication following colonoscopic examination. Early recognition and treatment are essential to optimize outcome. Prevention depends on training to obtain skillful advancement technique.

[Gunshot wound to gravid uterus: a case report]. / Plaie Balistique Pelvi-Abdominale Chez une Gestante.

The authors report the case of a 24-years old pregnant woman gravida 2 para 1 who sustained a gunshot injury at 23 weeks gestation. The bullet injured the rectosigmoid jonction, the jejunum and traversed the uterine cavity with resultant of fatal injury of the fetus. Laparotomy was required for treatment of the maternal injuries. Although a fetus demise was delivered by caesarian section a review of literature indicated that operative delivery should be avoided when the fetus has died already and the gravid uterus don't impaired the surgeon's ability to repair other visceral injuries. But the patient should be followed closely for signs of coagulopathy and intra uterine infection.