Diagnostic and therapeutic approach to abdominal masses in a country with limited resources.

OBJECTIVE: To report the diagnostic and therapeutic approach for the management of abdominal masses in the General Surgery department of the Niamey General Reference Hospital (HGR). MATERIALS AND METHODS: This were a retrospective and preliminary study of 2 years and 3 months on patients operated for abdominal masses in the General Surgery department of the HGR. A palpable mass and/or its size on imaging (40 mm) were the inclusion criteria. RESULTS: Abdominal masses accounted for 6.7% (n = 53) of other pathologies. The average age of the patients was 41.26 years, with a standard deviation of 14.2 and a female predominance of 75.5% (n = 40) with a sex ratio of 0.32. The abdominal mass was clinically palpable in 75.5% (n = 40). Abdominal pelvic ultrasound was performed as a first step in all patients and in 75.5% (n = 40) it specified the origin of the mass. Contrast-enhanced abdomino-pelvic CT scan, performed in 52.8% of patients (n = 28) and in 89.3% (n = 25) specified the preoperative diagnosis. The most frequent etiologies were uterine fibroids, 35.8% (n = 19). In 5.6% (n = 3) the diagnosis was not precise preoperatively despite the two imaging studies, and these patients had underwent exploratory laparotomy. Surgery was the initial therapeutic approach for all patients, and laparoscopy accounted for 22.6% (n = 12). Postoperative complications occurred in 7.5% (n = 11). The death rate was 5.6% of cases (n = 3). CONCLUSION: Imaging remains important in the etiological research for abdominal masses. Definitive treatment remains surgical; mortality would be linked to the malignant nature and the significant volume of the mass.

Splenic lymphangiomas as a common indication for splenectomy: a case series with literature review.

BACKGROUND: Splenic lymphangiomas (SL) are very rare benign cystic lesions found in pediatric population. Their occurrence in adults is exceptional. Splenectomy is the common management of splenic lesions for diagnostic and/or therapeutic purpose. Our aim is to report additional cases of SL diagnosed on splenectomy specimens at our Pathology laboratory with literature review. METHODS: This is a retrospective study including all cases of splenectomy recorded at our Pathology laboratory (June 2020-August 2022). We performed a comparison of clinicopathological features between patients with SL and those with other benign splenic diseases. RESULTS: Sixteen cases of splenectomy were included. The mean age was 30.25 years (range of 6-70 years). The final histopathological diagnoses were congestive spleens in all cases of sickle cell disease (SCD) (5/16 patients, 31.25%), splenic cystic lymphangiomas (4/16 patients, 25%), capsular splenic infiltration by gastric and colic cancers (3/16 cases, 18.75%), splenic abscess (2/16 cases, 12.5%) and splenic rupture with subcapsular hematoma (1/16 patients, 6.25%). 12/16 patients (75%) had benign splenic conditions (4/12 with SL, 5/12 with SCD, 2/12 with abscess and 1/12 with splenic trauma). Patients with SL were older than those with other benign splenic conditions (mean age of 28.27 years versus 20.87 years). Also patients with SL presented with massive splenomegaly (mean splenic weight of 1675 g versus 418.75 g, mean splenic size of 19.62 cm versus 14.63 cm). Open surgery was performed in 15/16 patients (93.75%). CONCLUSION: Unlike previous studies, our series shows that SL are a common indication for splenectomy and occur in older patients with massive cystic splenomegaly. Open splenectomy is still an usual surgical practice in our country.

Suivi hormonal post thyroidectomie : Etude prospective à propos de 112 cas opérés à l'Hôpital National de Niamey de Mars 2014 à Avril 2015

Le goitre est la maladie endocrinienne la plus répandue au monde. L'objectif de notre étude est d'évaluer l'influence de la thyroïdectomie sur la fonction hormonale dans le service de chirurgie générale de l'hôpital national de Niamey. A cet effet nous avons recueilli les données relatives à 112 cas, ayant bénéficié d'une thyroïdectomie, entre mars 2014 et avril 2015. Le sexe féminin est prédominant avec 96,4% soit un sex ratio de 0,04, la tranche d'âge comprise entre 30-39 ans est la plus touchées avec 37,5% et une moyenne de 41,2 ans. La durée d'évolution du goitre est plus de 4 ans dans 33% des cas avec une moyenne de 7,5 ans et des extrêmes allant de 5 mois à 20 ans. Le premier motif de consultation est la tuméfaction cervicale antérieure. L'échographie a montré un aspect hyperéchogène dans 58% des cas. La radiographie cervicale est pathologique dans 76% des cas. Le goitre euthyroidien est majoritaire avec 89,2%. Sur le plan thérapeutique, la loboisthmectomie est le geste le plus pratiqué avec 43,7%, suivi de la thyroïdectomie subtotale avec 34%, thyroïdectomie totale 16% et la nodulectomie avec 9%. Le bilan hormonal post opératoire a objectivé 16 cas (14,3%) d'hypothyroïdie à 1 mois, 30 cas (26,7%) à 3 mois et à 6 mois et 2 cas (1,8%) à 1 an. La corrélation entre les gestes chirurgicaux et le bilan hormonal à 6 mois nous a permis de faire les constats suivants : dans les 30 cas d'hypothyroïdie, 16 étaient liées à la thyroïdectomie totale, 8 patients des loboisthmectomies et 6 des thyroïdectomies subtotales. A 1 an, nous avons constatés au total 2 cas d'hypothyroïdie liée à la thyroïdectomie totale, malgré la subtutition hormonale. Partant de ce résultat, nous pensons qu'il faut conserver un peu du tissu thyroïdien que ça soit le lobe ou la lame postérieure afin d'éviter la prescription des hormones thyroïdiennes