Acute intestinal ischemia complicating mesenteric venous thrombosis.

Acute mesenteric venous thrombosis is a rare condition but serious. We report here a new case in a 35-year-old man presenting with paroxysmal abdominal pain during 13 days. The diagnosis of superior mesenteric venous thrombosis was confirmed by CT angiography, and the patient was operated on the third day of a well-conducted medical treatment with intravenous heparinotherapy, in the presence of localized peritonitis. The laparotomy revealed an ischemic ileal portion treated by segmental resection and terminoterminal anastomosis without complication.

[Management of carotid-jugular fistula: Case report and review of the literature]. / Prise en charge des fistules carotido-jugulaires : cas clinique et revue de la littérature.

We report here the management of an acquired left carotid-jugular fistula in a 29-year-old man. This patient was referred to us for a ballistic wound of the left cheek evolving since one month with the diagnosis of a carotid pseudo-aneurysm discovered on Doppler ultrasound. The clinical presentation was marked by cervical thrill in favor of an arteriovenous fistula confirmed by computed tomography angiography. The surgical exploration by cervicotomy revealed a communication between common carotid artery and internal jugular vein that were repaired using a saphenous vein patch and a lateral suture respectively without complication. The control at five months found an asymptomatic patient with good patency of the repaired vessels.

[Surgical treatment of a ruptured aneurysm of the left common iliac artery in a patient with miliary tuberculosis]. / Traitement chirurgical d'un anévrisme rompu de l'artère iliaque commune gauche chez un patient présentant une tuberculose miliaire.

Tuberculous aneurysms of the common iliac artery are rare. Only a few cases have been reported in the literature. We report a new case in a 47-year-old man admitted for abdominal pain and persistent fever. The aneurysm was evoked in the duplex ultrasound scan and confirmed by computed tomographic angiography. The patient underwent an extra-anatomic femorofemoral bypass with a dacron prosthesis and ligation of the aneurysmal artery. The postoperative course was marked by febrile dyspnea related to the tuberculous miliary found on the chest x-ray. Histological analysis of the operative specimens confirmed the tuberculous origin of the aneurysm. The patient was put on antituberculous drugs and the follow-up was uneventful. With a follow-up of four months, the patient was asymptomatic and the bypass was well patent.

Indications chirurgicales d'hémostase en urgence des hémorragies di- gestives au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo

Introduction : Notre objectif est de décrire les aspects épidémiologiques, cliniques et chirurgicaux des hémorragies digestives opérées. Matériels et Méthodes : Il s'agissait d'une étude observationnelle, descriptive, rétrospective réalisée au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHUJRA) Antananarivo sur une période de sept ans allant du 1er janvier 2009 au 31 Mars 2016. Résultats : Trente cas de patients étaient opérés. L'âge de nos patients variait de 3 à 84 ans, avec une moyenne de 48,7 ans. Le sex ratio était de 2,33. L'ulcère duodénal était la cause de l'hémorragie digestive chez 16 patients (53,33%). Dans 53,33% des cas, l'indication chirurgicale était l'état de collapsus cardio-vasculaire ré¬fractaire à un remplissage vasculaire adéquat. Quatre-vingt pourcent des patients avaient bénéficié d'une suture par point en X au niveau du saigne¬ment actif. Dans 96,66% des cas, Il n'y avait pas de récidive. Un patient était décédé en peropératoire. Conclusion : Si dans la littérature, les hémos¬tases sont endoscopiques dans 98,01% et seulement 1,99% des cas relèvent de la chirurgie, dans notre étude, la réanimation constitue la base du traitement. En cas d'échec uniquement, la chirurgie est recommandée. Ainsi, la chirurgie est indiquée en deuxième intention si la réanimation est inefficace. L'exploration peut être blanche, d'où l'intérêt des examens endoscopiques

[Dramatic evolution of a bilateral femoral artery aneurysm in a 16-year-old girl]. / Évolution dramatique d'un anévrisme bilatéral de l'artère fémorale chez une fille de 16 ans.

Femoral artery aneurysm is a rare entity among the vascular complications of Takayasu's disease. It is sometimes characterized by the risk of serious local complications with hemorrhagic or ischemic event, as well as by a big therapeutic handling difficulty. We report a case of bilateral femoral artery aneurysm in a 16-year-old girl having a dramatic evolution turn after surgical treatment and irreversible limb ischemia.

[Management of traumatic and iatrogenic arterial pseudoaneurysms in a tropical environment]. / Prise en charge des faux anévrysmes artériels traumatiques et iatrogènes en milieu tropical.

A false aneurysm or pseudoaneurysm (PA) is the formation of a pulsatile and encapsulated hematoma in communication with the lumen of a perforated artery. Its origin is different but most cases are associated with a traumatic event. Currently, the referenced treatment is endovascular surgery but it is not feasible for the majority of vascular surgeons working in a tropical environment. The aim of this study was to describe the diagnostic and therapeutic aspects of arterial PA (APA) encountered in our institution and to evaluate the place of open surgical technique in their management. This was a 30-month retrospective and descriptive study carried out in our institution (CHU-JRA, Antananarivo, Madagascar). Between 2012 and 2014, ten cases of APA were operated. There were 8 men with an average age of 30 years. The etiologies were accidental trauma (n=6) or iatrogenic vascular injury (n=4). Most patients had a painful and pulsatile swelling (n=8). The presence of a wound scar located on the swelling was observed in 5 patients. The false aneurysms were localized in the radial (n=3), femoral (n=2), brachial (n=2), carotid (n=2) and ulnar (n=1) arteries. The diagnosis was confirmed by ultrasound Doppler in all patients. The treatment was an open surgical procedure and consisted of lateral suture (n=4), resection with direct end-to-end anastomosis (n=1) or using autologous saphenous vein graft (n=2) or ligation (n=3). Postoperative courses and outcomes at last follow-up were uneventful with optimal patency rate.

[Management of popliteal artery pseudoaneurysms as a result of limb trauma and orthopedic surgery or associated with osteochondromas]. / Prise en charge des faux anévrismes de l'artère poplitée associés aux ostéochondromes et ceux dus aux traumatismes des membres ou secondaires à la chirurgie orthopédique.

Most published articles regarding popliteal artery pseudoaneurysms (PAPs) are case reports and in English language literature. In this context, no study with robust data was previously published. The exact epidemiology of these APs is not well-known and their management is not yet codified. We wanted to summarize the current knowledge on diagnostic and therapeutic features of PAPs as a result of limb trauma and orthopedic surgery or associated with osteochondromas. An electronic research on MEDLINE and EMBASE between 1953 and March 2015 was performed; using the key words "popliteal pseudoaneurysm". The referenced articles were selectively read and this systematic review included 116 articles. Patient demographics; clinical presentations; diagnostic and therapeutic features were reviewed. In sum, 122 cases were analyzed. Overall young adult (average age=30.48±21.25 years old) represented the majority of the affected population with a masculine preponderance (79%). The main etiologies included femoral exostosis (63%), followed by the orthopedic surgery (25%) and direct trauma into the knee (10%). Painful swelling (44%) and/or pulsatile mass (39%) represented the most commonly presenting symptoms. The commonest radiological investigations used included arteriography (49%) and CTA (27%). The treatment was open surgical repair (85%) or endovascular stenting graft (14%). Post-therapeutic courses were often uneventful (98%). The morbidity rate was low at about 2%. The treatment of direct post-traumatic PAPs was usually open surgical repair (83%) with saphenous vein grafting. Endovascular stenting may be an ideal option for managing PAPs following orthopedic surgery (88%). Open surgery for vascular repair and maximum exostectomy must be undertaken concomitantly in the setting of APs associated with osteochondromas.

Un cas de section traumatique de l'artère carotide commune droite de l'enfant : contribution à la prise en charge chirurgicale

La section traumatique de l'artère carotide commune est rare et grave avec un pronostic sombre dû à une mortalité élevée. Elle demeure l'un des problèmes urgents en chirurgie vasculaire et sa prise en charge reste un challenge en situation précaire. Notre objectif était de rapporter un nouveau cas afin de préciser les particularités thérapeutique et pronostique de cette lésion gravissime. Il s'agissait d'un garçon de 11 ans qui avait un traumatisme ouvert cervico-mentonnier latéral droit suite à une chute contre un objet tranchant. Le délai de prise en charge spécialisée était de 2 heures. A l'hôpital, les gestes d'hémostase provisoire étaient inappropriés. L'état hémodynamique du patient devenait rapidement instable. L'exploration chirurgicale immédiate révélait une section complète de l'artère carotide commune droite. La réparation consistait en une anastomose termino-terminale sans interposition de greffon. Le patient comateux en postopératoire immédiat, décédait 24 heures plus tard suite à un infarctus cérébral et une défaillance multi-viscérale. En situation précaire, le pronostic après une section complète de l'artère carotide commune est réservé malgré les efforts techniques hospitaliers apportés par la réanimation médico-chirurgicale

[Femoral artery pseudoaneurysms encountered in orthopedics and traumatology]. / Les faux anévrismes de l'artère fémorale en orthopédie et en traumatologie.

BACKGROUND AND PURPOSE: Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. METHODS: A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". RESULTS: A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. CONCLUSION: Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses.

[Successful management of an acquired uterine arteriovenous malformation by selective ligation of the internal iliac artery]. / Une malformation artérioveineuse utérine acquise traitée avec succès par ligature sélective de l'artère iliaque interne.

Uterine arteriovenous malformations can be congenital or acquired. When acquired, they result from abnormal arteriovenous communication between one or more uterine arteries and a myometrial and/or endometrial venous plexus, without the interposition of a vascular nidus. Arteriovenous malformations are composed of a tortuous net of fragile low-resistant arteriovenous shunts. Uterine arteriovenous malformations create a rare and potentially life-threatening condition. The method of treatment is determined by symptoms, desire for future fertility, extent, and location of the malformation. The first treatment option for uterine arteriovenous malformation is hysterectomy, and the second option is uterine artery embolization. Selective ligation of the vessels supplying the malformation is an effective treatment option when conservative methods have failed. The present report describes a patient whose uterine arteriovenous malformation was successfully managed by selective ligation of the internal iliac artery.

[Arteriovenous malformation of the left upper limb in stage II of Schöbinger: A case report in Madagascar]. / Malformation artérioveineuse du membre supérieur gauche au stade II de Schöbinger : à propos d'une observation à Madagascar.

Arteriovenous malformations are the most unpredictable and dangerous congenital malformations. They consist of multiple arteriovenous shunts with high flow and can progress to heart failure. They are rarely localized in the upper limb and pose therapeutic problems. We report a new case in a 27-year old woman, admitted for pulsatile pain in the left elbow. The diagnosis was made by clinical examination and ultrasonography. The surgical treatment without embolization and sclerotherapy, consisted of a large resection of the nidus without postoperative complication.

[The role of surgical treatment in the management of nonparasitic hepatic cysts in Madagascar]. / Place de la chirurgie dans la prise en charge des kystes non parasitaires du foie à Madagascar.

Non-parasitic liver cysts are rare in our country. We report the second case in a 61-year-old woman admitted for a painful epigastric mass. The diagnosis was suggested by ultrasound and confirmed by histological examination of the surgical specimen. Surgical treatment was performed through a right transverse subcostal incision and consisted of a maximal resection of the cystic wall. No complications followed. After 12 months, the patient was asymptomatic, and no recurrence had been observed.

[Osteosarcoma of the radius after intramedullary osteosynthesis]. / Ostéosarcome du radius après une ostéosynthèse par embrochage centromédullaire.

Osteosarcoma is a malignant neoplasm characterized by local lytic or plastic processes. We observed a case of radius osteosarcoma in a 10-year-old boy 3 months after intramedullary osteosynthesis in the ipsilateral distal radius. Treatment consisted of amputation of the distal humerus and adjuvant chemotherapy; no complications were observed.

[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. / Ascite urinaire, uropéritoine et péritonite urinaire chez l'enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar.

OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

[Nosocomial cavernous sinus thrombophlebitis due to multidrug-resistant Staphylococcus aureus. A pediatric case report]. / Thrombophlébite du sinus caverneux nosocomiale àStaphylococcus aureus multirésistant. À propos d'un cas.

Cavernous sinus thrombophlebitis is a serious disease. We report herein a case seen in a 9-year-old boy hospitalized for an acute pneumopathy. Clinical signs were made of a diffuse edema of the upper two-thirds of the face, eyelid edema, chemosis, exophthalmia, meningeal syndrome, and infections syndromes associated with alteration of consciousness. A CT scan revealed a heterogenous enhancement and enlargement of the left cavernous sinus and homogenous opacity of the sphenoidal sinuses. Therapeutic management was complicated due to allergy to ß-lactams and the multidrug resistance of Staphylococcus aureus.

[Spontaneous evisceration of an abdominal pregnancy. Report of a case in Madagascar]. / Éviscération spontanée d'une grossesse abdominale : à propos d'un cas à Madagascar.

Authors report the case of a 29-year-old woman who presented a 34-weeks abdominal pregnancy. Spontaneous foetal evisceration was observed on abdominal caesarean operation scar performed previously by median infra-umbilical incision. Clinical features and treatment are discussed in developing country environment.

[Isolated prostate tuberculosis. Report of a case in Madagascar]. / Tuberculose prostatique isolée. A propos d'un cas à Madagascar.

Isolated prostate tuberculosis is uncommon. Authors report herein the case of 64-year-old man who presented obstructive syndrome of low urinary tract. After clinical and biological examination, and imagery, prostate cancer was highly suspected. Transrectal biopsy was performed and histological examination showed tuberculosis lesions. We suggest that prostate tuberculosis should be evoked in old patient presenting similar signs and living in tuberculosis endemic zone.

[Tuberculous arthritis of the thumb: a case report]. / Ostéoarthrite tuberculeuse du pouce : à propos d'un cas.

Fingers are an uncommon location of osteoarticular tuberculosis. We report herein a case affecting the thumb in an 8-year-old boy. He presented painful swelling of the right thumb, which had a tumoral aspect and had been evolving for 3 months with general signs of tuberculosis impregnation. Bacteriology and biopsy findings confirmed the diagnosis. Medical treatment yielded satisfactory results. The particular features of care are discussed in the context of a developing country and in relation to the data in the literature.