Pseudotumeur inflammatoire colique / Colic inflammatory pseudotumor

Introduction : Les pseudotumeurs inflammatoires coliques sont des lésions bénignes très rares, d'étiologie inconnue et dont le diagnostic différentiel est difficile avec les adénocarcinomes. Résultat : Nous rapportons le cas d'une patiente de 20 ans, admise en urgence dans un contexte d'occlusion intestinale aiguë chez qui en per opératoire, nous avons retrouvé une tumeur ulcéro -nécrotique du côlon droit suspecte de malignité. Mais l'examen histologique de la pièce d'hémi colectomie a affirmé sa bénignité. Conclusion : Les pseudo-tumeurs inflammatoires bien que rares, ne sont pas exceptionnelles. Elles sont de diagnostic difficile car peuvent simuler des tumeurs malignes et l'examen histologique est indispensable pour affirmer le diagnostic

Introduction: Colonic inflammatory pseudotumors are rare benign lesions, they are of unknown etiology and the differential diagnosis is difficult with adenocarcinomas. Result: We report the case of a 20-year-old patient admitted urgently in an acute intestinal occlusion in which laparotomy has objectified an ulcerative-necrotic tumor of the right colon suspected of malignancy; it is the histological examination of the piece of hemicolectomy which affirmed its benignity. Conclusion: Inflammatory pseudo-tumors, although rare, are not exceptional; they are difficult to diagnose because they can simulate malignant tumors and histological examination is essential to assert the diagnosis

[Oncoplasty by the Thorek technique for lower quadrant cancers in a condition of gigantomastia]. / Oncoplastie selon la technique de Thorek pour cancers des quadrants inférieurs en situation de gigantomastie.

OBJECTIVE: Describe our experience of Oncoplasty according to Thorek in gigantomastia with hard and less plastic breasts and a major ptosis. METHODOLOGY: Thirteen cases of breast carcinoma on gigantomastia operated using the Thorek technique between 2014 and 2019 in Burkina Faso were analyzed retrospectively. The operative indications, technique and results were considered. Breast Q was used to assess patient satisfaction. RESULTS: The indication of oncoplasty by the Thorek's technique was breast lower quadrants carcinoma, associated with a major ptosis, gigantomastia. There was a consequence on the spine in 9 over 13 cases. The breasts were hard and less plastic, making the other breast reduction techniques difficult. This technique helped remove the carcinoma, reduce the volume of the breast and address the ptosis. The patients were satisfied with the volume of the remaining breasts and their aesthetic look. The resection margins were safe. Two cases of aerolar dyschromia were noticed. CONCLUSION: The Thorek technique remains an alternative concerning tumours on gigantomastia, with hard and less plastic breasts and a major ptosis. The results combine carcinological and aesthetic requirements.

Etiological, therapeutic and prognostic particularities of primary biliary peritonitis in tropical environments.

To describe the etiological, therapeutic, and prognostic aspects of primary biliary peritonitis in Burkina Faso. This retrospective study reviewed records of all patients admitted for primary biliary peritonitis at Tenkodogo Regional Hospital (Burkina Faso) from 2010 through 2016. Cases of secondary biliary peritonitis have been excluded. Thirty patients were identified. Their average age was 26.5 years. Fourteen patients were under 12 years of age. The reasons for consultation were dominated by abdominal pain (in all cases) and bile-induced vomiting (in 22 cases). Seven patients had a general condition classified in stage 2 of the World Health Organization classification, 18 in stage 3, and 5 in stage 4. The etiologies of peritonitis were acute typhoidal cholecystitis, which predominated (27 cases), and gallstones (3 cases). The surgical approach was a laparotomy in all cases. Intraoperative observation showed an inflamed and perforated gallbladder in 24 cases; gangrene was noted in 6 cases. Treatment consisted of cholecystectomy and peritoneal lavage, associated with antibiotic therapy. The post-operative period was complicated by septicemia in 12 cases. Fourteen patients died, for a mortality rate of 46.7 %. In rural Burkina Faso, primary biliary peritonitis occurs in young subjects. Its cause is most often acute cholecystitis due to Salmonella typhi. Mortality is very high.

So-called "historical" necrotic breast cancers: a terrifying actuality in Africa. The case of Burkina Faso.

Study the epidemiological, diagnostic, and treatment features and outcomes of necrotic breast cancer in women. This observational, longitudinal, and descriptive study covered the period from January, 2011, to the end of May, 2016 at the Surgery and Gynecology Departments of Yalgado Ouedraogo University Hospital and Schiphra Medical Center. The study included all women with necrotic breast cancers. Survival was calculated by the Kaplan Meier method and survival comparison was possible with the log-rank method. À risk of error of 0.05 was allowed. Necrotic cancer accounted for 9.1% of all breast cancers. The median age of the patients was 46 years old. The median interval before consultation was 12.4 months. The histological type was invasive ductal carcinoma in 90.8% of cases. Surgery was performed in 51 patients (52%). It was a palliative (cleaning) procedure in 92.2% of cases. Chemotherapy was performed in 28 patients. Overall survival was 61.8% at 6 months, 39.5% at 1 year, and 9.2% at 3 years. Median survival was 10 months: 13 months for women with surgery and 6 months for those without it (p<0.001). Necrotic breast cancer is still common in Ouagadougou. Surgery is the mainstay of the treatment. Survival is mediocre. It therefore seems urgent to focus on raising population awareness and organizing screening campaigns.

Les urgences en chirurgie digestive au Centre Hospitalier Universitaire Régional de Ouahigouya (Burkina Faso) à propos de 394 cas

Le but de cette étude a été de déterminer le profil épidémiologique et clinique des urgences en chirurgie digestive de même que les résultats de leur traitement en milieu semi-urbain du Burkina Faso. Il s'est agi d'une étude transversale descriptive dont la collecte de données a été réalisée de manière rétrospective sur 12 mois. Elle a porté sur 394 patients opérés pour une urgence chirurgicale digestive chez qui les aspects épidémiologiques, cliniques et thérapeutiques ont été colligés et analysés. Durant la période d'étude, 2 360 patients ont été admis, dont 394 opérés pour une urgence chirurgicale digestive, soit 16,7 % des admissions. Deux cent quatre-vingt-dix patients ont été de sexe masculin et 104 de sexe féminin, soit un sex-ratio de 2,7 avec un âge moyen de 33 ans. Les étiologies retrouvées ont été par ordre de fréquence décroissant, les péritonites aiguës généralisées avec 146 cas (37 %), les hernies étranglées avec 95 cas (24,1 %), les appendicites avec 89 cas (22,6 %) et les occlusions intestinales aiguës avec 64 cas (16,3 %). Des complications sont survenues dans 59 cas (14,9 %) avec une prédominance des suppurations pariétales (33 cas). La mortalité globale a été de 8,12 %. Les urgences chirurgicales digestives sont fréquentes ; il s'agit dans notre contexte d'une maladie de l'adulte jeune de sexe masculin. Elles relèvent de plusieurs étiologies avec une prédominance des péritonites aiguës généralisées d'origine appendiculaire. La prise en charge de ces urgences est médicochirurgicale et reste émaillée d'un fort taux de mortalité. Le double retard diagnostique et thérapeutique pourrait en être la cause. Aussi, l'amélioration du pronostic de ces urgences chirurgicales requiert une sensibilisation des communautés sur ces pathologies, la formation du personnel de santé au diagnostic de ces pathologies et la mise en place d'une couverture sanitaire universelle

Epidemiological, bacteriological and therapeutic aspects of chronic osteomyelitis in a sub-Saharan environment.

The purpose of this study was to describe the epidemiological and bacterial aspects of chronic osteomyelitis at the regional hospital of Tenkodogo, in Burkina Faso. This prospective study took place at the regional hospital in Tenkodogo during the 3 year-period 2011-2013 and included all cases of chronic osteomyelitis diagnosed during those years. The diagnosis was based on clinical and radiological evidence. In all, 86 patients were identified, with a mean age of 18.5 years, and predominantly male (73 %). The mean time to consultation was 18 months. The most common sites of chronic osteomyelitis were the tibia and femur. Bacteriologically, the pathogen most frequently isolated was Staphylococcus (75.6 %). The pathogens isolated were mostly responsive to gentamicin (75 % of pathogens) and ciprofloxacin (56.2 % of pathogens). Resistance to the combination amoxicillin + clavulanic acid was observed frequently. The treatment included a sequestrectomy and additional long-term antibiotic therapy based on susceptibility testing. The recurrence rate was 5.8 % over a one-year follow-up. Encouraging results can be obtained in chronic osteomyelitis with proper treatment. In this perspective, the isolation of the causative organism and knowledge of its sensitivity to antibiotics are essential information.

Acute appendicitis due to schistosomiasis: four cases at the Yalgado Ouédraogo University Hospital of Ouagadougou.

Acute appendicitis is a frequent pathology with diverse causes. Although Burkina Faso is a tropical country with endemic schistosomiasis, bilharzial appendicitis remains rare. We report 4 cases of appendicitis due to schistosomiasis that we treated at the university hospital of Yalgado Ouédraogo to call attention to the need for routine review of appendectomy parts. Four male patients, aged 22, 26, 30, and 35 years old, were admitted for abdominal pains. Eosinophilia was observed in one case. The preoperative diagnosis was acute appendicitis in 2 cases and appendiceal peritonitis in 2 others. Appendectomy was performed in all cases. Pathological examination of the appendectomy piece observed acute suppurative appendicitis due to schistosomiasis, specifically, Schistosoma haematobium. All patients received praziquantel for antiparasite treatment. Clinical course was uncomplicated in all cases. Routine antiparasite treatment would make it possible to prevent these cases of bilharzial appendicitis. In addition, routine histologic examination of appendectomy parts would enable us to determine the real frequency of this disease in our country, where bilharziasis is endemic. The treatment is appendectomy and the prognosis is good.

Epidemiological, clinical, and therapeutic features of typhoid intestinal perforation in a rural environment of Burkina Faso.

The aim of this study was to describe the epidemiological, clinical, and therapeutic features of ileal perforation due to typhoid fever at the regional hospital of Tenkodogo (Burkina Faso). This cross-sectional study examined the records over a 5-year period of all patients treated for typhoid ileal perforation. Ileal perforation was diagnosed intraoperatively, and its typhoid origin determined according to the following criteria : background signs of typhoid fever, location of the perforation on the antimesenteric edge of the terminal ileum, and a positive Widal-Felix serology. The study included 216  patients. Their mean age was 13.8 years, and 63.4% were male. The average time to consultation was 11 days. Clinical signs were mainly abdominal pain, vomiting, and abdominal tenderness. Anemia was observed in 135 patients (62.5%). All patients underwent laparotomy. Three procedures for treating surgical perforation were used : excision and suture of the perforation in 86 patients (39.8%), ileal resection with anastomosis in 98 (45.4%), and ileostomy with subsequent recovery in 32 (14.8%). The average length of hospital stay was 16.1 days. Postoperative complications occurred in 156 patients (72.2%). Thirty-seven patients died, for a mortality rate of 17.1 %. Ileal perforations due to typhoid fever are the main cause of peritonitis in rural areas of Burkina Faso. Patients are relatively young, and most are anemic at admission. Morbidity and mortality are significant.

[Acute pancreatitis at the Yalgado Ouedraogo University Hospital in Burkina Faso]. / Les pancreatites aigües au centre hospitalier universitaire (CHU) Yalgado Ouedraogo au Burkina Faso.

AIMS: To study the epidemiological, diagnostic, etiologic, therapeutic and evolutionary aspects of acute pancreatitis in Burkinabe. MATERIALS AND METHODS: We conducted a cross-sectional descriptive study referred from records of patients hospitalized for acute pancreatitis in the Department of General and Digestive Surgery of the Yalgado Ouedraogo University Hospital in Burkina Faso from 1 January 2007 to 31 December 2012. RESULTS: We noted 30 cases of acute pancreatitis, a frequency of 0.46 % of hospitalizations and an annual incidence of 4.6 cases per year. There were 22 men. The average age was 42.7 years. Alcohol consumption was found in 56.7%. The clinical aspects were dominated by abdominal pain (100%). Lipasemia was more than three times normal values in 66.3% of cases. An abdominal ultrasound was performed in 26.7% of cases and an abdominal CT was carried out in 50% of cases. The Balthazar score was evaluated in 15 patients and was lower in stage C in 9 cases. The treatment was mainly medical. The evolution was marked by the occurrence of systemic complications in 40% of patients and one death was recorded. CONCLUSION: Patients suffering from financial hardships present a major handicap for the diagnosis and early treatment.

BUT: Etudier les aspects épidémiologiques, diagnostiques, étiologiques, thérapeutiques et évolutifs de la pancréatite aiguë dans le contexte Burkinabè. MATÉRIELS ET MÉTHODE: Il a été mené une étude transversale à visée descriptive à partir des dossiers des patients hospitalisés pour pancréatite aiguë dans le service de chirurgie générale et digestive du CHUYO du 1er Janvier 2007 au 31 décembre 2012. RÉSULTATS: Trente cas de pancréatite aiguë ont été colligé soit une fréquence de 0,46% des hospitalisations et une incidence annuelle de 4,6 cas par an. Il y avait 22 hommes. L'âge moyen était de 42,7 ans. La consommation d'alcool était retrouvée dans 56,7%. Le tableau clinique était dominé par la douleur abdominale (100%). La lipasémie était supérieure à trois fois la normale dans 66,3%. L'échographie abdominale n'a été réalisée que dans 26,7% et le scanner abdominal a été réalisé dans 50%. Le traitement était essentiellement médical. L'évolution a été marquée par la survenue de complications générales dans 40% et un décès a été enregistré. CONCLUSION: Les difficultés financières des patients sont un handicap important pour le diagnostic et la prise en charge précoce.

Les gangrènes des organes génitaux externes masculins. Aspects épidémiologiques et thérapeutiques

Objectif : Décrire les aspects épidémiologiques et thérapeutiques des gangrènes des organes génitaux externes masculins. Matériel et méthodes : Il s'est agi d'une étude descriptive et descriptive sur une période de 5 ans allant du 1er janvier 2007 au 31 décembre 2011 au cours de laquelle nous avons enregistré 47 cas de gangrènes des organes génitaux externes. Nous avons analysé rétrospectivement les 39 dossiers qui étaient complets et exploitables. Résultats : Les gangrènes des organes génitaux externes étaient relativement peu fréquentes, constituaient 3,25% des urgences urologiques. Elles étaient l'apanage du sujet d'âge mur avec un âge moyen de 50,17 ans, tous de sexe masculin. Les patients provenaient majoritairement du milieu rural avec 56,4%. Le délai de consultation était assez long avec une moyenne de 9,69 jours avec des extrêmes de 2 jours et 30 jours. Les facteurs de comorbidité ont été retrouvés chez 46,11% des patients. L'origine cutanée a été retrouvée dans 48,7% des patients. Les prélèvements bactériologiques effectués chez 23 patients ont retrouvé un germe chez 13 patients et avec E. coli comme principal germe (10 cas) et accessoirement Staphylococcus aureus (1 cas), Klebsiella pneumoniae (1 cas) et Proteus mirabilis (1 cas). Au plan de la prise en charge tous les patients ont bénéficié d'un traitement médicochirurgical précédé d'une réanimation médicale. Un débridement large avec nécrosectomie a été réalisé chez tous les patients associé à une triple antibiothérapie d'abord probabiliste puis ajustée en fonction du résultat de l'antibiogramme lorsqu'un germe a été identifié. Tous les patients ont subi une cicatrisation dirigée et une plastie de recouvrement a été réalisée. La gangrène des organes génitaux externes reste une affection grave souvent invalidante avec un long séjour hospitalier. Le taux de mortalité était de 17,95%. Conclusion : Les gangrènes des organes génitaux externes masculins sont assez graves avec un fort taux de mortalité. Elles sont relativement peu fréquentes dans notre contexte et la prise en charge est médico-chirurgicale et doit être multidisciplinaire pour espérer obtenir des résultats satisfaisants

Les peritonites aigues generalisees en milieu rural au Burkina Faso : a propos de 221 cas

But. Etudier les peritonites aigues en milieu rural au Burkina Faso. Materiel et methode : Etude transversale descriptive sur trois ans allant du 1er janvier 2007 au 31 decembre 2009 des patients operes pour peritonite aigues generalisee dont le diagnostic a ete confirme en per operatoire au centre hospitalier regional de Dedougou. Resultats : En trois ans; 221 cas peritonites aigues generalisees ont ete operees. Ces peritonites ont represente 31;2 des urgences abdominales. L'age moyen de nos patients etait de 24;34 ans avec des extremes de 1 an et de 79 ans. L'etiologie typhique venait en tete avec 42;5 suivie de l'etiologie appendiculaire 33 et la perforation d'ulcere gastroduodenale avec 6;8. Les peritonites primitives representaient seulement 3;2. On a note 40;2 de complications dont la suppuration parietale constituait 56;2. La mortalite globale etait de 19

Les cancers du colon à Ouagadougou: 53 observations

Les cancers du côlon prennent de plus en plus une place importante dans la pathologie tumorale et atteignent des individus de plus en jeune. Aussi avons­nous jugé opportun de jeter en regard général sur les cancers du côlon opérés à Ouagadougou au Burkina Faso. Du 1er janvier 2003 au 31 décembre 2008, soit 6 années, nous avons entrepris une étude rétrospective sur les cancers du côlon opérés dans le Service de Chirurgie viscérale du CHU Yalgado Ouédraogo de Ouagadougou. 53 cas ont été recensés représentant 2% de l'ensemble des cancers et 16,2% de ceux du tube digestif. L'âge moyen était de 49 ans. Le sexe masculin était prédominant. Le délai moyen de consultation était de 16 mois. Les circonstances de découvertes avaient été dominées par les troubles du transit (67,9%). La coloscopie a été le moyen d'exploration le plus utilisé, elle a permis d'observer l'aspect macroscopique ulcéro-bourgeonnant et d'obtenir le type microscopique d'adénocarcinome après ana-lyse des biopsies effectuées. L'hémicolectomie a été le moyen théra-peutique le plus usité avec un taux de résécabilité de 86,8% et une médiane de survie à 5 ans de 47,2%

[Surgical abdomen caused by traditional treatment. Five-case report in teaching hospital Yalgado Ouédraogo of Ouagadougou]. / Les abdomens chirurgicaux dus au traitement traditionnel. À propos de cinq cas au Centre hospitalier Yalgado Ouédraogo de Ouagadougou.

The traditional products used to treat some pains can cause serious complications of which surgical abdomen. We listed in two years five cases of surgical abdomen complicating a traditional treatment in the service of digestive and general surgery of the hospital complex Yalgado Ouédraogo. There were two men and three women with an average age of 34,4 years. These traditional products were used to treat constipation, sexual impotence, sterility and to "posses" her husband. Oral and rectal routes were used by one and three patients respectively, another patient used triple routes (oral, rectal and vaginal). The digestive lesions were in the upper tract in one case (gastric phytobezoar), two patients presented acute intestinal occlusion and two others acute generalized peritonitis. All the five patients underwent laparotomy. Two patients died in immediately post-operative course. The prevention of severe surgical complications of the digestive tract induced by traditional treatments has to be broadcasted through information, education and communication.

[Primary ileostomy for typhoid-related ileal perforation: a 62-case series in Ouagadougou, Burkina Faso]. / Iléostomie première des perforations iléales d'origine typhique: 62 cas à Ouagadougou (Burkina Faso).

OBJECTIVES: The purpose of this report is to evaluate the efficacy of primary ileostomy for treatment of typhoid-related ileal perforation based on our experience. METHODS: This retrospective study included all cases of typhoid-related ileal perforation treated by primary ileostomy in the Visceral Surgery Department of the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso from January 2006 to June 2008. Diagnosis was based mainly on peroperative findings revealing specific anatomical lesions. There were 45 men (72.6%) and 17 women (27.4%) with a mean age of 26 years (range, 14 to 68). Asthenic forms were observed in 41 cases (66.1%) and sthenic forms in 21 (33.9%). The mean delay for seeking treatment was 6 days (range, 1 to 30 days). RESULTS: Primary ileostomy was used for treatment of typhoid-related ileal perforation in 78.5% of cases. Most cases (80.6%) involved single perforations. A temporary ileostomy was performed in 55 cases (88.7%) and terminal ileostomy was performed in 7 (11.3%). Complications were observed in 18 patients (29.03%) including suppuration of wall in 8 cases. The mean duration for re-establishing continuity and of hospital stay was 34 and 41 days respectively. Four deaths occurred due to hypovolemic shock. CONCLUSION: In our department, primary ileostomy for typhoid-related ileal perforation reduced mortality despite high morbidity.

Un appendicite de localisation atypique : apport de la coloscopie au diagnostic

Le diagnostic de l'appendicite a gauche est fait en dehors de la laparotomie a l'imagerie medicale (echographie et scanner). Les auteurs rapportent ici un cas ou le diagnostic a ete fait a la coloscopie. Ils militent a travers une analyse basee sur le cas rapporte et ceux de la litterature en faveur de l'emploi de la coloscopie comme moyen diagnostic de confirmation des appendicites lorsque l'imagerie medicale (scanner) est inaccessible ou est pris a defaut

[Darier and Ferrand dermatofibrosarcoma. About 7 cases at the Ouagadougou teaching hospital, Burkina Faso]. / Le dermatofibrosarcome de Darier et Ferrand (DFDF): A propos de 7 cas au CHU de Ouagadougou, Burkina Faso.

The authors report 7 cases of dermatofibrosarcoma of Darier and Ferrand over a 7 year- period at the Yalgado-Ouédraogo teaching hospital, that is to say an average of 1 case per year. A male predominance was noted (4 males and 3 females), average age: 48; 5 recurrences out of 7, with an average delay of 3 years for recurrence, preferentially localised on the trunk (5 cases) and thigh (2 cases). They emphasize the importance of wide surgical exeresis and histopathology essential to confirm the diagnosis. Finally they point out the importance of clinical surveillance because of frequent recurrences.

[Hyperthyroidism in surgery at the Teaching Hospital Yalgado Ouedraogo Burkina Faso. About 95 cases]. / Les hyperthyroïdies en milieu chirurgical au Centre Hospitalier Universitaire Yalgado Ouédraogo, Burkina Faso. A propos de 95 cas.

The authors pay in a retrospective study, 95 cases of hyperthyroidism, listed in the teaching hospital Yalgado Ouedraogo of Ouagadougou from January 2000 to June 2005. These hyperthyroidism represent 39% of the thyroid affections, with a female prevalence (97%), 32 years of average age, the urban source of the patients (90% of the cases) and the importance of self medication (73%). They stress the importance of sonography, allowing a classification in diffuse goiter (44%) and multi nodular (56%). They insist on a good preparation of the patient before the intervention and on the interest of the sub total thyroïdectomy. They estimate that a correct binding of the vessels, the dissection of recurring, the visualization and the dissection of parathyroid and their vascular pedicle should make it possible to reduce the post-operative complications: null morbidity and death rate 12.5%.

Les hyperthyroides en milieu chirurgical au centre hospitalier universitaire Yalgado Ouedraogo; Burkina Faso. A propos de 95 cas

Les auteurs rapportent dans une etude retrospective; 95 cas d'hyperthyroidie; recenses au CHU Yalgado Ouedraogo de janvier 2000 a juin 2005. Ces hyperthyroidies representent 39des affections thyroidiennes; avec une predominance feminine (97); un age moyen de 32 ans. La provenance urbaine des patients (90des cas) et l'importance de l'automedication (73) ont ete notees. Les auteurs soulignent l'importance de l'echographie; permettant une classification en goitres diffus (44) et multinodulaires (56). Ils insistent sur une bonne preparation du malade avant l'intervention et sur l'interet de la thyroidectomie subtotale. Ils estiment qu'une ligature correcte des vaisseaux; la dissection des recurrents; la visualisation et la dissection des parathyroides et de leur pedicule vasculaire devraient permettre de reduire les complications post-operatoires : taux de mortalite nul et de morbidite 12;5

[Intestinal invaginations in children: 24 cases treated at the Yalgado National University Hospital in Ouedraogo]. / Les invaginations intestinales de l'enfant. A propos de 24 cas traitésau Centre hospitalier national Yalgado-Ouédrago.

We report a retrospective study of 24 cases of acute intestinal invagination in children, accounting for 4.4% of the cases of mechanical intestinal occlusion. More boys than girls were affected (sex ratio of 3:1). Consultation was often delayed, there was a high frequency of occlusive forms and of idiopathic forms (17 of the 24 cases) and the mortality rate was high (1 of the 24 children died). This study demonstrates the importance of ultrasound scans in the diagnosis of this condition.