Reoperation of Anastomotic Stricture after Oesophageal Atresia Repair: An Uncommon Event.

Oesophageal atresia is a common malformation in which the survival rate in developed countries is around 90%, while its mortality remains very high in developing countries. Oesophageal stricture post-oesophageal atresia repair is traditionally treated by non-surgical approach. However, surgical resection of the oesophageal stricture may be necessary after the failure of dilations. We report one case of refractory oesophageal stricture post-EA repair in a 3-year-old girl, who underwent oesophageal atresia Type III repair at 11-day-old. We performed an end-to-end oesophageal anastomosis with tracheal oesophageal fistula closure by extra-pleural approach. The patient was lost to follow-up for 3 years. She was seen later for anastomotic oesophageal stricture with the failure of oesophageal dilatations. Surgical resection of oesophageal stricture was performed with end-to-end oesophageal anastomosis.

Ovarian tuberculosis mimicking a malignant tumour.

There has been reported increased incidence of ovarian tuberculosis in the tropics since the advent of HIV/AIDS disease. We report a case of bilateral ovarian tuberculosis associated with a single right kidney of uncertain origin in an immunocompetent 15-year-old generally healthy-looking girl. Abdominopelvic scan was equivocal about the diagnosis of the lesion as it failed to differentiate it from malignancy. Tuberculin and histopathology were necessary to confirm the diagnosis of ovarian tuberculosis. Antituberculous medical therapy successfully resolved the disease.

[Place of vulvovaginal candidiasis in the lower genital tract infections and associated risk factors among women in Benin]. / Place des candidoses vulvo-vaginales au cours des infections génitales basses et facteurs de risque associés chez les femmes au Bénin.

OBJECTIVE: Determine the place of vulvo-vaginal candidiasis (VVC) in the lower genital infections and seek risk factors among women in Benin. PATIENTS AND METHODS: The study was conducted in the laboratory of mycology of Hôpital de la Mère et de l'Enfant Lagune (Homel) from 1st March to 31st July, 2013. It involved all the women who were asked a vaginal swab and gave their consent in written form. After administration of a questionnaire, the vaginal samples were collected with sterile cotton swabs for a test with potassium hydroxide, an estimation of vaginal pH, direct microscopic examination, fresh, and after a Gram stain and culture on Sabouraud-chloramphenicol, ordinary agar and fresh blood agar. RESULTS: One hundred and thirty-one women were included in the study period. Clinical signs were dominated by vaginal discharge (74.8%), followed by vulvar pruritus (51.9%) and dyspareunia (36.6%). Culture on Sabouraud was positive in 51 cases or 38.9%. Candida albicans was isolated in 96.1% of cases, against 3.9% of Candida glabrata. The risk factors involved were: pregnancy, antibiotics, synthetic underclothing and frequent wearing tight pants. In addition of Candida, Gardnerella vaginalis was found in 36.6% of samples with an association with C. albicans in 28.2% of cases. CONCLUSION: This study showed that vulvovaginal candidiasis is the leading cause of lower genital tract infections in women in Benin with involvement of several risk factors which research is needed to develop appropriate preventive measures.

EXPERIENCE WITH MANAGING SOLID KIDNEY TUMOURS IN COTONOU, BENIN REPUBLIC.

BACKGROUND: Kidney cancer is the third most common urological tumour. Diagnosis is made in most cases at an advanced stage of the disease in our setting. AIM & OBJECTIVES: The aim of this work was to describe the management of solid tumors of the kidney and the outcome at the National University Hospital, Cotonou, Benin Republic, from January 2008 to December 2014. PATIENTS & METHODS: This is a retrospective, descriptive study conducted at the Clinic of Urology and Andrology at the National University Hospital CNHU-Hubert Koutoukou MAGA in Cotonou, Benin Republic. We included patients managed for solid kidney tumours from January 2008 to December 2014. The demographics, clinical presentations, management and outcome were recorded and the data obtained were analyzed using Epi info 3.2.2. RESULTS: Hospital frequency of solid renal mass was 1.9% with a mean age of 54 years and sex ratio of men to women of 1.6. Hematuria, back pain and lumbar mass were the most frequent clinical presentation found in 79.5% of cases. In all, 5% presented at an early stage while 95% presented at a late stage. Diagnosis was based on imaging; histopathological examination was requested in all the case though some could not afford the cost. Radical nephrectomy was performed in 51.5% of cases.The non- operated cases were those whose poor general condition as well as those who could not afford the procedure. Undifferentiated adenocarcinoma was the predominant pathological type found in 78% of operated cases. No patients underwent other treatments such as radiation therapy, immunotherapy or chemotherapy. Mortality occured in 10 cases including 1 intra operative death, 3 patients died in the early post operative period due to respiratory distress and 7 patients died from metatstasis discovered post operatively. CONCLUSION: This study has shown that majority of patients with solid renal tumours in this environment present late with advanced stages of the disease. The absence of the necessary investigative equipment, poverty and absence of adjuvant and adjunct therapeutic facilities make the treatment outcome poor.

Fournier'S gangrene in cotonou, benin republic.

BACKGROUND: Gangrene of the male genitalia called Fournier's gangrene is not an uncommon surgical condition in the urological service at Cotonou, Benin Republic; it is associated with high mortality and morbidity. PATIENTS & METHODS: This is a retrospective, descriptive study conducted at the Teaching Clinic of Urology and Andrology at the National and Hospitable Center CNHU- Hubert Koutoukou MAGA in Cotonou, Benin Republic. The study is on patients managed for Fournier's gangrene from January 2002 to December 2012. The demographics, clinical presentation, management and outcome were recorded in a proforma and the data obtained were analyzed using SPSS 10.0 software. RESULTS: Fournier's gangrene represented 1.8% of hospitalizations with an annual average of 5 cases. The mean age was 52 years with range of 21 - 85 years. 77.7% of patients were 40 - 59 years and; while 22.3% were 60 years and above. About 28% had a predisposing factor (diabetis, HIV, leukaemia, high blood pressure). Etiological factors were urogenital (42.5%), anorectal (22.5%), and cutaneous (17.5%). In 17.5% of cases, no etiologic factor was found. The diagnosis was clinically obvious because of late presentation, 95% of patients were admitted in the acute phase. CONCLUSION: Fournier's gangrene mostly affects young males and the diagnosis was clinical. It is a disease with high morbidity and mortality in Benin Republic.

[Apropos of 1 Ivoirian case of osseus and cutaneous histoplasmosis by Histoplasma capsulatum var. duboisii]. / A propos d'un cas ivoirien d'histoplasmose osseuse et cutanée à Histoplasma capsulatum var. duboisii.

Humeral, tibial and cutaneous localizations of Histoplasma capsulatum var. duboisii were observed on a 6 year old boy. The diagnosis was made possible by anatomo-pathological and mycological examinations. Treatment with terbinafine was administrated for 4 months. The boy recovered without after-effects in the tibial localization, but did suffer after-effects in the humeral localization.

[The treatment of prune-belly syndrome at the University Hospital Center at Abidjan (Treichville)]. / Le traitement du syndrome de ventre en pruneau (prune-belly syndrome) au CHU d'Abidjan (Treichville).

Over the past 10 years, we have seen sixteen children (15 males and 1 female) with the prune-belly syndrome. We have managed 12 of these children, but 4 of them were never reviewed. Abdominal wall reconstruction was performed in 11 children by dissection of spermatic vessels and fixing the testis in the scrotum. Because of our conservative approach to the management of urinary tract dilatation, we performed only one nephrostomy and 3 unilateral nephro-ureterectomies. Seven children were reviewed. The result of abdominal wall reconstruction was good in terms of cosmetic appearance and psychologic effect for the parents; we have observed no atrophic testes after orchidopexy. One of these children suffers from chronic renal failure, while the other children have good renal function. Prune-belly syndrome is a disease with a broad spectrum. The prognosis depends on the degree of renal dysplasia. These children require long-term follow-up.

[Acquired recto-vaginal fistula in children: is HIV infection a cause?]. / La fistule recto-vaginale acquise (FRVA) chez l'enfant: le VIH est-il en cause?

Seven successive cases of acquired rectovaginal fistula have been diagnosed on children of three and half to eighteen months old. These fistula were localised on the fourchette. The seropositivity for HIV of five cases confirmed the results of similar reports found in literature. Surgical treatment of these girls was not done because of their bad presentation. Two of these children died. The other did not come for follow-up. The acquired rectovaginal fistula seems to be a sign of HIV infection. This work is meant to emphasise the relationship between AIDS and acquired rectovaginal fistula for a closer surveillance of future cases.

[The treatment of bladder exstrophy at the University Hospital Center in Treichville (Abidjan)]. / Le traitement de l'exstrophie vésicale au CHU de Treichville (Abidjan).

The care and follow-up of children with bladder exstrophy is still a major problem in West Africa. From 1986 to 1994, we saw 17 cases of bladder exstrophy predominantly in females. We performed 13 successful bladder closures and two ureterosigmoidostomies. The high mortality was due to lack of adequate intensive care structures.

[Experiences in the treatment of hypospadias at the University Hospital Center in Treichville (Abidjan)]. / Expérience du traitement de l'hypospadias au CHU de Treichville (Abidjan).

From 1984 to 1994, 105 children with hypospadias were seen. Only 52 of them were treated. Hypospadias was distal (glandular subglandular or subcoronal hypospadias) in 38.4% of cases and involved the penile distal shaft or penile midshaft in 38.4% and posterior hypospadias in 23% of cases. Meatotomy with circumcision was performed in 70% of cases of distal hypospadias. The best results were obtained with distal penile shaft hypospadias by Mathieu's method. The fistula rate was high (17.3%). 2-or-3-stage treatment of posterior hypospadias is now performed in one stage using Duckett's or Duplay's method. The results of these methods are discussed.

[Inflammatory pseudo-tumor of the liver in a child: case report]. / Pseudo-tumeur inflammatoire du foie chez l'enfant: à propos d'un cas.

Inflammatory pseudotumor of the liver is uncommon in children. Only 14 cases have been reported in the literature. The underlying etiology is unclear but traumatic and infectious factors may be implicated. This report describes an inflammatory pseudotumor that was observed in a 9-year-old child from the Ivory Coast one year after traumatic injury of the right hypochondrium. Clinical findings were limited to non-febrile but painful hepatomegaly with weight loss. Laboratory tests were consistent with an inflammatory process. Ultrasonography revealed a poorly delimited, heterogeneous area approximately 5 cm in diameter at the level of the VI segment which had been resected. Histology documented the presence of fibro-inflammatory tissue with granulomatous inclusions. At the center of the lesion was a foreign body corresponding to a Schistosoma mansoni egg. In this case the mechanism underlying inflammatory pseudotumor could have involved either bilharziasis or trauma. A review of the literature allows the authors to enumerate the main features of this uncommon benign tumor of the liver in children.

Les séquelles de la circoncision et de l'excision traditionnelles

De 1985 a 1993; 22 enfants ages de 3 mois a 11 ans ont ete vus a notre consultation pour des sequelles de la circoncision et de l'excision traditionnelles. Parmi ces 22 enfants; on comptait 6 filles dont 4 avaient une stenose partielle du vagin et de l'uretre; une avait une stenose complete du vagin; et la derniere avait une cicatrice hypertrophique du clitoris : chez les 16 garcons; il y avait 3 cas de phimosis cicatriciels; 4 cas de fistules uretrales; 4 cas d'hypospadias iatrogenes; 3 cas d'amputations du gland; un cas d'amputation partielle du scrotum et un cas de granulome du sillon balanopreputial. Cinq filles et 11 garcons ont ete traites avec des resultats fonctionnels satisfaisants

[Pygomelus. An African surgical case report]. / La pygomélie. A propos d'un cas african opéré.

Pygomelus is a malformation characterized by the presence of one or more extra-extremities in the pelvic region. This article describes a case of pygomelus involving a child in Cote d'Ivoire. It is the tenth operated case to be reported in the literature. The malformation consisted of a well developed third lower extremity attached to the right iliac crest, without a rudimentary pelvis, and of a poorly developed upper extremity attached to the subpubic region. The two extra-extremities were removed surgically without complications. Pygomelus is an uncommon malformation whose nosologic limits are unclear since it is comparable to lower extremity duplication and dipygus. According to the authors pygomelus is a more appropriate term than caudal duplication which is widely used in English-speaking physicians.

Vesicostomy in childhood: indications and results.

The authors report their experience with 27 patients who underwent cutaneous vesicostomy (CV) diversion for either lower tract disorders or obstruction. The indications for CV included 18 cases of neurogenic bladder, 3 pseudo-prune belly syndrome, 3 bladder exstrophy, 2 vesicoureteral reflux, and 1 posterior urethral valves. A Lapides-type technique with minor changes was performed in all cases. Improvement of renal function occurred after CV in all but 3 patients (11.1%). No early surgical complications were observed. Late complications occurred in 8 patients (29.6%): 4 (14.8%) had a stomal stenosis and 4 (14.8%) urinary tract infections. The overall revision rate was 7.4%. We believe this technique is simple to perform, tubeless, easy to manage, and readly reversible. Our experience tends to confirm CV to be an easy, effective, and reversible means to treat children and infants with selected pathology of the lower urinary tract. Results and complications are discussed.