[Gynaecomastia and adipomastia on black skin: Clinical and surgical particularity]. / Gynécomastie et adipomastie sur peau noire : particularités clinique et chirurgicale.

AIM: Analyze the management of gynecomastia and adipomastia; and identify the peculiarities in black people in a general surgery department of the CHU Sylvanus Olympio in Lomé (Togo). PATIENT AND METHOD: Descriptive retrospective study included 43 cases of gynecomastia and 5 cases of adipomastia (January 2014 to December 2020). The data taken into account were: epidemiological, clinical, paraclinical and the treatment (surgery and medical). The administration of hydrocortisone (solumedrol 120mg/day) for 3days immediately after surgery and the application of shea butter on the scar were performed. RESULT: Patients consult for aesthetic discomfort, especially with bilateral lesions and fear of breast cancer for unilateral lesions. Morpho-types 3 and 4 are therefore the most frequent in 75% of cases. Age was over 30years in 87% of patients. We noted retro-areolar fibrosis. The etiology was dominated by idiopathic causes. The surgery was performed in 85% of the cases. The morbidities were 5 cases of hypertrophic scars without keloid. CONCLUSION: Surgical difficulties on black skin are not only technical, but also scarring: hypertrophy and keloids. A delay in surgical management after 30years, and the prevention of unsightly scars would be a track for improving the aesthetic result.

[Ambulatory treatment of penile fracture at teaching hospital in Lomé]. / Traitement ambulatoire des fractures de la verge au centre hospitalier universitaire de Lomé.

OBJECTIVES: To study the feasibility of outpatient management of fractures of the penis and to identify factors that promote their occurrence. MATERIALS AND METHOD: This were a prospective, monocentric study of patients who received emergency treatment for fractured penises. It took place from January 2016 to January 2019. The data analyzed were circumstances of occurrence, time elapsed before management, clinic, type of anesthesia, functional outcomes (assessment based on IIEF5 questionnaire) and complications. RESULTS: Seven cases were recorded. The average age of the patients was 35 years. The diagnosis was clinical and surgical treatment in all our patients. Management was outpatient in 6 patients. Sexual function was normal in six patients with an IIEF-5≥21 with a normal erection and no pain at intromission. No complications were objectified. CONCLUSION: Emergency surgical management of patients with clinical and confirmed per-operative penis fractures may be outpatient without negative impact on functional outcomes and regardless of the cause of fracture. LEVEL OF EVIDENCE: 3.

Torsion du cordon spermatique chez l'adulte. Aspects diagnostiques, thérapeutiques et pronostiques au Centre Hospitalier et Universitaire Sylvanus Olympio de Lomé

Objectifs : Etudier les aspects diagnostiques, thérapeutiques et pronostiques des torsions du cordon spermatique. Patients et méthodes : Il s'agissait d'une étude prospective, et était inclus dans l'étude tous les patients de plus de 15 ans admis en urgence pour une douleur scrotale aiguë et chez qui le diagnostic d'une torsion du cordon spermatique était suspecté durant la période d'étude.Résultats : Sur une période de 12 mois allant du 1er janvier 2015 au 31 décembre 2015, 22 patients étaient colligés. L'âge moyen des patients était de 22 ans avec des extrêmes allant de 17 à 35 ans. Le diagnostic était clinique dans tous les cas et dans 100% des cas les constatations per opératoires étaient en faveur d'une torsion du cordon spermatique. Le tour maximum de spire était de 4 tours. L'orchidectomie avait été réalisée chez 4 patients. Dans tous les autres cas une orchidopexie bilatérale était réalisée.Conclusion : La vitalité du testicule dans les torsions du cordon spermatique est surtout fonction de la durée de la torsion et du degré de la torsion

Myomectomies for massive hemoperitoneum from spontaneous bleeding of a uterine myoma.

Massive hemoperitoneum from spontaneous bleeding of uterine myoma is an extremely rare condition, that needs urgent surgical exploration. We report a 40-year-old woman, admitted for acute onset of abdominal pain. Physical examination revealed hypovolemic shock. The hemoglobin level was of 5 g/dL. Ultrasonography revealed hemoperitoneum. Emergency surgical exploration was planned. There was hemoperitoneum of 3 L, uterine myomas with multiple subserous myomas, bleeding from superficial ruptured varice overlying the most largest subserous myoma, which measured 15 cm. Glove adapted as a tourniquet, was applied at the base of the uterus, and myomectomies were performed with removal of around twenty myomas. The postoperative course was uneventful. Myomectomies can be safely and effectively performed by using a tourniquet, for massive hemoperitoneum with precarious hemodynamic status due to subserous myoma bleeding, despite the number and the size of myomas.

[Gallstone ileus: a rare cause of acute bowel obstruction]. / Iléus biliaire : une cause rare d'occlusion intestinale aiguë.

Gallstone ileus is a rare cause of bowel obstruction observed in older persons. The diagnosis is based on computed tomography. Enterolithotomy with or without cholecystectomy and the repair of the fistula is the treatment of choice. The aim of our study is to report two cases of gallstone ileus and to describe the epidemiology, diagnosis and therapy of gallstone ileus.

L'iléus biliaire est une cause rare d'occlusion intestinale, qu'on rencontre chez le sujet âgé. Le diagnostic est apporté par le scanner qui constitue l'examen de référence. Le traitement est chirurgical consistant en une entérolithotomie, associée ou non à une cholécystectomie et à une cure de la fistule. Le but de notre travail est de rapporter deux cas d'iléus biliaire et de décrire les particularités épidémiologiques, diagnostiques et thérapeutiques des iléus biliaires.

Management of peptic pyloroduodenal stenosis in Sylvanus Olympio teaching hospital in Lome (Togo).

This study's aim was to describe the management of ulcerous pyloroduodenal stenosis in Sylvanus Olympio teaching hospital of Lomé (Togo). It was a retrospective study of medical files of all patients managed for peptic pyloroduodenal stenosis at the visceral surgery department of Sylvanus Olympio teaching hospital in Lomé (Togo) from january 1(st), 2002 to december 31(th), 2011. Twenty-five patients were selected. Mean age was 38 ± 7.4 years. Sex-ratio was 5. Twenty four patients underwent upper digestive tract endoscopy, completed by upper gastrointestinal series in 18 cases. One patient had only an upper gastrointestinal series. Pyloroduodenal stenosis was improved by antisecretory therapy in 3 cases. Twenty two patients underwent laparotomy. Truncal vagotomy was performed in 15 cases associated with pyloroplasty in 8 cases, and gastrojejunostomy in 7 cases. An antrectomy was performed in 5 cases. Selective vagotomy was associated with pyloroplasty in 1 case, and a gastrojejunostomy in 1 case. One patient died in postoperative period. Functional results were classified Visick I (17 cases) and II (4 cases). Peptic pyloroduodenal stenosis affects young adults. Its tight nature requires association of upper gastrointestinal series and esophagogastroduodenoscopy for diagnosis. Its surgical treatment is exclusively performed by laparotomy at present. Mortality is low and functionnal prognosis is good.

[Diagnostic, therapeutic, and prognostic aspects of typhoid intestinal perforations in Dapaong, Togo]. / Aspects diagnostiques, thérapeutiques et pronostiques des perforations typhiques du grêle à Dapaong, Togo.

PURPOSE: This study's aim is to describe the diagnostic, therapeutic, and prognostic aspects of typhoid intestinal perforations (TIP) at the Dapaong regional hospital (Togo). MATERIAL AND METHODS: This retrospective study covered all patients with such perforations seen and managed in the Dapaong regional hospital's general surgery department during the 3-year period of 2009-2011. RESULTS: There were 110 patients with TIP during the study period, and they accounted for 67.9% of the patients treated for generalized peritonitis (162 cases). Their mean age was 10.2 years. The sex-ratio was 1.4. A single perforation was present for 69 patients (62.7%) and multiple perforations for the other 41 (37.3%). Sixty (54.5%) patients underwent simple closure, 36 (32.8%) had an ileal resection and enteroanastomosis, and 14 (12.7%) had loop or double-barrelled ileostomy. The postoperative course was complicated in 26 cases (23.6%), most often by surgical site infection, seen in 19 patients (17.3%). Overall, 23 patients died during the postoperative period, for a mortality rate of 20.9%. CONCLUSION: Typhoid intestinal perforations are the most common cause of generalized peritonitis at the Dapaong regional hospital. Most patients have only a single perforation, which is repaired by excision-suture. Their morbidity and mortality rate are high.

Hernie interne péri-caecale à propos d'un cas et revue de littérature

Les hernies internes de découvertes rares représentent deux pour cents des occlusions intestinales. Elles peuvent se révéler selon un mode aigu ou plus progressif avec des épisodes sub-occlusifs répétés.Le diagnostic doit être évoqué chez un sujet sans antécédents chirurgicaux présentant un syndrome occlusif. Nous rapportons un cas, de hernie interne péri-caecale par un récessus iléo-caecal inférieur chez un sujet de 55 ans responsable d'une strangulation iléale avec ischémie réversible

Torsion du cordon spermatique chez l'adulte: aspects diagnostiques, thérapeutiques et pronostiques au Centre Hospitalier et Universitaire Sylvanus Olympio de Lomé

La torsion du cordon spermatique est la rotation de la glande testiculaire autour de l'axe du cordon. Ils'agit d'une urgence chirurgicale dont le délai de prise en charge détermine le pronostic fonctionnel du testicule. Le but était d'étudier les aspects diagnostiques, thérapeutiques et pronostiques des torsions du cordon spermatique. Il s'agissait d'une étude prospective. Etaient inclus dans l'étude tous les patients de plus de 15 ans admis pour douleur scrotale aigue et chez qui le diagnostic d'une torsion du cordon spermatique était suspecté. Sur une période de 12 mois, 22 patients étaient colligés. L'âge moyen des patients était de 22 ans avec des extrêmes allant de 17 à 35 ans. Le diagnostic était clinique dans tous les cas et dans 100 % des cas les constatations per opératoire étaient en faveur d'une torsion du cordon spermatique. Le tour maximum de spire était de 3 tours. L'orchidectomie avait été réalisée chez 4 patients. Dans tous les autres cas une orchidopexie bilatérale était réalisée. La vitalité du testicule dans les torsions du cordon spermatique est surtout fonction de la durée de la torsion et du degré de la torsion

Acute cholecystitis from typhic origin in children

Background: To evaluate the particularities of typhoid cholecystitis in children. Materials and Methods: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings; confirmed by operative findings at cholecystectomy. Results: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females). Their ages ranged from five to 13 years (median 8.8 years). The mean duration of symptoms was six to 21 days. The clinical signs were fever; abdominal pain; which predominated at the right upper abdominal quadrant; and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal's test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3); perforation (2) and empyema (1). All the patients made an uneventful recovery; and have remained symptom free one and three months on follow-up. Conclusion: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice