[Acute intestinal occlusion revealing abdominal pregnancy: a case study]. / Occlusion intestinale aiguë révélant une grossesse abdominale: à propos d'un cas.

Abdominal pregnancy (AP) is defined as the implantation and the development of the fertilized egg in the peritoneal cavity. It is a rare type of ectopic pregnancy, whose detection can be fortuitous, mimicking surgical emergency. We report a rare case of acute febrile bowel obstruction revealing abdominal pregnancy in a 27-year old patient, with no particular past medical history, admitted to hospital for the treatment of occlusive syndrome evolving over the last week. Physical examination showed shiny, distended, meteoric, completely sensitive abdomen. Laboratory tests showed white blood cell count 20300, haemoglobin 7,2g/dL. Surgical exploration showed hemoperitoneum 2000ml, retrouterine encapsulated mass, strongly adherent to the mesosigmoid and to the sigmoid, responsible of a stenosis of the descending colon. The patient underwent monobloc exeresis, which showed a portion of placenta next to the mesosigmoid attached to the fetus, right annexectomy and colostomy.

Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.

INTRODUCTION: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. PATIENTS AND METHODS: We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. RESULTS: Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. CONCLUSION: The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.

INTRODUCTION: Les traumatismes du diaphragme comprennent les ruptures et les plaies du diaphragme. Leur incidence varie entre 0,8 % et 15 %. Elles sont très souvent méconnues malgré les techniques performantes d'imagerie médicale. Leur prise en charge chirurgicale reste controversée. La mortalité de cette pathologie est liée aux lésions associées. Le but de notre étude était d'apprécier l'incidence des lésions diaphragmatique dans les traumatismes thoraco-abdominaux, et de discuter les aspects épidémiologiques, diagnostiques et thérapeutiques. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective sur 21 ans allant du 1er janvier 1994 au 30 juin 2015. Cette étude a été réalisée au Service de Chirurgie Générale de l'Hôpital Aristide Le Dantec de Dakar. Etaient inclus dans cette étude tous les patients qui présentaient une lésion diaphragmatique consécutive à un traumatisme abdominal et/ou thoracique ouvert ou fermé. RÉSULTATS: Durant cette période d'étude, nous avons reçu 1535 patients victimes de traumatisme thoracique et/ou abdominal. Il s'agissait de 859 cas de contusions et 676 cas de plaies thoraciques et/ou abdominaux. Notre étude portait sur 20 cas de lésions diaphragmatiques (1,3 %). Le sex-ratio était de 4. L'âge moyen était de 33 ans. Les agressions par arme blanche représentaient 60 % (12 cas). L'incidence des lésions diaphragmatiques était de 2,6 %. La plaie cutanée était de siège thoracique dans 60 % (7 cas). La radiographie du thorax était contributive dans 45 % (9 cas). Le diagnostic de lésion diaphragmatique était préopératoire dans 45 % (9 cas). La brèche diaphragmatique siégeait à gauche dans 90 % (18 cas) et la taille moyenne était de 4,3 cm. Le geste chirurgical avait consisté en une réduction des viscères herniés et une suture du diaphragme par des points en « X ¼ dans 85 % (17 cas). Le drainage thoracique était systématique. Le taux de morbidité était de 10 % et la mortalité de 5 %. CONCLUSION: Leur diagnostic est difficile. Elles siègent le plus souvent à gauche. Leur traitement est chirurgical et la voie d'abord préférentielle est la laparotomie.

Appendicular peritonitis in situs inversus totalis: a case report.

INTRODUCTION: Situs inversus is a congenital anomaly characterized by the transposition of the abdominal viscera. When associated with dextrocardia, it is known as situs inversus totalis. This condition is rare and can be a diagnostic problem when associated with appendicular peritonitis. CASE PRESENTATION: We report the case of a 20-year-old African man who presented to the emergency department with a 4-day history of diffuse abdominal pain, which began in his left iliac region and hypogastrium. After examination, we initiated a surgical exploration for peritonitis. We discovered a situs inversus at the left side of his liver, and his appendix was perforated in its middle third. A complementary post-operative thoracic and abdominal tomodensitometry revealed a situs inversus totalis. CONCLUSION: Appendicular peritonitis in situs inversus is a rare association that can present a diagnostic problem. Morphologic exploration methods such as ultrasonography, tomodensitometry, magnetic resonance imaging, and laparoscopy may contribute to the early management of the disease and give guidance in choosing the most appropriate treatment for patients.

Giant splenic pseudocyst, a rare aetiology of abdominal tumor: a case report.

INTRODUCTION: Splenic pseudocysts are nonparasitic cyst without epithelial lining. We report this case especially by its way of revelation, its large size and its per operative presentation which needed total splenectomy. To this opportunity, we discuss the diagnostic procedure and therapeutic indications. CASE PRESENTATION: A twenty-year old Senegalese woman, was admitted with a three-month history of spontaneous abdominal mass associated with a pain. Ultrasonography and CT scan found the giant splenic pseudocyst with a diameter of 20 cm which needed a total splenectomy by median laparotomy. CONCLUSION: Usually, symptomless splenic cysts are untreated. When surgical treatment is indicated, recommendations are to preserve splenic parenchyma by partial splenectomy or fenestration especially by laparoscopy. Total splenectomy retains some guidance.

[The surgical treatment results of ulcerous pyloro-duodenal stenosis: about 160 cases]. / Resultats du traitement chirurgical de la stenose ulcereuse pyloroduodenale: a propos de 160 cas.

OBJECTIVE: To evaluate the outcomes of the surgical treatment of ulcerous pyloro duodenal stenosis at Dakar. PATIENTS AND METHODS: We carried out a retrospective study including 160 medical records of patients presenting an ulcerous pyloroduodenal stenosis from January 2000 to December 2006. After a mean follow up of 16 months, surgical outcomes were evaluated including mortality and morbidity. The functional results were evaluated using Visick Classification. RESULTS: The mean age of our patients was 42 years and 6 months (range: 17-20 years). Our population included 126 men (78,7%) and 34 women (21,3%). Oeso-gastro-duodenal fibroscopy was performed in 136 patients (85%) whereas barium meal was carried out in 82 patients (51,25%). Surgical approach was laparoscopy in 132 cases (82%) and laparotomy in 28 cases (18%). All patients underwent a troncular vagotomy. In addition a gastroentero anastomosis was performed in 89,2% of cases, a pyloroplasty in 10% of cases and an antrectomy in 0,6% of cases. Mortality rate was 0%. The morbidity rate was 10% including parietal suppuration, diarrhoea and hiccups. Functional outcomes were as follows: Visick I in 91% of cases, Visick II in 6,3% of cases and Visick III in 2,7%. CONCLUSION: Ulcerous pyloro duodenal stenosis is a frequent complication of ulcer disease. Its treatment is surgical based on a vagotomy with gastric discharge. The outcomes are satisfactory in our context.

Internal supravesical hernia as a rare cauase of intestinal obstruction: a case report.

INTRODUCTION: Supravesical hernias develop at the supravesical fossa between the remnants of the urachus and the left or right umbilical artery. They are often the cause of intestinal obstruction. We describe the anatomical variant of the supravesical hernia in this case and discuss the pre-operative findings revealed by computed tomography. We discuss diagnostic and therapeutic procedures, and review other anatomical variants. CASE PRESENTATION: A 60-year-old Senegalese man was admitted with a two-day history of small bowel obstruction. A physical examination showed abdominal distension. An abdominal X-ray revealed dilated small bowel loops. A computed tomography scan showed an image at the left iliac fossa that suggested an intussusception. A median laparotomy showed a left lateral internal supravesical hernia. The hernia was reduced and the defect was closed. The patient recovered uneventfully. CONCLUSIONS: Supravesical hernia is a possible cause of intestinal obstruction and diagnosis is very often made intraoperatively. Morphological examinations, such as computed tomography scanning, can lead to a preoperative diagnosis. Laparoscopy may be useful for diagnosis and therapy.