[Necrotizing cervico-facial cellulitis of dental origin in a developing country]. / Les cellulites cervico-faciales nécrosantes d'origine dentaire dans un pays en voie de développement.

INTRODUCTION: Necrotizing cellulitis of dental origin is a serious disease and requires prompt and effective management to avoid adverse outcomes. The purpose of this work is to describe the diagnostic and therapeutic difficulties encountered in this condition. METHODS: This was a prospective study in the thoracic surgery department of Mali Hospital from January 2011 to February 2015. We collected consecutively 19 cases of complicating cervico-facial cellulitis of dental origin. The anatomical and clinical aspects, therapeutic modalities and difficulties are described. RESULTS: Dental pain and fever were the predominant symptoms followed by cervical edema. Chest CT-scan was the basis for the diagnosis in all cases. Cervicotomy with debridement was the most performed surgical procedure. Pleural drainage was performed in 6 cases. Three patients (15.8%) died. CONCLUSION: Necrotizing cellulitis of dental origin is a serious disease with high morbidity and mortality. The key radiological examination is the thoracic CT-scan. Early medico-surgical management by emergency care, tailored antibiotic therapy, removal of necrotizing tissues and drainage of collections are required to deliver a good outcome.

[Heller myotomy by transthoracic procedure, a single center experience in Mali with 21 cases]. / Myotomie de heller par voie transthoracique : une experience monocentrique au mali de 21 cas.

AIMS: To evaluate the midterm results of myotomy for achalasia by thoracotomy procedure with the introduction of anti-reflux system by diaphragmatic flap. PATIENTS AND METHODS: This was a prospective study involved 21 patients (14 women and 7 men) operated for idiopathic megaesophagus during a period of 3 years. All the patients were operated by thoracotomy procedure. An anti-reflux system was performed using a diaphragmatic flap over the entire length of the myotomy. RESULTS: The mean age was 32 years (range 16 and 68 years). After the surgery we have seen a complete disappearance of dysphagia in 21 patients (100 %) (p <0.001) and a significant weight regain. Short term outcomes were marked by the occurrence of clinical gastroesophageal reflux disease in 1 patient (4.76%) who has received the anti-reflux system (p> 0.05). CONCLUSION: Oeso-cardio-myotomy of Heller by transthoracic procedure associated with the establishment of an anti reflux system by diaphragmatic flap has goods results.

BUT: Evaluer les résultats à mi-parcours de l'œsocardiomyotomie de Heller par voie transthoracique avec la mise en place du système anti-reflux par un lambeau diaphragmatique pour le mégaoesophage idiopathique. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective ayant concerné 21 patients (14 femmes et 7 hommes) opérés pour un mégaoesophage idiopathique durant une période de 3 ans. La voie d'abord a été la voie transthoracique gauche pour tous nos patients. Un système anti-reflux avait été réalisé en utilisant un lambeau diaphragmatique sur toute la longueur de la myotomie de l'œsophage thoracique. RÉSULTATS: L'âge moyen était de 32 ans (extrêmes : 16 et 68 ans). Les suites immédiates étaient simples. Après l'intervention nous avons assisté à une disparition complète de la dysphagie chez 21 patients (100 %) (p < 0,001) et une reprise pondérale conséquente. Les suites à court terme étaient marquées par la survenue d'un reflux gastro-œsophagien clinique chez 1 patient (4.76 %) qui avait bénéficié d'un système anti-reflux (p > 0,05). CONCLUSION: L'œsocardiomyotomie de Heller par voie transthoracique associée à la mise en place systématique d'un système anti-reflux par lambeau diaphragmatique donne de bons résultats.

Myotomie de Heller par voie transthoracique : une experience monocentrique au Mali de 21 cas

But : Evaluer les resultats a mi-parcours de l'osocardiomyotomie de Heller par voie transthoracique avec la mise en place du systeme anti-reflux par un lambeau diaphragmatique pour le megaoesophage idiopathique. Patients et methodes : Il s'agissait d'une etude prospective ayant concerne 21 patients (14 femmes et 7 hommes) operes pour un megaoesophage idiopathique durant une periode de 3 ans. La voie d'abord a ete la voie transthoracique gauche pour tous nos patients. Un systeme anti-reflux avait ete realise en utilisant un lambeau diaphragmatique sur toute la longueur de la myotomie de l'oesophage thoracique. Resultats : L'age moyen etait de 32 ans (extremes : 16 et 68 ans). Les suites immediates etaient simples. Apres l'intervention nous avons assiste a une disparition complete de la dysphagie chez 21 patients (100 %) (p 0;001) et une reprise ponderale consequente. Les suites a court terme etaient marquees par la survenue d'un reflux gastro-osophagien clinique chez 1 patient (4.76 %) qui avait beneficie d'un systeme anti-reflux (p 0;05). Conclusion : L'osocardiomyotomie de Heller par voie transthoracique associee a la mise en place systematique d'un systeme anti-reflux par lambeau diaphragmatique donne de bons resultats

[Ileal typhoid perforations: clinical and therapeutic aspects in tropical area]. / Perforations typhiques ileales: aspects cliniques et thérapeutiques en milieu tropical.

AIMS: The aim of this study was to describe the clinical and therapeutic aspects of peritonitis by typhoid ileal perforation in a tropical typhoid fever endemic area. PATIENTS AND METHODS: A descriptive retrospective study over an 8 year period (January 2000 to December 2007) was undertaken in a visceral service of the Point G teaching hospital in Bamako, Mali. Only patients diagnosed and operated for peritonitis presenting lesions or perforations of the final ileum were included in the study. RESULTS: The data from 120 patients meeting the inclusion criteria was collected. The average age was 22.7 years old. Triad abdominal pains (120 cases; 100%), vomiting (41; 62.3%), lack of matter and gas (22; 32.3%) constituted the main part of the functional signs. The physical examination showed a localised abdominal defence (7 cases, 10.3%), generalized defence (98 cases; 81.6%), and 2 unspecified cases (2.9%). A "wood belly" abdomen was palpated among 105 patients (87.5%), as well as umbilical hernias (106 cases; 88.3%). The Felix and Widal agglutination test was positive for 75 patients (62.5%) and negative for 27 patients (22.5%). During the operation, the quantity of aspirated pus was higher than 1500 ml in 2 cases and lower or equal to 500 ml in 57.4% of cases. The site of the perforation was ante mesenteric in 64 cases (53.3%). Excision-suture and abdominal cleansing were the most common surgical procedures (68 cases; 57%). Postoperatively 19 patients (15.83%) died of septic shock. The average duration of hospitalization was 20.6 days. CONCLUSION: The peritonitis by typhoid ileum perforation is still the cause of a high mortality rate in our country. The prevention by the vaccination in young populations could decrease the incidence of pathology and the serious complications which result from this.

BUT DE L'ÉTUDE: Le but de cette étude était de décrire les aspects cliniques et thérapeutiques de la péritonite par perforation iléale d'origine typhique en milieu d'endémie typhique tropicale. PATIENTS ET MÉTHODES: Une étude rétrospective descriptive sur une période de 8 ans (janvier 2000 à décembre 2007) a été menée dans un service de chirurgie viscérale du CHU du POINT G, Bamako, Mali. Les malades diagnostiqués et opérés pour péritonites présentant des lésions de perforations de l'iléon terminal ont été inclus dans l'étude. Les perforations iléales d'autres étiologies n'ont pas été retenues. RÉSULTATS: Un total de 120 malades répondant aux critères d'inclusion ont été recensés. La moyenne d'âge était de 22,7 ans. La triade douleurs abdominales (120 cas; 100%), vomissements (41; 62,3%), arrêt de matières et de gaz (22; 32,3%) a constitué l'essentiel des signes fonctionnels. A l'examen physique existait une défense abdominale localisée (7 cas, 10,3%), généralisée (98 cas; 81,6%), indéterminée 2 fois (2,9%). La contracture abdominale en « ventre de bois ¼ était palpée chez 105 malades (87,5%), ainsi qu'un cri de l'ombilic (106; 88,3%). Le test d'agglutination ou sérodiagnostic de Felix et Widal était positif pour 75 malades (62,5%) et négatif pour 27 malades (22,5%). En per opératoire la quantité de pus aspiré était supérieure à 1500 ml pour 2 cas et inférieure ou égale à 500 ml pour 57,4% de cas. Le siège de l'orifice de perforation était anté-mésentérique dans 64 cas, soit 53,3%. L'excision-suture et toilette abdominale a été la procédure chirurgicale la plus courante (68 cas soit 57%). En post opératoire 19 malades (15,83%) sont décédés de choc septique. La durée moyenne d'hospitalisation a été de 20,6 jours. CONCLUSION: La péritonite par perforation typhique iléale, est toujours et encore responsable d'une mortalité forte dans nos pays. La prévention par la vaccinationn de la population jeune pourrait diminuer l'incidence de la pathologie et les complications graves qui en découlent.

[Digestive tract perforations at Point G Teaching Hospital in Bamako, Mali]. / Perforations Digestives Au CHU Du Point G.

AIMS: To determine the most frequent causes of the digestive perforations and to evaluate the surgical procedures, the morbidity and mortality. PATIENTS AND METHODS: It was about a retrospective descriptive study, over 5 year's period in a visceral service of CHU du Point G, Bamako. Were included in the study all the patients operated for digestive perforation and hospitalized in the service of surgery "A". Were not included in the study patient operated not presenting a digestive perforation. Per operational etiologies of the perforations and their frequency were determined, as well as the morbidity and morbidity and mortality. RESULTS: Files of 202 patients were collected. The average age of the patients was 28.3 ± 15.5 years with extremes of 6 and 71 years. The frequency of digestive perforations was higher in the age from 11 to 20 years (29.7%). The average time of consultation was of 7± 6 days. Abdominal pains, nauseas and vomiting, matter and gas stop (48.5%) were the most current functional signs. A "wood belly" abdomen was found in 72,3% of the cases. The radiography of abdomen without preparation found a diffuse greyness (64.7%), a pneumoperitoine (30.7%). A double antibiotic therapy was made in all the cases. A median laparotomy was practiced in 98,5%, and laparoscopy in 3 cases (1.5%). A single perforation was found among 172 patients (85,1%). Morbidity, all confused causes, was made of 30 cases of parietal suppurations (14.8%). Total mortality was 74%. According to aetiologies it was 10.3% in the typhic perforations, 4.6% in the appendicular perforations and 4.9% in the perforations of gastroduodenal ulcers. CONCLUSION: The most frequent aetiologies of digestive perforation in our context were the typhoid fever, acute appendicitis and the gastroduodenal ulcer. The résection - joining and peritoneal toilet were the most practised procedure. The main factor of bad outcome remains the diagnostic delay burdening morbidity and mortality.

[Prise en charge chirurgicale des goitres hyperthyroïdiens a Bamako]. / Prise en charge chirurgicale des goitres hyperthyroïdiens a Bamako.

GOAL: To assess the surgical therapy in goiter with hyperthyroidism in a surgical unit of CHU du Point-G. PATIENTS AND METHODS: A retrospective study was conducted, concerning 131 patients having undergone a thyroidectomy for goiter with hyperthyroidism from January 1st 1998 to December 31st 2007. RESULTS: The files of 131 patients were analysed. The average age of patients was 39.74 years, with 114 women and 17 men. The goiter in Basedow disease was the first indication for surgery in hyperthyroidism (48 cases; 36.6%) followed by toxic adenoma (39; 29.8% of the cases) and toxic multinodular goiter (38; 29% of cases). Ninety patients had a subtotal thyroidectomy (68.7% of cases). One total thyroidectomy (0.8%), 39 isthmolobectomies (29.7%) and one isthmectomy (0.8%) were carried out. Anatomohistology showed 67.1% of colloid benign tumours, and 8 cases of cancers (6.2% of the cases). Early postoperative follow ups were due to hemorrhage (2 cases; 1.5%) and 3 cases of dysphonia (2.5%). One patient died (0.8%). After six months, 3 cases of wound cheloide (2.5%), one case of dysphonia, and one case of hypothyroidism were noted. For 86 patients (71.1%) the postoperative follow up was simple. CONCLUSION: Surgery remains a treatment of choice for hyperthyroidism goiter. Other options are too expensive or not available.

BUT: évaluer la prise en charge chirurgicale des goitres hyperthyroïdiens dans le service de chirurgie « A ¼ du CHU du Point-G. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective descriptive portant sur tous les patients ayant subi une thyroïdectomie pour goitre hyperthyroïdien sur la période allant du 01 Janvier 1998 au 31 Décembre 2007. RÉSULTATS: Au total 131 malades ont été recensés, soit 114 femmes et 17 hommes. La moyenne d'âge des patients était de 39,74 ans avec un écart type de 11,72. Les indications chirurgicales les plus courantes étaient les goitres de la maladie de Basedow (48; 36,6% des cas) les adénomes toxiques (39; 29,8% des cas) et les goitres multinodulaires toxiques (38; 29% des cas). La technique opératoire a été la thyroïdectomie subtotale (90; 68,7%), l'isthmolobectomies (39; 29,7%), la thyroïdectomie totale (1; 0,8%), et l'isthmectomie (1; 0,8%). L'examen histo-anatomo-pathologique des pièces opératoires a permis de mettre en évidence un taux élevé de tumeurs épithéliales bénignes (67,1%), ainsi que 8 cas de cancers (6,2%). Les suites opératoires de J0 à J3 ont été marquées par deux cas d'hémorragie (1,5%) et 1 décès (0,8%). A six mois postopératoire 3 cas de cicatrices chéloïdes (2,5%), 3 cas de dysphonie persistante (2,5%) et un cas d'hypothyroïdie biologique (0,8%) ont été enregistrés. Pour 86 malades (71,1%) les suites ont été simples. CONCLUSION: La chirurgie reste une des options privilégiées pour le traitement des goitres hyperthyroïdiens dans notre contexte. Les autres options sont onéreuses ou non disponibles.

[Cephalic duodenopancreatectomy at the Hopital du Point G, Bamako]. / La duodenopancreatectomie cephalique (DPC) a l'Hopital du Point G, Bamako.

PURPOSE OF THE STUDY: to bring back the clinical and therapeutic aspects of 6 cases of DPC in the service of surgery A of the hospital of the POINT G. PATIENTS AND METHODS: descriptive retrospective study of 5 years and 6 months in the service. All the patients presenting a duodéno-pancreatic malignant tumour treated by DPC with histological diagnostic confirmation were included in the study. The palliative techniques of biliary and digestive derivations were not retained. RESULTS: 6 files of patients were collected. The average age of the patients was 63 years. The average time of consultation was 8 months. The abdominal pains, the jaundice and the cutaneous prurit were the reasons for consultation of first order. The functional signs were the cutaneous prurit and vomiting, the faded saddles (2 cases, 33.3%), and the dark urines (a case, 16,7% of the cases). The seat of pain was epigastric among 3 patients (50%), diffuse with epigastric starting point in a case, pain of the right hypochondre in one case. An epigastric mass was palpated by 4 patients (66,6%). A hepatomegaly and a large blister were palpated once (16,7% of the cases). High blood amylase rates are noted by 4 patients (66,7%). The rates of bilirubine free and total in blood were very high. The echographic image was that of a mass of the head of the pancreas and a dilation of the bile ducts will intra and extrahepatic as well as channel of Wirsung (4 cases, 66.7%). The computer tomodensitometry did not objectify local vascular invasion, hepatic metastases, or of ascite. The tomodensitometric images of the lesions were a cystic tumour of the head of the pancreas (one case), a pancreatic tumour + cholestase (one case), a tumour of the head of the pancreas with compression of duodenum (4 cases). Classes ASA II (4, 66.7%) and III (2, 33.3%) were only represented. The procedures of resection were practised according to the technique of WHIPPLE or its alternatives. The ganglionic clearing out related to the 5 classical chains. The early continuations were simple for 4 patients (66,6%). A case of parietal suppuration, a pancreatic leak (operated again at J3) and a death were recorded. The average duration of the hospital stay was 16 days. Two patients died between 0 and 3 months into postoperative, and 2 others died between the 3rd month (33,33%) and the 10th month (33,3%). The results of the histological examination were 4 cases of adenocarcinomists of the pancreas (66,6%), a adenocarcinomist inflammatory and necrotic, a fairly differentiated adenocarcinomist. CONCLUSION: the tumours of the head of the pancreas very often diagnosed at a late stage are of weak frequency in our context of exercise. The DPC is burdened with a made morbidity of pancréato-jejunal dents. The rate of survival at 5 years remains around 5%.

[Recklinghausen disease and surgery: clinical case]. / Maladie de Recklinghausen et chirurgie: cas clinique.

PURPOSE OF THE STUDY: To bring it back a clinical case of neurofibromatosis of the type 1 (NF1) in service of general surgery complicated of bulky invalidating royal tumours. The 35 year old patient presented on all the body multiples small tumefactions but also of bulky heavy cervico-thoracic royal tumours, invalidating, deteriorating the body and psychic image. A surgical ablation and a cutaneous closing in a time were necessary. The results of this esthetic palliative surgery were very satisfactory. The surgery can be of a great contribution during the evolution of the NF1 especially when the lesions become invalidating.

[Cancer of the head of the pancreas: clinical, diagnostic and therapeutic aspects at Bamako]. / Cancer du pancreas cepihalique: aspects cliniques, diagnostiques et thérapeutiques à Bamako.

OBJECT: to determine the relative frequency of the cancer of the head of the pancreas in our structures of 3(ieme) reference to Bamako as well as the diagnostic and therapeutic aspects. PATIENTS AND METHODS: It is about a descriptive retrospective study in the services of general surgery of the Hospital of the Point G and the Hospital Gabriel Touré from January 2000 to June 2004. Were included in the study all the patients presenting a malignant tumour of the head of the pancreas having been confirmed by a histological examination. RESULTS: 26 patients were listed, that is to say 0.3% of the hospitalizations for the period of the study. The reason for hospitalization was an abdominal mass in 57.14% of the cases. The average age of the patients was 58 years. The sex ratio was 4:2 in favour of the men. Clinical signs of cholestase with type of jaundice frankly accompanied by prurit were present at the clinical examination in 95.24% of the cases. The other signs were the pain, a palpable mass, a ascite representing respectively 71.43%, 66.67%, 23.81% of the cases, Abdomino-pelvic echography allowed the diagnosis in 90% of the cases and the scanner in 100% of the cases. The rate of bilirubine total and free as well as the rates of transaminases (ASAT, ALAT) was high in respectively 95.24% and 85.71% of the cases, The curative therapy consisted of a duodeno-pancreatectomy in 9 cases (39.16% of the cases). A double palliative bilio-digestive derivation was carried out in treatment in 53.84 of the cases, The histological type was the adenocarcinomist in 95.24% of the cases. The rate of survival to 1 year was 10.5% in the event of curative treatment and 5.3% in the event of palliative treatment. CONCLUSION: The diagnosis of cancers of the head of the pancreas is posed at late stages in our structures. The DPC is feasible but the rate of resecability is weak. The palliative treatment can help to improve the quality of life of the patients.

[Assessment of endoscopic surgery at the Hospital of Point G in Bamako]. / Bilan de 45 mois d'activites de coeliochirurgie a Bamako.

PURPOSE OF THE STUDY: To carry out the first 45 months assessment of activities of coeliochirurgie at the hospital of the Point G Bamako. PATIENTS AND METHODS: It was about a retrospective study of 45 months carried out in the service of surgery "A" of the CHU of the Point G All the patients having undergone an intervention by technique coeliochirurgicale with or without conversion into conventional surgery were retained. RESULTS: for 45 months, 426 patients profited from the technique, i.e., 18.99% of the patients operated in the service for this period. The most frequent indications were the gynaecological surgery (61.27%), with pathologies tubaires, followed digestive surgery (33.33%) with the lithiasic cholécystite and acute appendicitis. The parietal surgery and the "staging" of cancerous pathologies represented respectively (3.05%) and (2.35%). Conversion into conventional surgery related to 7.5% of patients. We listed few accidents and incidental per operational. The duration of the hospital stay shorter was compared with that of the conventional surgery. The operational continuations were simple in 97.9% of the cases. CONCLUSION: the coeliochirurgie is realizable and reliable under the conditions of exercise of the surgery in Mali. The indications are to be measured in order to avoid the complications inherent in the technique and to progress positively. The benefit of the technique is ensured for the patient and the hospital.

Maladie de Recklinghausen et chirurgie : cas clinique

But de l'etude : rapporter un cas clinique de neurofibromatose de type 1 (NF1) en service de chirurgie generale complique de volumineuses tumeurs royales invalidantes. La patiente de 35 ans presentait sur tout le corps de multiples petites tumefactions mais aussi de volumineuses tumeurs royales cervico-thoraciques lourdes; invalidantes; alterant l'image corporelle et psychique. Une ablation chirurgicale et une fermeture cutanee en un temps ont ete necessaires. Les resultats de cette chirurgie palliative esthetique ont ete tres satisfaisants. La chirurgie peut etre d'un grand apport au cours de l'evolution de la NF1 surtout lorsque les lesions deviennent invalidantes