Epidemiology of Pediatric Surgical Conditions Observed in a First-Level Hospital in Burundi.

Background: Little is known about the surgical conditions affecting the pediatric population in low-income countries. In this article we describe the epidemiology of pediatric surgical diseases observed in Mutoyi hospital, a first-level hospital in Burundi. Methods and Findings: We retrospectively reviewed the records of all children (0-14 years) admitted to the Surgery ward from January 2017 to December 2017. We also reviewed the records of all the patients admitted to the Neonatology ward in 2017 and among them we selected the ones in which a surgical diagnosis was present. Five hundred twenty-eight children were admitted to the surgical ward during the study period. The most common conditions requiring hospitalization were abscesses (29.09%), fractures (13.59%), osteomyelitis (9.76%), burns (5.40%) and head injuries (4.36%). The average length of stay was 16 days. Fifty-six newborns were admitted to the Neonatology ward for a surgical condition; 29% of them had an abscess. Conclusions: Conditions requiring surgical care are frequent in Burundian children and have a completely different spectrum from the western ones. This is due on one side to an under-diagnosis of certain conditions caused by the lack of diagnostic tools and on the other to the living conditions of the population. This difference should lead to intervention plans tailored on the actual necessities of the country and not on the western ones.

Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review.

INTRODUCTION AND IMPORTANCE: Advanced abdominal pregnancy (> 20 weeks gestation) is a rare condition life-threatening for mother and fetus. CASE PRESENTATION: A 31-years-old African woman presented from a rural district to Mutoyi Hospital for first gynecological evaluation after 37 weeks of amenorrhea, abdominal pain and vaginal bleeding. An ultrasound revealed an extra-uterine fetus. Laparotomy was done and a live fetus weighing 1980 g was delivered. Removal of the placenta, triggered massive bleeding (5000 mL) with shock. After re-laparotomy for post-operative ileus and hemoperitoneum, the mother and infant were discharged in good health. CLINICAL DISCUSSION: Viable fetus can be delivered after an advanced abdominal pregnancy. Removal of the placenta is controversial. We review currently medical literature on advanced abdominal pregnancy and propose a management of the placenta in these patients. CONCLUSION: We recommended to leave the placenta in situ, to avoid intraoperative bleeding. Placenta involution during follow-up can be revealed by ultrasound, colordoppler and ß-hCG serum level decrease.