Perforated mesenteric Meckel's diverticulum in an adult: a real variant?

A Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a real diverticulum that is usually located on the anti-mesenteric edge in the last meter of the ileum. Its location on the mesenteric edge has been rarely reported. It may lead to several complications including perforation that may be life-threatening for the patient. We report herein a case of perforated mesenteric Meckel's diverticulum in an adult patient. Upon surgical exploration by laparotomy, we found a perforated Meckel's diverticulum located on the mesenteric edge of the ileum 60 cm from the ileocoecal junction and 400 ml of seropurulent peritoneal fluid. The patient underwent a segmental ileal resection and an end-to-end anastomosis. The postoperative outcomes were marked by a persistent peritonitis that required successful revision surgery.

[Breast hypertrophy: preliminary study in Dakar]. / Les Hypertrophies Mammaires : Etude Preliminaire A Dakar.

The management of breast hypertrophy has become a new and increasing need in Senegal. The files of 47 patients presenting with breast hypertrophy were collated over twelve years. The mean age was 33,9 years. Three surgical techniques were used. The average sternal notch to nipple measurement was 33 cm. Surgery was performed on twenty-two patients, or 42 breast. The surgical technique of Mac Kissock was used in 50% of the cases, the inferior pedicle technique in 13.6% of the cases and the technique of Thorek in 36.4% of the cases. The average weight of tissue removed was 1.3 kg per breast. Our rate of post-operative complications was 9.5% , mostly suppurations. Close to 91% of the patients expressed being satisfied with the aesthetic result obtained. The surgery of breast hypertrophy is increasing in our activity.

[Incarcerated internal hernia through a breach of the broad ligament, a case report]. / Occlusion intestinale par hernie étranglée du ligament large gauche, à propos d'un cas.

We report a case of 44-year-old women presented with an acute small bowel obstruction revealated by tomodensitometry. Laparotomy showed an incarcerated internal hernia through the broad ligament. We performed liberation of the ileal segment and closed the hernial orifice. The patient evolution was excellent.

Resultats du traitement chirurgical de la stenose ulcereuse pyloroduodenale: a propos de 160 cas

Objectif : Evaluer les resultats du traitement chirurgical de la stenose pyloro-duodenale ulcereuse chez l'adulte a Dakar. Patients et methodes : Il s'agit d'une etude retrospective portant sur 160 dossiers de stenose pyloro-duodenale d'origine ulcereuse colliges entre janvier 2000 et decembre 2006 au service de chirurgie generale de l'hopital Aristide Le Dantec. L'abord chirurgical a ete une laparotomie ou une coelioscopie. Tous les patients ont beneficie d'une vagotomie tronculaire associee a un geste de vidange gastrique qui pouvait etre une gastro-entero-anastomose ou une pyloroplastie ou une antrectomie. Apres un recul moyen de 16 mois; les resultats du traitement chirurgical etaient evalues par la mortalite et la morbidite. Les resultats fonctionnels ont ete apprecies selon la classification de Visick. Resultats : L'age moyen de nos patients etait de 42 ans 6 mois avec des extremes de 17 et 77 ans. Il y avait dans la serie 78;7d'hommes (n=126) et 21; 3de femmes (n=34). L'abord chirurgical etait la coelioscopie pour 132 cas (82) et la laparotomie pour 28 patients (18). Une vagotomie tronculaire etait faite chez tous les patients. Le geste de vidange etait une gastroentero- anastomose dans 89;4des cas; une pyloroplastie dans 10des cas et une antrectomie dans 0;6des cas. La mortalite etait nulle. La morbidite a concernee 10des patients. Elle etait a type de suppuration parietale; de diarrhee; de hoquets. Ainsi 91des patients ont ete classes Visick I; 6;3Visick II; et 2;7Visick III. Conclusion : La stenose pyloro-duodenale est une complication frequente de l'ulcere gastroduodenal. La vagotomie tronculaire associee a un geste de vidange semble donner de bons resultats dans notre contexte

[Drainage of liver abscess by "mini-hepatotomy"]. / Drainage des abcès du foie par la technique de "l'hépatotomie a minima".

UNLABELLED: We have developed a a "mini-hepatotomy" technique to prevent rupture of large superficial liver abscesses. AIM: The purpose of this report is to describe our results using this technique. PATIENTS AND METHOD: Data was extracted from the files of 40 patients hospitalized in our department for liver abscess from January 2000 to June 2005. Antimicrobrial therapy including metronidazole was administered to all patients and was the sole treatment in two. Additional treatment included laparotomy for ruptured abscess in 4 cases, pleural drainage for rupture in the right pleural cavity in one, and "mini hepatotomy" in 33. This study includes the 33 patients who underwent mini-laparotomy. There were 30 men and 3 women with a mean age of 38 years. The mean delay for consultation was 51 days. RESULTS: Liver abscess was classified as amoebic abscess in 28 cases and pyogenic abscess in 5. The mean diameter of the abscess was 11.5 cm. The abscess was located in the right lobe in 21 cases and left lobe in 12. The mean quantity of liquid drained from the abscess was 1060 mL. Outcome was favorable in 28 cases (success rate: 84.8%). In the remaining 5 cases abscess persisted after drain removal including two that required a second drain procedure and three that resolved after medical treatment. The failure rate was 6% (2/33). No patient died. CONCLUSION: Large size and superficial location are risk factors for rupture of liver abscess. Drainage is warranted in patients at risk for this complication. The results of this study show that our "mini-hepatotomy" drainage technique has a high success rate and can achieve good results.

[Breast cancer screening in Dakar: knowledge and practice of breast self examination among a female population in Senegal]. / Dépistage du cancer du sein: connaissance et pratique de l'auto-examen des seins au sein d'une population féminine au Sénégal.

In front of the absence of a mammographic screening program and the late diagnosis of the breast cancers in Senegal, we wanted to evaluate the knowledge and the practice of the breast self examination (BSE) by feminine population in Senegal. During the period between July 10th to August 25th 2006, through five big hospitals in Dakar, we interviewed 300 patients coming from a medical or surgical consultation. For every patient we studied the social and demographic characteristics, the antecedents and arguments about the knowledge and practice of BSE. We found, in majority, a young population (the average age was 34 years), no sent to school (26.7%), without any financial income (58.7%), with a brief knowledge about BSE (42.7%) and a regular practice of BSE (29%). The information about BSE originated essentially from educational television (52.9%). This knowledge and practice were significantly influenced by the study level (p = 0.000) and the level of financial income (p = 0.02). Among these who presented certain factors of breast cancer risk, the knowledge and the practice of the BSE were however low. The authors insist on the need to encourage the women schooling and their socioprofessional insertion so to improve the knowledge and practice of the breast self-examination in our developing countries.

[Incarcerated procidentia due to giant cervical fibromyoma: a case report]. / Trachélocèle incarcérée à la suite d'un fibrome géant du col utérin: à propos d'un cas.

The authors report a sparse case of incarcerated procidentia due to cervical fibromyoma in a 43-year-old Senegalese woman. This is about the second case known around the world. Clinic was about a giant cervical mass, irreducible with haemorrhage and procidentia.

[Giant leiomyoma of fallopian tube: a rare aetiology of abdominal tumor]. / Léiomyome géant de la trompe utérine: une cause rare de tumeur abdominale.

Leiomyomas of the fallopian tube are extremely rare. They are often managed with autopsy or surgery. We report a revealed case by a voluminous-abdominal mass in a 35-year-old woman. Neither the tomodensitometry nor, even, the laparoscopy did not permit specifying the tubal origin of the tumor. The diagnosis has been finally carried to the laparotomy. An annexectomy had been achieved. The histological examination concluded to a leiomyoma without malignant-cellular atypia.

[Strangulated groin hernias in adults: a survey of 228 cases]. / Les hernies etranglees de l'aine de l'adulte: une serie de 228 observations.

UNLABELLED: Strangulation is the most complication of groin hernias in adults. OBJECTIVE: To report our experiment in the treatment of strangulated groin hernias and their presentation in adults. MATERIAL AND METHOD: It is a retrospective study carried out from January 1997 to June 2002, involving 228 patients operated for strangulated groin. Epidemiologic, clinical and therapeutic aspects were studied. RESULTS: The average age of the patients was 45 years with extremes of 17 and 85 years. There were 220 men (96%) and 8 women (4%). Inguino-scrotal hernia was seen in 176 cases (77.2%), inguinal hernia in 46 cases (20.1%), and femoral hernia in 6 cases (2.7%). The hernia seat on the right side in 145 cases (63.6%) and on the left side in 83 cases (36.4%). The average duration of symptoms was 24 hours. Elective oblique kelotomy was realised in 140 cases (61.4%), elective transversal kelotomy in 87 cases (38.2%) and median laparotomy in 1 case (0.4%). Bowel resection is required in 16 cases (7%). Bassini procedure was carried out in 158 cases (69%) and modified Mac Vay procedure in 70 cases (31%). The average duration of hospital stay was 3.6 days. One death (0.4 %) caused by cardiopathy was noted. The morbidity rate was 8.3% (19 cases). Those following complications were noted: bowel injury (2 cases), caecal injury (1 case), bladder injury (1 case), wall abscess (5 cases), post-operative pain (5 cases), late transit restart (2 cases) and scrotal haematoma (3 cases). On 108 patients (47.4%) followed regularly with a median follow-up period of 42 months, 8 cases (7.4%) of recurrence were noted. CONCLUSION: In our survey, the mortality rate is very low, the rate of bowel resection is low, and the morbidity rate is negligible. Despite the current tendency to use prosthetic mesh in emergency, traditional procedure in particular Bassini procedure gives good results with an acceptable rate of recurrence in a short and medium follow-up period.

[Peritonitis from liver abscess: retrospective study of 5 cases]. / Peritonite par rupture d'abces du foie: etude retrospective a propos de 5 observations.

AIM: To report the clinical, paraclinical and therapeutic aspects of peritonitis from liver abscess and to study the risk factors of rupture MATERIAL AND METHOD: From January 2000 to March 2007, we retrospectively studied 5 cases of peritonitis secondary to ruptured of liver abscess at the surgery department of the University Teaching Hospital Le Dantec. These cases were selected among 48 cases of liver abscess managed during the same period. RESULTS: There were four men and one woman. The mean age was 40.5 years. In 4 cases the Peritonitis was generalised and it was localised in one case. Percutaneous needle aspiration was already performed in 2 cases in a medical department. The abscesses were located in the right hepatic lobe in 3 cases and in left hepatic lobe in 2 cases. The mean diameter of the collection was 10.6 cm with extreme of 8 cm and 15 cm. The right liver abscesses were larger than the left ones (12.3 cm versus 8 cm). There were 2 cases of amoebic liver abscess and 3 cases of pyogenic liver abscess. All our patients underwent resuscitation prior and after the surgical treatment which consisted of abscess evacuation, peritoneal lavage and drainage. We noticed one case of recurrence successfully treated with antibiotics and percutaneous drainage. No death was recorded. CONCLUSION: The big size of the abscess, the superficial location or on left hepatic lobe are risk factors of rupture. It justifies the necessity of instrumental evacuation of large hepatic abscess. Surgical drainage offer better results than other modalities in management of ruptured liver abscess.

[Postoperative peritonitis at the department of general surgery of Aristide le Dantec Hospital: report of 15 cases]. / Les peritonites post operatoires dans la Clinique Chirurgicale de l'Hôpital Aristide Le Dantec à propos de 15 cas.

INTRODUCTION: Post-operative Peritonitis (PPO) put some diagnostic and therapeutic problems to surgeons. The aim of the study was: first, to analyze the epidemiological, diagnostic, and therapeutic factors of post-operative peritonitis; then, to define a strategy to improve their prognosis. MATERIAL AND METHOD: We did a retrospective study carried out at department of general surgery of the Aristide Le Dantec hospital from January 2001 to March 2007 on cases of PPO. Fifteen cases were included. It was about 12 men and 3 women of middle age of 38.2 years with extremes of 17 and 70 years. RESULTS: Clinical signs were dominated by the abdominal pain (73.3%) and the fever (66.7%). Abdominal collections were multi-microbial. The digestive suture failure was the dominant reason. All patients have been managed in the 48 hours that followed the diagnosis of PPO. The treatment consisted, essentialy in temporary digestive derivation, washing and drainage of the abdominal cavity framed by an adequate resuscitation. The recovery was 67.7%. Morbidity rate is 33.3%. Mortality concerned 5 patient (33.3%) especially carriers of 2 or 3 visceral failings. Criteria of precocious re-laparotomy have been specified. CONCLUSION: The improvement of the prognosis passes indeed by a precocious diagnosis and a coherent multidisci lina a roach.

[What determines the sick leave of repair and rehabilitation of the hand flexor tendons injuries]. / Recherche sur les facteurs influençant la durée de l'arrêt de travail dans les réparations des tendons fléchisseurs de la main.

OBJECTIVES: The purpose of this study is to analyse the relationship between the social and economical consequences, after repair and rehabilitation of the hand flexor tendon injuries, and to prove that it is not related to local factors. METHOD: All the patients who underwent surgery for at least one flexor tendons injury of one or several long fingers, between the years 2003-2004 were included in this study. Information regarding the data was taken from the patient file. Statistical tests were used for analysing these data. RESULTS: Significant first rate factors related to the length of sick leave are the chaotic professional history (P=0.03), the type of occupation (P=0.01) and the age (P=0.0002). A significant second rate factor is represented by the type of mobilization/retraining (P=0.04). Sex, side of injury, finger injured, zone of injury, associated damages, did not significantly influence the results of this study. CONCLUSION: The environmental factors determine the length of sick leave more than the characteristic of injury in hand flexor tendons surgery.

[Glimpse of infectious diseases associated with HIV infected patients at general surgery department]. / Aperçu des pathologies infectieuses associées au terrain du VIH dans un service de chirurgie générale.

UNLABELLED: Because surgery is a bloody treatment its constitutes a situation of risk trannsmissibles disease like viral infections in peculiar the HIV. PURPOSE: To identify infectious pathologies associated with the ground with the HIV-infected patients and to report socio-demographic characteristics of the infected patients. METHOD: This descriptive and analytical study covered one period active of January 1, 1995 to December 31, 2005. We exploited the data base of the laboratory of bacteriology and virology of the CHU Aristide Dantec of Dakar. Thus on 530 requests for serology coming from the department of general surgery, 61 was positive with the HIV. And among these 61, 32 (52,4%) had an infectious disease and were the subject of this present study. RESULTS: There are 19 (59,3%) men and 13 (40,7%) women including 30 Senegalese, 1 Rwandan and 1 Guinean with an average age of 41,1+/-13,1 years. The housewives (7 cases), the tradesmen (5 cases) and the craftsmen/workers (5 cases) constituted the most represented professions. Matrimonial status was distributed as follow: 20 (62,5%) married, 6 (18,9%) unmarried, 2 (6,2%) widowed, 2 (6,2%) divorced, and for 2 (6,2%) patient this status was not specified. The HIV 1 was found at 25 (78,2%) patients, the HIV 2 at 5 (15,6%) patients and the association of the two viruses at 2 (6,2%) patients. Twenty seven (84,4%) patients was received in emergency and 5 (15,6%) had a programmed intervention. Suppuratives diseases of the proctologic area were in the first rang with 10 (31,2%) cases, followed by pleuro-pulmonary suppuratives diseases, 8 (25%) cases, then of the suppuratives wound infections, 6 (18,8%) and finally of the intra abdominal suppuratives infections and of the candidosis of the esofagus, 4 (12,5%) cases each one. CONCLUSION: Socio-demographic characteristics of HIV-infected patients and presenting a suppurative disease "surgical" is identical to those of the other HIV positive patients. These patients were generally received in an emergency context for anorectal, pleuro-pulmonary or parietal suppuratives diseases.

[Diagnostic interest of Barr chromatin test in sex determination: about one case of male pseudohermaphrodism]. / Interet diagnostique du test chromatinien de Barr dans la determination de sexe: a propos d'un cas de pseudo- hermaphrodisme masculin.

INTRODUCTION: The Barr chromatin test is a medical cytogenetic test, very quick to make, consisting in determination of the percentage of Barr corpuscles that correspond to the condensation of the second X chromosome in female epithelial cells of mammal, which range between 20 and 50% the percentage of Barr corpuscles in male epithelial cells range between 2 and less than 5%). In the less developed countries where caryotype isn't realized, this test can give invaluable informations about individual sex. The aim of this study was to show the Barr chromatin test interest in the sexual ambiguity diagnosis orientation in some cases of these sexual ambiguities. PATIENT AND METHODS: To carry this study, we have done a Guard coloration on nude nucleus of epithelial cells taken on the cheeck internal side of our patient, a 19 years old woman that a gynaecologist had sent to us for sexual ambiguity. We have examinated the nude nucleus. RESULTS: None of the nude nucleus had showed a Barr corpuscle (0% of Barr corpuscles, corresponding to male chromatin sex). CONCLUSION: This rate has gived us a Morris syndrome diagnosis orientation; the diagnosis was confirmed later by the surgery and by the removal histological study. When caryotype or molecular biology are not available, the Barr chromatin test can represent a substitute biological test that can contribute to some sexual ambiguity diagnosis.

Tumeur stromale gastrique polaire superieure revelee par une gastrite ulceree a Helicobacter pylori: a propos d'une observation

Les tumeurs stromales constituent le sarcome gastro-intestinal le plus frequent du tube digestif. Nous rapportons dans cette observation un cas de tumeur stromale gastrique particulier pour trois raisons: d'abord son mode de revelation par une gastrite ulceree a Helicobacter pylori; ensuite sa situation gastrique polaire superieure qui necessitait une gastrectomie totale et enfin l'inaccessibilite du traitement adjuvant en milieu defavorise pour la prise en charge de sa recidive metastatique

[Penetrating wound of the abdomen. Profile of the suffering patient at Dakar teaching hospital]. / Plaies penetrantes de l'abdomen. Profil du blesse admis au centre hospitalier universitaire de Dakar.

INTRODUCTION: In Senegal, the rate of penetrating wound of the abdomen seems to be in great progression. The purpose of this study was to make a descriptive analysis of the epidemiological data on the patient suffering from a penetrating wound of the abdomen. MATERIAL AND METHOD: It is about a retrospective study performed on a 5 years period from January 1997 to January 2002. This study covered 90 cases of penetrating wounds of the abdomen listed at the emergency department of Dakar teaching hospital. The rate, age, sex, responsible agent, circumstances of the wound, place of the injury, evacuation mode, time of admission and check-up injury were studied. RESULTS: The average absolute rate of the penetrating wounds of the abdomen was 18 cases per year. The average age was about 27 +/- 10 years with 88 men for 2 women. The responsible agent was a knife (87%), a firearm (6%), a broken glass (4%), a bullock horn (2%) and a piece of iron (1%). Circumstances of the injury was aggression (91%), accident (6%), self-mutilation (2%), suicide attempt (1%). Evacuation was done by firemen (60%), by the ambulances of the medical structures (22%), and by private individuals (18%). The average time of admission was 5 hours. Nearly 61% of the wounds were located in the umbilical, epigastric, left hypochondre and left side areas. Wound was single in 93,4% of cases and linear in 71,8% of cases. We noted an exit of epiploon (38 cases), peritoneal signs (13 cases) and a small bowel evisceration (9 cases). The treatment was a systematic laparotomy (68%) and a simple closure of the wound with a good follow-up for any further aggravation (32%). CONCLUSION: The patient admitted at the surgical emergency unit of Dakar teaching hospital for penetrating wound of the abdomen is generally a young man, victim of aggression by knife, evacuated by firemen within 5 hours, which present a single and linearwound in perish-umbilical area with exit of epiploon and/or small bowel evisceration, which would undertaken a surgical operation in 68% of cases.

[Etiology and therapeutic aspects of generalized acute peritonitis of digestive origin. A survey of 207 cases operated in five years]. / Aspects etiologiques et therapeutiques des peritonites aiguës generalisees d'origine digestive. Une série de 207 cas opérés en cinq ans.

UNLABELLED: Generalized acute peritonitis is defined as a brutal and diffuse peritoneum inflammatory. AIM: To assess the organic aspects of acute peritonitis of digestive origin and to evaluate the results of their surgical treatment. MATERIAL AND METHOD: Between January 1997 and December 2001, 221 patients were operated for generalized acute peritonitis. Among them, 207 patients (93.6%) had a digestive aetiology and were included in this study. They were 188 men (91%) and 19 women (9%). The average age of patients was 31.1 +/- 10.1 years old with extremes of 16 and 74 years. The organic (aetiologies) and therapeutic aspects as well as the remote follow-up were studied. RESULTS: The following aetiologies were found: perforation of gastro-duodenal ulcer, 109 cases (52.7%), complicated appendicitis, 76 cases (36.7%), ileal perforation, 13 cases (6.3%), colic perforation, 5 cases (2.4%), jejunal perforation, 1 case (0.5%), rupture of liver abscess, 1 case (0.5%) and pyo-cholecyst, 2 cases (0.9%). Complications had occurred among 65 patients i.e. 31.4% of the cases and were distributed as follows: local wound abscess, 42 cases (20.3%); evisceration, 10 cases (4.8%); post-operative peritonitis, 6 cases (2.9%); digestive fistula, 4 cases (2%) and resumption of ileostomy, 3 cases (1.4%). Mortality concerned 19 patients and the rate was 9.1%. Aetiology of death was septic shock or multiorgan failure in most of cases. The average time in which the continuity of the digestive tract was restored after stoma was 36.3 +/- 10.7 days. The late complications were: incisional hernia in 7 cases (3.5%), small bowel obstruction in 3 cases (1.5%) and pylorus stenosis in 1 case (0.5%). CONCLUSION: The perforations of gastro-duodenal ulcers, in first, followed complicated appendicitis are the most frequent aetiology. Mortality and morbidity, especially in parietal peritonitis, are not negligible.