[Intestinal intussusception in adults: contribution of ultrasonography]. / Invagination intestinale de l'adulte: apport de l'échographie.

After observing a benign tumour of the small bowel which led to ileo-ileal invagination in an adult we recalled the main data on the epidemiology, aetiology and diagnosis. In infants, the diagnosis is usually made but in adults, the situation is much rarer and the clinical and radiographic signs are not specific. Echotomography of the abdomen is the most reliable examination. In the adult, surgery is always indicated because invagination is caused by an organic cause in 9 out of 10 cases.

[Continent esoduodenal intubation after total gastrectomy for cancer. An African experience apropos of an initial series of 17 cases]. / L'intubation oeso-duodénale continente après gastrectomie totale pour cancer. Expérience africaine à propos d'une série préliminaire de 17 cas.

On the basis of a series of 17 cases in which GI continuity was restored by a containing esoduodenal intubation, the authors describe the technique, which consists in the approximation of the duodenum opposite the diaphragm. Esophageal intubation in the duodenum, the margins of which have been everted, allows preserving the physiological circuit, producing a new container within 3 months and ensuring an effective protection against reflux. The 17 patients had undergone total gastrectomy for advanced cancer, Gutman's stage II in 80% of all cases and stage III or more in the other 20%. 88% of the tumors were adenocarcinomas. There were no clinical or radiological signs of reflux, and no esophagitis was noted on repeated endoscopies. The postoperative mortality rate was 5.8%. The shortest time lapse is 1 year.

[Reconstruction of the intestinal tract by intracolonic ileal sleeve. An experimental study and 1st clinical cases]. / Rétablissement du circuit intestinal par trompe iléale intracolique. Etude expérimentale et premiers cas cliniques.

An experimental study on 15 piglets allowed defining the technical procedure and controlling the anatomical and functional results of various modes of restoration of the ileocolic tract after resection with a terminolateral tubing including and intracolic ileal sleeve. Coloileal fixation was ensured only by a few seromuscular sutures and adhesion with "Tissucol". The clinical application of this procedure was very satisfactory for 9 recent right colectomies, thus confirming the results previously observed for 33 ileal perforations in Africa. The ileocolic tubing technique is easy, reliable, morbidity-free, and causes no leakage of intestinal fluid, no intestinal ischemia and no stenosis. As it prevents coloileal reflux, this assembly may prevent ileitis after right colectomy. Its valvular effect also contributes in the mechanical regulation of transit. The assembly produces a system that can be compared to the ileocecal valve.

[Highly malignant tumors of the uterine corpus at the Hospital Principal in Dakar. Apropos of 8 cases in 1986-1987]. / Tumeurs corporéo-utérines de haute malignité à l'Hôpital Principal de Dakar. A propos de 8 cas en 1986-1987.

8 observations of corporeo-uterine tumors, observed during 2 years (1986-1987) at the Hospital Principal of Dakar (Senegal), are expounded. Their connected chemical, surgical and evolutive expression allowed us to gather 4 "Carcinoma" (epithelial malignant tumours), 2 sarcomas (conjunctival malignant tumours) and 2 uterine corpus extensive choriocarcinoma (trophoblastic tumours). Late detected, unfortunately developed, these tumours are characterized by their high seriousness and the appalling prognosis they mean (the victim doesn't generally survive more than 10 months).

[Epidemiology of cancer of the digestive tract in Senegal. Review of 18,000 endoscopies performed at the Principal Hospital of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. Apport de 18.000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 alimentary tract cancers were discovered in 219 black males and 95 black females at the occasion of 18.000 endoscopies (high or low) performed during the 5 past years at the Principal Hospital (Dakar-Senegal). Mean age of the patients was 50, gastric cancer (170 cases) was the most frequent localization, then rectocolonic one (71 cases) and oesophageal one (61 cases). The more frequent utilization of endoscopy and may be a modification of diet in urban milieu might explain such a high frequency of discovery of alimentary tract cancers in Dakar.

[Restoration of continuity after rectosigmoidectomy by colorectal intubation and transproctoanal anastomosis. An African experience with 10 cases]. / Rétablissement de continuité après rectosigmoïdectomie par intubation colorectale et anastomose transproctoanale. Expérience africaine de dix cas.

On the basis of 10 cases (8 cases of rectosigmoid cancer and 2 of sigmoid volvulus), the authors report about their experience in the restoration of GI tract continuity using colorectal intubation into the rectal lumen and a transproctoanal anastomosis. This technique helps avoiding subperitoneal sutures, which are a cause of fistulae and shrinkage. It is simple enough to be performed by younger surgeons. This technique was initially developed for anterior resections for rectosigmoid cancer, and it can be utilized as an emergency procedure with single-piece resection without untwisting the sphacelous sigmoid loops, so that neither a temporary left iliostomy nor a second operation are needed.

[Right ileocolonic intubation after resection of the terminal ileum for generalized peritonitis caused by ileal perforation. An African experience with 33 cases]. / Intubation iléo-colique droite après résection de l'iléon terminal pour péritonite généralisée par perforation iléale. Expérience africaine de 33 cas.

Generalized peritonitis due to ileal perforation is common in Africa, and is caused by typhoid fever in most cases. For various reasons, the patients arrive at hospital in a poor general condition. In spite of combined intensive care and surgery, the general evolution of the disease resulted in a high mortality rate. All surgical techniques requiring sutures on a poor-quality ileon, ie. excision and suture, limited segmental resection or extensive ileal resection, most often lead to the breakdown of suture lines, so that the patient enters the vicious circle of repeated peritonitis and hazardous re-operations. Even exteriorized suture lines turn into fistulae, and temporary terminal ileostomy requires an amount of maintenance that is sometimes difficult to ensure in Africa. The technique proposed by the authors was developed in the department of surgery of the Dakar Main Hospital and has several advantages: It is a simple and quick procedure, which does not require the surgeon to be very experienced and can be performed in underequipped hospitals. There is no procedure-associated mortality. Morbidity decreases as the surgeon's experience increases. GI continuity can be established even in a septic environment. No second-look operation is necessary, so that the stay at hospital becomes shorter and the costs of treatment lower. Lastly, this type of restoration can be applied to other indications such as right colectomy and ileocolic or transverse ileal intubation.

[Epidemiology of digestive tube cancers in Senegal. Apropos of 18,000 endoscopies carried out at the Hospital Principal of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. A propos de 18,000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 bowel cancers were discovered in 219 men and 95 women of negroid race in the course of 18,000 upper and lower endoscopies taken over the past 5 years at Dakar's Main Hospital. The average age of the sick persons is 50 years. Gastric cancer (170 cases) is the most frequent, followed by recto-colic cancer (71 cases) and oesophagian cancer (61 cases). The use of endoscopy and perhaps dietetic changes in the urban area, explain the large number of bowel cancers discovered in Dakar.

[Vaginal hysterectomy: its place in surgical practice overseas as related to the experience of the Principal Hospital of Dakar]. / L'hystérectomie vaginale: sa place en pratique chirurgicale outre-mer à propos de l'expérience de l'Hôpital Principal de Dakar.

The authors report on their surgical practice of vaginal hysterectomy at the Principal Hospital of Dakar. First, they assign a place to the frequency of this technic. Then, they recall the major technical details, underlining advantages and limits. They conclude in favour of better knowledge and performing this technic more often, while recognizing some limits related to the pathologic context overseas.

[Gelatinous disease of the peritoneum of appendiceal origin. Apropos of 2 Senegalese cases]. / Maladie gélatineuse du péritoine d'origine appendiculaire. A propos de deux observations sénégalaises.

The authors report two cases of Peritoneum Gelatinous Sickness of appendicular origin, occurring in male adults aged 65 and 57. Laparoscopy practised on an extended abdomen showing non-homogeneous dullness confirmed the diagnosis in both cases. The laparotomy highlighted the gelatinous substance and led to appendicectomy aimed at the mucocele. They take this opportunity to discuss the unusualness of this affliction in Africa, and recall the clinical and etiological means and the diagnostical difficulties that this disease evokes.

[Surgical pelviperitonitis and the African gynecologic complex]. / Pelvipéritonites chirurgicales et complexe gynécologique africain.

From the analysis of 28 records in the gynecological Department of the Hospital Principal in Dakar, all of them recording cases of pelviperitonitis having demanded a surgical intervention, it seems permissible to the authors to maintain the denomination, full of imagery, of "Gynecologic African Complex". They define it as appearing in a peculiar socio-economical environment (in Africa but also in the Third World) and characterised anatomically by an inflammatory pelviperitoneal syndrome presenting a large anatomic diversity. In the studied records, the authors sorted out 14 cases with an acute clinical aspect and 14 with a chronic one. These 28 cases represented 1.5% of the admissions and 5% of the operated patients in the gynecologic Department. The aspect "complex", linked with the polymorphism of the diagnosed lesions (among them 2 tubal tuberculosis, 1 peritoneal tuberculosis, 2 genital bilharziosis) and their frequent association, constitutes a surgical entity about which therapeutic tactics has to be adapted and reasonably mutilating. The concern of preservation must take into consideration future evolution of surgical consequences, genital and obstetrical future of women often young.

[A misestimated aspect of tropical traumatology: abdomen penetrating injuries caused by buffalo horn. Review of 64 Cambodian cases (author's transl)]. / Un aspect méconnu de la traumatologie tropicale: les plaies pénétrantes de l'abdomen par corne de buffle. A propos de 64 observations cambodgiennes.

These injuries are frequent in Cambodia; they are work casualties and patients are most often young males (65 p. 100 under 20 years). In half of the cases there is no visceral damage and when it happens it is, in 76,7 p. 100 of the cases, limited to a single viscus. Rules of treatment are not much different from those of war surgery and must taken in account the socio-economic and cultural environment.

[African vesico-vaginal fistulas (author's transl)]. / Les fistules vésico-vaginales africaines.

Obstetrical vesico-vaginal fistulas in Africa are very frequent and are correlated with the insufficiency or even the lack of health structures and sanitary conditions. They follow up a dystocic parturition, and their prevention requires a correct surveillance of pregnancy and parturition. Their pathogenesis consists in a durable compression of the pelvic cavity by the foetal head, inducing ischemia and later on necrosis. Their difficult treatment is based on clinical inspection which makes possible to distinguish several pathological types of fistulas. Surgical tactic will be selected according to the size of the fistula, the conservation or the destruction of the uretra with the vesico-uretral sphincters, the importance of perifistula sclerosis. BRACQUEHAYE'S operation is the basis of the conservatory treatment, associated or not with a technic restoring the urinary continence: either the INGELMAN-SUNDBERG operation of the LE GUYADER rectomyoplasty. When uretra is destroyed, the best palliative intervention is probably the building up of a rectal neobladder. These operations can be performed under conditions often prevailling in Africa. In most cases, they have restored normal social life for the women affected. But setbacks are not rare, and demonstrate the importance of prophylaxis.

[Surgical indications in urogenital schistosomiasis in West Africa (author's transl)]. / Les indications chirurgicales dans la bilharziose urogénitale en Afrique de l'ouest.

Surgical indications in urogenital schistosomiasis are discussed after 12 years of experience in Senegal hospitals. Stenosis or achalasia of lower ureter might cause ureterohydronephrosis which appears to be the main sequella. The local hospitals conditions and the difficulties met with in the long-range surveillance of the patients both require a prudent approach. The replacement plastics with intestine is the logic and ideal solution, but other and simpler techniques are available and may be selected according to the localization and to the value of renal functions.