Psoas primary abscess: A case report in an immunocompetent subject.

INTRODUCTION: Primary psoas abscess is a rare disease characterised by a purulent collection in the thickness of the psoas muscle. Its incidence and etiopathogenesis are not well defined. It is mainly encountered in developing countries in weakened conditions. The involvement of an immunocompetent subject is exceptional. We report a case of primary psoas abscess in an immunocompetent patient in Togo. CASE PRESENTATION: A 67-year-old retired teacher with no previous medical history was seen in the emergency room with acute and severe abdominal pain. The clinical examination revealed an infectious syndrome and a painful abdominal mass in the right iliac fossa. CT scan showed a heterogeneous fluid collection in the right psoas muscle. Surgical drainage was indicated and performed. The patient was treated postoperatively with dual antibiotics with a favourable outcome. No germs were isolated from the collection. CLINICAL DISCUSSION: Rare infectious disease, its real incidence is unknown. The most common germ is staphylococcus aureus. Its etiopathogenesis is also poorly understood. Immune deficiency is a predisposing factor for the condition. Diagnosis of the disease is difficult due to a lack of specificity of the signs encountered. Imaging is the key to positive diagnosis with a high sensitivity of CT scan. Treatment is medical-surgical with drainage and antibiotic therapy. CONCLUSION: Primary psoas abscess is a potentially serious disease requiring early diagnosis and management.

The place of presumptive diagnosis in the management of peritoneal tuberculosis: A case report from rural Togo.

INTRODUCTION AND IMPORTANCE: Tuberculosis is a major public health problem in developing countries. Its main abdominal form is peritoneal. The diagnosis of this peritoneal form is complex and difficult. We describe the role of presumptive diagnosis in the management of this condition in Togo, based on a case study. CASE PRESENTATION: A security guard with no previous pathological history was seen in consultation with febrile ascites. Investigations revealed the exudative and lymphocytic nature of the ascites. The other investigations did not reveal any other organic lesion, particularly hepatic, or the germ. This typical ascites picture had for us a strong diagnostic value in favour of a tubercular origin. The patient was treated with antituberculosis drugs for 6 months. The evolution was satisfactory. CLINICAL DISCUSSION: The diagnosis of peritoneal tuberculosis is difficult. Biological explorations are rather disappointing in this approach. Laparoscopy coupled with histological examination represents the best means of diagnosing peritoneal tuberculosis to date. However, in developing countries, the absence of these resources poses a real problem. Clinical and biological arguments are always at the forefront of the diagnosis in endemic countries. The latter is based on the demonstration of febrile, exudative and lymphocytic ascites. CONCLUSION: The difficult diagnosis of peritoneal tuberculosis coupled with the lack of technical facilities gives the presumptive diagnosis an important place in the management of this condition in endemic countries.

[Non-traumatic splenic rupture revealed by acute renal failure]. / Rupture non traumatique de la rate révélée par une insuffisance rénale aiguë.

We report a case of rupture of spontaneous subcapsular splenic hematoma caused by toxic product and revealed by acute renal failure with intravascular hemolysis.

Emergency treatment of a ruptured huge omphalocele by simple suture of its membrane.

BACKGROUND: The rupture of a huge omphalocele is an emergency that threatens the newborn baby's life. It constitutes a therapeutical concern in the absence of prosthesis especially in developing countries. METHODS: We are reporting herein the case of a newborn baby that we managed in emergency successfully thanks to a simple treatment. RESULTS: It was a huge omphalocele, ruptured during delivery, in a male newborn baby. We conducted a simple and conservative surgical treatment without prosthesis, which consisted of reconstruction of the omphalocele's membrane by closing it with absorbable suture materials. The suture of the omphalocele's membrane was followed by treatment with the Grob's method. This treatment saved the newborn baby's life. The total skinning was obtained after 3 months. CONCLUSIONS: In case of rupture of huge omphalocele in absence of prosthesis, it is better to suture the membrane, and continue the treatment according to the Grob's method; the residual disembowelment can be repaired later.

Locations of osteomyelitis in children with sickle-cell disease at Tokoin teaching hospital (Togo).

BACKGROUND: The sickle-cell children are particularly affected by osteomyelitis in specific locations. This study was done in order to point out the locations of osteomyelitis in children with sickle-cell disease. This direct clinical examination for a quick diagnosis. MATERIALS AND METHODS: This is a retrospective study done by examining files of 43 children (15 girls and 28 boys), aged from 0 to 15 years, treated for osteomyelitis between January 1998 and December 2006. Their phenotypes included 18 SS, 14 SC and 11 AS. Osteomyelitis was acute in 20 cases and chronic in 23 cases. The different localisations are classified according to the type of osteomyelitis and the kind of bones concerned. RESULTS: The 43 children presented 63 locations: 57 on long bones and 6 on short bones. The osteomyelitis was unifocal in 32 cases, and multifocal in 11 cases. The locations on long bones were humeral (18 cases), tibial (12 cases), femoral (9 cases), fibular (7 cases), radial (7 cases) and ulnar (4 cases). The 6 short bones included 3 metacarpus and 3 phalanxes. The 11 multifocal locations concerned 8 SS, 2 AS and 1 SC. In chronic osteomyelitis, 7 patients had sequestrum and 2 had pathological fracture. CONCLUSION: During examination of sickle-cell children with fever, particular attention must be shown, respectively to the arm, the leg and the thigh, in order to track down quickly, an acute osteomyelitis. Early diagnosis and quick treatment permit to avoid complications and heavy sequela in these children.

[Aseptic osteonecrosis of the femoral head in children with sickle-cell disease]. / Les ostéonécroses aseptiques de la tête fémorale chez l'enfant drépanocytaire.

PURPOSE: To identify the epidemiological, clinical and therapeutic aspects of hip-joint disorders in children with sickle cell disease, to point out the diagnostic problems, and to stress the necessity of early diagnosis for optimal outcome. MATERIAL AND METHODS: This retrospective study, conducted from January 1987 through December 2006, included children with at least one haemoglobin S gene and hospitalised for osteonecrosis of the femoral head. Ficat staging was used. RESULTS: The study included 14 children (12 boys and 2 girls) with a mean age of 14 years, all hospitalised and treated for osteonecrosis of the femoral head during the study period 8 SS and 6 SC. Osteonecrosis of the femoral head was diagnosed at Ficat stage 3 in 8 cases and at stage 4 in 6. Ten children (8 at stage 3 and 2 at stage 4) had orthopaedic treatment (continuous traction for 30 days and then a Thomas's splint for a mean 14 months). Outcome was good for 6 of the stage-3 cases (mean follow-up period 9 years) and poor for the other patients with purely orthopaedic treatment (mean follow-up period 11 years). Four children at stage 4 underwent surgery (varus osteotomy, immobilization in a cast for 8 weeks, and then Thomas's splint for a mean 12 months) with good results (mean follow-up period 10 years). CONCLUSION: Early diagnosis, assisted by computed tomography, magnetic resonance imaging or scintigraphy, makes it possible to provide better treatment and preserve hip function.