[Management of congenital diaphragmatic hernia in sub-Saharan Africa: experience in the Albert Royer National Children's Hospital Center, Senegal]. / Prise en charge de la hernie diaphragmatique congénitale en Afrique sub-Saharienne: l'expérience du Centre Hospitalier National d'Enfants Albert Royer au Sénégal.

Introduction: congenital diaphragmatic hernia has been rarely reported in Africa. It can manifests early or late. Prognosis mainly depends on associated malformations. The purpose of this study is to report our experience in the Albert Royer National Children's Hospital, Dakar, Senegal. Methods: we conducted a retrospective study of patients treated for congenital diaphragmatic hernia between January 2010 and December 2019. Results: twelve patients were enrolled, with an average age of 8.9 months. Bochdalek hernias were detected in 10 patients. The most common symptoms were respiratory symptoms (83.3%), followed by digestive symptoms (41.6%). Thoraco-abdominal X-ray was used to make a diagnosis in all patients. Three patients underwent preoperative stabilization. All patients underwent laparotomy. Hernia sac was found in 10 patients, and 50% of patients had a defect measuring between 5 and 10 cm. The postoperative course was simple in 10 patients; a polymalformed patient died. Conclusion: congenital diaphragmatic hernia is a reality in our environment; it most often manifests beyond the neonatal period. Prognosis is generally good in our context.

Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal.

Objective: Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department. Methods: We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression. Results: Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425). Conclusion: The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.

[Meckel's diverticulitis by ascaris in children: about a case]. / Diverticulite de Meckel d´origine ascaridienne chez l´enfant: à propos d´un cas.

We here report the case of a 4-year-old male child presenting with congenital umbilical bud that, recently, had begun to bleed. Physical examination showed pinkish umbilical bud with blood stains but without any fistula, measuring about 1,5 cm in diameter. Abdominal ultrasound was performed, which suggested urachal sinus. Surgery revealed umbilical bud communicating, in the abdominal portion, with hyperemic, inflammatory Meckel´s diverticulum placed 90 cm away from the ileocaecal angle in which many ascaris were detected. Anatomo-pathological examination of the surgical specimen showed diverticulitis. Thus, the diagnosis of Meckel´s diverticulitis by Ascaris was retained. Resection and anastomosis with bud excision were performed. The postoperative course was simple even after a 6-month follow-up period.

Choledochal cyst in children in dakar: Diagnostic and therapeutic aspects.

CONTEXT: Choledochal cyst is a rare malformation that mainly affects girls. AIMS: The aim of this work is to report the diagnostic, therapeutic and evolutionary aspects of bile duct cyst in children in Dakar. SUBJECTS AND METHODS: we conducted a prospective monocentre descriptive study from 1 July, 2016, to 30 June, 2019, in the Pediatric Surgery Department of Albert Royer Children's Hospital in Dakar. The studied parameters featured clinical, biological, radiological, therapeutic and evolutionary data. Overall, ten patients, including eight girls and two boys, were selected. RESULTS: Two patients presented the classic triple-syndrome complex featuring an abdominal pain, an abdominal mass and jaundice. Most of the patients presented a symptomatology associating abdominal pain and vomiting. Biological cholestasis syndrome was present in six cases and biological cytolysis syndrome in five cases. The abdominal ultrasound-computed tomography (CT) scan confirmed the diagnosis and helped to set the Todani classification with a predominance of Types 1 and 4. Surgical treatment by laparotomy consisted of total excision of the cyst followed by a Y-en-Roux hepatico-jejunal anastomosis in nine cases, whereas we performed a drainage of the cyst in one case. Two patients presented a morbidity of anastomotic suture release and evisceration and had a good outcome after surgical repair. There was no mortality. CONCLUSIONS: The diagnosis of choledochal cyst dilatation (CCD) can be suspected in the postnatal period on the basis of a gastro-intestinal symptomatology with or without associated to jaundice. The combination ultrasound-abdominal CT-scan helps set the diagnosis. The laparatomic approach always has its place for the management of CCD, especially in our context.

[Transanal evisceration of small bowel caused by impalement in children: about a case]. / Eviscération transanale de l´intestin grêle par empalement chez l´enfant: à propos d´un cas.

Transanal evisceration of the small intestine caused by impalement is exceptional among children. We report the case of an 11-year old girl with intestinal loops eviscerating through the anus due to a fall on a sharp piece of wood which stuck into her, occurring two hours before hospitalization. On examination, his general condition was good, with transanal evisceration of approximately 25 cm of viable small bowel through the anus and abdominal tenderness. Preoperative laboratory tests were normal and no imaging test was performed. After resuscitation, surgical exploration was performed which showed serohematic fluid collection (300 ml) and evisceration of approximately 60 cm of inflammated intestinal loops through a rupture of approximately 5 cm of the anterior wall of the rectum. Reduction of the eviscerated intestinal loops by gentle traction, repair of the rectal wall by separated sutures, wash and drainage were performed. The patient received broad-spectrum antibiotic. The operating suites were simple with a resumption of transit two days after surgery. The patient was discharged seven days after surgery. After a follow-up period of one month, the patient came for a further consultation and clinical examination was normal.

[Volvulus of the small intestine caused by mesenteric lipoma]. / Volvulus du grêle sur lipome du mésentère.

We report the case of a 7-year old girl presenting with sub-occlusive syndrome associated with acute paroxysmal abdominal pain at the level of the upper abdomen, vomiting and no evacuation of faeces. Physical examination showed discomfort with palpation of the upper abdomen. Abdominal ultrasound showed poorly limited intraperitoneal tissue formation without vascular features on doppler, exercising a mass effect on the neighborhood structures; mesenteric vessels were in their normal position. This mass on CT scan scorresponded to a well limited lipomatous formation exercising a mass effect on the caecum associated with volvulus of the small intestine. The diagnosis of volvulus of the small intestine caused by mesenteric lipoma was retained. Surgical exploration confirmed this diagnosis. The patient underwent unrolling of the small intestine and lipoma enucleation. The postoperative course was uneventful after a follow-up of 6 months. Anatomo-pathological examination confirmed the lipomateuse nature of the mass.

[Scooter accidents in children at Aristide Le Dantec, Unversity Hospital of Dakar: a study of 74 cases]. / Les accidents de scooter chez l'enfant au CHU Aristide Le Dantec de Dakar: à propos de 74 cas.

INTRODUCTION: Scooter accidents are becoming more frequent in Dakar. The purpose of this study is to report the epidemiological and lesional aspects of these accidents on children in Dakar. MATERIALS AND METHODS: A retrospective and descriptive study was conducted in Pediatric Surgery Unit of the Aristide Le Dantec Hospital in Dakar from January 1st, 2009 to December 31, 2011. Various parameters were studied. These parameters include: frequency, sociodemographic and lesional aspects. RESULTS: Scooter accidents represent 12% of highway accidents. They were more frequent in the day, from 12 am to 2 pm (27%) and in the night, from 6 pm to 8 pm (28.4%). They might occur every day but were more frequent during April (17.6%) and June (13.5%). They occurred mainly in the suburban district of Dakar (78%). The age group most affected was the one from 3 to 8 years (60.8%). Male gender was predominant (sex ratio 1.5). Pedestrians are the most vulnerable (93.2%). The fall was the dominant mechanism (98.7%). Lesions affected mainly the lower limb (51.1%) and were essentially constituted by fracture. CONCLUSION: The frequency of scooter accidents in children is related to the galloping urbanization and to the increase of the number of cars on the roads in the peninsula. Victims are essentially pedestrians and present most of the time fractures.