Traumatismes abdominaux graves aux urgences du «Trauma Center¼ de Libreville: Aspects épidémiologiques, diagnostiques et évolutifs / Severe abdominal trauma in the emergency room of the Trauma Center Libreville: Epidemiological, diagnostic and evolutionary aspects

Les traumatismes abdominaux représentent environ 15-20 % des lésions observées en traumatologie. L'objectif est de décrire les aspects épidémiologiques, diagnostiques et évolutifs des traumatismes abdominaux graves admis aux urgences du Centre Hospitalier Universitaire d'Owendo (CHUO) au Gabon. Méthodes : Il s'agit d'une étude rétrospective transversale et descriptive. Elle s'est déroulée sur une période de vingt quatre mois de 2020 à 2021 aux urgences du CHUO. Seuls les patients présentant une pathologie abdominale traumatique classée grave ont été inclus. Les variables de l'étude étaient : l'âge, le genre, le mécanisme du traumatisme, la prise en charge pré hospitalière, les signes cliniques, le bilan paraclinique réalisé, le traitement chirurgical et l'évolution. Les données ont été analysées par le logiciel Microsoft Excel© Pro version 2019. Résultats : durant cette période, 4,6% (n=105) des patients présentaient un traumatisme abdominal dont 66,7% (n=70) avaient un traumatisme abdominal grave. L'âge moyen des patients était de 29,8 + 13,8 ans. Dans 70% des cas (n=49), les accidents de la voie publique étaient le principal mécanisme étiologique, puis secondairement les agressions avec 11,4% des cas. En per opératoire, les lésions spléniques représentaient 60% (n=42) des cas. La mortalité brute était de 20% (n=14). Les décès étaient survenus chez 64,2% de patients au cours des quarante-huit premières heures. Conclusion : A Libreville, les accidents de la voie publique représentent le principal pourvoyeur des traumatismes abdominaux graves. Ces urgences restent encore responsables d'une forte mortalité au Gabon

Accuracy of the product of symphysio-fundal height and abdominal girth in prediction of birth weight among term pregnant women at Keffi, Nigeria

Background: A reliable prediction of foetal birth weight aids in decision regarding time and mode of delivery. Aim: This study aimed to determine the accuracy of the product of symphysio-fundal height and abdominal girth in predicting birth weight among pregnant women in Keffi, Nigeria. Setting: The study involved pregnant women presenting for delivery at the Federal Medical Centre, Keffi, Nigeria from July to October 2017. Methods: One hundred and fifty-three pregnant women at term with singleton foetuses were recruited by systematic random sampling. An interviewer-administered questionnaire was used to obtain their socio-demographic data, past medical and obstetric history. Symphysio-fundal height and abdominal girth measurements were used to calculate the estimated foetal weight. This was compared with the actual birth weight. Absolute percentage error was used to determine the overall predictive error of Dare's formula. Data were analysed using SPSS version 20.0. Statistical significance was set at p < 0.05 and 95% confidence level. Results: The mean age of the participants was 29.65 ± 5.15 years. The mean gestational age was 39.5 ± 1.2 weeks. There was a significant correlation (r = 0.52, p < 0.001) between the estimated foetal weight and the actual birth weight. Ninety (66.2%) of the babies within normal weight and six (85.7%) of macrosomic babies were correctly predicted. None of the low birth weight babies was correctly predicted by the formula. Conclusion: Dare's formula accurately predicted normal weight and macrosomic babies, but less accurately predicted low birth weight babies

Practice of hot abdominal compression among parturient women at the University College Hospital, Ibadan, Nigeria

Background: The postpartum period is an important period of excitement with the arrival of the newborn. The body then starts physiological adaptations to revert to the pregnancy states. These physiological adaptations can be associated with some cultural practices like hot abdominal compress (HAC) which may have harmful effects such as hot water burns, abdominal wrinkling and darkening. This study assessed the practice of HAC among mothers seen at the postnatal clinic of the University College Hospital (UCH), Ibadan, Nigeria. Methods: This was a cross-sectional study among 290 postpartum women recruited consecutively at the postnatal clinic in UCH between 1st December 2015 and 29th February 2016. Data collection was by pretested self-administered questionnaire and was analysed using SPSS version 22.0. p value was set at < 0.05. Results: The participants' mean age was 31.88 (SD+ 5.1 years), 97.2% of the women had ANC in formal setting and 53.8% had vaginal delivery. Of the 290 participants, 264 (91.0%) were aware of HAC and 51.7% practiced HAC. The return of uterus to normal size (34.7%) and mothers' encouragements (24.7%) were the commonest reason for practice of HAC. Mothers' and mothers-in-law' assisted with HAC in 46.2% and 36.6% of cases, respectively. More vaginally-delivered women practiced HAC (p < 0.001). Conclusion: This study showed that practice of postpartum HAC is high and the reasons for the practice are more of tradition and cultural beliefs. There is need for more studies to better understand this culturally deep-rooted practice

Practice of hot abdominal compression among parturient women at the University College Hospital, Ibadan, Nigeria

Background: The postpartum period is an important period of excitement with the arrival of the newborn. The body then starts physiological adaptations to revert to the pregnancy states. These physiological adaptations can be associated with some cultural practices like hot abdominal compress (HAC) which may have harmful effects such as hot water burns, abdominal wrinkling and darkening. This study assessed the practice of HAC among mothers seen at the postnatal clinic of the University College Hospital (UCH), Ibadan, Nigeria. Methods: This was a cross-sectional study among 290 postpartum women recruited consecutively at the postnatal clinic in UCH between 1st December 2015 and 29th February 2016. Data collection was by pretested self-administered questionnaire and was analyzed using SPSS version 22.0. p value was set at < 0.05. Results: The participants' mean age was 31.88 (SD+ 5.1 years), 97.2% of the women had ANC in formal setting and 53.8% had vaginal delivery. Of the 290 participants, 264 (91.0%) were aware of HAC and 51.7% practiced HAC. The return of uterus to normal size (34.7%) and mothers' encouragements (24.7%) were the commonest reason for practice of HAC. Mothers' and mothers-in-law' assisted with HAC in 46.2% and 36.6% of cases, respectively. More vaginally-delivered women practiced HAC (p < 0.001). Conclusion: This study showed that practice of postpartum HAC is high and the reasons for the practice are more of tradition and cultural beliefs. There is need for more studies to better understand this culturally deep-rooted practice

Abdominal Masses in Children: A 10-Year Review

Background: Some childhood diseases present with abdominal masses alone or with other constitutional symptoms. The knowledge of the common causes of abdominal masses in children can assist in developing a protocol of management by clinicians.Objective: To describe the aetiology and presentation of abdominal masses in children.Methods: The hospital records of all cases of intra-abdominal masses in children managed between May 1998 and April 2008 were retrieved for analysis. Socio-demographic and clinical data were obtained and analysed using simple descriptive statistics.Results: A total of 93 children were included while those without clinical, radiological and intra-operative evidence of intra-abdominal masses were excluded from the study. There were 49 males (52.7%) and 44 (47.3%) females with male-to-female ratio of 1.1:1. The children were aged 1 day to 14 years; 15 (16.1%) were aged <3 years while 23 (24.7%), 27 (29%) and 14 (15.1%) each were aged 3-6 years, >6-9 years, >9-12 years and >12-14 years. The most common cause of abdominal masses was appendiceal mass/abscess in 29%, followed by hydronephrosis in 22.6% and nephroblastoma in 16.11%. The most common symptoms included abdominal pain (86.0%), fever (46.2%), vomiting (40.9%) and abdominal distension (32.2%). The mortality rate was 13%.Conclusion: Non-malignant conditions were mostly responsible for abdominal masses in children while abdominal pain, fever and vomiting were the leading presentations of abdominal masses in children

Acute Abdominal Conditions in People with Sickle Cell Disease: A 10-year Experience in Port Harcourt; Nigeria

Background: Abdominal crises (vaso-occlusive) are not infrequent in patients with sickle cell anemia. They usually present as acute abdomen. These patients none the less present with other causes of acute abdomen like others without hemoglobinopathy. Six cases of surgical acute abdomen in sickle cell disease patients treated in the University of Port Harcourt Teaching Hospital (UPTH) are presented. Materials and Methods: Six sickle cell anaemia patients presenting with acute abdominal conditions from 1999 to 2008 (inclusive) in the University of Port Harcourt Teaching Hospital were studied retrospectively (two patients) and prospectively (four patients). After initial resuscitation; appropriate surgical procedures; namely; appendicectomy (2); cholecystectomy (1); open drainage of splenic abscess (1); and release of adhesive band (1) were performed. Results: Six cases were treated (female/male ratio 2:1). Four patients were in the 11-20 year age group. Two patients had appendicectomy and two presented with acute cholecystitis/cholelithiasis; one of whom had open cholecystectomy. One young girl had drainage of splenic abscess and a 42-year-old male had division of obstructive adhesive band at laparotomy. There were two complications; namely; postoperative haemorrhage (in cholecystectomy patient) and acute chest syndrome (in one appendicectomy patient). These were successfully managed with blood transfusion and antibiotic/oxygen therapy; respectively. There was no mortality. Conclusion: Sickle cell anaemia patients are not exempt from acute abdominal conditions requiring surgery. A high index of suspicion coupled with repeated clinical examination is needed for early diagnosis and appropriate treatment

Acute Abdomen at El Obeid Hospital; Western Sudan

Background: Acute abdominal pain is the presenting complaint in emergency departments of all hospitals worldwide; resulting in a huge drain of human and non-human resources. Objectives: To study the pattern; causes and management outcomes of patients presenting with acute abdomen to El Obeid Hospital; Western Sudan. Patients and Methods: This was a prospective study. All patients who presented with acute abdomen to the University Surgical Unit at El Obeid Hospital between January 1999 and December 2000 were included. The patient characteristics; clinical features; investigations; management and postoperative care were recorded in a pre-designed sheet. Results: There were 421 patients. 242 were males (57.5). Acute appendicitis was the commonest cause accounting for 63of the patients; followed by acute intestinal obstruction 20.4and abdominal trauma 11.6.One third of the patients with acute appendicitis reported with complications. The majority of acute intestinal obstruction cases were due to obstructed and/or strangulated hernia. Acute cholecystitis and perforated duodenal ulcers were not common. Perforated typhoid ulcers and tuberculous peritonitis were less frequent but had high mortality. The overall mortality was 8.5and those deaths occurred mostly in patients presenting late with generalized peritonitis. Conclusions: Acute abdomen was a common surgical emergency at El Obeid Hospital; Western Sudan. The leading causes were acute appendicitis; acute intestinal obstruction and abdominal trauma. Awareness of the seriousness of the condition and better hospital facilities and care may reduce an unacceptable high mortality

The acute AIDS abdomen - a prospective clinical and pathological study

Objectives: Patients with AIDS who present with an acute abdomen pose a new challenge to surgeons. The purpose of this study was to determine the nature and outcome of intra-abdominal catastrophes in AIDS patients. Methods: A prospective clinical study was conducted on HIV-positive patients who presented with an acute abdomen. Results: Thirteen patients were included. Average age was 36 years. Seven patients presented with advanced AIDS. In 10 the ileo-caecal region was affected by a chronic inflammatory process resulting in ulceration and necrosis. Intestinal tuberculosis was found in 7 patients. Despite optimal treatment more than half the study group died in hospital. Conclusion: The 'acute AIDS abdomen' proved to be different in nature and prognosis than has been described previously. Intestinal tuberculosis can reasonably be suspected. Operative mortality is unacceptably high. Other treatment options are being investigated

The acute AIDS abdomen - a prospective clinical and pathological study : short report

Objectives. Patients with AIDS who present with an acute abdomen pose a new challenge to surgeons. The purpose of this study was to determine the nature and outcome of intra-abdominal catastrophes in AIDS patients. Methods. A prospective clinical study was conducted on HIV-positive patients who presented with an acute abdomen. Results. Thirteen patients were included. Average age was 36 years. Seven patients presented with advanced AIDS. In 10 the ileo-caecal region was affected by a chronic inflammatory process resulting in ulceration and necrosis. Intestinal tuberculosis was found in 7 patients. Despite optimal treatment more than half the study group died in hospital. Conclusion. The 'acute AIDS abdomen' proved to be different in nature and prognosis than has been described previously. Intestinal tuberculosis can reasonably be suspected. Operative mortality is unacceptably high. Other treatment options are being investigated

Ultrasound in diagnosis of hepatic pathologies a review of two years experience in university of Nigeria teaching hospital; Enugu; Nigeria

We have tried to evaluate the diagnostic yield of abdominal sonology for detection of liver pathologies by reviewing the ultrasonic findings in our department over a period of two years. Analysis of 879 patients that underwent abdominal sonography between 2001 and 2002 revealed relative incidences of liver; renal; splenic; pancreatic and cholecystic pathologies. 43 cases out of those clinically suspected to have pathology related to liver; were ultrasonically negative. Evaluation of the 289 patients with positive ultrasound findings for liver pathology revealed that 46

Factors affecting outcome of emergency paediatric abdominal surgery

Background: Paediatric surgical abdominal emergencies are important causes of morbidity and mortality in children. None of the previous studies on abdominal surgical emergencies specifically addressed the problem as it affects children. Methods: An eight-year retrospective review of all children aged 0-15 years who presented with acute abdominal emergency. Results: Two-hundred and fifty one (251) children; male to female ratio of 1.5:1 and median age of presentation of 78 months (range 1 day-15 years). The median duration of symptoms before presentation to hospital was 96 hours. The median duration between admission and surgical intervention was 24 hours. Intestinal obstruction accounted for 87 (34.7) of acute abdominal emergency. This was the commonest emergency encountered overall. Typhoid perforation (TP) was responsible for 71 (28.3) of all acute abdominal emergencies and was the commonest condition encountered in children above the age of one year. Others included 55 (21.9) cases of appendicitis; 18 (7.2) of abdominal trauma; 6 (2.4) anterior abdominal wall defects and 5 (2.0) each of infantile hypertrophic pyloric stenosis and primary peritonitis. Postoperative complications were observed in 85 (33.9) of patients. The commonest complications were wound infection 31 (12.4) and wound dehiscence 23 (9.2); while mortality rate was 16 overall; and 31.8 in the neonatal period. Overwhelming sepsis was responsible for 26 (63.4) of all deaths recorded. Multiple congenital anomalies were the cause of death in 5 (12.2). Other causes of death were prolonged ileus with malnutrition in 4 patients; respiratory insufficiency in 2 patients and a patient each died from necrotising enterocolitis; acute renal failure; enterocutaneous fistula and over hydration. Conclusion: intestinal obstruction was the commonest acute abdominal emergency in children. The high rates of postoperative morbidity observed could be attributed to delayed presentation to hospital

Analgésie post-opératoire : essai comparatif du kétoprofène et de la buprénorphine en chirurgie abdominale

Abstract: Une étude prospective randomisée en double aveugle d'un anti-inflammatoire (le kétoprofène) et d'un morphinique (la Buprénorphine) a permis de comparer leur efficacité antalgique. Cette étude a été réalisée sur 128 patients dont 72 ayant re‡u la Buprénorphine et 54 le Kétoprofène. Ces patients ont subi une chirurgie abdominale pour appendicite, hernie de l'aine, péritonite occlusion ou lithiase vésiculaire. Au réveil du patient, la douleur a été évaluée aux moyens de l'échelle verbale simple (EVS) et de l'échelle visuelle analogique (EVA). La première évaluation s'est faite au temps T0 avant l'injection de l'analgésique tiré au hasard : Kétoprofène 110 mg en IV; Buprénorphine 0,3 ml en S/C. Les évaluations post thérapeutiques se sont faites aux temps T15 mn, T 30 mn, T1h, T2h puis toutes les 2h jusqu'à la 12ème heure ; ensuite toutes les 6h jusqu'à la 48ème heure. L'analyse a porté sur l'évolution de la douleur en fonction du temps. Les résultats ont montré une réduction de l'intensité douloureuse initiale de 30 pour cent à la 15ème mn d'injection du produit dans chaque groupe. Le soulagement complet a été observé après la 30 ème heure avec le Kétoprofène et après la 36èmc heure avec la Buprénorphine. Nous avons constaté 70,8 pour cent de cas de somnolence avec la Buprénorphine contre 39,3 pour cent avec le Kétoprofène, soit une différence assez significative. Il a été également observé 26,8 pour cent de cas de brûlures locales avec le kétoprofène. En ce qui concerne l'appréciation globale du personnel soignant, nous avons observé : 70,8 pour cent de résultats excellents avec la Buprénorphine; 69,6 pour cent de résultats excellents avec le Kétoprofène. Pour l'appréciation globale du malade, nous avons noté : 95,8 pour cent de résultats excellent dans le groupe Buprénorphine; 92,8 pour cent de résultats excellents dans le groupe de Kétoprofène. Ces différences ne sont pas statistiquement significatives

Les plaies penetrantes de l'abdomen au CHU de Lome; a propos de 44 cas

Les auteurs rapportent les resultats d'une etude retrospective de 44 cas de plaies penetrantes de l'abdomen vue en 5 ans (Janvier 1990 a Decembre 1994) dans le service de chirurgie general du CHU Tokoin; dans le but d'en ressortir les problemes diagnostiques et therapeutiques. Les plaies penetrantes ont represente 0;73 pour cent des urgences abdominales chirurgicales durant la meme periode. La plupart des blesses etaient de sexe masculin (90;9 pour cent) et ages de 20 a 40 ans (70;5 pour cent). L'agent causal etait l'arme blanche dans 72;7 pour cent des cas. La lesion intra-abdominale etait cliniquement evidente dans 45;4 pour cent des cas; devant l'existence d'un choc hemorragique; d'un hemoperitoine ou d'une peritonite. Les plaies par armes a feu ont occasionne plus frequemment des lesions abdominales multiviscerales ainsi que des lesions extrathoraciques associees. Compte tenu de l'insuffisance de ressources humaines et materielles dans les services; l'attitude demeure la laparotomie systematique devant toutes les plaies penetrantes abdominales malgre un taux important de laparotomie blanche (40;9 pour cent). La lourde mortalite (15;9 pour cent) pourrait etre reduite par l'amelioration de mesures de reanimation

Complications infectieuses postoperatoires en chirurgie abdominale: role et signification de la duree de l'intervention

L'infection postoperatoire est polyfactorielle. Sur une serie de 369 operes de l'abdomen ayant presente 15;7 pour cent de complications infectieuses postoperatoires (58 cas); quatre facteurs de risque se revelent tres significatifs : la saison; l'etat general preoperatoire; la classe de risque infectueux et la duree de l'intervention. Les auteurs constatent que ce dernier facteur influe nettement sur le taux des complications infectieuses; en particulier dans les situations ou l'inoculum bacterie preoperatoire est en principe le plus faible (bon etat general; chirurgie reglee; chirurgie propre ou propre contaminee). Le taux d'infection etant significativement plus eleve lorsque l'intervention dure plus de 60 minutes; ils en concluent qu'un meilleur respect de l'asepsie pourrait favorablement influencer ce taux en diminuant le volume de l'inoculum bacterien recu par l'opere

Une etiologie peu connue d'un syndrome abdominal aigu chez l'enfant

Le syndrome abdominal aigu; urgence chirurgicale necessite pour une indication operatoire exacte; un minimum d'investigation clinique et para clinique. Parfois; malgre la pratique de differentes explorations; il arrive qu'en per-operatoire que l'on soit confronte a une etiologie particuliere qui conduit a executer un acte beaucoup plus large que prevu. Nous rapportons ici l'observation d'un enfant presentant une tumeur maligne du rein; decouverte en per-operatoire; dans un tableau d'abdomen aigu febrile avec le diagnostic d'abces du foie