Prise en charge des plaies pénétrantes de l'abdomen de l'enfant au Centre hospitalier de Treichville / Management Of Penetrating Abdominal Wounds In Children At Treichville Teaching Hospital

Contexte. La prise en charge des plaies pénétrantes de l'abdomen chez l'enfant ne fait pas l'objet de consensus. Le dogme de laparotomie d'emblée est remis en cause au profi t d'un traitement conservateur à appliquer selon des critères précis. Notre objectif était de caractériser les aspects épidémiologiques, cliniques et thérapeutiques des plaies pénétrantes de l'abdomen afi n de proposer un algorithme de prise en charge. Méthodes. Etude rétrospective de Janvier 2009 à décembre 2019, au service de chirurgie pédiatrique du CHU de Treichville.Huit cas ont été colligés dans les dossiers de patients retrouvés et complets. L'analyse statistique a été faite par le test de Fisher. Résultats. L'âge médian était de 9 avec des extrêmes de 2 et 15 ans. Tous les patients étaient de sexe masculin. Quatre patients présentaient un tableau de péritonite.Tous nos patients étaient hémodynamiquement stables.La radiographie de l'abdomen sans préparation (ASP) a été faite chez 5 patients (62,5 %) avec un pneumopéritoine chez 3 patients.Il a été réalisé4 (50%) laparotomies d'emblée et 4 traitements conservateurs.Le test exact de Fisher était statistiquement signifi catif pour p<0,05. Aucune laparotomie secondaire n'a été réalisée après le traitement conservateur. La mortalité a été nulle Conclusion. Les critères de réalisation du traitement conservateur reposent sur la clinique et un plateau technique disponible.

Background: The management of penetrating wounds of the abdomen in children is not the subject of consensus. The dogma of surgical exploration from the outset is called into question in favor of a conservative treatment. This treatment, however, must be applied according to precise criteria. The aim of this study was to characterize the epidemiological, clinical and therapeutic aspects of penetrating abdominal wounds in order to propose an accurate management algorithm.Methods. We performed a retrospective study from January 2009 to December 2019, in the pediatric surgery department of the Teaching Hospital of Treichville. Eightcases were collected.The statistical analysis was done using Fisher's test.Results. The median age was 9 with extremes of 2 years and 15 years. All patients were male. All our patients were hemodynamically stable. Four presented a peritonitis.Abdomen X-ray (ASP) was performed in 5 patients (62.5%) with pneumoperitoneum in 3 patients (37.5%). Four laparotomies (50%) were performed immediately and 4 conservative treatments.Fisher's exact test was statistically signifi cant for p<0.05. No secondary laparotomy was performed after conservative treatment. Mortality was zero. Conclusion. The criteria for performing conservative treatment are based on clinical elements and a technical platform available.

Caesarean section wound infiltration with ropivacaine versus placebo: Survey of chronic pelvic pain after 4 years' follow-up

Objective.To test the hypothesis that optimal management of postoperative pain may reduce the risk of developing chronic pelvic pain in women who undergo caesarean section.Methods. In a randomised trial in 2006/2007; ropivacaine was infiltrated through all the layers of the anterior abdominal wound in patients undergoing caesarean section. The outcome was a reduction in severe pain or the need for rescue narcotic analgesia within 1 hour after the operation in the ropivacaine group compared with a placebo group (relative risk 0.51; 95 confidence interval 0.38 - 0.69). A follow-up study 4 years later was designed to assess the prevalence of chronic pelvic pain by carrying out telephonic interviews with these women; of whom 77 were contactable and 75 were analysed. Data and statistical analysis were done using Microsoft Excel (2007); Epi Info (version 343) statistical and Review Manager 5 software.Results. Three out of 40 women in the ropivacaine group and 3/35 in the placebo group had persistent pelvic pain (total rate of chronic pelvic pain 8.1).Conclusion. There was no significant difference in the prevalence of chronic pelvic pain between the ropivacaine wound infiltration group (7.5) and the placebo group (8.6) after 4 years' follow-up

Abdominal Blockage of Iliohypogastric and Ilio-inguinal Nerves for Management of Post-Caesarean Pain: A Novel Method

Objective. The aim of this study was to compare pain relief after caesarean section achieved by an intra-abdominal iliohypogastric and ilio-inguinal (IHII) nerve block with levobupivacaine with that in patients given a placebo. Study design. A total of 60 healthy women scheduled for caesarean delivery under general anaesthesia were enrolled in the study. The patients were randomised to an abdominal IHII nerve block with levobupivacaine (levobupivacaine group) or administration of saline (placebo group). Instead of the classic percutaneous method; the block was administered intra-operatively from the peritoneal aspect. Scores on a visual analogue scale (VAS) at 2; 6; 12 and 24 hours; adverse effects; morphine consumption and success of blockage by a pinprick test were recorded.Results. In the levobupivacaine group; the pinprick test showed there to be successful bilateral block in 22 patients and unilateral block in 5; while the block failed in 3. No block was recorded in the placebo group. When morphine consumption at 12 and 24 hours were compared; consumption was found to be significantly low for both time points in the levobupivacaine group. VAS scores 2; 6 and 12 hours after the operation were also significantly lower in the levobupivacaine group.Conclusion. A block of the IHII nerves from inside the abdomen just before abdominal closure appears to be an effective and safe way of relieving pain after caesarean section