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.

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

Background: This study reviews our experience with penetrating Traumatic Brain Injury (TBI) in order to define and describe the injury pattern and the outcome. A secondary aim of this study was to review the use of the Motor Score (M Score) and the Simplified Motor Score(SMS) to assess and triage patients with penetrating TBI. Methods: All patients with a TBI secondary to a penetrating mechanism were identified from the Hybrid Electronic Medical Registry at Pietermaritzburg Metropolitan Trauma Service (PMTS) from January 2012 to December 2014. Standard demographic data, need for neuro-surgical intervention, location of external wounds, CT findings and mortality where analysed. The Glasgow Coma Scale (GCS) M score and SMS score were specifically evaluated to determine the relationship between the individual motor component and patient outcome. Results: Over the two-year period January 2012­December 2014, a total of 384 patients were admitted following a penetrating TBI. There were 350 males and 34 females and of this total 7 (1.82%) died. The mechanism of injury was axe (30), bottle (34), gunshot wound (GSW)(22) and stab wound (298). The average age for axe injuries was 27 and bottle injuries was 30. The average age for firearms and knives was 29 and 30 respectively. Surgery was not required for 76.67% of patients. The need for surgery varied according to mechanism of injury. Axe injuries were treated non-operatively in 47.83%, bottle injuries in 87.50%, firearms 70% and knife injuries were treated non-operatively in 86.84% of cases.The overall survival rate for a penetrating head injury in this population is 98.16%. There were a total of 368 patients with a motor score of 6 of which one died. The survival rate was 99.7% and the mortality rate 0.3%. There were only 6 patients with a motor score of 5 and only 2 with a motor score of 4. The survival rate for both these groups was 100%. There was a total of 6 patients with a motor score of 1. There was a 100% mortality rate is this group. Conclusion: Penetrating TBI has a good prognosis. The vast majority of cases do not require neuro-surgical intervention. Poor motor score is associated with a poor outcome

Head injury burden in a major referral hospital emergency centre in Botswana

Introduction:This study describes the demographics, aetiology, emergency centre diagnosis and severity indicators of patients with head injuries presenting to the largest referral hospital emergency centre in Botswana.Methods:Cross-sectional retrospective data was collected from July 2015 to September 2015 for all emergency centre head injury presentations at Princess Marina Hospital. Information was extracted from emergency centre records regarding patient demographics, mechanism of injury, clinical observations, diagnosis, and treatment.Results:Three-hundred and sixty head injury patients presented to the emergency centre in the three months, averaging four per day. 80% were less than 40 years of age and males accounted for 69% of all presentations. 58% of injuries were listed as being accidental, 39% recorded from assaults and 38% from road traffic accidents. The most common emergency centre clinical diagnosis was concussion and the most common radiological diagnosis skull fracture. The median Glasgow Coma Scale was 15 with a range from 3 to 15; and, among patients for whom Revised Trauma Score could be calculated, 79% scored the lowest probability of death in the Revised Trauma Score.Discussion:Head injury disproportionately overburdened males in this study, and head injury aetiology and demographic picture was similar to regional data. Severity scoring using the Glasgow Coma Scale was only available among 66% of patients and Revised Trauma Score calculable in half of presentations. Only 55% of head injury patients were discharged from the emergency centre, despite the preponderance of low severity scores. Head CTs appear to have been over-utilised and implementation of a Traumatic Head CT guideline for our setting is proposed. This study improves understanding of the burden of head injury in Botswana and advocates for national referral guidelines for patients with head injury in Botswana

Civilian penetrating gunshot injury to the neurocranium in Enugu

Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004­2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality. Conclusions: Admitting GCS and bullet trajectory were predictive of outcome