Facteurs associés à la mortalité des urgences chirurgicales néonatales à Douala / Determinants of mortality of neonatal surgical emergencies in Douala

Introduction. Les urgences chirurgicales néonatales (UCN) se manifestent de la naissance au 28e jour de vieet nécéssitent un traitement chirurgical dans un délai court. L'objectif de ce travail est d'identifier les facteurs associés à la mortalité des UCN dans quatre hôpitaux de la ville de Douala.Méthodologie. Nous avons mené une étude transversale analytique avec collecte de données rétrospective sur une période de 10 ans, allant du 1er Janvier 2013 au 31 Décembre 2022 dans 4 hôpitaux de la ville de Douala à savoir: l'Hôpital Général, l'Hôpital Laquintinie, l'Hôpital Gynéco-obstétrique et pédiatrique de Yassa, et l'Hôpital Protestant de Ndogbati. Résultats.Laprévalence hospitalièredes urgences chirurgicales néonatalesétait de6,1%. La tranche d'âge la plus représentée était celle de 2 à 7 jours avec un sex-ratio de 1,7. La mortalité était de 48%avec une majorité de décès en post-opératoire (64,4%).Les déterminants de mortalité sur le plan sociodémographique étaient : l'âge à l'admission inférieur à 8 jours (OR= 1,95 ; P<0,001), le sexe masculin (OR=1,51 ; P=0,002); la moyenne prématurité (OR=0,91 ; P<0,001), le poids de naissance < 2500g (OR= 5,15 ; P=0,009), et le délai d'admission > 2 jours (OR=0,73 ; P<0,001). Sur le plan évolutif, les facteurs de mauvais pronostic étaient : les malformations anorectales (OR=2,23; P< 0,001), l'atrésie de l'œsophage (OR=3,63 ; P=0,001), la présence de complications post opératoires (OR= 3,45 ; P<0,001) et le sepsis (OR= 7,87; P=0,037).ConclusionLa mortalité post opératoire est très élevée. Les facteurs associés sont le long délai diagnostic, la prématurité, les pathologies malformatives digestives et le seps

Introduction.Neonatal surgical emergencies (NSE) occur from birth to the 28th day of life and require surgical treatment within a short timeframe. The objective of this study is to identify factors associated with mortality in NSE in four hospitals in the city of Douala. Methodology.We conducted a cross-sectional analytical study with retrospective data collection over a period of 10 years, from January 1st, 2013 to December 31st, 2022, in 4 hospitals in the city of Douala, namely: General Hospital, Laquintinie Hospital, Gynecological-Obstetric and Pediatric Hospital of Yassa, and Protestant Hospital of Ndogbati. Results.The hospital prevalence of neonatal surgical emergencies was 6.1%. The most represented age group was 2 to 7 days with a sex ratio of 1.7. The mortality rate was 48%, with a majority of deaths occurring in the post-operative period (64.4%). Sociodemographic determinants of mortality were: age at admission less than 8 days (OR=1.95; P<0.001), male sex (OR=1.51; P=0.002); moderate prematurity (OR=0.91; P<0.001), birth weight < 2500g (OR=5.15; P=0.009), and admission delay > 2 days (OR=0.73; P<0.001). In terms of progression, factors associated with poor prognosis were: anorectal malformations (OR=2.23; P<0.001), esophageal atresia (OR=3.63; P=0.001), presence of post-operative complications (OR=3.45; P<0.001), and sepsis (OR=7.87; P=0.037). Conclusion Post-operative mortality is very high. Associated factors include delayed diagnosis, prematurity, digestive malformative pathologies, and sepsis.

Approach to a sewing needle in the parapharyngeal space: A case report

Objective@#To describe a unique situation of a sewing needle lodged in the parapharyngeal space and elucidate the problems encountered in its successful removal.@*Methods@#Design: Case Report. Setting: Tertiary Private Hospital. Patient: One.@*Result@#A 24-year-old male tailor accidentally swallowed a sewing needle that pierced the oropharyngeal wall and was wedged in the parapharyngeal space. After a thorough physical examination, 70 degree rod endoscopy, radiography and doppler ultrasonography and intraoperative C-arm X-ray for intraoperative localization and as a guide for extraction all yielded less than optimal guidance. Although an intra-oral approach was initially taken, the transcervical approach provided the best access. @*Conclusion@#Removal of a sharp foreign body in the parapharyngeal space should be considered a surgical emergency owing to its close proximity to vital structures and the potential for serious complications. Identifying the exact location may require a variety of imaging modalities, and foreign body extraction may entail multiple surgical approaches.

Surgical emergencies, onco-surgeries and colorectal surgeries in COVID-19 pandemic: practical advice based on the global experience and at Dr. D. Y. Patil Medical College, Hospital and Research Centre

The existing coronavirus 2019 (COVID-19) pandemic is challenging healthcare systems at global level. We provide a practical strategy to reform pathways of emergency elective onco-surgery and colorectal surgery in the COVID- 19 pandemic. The novelists, from areas affected by the COVID-19, thought to outline the key-points to be conferred. Responsibilities were allotted, concerning specific characteristics of surgical emergencies, onco-surgery and colorectal surgery during the pandemic, including the administrative management of the catastrophe in India. The endorsements were collected and summarized. During the swift spread of COVID-19, it remains thoughtful to halt non-cancer procedures and prioritize surgical emergencies. Endoscopy, proctological procedures have to be completed selectively. With colorectal emergencies, a conservative approach is recommended. Detailed procedures should be followed when operating on COVID-19 patients, using committed personal protective equipment and adhering to specific rules, containing minimally invasive surgery. These guidelines summarize the strict instruction of entry/ exit into theatres and operating block as well as advice on performing procedures carefully to decrease risk of contracting the virus. It is likely that restructuring of health system is required, at central, state, and district levels. A description of the strategy adopted in Dr. D.Y. Patil Medical College Hospital, Kolhapur is provided. Evidence on the management of patients requiring surgery for surgical emergencies, onco-surgery and colorectal conditions during the COVID-19 pandemic is presently deficient. Healthcare professionals have succeeded with high volumes of surgical patients during the pandemic, could be useful to alleviate some risks and decrease exposure to other patients, public and healthcare staff.

Demographics in trauma: a prospective observational study in a tertiary care zonal hospital

Background: Trauma represents a major challenge worldwide and is the leading cause of morbidity and mortality in young population. There is significant change in trauma related injuries due to urbanization, motorization, industrialization and the socioeconomic changes in India. Road traffic accidents (RTA) pose the largest threat to human lives and have become the number one public hazard all across the world causing morbidity and mortality. The aim of this study is to find out the demographics and to determine the injury pattern of surgical trauma cases presenting to this tertiary care zonal hospital.Methods: A prospective observational study was conducted in a tertiary care zonal hospital from June 2018 to December 2018. Data was collected for 105 patients presented with trauma in surgical emergency centre of this hospital were included in the study which excluded only orthopaedic trauma cases. The data collected was analysed.Results: Out of 105, 76 (72.38%) were male and 29 (27.61%) were female with 21 (20%) in the 31-40 age group. The average age of cases was 40.2 years.  RTA was the major cause of trauma i.e. (77.14%) followed by accidental fall and slips (18.09%) and assaults (4.76%). Contusion was the common injury sustained (45.71%) followed by laceration (38.09%), abrasion (35.23%) and fracture (17.14%).Conclusions: There is a need for trauma registries which can help to formulate strategies towards decreasing the burden of trauma and improved outcomes at hospital as well as in public health.

Monoartritis aguda. Urgencia en la atención reumatológica / Acute monoarthritis. Urgency in rheumatologic care

Introducción: el dolor articular agudo es una emergencia reumatológica. Con pocas excepciones, todas las patologías articulares pueden presentarse inicialmente como dolor agudo mono o poliarticular. Objetivo: revisar elementos asociados al diagnóstico temprano de la monoartritis aguda en pacientes con o sin evidencia de trauma para que sea identificada como una urgencia clínico quirúrgica. Desarrollo: la monoartritis aguda es la inflamación de una sola articulación con un dolor intenso, que se caracteriza por enrojecimiento de la articulación, calor, tumefacción y limitación de los movimientos con una duración aproximada hasta 6 semanas. Conclusiones: para realizar el diagnóstico y poder efectuar una correcta atención de urgencia es necesario tener en cuenta un amplio espectro de patologías en el diagnóstico diferencial, por tanto, es esencial llevar a cabo un buen interrogatorio, obtener información sobre la historia de la enfermedad actual y hacer un examen físico detallado. Ante estos eventos es preciso que las instituciones y servicios implicados disponibles de forma inmediata, prevista y coordinada las condiciones físicas y materiales necesarias para recibir al paciente e iniciar el inicio el tratamiento indicado bajo la supervisión de los especialistas(AU)

Introduction: Acute joint pain is a rheumatological emergency. With few exceptions, all joint pathologies can present initially as acute mono or polyarticular pain. Objective: To review elements associated with the early diagnosis of acute monoarthritis in patients with or without evidence of trauma to be identified as a surgical clinical emergency. Development: Acute monoarthritis is the inflammation of a single joint with intense pain, characterized by redness of the joint, heat, swelling and limitation of movements with an approximate duration of up to 6 weeks. Conclusions: In order to make the diagnosis and be able to carry out a correct emergency care, it is necessary to take into account a wide spectrum of pathologies in the differential diagnosis, therefore, it is essential to carry out a good interrogation, obtain information about the history of the current disease and do a detailed physical examination. In view of these events, it is necessary that the institutions and services involved immediately available and planned and coordinated the physical and material conditions necessary to receive the patient and initiate the indicated treatment under the supervision of the specialists(AU)

Dehiscencia y evisceración vaginal recidivante: a propósito de un caso / Recurrent vaginal dehiscence and evisceration: a case report

La dehiscencia de la cúpula vaginal, con o sin evisceración, es una complicación rara de la cirugía ginecológica. El principal factor de riesgo es el antecedente de una histerectomía, a lo que se añaden otros factores desencadenantes, entre los que destaca la atrofia vaginal. El diagnóstico de evisceración es fácil, al comprobar salida de material intestinal a través de la vagina, siendo más dificultoso el diagnóstico de dehiscencia, ya que puede acontecer con síntomas banales. El tratamiento supone una urgencia quirúrgica al existir riesgo de lesión intestinal y peritonitis, pudiéndose realizar diferentes vías de abordaje teniendo en cuenta sobre todo la clínica de la paciente y tras comprobar el estado del contenido eviscerado. Presentamos el caso de una paciente con varios factores de riesgo, que presentó dehiscencia de la cúpula vaginal con evisceración de intestino de manera reiterada, y a la que se le practicó tratamiento quirúrgico por diferentes vías de abordaje así como tratamiento médico.

Dehiscence of the vaginal vault with or without evisceration is a rare complication after gynaecological surgery. The main risk factor is a previous hysterectomy, with the addition of other trigger conditions, the most important is vaginal atrophy. The diagnosis of evisceration is easy by confirmation the loosing of intestinal contents through the vagina. Diagnosis of dehiscence is more difficult because its symptoms could be more generic. The treatment is an emergency surgery as there is a risk of intestinal injury and peritonitis. There could be different surgical approaches taking into consideration the patient's clinic symptoms and after checking the state of eviscerated tissues. We expose the case of a patient with several risk factors, who presented dehiscence of the vaginal vault with recurrent bowel evisceration, and who we performed surgical treatment by different approaches and medical treatment.

Intussusception in Pregnancy: A Rare Case Report.

Intussusception is a surgical emergency characterized by invagination of a segment of bowel into a distal portion. It leads to obstruction and compromise of mesenteric blood flow with resultant inflammation and the potential for ischemia of the bowel wall. It is very rare in pregnancy, and the high fetal and maternal mortality is due to a delay in diagnosis and treatment. We report a case of intussusception at a gestational age of 14 weeks and 6 days, when she presented with severe lower abdominal pain and vomiting. Diagnosis was confirmed by ultrasonography which revealed heteroechoic bowel in bowel appearance. Emergency laparotomy was done. Lead point was a submucosal lipoma at 60 cm from the ileocecal junction. Iloeocecal intussusception reduction and segmental ileal resection and end-to-end anastomosis was done. The post-operative period was uneventful.