Infections du site operatoire en chirurgie generale dans un hopital regional au Togo

Objectifs : etudier la frequence des pathologies operees et relever les principaux germes retrouves au cours des infections de la plaie post-operatoire en chirurgie generale au CHR-Tsevie. Methodologie : etude retrospective sur les dossiers d'infections post-operatoires des patients operes dans le service de chirurgie generale au CHR - Tsevie du 1er Janvier 2012 au 31 Decembre 2013 (deux ans). Les parametres etudies etaient socio-demographiques; diagnostiques; le type d'intervention; le delai de survenue de l'infection; le traitement; l'evolution et la duree d'hospitalisation. Resultats : durant la periode d'etude 30 dossiers d'infections de la plaie post-operatoire ont ete colliges sur un total de 271 patients operes; soit 11%. Deux cent vingt neuf patients avaient ete operes en urgence soit 84;5% et 42 patients (15;5%) operes en chirurgie programmee. La sex ratio etait de 1;72. La tranche d'age de 19 a 30 ans constituait 40% des cas. Les patients etaient des cultivateurs (30%) et des eleves (23;3%). Les antecedents notes etaient : une hypertension (2cas); un diabete (1cas); une hypertension associe au diabete (1cas); un alcoolisme (30%) et un tabagisme (10%). L'infection post-operatoire a ete notee apres la prise en charge en urgence des affections comme la peritonite aigue generalisee (11cas/49 soit 22;4%) et l'appendicite aigue (6cas/34 soit 17;6%). L'antibio-prophylaxie a ete systematique chez tous les patients operes. Les germes retrouves etaient le Staphylococcus aureus (15 cas/50%); Escherichia coli (07 cas/23;3%) et le streptocoque (05 cas/16;6%). Les infections etaient notees entre 7 et 14 jours post-operatoire dans 70% des cas. La duree moyenne d'hospitalisation etait de 34 jours. Conclusion : l'infection de la plaie operatoire est frequente chez les patients operes en urgence. Les germes isoles a la culture sont souvent des bacteries cutanees. La prevention de l'infection du site operatoire necessite un respect rigoureux de regles d'asepsie

Acute cholecystitis from typhic origin in children

Background: To evaluate the particularities of typhoid cholecystitis in children. Materials and Methods: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings; confirmed by operative findings at cholecystectomy. Results: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females). Their ages ranged from five to 13 years (median 8.8 years). The mean duration of symptoms was six to 21 days. The clinical signs were fever; abdominal pain; which predominated at the right upper abdominal quadrant; and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal's test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3); perforation (2) and empyema (1). All the patients made an uneventful recovery; and have remained symptom free one and three months on follow-up. Conclusion: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice