Haemorrhagic rupture of hepatocellular carcinoma: Management of a case in a resource-constrained hospital in TOGO.

INTRODUCTION: Hepatocellular carcinoma (HCC) is the major malignant tumour of the liver. Its rupture is a serious and fatal complication. Its diagnosis and management are a major challenge in sub-Saharan Africa. The peri-hepatic packing: the only alternative for the management of hepatic tumour ruptures in resource-constrained hospitals. CASE REPORT: We are reporting the case of a 45 years old man, carrier of viral hepatitis B and poorly followed up, who presented a sudden picture of hemodynamic instability. A laparotomy allowed finding a hepatic tumour rupture. He benefited from a damage control by peri hepatic packing. CONCLUSION: Peri hepatic packing is a major solution in the management of ruptured liver tumour in Africa.

Duodenocolic fistula by nail ingestion in a child.

Unintentional foreign body ingestion is common among children. Normally, these ingested foreign bodies pass spontaneously. Only few of them may lead to complications such as fistula, which requires surgical intervention. We are reporting a case of accidental construction nail ingestion in a 3-year-old male child, for 30 days, without any symptoms. Diagnosis of duodenocolic fistula by construction nail was made on clinical examination and abdominal radiography features. He underwent surgical intervention, with nail removal, dudenal and colic primary closure. The follow-up was uneventful. We recommend emergently retrieval of sharp-pointed and long-ingested foreign bodies like a construction nail. Conservative outpatient management by clinical observation is not appropriate for this kind of foreign bodies. It may lead to complications such as perforation and fistula.

Severe snakebite envenomation revealed by an acute abdomen.

Acute abdomens are common conditions, with many aetiologies in developing countries. Abdominal bleeding due to snake envenomation is an extremely rare aetiology. A 11-year-old girl was admitted for acute abdominal pains. She had a history of foot bite of unknown origin. Physical examination revealed palor and abdominal tenderness. At laparotomy, there were peritoneal and retroperitoneal diffuse hematomas. Laboratory studies revealed abnormal coagulation profile. Retroperitoneal and peritoneal hematomas' diagnosis, by consumptive coagulopathy, due to snakebite envenomation, was made. Polyvalent antivenom administration permitted a normalization of coagulation profile, however, with persistent surgical site bleeding. Whole blood transfusion was administered with bleeding stop. Sudden abdominal pain, palor and signs of peritonism suggest an acute abdomen. However, abdominal bleeding due to snakebite envenomation should be considered, especially in child with unidentified bite history. Imaging modalities may helpful to confirm the abdominal bleeding. Antivenom is the mainstay of the treatment.

Surgical management for squamous cell carcinoma of vulva.

To analyze our surgical management and the result of squamous cell carcinoma (SCC) of vulva. Retrospectively, we collected 38 cases of SCC; 17 cases of them were early SCC and 21 cases were locally advanced. The patients underwent primary surgery. The survival was estimated using Kaplan-Meier analysis and the log rank test. The mean age was 60.78 years. Total vulvectomy was performed in all patients. Superficial and deep incision of bilateral inguinal lymphadenectomy was performed by separates incisions for SCC infiltrating more than 1mm. The average tumor size was 53 mm (10 to 140mm). Morbidity was 42.1%. Lateral resection margin ≥8mm was obtained in 57.1%. Eighteen patients benefited from adjuvant radiotherapy. The follow-up median was 19.4 months (6 to 61.5 month) with 05 recurrences in 12 months. The survival using the Kaplan-Meyer analysis at 5 years, was 62.1% (71.2%N(-) vs 46.7%N(+); p = 0.13). We identified two groups for locally advanced vulva cancer. Primary surgery keeps its place. Neo adjuvant radio chemotherapy followed by surgery is the alternative treatment for locally extensive lesions.