A case of Amyand hernia at the Central Hospital of Yaounde and review of the literature.

INTRODUCTION: Amyand's hernia is defined as an inguinal hernia, containing the appendix in the hernia sac. It is a rare form of hernia. Its management is increasingly codified. CLINICAL HISTORY: A 5-year-old patient with a non-remarkable past history was brought for consultation with an intermittent inguino-scrotal swelling and discomfort. Clinical examination revealed a non-tender inguino-scrotal swelling with positive transillumination. A conclusion of a communicating hydrocele was made; hence, an indication for surgery. Per operatively, we had as findings the appendix present within, and linked to the hernia sac. We performed an appendectomy and a high ligation of the hernia sac. The post-operative evolution was favourable. Anatomopathological analysis revealed a catarrhal appendix. CONCLUSION: Amyand's hernia remains a rare pathology that can be seen in children with a persistent peritoneo-vaginal canal. Dissection of the hernia sac must be carried out carefully since it is most often discovered intraoperatively and accidental injury to the appendix, which is attached to the wall of the hernia sac can lead to serious complications.

Locked book pubic symphysis: A case report in a resource-limited setting in sub-Sahara Africa.

INTRODUCTION: Locked pubic symphysis is a rare but serious injury that occurs by lateral compression mechanism. It is an overlapping pubic symphysis dislocation, with one pubic bone entrapped behind the contralateral pubis, locked into the contralateral obturator foramen. CASE REPORT: We report the case of a 25 years old male who presented with acute urine retention following a left lateral compression pelvic trauma by a motor vehicle and was diagnosed with a locked pubic symphysis treated successfully by open reduction and combined internal and external fixation. CONCLUSION: Locked pelvic symphysis is a rare form of pelvic injury. The majority of cases require stabilization by open reduction and internal fixation of the anterior pelvic ring. Urogenital injuries are the commonest associated injuries, despite unfavourable mechanism.

Indications; complications; et resultats des colostomies transverses a l'hopital general de Douala; Cameroun

Introduction : Une stomie digestive peut etre realisee a partir de l'ileon; du colon ascendant; transverse ou descendant. Elles peuvent etre laterales ou terminales. L'etude s'interesse plus particuliere-ment des colostomies transverses afin d'evaluer leur frequence parmi les autres stomies laterales realisees pendant une periode de 10 ans a l'hopital general de Douala dans le meme service de chirurgie digestive dans Le but d'etudier retrospectivement leurs indications tout en faisant enfin une evaluation critique de cette pratique. Methodes :De decembre 1999 jusqu'au mois de decembre 2009 nous avons recense tous les patients ayant beneficie d'une stomie laterale en relevant les caracteristiques cliniques des porteurs d'une colostomie transverse; ainsi que des complications majeures et mineures repertoriees par le personnel infirmier.Resultats :110 colostomies laterales effectuees; 72(68) de colostomies transverses; l'age moyen etait 69;5ans (24-95); le sexe ratio h/f etait de 0;8. elles avaient ete realisees en urgence dans 60 cas et dans le meme temps temporaires. L'occlusion aigue colique pour (43;1) des cas a constitue notre indication majeure. Le taux de complications specifiques etait de 44 et d'une part (32) de cas de prolapsus stomial comme complications majeures Puis (9;7) d'eventrations parastomiales et les retractions stomiales observees dans (7) de cas; aucune ischemie ou necrose n'ayant pas ete observee. Conclusion : L'occlusion aigue du colon justifie une indication d'une colostomie transverse en urgence comparativement aux autres stomies; elle semble comporter moins de complications a type de necrose et d'ischemie par rapport aux Stomies laterales

[Perioperative cholangiography: a case study at Yaounde (Cameroon)]. / Cholangiographie peropératoire: une observation a Yaoundé (Cameroun).

For many years peroperative cholangiography has been routinely used for bile duct surgery in the Western countries. However recent publications showing high rate of inconclusive peroperative cholangiography (47%) has cast doubt on this attitude. Surgeons in Africa and particularly in Cameroon have already replaced peroperative cholangiography with other indicators such as clinical history and preoperative echography, anticipating cholangitis. For some indications, e.g. Mirizzi syndrome, peroperative cholangiography is essential for surgery. The fluoroscopes required for this exploration should be made available in our hospitals since they are also needed for traumatology, vascular surgery, and other specialities. In addition this syndrome may be more common in our region.

[Analysis of operative indications and outcomes in 238 re-operations after abdominal surgery in an economically disadvantaged setting]. / Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas).

AIM OF THE STUDY: We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. PATIENTS AND METHODS: Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery. RESULTS: During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications. CONCLUSION: In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.

Depressed skull fractures in children: Treatment using an obstetrical vacuum extractor.

INTRODUCTION: A depressed skull fracture is an inward buckling of the skull bones. It is referred to as a ping-pong ball fracture in neonates; in older children, some fractures take a cup shape mimicking 'ping-pong' ball fractures. OBJECTIVE AND METHODS: The aim of this study was to assess the use of an obstetric vacuum extractor to elevate cup-shaped depressed skull fractures in children irrespective of age. All children admitted into the Central Hospital of Yaounde between 1999 and 2004 with a cup-shaped simple depressed skull fracture and treated with the vacuum extractor were included. RESULTS: Nine children aged from 3 months to 17 years were treated with the vacuum extractor. The cosmetic and radiographic results were satisfactory. The procedure was simple and without any complication. CONCLUSION: The elevation of 'ping-pong-ball-like' or 'cup-shaped' skull fractures in older children (beyond the neonatal period) is a simple, effective and safe procedure.

[Acute abdomens of parasitic origin: retrospective analysis of 135 cases]. / Les abdomens aigus d'étiologie parasitaire: analyse d'une série rétrospective de 135 cas.

OBJECTIVE: To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities. MATERIALS AND METHODS: Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon). RESULTS: Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus). CONCLUSIONS: Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.

Growing skull fractures.

INTRODUCTION: Growing skull fractures are a rare complication of head injuries (Ersahin et al. in Neurosurg Rev 23:139-144, 2000; Hayashi et al. in Childs Nerv Syst 13:349-351, 1997; Ramamurthi and Kalyanaraman in Neurosurgery 32:427-430, 1970; Zegers et al. in Eur J Pediatr 162:556-557, 2003). Although early diagnosis and prompt treatment are important to prevent the underlying progressive brain damage, the clinical presentation and the morphological investigations are rarely specific or sensitive shortly after the trauma. DISCUSSION: The authors present three cases of growing skull fractures: the use of ultrasonography (US) via the fracture line contributed to early diagnosis and prompt treatment in two cases. US was not performed in the third case, and this delayed management. Treatment consisted of a watertight duraplasty with a free flap of pericranium without cranioplasty. US via the fracture line appears to be a sensitive and reliable method of detecting the dural tears in the early stages of growing skull fractures. CONCLUSION: Duraplasty alone with a flap of pericranium remains the simplest and least expensive method of treatment. Cranioplasty is not necessary in young children.

[Abdominal gunshot wound: description of 86 cases in Cameroon]. / La plaie abdominale par balle: à propos de 86 observations au Cameroun.

Abdominal gunshot wound (AGSW) is a trauma emergency. The purpose of this report is to describe our experience with managing AGSW largely without modem investigational modalities. Data was collected retrospectively by reviewing the surgical reports and clinical charts of patients admitted to live hospitals dealing with AGSW over a 5-year period. Incomplete files and wounds not involving the abdomen were not included. A total of 86 files were analyzed. Patients ranged in age from 10 to 63 years ivith mean age of 32 years and a sex ratio of 5.5. Most patients (87%) underwent surgical exploration. Laboratory revealed no lesions in 22.5% of cases, minor lesions in 9.5% and major lesions justifying surgical repair in 68%. A total of 86 visceral lesions were found in the patients who underwent surgical exploration. The lesion involved the small intestine in 31.5% of case, colon in 24.5%, liver in 23.5%, spleen in 7%, stomach in 6%, and uterus in 2%. The kidney, pancreas, mesenteries, large momentum, and transverse mescaline each accounted for 1% of lesions. Conventional operative techniques were used with a mortality of 5.5% and morbidity of 4%. Based on our findings we conclude that when investigational tools (CT-scan, peritoneal lavage and laparoscopy) are unavailable prolonged watchful waiting increases the risk of mortality and morbidity in patients presenting AGSW associated with suspicious clinical signs. Prompt surgical treatment improves prognosis but is associated with a high rate of cases showing no lesions.

[Traumatic jejuno-ileal ruptures: apropos of 18 cases at the Central Hospital of Yaounde]. / Les ruptures traumatiques jéjuno-iléales: àpropos de dix huit (18) observations àl'hôpital Central de Yaoundé

Eighteen blunt small bowel traumas were reviewed in this retrospective study (1986-1996) concerning 12.8% of laparotomies for blunt abdominal trauma. The clinical presentation at admission was peritonitis (9 cases) or hemoperitoneum (4 cases) whereas 5 cases were diagnosed lately because of non specific signs at the beginning. All patients underwent surgery: simple suture or suture after excision of edges (12 cases); resection anastomosis (6 cases). There were no post-operative complications in most of the cases. The mortality rate was 5%. Blunt small bowel traumas are not frequent in our practice. Their diagnostic is often per-operative. If the clinical signs of intraperitoneal lesion are not present, a clinical follow-up by repeated and thorough physical examination can permit an early diagnosis. The surgical treatment is simple, and the prognosis more linked to severe associated lesions than the bowel lesion.

[Blunt trauma of the liver. An analysis of a series of 29 cases]. / Traumatismes fermés du foie. Analyse d'une série de 29 cas.

Twenty nine patients with blunt liver trauma were recorded in the Central Hospital of Yaounde between 1986 and 1996. The average age was 23.4 years, with the 20 to 25 and 5 to 15 age groups being the most affected. The most characteristical clinical presentation was hemoperitoneum with shock. Twenty-three patients were operated (18 in emergency and 5 secondary). While 6 patients benefited from non operative treatment due to their stable hemodynamic state. Exploration of lesions revealed 16 grade I and grade II, 8 grade III and 5 grade IV and V lesions. The operation was a simple suture in 13 cases, selective ligature of hepatic artery in 2 cases and 2 tamponades while in 4 cases the treatment was inactive. The bleeding could not be controlled in 2 cases. Peri-operative mortality was 17.39% and morbidity 21.74%, made up mainly of parietal sepsis. In our practice, blunt liver trauma are generally benign and treatment should be conservative.

Fine needle aspiration of the spleen at the Yaounde Central Hospital

The aim of the study was to find out if the fine needle aspiration (FNA) of the spleen is feasible in our milieu. The technic was used in 5 patients with splenomegaly and without a precise disgnosis; at the Yaounde Central Hospital. The aspirated sample was submitted to a cytological examination that showed lymphomatous lymphoblastic cells in 3 patients and normal lymphoid cells in 2. Fine needle aspiration of the spleen is feasible in our milieu under certain conditions. Hemorrage which is its main complication was not observed in our study of 5 patients

[Liver trauma: analysis of 42 cases in Yaounde]. / Traumatismes hépatiques: analyse d'une série de 42 cas à Yaoundé.

Forty-two cases of liver trauma were reviewed at the Central Hospital of Yaounde between 1984 and 1994. The mean patient age was 22 years, the most commonly involved age group being between 20 and 35 years. Trauma was blunt in 24 cases (57.1%) and penetrating in 18 cases (42.8%). Diagnosis was achieved most frequently by abdominal needle puncture confirming hemoperitoneum. Emergency surgery was performed in 38 cases. In the remaining 4 cases hemodynamic status was stable and surgery was not required. Lesions were classified as grade I and II in 24 cases, grade III in 5 cases, grade IV in 3 cases, and grade V in 1 case. In the remaining 9 cases the grade of the lesion was not mentioned. Management consisted of simple suture in 26 cases, debridement in one case, packing in 4 cases, and a watchful attitude in 4 cases. In 3 cases hemorrhage was uncontrollable. Overall perioperative mortality was 14.2%. The main complication was parietal sepsis which occurred in 6 cases. In the present African series liver trauma was most often benign. This finding suggests that a conservative surgical approach is indicated.

Perforation traumatique du grele et engagement occasionnel du taenia saginata : a propos de 2 observations. [Lettre]

L'engagement occasionnel de parasites a travers une breche intestinale; en dehors de l'ascaris; est un fait assez rare au Cameroun. La presence intraperitoneale du taenia saginata confirme l'hypothese d'une utilisation accidentelle par le parasite d'une perforation pre-existante. Cette presence ne modifie pas le cours de l'intervention. Le traitement antiparasitaire post-operatoire complete la destruction parasitaire mecanique peroperatoire

Interet du traitement chirurgical de la cryptorchidie a Yaounde

Une etude retrospective visant a evaluer l'interet du traitement chirurgical de la cryptorchidie a porte sur 123 patients operes a Yaounde pendant une periode de 10 ans allant de 1984 a 1994. L'analyse a revele que 93 patients (75;6 pour cent) avaient ete operes apres l'age de trois ans; au moment ou des alterations histologiques avaient deja compris le pronostic fonctionnel du testicule et augmente le risque de cancerisation. Des resultats comparables dans la litterature montrent l'insuffisance de l'information medicale sur l'age optimal de l'abaissement des testicules cryptorchides. L'etude fait des propositions pour un changement de comportement

Preoperative carcinoembryonic antigen level as a prognostic indicator in resected primary lung cancer.

The aim of this study was to evaluate the prognostic significance of elevated preoperative carcinoembryonic antigen (CEA) levels in cases of resected primary lung cancer. Between 1985 and 1989, 152 patients with tumors and CEA levels above 10 ng/mL underwent operation. One hundred twenty-five of them underwent resection of their tumors and the other 27 underwent exploratory thoracotomy only. Fifty-two percent of cancers were adenocarcinomas and 33% were epidermoid. Forty-two resected tumors were classified as stage I, 29 as stage II, 45 as stage IIIa, 7 as stage IIIb, and 2 as stage IV. The 3-year actuarial survival rate was 54% for patients with stage I tumors, 28% for those with stage II, 18% for those with stage IIIa, 44% for those with stage IIIb, and 0% for those with stage IV tumors. The 5 year actuarial survival was 40% for those with stage I tumors, 28% for those with stage II, 7% for those with stage IIIa, and 0% for those with stage IIIb tumors. Preoperative CEA levels increased from stage I to stage IIIa (p < 0.05). However, based on preoperative CEA levels we were not able to predict resectability, because levels were not significantly different between stage IIIa and exploratory thoracotomy-only groups. Adenocarcinoma was not significantly associated with higher CEA levels than was epidermoid, except in stage IIIa disease (p < 0.05). We found a critical unfavorable level of prognostic significance at 30 ng/mL.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary abscess of the psoas. A common disease in tropical countries. Apropos of 87 cases]. / Abcès primaires du psoas. Affection courante en milieu tropical. A propos de 87 cas.

Over a 4 years period, 87 cases of primary abscesses of the psoas were treated surgically at the Central Hospital in Yaoundé. The psoas muscle was involved in 10.17% of the cases with myositis. Most patients were in young male and the abscesses were in an advanced stage. Staphylococcus was the most frequently encountered germ (78.4%) and enterobacteria were only found in 3.07%. The diagnosis was based on clinical and echographic findings. There was 1 patient with acquired immunodeficiency syndrome (AIDS). Most cases were treated by extraperitoneal drainage. Morbidity and mortality were low and generally occurred in debilitated patients (AIDS, involvement of several muscle groups, diabetes).

[Treatment of postoperative incisional hernias by a composite prosthesis (polyester-polyglactin 910). Clinical and experimental study]. / Le traitement des éventrations post-opératoires par prothèse composée (polyester-polyglactine 910). Etude clinique et expérimentale.

Because of complications resulting from the use of intraperitoneal prosthetic materials, the authors studied a new double Layered composite mesh (formed by a Dacron mesh, and a polyglactin 910 mesh). The experimental study (40 rats) compared the composite mesh with Dacron mesh. Statistical analysis demonstrated the following conclusions. At 6 months, the poor fibroblastic activity with the composite mesh, indicated the absence of replacement of the polyglactin 910 mesh by a neo-tissue. The Dacron mesh remained in contact the abdominal viscera and contracted with them as many adhesions as when Dacron mesh was used alone. The composite mesh showed poor biological tolerance, lower than that of Dacron mesh. The clinical study concerned 24 patients, 3 recurrences were observed. In one case, we observed migration of the mesh in the small bowel. The unfavorable results of the experimentation, and the risk of visceral migration lead us to avoid the use of composite mesh in intraperitoneal sites.