Chirurgie foraine pédiatrique: organisation et prise en charge anesthésique

Introduction : La chirurgie foraine est une chirurgie de proximité aux populations présentant des difficultés d'accès aux soins. L'objectif des auteurs était d'évaluer l'approche d'interventions chirurgicales et le mode d'anesthésie proposée par les organisateurs pour apporter des soins de qualité et à moindre coût à des populations démunies. Patients et Méthodes : Il s'est agi d'une étude transversale et descriptive menée au cours d'une mission foraine réalisée au Centre Hospitalier Universitaire Départemental ­ Ouémé / Plateau du 30 Septembre au 06 Octobre 2018. Elle concernait les enfants de 0 à 15 ans, opérés durant la mission. L'équipe d'intervention était dirigée par 3 chirurgiens pédiatres et 2 Médecins anesthésistes. Etaient étudiées, les données épidémiologiques, les indications chirurgicales, la classification ASA, les techniques anesthésiques et les suites opératoires. Résultats : Parmi les 483 enfants ayant consulté, l'indication d'une intervention chirurgicale a été poséchez 348 (72,04%) enfants parmi lesquels 136 (39,08%) ont été opérés. Ces derniers avaient une moyenne d'âge de 6,10 ± 4,23 ans avec des extrêmes de 2 jours de vie à 15 ans. Il y avait une prédominance masculine (85,29%), avec une sex-ratio de 5,8. Les hernies de la paroi abdominale étaient prédominantes (60,93%). La rachianesthésie (47,06%) était la plus pratiquée. La majorité des enfants opérés était classée ASA1 et ASA2. La durée moyenne d'hospitalisation était 1,16 ± 0,47 jouret la mortalité péri-opératoire était nulle, avec une morbidité négligeable. Conclusion : Certains actes chirurgicaux chez l'enfant peuvent être exécutés dans le cadre d'une mission foraine. Mais leurréalisation nécessite une structure et une organisation permettant d'assurer la sécurité pour la prise en charge de ces malades

Mal de Pott chez l'enfant : aspects épidémiologiques, cliniques et thérapeutiques en chirurgie pédiatrique à Cotonou

Introduction : Le mal de Pott est une forme grave de tuberculose extra-pulmonaire à cause du risque de lésions neurologiques. Patients et méthodes : Il s'est agi d'une étude rétrospective menée sur 10 ans (janvier 2006 à décembre 2015) dans le service de chirurgie pédiatrique du Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM). Nous avons étudié ses caractéristiques épidémiologiques, cliniques et thérapeutiques chez des sujets âgés de 0 à 15 ans. Résultats : Il a été colligé 20 cas, soit 2 cas/an. L'âge moyen des enfants était de 5,5 ans avec des extrêmes de 9 mois et 15 ans. Ceux de moins de 5 ans étaient les plus atteints (14 cas). Le sex-ratio était de 3. Les douleurs rachidiennes (10 cas) et les tuméfactions du dos (8 cas) étaient les principaux motifs de consultation. La fièvre et la douleur provoquée à la palpation des épineuses vertébrales étaient les signes cliniques les plus résents chacun dans 16 cas/20. Des signes neurologiques étaient notés dans 8 cas. Les signes radiographiques étaient dominés par l'ostéolyse vertébrale et le pincement de l'interligne articulaire. Il a été identifié 1 cas d'image en fuseau. Les lésions siégeaient essentiellement sur le rachis lombaire (8 cas). Le traitement était spécifique et orthopédique. L'évolution était favorable chez 16 patients après un recul moyen de 86 mois. Conclusion : Le mal de Pott est une affection qui doit être vite diagnostiquée et traitée afin d'en éviter les complications qui sont redoutables

[Epidemiological and clinical aspects of visible urogenital malformations among adolescent's schoolboys at Cotonou]. / Aspects épidémiologiques et cliniques des malformations urogénitales cliniquement visibles chez les élèves adolescents de Cotonou.

AIMS: To detect systematically visible urogenital malformations (VUGM) in adolescents and describe their epidemiological and clinical aspects. PATIENTS AND METHODS: It was a cross sectional, descriptive and analytical study, conducted from February to August 2012. Upon 2724 adolescents from 10 to 19 years old, of the public secondary schools of Cotonou. Among the 26,594 registered pupils, 2724 were included and examined after a randomized sampling of 30 clusters. RESULTS: The mean age of the pupils was of 15 ± 2.30 years (11-19 years), with a peak at 18 years. The prevalence of the VUGM was slightly higher (9.57%) in individuals those had parents with low socioeconomic level. The prevalence of the VUGM was high in Yoruba and related (P=0.02). It was stronger (9.84%) among subjects in puberty period's than in pre-puberty (6.69%) (P=0.03). From the 253 having VUGM, 78 (30.83%) had 146 functional signs. It was indexed 266 affections and of malformatives associations in 21 pupils (8.30%). Varicocele was the most frequent (5.47%), followed by inguinal hernia (0.99%), hydrocele (0.88%), anomalies of testis migration (0.59%), cyst of spermatic cord (0.51%), insulated testicular hypotrophy (0.48%), micro-penile (0.33%), hypospadias (0.22%), penile curvature (0.22%) and epididymis cyst (0.07%). CONCLUSION: Among patients who had VUGM, the majority had at least a varicocele, which occupies so far the first place within these malformations at the adolescents in Cotonou.

Distal quadricepsplasty in children: 88 cases of retractile fibrosis following intramuscular injections treated in Benin.

INTRODUCTION: Retractile fibrosis of the quadriceps (RFQ) is a physical and social handicap in children, and often results from a past history of quadriceps intramuscular injection. The aim of this study was to evaluate the therapeutic results of RFQ treated by distal quadricepsplasty using a modified Thompson-Payr procedure (DQPMTP). HYPOTHESIS: Functional recovery will be good with DQPMTP. PATIENTS AND METHODS: This is a descriptive retrospective 10-year study from 2002 to 2011, including 74 children (88 knees) less than 15 years old, admitted for RFQ and treated in Benin. The types of RFQ were: knee flexion loss of motion 16 cases (18.2%), lag of extension 54 cases (61.4%) and associated genu recurvatum, 18 cases (20.5%). Wasting of the thigh was found in all cases. An associated distal femoral osteotomy was performed to correct a bone deformity in 18 cases (20.5%). RESULTS: There were 16 cases (18.2%) of poorly looking postoperative scars and 2 cases (2.3%) of fracture during physical therapy. Mean flexion ROM after surgery was 77.7°. Mean flexion increased from 77.7° to 108.5° following postoperative rehabilitation or a mean gain of 30.7°. The quadriceps muscle testing scores were at least 3/5. Results of DQPMTP were good in 80.7% of cases, as shown by mean active knee flexion of 108.5° with normal active extension. The results were satisfactory in 17 cases (19.3%). DISCUSSION: DQPMTP has the advantage of cutting a minimum of blood vessels, thus limiting the risk of hematoma. Laterally placed incisions create less tension reducing the risk of skin necrosis. The clinical and radiological results of this series confirm those in the literature. Treatment of RFQ by DQPMTP provides satisfactory functional rehabilitation in patients, which confirms our hypothesis. LEVEL OF EVIDENCE: Level IV, retrospective study without comparison.

Urethral mucosal prolapse in young girls: a report of nine cases in Cotonou.

BACKGROUND: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. MATERIALS AND METHODS: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. RESULTS: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The main presentation was vaginal bleeding (five cases). Physical examination revealed a soft, non-tender mass that bleeds on touch (six cases), with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery, one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. CONCLUSION: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical.

Urethral mucosal prolapse in young girls: a report of nine cases in Cotonou

Background: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. Materials and Methods: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. Results: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The main presentation was vaginal bleeding (five cases). Physical examination revealed a soft; non-tender mass that bleeds on touch (six cases); with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery; one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. Conclusion: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical

Femoral bifurcation associated with tibial aplasia: about 3 cases.

Femoral bifurcation associated with tibial aplasia of the limb is a very rare pathology. Its radical treatment is a disarticulation of the knee, followed by fitting of a prosthesis. In Benin the reluctance of parents to allow their children to undergo amputation and the access to equipment for the amputated child are a major technical and financial hindrance. Here we report three cases.

[Surgery of congenital clubfoot in Don Orione, Health Center for physical handicaps of Ivory Coast (About 554 feet)]. / Chirurgie du pied-bot varus équin congénital au centre pour handicapés physiques Don Orione de Côte-d'Ivoire (A propos de 554 pieds).

OBJECTIVES: Treatment of congenital clubfoot improved in occidental country. We have studied the epidemiology, clinical and therapeutic aspects of this malformation in the context of Africa. PATIENTS AND METHODS: This was a retrospective study. Two thousand five hundred and sixty-two patients were hospitalised and operated during 12 years, 362 of them were diagnosed with congenital clubfoot. This represented 14,1% of the surgical diseases, with an incidence of 30,2 cases per year. The male to female ratio was 1,6:1, and ages ranged from 4 months to 38 years old, 59% of which were less than 15 years old. Two hundred and four (56,3%) patients had bilateral disease, 93 (25,7%) had right side disease and 65 (18%) had left sided disease. Considering the classification types we noted in our patient population 82% type III, 5% type II, 3% type I and 10% were undefined. RESULTS: Posteromedial approach describe by Codivilla was used in 45,5% of cases. Codivilla approach associated with lateral access to the foot in 44,4% of cases, with dorsal access in 2,3%. Few patients (7,8%) have had another approach. One hundred and seventeen patients received physiotherapy prior, but all the patients operated have postoperative physiotherapy while wearing orthopaedic shoes. Results obtained were: good in 510 cases (92%), quite good in 35 cases (6,3%), fairly good in 7 cases (1,3%) and mediocre in 2 cases (0,4%). CONCLUSION: The surgical aspect is still only a fraction of the entire treatment. It is imperative that physiotherapy is started immediately and orthopaedic shoes be worn postoperatively.