Successful management of oesophageal atresia in Cameroon, Sub-Saharan Africa.

Background: Oesophageal atresia (EA) is the most common congenital anomaly of the oesophagus. Despite improvement of survival observed over the previous two decades in developed countries, the mortality remains very high and the management greatly challenging in resource-poor settings such as Cameroon. We report our experience of management of EA in this environment, with a successful outcome. Materials and Methods: We prospectively assessed patients diagnosed with EA and operated in January 2019, at the University Hospital Centre of Yaounde. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures and outcomes. The study has received approval from the Institutional Ethics Committees. Results: In total, six patients (three males and three females, sex ratio, 0.5; mean age at diagnosis, 3.6 days; range, 1-7 days) were assessed. A past history of polyhydramnios was found in one patient (16.7%). All patients were classified Waterston Group A at diagnosis, with Ladd-Swenson type III atresia. Early primary repair was performed in four patients (66.7%) and delayed primary repair in two patients (33.3%). Operative repair mainly involved resection of the fistula, suture of trachea and oesophagus end-to-end anastomosis, followed by interposition of vascularised pleural flap. Patients were followed up 24 months. With one late death, the survival rate was 83.3%. Conclusion: Improvement has been achieved in the outcomes of neonatal surgery in Africa in the past two decades, but EA-related mortality remains relatively too high. Using simple techniques and available, reproducible equipment can improve survival in resource-poor settings.

Very late diagnosed Retrocaval ureter: A case report of a very rare entity in Cameroon, sub-Sahara Africa.

INTRODUCTION AND IMPORTANCE: Retrocaval ureter (RCU) is a rare congenital anomaly usually associated with upper urinary tract stasis, in which the ureter itself passes behind the inferior vena cava. RCU is often misdiagnosed and can lead to serious complications related to the upper urinary tract stasis. CASE PRESENTATION: We report the case of a 57-year-old female who presented with 1-year history of intermittent right flank pain, of gradual onset. She was diagnosed with right RCU, with advanced functional deterioration of the kidney, managed by nephrectomy. The postoperative course was uneventful. CLINICAL DISCUSSION: RCU results in varying degrees of hydronephrosis and thus, in a non-specific clinical presentation. Most cases are asymptomatic, discovered only during imaging or surgery for unrelated conditions or at autopsy. A late diagnosis can lead to an obstructive nephropathy which can be very harmful to the kidney. CONCLUSION: RCU is a very rare entity. The diagnosis can sometimes be late in under-medicalized settings, and must be taken into consideration in front of any hydronephrosis associated or not with intermittent flank pain. RCU-related complications can be very serious. Fish hook sign may be absent in case of nonfunctional kidney and must not exclude the diagnosis. Emphasis should be placed on prenatal diagnosis and routine abdominal ultrasound for early detection.

Eighteen years lasting bronchial foreign body: A case report in Cameroon, sub-Sahara Africa.

INTRODUCTION: Foreign body aspiration represents an important cause of morbidity and mortality during childhood. A neglected aspirated foreign body can last for years, leading to complications that are sometimes difficult to manage, dramatically affecting the quality of life of the patient. CASE REPORT: We report the case of a 29-year-old female who presented with eighteen-year history of recurrent cough, choking, and respiratory infections following a foreign body aspiration. The course was complicated by a chronic secondary lung abscess, successfully managed by combined medical and surgical treatment. DISCUSSION: In low-income countries like ours, foreign body aspiration is often misdiagnosed. The often delayed management due to low socioeconomic status can lead to serious complications. To the best of our knowledge, it is the longest period of bronchial foreign body retention reported in the medical literature in Africa. CONCLUSION: Foreign body aspiration is common in childhood and requires early recognition and treatment, in order to avoid complications that can be very serious or even fatal.