[A rare triple combination of mesenteric panniculitis, acute appendicitis and König´s syndrome in a patient operated for acute febrile intestinal obstruction: a case report]. / Une rare triple association de panniculite mésentérique, appendicite aigüe et syndrome de Koenig chez un patient opéré pour une occlusion intestinale aigüe fébrile: à propos d'un cas.

Mesenteric panniculitis is a primary inflammation of the mesentery with variable necrosis, inflammation and fibrosis of the fatty tissue. It can be idiopathic (primary) or secondary (associated) to other diseases, asymptomatic and accidentally discovered or revealed by abdominal pain or complications (intestinal obstruction or peritonitis). We here report the case of a 53-year-old patient, admitted with acute abdominal pain, cessation of the transit of materials and gases, in a febrile context. Patient's history included chronic abdominal pain suggesting König´s syndrome and epigastralgia lasting several years. Physical examination showed sore face and abdominal examination revealed mild bloating, marked tenderness in the right iliac fossa (RIF) and in the periumbilical region, without guarding or rigidity and borygms heard on auscultation and with normal rectal examination. A diagnosis of bowel obstruction and fever was made, with suspicion of meso-celiac appendicitis. Abdominal X-ray without preparation and ultrasound confirmed the diagnosis of bowel occlusion. Exploratory laparotomy revealed functional stenosis of the ileum (König´s syndrome) at 1.20m from the ileocecal junction, with multiple adhesions. Adhesiolysis revealed hyperemic appendix measuring 15cm long, whose anatomo pathological examination showed a mucous membrane with inflammatory infiltrate and a wall rich in polynuclear cells. Infiltration of the ileal mesentery causing color change (reddish and greyish in some areas) and small nodosities with friability and tearing on simple handling led to suspicion of mesenteric panniculitis, then confirmed by anatomopathological examination, showing inflammatory reaction in the fatty tissue specimen with infiltration by macrophages, associated with necrotic patches and degeneration. Treatment was based on bowel emptying, anterograde appendectomy, and a combination of corticosteroid (Dexamethasone 24 mg/day) and chymotrypsin (10000 IU/day). The patient´s outcome was good and he was discharged in the 10th postoperative day. The patient underwent clinical and paraclinical follow-up (3 months) for another unknown associated pathology or a pathology that may have occurred early.

[Mesenteric abscess due to Chryseobacterium meningosepticum revealing mesenteric Castleman´s disease in an immunocompetent young adult]. / Abcès mésentérique du au Chryseobacterium meningosepticum révélant la maladie de Castleman à localisation mésentérique chez un jeune adulte immunocompetent.

Mesenteric abscess caused by chryseobacterium meningosepticum is an extremely rare clinical entity, most often found in immunodeficient patients. Castleman disease can manifest as a mesenteric abscess. We here report the case of a 23-year-old patient admitted with generalized acute peritonitis evolving over the last 2 weeks. Abdominal ultrasound showed hypoechoic mass in the intestinal loops, without any further details. During laparotomy, pus was found in the large cavity, a mesenteric abscess was detected in the mesentery of the jejunum 35 cm from the angle of Treitz, without loop perforation and mesenteric adenopathy was found in corresponence with the abscess. Pyoculture isolated chryseobacterium meningosepticum. Histological analysis of mesenteric adenopathy biopsies showed structural anomalies, suggesting hyaline vascular type of Castleman disease. Treatment was based on incision and drainage of the abscess, with pyogenic membrane removal and abdominal cavity lavage with physiological saline solution. Chryseobacterium meningosepticum was only susceptible to Ciprofloxacin. The postoperative course was simple and the patient was discharged on postoperative day 10 after surgery. Clinical and paraclinical follow-up at 12 months did not show any other lymphadenopathy or recurrence. The purpose of this study is to show an extremely rare case of mesenteric abscess due to chryseobacterium meningosepticum associated with isolated mesenteric Castleman disease in an immunocompetent patient and management approaches.

Esophageal achalasia in an adolescent in Central Africa: a case report.

Esophageal Achalasia has rarely been reported in sub-Saharan Africa. We report a case of a 12 years old boy who has been diagnosed after experiencing dysphagia for a year and progressive wasting. Esophagogram was the only exploration available in our settings and showed classical features. He underwent a Heller esophago-cardiomyotomy with Toupet fundoplication. Postoperative period was unremarkable and BMI normalized for age and sex on the sixth postoperative month. In low settings, history is a key step which lead to clinical suspicion as esophagogram is often the only available exploration to confirm the diagnosis.

[Conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: a case serie]. / Traitement conservateur des omphalocèles géantes par l'éosine aqueuse disodique 2%: une série des cas.

Primary surgical closure for the treatment of giant omphalocele is punctuated by the onset of unpleasant complications. Conservative treatment is an option in low-income countries where neonatal resuscitation is associated with high mortality rates. We conducted a prospective study of patients admitted to the University Clinics of Lubumbashi between January and April 2020 and receiving conservative treatment based on dissodic 2% aqueous eosin according to a defined protocol. Three patients were included in our series. The mean age was 24 hours (1 - 48); they were all full term newborns (38 - 39 SA), born vaginally and with no prenatal diagnosis. Mean birth weight was 2,800 grams (2,400 - 3,000). Mean amniotic sac diameter was 13.7 cm (11 - 15 cm); it contained the liver in all cases. The median time to enteral feed was 4.3 days (4 - 5 days), to granulation was 31.7 days (30 - 33 days) and to epithelialization was 71.7 days (60 - 90 days). No death was reported. These preliminary results encourage the use of disodium aqueous eosin for the conservative treatment of unbroken giant omphaloceles.

[The role of open surgery in the treatment of patients with a history of extended and postinfectious ureteral stricture: a case report]. / La place de la chirurgie à ciel ouvert dans la reprise de la sténose urétérale étendue, ancienne et post infectieuse: à propos d'un cas.

The purpose of this study is to highlight the role of open surgery in the treatment of patients with a history of extended and postinfectious ureteral stricture as well as our experience with therapy. The study involved a 38-year old patient presenting at the urology service of the University Clinics of Lubumbashi with left lumbar pain, burning sensation during urination and fever. Clinical and paraclinical assessment showed extended ureteral stricture. Temporary urinary diversion (left ureterostomy) was performed followed by ureterectomy and left ureterovesical reimplantation. The postoperative course was simple. Three months after surgery the patient had no complaints, creatinine levels were normal, ultrasound and uroscan results were normal.

[Anorectal malformations: a 6-years review at the University Clinics of Lubumbashi]. / Malformations anorectales: revue de 6 ans aux Cliniques Universitaires de Lubumbashi.

Anorectal malformations (ARM) are developmental anomalies of the genitor anal elements, they represent a wide range of anomalies. An early diagnosis allows a better management as it reduces mortality associated with ARM, especially in developing countries. A prospective cross-sectional study has been carried, including patients from 0 to one year, admitted in our service for ARM. Twenty-four (24) patients have been considered. The median age was 2 days, the sex ratio 1/3 for female. Intestinal occlusions were the most frequent circumstances of diagnosis (50%), low ARMs were the most frequent, diagnosed in 11 patients (45.7%) of which 10 did not have any fistula. The most common associated malformation was intestinal atresia (3 patients). Anoplasty was done using abdominoperineal pull-through associated to anal dilatations in 13 patients (54.1%). Six patients died from unknown etiology and 6 were lost from the follow-up. Concerning the functional outcome, 12 of the 24 patients concerned by the study attended review and 3 of them presented signs of fecal incontinence, 9 of them were continents among whom 8 were diagnosed low ARM and one with high ARM. ARMs are encountered in our environment, nonetheless, the diagnosis is still made most of the time, during an intestinal occlusion. The mortality rate is still high and measures should be taken to allow long-term reviews, which will surely reduce the number of lost patients.

[Osteoarticular infections in patients with sickle cell disease in Lubumbashi: epidemiological study focusing on etiology and management]. / Les infections ostéo-articulaires chez les drépanocytaires à Lubumbashi: étude épidémiologique, étiologie et prise en charge.

INTRODUCTION: infections are the leading cause of morbidity and mortality in patients with sickle cell disease, especially before age 5 years. The purpose of this study was to highlight the epidemiological features, etiologies and management of osteoarticular infections in patients with sickle cell disease in Lubumbashi. METHODS: we conducted a descriptive, cross-sectional and retrospective study at the Research Center for Sickle Cell Disease in Lubumbashi (RCSCDL) over a three-year period from June 2014 to June 2017. It included all patients with sickle cell disease on follow up at the RCSCDL who developed osteoarticular infection. Data were obtained from a survey form. Parameters were patient's age, age at first visit, sex, reason for consultation, history, physical signs, diagnosis, paraclinical assessment and treatment. RESULTS: we identified 35 cases of osteoarticular infections out of a total of 380 cases of sickle-cell disease, reflecting a rate of 9.2%. The most affected age group was people under 5 years of age (37.1%); the average age was 10.9±9.5 years ranging from 8 months and 37 years. There was a slight female predominance (51.4% of cases; sex ratio 1.06 in favor of women). Most patients with osteoarticular infection had a history of transfusion (16.6%) and splenectomy (8.6%). The most common reason for consulting was limb pain (84%); 20 patients (57.1%) had bulbar conjunctival icterus and 26 (74.3%) were pale. Clinical examination showed limb swelling and wound in 27 patients (77.1%) and 19 patients (54.3%), respectively. Clinical palpation of the splenomegaly was performed in 6 patients (17.1%). Three types of osteoarticular infections were detected. They were dominated by osteomyelitis (24 cases; 68.57%) followed by osteitis (7 cases; 20%) and suppurative arthritis (4 cases; 11.43%). Out of 24 cases of osteomyelitis, 18 were acute (75%) and 6 were chronic (25%), of which 4 had a hyperostosing behaviour and 2 a fistulising behaviour. Tibia was the most affected bone (18 cases), X-ray mainly showed osteolysis (27 cases; 77.1%) and then periosteolysis (15 cases; 42.9%). Homozygous sickle cell disease was found in 88.6% of cases. Hemoculture was performed in 17 out the 35 patients and salmonella was isolated in 15 out of 17 cultures (88.23%). Pyoculture was performed in 10 patients; it isolated other germs. Assessment of inflammation was performed in 21 patients: 15 had hyperleukocytosis, 13 pathological white blood cell formula , all had increased sedimentation rate (greater than 20mm in the 1st hour). With respect to immunization schedule, 62.86% of patients received EPI vaccines while patients with sickle cell disease who needed specific vaccine had an adherence rate of 17.14%. With respect to therapy, all of our patients received medical treatment; 6 patients underwent sequestrectomy (17.14%) while the majority of patients (25 cases) underwent orthopedic treatment. Conclusion: bone infection in patients with sickle cell disease is a worryng issue in our poor environment where there isn't a specific vaccine for patients with sickle cell disease.

Congenital segmental dilatation of the jejunum in an African child: a case report.

Congenital segmental dilatation of the intestine is a rare disease. It is rarely located in the jejunum and its etiology is still unknown despite many theories suggesting its mechanism. We report a case of a 17 months girl who experienced nonspecific symptoms (abdominal pain, constipation and loss of appetite) since early her infancy. She had no growth retardation and had moderate abdominal distension on physical examination. Investigations undertaken could not increase suspicion of congenital segmental dilatation of the intestine (CSDI). The diagnosis was made peroperatively and a resection was done, followed by end-to-end jejunal anastomosis. There were no postoperative complications and the patient is doing well after four months. One should think of CSDI in children with chronic subocclusion or digestive hemorrhage.

[Angiosarcoma of the shoulder revealed by previous trauma: about a case and literature review]. / Angiosarcome de l´épaule révélé par un ancien traumatisme: à propos d´un cas et revue de la littérature.

Angiosarcoma is a rare tumor which can affect multiple sites. However, it most commonly arises from the skin. Then symptoms have been associated with clinical polymorphism. This tumor has a poor prognosis due to its high tendency to local recurrence and distant metastases. We here report the case of a 72-year old man in whom an angiosarcoma of the shoulder arose from a trauma which occurred one year before it was accidentally detected. The patient presented with persistent pain in a swelling area at the posterior portion of the shoulder involved in the trauma. Clinical examination showed previous and partially calcified hematoma. Diagnosis was based on puncture biopsy of the mass collecting 5 cc of blackish blood and on ultrasound. Shoulder x-ray was normal. An assessment of the swelling was performed. This helped to highlight and resect some reddish, significantly bleeding friable tissue hardly managed for two days and complicated by poorly tolerated anemia corrected with two blood transfusions. Anatomopathological examination of the resected tissues showed moderately differentiated angiosarcoma unfortunately without healthy margins. Staging evaluation was performed in order to detect metastases. No local recurrence was reported over a period of three months and the patient was referred to a specialized center in Lusaka for complementary radiotherapy. The purpose of this work is to report a rare case of angiosarcoma accidentally detected in a patient with a history of trauma to the left shoulder and to highlight the therapeutic features, while conducting a literature review.

[Cystic hygroma of the neck in a young adult: about a case and literature review]. / Lymphangiome kystique du cou chez un adulte jeune: à propos d'un cas et revue de la littérature.

Cystic hygromas are congenital malformations affecting the lymphatic system. These are rare benign dyssembryoplastic lesions mainly affecting the head and neck, in particular the posterior triangle of the neck. They usually occur during childhood and exceptionally in adults. We here report a clinical case of cystic hygroma of the neck in a 22-year old subject.

[Acute prostatitis associated with noncancerous prostate at the Lubumbashi University Clinics: epidemioclinical and therapeutic features]. / Prostatites aiguës sur prostate non tumorale aux cliniques universitaires de Lubumbashi: aspects épidémio-clinique et thérapeutique.

INTRODUCTION: acute prostatitis is a common urological condition. The purpose of this study was to analyze the epidemioclinical features and therapy of acute prostatitis associated with noncancerous prostate at the Lubumbashi University Clinics. METHODS: we conducted a descriptive cross-sectional and retrospective study of a series of 25 patients with documented acute prostatitis and treated at the Lubumbashi University Clinics over a period of four years, from 2015 to 2018. All patients with prostate cancer were excluded from our study. Data were collected via a survey form based on different study parameters divided into 3 categories, namely epidemiological data including age, study period, residence, clinical data with subjective signs, objective signs, general status, findings on rectal examination as well as paramedical data divided into laboratory and imaging tests. RESULTS: acute prostatitis associated with noncancerous prostate accounted for 1.27% of all surgical diseases and 7.66% in urology. The most affected age group was 19-37 years (64% of cases), mean age was 33.16±2.4 years. Seventeen patients (68%) were followed up in outpatient clinics and 8 (32%) in hospital. Clinically, fever above 38.5°C was found in 15 patients (60%), dysuria in 11 patients (44%), acute urinary retention in 3 patients (12%), burning during urination in 8 patients (32%), pain syndrome in 21 patients (84%), tender prostate on rectal examination in 18 patients (72%). Ultrasound was the only examination performed in 16 patients (64%). Biologically, assessment of inflammation was performed almost systematically in all patients (100%) including complete blood count (CBC), sedimentation rate (SR), C reactive protein (CRP) levels; blood culture was performed in 4 patients (16%), three of whom had positive blood culture. All patients underwent cytobacteriological examination of the urine or prostatic secretions collected by prostate massage. Urine culture was sterile in 6 patients (24%) and positive in 19 patients (76%). Escherichia coli was the most common germ in 16 out of a total of 19 patients (84.21%). All patients received rectal anti-inflammatory drugs. Fluoroquinolones were the most used antibiotics in 18 patients (64%), twelve of whom received antibiotics as monotherapy. Six out of 25 (24%) cases were associated with orchiepididymitis. The lenght of treatment ranged from 2 to 4 weeks, with either sterilization in secretions or urine or disappearance of leukocyturia as the criteria for treatment discontinuation. Thus, out of 19 patients with positive culture on admission, 14 underwent a second culture (73.68%) at 2 weeks of treatment, three of whom (12%) still had positive test and had to undergo a third culture 4 weeks after they had started treatment. Patient's course was good in 22 cases (88%) with complete clinical and biological remission; three patients (12%) persisted in symptoms which became chronic; no patients had prostatic abscess. CONCLUSION: acute prostatitis associated with noncancerous prostate is a really worrying urological, nosologic condition whose management must be rigorous, especially in people at risk, namely those with intense sexual behaviour. Endorectal ultrasound and prostate massage should be integrated into patient care at the Lubumbashi University Clinics.

[Recurrent hernia of the Jean Louis Petit triangle: a case study]. / Récidive d'une hernie primaire de Jean-Louis Petit: à propos d'un cas.

Hernia of the Jean Louis Petit triangle and hernia of Grynfeltt's quadrilateral space can be classified as lumbar hernias. Its clinical diagnosis is confirmed by computed tomography and, possibly, by ultrasound or x-ray. There is a formal indication for surgery including swelling or functional discomfort but, above all, the risk of strangulation. We here report a rare case of recurrence of primary hernia of the Jean Louis Petit triangle in a 65-year old man.

[Delayed management of anorectal malformation with rectouretrobulbar fistula: a case study]. / Malformation anorectale avec fistule recto-uretro-bulbaire prise en charge tardivement: à propos d'un cas.

Ano-rectale malformations (ARM) are a spectrum of heterogeneous abnormalities in the development of the rectal canal. Its incidence is usually low and it is a little higher in some developing countries. Boys are more affected than girls and rectobulbar fistula associated with atresia of the anal canal is the most frequent disorder among them. We report the case of a 10-months old infant of male sex, whose mother lived in a mining area and had been complaining of fecaluria since the birth of her child. Physical examination showed fingerprint 1 cm below the intersection of the median raphe and the bi-ischiatic line. Paraclinical examinations showed no other associated malformation. Patient's management was based on anorectoplasty through abdominal and perineal approach with lower abdominoperineal reconstruction. In the post-operative period, the patient received antibiotic treatment and intravenous analgesia as well as dilations, which continued after discharge 2 weeks after surgery. No complications were observed and outcome was favorable.

[Recurrent invasive bladder urothelial carcinoma treated by cystectomy with substitutive ileal enterocystoplasty: case report]. / Carcinome urothélial invasif vésical récidivant traité par cystectomie avec enterocystoplastie iléale de substitution: à propos d'un cas.

We here report a case of bladder urothelial carcinoma, a rare tumor in subjects less than 40 years, as well as our therapeutic experience. The study involved a 37-year old patient with a history of urinary tract infection and of staying at a riparian area (bilharzia) presenting with hypogastralgia and total macroscopic hematuria. Clinical and paraclinical assessment showed voluminous bladder mass suggesting infiltrative tumor without local or distant lymph node or organic involvement. Surgical management was based on resection of bladder tumor and biopsy followed by total cystectomy with substitutive ileal enterocystoplasty. The postoperative course was uneventful. The patient also underwent adjuvant chemotherapy and vitamin B-12 therapy. Clinical and paraclinical assessment, performed after 6 and 12 months, showed no recurrence.