Severe head injury in children: Management of a traumatic craniotomy case in a resource-constrained hospital.

INTRODUCTION AND IMPORTANCE: Craniocerebral wounds are potentially serious and life-threatening injuries. These are real medical and surgical emergencies. The authors report a case of craniocerebral injury in a child with extensive craniotomy and its management in a hospital with limited resources in Togo. CASE REPORT: He was a young 11-year-old schoolboy who presented with an extensive craniocerebral injury with craniotomy after a road traffic accident. On admission, he had no focal neurological deficits or other signs related to an intracranial expansive process. After preoperative reanimation, antibiotic therapy and anti-tetanus serovaccination, he was taken to the operating room by general surgeons. He underwent lavage, suture of the dura mater, placement of the bone flap and suture of the scalp wound. The postoperative course was simple. CLINICAL DISCUSSION: Cranioencephalic trauma is one of the main causes of pediatric mortality in developing countries. Cranio-cerebral wounds are a therapeutic emergency because of the risk of infection, which remains the main concern. Treatment consists of a medical component followed by a surgical component. Reanimation remains an essential component of medical treatment. CONCLUSION: Craniocerebral wounds are serious injuries. It requires rapid and appropriate medical and surgical management to avoid complications, particularly infection.

Psoas primary abscess: A case report in an immunocompetent subject.

INTRODUCTION: Primary psoas abscess is a rare disease characterised by a purulent collection in the thickness of the psoas muscle. Its incidence and etiopathogenesis are not well defined. It is mainly encountered in developing countries in weakened conditions. The involvement of an immunocompetent subject is exceptional. We report a case of primary psoas abscess in an immunocompetent patient in Togo. CASE PRESENTATION: A 67-year-old retired teacher with no previous medical history was seen in the emergency room with acute and severe abdominal pain. The clinical examination revealed an infectious syndrome and a painful abdominal mass in the right iliac fossa. CT scan showed a heterogeneous fluid collection in the right psoas muscle. Surgical drainage was indicated and performed. The patient was treated postoperatively with dual antibiotics with a favourable outcome. No germs were isolated from the collection. CLINICAL DISCUSSION: Rare infectious disease, its real incidence is unknown. The most common germ is staphylococcus aureus. Its etiopathogenesis is also poorly understood. Immune deficiency is a predisposing factor for the condition. Diagnosis of the disease is difficult due to a lack of specificity of the signs encountered. Imaging is the key to positive diagnosis with a high sensitivity of CT scan. Treatment is medical-surgical with drainage and antibiotic therapy. CONCLUSION: Primary psoas abscess is a potentially serious disease requiring early diagnosis and management.

The place of presumptive diagnosis in the management of peritoneal tuberculosis: A case report from rural Togo.

INTRODUCTION AND IMPORTANCE: Tuberculosis is a major public health problem in developing countries. Its main abdominal form is peritoneal. The diagnosis of this peritoneal form is complex and difficult. We describe the role of presumptive diagnosis in the management of this condition in Togo, based on a case study. CASE PRESENTATION: A security guard with no previous pathological history was seen in consultation with febrile ascites. Investigations revealed the exudative and lymphocytic nature of the ascites. The other investigations did not reveal any other organic lesion, particularly hepatic, or the germ. This typical ascites picture had for us a strong diagnostic value in favour of a tubercular origin. The patient was treated with antituberculosis drugs for 6 months. The evolution was satisfactory. CLINICAL DISCUSSION: The diagnosis of peritoneal tuberculosis is difficult. Biological explorations are rather disappointing in this approach. Laparoscopy coupled with histological examination represents the best means of diagnosing peritoneal tuberculosis to date. However, in developing countries, the absence of these resources poses a real problem. Clinical and biological arguments are always at the forefront of the diagnosis in endemic countries. The latter is based on the demonstration of febrile, exudative and lymphocytic ascites. CONCLUSION: The difficult diagnosis of peritoneal tuberculosis coupled with the lack of technical facilities gives the presumptive diagnosis an important place in the management of this condition in endemic countries.