[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.

[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.

[Developing cancer from a probable misdiagnosed pancreatic cystadenoma]. / Cancérisation d'un probable cystadénome pancréatique méconnu.

This paper reports the malignant transformation of a benign pancreatic cyst treated by internal drainage in a 30-year-old woman. The initial lesion was diagnosed on surgical biopsy of the cyst wall. The diagnosis of pancreatic carcinoma was made after one year of satisfactory course, by fine needle cytologic aspiration of the fibrous retraction of the cyst; at that time the patient had severe pancreatic pain with multinodular liver on ultrasonography. The conclusion is the recommendation of total excision of pancreatic cysts whenever the diagnosis is incomplete or imprecise.

[Hepatocellular adenoma with a high level of alpha fetoprotein. Apropos of a case observed in the Central hospital of Yaoundé, Cameroon]. / Adénome hépato-cellulaire avec un taux élevé d'alpha foetoprotéine. A propos d'un cas observé à l'hôpital Central de Yaoundé, Cameroun.

The authors report a case of a young girl aged 23 years, suffering from hepato-cellular adenoma associated with a high level of alpha-foeto-protein. The patient after having been operated recovers and the level of alpha-foeto-protein returns to normal.

[Obstructive jaundice in Yaounde. Value of echography and transhepatic cholangiography in determining the cause]. / Ictères obstructifs à Yaoundé. Valeur de l'échographie et de la cholangiographie transhépatique dans la recherche de la cause.

The purpose of the study was to assess the clinical value of ultrasonography (US) and percutaneous transhepatic cholangiography (PTC) in the workup of obstructive jaundice in Yaoundé. From 3,000 ultrasonographic studies done between September 1987 and February 1990, the authors drew 37 cases of obstructive jaundice. 22 of them were explored with both US and PTC. The cause of obstruction was tumor for 14, inflammation or malformation for 4 and biliary stone for 4. US could predict the cause in 55 p. cent of cases and PTC in 77 p. cent of cases. PTC was particularly helpful in case of non tumoral causes. The authors conclude that, in their setting where computed tomography is scarce and expensive, the combination of both US and PTC is rewarding, when the problem is the determination of the nature of obstruction.

[Conservative treatment of splenic lesions by splenorrhaphy and incomplete splenectomy in abdominal injuries]. / Le traitement conservateur des lésions spléniques par splénorraphies et splénectomie partielle dans les contusions de l'abdomen.

Fifteen cases of rupture of the spleen were reported, in which a conservative form of treatment was applied with success. These consisted of 4 splenorrhaphies and 11 partial splenectomies. Collagen (PANGEN) was used in 6 of the cases to buttress the suture. In view of the relatively low incidence of post of complications, the authors are of the opinion that the above described treatment be widely applied in cases of rupture of the spleen, especially in the child where the spleen still plays a vital role.

[The value of metronidazole in the indications for appendicectomy in a tropical environment. Apropos of 183 cases]. / Intérét du métronidazole dans l'indication d'une appendicectomie en milieu tropical. A propos de 183 cas.

This work was carried out consequently to three observations followed up by regrettable consequences: one right hemicolectomy about acute perforated typhlitis, two post-operative fistulae about clinical feature of pseudo-appendicitis. A study was undertaken on 183 patients; 160 patients complained of chronic in right iliac fossa, 23 of acute or subacute pain. Out of the 160 chronic patients, treated by metronidazole did not show symptoms anymore. Out of the 23 acute patients, 14 were cured thanks to the amebicide test-treatment and the 9 others showed during surgical intervention: 4 phlegmonous appendicitis, 3 appendicitis with inflammation of the mucous membrane, 2 appendicitis with abscess. In the acute cases, the duration of the therapeutic test was 10 ho. In the operated chronic cases (37 out of 160), histology substantiated surgery in revealing typical lesions of chronic appendicitis sometimes associated to anatomical deformity such as diverticulum. The authors strongly suggest such a test-treatment by metronidazole. It is well accepted and has enabled to get rid of post-operative morbidity of appendicectomy in tropical milieu.