Aggressive angiomyxoma as a rare cause of scrotum enlargement in a 10-month-old boy: a case report.

BACKGROUND: Aggressive angiomyxoma (AAM) is a locally infiltrative mesenchymal tumour that most commonly affects the pelvis and/or perineum in adult women. AAM is very rare in males, especially in infancy. CASE PRESENTATION: A 10-month-old fulani (African) male infant was referred to our department for a large painless mass in the right testicule. The mass was detected during the neonatal period and gradually increased in size. Ultrasound examination revealed a large heterogeneous lesion; computed tomography results led to the conclusion that the mass was a mesenteric hernia. An inguinal and scrotal surgical approach was adopted. Exploratory surgery found a normal right testicle displaced upwardly and a large scrotal mass. Radical excision of the mass and orchidopexy were performed. Subsequent histology and immunohistochemstry studies indicated that the mass was a scrotal angiomyxoma. The postoperative course was uneventful. No recurrence occurred during the 6-month follow-up. CONCLUSION: To the best of our knowledge, this is the youngest patient with AAM reported to date. Angiomyxoma should be included in the differential diagnosis of scrotal masses, for which radical excision is justifiable to prevent recurrence.

[Female inguinal herniain Niger : diagnostic, therapeutic and evolutionary aspects]. / La hernie inguinale de la fille au Niger : aspects diagnostique, therapeutique et evolutifs.

AIM: The aim of this study was to evaluate the diagnostic, therapeutic and evolutionary aspects of female inguinal hernia (ovarian hernia). PATIENTS AND METHODS: This was a prospective and descriptive study lasting 6 years (1st January 2014 to 31st December 2019). It included all girls aged 0 to 15 years old with ovarian hernia, received in the pediatric surgery department of the Hôpital National AmirouBoubacar Diallo in Niamey. The variables studied were the socio-demographic characteristics of the patients, personal and family history, and those related to diagnostic, therapeutic and evolutionary aspects. RESULTS: With 23 recorded cases, ovarian hernia had a hospital frequency of 8.7%. The average age of the patients was 5.6 years (range: 4 months and 11 years). The average duration of evolution before diagnosis was 8 months (range: 0 days and 36 months). The hernia was mainly located on the right side: 14 cases (60.85%). The hernial sac during the operation was most often empty: 11 cases (47.85%). It contained at least the ovary for 10 patients (43.5%). There were 2 cases of strangulated hernia (8.6%). All the patients benefited from a herniotomy. The average operating time was 26.7 days (range: 0 days and 146 days). No deaths and no postoperative complications were recorded after a 3-month follow-up. CONCLUSION: Ovarian hernia in this study is a rare condition often encountered in young girls. In spite of a late treatment, the therapeutic results were satisfactory.

BUT: Le but de cette étude était d'évaluer les aspects diagnostiques, thérapeutiques et évolutifs de la hernie inguinale de la fille (hernie de l'ovaire). PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive portant sur une période de 6 ans (1er janvier 2014 au 31 décembre 2019). Elle incluait toutes les filles âgées de 0 à 15 ans présentant une hernie de l'ovaire reçus dans le service de chirurgie pédiatrique de l'Hôpital National Amirou Boubacar Diallo de Niamey. Les variables étudiées étaient les caractéristiques sociodémographiques des patientes, les antécédents personnels et familiaux et celles liées aux aspects diagnostiques, thérapeutiques et évolutifs. RÉSULTATS: Avec 23 cas recensés, la hernie de l'ovaire avait une fréquence hospitalière de 8,7%. Les patientes étaient en moyenne âgé de 5,6 ans (extrêmes : 4 mois et 11 ans). La durée moyenne d'évolution avant le diagnostic était de 8 mois (extrêmes : 0 jours et 36 mois). La hernie était principalement située à droite : 14 cas (60,85%). Le sac herniaire au cours de l'intervention était le plus souvent vide : 11 cas (47,85%). Il contenait au moins l'ovaire chez 10 patientes (43,5%). Il y avait 2 cas de hernie étranglée (8,6%). Toutes les patientes bénéficièrent d'une herniotomie. Le délai opératoire moyen était de 26,7 jours (extrêmes : 0 jours et 146 jours). Aucun décès et aucune complication postopératoire après un suivi de 3 mois n'avaient été enregistrés. CONCLUSION: La hernie de l'ovaire est dans cette étude une affection rare rencontrée souvent chez la petite fille. Malgré une prise en charge tardive les résultats thérapeutiques étaient satisfaisants.

Waiting time for short-stay surgery in a paediatric surgery department.

AIM: The aim of this study was to assess the waiting time (WT) for a short-stay surgery and determine its possible determinant factors. PATIENTS AND METHODS: This was a retrospective study conducted in the Department of Paediatric Surgery at the National Hospital of Lamordé of Niamey, Niger. It included patients aged 0-15 years who benefitted from a short-stay surgery (24-48 h of hospitalisation) during a period of 19 months (1st January 2017 - 31st July 2018). Patient, diagnosis and surgical treatment data were gathered. WT was the time elapsed between the indication of a surgical operation and its realisation. The Kruskal-Wallis test was used with a threshold statistical significance of < 0.05. RESULTS: Short-stay surgery constituted 25.4% of all operating activities (n = 271). Inguinal or inguinoscrotal hernia was the most frequent pathology at 31.38% (n = 85). The mean WT was of 116.6 days (range: 4-491 days) and the median was 114 days. WT was greater than or equal to 3 months for 63.9% of the patients (n = 173). Based on pathology, the mean WT varied between 57.5 days (ovarian hernia) and 163.6 days (5.8 months) for epigastric hernia. A significantly longer WT was observed with the presence of a comorbidity (P = 0.0352) but was not associated with patient residence (P = 0.0951). CONCLUSION: A long WT for a short-stay surgery should be improved upon by different interventions with respect to the supply and demand of care and the setting of priorities.

Isolated Right-Sided Posttraumatic Diaphragmatic Hernia.

Diaphragm is a compliant musculoaponeurotic barrier located between thoracic and abdominal cavities. Traumatic diaphragmatic rupture is a rare clinicopathological entity. We report a case of right-sided posttraumatic hernia in a child following blunt trauma to highlight diagnostic difficulties and therapeutic specific aspects. A 10-year-old boy was admitted to the emergency surgical department with thoracic trauma following pedestrian accident. At admission a haemothorax was suspected and treated by pleural drainage. The diagnosis of a right-sided diaphragmatic rupture was made after computed tomographic scan forty-eight hours later. At surgery, a reduction of herniated abdominal content and a suture of diaphragmatic defect were performed. The postoperative recoveries were uneventful and the patient was followed up for 12 months without symptoms. The possibility of a diaphragmatic rupture should be kept in mind and sought after any trauma of the thoracoabdominal junction as the diagnosis can be challenging in emergency department.

Isolated gallbladder perforation after blunt abdominal trauma in children.

Injury of the gallbladder after blunt abdominal trauma is rare. Isolated contusion of the gallbladder is exceptional because of its anatomical localization. It is protected by the liver, intestines, the omentum, and ribs. Its clinical presentation is often insidious, the reason why the diagnosis is often made during an exploring laparotomy. The delayed diagnosis is often responsible for high morbidity and mortality. The early diagnosis is thus essential but still remains a challenge. We report a case of isolated perforation of the gallbladder after blunt abdominal trauma in a 15-years-old boy found at the stage of generalized peritonitis. The exploratory laparotomy leads to diagnosis and treating the lesion by cholecystectomy.