Ileal perforation peritonitis secondary to ingestion of magnetic beads in the older child: A case report.

INTRODUCTION AND IMPORTANCE: Foreign body ingestion is frequent in younger children, with generally good outcome on conservative management. However, magnetic beads ingestion is an exceptional cause of intestinal perforation in the older children. CASE PRESENTATION: An 8-year-old boy presented with clinical signs of generalized acute peritonitis. Abdominal plain X-ray confirmed the foreign object in the digestive tract and oriented the etiology by highlighting several air-fluid levels, distended small bowel loops, pneumoperitoneum and the presence of a bilobed foreign body projected adjacent to the 5th lumbar vertebra. Open surgical exploration was performed and revealed a peritoneal fluid, 2 perforations in the small bowel and 2 adhered pieces of magnets. A 20 cm ileal resection, including the segment with the 2 perforations, was performed followed by a terminal ileostomy. The restoration of gastrointestinal continuity was performed 16 days later. After a follow-up of 2 years and 8 months, the patient was free of any symptom. CLINICAL DISCUSSION: In cases of acute peritonitis due to perforation, the general condition deteriorates progressively. Fever may be absent, as was the case with our patient. Abdominal pain is the predominant symptom, it is often accompanied by vomiting that can be alimentary, bilious, or even fecaloid and/or by cessation of bowel movements and/or gas. Abdominal rigidity is a major physical sign, sometimes replaced by generalized guarding. CONCLUSION: Ingestion of gastrointestinal foreign bodies is rare in older children, the presence of more than one magnet can lead to peritonitis due to intestinal perforation.

Telomere Dysfunction in Pediatric Patients with Differences/Disorders of Sexual Development.

Differences/Disorders of sex development (DSDs) are conditions in which the development of chromosomal, gonadal, and anatomical sexes is atypical. DSDs are relatively rare, but their incidence is becoming alarmingly common in sub-Saharan Africa (SSA). Their etiologies and mechanisms are poorly understood. Therefore, we have investigated cytogenetic profiles, including telomere dysfunction, in a retrospective cohort of Senegalese DSD patients. MATERIALS AND METHODS: Peripheral blood lymphocytes were sampled from 35 DSD patients (mean age: 3.3 years; range 0-18 years) admitted to two hospital centers in Dakar. Peripheral blood lymphocytes from 150 healthy donors were used as a control. Conventional cytogenetics, telomere, and centromere staining followed by multiplex FISH, as well as FISH with SRY-specific probes, were employed. RESULTS: Cytogenetic analysis identified 19 male and 13 female patients with apparently normal karyotypes, two patients with Turner syndrome, and one patient with Klinefelter syndrome. Additional structural chromosome aberrations were detected in 22% of the patients (8/35). Telomere analysis revealed a reduction in mean telomere lengths of DSD patients compared to those of healthy donors of similar age. This reduction in telomere length was associated with an increased rate of telomere aberrations (telomere loss and the formation of telomere doublets) and the presence of additional chromosomal aberrations. CONCLUSIONS: To the best of our knowledge, this study is the first to demonstrate a correlation between telomere dysfunction and DSDs. Further studies may reveal the link between telomere dysfunction and possible mechanisms involved in the disease itself, such as DNA repair deficiency or specific gene mutations. The present study demonstrates the relevance of implementing telomere analysis in prenatal tests as well as in diagnosed genetic DSD disorders.

Management of Umbilical Hernia in African Children: The Experience of 2146 Cases.

Aims: Umbilical hernia (UH) is common in African and African-descent children. In high-income countries (HICs), it is considered benign, which is not the case in Sub-Saharan ones. Through this study, we aimed to share our experience. Materials and Methods: A descriptive review was conducted from January 01, 2012 to December 31, 2017 at Albert Royer National Children's Hospital Center. Among the 2499 patients, 2146 cases were included in the review. Results: UH had a frequency of 6.5%, with patients having a mean age of 2.6 years, with a male preponderance of 63%. Emergency consultation occurred in 37.1%. The symptomatic hernia was present in 90.9%. The congenital type was found in 96%, a history of painful episodes was reported in 46%, and medical and surgical comorbidities were found in 30.1% and 16.4%, respectively. Multimodal anesthesia was used in 93.1%. A lower umbilical crease incision was made in 83.2%, the sac was not empty in 16.3%, and additional umbilicoplasty was performed in 16.3%. During a 14-month follow-up, a complication occurred in 6.5% and mortality in 0.05%. Conclusion: In our region, the pediatric UH was predominantly symptomatic, with its natural evolution leading to more complications than in HICs. Its management carried acceptable morbidity.

[Management of congenital diaphragmatic hernia in sub-Saharan Africa: experience in the Albert Royer National Children's Hospital Center, Senegal]. / Prise en charge de la hernie diaphragmatique congénitale en Afrique sub-Saharienne: l'expérience du Centre Hospitalier National d'Enfants Albert Royer au Sénégal.

Introduction: congenital diaphragmatic hernia has been rarely reported in Africa. It can manifests early or late. Prognosis mainly depends on associated malformations. The purpose of this study is to report our experience in the Albert Royer National Children's Hospital, Dakar, Senegal. Methods: we conducted a retrospective study of patients treated for congenital diaphragmatic hernia between January 2010 and December 2019. Results: twelve patients were enrolled, with an average age of 8.9 months. Bochdalek hernias were detected in 10 patients. The most common symptoms were respiratory symptoms (83.3%), followed by digestive symptoms (41.6%). Thoraco-abdominal X-ray was used to make a diagnosis in all patients. Three patients underwent preoperative stabilization. All patients underwent laparotomy. Hernia sac was found in 10 patients, and 50% of patients had a defect measuring between 5 and 10 cm. The postoperative course was simple in 10 patients; a polymalformed patient died. Conclusion: congenital diaphragmatic hernia is a reality in our environment; it most often manifests beyond the neonatal period. Prognosis is generally good in our context.

Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal.

Objective: Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department. Methods: We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression. Results: Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425). Conclusion: The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.

[Meckel's diverticulitis by ascaris in children: about a case]. / Diverticulite de Meckel d´origine ascaridienne chez l´enfant: à propos d´un cas.

We here report the case of a 4-year-old male child presenting with congenital umbilical bud that, recently, had begun to bleed. Physical examination showed pinkish umbilical bud with blood stains but without any fistula, measuring about 1,5 cm in diameter. Abdominal ultrasound was performed, which suggested urachal sinus. Surgery revealed umbilical bud communicating, in the abdominal portion, with hyperemic, inflammatory Meckel´s diverticulum placed 90 cm away from the ileocaecal angle in which many ascaris were detected. Anatomo-pathological examination of the surgical specimen showed diverticulitis. Thus, the diagnosis of Meckel´s diverticulitis by Ascaris was retained. Resection and anastomosis with bud excision were performed. The postoperative course was simple even after a 6-month follow-up period.

Choledochal cyst in children in dakar: Diagnostic and therapeutic aspects.

CONTEXT: Choledochal cyst is a rare malformation that mainly affects girls. AIMS: The aim of this work is to report the diagnostic, therapeutic and evolutionary aspects of bile duct cyst in children in Dakar. SUBJECTS AND METHODS: we conducted a prospective monocentre descriptive study from 1 July, 2016, to 30 June, 2019, in the Pediatric Surgery Department of Albert Royer Children's Hospital in Dakar. The studied parameters featured clinical, biological, radiological, therapeutic and evolutionary data. Overall, ten patients, including eight girls and two boys, were selected. RESULTS: Two patients presented the classic triple-syndrome complex featuring an abdominal pain, an abdominal mass and jaundice. Most of the patients presented a symptomatology associating abdominal pain and vomiting. Biological cholestasis syndrome was present in six cases and biological cytolysis syndrome in five cases. The abdominal ultrasound-computed tomography (CT) scan confirmed the diagnosis and helped to set the Todani classification with a predominance of Types 1 and 4. Surgical treatment by laparotomy consisted of total excision of the cyst followed by a Y-en-Roux hepatico-jejunal anastomosis in nine cases, whereas we performed a drainage of the cyst in one case. Two patients presented a morbidity of anastomotic suture release and evisceration and had a good outcome after surgical repair. There was no mortality. CONCLUSIONS: The diagnosis of choledochal cyst dilatation (CCD) can be suspected in the postnatal period on the basis of a gastro-intestinal symptomatology with or without associated to jaundice. The combination ultrasound-abdominal CT-scan helps set the diagnosis. The laparatomic approach always has its place for the management of CCD, especially in our context.

Elbow floating in children: About three cases and literature review.

PURPOSE: The aim of this study was to determine the epidemiological, lesion, treatment and outcome of the 'floating elbow' in children. OBSERVATIONS: It was two boys and a girl with a mean age of 7 years. The average consultation time was 3.6 h. In two patients, the trauma had occurred during playful accident with fall from a height. Supracondylar fracture was associated with a fracture epiphyseal separation-type II distal end of the right radius in one case, a fracture of the distal quarter of the bones 2 of the forearm in the second patient and fracture quarter distal radius in the third patient. All fractures of the elbow were treated by osteosynthesis as well as a fracture of the distal radius ». The average hospital stay was 5 days. After a mean of 8 months was rated limitation of elbow flexion to 100° in a patient, an externalisation of the pins at the elbow in M3 in one patient and a limitation of elbow extension at 30° in 2 patients. One patient had a varus ulna. The pronosupination was preserved in all patients. CONCLUSION: The 'floating elbow' is unusual in children and usually occurs during a high-energy trauma. His treatment is not yet the subject of consensus. Complications often involve the elbow.

[Omphalomesenteric fistulas; epidemiological diagnostic and therapeutic features: study of four cases in the Department of Pediatric Surgery at the Aristide Le Dantec University Hospital in Dakar]. / Fistules omphalo-mésenteriques; aspects épidémio logiques, diagnostiques et thérapeutiques: à propos de quatre observations au Service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar.

This study aims to determine the epidemiological, therapeutic and diagnostic features of omphalomesenteric fistulas (OMF). We conducted a study of four cases over a period of 10 years, from January 2004 to December 2013. The parameters studied were: frequency, age, sex, clinical and radiological signs, therapeutic and evolutionary features. Frequency was 0.4 cases per year. Patients were aged 11 days, 40 days, 45 days and 3 years respectively (three girls and one boy). Clinical examination showed intestinal fluid discharge from the belly button and belly button bud catheterisable in all the cases. The bud was prolapsed in the patient aged 45 days. Fistulography performed in two cases helped to confirm the diagnosis by showing a communication between the fistula and the small intestine. The assessment of malformations revealed congenital cyanogen heart disease with interventricular communication in the newborn aged 45 days, anorectal cloacal malformation associated with urachus fistula in the newborn aged 11 days. All patients underwent surgery. Semicircular periumbilical incision was performed in the absence of associated abdominopelvic malformations. A communication between the fistula and the ileum was found in the majority of cases. Bowel resection with termino-terminal anastomosis was performed in three cases. Cuneiform resection was performed in one case and was completed by complete resection of the urachal fistulous tract and bladder suture, with colostomy in newborn with urachal fistula and anorectal cloacal malformation. The postoperative course was marked by non-febrile seizures in the first child with good evolution and by superficial parietal suppuration followed by death due to cardiac decompensation in the third case. Omphalomesenteric fistula is rare. Diagnosis is based on clinical examination complemented by the fistulography. Surgical treatment using semicircular periumbilical incision gives good results. However, the assessment of malformations is necessary.

[Transanal evisceration of small bowel caused by impalement in children: about a case]. / Eviscération transanale de l´intestin grêle par empalement chez l´enfant: à propos d´un cas.

Transanal evisceration of the small intestine caused by impalement is exceptional among children. We report the case of an 11-year old girl with intestinal loops eviscerating through the anus due to a fall on a sharp piece of wood which stuck into her, occurring two hours before hospitalization. On examination, his general condition was good, with transanal evisceration of approximately 25 cm of viable small bowel through the anus and abdominal tenderness. Preoperative laboratory tests were normal and no imaging test was performed. After resuscitation, surgical exploration was performed which showed serohematic fluid collection (300 ml) and evisceration of approximately 60 cm of inflammated intestinal loops through a rupture of approximately 5 cm of the anterior wall of the rectum. Reduction of the eviscerated intestinal loops by gentle traction, repair of the rectal wall by separated sutures, wash and drainage were performed. The patient received broad-spectrum antibiotic. The operating suites were simple with a resumption of transit two days after surgery. The patient was discharged seven days after surgery. After a follow-up period of one month, the patient came for a further consultation and clinical examination was normal.

Peritoneal Tuberculosis in Infants: Diagnostic Challenges.

Abdominal tuberculosis is rare in immunocompetent infants. We report on two infants with peritoneal tuberculosis (6 and 8 months) who underwent laparotomy for suspected intussusception. In the first patient, characteristic lesions of peritoneal tuberculosis were observed intraoperatively with presence of multiple granulations. Tuberculin intradermal reaction (IDRt) was positive and tuberculous contagium could be cultured. In the second patient, the IDRt and GeneXpert tests were negative. In both patients, the histopathological examination of the biopsy specimens confirmed the diagnosis of peritoneal tuberculosis. The clinical courses under tuberculostatic therapy were favorable in both cases.

[Accidents of the everyday life (AcVC) in children in Dakar: about 201 cases]. / Les accidents de la vie courante chez l'enfant à Dakar: à propos de 201 cas.

Accidents of everyday life (AcVC) are common in children and can led to disabling injuries and death. This study aimed to analyze the epidemiological aspects of AcVC and the related injury mechanisms in Dakar. We conducted a descriptive, cross-sectional study conducted from 1 January 2013 to 30 June 2013. All the children victims of domestic accidents, sport and leisure accidents or school accidents were included. We studied some general parameters and some parameters related to each type of AcVC. Two hundred and one children were included, accounting for 27% of emergency consultations. There were 148 boys and 53 girls. Children less than 5 years of age were most affected (37.8%). Football and wrestling game were the main causes of AcVC. AcVC occur mainly at home (58.2%) and in the areas of sport and recreation (31.8%). The fractures predominated in the different types of AcVC: 54.9% of domestic accidents, 68.8% of sport and recreation accidents and 40% of school accidents. From an epidemiological perspective, our results are superimposable to literature. Fractures predominated contrary to literature where bruises were preponderant. Wrestling game is the main cause of these fractures, after football. The acquisition of knowledge about the epidemiological aspects of AcVC and the related injury mechanisms will allow for prevention campaigns in Dakar.

[Volvulus of the small intestine caused by mesenteric lipoma]. / Volvulus du grêle sur lipome du mésentère.

We report the case of a 7-year old girl presenting with sub-occlusive syndrome associated with acute paroxysmal abdominal pain at the level of the upper abdomen, vomiting and no evacuation of faeces. Physical examination showed discomfort with palpation of the upper abdomen. Abdominal ultrasound showed poorly limited intraperitoneal tissue formation without vascular features on doppler, exercising a mass effect on the neighborhood structures; mesenteric vessels were in their normal position. This mass on CT scan scorresponded to a well limited lipomatous formation exercising a mass effect on the caecum associated with volvulus of the small intestine. The diagnosis of volvulus of the small intestine caused by mesenteric lipoma was retained. Surgical exploration confirmed this diagnosis. The patient underwent unrolling of the small intestine and lipoma enucleation. The postoperative course was uneventful after a follow-up of 6 months. Anatomo-pathological examination confirmed the lipomateuse nature of the mass.

Pyloric atresia: a challenge in an underdeveloped country.

Pyloric atresia is a rare congenital malformation. We report a case in a 5-day newborn with pyloric atresia type C. Authors emphasize the diagnostic difficulties and therapeutic challenges in a resource-limited country.

[Volvulus of the small bowel due to ascaris lumbricoides package: about a case]. / Volvulus du grêle sur paquet d'ascaris: à propos d'un cas.

We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.

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.