[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. / Ascite urinaire, uropéritoine et péritonite urinaire chez l'enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar.

OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

[Bladder neck traumatic rupture in children]. / Rupture traumatique du col vésical chez l'enfant.

Transverse rupture of the bladder neck injury is rare in children. We report a new case in a 10-month boy with urinary peritonitis. Diagnosis was intraoperative. Surgical treatment in emergency with urethrovesical anastomosis protected by a perivesical drain and a large-bore urinary catheter was performed without urogenital complication.

[Spontaneous intraperitoneal rupture of hydronephrosis in an infant]. / Rupture spontanée intrapéritonéale d'une hydronéphrose.

Spontaneous intraperitoneal rupture of hydronephrosis is a rare complication. We report a case in a 30-month old boy admitted for fever, with a temperature up to 38.5°C, and abdominal distension. The diagnosis was made intraoperatively. The treatment consisted of an emergency internal urinary diversion and a deferred definitive cure of the pyelo-ureteral junction stenosis. Surgical management in two steps is more prudent and beneficial.

[Isolated prostate tuberculosis. Report of a case in Madagascar]. / Tuberculose prostatique isolée. A propos d'un cas à Madagascar.

Isolated prostate tuberculosis is uncommon. Authors report herein the case of 64-year-old man who presented obstructive syndrome of low urinary tract. After clinical and biological examination, and imagery, prostate cancer was highly suspected. Transrectal biopsy was performed and histological examination showed tuberculosis lesions. We suggest that prostate tuberculosis should be evoked in old patient presenting similar signs and living in tuberculosis endemic zone.

Mortalite pediatrique aux urgences chirurgicales du centre hospitalier Universitaire d'Antananarivo

Objectif: La place et les problematiques des urgences chirurgicales pediatriques dans un pays en developpement ne sont pas bien connues. Aussi; nous sommes-nous permis de determiner la frequence et les facteurs de risque de mortalite pediatrique dans le cadre des urgences chirurgicales. Patients et methode: Il s'agit d'une etude retrospective sur dossiers; menee dans le service des urgences chirurgicales du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona d'Antananarivo. Tous les malades ages de moins de 14 ans admis dans le service du 1er janvier au 31 decembre 2006 et decedes quelle que soit leur pathologie etaient inclus. Resultats: La mortalite pediatrique s'elevait a 15;92 pour 1000 enfants hospitalises. L'age moyen des malades etait de 2;6 ans et 53;84avaient moins d'un an. Le sexe masculin representait 61;53. Une proportion de 88;52etait issue d'une famille a faible niveau socio-economique. La duree moyenne d'evolution de la maladie avant la consultation etait de 3;2 jours avec des extremes allant de deux heures a 16 jours. Les etiologies etaient dominees par les pathologies digestives acquises ou congenitales. Conclusion: Le retard de la prise en charge lie au probleme socio-economique; au manque d'equipement et la penurie de personnels qualifies pour la chirurgie pediatrique etaient autant de facteurs qui avaient accru la mortalite. Ainsi; la creation d'une unite d'urgence pediatrique est justifiee car le nombre de passage est assez consequent; ceci afin de reduire la mortalite

[Paratesticular tumors seen in UTH Ravoahangy-Andrianavalona: epidemioclinical and therapeutical aspects]. / Les tumeurs paratesticulaires rencontrées au CHU Ravoahangy-Andrianavalona : aspects épidémiocliniques et thérapeutiques.

OBJECTIVES: To analyze the frequency, clinical and therapeutical aspects of paratesticular tumors encountered in Universiatry Teaching Hospital Ravoahangy-Andrianavalona. METHODS: This a retrospective study carried out on 12 patients with paratesticular tumor seen in UTH Ravoahangy-Andrianavalona between January 1997 and December 2007. Studied parameters were: age, discovery circumstances, primitive or secondary character of the tumor, histological type and their surgical management. RESULTS: Twelve paratesticular tumors have been recorded amongst 1380 patients admitted for an urogenital tumor with a prevalence of 0.86% which represents one case per year. Middle age is 52 years (ranged from 6 to 68 years). Discovery circumstances were as follows: scrotal tumor in 75% of the cases (nine patients) and inguinofunicular tumor in 25% of the cases (three patients). Many histological types of tumors have been encountered: four cases of rhabdomyosarcoma (33.33%), one case of liposarcoma (8.33%), two cases of adenocarcinoma (16.66%), two cases of fibromas (16.66%) and three cases of leiomyoma (25%). Tumors were primitive in 10 patients (83.33%) and metastatic in two cases (16.66%). The surgical management were: large orchidectomy by high inguinal incision with lymphadenectomy in four cases; large orchidectomy by high inguinal incision without lymphadenectomy in four cases; large orchidectomy by high inguinal incision with hemiscrotectomy in one case; simple tumorectomy in three cases. CONCLUSION: Paratesticular tumors are rare and polymorphous. Clinical presentation is variable and the diagnosis is often delayed. Treatment is essentially surgical. Our study illustrates large histopathological variety of paratesticular tumor.

[Isolated testicular tuberculosis in children. Report of 2 Malagasy cases]. / Tuberculose testiculaire isolée chez l'enfant. A propos de 2 cas malgaches.

Isolated testicular tuberculosis is rare. The authors report 2 cases in children. The clinical features had no specificity: one case of hydrocele and 1 case of acute scrotum inflammation. Surgical exploration showed testicular nodules in both cases. Only histological examination provided the definitive diagnosis. The details of diagnosis and treatment are discussed and compared to the information available in the literature.

Grossesse heterotopique revelee par une rupture de grossesse ampullaire: fait clinique

La grossesse heterotopique represente une affection rare; caracterisee par la coexistence d'une grossesse intra-uterine et d'une grossesse extra-uterine chez une meme patiente. Nous en rapportons un cas survenu chez une femme de 40 ans; revele par un tableau clinique d'hemoperitoine massif. L'echographie demandee en urgence avait permis de porter le diagnostic. Une salpingectomie gauche etait pratiquee. Les suites operatoires etaient marquees par la survenue d'une fausse couche malgre la tocolyse et la manipulation minime de l'uterus en peroperatoire. Les particularites diagnostiques; l'etiopathogenie ainsi que les principes du traitement sont discutes a la lumiere d'une revue de la litterature

[Pheochromocytoma revealed by stroke in a child]. / Phéochromocytome révélé par un accident vasculaire cérébral chez un enfant.

Pheochromocytoma is uncommon in children. We report herein a case in a 6-year-old boy whose pheochromocytoma was revealed by cerebral ischemia as a consequence of acute-cardiac failure. Twenty-four-hour urinary catecholamines were markedly increased. Abdominal ultrasonography and computed tomography located the tumor on the left adrenal gland. After surgical excision, hypertension disappeared. Diagnosis and treatment of pheochromocytoma in children are discussed.

[A rare case of polyorchidism: review of the literature]. / Un cas rare de polyorchidie: revue de la littérature.

Polyorchidism is a rare congenital anomaly. We report 1 case in a Malagasy young man revealed by left scrotal mass. The diagnostic was suspected by clinical examination and confirmed by testicular sonography. Management is conservative, based on clinical and sonography surveillance of supernumerary testicle.

Les cancers de la vessie vus au CHU Joseph Ravoahangy Andrianavalona

Le cancer de la vessie regroupe des lesions tres diverses sur le plan clinique et surtout histopronostique. Aucune etude n'a ete realisee a Madagascar sur cette pathologie. L'objectif de cette etude est de determiner les aspects epidemio-cliniques et therapeutiques de cette pathologie cancereuse. Patients et methodes: Une etude retrospective sur une periode de 6 ans portant sur les dossiers des patients presentant un cancer de la vessie a ete faite au service d'urologie du CHU Joseph Ravoahangy Andrianavalona. Nous avons inclus dans cette etude 31 patients avec 20 hommes et 11 femmes. Resultats : L'age moyen est de 52 ans. Les facteurs de risque sont representes surtout par le tabagisme et la schistosomiase. L'hematurie et des signes urinaires constituent les signes revelateurs a part un seul cas decouvert fortuitement au cours d'une lithiase vesicale. L'echographie a decouvert la tumeur vesicale dans 25 cas. La cystoscopie; realisee seulement chez 23 patients; a permis de visualiser la tumeur et de faire une biopsie dans tous les cas et une exerese-biopsique dans 13 cas. Le carcinome a ete retrouve dans 25 cas et l'adenocarcinome dans 6 cas. Seulement 12 cas ont eu un traitement curatif. Conclusion: Le cancer vesical est une pathologie grave. Son pronostic depend de la precocite du diagnostic. L'apparition d'une hematurie doit toujours alerter le clinicien

Un cas d'hematome retroperitoneal spontane idiopathique chez une femme enceinte

L'hematome retroperitoneal est habituellement secondaire a un traumatisme. La forme spontanee idiopathique est rare surtout quand il survient chez la femme enceinte. Nous rapportons le cas d'une femme de 29 ans enceinte de 20 semaines d'amenorrhee; qui a presente une douleur abdominale aigue avec instabilite hemodynamique et deglobulisation. La difficulte est d'affirmer le diagnostic de cet hematome afin d'evaluer le retentissement foto-maternel et d'adapter la prise en charge therapeutique

Un cas de syndrome de la jonction pyelo-ureterale sur rein unique

Les auteurs rapportent une observation exceptionnelle de syndrome de la jonction pyelo-ureterale congenital sur rein unique. Il s'agit d'un cas decouvert chez un jeune homme de 21 ans apres une lombalgie chronique unilaterale droite evoluant depuis trois ans. La fonction renale etait toujours conservee. Le diagnostic a ete confirme par les examens d'imagerie. Une pyeloplastie a ciel ouvert a donne un excellent resultat

Les complications de la nephrectomie laparoscopique

Objectif: Depuis l'avenement de la chirurgie minimale invasive; la voie laparoscopique devient la reference pour le traitement chirurgical des pathologies renales. L'objectif de ce travail est d'analyser les complications de la nephrectomie laparoscopique. Patients et methodes: Les nephrectomies laparoscopiques realisees en 10 ans (1996 - 2005) ont ete revues. Les caracteres demographiques; les incidents per-operatoires et les complications post-operatoires ont ete etudies. Resultats: Il y avait 181 patients operes dont 83 nephrectomies radicales; 80 nephrectomies simples et 18 nephro-ureterectomies. L'age moyen est de 59 ans. Des antecedents de chirurgie et/ou de radiotherapie etaient observes chez 103 patients (56;91). Chez 25 patients (13;81); on notait au moins une complication. Une conversion etait necessaire chez 6 patients (3;31) avec 4 plaies vasculaires et 2 difficultes de dissection. Dans 10 cas (5;52); les complications etaient majeures (8 cas de saignements; 1 cas d'odeme aigu des poumons; 1 cas de fistule digestive) avec 2 deces. Chez 15 patients (8;29); elles etaient mineures avec 9 cas d'hematome; 3 cas d'infection parietale; 2 cas d'emphyseme sous cutanee et 1 cas d'eventration lombaire. Conclusion: Le taux global de complications est de 13;81. Il semblerait que l'existence de facteurs de risque associes (age avance; tares; antecedents chirurgicaux ou irradiation) augmente le taux de complication. Le profil de ces patients est un des elements a prendre en compte pour prevoir et prevenir ces complications

[A case of acute gastric volvulus in a child]. / Un cas de volvulus aigu de l'estomac chez l'enfant.

Gastric volvulus is an abnormal rotation of the stomach around its axis. The acute form is a surgical emergency, which doesn't tolerate any therapeutic delay. We report on a case in a young girl, revealed by painful epigastric mass and distended gastric bubble on abdominal X-ray. This case was been successfully treated by detorsion and gastropexy. The clinical picture of gastric volvulus is characterised by the Borchardt triad of symptoms: upper abdominal pain, vomiting and difficulty to pass a nasogastric tube. The gastrointestinal barium series and CT-scan help to confirm the diagnosis. As was demonstrated in this case, the treatment is surgical by reducing the volvulus and fixing the stomach to prevent recurrence.

[A case of Klippel-Trenaunay-Weber syndrome of the hand: description and review of the literature]. / Un cas de syndrome de Klippel-Trenaunay-Weber de la main: description et revue de la littérature.

We report the first malagasy case of a 10 years-old child with a Klippel-Trenaunay-Weber syndrome. The patient presented with cutaneous hemangioma, varicosities and unilateral hypertrophy of soft tissues of the left hand. Arteriovenous fistula was findings by the echo-doppler. Ligature of the fistula was performed.

[Children's strangulated inguinal hernia]. / Les hernies inguinales étranglées chez l'enfant.

The inguinal hernia, malformations caused by persistence of peritonea-vaginal duct, is frequent in children. It is a benign affection as long as it is not strangled. During our five-year-retrospective study, we have found 32 cases (30 boys and 2 girls) of strangled inguinal hernia. There are 78,12% of cases under five years old. In 54%, the hernia was on the right side. Malnutrition and inguinoscrotal hernia are very exposed to strangulation. We observed obstruction syndrome in 81,25% of cases. We have to deplore one case of scrotal fistulae by intestinal necrosis and two cases of testicle necrosis. For all of our patients, the peritonea-vaginal duct was closed with ligature, associated with pre-funicular parietal refection. One case of recurrence is found in postoperative time.

[The voluminous primitive psoas abscess in children: report of three cases]. / Les volumineux abcès primitifs du psoas chez l'enfant: à propos de trois cas.

The primitive psoas abscess is a pathology extremely rare in the child. The diagnosis is difficult and often delayed. Their treatment requires a local and general sterilization of the infection. We report three observations of primary abscess of the psoas in the child. The clinic presentation is uncommon. Ultrasonography keeps an important place. The biology objective an infectious and inflammatory syndrome. Histology permits to put in evidence all shapes association of lesions. The bacteriological survey of the pus after drainage is only positive in one case. Surgical drainage with bactericidal antibiotherapy permit a definitive recovery.