Polypes recto-coliques de l'enfant. A propos de 13 cas au centre d'endoscopie digestive de l'hôpital Aristide Le Dantec

Introduction : La principale indication de l'endoscopie digestive basse chez l'enfant est représentée par les rectorragies. Les polypes en constituent l'étiologie la plus fréquente. Notre objectif était de décrire les aspects épidémiologiques, cliniques, endoscopiques et histologiques des polypes recto-coliques chez l'enfant dans le centre d'endoscopie digestive du service d'hépato-gastroentérologie de l'hôpital Aristide Le Dantec de Dakar. Patients et méthode : Il s'agissait d'une étude rétrospective de janvier 2010 à décembre 2014. Tous les patients âgés de 0 à 15 ans qui présentaient des polypes recto-coliques à l'endoscopie digestive basse étaient inclus. Les données concernant l'âge et le sexe des patients, les indications, les conditions de l'examen, la nature des lésions, le geste thérapeutique réalisé ainsi que l'histologie des polypes ont été recueillis. Résultats : Nous avons inclus 13 patients. La prévalence des polypes recto-coliques était de 10,5%. L'âge moyen était de 5 ans. Il y avait 9 garçons et 4 filles (sex-ratio = 2,25). Les rectorragies constituaient la principale indication de l'endoscopie digestive basse (84,6%). Une moyenne de 1,5 polype par enfant était retrouvée. Le polype était solitaire dans 8 cas (61,5%). Il siégeait le plus souvent dans le rectum (69,2%). Une polypectomie a été réalisée dans 9 cas (69,2%) et une biopsie-exérèse à la pince froide dans 4 cas. Il s'agissait de polypes hamartomateux de type juvénile dans 11 cas (84,6%). Conclusion : Les rectorragies représentent la principale manifestation des polypes de l'enfant. Ces polypes sont le plus souvent de type hamartomateux. Le traitement repose essentiellement sur la polypectomie

[Stomach cancer: a descriptive study of 101 cases at the gastrointestinal endoscopy center at Aristide Le Dantec University Hospital]. / Le cancer gastrique : étude descriptive de 101 cas dans le centre d'endoscopie digestive du CHU Aristide Le Dantec.

INTRODUCTION: Stomach cancer is a real public health problem in Black Africa. We report its epidemiological, endoscopic, and histological aspects, as observed in our gastrointestinal endoscopy center at Aristide Le Dantec University Hospital in Dakar (Senegal). PATIENTS AND METHODS: This retrospective study covered the 5-year period from January 1, 2006, to December 31, 2010 and included all patients with stomach cancer confirmed by anatomo-pathological examination. We collected data about age, sex, indications for the examination, and description of the gastric lesions and any other associated lesions from the upper GI endoscopy reports. We also recorded information from the histological reports of all lesions. RESULTS: The study included 101 patients. The incidence of gastric cancer was 20 cases/year. Patients' mean age was 58 years [range: 24-83]. The sex ratio was 2.48. The main indications for the upper GI endoscopy were epigastralgia (33.3%), vomiting (26.1%), and tumoral hepatomegalia (10.81%). The examination found mainly ulcerative and protruded lesions (59.40%). Other types of lesions associated with the tumor were esophageal candidiasis (34.6%), peptic esophagitis (25%), and gastroesophageal junction incompetence (25%). The tumor was located in the antrum in 68% of the cases and was an adenocarcinoma in 83.2%. CONCLUSION: A cancer register to determine the characteristics and prevalence of stomach cancer in Senegal would be useful. The link with Helicobacter pylori requires further study.

[Spontaneous bacterial peritonitis in Dakar, Senegal: study of 55 patients with cirrhosis]. / Infection spontanée du liquide d'ascite à Dakar, Sénégal : étude de cinquante-cinq patients cirrhotiques.

OBJECTIVES: To report the prevalence of spontaneous bacterial peritonitis (SBP) and its clinical and laboratory features in patients with cirrhosis followed at the Aristide Le Dantec Hospital in Dakar (Senegal). PATIENTS AND METHODS: From May through December, 2010, we prospectively included patients with cirrhosis and a first episode of ascites on clinical examination. Diagnostic abdominal paracentesis was performed in all cases to determine the macroscopic appearance of the fluid, protein concentration, and cell count, and to culture the ascitic fluid in a blood culture bottle. SBP was diagnosed when the fluid contained more than 250 polymorphonuclear leukocytes per cubic millimeter of fluid. The data were analyzed with Epi-Info software, version 3.5.2. Comparisons used Fisher's exact and Chi-square tests, with significance set at p < 0.05. RESULTS: The study included 55 patients with cirrhosis, with a mean age of 45 years and a male/female sex ratio of 1.89 (36 men). The prevalence of SBP was 27.3%. Factors significantly associated with SBP were female gender, malnutrition, turbid appearance of the ascites, and neutrophilia. In samples from patients with SBP, the mean protein concentration was 20.7 g/L, the white cell count was 1797/mm(3), and the neutrophil count 1,102/mm(3). Ascitic fluid culture was positive in 20% of the SBP cases (n=3). CONCLUSION: In Dakar, cirrhosis is found especially in young adults, and the prevalence of SBP in our population was 27.3%. Improved technical equipment would improve the hospital's ability to determine the causes of cirrhosis and identify the various germs responsible for SBP.

[Esophageal variceal band ligation in Dakar, Senegal]. / La ligature élastique des varices œsophagiennes à Dakar (Sénégal).

After a preliminary study in the gastrointestinal endoscopy center of the Aristide-Le-Dantec Teaching Hospital in Dakar, Senegal, demonstrated the feasibility and effectiveness of endoscopic ligation of esophageal varices, this procedure entered regular use for management of patients admitted for upper digestive tract bleeding due to these varices. This study sought to assess its effectiveness. Patients and method. This study, conducted from July 2005 through January 2010, included all patients with upper digestive tract bleeding due to rupture of esophageal varices. Results. In all, 140 patients with a mean age of 36 years [range: 16-75] were admitted for this diagnosis and included in the study: 93 men and 47 women (sex-ratio = 1.98). The presence of at least one clinical sign of portal hypertension was noted in 72% of cases. Esophageal varices were graded as stage III in 75.7% of cases. The underlying cause of portal hypertension was cirrhosis in 94.3%, presumptively due to hepatitis B virus among 37.1%. The varices were successfully eradicated in 64 patients (45.7%). The mean number of sessions required was 2 [range: 2-4] in patients with stage II and 3.4 [range, 3-8] in patients with stage III varices, and the mean number of bands applied per session was 5.1 [range: 2-6] and 5.6 [range: 2-10], respectively. The interval between sessions was 4 weeks [range: 3 -12]. Bleeding recurred in 8 patients (5.7%) before eradication was achieved; 4 (2.8%) of them died. Conclusion. Esophageal variceal ligation is an effective therapeutic and prophylactic procedure for management of esophageal varices in Senegal.