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An 8-year-old boy was brought to the paediatric surgery department having amputated his penis and both testicles during a road traffic accident. Examination of the perinea showed a complete amputation of penis, scrotum and testicles. We performed debridement and skin suture initially. The urethral orifice was catheterized by a 10â¯F Foley's catheter. I the herein case report, we discuss the incidence, management and complications of genital amputation in a young boy. Moreover, the existing literature in this subject is reviewed.
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Introduction: Les urgences chirurgicales néonatales dans les pays en voie de développement sont caractérisées par une mortalité élevée. Le but de cette étude était de recenser les urgences chirurgicales néonatales et d'analyser leur pronostic dans notre environnement.Patients et méthode: Il s'agit d'une étude rétrospective portant sur 96 dossiers de nouveau-nés hospitalisés sur une période de 4 ans (janvier 2010 à décembre 2014) pour une urgence chirurgicale opérée ou non. Nous avons étudié les aspects étiologiques, thérapeutiques et évolutifs.Résultats: La fréquence des urgences chirurgicales néonatales était de 19,8%. Le délai moyen de consultation était de 6 jours extrêmes (1 et 14 jours). Les pathologies du tube digestif représentaient 58,3% (n=56) suivies des pathologies de la paroi abdominale antérieure dans 41,7% (n=40). Le délai thérapeutique moyen était 6 jours. Vingt-six (27,1%) nouveau-nés ont pu être opérés. Le taux de mortalité néonatale était de 58,2% (n=53). La mortalité préopératoire était de 49,4% (n=45) avec un délai moyen de 5 jours. La mortalité post opératoire était de 8,79% (n=8) avec un délai moyen de survenue de 5,2 jours. Les pathologies de la paroi abdominale étaient responsables de 54,7% (n=29) des décès.Conclusion: Les urgences chirurgicales du nouveau-né sont caractérisées par un retard de prise en charge avec une mortalité élevée. L'amélioration de leur pronostic passe par un diagnostic précoce (diagnostic anténatal) et une prise en charge adéquate
Subject(s)
Academic Medical Centers , Cote d'Ivoire , Emergency Service, Hospital , Infant Mortality , Infant, Newborn , Intensive Care Units, Neonatal , Surgical Procedures, OperativeABSTRACT
INTRODUCTION: Elastic stable intramedullary nailing (ESIN) has transformed children's femoral shaft fracture treatment, but this technique requires an image intensifier. Without it, open reduction is used to check fracture reduction and pin passage. The aim of this study was to describe our techniques and to evaluate our results at the middle term. HYPOTHESIS: The open reduction and ESIN technique provides satisfactory results with few major complications. PATIENTS AND METHODS: This was a retrospective study that focused on femoral diaphyseal fractures treated in the pediatric surgery unit at Yopougon Teaching Hospital (Abidjan, Côte d'Ivoire) between January 2007 and December 2013. Twenty children older than 6 years of age who underwent open reduction and ESIN without image intensifier assistance were included. Functional outcomes were assessed using Flynn's criteria. Postoperative complications and sequelae were recorded. RESULTS: At the 16-month follow-up, the results were excellent in 11 (55%) cases, good in eight (40%), and poor in one (5%) case. The mean duration of surgery was 71min (range, 57-103 min). The mean time for bone healing was 11.6 weeks (range, 7-15 weeks) and the average time to nail removal was 6 months. Complications included wood infection (n=3), skin irritation (n=3), knee stiffness (n=2), malunion (n=3), scar (n=5), and leg length discrepancy (n=3). DISCUSSION: Open reduction and ESIN yielded satisfactory results with few major complications. This method could be an alternative in low-income countries where the image intensifier is often unavailable. LEVEL OF EVIDENCE: Level IV retrospective study.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation, Intramedullary/methods , Child , Cote d'Ivoire , Developing Countries , Female , Hospitals, Teaching , Humans , Male , Postoperative Complications , Retrospective StudiesABSTRACT
BACKGROUND: The surgical management of giant omphalocele is a surgical challenge with high mortality and morbidity in our country due to the absence of neonatal resuscitation. This study evaluates conservative management of giant omphalocele with dissodic 2% aqueous eosin. MATERIALS AND METHODS: In the period from January 1997 to December 2012, giant omphaloceles were treated with dissodic 2% aqueous eosin. The procedure consisted of twice a day application of dissodic 2% aqueous eosin (sterile solution for topical application) on the omphalocele sac. The procedure was taught to the mother to continue at home with an outpatient follow-up to assess epithelialization. We studied the duration of the hospital stay, the learning curve of the procedure by the mother, the complications, the duration and the percentage of complete epithelialization and the mortality. RESULTS: A total of 173 giant omphaloceles had a conservative treatment with dissodic 2% aqueous eosin. The average hospital stay was 21 ± 6 days. The learning curve by the mother of the procedure was 10 ± 3 days. Complications of treatment were intestinal functional occlusion 22% and omphalocele sac infection 18%. The complete epithelialization of the omphaloceles sac after application of dissodic 2% aqueous eosin was 68.5%. Mortality was observed in 25.5%. CONCLUSION: Conservative treatment of giant omphaloceles by dissodic 2% aqueous eosin is a simple, efficient and a good alternative to surgery. The mother can easily learn its procedure which reduces the duration of hospital stay.
Subject(s)
Eosine Yellowish-(YS)/administration & dosage , Hernia, Umbilical/diagnosis , Hernia, Umbilical/drug therapy , Cohort Studies , Cote d'Ivoire , Female , Follow-Up Studies , Humans , Infant, Newborn , Injections, Intralesional , Length of Stay , Male , Patient Safety , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Contexte. Dans les pays industrialises; les IoA sont prises en charge tres rapidement au debut des manifestations cliniques contrairement aux pays en developpement ou elles sont traitees tard au stade subaigu ou chronique. L'objectif de cette etude etait de decrire les IAo chez les enfants de moins de 3 ans afin de definir leurs particularites cliniques; d'identifier les bacteries en cause. Patients et methode. Sur une periode de 11 ans; de Decembre 2002 a Janvier 2013; nous avons collige des dossiers d'Infections osteo Articulaires (IoA) d'enfants au Centre Hospitalier Universitaire de Yopougon Abidjan Cote d'Ivoire. Les donnees cliniques concernaient; le delai de consultation; les portes d'entrees; la symptomatologie clinique (signes generaux; signes fonctionnels; signes physiques); Les parametres etudies etaient cliniques; biologiques; bacteriologiques; therapeutiques et evolutifs. Resultats. Au total; nous avons collige 105 dossiers d'Infections osteo Articulaires (IoA) d'enfants de 0 a 36 mois. Les resultats de l'hemoculture ont ete positifs dans 22%; ceux de la ponction articulaire ont ete positifs dans 51;5%; ceux de la ponction metaphysaire dans 22% et ceux du prelevement de la porte d'entree dans 60% . Les bacteries isolees etaient; le staphylococcus aureus dans 54%; Salmonella dans 23%; Klebsiella pneumoniae dans 19%; Pyocianique dans 4%. L'antibiogramme a montre une sensibilite des bacteries isolees dans 100% des cas aux Aminosides; aux Fluoroquinolones; a la Fosfomycine; aux Imipenemes et aux Glycopeptides. La sensibilite aux Betalactamines etait de 60%. Conclusion. Il faut eviter les betalactamines en mono antibiotherapie de premiere ligne au cours des IAo chez les nourrissons de moins de 3 ans. Nous suggerons l'utilisation d'une mono antibiotherapie avec amoxicilline acide clavulanique qui vise l'elimination du Kingella Kingae premiere bacterie en cause au cours des infections orL des nourrissons mais aussi a cause de l'acide clavulanique pour eliminer les staphylocoques dores producteurs de betalactamase
Subject(s)
Arthritis, Infectious , Bacteriology , Child, Preschool , Infant , OsteomyelitisABSTRACT
BACKGROUND: Supracondylar fractures are the most common elbow fractures in children and are usually treated on an emergency basis, using percutaneous pinning. However, the treatment is often delayed in areas where healthcare resources are scarce. HYPOTHESIS: Delaying treatment does not influence the perioperative complication rate. MATERIALS AND METHOD: We retrospectively reviewed the medical charts of 89 children aged 2 to 15 years in whom surgery for extension-type supracondylar elbow fractures was delayed by more than 48 hours. The 53 boys and 36 girls with a mean age of 6 years 9 months had severe fracture displacement (28 stage III and 61 stage IV according to Lagrange and Rigault classification scheme). Mean time to treatment was 4.5 days (range: 2-17 days). Open reduction and crossed K-wire fixation via the posterior approach were performed in all 89 patients. Postoperative complications and sequelae were collected. Functional outcomes were evaluated using Flynn's criteria. RESULTS: Outcomes were satisfactory in 74 (83.2%) of patients. Postoperative complications occurred in 13 (14.6%) patients and consisted of surgical site infection (n=7, 7.8%), iatrogenic nerve injury (n=3, 3.4%), and reoperation (n=3, 3.4%). At last follow-up after a mean of 5 months, three (3.4%) patients had cubitus varus and one had a recurrent fracture due to massaging. Elbow motion was limited in 11 (12.4%) patients. No case of compartment syndrome was recorded. DISCUSSION: Despite an average time to surgery of 4.5 days, the outcome was satisfactory in 83% of cases. Delayed treatment was not associated with an increased rate of perioperative complications. LEVEL OF EVIDENCE: Level IV, retrospective study.
Subject(s)
Bone Wires , Elbow Injuries , Fracture Fixation, Internal , Humeral Fractures/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Humeral Fractures/diagnosis , Humeral Fractures/physiopathology , Male , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Supracondylar fractures of the elbow are common in children. Their treatment is controversial when displacement has occurred, although percutaneous pinning is usually advocated. HYPOTHESIS: In paediatric extension-type supracondylar fractures of the elbow, percutaneous pinning and crossed K-wire fixation after open reduction via the medial approach produce similar functional outcomes and complication rates. MATERIALS AND METHODS: We retrospectively reviewed the medical charts of 58 children aged 2 to 15 years who underwent surgery for extension-type supracondylar elbow fractures between 2004 and 2008. Closed reduction and percutaneous pinning was used in 33 patients with a mean age of 7 years and 11 months; open reduction with cross-wiring in 25 patients with a mean age of 7 years. Functional outcomes were assessed using Flynn's criteria. Baumann's angle was determined and postoperative complications and sequelae were recorded. RESULTS: Outcomes were satisfactory in 30 (90.9%) patients treated with percutaneous pinning and in 23 (92%) patients treated with open reduction and cross-wiring. Mean Baumann's angle at last follow-up was 73.9±5.74° after percutaneous pinning and 74.76±4.07° after open reduction and cross-wiring. Postoperative complications consisted of reoperation in six (10.3%) patients and iatrogenic nerve injury in two (3.4%) patients. Cubitus varus occurred in two (6.06%) patients after closed treatment and in one (4%) patient after open treatment. In each group, three (5.1%) patients had greater than 15° of motion range limitation. DISCUSSION: In children with extension-type supracondylar elbow fractures, outcomes are similar with percutaneous pinning and with open reduction via the medial approach followed by cross-wiring. LEVEL OF EVIDENCE: Level IV, retrospective study.
