[Abdomen Trauma From A Fall From A Height In Two University Teaching Hospital In Burkina Faso]. / Traumatismes De l'Abdomen Par Chute De Hauteur Dans Deux Centres Hospitaliers Universitaires Du Burkina Faso.

PURPOSE: The purpose of this study was to describe the nature and reasons for the fall, the injuries caused and their prognosis. PATIENTS AND METHODS: This was a descriptive cross-sectional study over a period of 9 years. Patients admitted for abdominal trauma from a fall from a height during the study period were included. Ultrasound and CT scan allowed diagnosis of the lesion. Patients in shock who do not respond to resuscitation are considered to have unstable hemodynamics. RESULTS: fifty-three cases of abdominal trauma by falling from a height, including 11 adults and 42 children, were collected. They were 46 men and 7 women. The average age was 11.6 years. In 86.8% (n=46) of the cases it was a fall from the top of a tree. There were 83% (n=44) abdominal contusion and 17% (n=9) open trauma. Other lesions were associated in 28.3% (n=15) of cases. There were 26 splenic lesions (49%), 14 liver (22.6%) and 6 hollow organs (11.3%). Non-operative treatment was applied in 79.2% (n=42) of cases. Morbidity was 9.4% (n=5) and mortality 5.7% (n=3). CONCLUSION: Abdominal trauma from a fall from a height was dominated by falls from the top of fruit trees, and occurred in young male subjects.

BUT: Le but de cette étude était de décrire la nature et les raisons de la chute, les lésions engendrées et leur pronostic. PATIENTS ET MÉTHODES: il s'est agi d'une étude transversale descriptive sur une période de 9 ans. Les patients admis pour traumatisme abdominal par chute de hauteur au cours de la période d'étude ont été inclus. L'échographie et le scanner ont permis de poser le diagnostic lésionnel. Les patients en état de choc ne répondant pas à la réanimation ont été considérés à hémodynamie instable. RÉSULTATS: cinquante-trois cas de traumatisme abdominal par chute de hauteur dont 11 adulteset42 enfants, ont été colligés. Il s'agissait de 46 hommes et de 7 femmes. L'âge moyen était de 11,6 ans. Dans 86,8% (n=46) des cas il s'agissait d'une chute du haut d'un arbre. Il y avait83%(n=44) de contusion abdominale et 17% (n=9) de traumatisme ouvert. D'autres lésions étaient associées dans 28,3% (n=15) des cas. Il y avait 26 lésions spléniques (49%), 14 hépatiques (22,6%) et 6 d'organes creux (11,3%). Le traitement non opératoire avait été appliqué dans 79,2% (n=42) des cas. La morbidité était de 9,4% (n=5) et la mortalité de 5,7% (n=3). CONCLUSION: Les traumatismes de l'abdomen par chute de hauteur étaient dominés par les chutes du haut d'arbres fruitiers, et étaient le fait des sujets jeunes de sexe masculin.

[Biliary peritonitis: diagnostic and therapeutic aspects]. / Les péritonites biliaires : aspects diagnostiques et thérapeutiques.

AIMS: The aim was to describe the diagnostic and therapeutic aspects of biliary peritonitis. PATIENTS AND METHODS: This was a descriptive cross-sectional study with retrospective collection over a period of 10 years including patients operated on for biliary peritonitis. RESULTS: We collected 10 cases of biliary peritonitis with an average age of 38 years with a sex ratio of 2.3. Two patients presented with an abdominal contusion following a road traffic accident. Maximum abdominal pain in the right hypochondrium was present in three patients, signs of peritoneal irritation in all patients, positive Widal and Felix serodiagnosis in eight patients. At midline laparotomy, the gallbladder was perforated in three patients, gangrenous in five, phlegmonous in one, sclero-atrophic in one. Cholecystectomy was performed in all patients. Biliary peritonitis was of traumatic origin in two patients, and typhoid in eight. Postoperatively, there were four cases of sepsis and three cases of parietal suppuration. Three patients died. CONCLUSION: Biliary peritonitis discovered during laparotomies for peritonitis, was secondary to typhoid cholecystitis, and had a high morbidity and mortality.

BUTS: Le but était de décrire les aspects diagnostiques et thérapeutiques des péritonites biliaires. PATIENTS ET MÉTHODES: Il s'est agi d'une étude transversale descriptive à collecte rétrospective sur une période de 10 ans incluant les patients opérés pour péritonite biliaire. RÉSULTATS: Nous avons colligé 10 cas de péritonite biliaire d'un 'âge moyen de 38 ans avec un sex-ratio de 2,3. Deux patients présentaient une contusion abdominale par suite d'un accident de la circulation routière. Une douleur abdominale maximale à l'hypochondre droit était présente chez trois patients, des signes d'irritation péritonéale chez tous les patients, un sérodiagnostic de Widal et Félix positif chez huit patients. À la laparotomie médiane la vésicule biliaire était perforée chez trois patients, gangrénée chez cinq, phlegmoneuse chez un, scléro-atrophique chez un. La cholécystectomie a été réalisée chez tous les patients. La péritonite biliaire était d'origine traumatique chez deux patients, et typhique chez huit. En post opératoire on notait quatre cas de sepsis, et trois cas de suppuration pariétale. Trois patients sont décédés. CONCLUSION: les péritonites biliaires découvertes lors de laparotomies pour péritonite, étaient secondaires à des cholécystites typhiques, et avaient une forte morbi-mortalité.

Surgical Site Infection after Digestive Surgery: Diagnosis and Treatment in a Context of Limited Resources.

Background: Surgical site infections (SSIs) are responsible for substantial morbidity in patients who undergo digestive surgery. However, very little is known about the aspects of SSIs in sub-Saharan Africa. Methods: The purpose of this study was to assess the prevalence and identify the risk factors of SSI in patients who were treated in the Department of Digestive Surgery of Tenkodogo Hospital in Burkina Faso. We performed a prospective study from January 1, 2016 to December 31, 2016. All patients who underwent digestive tract surgery during this period were included and followed. Patients whose post-operative surgical sites were complicated by infection were identified. Surgical site infection was diagnosed according to the U.S. Centers for Disease Control and Prevention (CDC) definition. Bacteriologic sampling was performed in all included patients. Results: A total 964 patients underwent surgery during the study period and were included in the study. Seven hundred thirty-seven were females (76.4%), and 227 were males. The mean age of the included patients was 47.5 years (standard deviation [SD] = 9 years). One hundred fourteen patients presented with SSI, the incidence of which was 11.8%. The incidence of SSI was substantially higher in females than in males (63.2 vs. 36.8%, p < 0.05). The incidence was also higher in patients living below the poverty line (71.1 vs. 28.9%, p < 0.05). Clinically, the incidence of SSI was higher in emergency surgery than in scheduled surgery (84.2 vs. 15.8%, p < 0.05). Contaminated or dirty surgery was more risky than clean surgery (p < 0.05). With respect to bacteria, the most commonly isolated microbes were Escherichia coli (66.7%) and Staphylococcus aureus (15%). Treatment mainly consisted of appropriate antibiotic therapy and local care. Three deaths were recorded for a mortality rate of 2.6%. Conclusions: Surgical site infections are frequent in sub-Saharan environments. The risk factors seem to be clinical and social.

[Epidemiology, treatment and prognosis of colorectal cancer in young adults in sub-Saharan Africa]. / Épidémiologie, traitement et pronostic du cancer colorectal de l'adulte jeune en milieu sub-saharien.

Colorectal cancer is the most common digestive cancer. The objectives of this study was to analyse the frequency, aetiologies, and the therapeutic and progressive aspects of colorectal cancer in young adults in Burkina Faso. This study was a 10-years descriptive study conducted in 2 regional hospitals in Burkina Faso. It included all patients aged 20 to 45 years admitted to these two hospitals for colon cancer or rectal cancer during the study period. A total of 116 patients were included, which was 39.2% of all patients admitted for colorectal cancer during the same period. The average age of the included patients was 35.4 years old. There were 70 male patients (60.3%). Seven patients had a history of chronic inflammatory bowel disease, and six had a family history of colon cancer. The average consultation time was 6.2 months. In 25 cases (19.9%), the cancer was discovered in the context of an abdominal emergency. Ninety-two patients (79.3%) were diagnosed at stage 3 or stage 4 according to the TNM Staging System. The most common histological type was adenocarcinoma (103 cases, 88.9%). Therapeutically, surgery was performed on 87 patients (75%) and chemotherapy was used in 37 cases (31.9%). Sixteen patients received radiotherapy. The intra operative mortality rate was 4.6%. The 5-year survival rate was 17%. In conclusion, colorectal cancer in young adults occurs without obvious risk factors in Burkina Faso. Mortality remains high because of the limited therapeutic arsenal.

[Cancer of the vulva: Diagnostic stages, treatment and survival in a country with limited resources (Burkina Faso)]. / Cancer de la vulve : stades diagnostiques, traitement et survie dans un pays aux ressources limitées (Burkina Faso).

INTRODUCTION: Vulvar cancer is rare and belatedly diagnosed in Africa. We describe its diagnostic stages, therapeutic and evolution features in a country with limited resources. METHODOLOGY: Forty-seven cases of vulvar cancer diagnosed between 2013 and 2018 in Burkina Faso, were analyzed retrospectively. The diagnostic stages, therapeutic and evolution terms were considered. Survival was calculated through the Kaplan Meier Method and compared using the Logrank technique. RESULTS: Stages IA and IB accounted for 10.6%. Radiotherapy was not available and chemotherapy was done in 9 cases. Full vulvectomy with bilateral inguino-femoral dissection was performed in 11 cases. Average survival was 41 months with a median of 52 months. The difference in survival according to the diagnostic stages were highly significant statistically (P=0.000). DISCUSSION: Cancer of the vulva is rare and raises major therapeutic difficulties in countries with limited resources. Surgery is the only affordable weapon. Evolution would be better if radiochemotherapy was possible. CONCLUSION: Radiochemotherapy cannot be done due to the lack of a radiotherapy unit and the high cost of cytotoxics. Surgery is largely palliative and/or mutilating. Survival is modest. An early diagnosis could help promote conserving treatments.

Ectopic pheochromocytoma or paraganglioma of the ZUCKERKANDL organ: A case report and review of the literature.

INTRODUCTION: Paraganglioma of the ZUCKERKANDL organ are rare. Diagnosis is based on clinical, radiological and biological arguments. We report a case to describe our surgical procedure and insist on the necessity of preoperative diagnosis. PRESENTATION OF CASE: BA, 52-years-old male patient was seen in consultation for left hypochondrium pains. The clinical examination had revealed a painful tumefaction in the left flank and the left hypochondrium. A deep mass was observed, but was difficult to be assessed, due to pain. Abdominal-pelvic CT scan with contrast injection had revealed a tissue mass, suggesting a tumor of the tail of the pancreas. Laparotomy showed this mass was not attached to the tail of the pancreas, and was along the abdominal aorta up to the aortic bifurcation. Upon touching the mass, blood pressure raised up to 240 mmHg. A least mobilization of the mass and the use of nicardipine helped maintain blood pressure below 180mmhg. Dissection was carried out from the aortic bifurcation to the TREITZ's angle and the mass was removed. The follow-ups were characterized by low blood pressure a few minutes following the resection of the mass. DISCUSSION: Pheochromocytoma is rare. The Clinical signs, Abdominal-pelvic CT scan and biology are the steps of the preoperative diagnosis. The surgery consists a lumpectomy. The resuscitation determines the patient's prognosis. CONCLUSION: Pheochromocytoma is an unusual mass. Preoperative diagnosis can be difficult in pauci-symptomatic cases. One should consider this in the face of any abdominal mass, so as to improve planning of resuscitation which determines the patient's prognosis.

A case report of Villar's nodule in a woman without surgical history.

INTRODUCTION: Villar's nodule is an umbilical endometriosis without anterior or ongoing pelvic endometriosis. The primitive location of this nodule at the umbilical level is rare. Its etiopathogenesis remains unclear. PRESENTATION OF CASE: We report a case of umbilical endometriosis with unusual clinical expression in a woman in the reproductive years with no surgical history and no known history of endometriosis. Endometriosis manifested as progressive transformation of the normal umbilicus into several small nodules, with bleeding coinciding with the menstrual cycle. The diagnosis was confirmed by histology and surgical treatment consisted of omphalectomy. DISCUSSION: Umbilical endometriosis is a rare disease that occurs naturally in patients with pelvic endometriosis. Etiopathogenesis of the disease is still unclear. In our patient, the appearance of the nodule was impressively, by a gradual transformation of the normal aspect of the umbilicus, into several small, slightly pigmented, firm, painful and concomitantly bleeding nodules during periods of menstruation. In the literature, this multinodular or budding form would be of exceptional observation. CONCLUSION: The characteristics of the umbilical tumor, associated with the cyclical nature of tumor bleeding in a patient without previous history of endometriosis, strongly suggest the diagnosis of Villar's nodule, but the confirmation is still histological. The treatment is always surgical and recurrence is very rare.

Male breast cancer: diagnosis stages, treatment and survival in a country with limited resources (Burkina Faso).

BACKGROUND: Male breast cancer is a rare and less known disease. Therapeutic modalities affect survival. In Burkina Faso, male breast cancers are diagnosed in everyday practice, but the prognosis at short-, middle-, and long-term remains unknown. The objective of this study is to study the diagnosis stages, therapeutic modalities, and 5-year survival in male breast cancer at the General Surgery Unit of Yalgado Ouedraogo University Hospital from 1990 to 2009. METHODS: A cohort longitudinal study concerning cases of breast cancer diagnosed in man. Survival was assessed using the Kaplan-Meier method and survival curves were compared through the LogRank test. RESULTS: Fifty-one cases of male breast cancer were followed-up, i.e., 2.6% of all breast cancers. Stages III and IV represented 88% of cases. Eleven patients (21.6%) were at metastatic stage. Patients were operated in 60.8% of cases. The surgery included axillary dissection in 25 (80.6%) out of 31 cases. Lumpectomy was performed on 6.5% of patients (2 cases). Fifteen (29.4%) and 11 (21.6%) patients underwent chemotherapy and hormonal therapy, respectively. The FAC protocol was mostly used. Radiation therapy was possible in two cases. The median deadline for follow-up was 14.8 months. A local recurrence was noticed in 3.2% of cases. The overall 5-year survival rate was 49.9%. The median survival was over 5 years for stages I and II. It was 54 down to 36 months for stages III and IV. CONCLUSION: Diagnosis is late. The lack of immunohistochemistry makes it difficult to define the proportion of their hormonal dependence. Surgery is the basic treatment. Five-year survival is slow and the median survival depends on the diagnosis stage. It can be improved through awareness-raising campaigns and the conduct of individual screening.

[Occlusion secondary to congenital internal transmesenteric hernia: about 2 cases]. / Occlusion par hernie interne transmesenterique congénitale: à propos de deux cas.

Internal hernia due to mesenteric defect or transmesenteric hernia is a rare cause of acute intestinal obstruction. Its diagnosis is most often done during surgery. The knowledge of its clinical peculiarities allows the preoperative diagnosis. We here report 2 cases of acute intestinal obstruction secondary to congenital transmesenteric hernia in two adult patients. This study aims to highlight the clinical peculiarities of this rare form of internal hernia.

Cancer of the vulva in Burkina Faso: a hospital-based case series.

BACKGROUND: Vulvar cancer is a rare gynaecological cancer. In Burkina Faso, the diagnosis of vulvar cancers is delayed and the prognosis is poor. However, no specific study on vulvar cancers has been conducted at the moment. This work aimed to study the characteristics of these cancers. METHODS: This is a prospective study on histologically confirmed primary cancers of the vulva diagnosed between 1st January 2013 and 30th June 2015. The demographic and clinical aspects were studied at the Yalgado Ouedraogo University Hospital of Ouagadougou (CHU-YO). RESULTS: We noticed 21 cases of vulvar cancers within 30 months, ranking it as the 4th most common gynaecological cancer. The average age of the patients was 55 years (standard deviation +/- 6.3) and the median age was 57 years. Scars resulting from female circumcision, menopause (n = 20) and HIV infection were noticed in 19 cases and 6 cases respectively. The average time from first symptoms to first consultation was 29 months. Pain and ulceration were the main reasons for consultation. The clinical picture was chiefly an ulcero-granulating tumour. There was squamous cell carcinoma in 20 cases and basal carcinoma in 1 case. Fifteen patients were at stage III or IV, where of three patients had metastatic disease. We noticed vitiligo in 9 vulvar cancer cases. CONCLUSION: The cancer of the vulva is rare. Women are of menopausal age, are mostly circumcised and HIV-infection is common. A majority of patients sought consultation at advanced stage of disease, and diagnosis was belatedly made. Pain and ulceration were the main reasons for consultation. The sensitization of the population, education for self- examination would allow earlier diagnosis.

[Tourniquets, a drama in the infant: about 3 cases]. / Les garrots de prélèvement, un drame chez le nourrisson: à propos de 3 cas.

The time limit for the removal of a tourniquet is short; any delay in tourniquet deflation, especially if it exceeds the 3 hour limit, exposes to amputation hazards. Our objective was to report three cases of ischemic limb gangrene, caused by having forgotten to take a tourniquet off after a blood sampling, to inform healthcare professionals about the risk associated with that negligence. We encountered 3 cases of infants (2 three-month-old infants and 1 five-month-old infant), hospitalized in intensive care unit of Yalgado Ouédraogo University Hospital for upper-left limb swelling. Their medical history shows that there was a delay in tourniquet deflation after a blood sampling of 24 hours in two cases and of 48 hours in one case. Physical examination revealed a diffuse edema associated with upper limb gangrene spread to the mid-third of the upper arm, abolition of the ulnar and radial pulse as well as loss of sensation in the hand in 2 cases. In one case clinical signs were attenuated. The diagnosis of ischemic limb gangrene was confirmed in all cases. Laboratory examinations were normal. Two cases needed urgent trans-humeral amputation and one case needed debridement plus amputation of four fingers. The evolution was simple in all cases. Iatrogenic dry gangrene caused by a delay in tourniquet removal should never happen at hospitals. This can be guaranteed only by tightening up health management and by performing regular and accurate patient monitoring.

[An atypical localized appendicitis: the role of colonoscopy in the diagnosis]. / Une appendicite de localisation atypique: apport de la coloscopie au diagnostic.

The left sided appendicitis diagnosis is made apart from the medical imaging laparotomy (echography, and computed tomography). In this text, the authors deal with a case where colonoscopy has been used to make the diagnosis. Through an analysis based on a reported case and literature, they argue for the use of colonoscopy as diagnosis means to confirm appendicitis when medical imaging (computed tomography) is not accessible or has been used.

Place de la chirurgie dans la prise en charge des cancers du sein chez la femme au Centre Hospitalier Universitaire Yalgado Ouedraogo: a propos de 81 cas

Etudier la place de la chirurgie dans la prise en charge des cancers du sein au centre hospitalier universitaire Yalgado Ouedraogo. Nous avons realise une etude prospective et descriptive sur dix (10) mois portant sur la place de la chirurgie dans le cancer du sein. Elle a eu pour cadre les services de gynecologie-obstetrique et de chirurgie viscerale et digestive du centre hospitalier universitaire Yalgado Ouedraogo. Ont ete pris en compte les indications; les gestes et les resultats de la chirurgie. Nous avons collige 81 cancers mammaires. Le delai moyen de consultation a ete de 14;26 mois. Les tumeurs T3 a T4 representaient 82;71% des cas. Trente-huit patientes (46;91%) ont ete operees. La chimiotherapie neo adjuvante a ete realisee dans 29;63% des cas. Trente-quatre patientes (41;97%) etaient operables d'emblee. Il s'agissait de mastectomie selon Madden dans 94;74% des cas et de chirurgie de proprete dans 2 cas (5;26% des cas). Une chimiotherapie adjuvante a ete realisee chez 52;63% des patientes operees. Des complications a type de lymphocele ont ete notees dans 23;68% des cas. Leur traitement a consiste en des ponctions evacuatrices. Les indications de la chirurgie sont limitees par le retard diagnostique corollaire de stades avances des cancers du sein. L'absence de la radiotherapie rend delicate la pratique de la chirurgie conservatrice et la mastectomie occupe toujours une place importante. Un diagnostic precoce permettrait d'augmenter les indications chirurgicales