[Skin gangrene of the external genitalia. Report of 44 cases]. / Gangrène cutanée des organes génitaux externes. A propos de 44 cas.

STUDY AIM: The aim of this study is to report 44 cases of male external genitalia cutaneous gangrene which have been observed at the Principal Hospital of Dakar (Senegal) during a 4-year period. PATIENTS AND METHODS: The patients all belonged to a black and poor population (mean age: 60 years). Diabetes was present in 11% of the patients. In ten patients, no aetiology was found. The other 34 cases were secondary mainly to urogenital pathology (50%). In 50% of the cases, the lesions were localised on the external genitalia, in the other 50%, the lesions had spread to the hypogastrium and/or the perineum. Medical treatment included intensive care and triple antibiotic therapy, penicillin, gentamycin and metronidazole. A hyperbaric oxygen therapy was associated in 25% of the cases. The surgical treatment in the acute period included incising, debridement, paring, draining, urinary derivation (n = 36), and colostomy (n = 5). Thirteen patients had the benefit of sequential and prospective bacteriological tests. RESULTS: Spontaneous healing was obtained in 48% of the patients within 2 to 3 months. Secondary reconstructive surgery consisted mainly in cutaneous grafts. Global mortality rate was 34%, mortality rate was 30% in the secondary gangrenes, 40% in the primitive gangrenes. Mean hospitalisation duration was 6 weeks. Main sequelae were cheiloïd scars. CONCLUSIONS: The authors try to clarify the nosological imprecisions of this pathology by distinguishing between the secondary types and the primitive types corresponding to Fournier's gangrene, which still inspires many questions concerning its etio-pathogenesis. The surgical treatment must eradicate all necrosis by suited iterative procedures, associated with local care. Hyperbaric oxygen therapy was not efficient in this series. This pathology, although rare, needs to be better known, because only an early and efficient surgical and medical treatment will be able to decrease the exceptional gravity of the prognosis.

[Post-partum malignant amebic colitis. Apropos of a case]. / Amibiase colique maligne du post-partum. A propos d'un cas.

A 26-year old female developed acute fulminant amoebic colitis during the post-partum period, successfully managed by subtotal colonic resection without anastomosis. Fulminant transmural amoebic colitis is a rare life-threatening complication of invasive bowel amebiasis. Pregnancy, delivery, diabetes mellitus and immunodeficiency are the main risk factors. At pathologic examination, bowel wall necrosis can be seen with amoebae present in the lumen of capillary vessels. The diagnosis of amoebic colonic perforation is difficult, especially in a non-endemic area. Conservative surgical management is required in non-perforated forms. If perforated, the bowel must be resected, limited to macroscopic lesions.

[Congenital cystic dilatation of the choledochus: apropos of a case diagnosed in an adult Senegalese women]. / La dilatation kystique congénitale du cholédoque: à propos d'un cas diagnostiqué chez une adulte sénégalaise.

The authors report a case of congenital cystic dilatation of the choledochus diagnosed on a 37 years old senegalese woman. It is an uncommon affection in Africa. The clinical presentation with various signs is reviewed. Ultrasound or cholangiography confirms the diagnosis. Surgical excision of the cystic dilatation is the best treatment because of the high risk of cancerisation.

[Late revascularization of the limbs for post-traumatic chronic ischemia]. / Revascularisation tardive de membre pour ischémie chronique post-traumatique.

Chronic post traumatic ischaemia is a specific late complication of vascular injuries. The authors report a four cases series, including three war vascular injuries. They emphasize the surgical management lines and point out the preeminence of vascular restoration on reconstructive bone and joint surgery.

[Multiple wounds caused by a 5.56 mm bullet: the Famas, a competitive weapon]. / Polyblessure par balle de 5.56: le Famas, une arme compétitive?

A case is reported of multiple wounds to abdomen and spine from a 5.56 mm bullet. Differing from currently used weapons, a high speed bullet is projected producing damage that has been studied precisely and compared with lesions caused by conventional bullets. The weapon responsible is progressively equipping a certain number of French regiments.

[Combination of traumatic vascular and neural lesions of the limbs. Surgical approach. Apropos of 10 cases]. / Association de lésions vasculaires et nerveuses traumatiques au niveau des membres. Tactique chirurgicale. A propos de 10 cas.

Ten cases of limb injuries including vascular and nervous lesions are reported. After pointing out the modalities of diagnosis, the authors describe the surgical technic: vascular management first, and then nervous repair. After a six months to three years follow-up, among eight cases, the vascular repair is successful every time, and the nervous repair five times. Although each technic is usually easy, the association of both lesions needs the collaboration of multidisciplinary surgical teams.

[Bilateral popliteal artery aneurysm revealing an entrapment]. / Anévrysme poplité bilatéral révélateur d'un piège.

Popliteal entrapment syndrome is not so rare if usually researched by clinical examination. But it is very unusual to find a bilateral aneurysm when you first examine your patient. One of them was complicated by a rupture. The surgical management with bilateral venous grafts is described.