Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger.

To report etiological and prognostic characteristics of acute peritonitis in children. This retrospective study reviewed the records for a 30-month period (January 2013-June 2015) at Zinder National Hospital (Niger) of all children between the ages of 0-15 years who underwent surgery for non-traumatic acute peritonitis. Statistical tests were performed, with significance defined by a P-value < 5 %. Acute peritonitis accounted for 62.12 % (226/358) of all emergency gastrointestinal surgery in children. Their median age was 10 years (range: 0-15 years), with almost two-thirds of them male (n=148). Ileal perforation, presumably due to typhoid fever, was the main cause (n=153), with acute appendicular peritonitis in second place, accounting for 25.22 % (n=57) of cases. Gastrointestinal ostomy was performed in 101 patients (44.7 %) and an appendectomy in 56 (24.8 %). The average length of stay was 10.9±3.6 days. Postoperative complications, defined by the Clavien-Dindo classification, occurred in 46.5 % of these procedures (n=105). Surgical site infections were recorded in 66 cases. Overall mortality was 13.7 % (n=31) and was statistically associated with an American Society of Anesthesiologists (ASA) score of IV (OR = 3,32 : 1,07-10,27 ; P = 0,037) and Mannheim Peritonitis Index (MPI) ≥ 26 (OR = 44,68 : 10,17 - 196,32 ; P = 0,000), time to admission (OR = 4,626 : 1,39 - 15,34, P = 0,012), and time to surgery in hours (OR = 4,59 : 1,60 - 13,18 ; P = 0,0046). In Niger, perforation apparently due to typhoid is the main cause of peritonitis in children. Mortality is associated with an ASA score of IV, Mannheim Peritonitis Index ≥ 26, time to admission, and time to surgery.

[Macrocystic serous cystadenoma of the pancreas, about a case]. / Cystadénome séreux macrokystique du pancréas, à propos d'un cas.

Serous cystadenomas of pancreas are unusual cystic tumour. The microcystic forms is more common and its radiological diagnosis is easy. However, the macrocystic unilocular form of serous cystadenoma can be mistaken with other malignant macrocystic lesions of the pancreas. We report the case of a 17 year-old girl, admitted to the National Hospital of Niamey (Niger), with abdominal pain and an unilocular macrocystic serous cystadenoma of pancreas, diagnosed after histological examination of the surgical specimen. The diagnostic tests, including ultrasound, CT scan, MRI, endoscopic ultrasonography are inconclusive. Challenge of its management is related to the preoperative diagnosis.

Les cystadénomes séreux (CS) du pancréas sont des tumeurs kystiques rares. La forme microkystique du CS est la plus fréquente et de diagnostic radiologique facile. Par contre la forme macrokystique du CS peut être confondue avec les autres lésions macrokystiques du pancréas à potentiel malin. Nous rapportons l'observation d'une jeune patiente de 17 ans admise à l'Hôpital national de Niamey (Niger) dans un tableau de douleurs abdominales, ayant un cystadénome séreux macrokystique uniloculaire du pancréas, diagnostiqué après l'examen histologique de la pièce opératoire. Les examens paracliniques réalisés, notamment l'échographie, le scanner, l'IRM, l'échoendoscopie ne sont pas concluants. La difficulté de la prise en charge réside dans le diagnostic préopératoire.

[Digestive surgical emergencies in Sub-Saharan Africa: a prospective study of a series of 622 patients at the National Hospital of Zinder, Niger]. / Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d'une série de 622 patients à l'Hôpital national de Zinder, Niger.

The purpose of this study was to describe the epidemiologic, therapeutic, and prognostic aspects of surgical acute abdomen at the National Hospital of Zinder (HNZ). This was a prospective study of patients undergoing digestive surgical emergencies in HNZ over 24 months (January 2013-December 2014). During the study period, 622 digestive surgical emergencies were operated. The mean age was 22.91 ± 18.14 years old, with a sex-ratio of 3:1. The average admission time was 64.31 ± 57.90 h. Abdominal pain was the main reason for admission in 61.90% (N = 385) of the cases, with or without fever throughout the course in 26.05% (N = 162) of the cases. The average time before surgery was 9.13 ± 5.97 h. Acute peritonitis accounted for 51.61% (N = 321) of cases, led by ileal perforation maybe from typhoid (N = 175). The acute intestinal obstruction and acute appendicitis accounted for 27.49% (N = 171) and 9.65% (N = 60) of the cases, respectively. Abdominal trauma had affected 53 patients (8.52%). The average length of hospital stay was 8.71 ± 5.29 days. Postoperative morbidity was 38.10% (N = 237). Septic complications (N = 187) were predominant. Overall lethality of 13.67% (N = 85), was associated with the delay of diagnosis and treatment (P < 0.001). The incidence and the high morbidity and lethality of digestive surgical emergencies in the Sub-Saharan context, could be avoided through prevention, early consultation, and adequate intra-hospital management.

[Patient satisfaction, an important part of care: case of a surgical department in Niger]. / Satisfaction des patients, element important dans la globalite des soins: cas d'un service des urgences chirurgicales au Niger.

INTRODUCTION: The aim of this study was to assess patient satisfaction in the surgical emergencies department at the National Hospital of Zinder, Niger. MATERIALS AND METHOD: This was a cross-sectional study focusing on patients admitted to the surgical emergency department of the National Hospital of Zinder (NHZ). The study was conducted over a period of 2 month - from July 1st to August 31st, 2015. During a face to face interview, patients were asked a series of questions. RESULTS: Of the 227 patients surveyed, 54.62% (n=124) were satisfied with their experience of the surgical emergencies department. The main factors associated with high satisfaction scores were patient reception (OR: 0.27, 95% CI=0.14 to 0.52; p <0.001), and the management of symptoms (OR: 0.28, 95 % CI=from 0.14 to 0.58; p < 0.001). Dissatisfaction factors were: waiting time before receiving treatment (OR 16.57, 95% CI=8.52 to 32.23; P <0.0001), the environment (OR: 3.89, 95% CI=2.12 to 7.12; p <0.001), accessibility (OR: 5.85, 95% CI=2.54 to 13.46, p < 0.001) and poor staff-patient communication (OR, 13.76; 95% CI 6.54 to 28.98; P <0.0001). CONCLUSION: Despite the shortcomings of the surgical emergencies department of NHZ, a good welcome and prompt patient management have been the key components associated with patient satisfaction.

INTRODUCTION: Le but de cette étude était d'évaluer la satisfaction des patients pris en charge au service des urgences chirurgicales de l'Hôpital National de Zinder, Niger. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale portant sur des patients admis aux urgences chirurgicales de l'hôpital National de Zinder (HNZ). L'enquête a été réalisée sur une période de 2 mois du 1er juillet au 31 août 2015. Un questionnaire adressé aux patients était rempli à travers un entretien direct. RÉSULTATS: Sur les 227 patients retenus, 54,62% (n=124) étaient satisfaits des prestations au service des urgences chirurgicales. Les principaux éléments associés à une bonne satisfaction étaient l'accueil (OR: 0,27; IC95%= 0,14 ­ 0,52; p<0,001) et la prise en charge de la symptomatologie (OR: 0,28; IC95% = 0,14 ­ 0,58; p<0,001). Les facteurs incriminés dans l'insatisfaction étaient: le temps d'attente avant la prise en charge (OR: 16,57; IC95% = 8,52 ­ 32,23; p<0,0001), l'environnement (OR: 3,89; IC95%=2,12 ­ 7,12; p<0,001), l'accessibilité (OR: 5,85; IC95%=2,54 ­ 13,46; p<0,001) et la mauvaise communication soignant-patient (OR: 13,76; IC95% =6,54­28,98; p< 0,0001). CONCLUSION: Malgré les insuffisances du service des urgences chirurgicales de l'HNZ, un bon accueil et une prise en charge rapide, sont les éléments clés associés à la satisfaction du patient.

A CASE OF LITTRÉ'S HERNIA AT ZINDER NATIONAL HOSPITAL, ZINDER, NIGER.

The presence of a Meckel's diverticulum in a hernia sac is known as Littré's hernia. We report a case of Littré's hernia in an 18-year old young man because of the uncommon condition. An 18-year old young patient was admitted to the Emergency Surgical Department of Zinder National Hospital, Zinder, Niger with a painful inguinoscrotal swelling of three days duration. The diagnosis of strangulated right inguinoscrotal hernia was made. At surgery, a Meckel's diverticulum was found at the antimesenteric border of the ileum in the hernia sac, the bowel loop was not viable. Resection of the non-viable ileal loop with the Meckel's diverticulum attached to it was performed with an end-to-end ileal anastomosis. The hernia defect in the groin was repaired according to Bassini procedure. The postoperative recovery was uneventful and the patient was followed up for 5 months without symptoms. CONCLUSION: Littre hernia is uncommon and difficult to diagnose; it is often an incidental finding at surgery which should ensure complete resection of the Meckel's diverticulum in order to prevent future complications.