Evaluation of the Management of Gastroschisis in Aristide Le Dantec University Hospital Center in Dakar.

INTRODUCTION: The management of gastroschisis remains problematic in low- and middle-income countries with high perioperative mortality. The objective of this work was to make an initial assessment of our management of gastroschisis. MATERIALS AND METHODS: This was a monocentric and cross-sectional study including all newborns with gastroschisis between January 2017 and December 2021 in the Pediatric Surgery and Anesthesia Resuscitation Department of the Aristide Le Dantec University Hospital Center from Dakar. The socio-demographic, diagnostic, therapeutic and evolutionary parameters were studied. RESULTS: Were collected 18 cases of gastroschisis (11 males and 7 females). The mothers were on average 23.1 ± 5.7 years old. Only one antenatal diagnosis was made. The term of pregnancy was on average 36.5 ± 1.5 weeks. On admission, the mean age was 16.8 ± 6.3 h and the mean weight 2244 ± 260.3 g. Gastroschisis was complex in four patients. Primary bowel reintegration was performed in 8 cases (44.4%) and progressive reintegration using an Applied Alexis retractor in 9 newborns (55.6%). Complications were dominated by respiratory distress (28.3%) and sepsis (22.2%). The mean delay of oral feeding was 5.1 ± 1.9 days. Mortality was 94.4% (17/18). CONCLUSION: Reducing gastroschisis-related mortality in our low-income countries remains a major challenge.

Management of Umbilical Hernia in African Children: The Experience of 2146 Cases.

Aims: Umbilical hernia (UH) is common in African and African-descent children. In high-income countries (HICs), it is considered benign, which is not the case in Sub-Saharan ones. Through this study, we aimed to share our experience. Materials and Methods: A descriptive review was conducted from January 01, 2012 to December 31, 2017 at Albert Royer National Children's Hospital Center. Among the 2499 patients, 2146 cases were included in the review. Results: UH had a frequency of 6.5%, with patients having a mean age of 2.6 years, with a male preponderance of 63%. Emergency consultation occurred in 37.1%. The symptomatic hernia was present in 90.9%. The congenital type was found in 96%, a history of painful episodes was reported in 46%, and medical and surgical comorbidities were found in 30.1% and 16.4%, respectively. Multimodal anesthesia was used in 93.1%. A lower umbilical crease incision was made in 83.2%, the sac was not empty in 16.3%, and additional umbilicoplasty was performed in 16.3%. During a 14-month follow-up, a complication occurred in 6.5% and mortality in 0.05%. Conclusion: In our region, the pediatric UH was predominantly symptomatic, with its natural evolution leading to more complications than in HICs. Its management carried acceptable morbidity.

Fibromatosis Colli: About 26 Cases.

Aims: The aim is to identify the epidemiological, diagnostic, therapeutic, evolutionary aspects, and risk factors related to the occurrence of this condition. Subjects and Methods: It was a retrospective and descriptive study of a series of 26 cases of fibromatosis colli collected over a period of 3 years (from January 1, 2017 to December 31, 2019). We studied the following parameters: frequency, age, sex, delay of consultation, motive of consultation, gravidity, parity, type of delivery, notion of birth trauma, birth weight, examination findings, ultrasound results, type of treatment, and evolutionary modalities. The data were collected from patients' files. The analysis was done on Excel 2016. Results: The frequency was 6.5 cases/year. The mean age was 2.1 months. The average delay of consultation was 6.3 weeks. A notion of obstetrical trauma was found in 16 cases (61.5%). Primiparity was noted in 15 cases (57.5%). Associated torticollis was noted in 03 cases. Cervical ultrasonography was performed in all cases (n = 26/26) enabling diagnostic confirmation. Surveillance was the main treatment (84.6%). After a mean follow-up of 20.8 months, evolution was favorable in the majority of patients. The average time of complete regression of the mass was 3.8 months. Conclusions: Rare condition of the newborn and infant for which the diagnosis is clinical and the confirmation is based on ultrasound. The management is simple and based on surveillance. The evolution is most often toward spontaneous regression.

Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal.

Objective: Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department. Methods: We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression. Results: Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425). Conclusion: The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.

Choledochal cyst in children in dakar: Diagnostic and therapeutic aspects.

CONTEXT: Choledochal cyst is a rare malformation that mainly affects girls. AIMS: The aim of this work is to report the diagnostic, therapeutic and evolutionary aspects of bile duct cyst in children in Dakar. SUBJECTS AND METHODS: we conducted a prospective monocentre descriptive study from 1 July, 2016, to 30 June, 2019, in the Pediatric Surgery Department of Albert Royer Children's Hospital in Dakar. The studied parameters featured clinical, biological, radiological, therapeutic and evolutionary data. Overall, ten patients, including eight girls and two boys, were selected. RESULTS: Two patients presented the classic triple-syndrome complex featuring an abdominal pain, an abdominal mass and jaundice. Most of the patients presented a symptomatology associating abdominal pain and vomiting. Biological cholestasis syndrome was present in six cases and biological cytolysis syndrome in five cases. The abdominal ultrasound-computed tomography (CT) scan confirmed the diagnosis and helped to set the Todani classification with a predominance of Types 1 and 4. Surgical treatment by laparotomy consisted of total excision of the cyst followed by a Y-en-Roux hepatico-jejunal anastomosis in nine cases, whereas we performed a drainage of the cyst in one case. Two patients presented a morbidity of anastomotic suture release and evisceration and had a good outcome after surgical repair. There was no mortality. CONCLUSIONS: The diagnosis of choledochal cyst dilatation (CCD) can be suspected in the postnatal period on the basis of a gastro-intestinal symptomatology with or without associated to jaundice. The combination ultrasound-abdominal CT-scan helps set the diagnosis. The laparatomic approach always has its place for the management of CCD, especially in our context.

[Cryptorchidism in Prune Belly syndrome]. / La Cryptorchidie dans le Syndrome de Prune Belly.

PURPOSE: To analyze the epidemiological, diagnostic, therapeutic and evolutionary aspects of cryptorchidism in Prune Belly syndrome. PATIENTS AND METHOD: This is a retrospective and descriptive study over an 11-year period involving 24 cases of children admitted for cryptorchidism that is part of Prune Belly syndrome in the paediatric surgery department of the Aristide Le Dantec University Hospital in Dakar. We were interested in epidemiological, diagnostic, therapeutic and evolutionary aspects. RESULTS: The incidence of cryptorchidism in Prune Belly syndrome was 2.4 cases per year. The average age of discovery was 1 year and the age of testicular lowering was 20 months. The bilateral form predateed with 91.7% of cases. Simple orchidopexia was practiced in 50% of cases. An orchidopexia using the Fowler-Stephens technique in one time was practiced in 45.8% of cases. A right orchidectomy was needed in 4.2% of cases. Surgical procedures were simple in 47.8% of the lowered testicles. The most common complication was testicular atrophy noted primarily in the Fowler-Stephens technique in a single time. CONCLUSION: Cryptorchidism in Prune Belly syndrome is most often bilateral and the testicle was frequently palpable. His diagnosis remains very late in our context. Given the number of testicular atrophies driven by the Fowler-Stephens technique in one time, it should be abandoned in favour of the Fowler-Stephens technique in two stages.

BUT: Analyser les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la cryptorchidie dans le syndrome de Prune Belly. PATIENTS ET MÉTHODE: Il s'agit d'une étude rétrospective et descriptive sur une période de 11 ans portant sur 24 cas d'enfants admis pour une cryptorchidie qui entre dans le cadre du syndrome de Prune Belly au service de chirurgie pédiatrique du centre hospitalier universitaire Aristide Le Dantec de Dakar. Nous nous sommes intéressés aux aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs. RÉSULTATS: L'incidence de la cryptorchidie dans le cadre du syndrome de Prune Belly était de 2,4 cas par an. L'âge moyen de découverte était de 1 an et celui de l'abaissement testiculaire était de 20 mois. La forme bilatérale prédominait avec 91,7% de cas. Une orchidopexie simple a été pratiquée dans 50% des cas. Une orchidopexie selon la technique de Fowler-Stephens en un temps a été pratiquée dans 45,8% des cas. Une orchidectomie droite était nécessaire chez 4,2% des cas. Les suites opératoires étaient simples chez 47,8% des testicules abaissés. La complication la plus fréquente était l'atrophie testiculaire notée essentiellement dans la technique de Fowler-Stephens en un seul temps. CONCLUSION: La cryptorchidie dans le cadre du syndrome de Prune Belly est le plus souvent bilatérale et le testicule était fréquemment palpable. Son diagnostic reste très tardif dans notre contexte. Au vu du nombre d'atrophies testiculaires entraîné par la technique Fowler-Stephens en un temps, elle devrait être abandonnée au profit de la technique de Fowler-Stephens en deux temps.

Elbow floating in children: About three cases and literature review.

PURPOSE: The aim of this study was to determine the epidemiological, lesion, treatment and outcome of the 'floating elbow' in children. OBSERVATIONS: It was two boys and a girl with a mean age of 7 years. The average consultation time was 3.6 h. In two patients, the trauma had occurred during playful accident with fall from a height. Supracondylar fracture was associated with a fracture epiphyseal separation-type II distal end of the right radius in one case, a fracture of the distal quarter of the bones 2 of the forearm in the second patient and fracture quarter distal radius in the third patient. All fractures of the elbow were treated by osteosynthesis as well as a fracture of the distal radius ». The average hospital stay was 5 days. After a mean of 8 months was rated limitation of elbow flexion to 100° in a patient, an externalisation of the pins at the elbow in M3 in one patient and a limitation of elbow extension at 30° in 2 patients. One patient had a varus ulna. The pronosupination was preserved in all patients. CONCLUSION: The 'floating elbow' is unusual in children and usually occurs during a high-energy trauma. His treatment is not yet the subject of consensus. Complications often involve the elbow.

[Omphalomesenteric fistulas; epidemiological diagnostic and therapeutic features: study of four cases in the Department of Pediatric Surgery at the Aristide Le Dantec University Hospital in Dakar]. / Fistules omphalo-mésenteriques; aspects épidémio logiques, diagnostiques et thérapeutiques: à propos de quatre observations au Service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar.

This study aims to determine the epidemiological, therapeutic and diagnostic features of omphalomesenteric fistulas (OMF). We conducted a study of four cases over a period of 10 years, from January 2004 to December 2013. The parameters studied were: frequency, age, sex, clinical and radiological signs, therapeutic and evolutionary features. Frequency was 0.4 cases per year. Patients were aged 11 days, 40 days, 45 days and 3 years respectively (three girls and one boy). Clinical examination showed intestinal fluid discharge from the belly button and belly button bud catheterisable in all the cases. The bud was prolapsed in the patient aged 45 days. Fistulography performed in two cases helped to confirm the diagnosis by showing a communication between the fistula and the small intestine. The assessment of malformations revealed congenital cyanogen heart disease with interventricular communication in the newborn aged 45 days, anorectal cloacal malformation associated with urachus fistula in the newborn aged 11 days. All patients underwent surgery. Semicircular periumbilical incision was performed in the absence of associated abdominopelvic malformations. A communication between the fistula and the ileum was found in the majority of cases. Bowel resection with termino-terminal anastomosis was performed in three cases. Cuneiform resection was performed in one case and was completed by complete resection of the urachal fistulous tract and bladder suture, with colostomy in newborn with urachal fistula and anorectal cloacal malformation. The postoperative course was marked by non-febrile seizures in the first child with good evolution and by superficial parietal suppuration followed by death due to cardiac decompensation in the third case. Omphalomesenteric fistula is rare. Diagnosis is based on clinical examination complemented by the fistulography. Surgical treatment using semicircular periumbilical incision gives good results. However, the assessment of malformations is necessary.

Peritoneal Tuberculosis in Infants: Diagnostic Challenges.

Abdominal tuberculosis is rare in immunocompetent infants. We report on two infants with peritoneal tuberculosis (6 and 8 months) who underwent laparotomy for suspected intussusception. In the first patient, characteristic lesions of peritoneal tuberculosis were observed intraoperatively with presence of multiple granulations. Tuberculin intradermal reaction (IDRt) was positive and tuberculous contagium could be cultured. In the second patient, the IDRt and GeneXpert tests were negative. In both patients, the histopathological examination of the biopsy specimens confirmed the diagnosis of peritoneal tuberculosis. The clinical courses under tuberculostatic therapy were favorable in both cases.

Heterotopic pancreas without Meckel's diverticulum in children as unique cause of gastrointestinal bleeding: think about it!

Ectopic pancreas also known as heterotopic pancreas (HP) is a rare congenital anomaly, mainly found as incidental finding during autopsy or abdominal exploration for an other condition. Incidence rate is probably underestimated as patients are mostly asymptomatic; otherwise, it is capable of producing symptoms depending on its location, size, often appearing in the 4th-to-6th decades. Complications such as inflammation, obstruction, bleeding, and malignancy degeneration must be considered. Pediatrics cases are very rare, generally concerning HP within Meckel's diverticulum, manifesting by gastrointestinal bleeding and intussusception. We report a rare case of jejunum bleeding, due to an isolated HP in a 15-year-old adolescent. Endoscopic and computed tomographic scan were normal, in particular did not found Meckel's diverticulum. Diagnosis and treatment have been apprehended performing a laparoscopic exploration. It is a singular location for HP, predominantly found in upper gastrointestinal tractus. So far, there have been no case reports of jejunal bleeding from ectopic pancreas without Meckel's diverticulum in children.

[Accidents of the everyday life (AcVC) in children in Dakar: about 201 cases]. / Les accidents de la vie courante chez l'enfant à Dakar: à propos de 201 cas.

Accidents of everyday life (AcVC) are common in children and can led to disabling injuries and death. This study aimed to analyze the epidemiological aspects of AcVC and the related injury mechanisms in Dakar. We conducted a descriptive, cross-sectional study conducted from 1 January 2013 to 30 June 2013. All the children victims of domestic accidents, sport and leisure accidents or school accidents were included. We studied some general parameters and some parameters related to each type of AcVC. Two hundred and one children were included, accounting for 27% of emergency consultations. There were 148 boys and 53 girls. Children less than 5 years of age were most affected (37.8%). Football and wrestling game were the main causes of AcVC. AcVC occur mainly at home (58.2%) and in the areas of sport and recreation (31.8%). The fractures predominated in the different types of AcVC: 54.9% of domestic accidents, 68.8% of sport and recreation accidents and 40% of school accidents. From an epidemiological perspective, our results are superimposable to literature. Fractures predominated contrary to literature where bruises were preponderant. Wrestling game is the main cause of these fractures, after football. The acquisition of knowledge about the epidemiological aspects of AcVC and the related injury mechanisms will allow for prevention campaigns in Dakar.

[Volvulus of the small intestine caused by mesenteric lipoma]. / Volvulus du grêle sur lipome du mésentère.

We report the case of a 7-year old girl presenting with sub-occlusive syndrome associated with acute paroxysmal abdominal pain at the level of the upper abdomen, vomiting and no evacuation of faeces. Physical examination showed discomfort with palpation of the upper abdomen. Abdominal ultrasound showed poorly limited intraperitoneal tissue formation without vascular features on doppler, exercising a mass effect on the neighborhood structures; mesenteric vessels were in their normal position. This mass on CT scan scorresponded to a well limited lipomatous formation exercising a mass effect on the caecum associated with volvulus of the small intestine. The diagnosis of volvulus of the small intestine caused by mesenteric lipoma was retained. Surgical exploration confirmed this diagnosis. The patient underwent unrolling of the small intestine and lipoma enucleation. The postoperative course was uneventful after a follow-up of 6 months. Anatomo-pathological examination confirmed the lipomateuse nature of the mass.

Wrestling game injuries among children in Dakar: a report on 172 cases.

INTRODUCTION: The objective was to report epidemiological and lesional features among children practicing wrestling as a game in Dakar, Senegal. METHODS: It was a retrospective study including all patients under 16, victims of wrestling game injuries. We studied epidemiological and lesional aspects in children: frequency of wrestling game injuries among all games, age, sex, geographic origin, place of injury, parent's socioeconomic status, nature of the injury and location. RESULTS: Wrestling game injuries represented 19.9% injuries in all games. Sex-ratio was 33.4. The most affected age group was the 6-10 years old age group. The majority of children are from suburban Dakar (64%). Injuries occurred most often at home and in the street. Most children are from low socioeconomic status (64%). Fractures predominated and were localized almost exclusively on the elbow. CONCLUSION: Wrestling game injuries in Dakar occur among older children from the suburbs, living in the neighborhood of great wrestling champions' districts of residence. Wrestling game cause injuries, consisting mostly of elbow fractures.

Pyloric atresia: a challenge in an underdeveloped country.

Pyloric atresia is a rare congenital malformation. We report a case in a 5-day newborn with pyloric atresia type C. Authors emphasize the diagnostic difficulties and therapeutic challenges in a resource-limited country.

[Volvulus of the small bowel due to ascaris lumbricoides package: about a case]. / Volvulus du grêle sur paquet d'ascaris: à propos d'un cas.

We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.

Aneurysmal femoral neck cyst: Report of a paediatric case and review of literature.

The aneurysmal bone cyst (ABC) is a benign tumour of children and young adults. It represents approximately 1-2% of all bone tumours. The ABC may develop on all skeletal bones, but the proximal end of the femur is the most common location. The authors report a ABC femoral neck in a child of 13 years. This location is pretty special. Indeed, the fragility of the femoral neck due partly to the pathology itself and secondarily curettage requires a judicious attitude surgical (excisional curettage + bone graft + screw) to prevent the risk of high local recurrence and pathological fracture.

[Scooter accidents in children at Aristide Le Dantec, Unversity Hospital of Dakar: a study of 74 cases]. / Les accidents de scooter chez l'enfant au CHU Aristide Le Dantec de Dakar: à propos de 74 cas.

INTRODUCTION: Scooter accidents are becoming more frequent in Dakar. The purpose of this study is to report the epidemiological and lesional aspects of these accidents on children in Dakar. MATERIALS AND METHODS: A retrospective and descriptive study was conducted in Pediatric Surgery Unit of the Aristide Le Dantec Hospital in Dakar from January 1st, 2009 to December 31, 2011. Various parameters were studied. These parameters include: frequency, sociodemographic and lesional aspects. RESULTS: Scooter accidents represent 12% of highway accidents. They were more frequent in the day, from 12 am to 2 pm (27%) and in the night, from 6 pm to 8 pm (28.4%). They might occur every day but were more frequent during April (17.6%) and June (13.5%). They occurred mainly in the suburban district of Dakar (78%). The age group most affected was the one from 3 to 8 years (60.8%). Male gender was predominant (sex ratio 1.5). Pedestrians are the most vulnerable (93.2%). The fall was the dominant mechanism (98.7%). Lesions affected mainly the lower limb (51.1%) and were essentially constituted by fracture. CONCLUSION: The frequency of scooter accidents in children is related to the galloping urbanization and to the increase of the number of cars on the roads in the peninsula. Victims are essentially pedestrians and present most of the time fractures.

Oesophageal atresia: Diagnosis and prognosis in Dakar, Senegal.

BACKGROUND: Oesophageal atresia is a neonatal emergency surgery whose prognosis has improved significantly in industrialised countries in recent decades. In sub-Saharan Africa, this malformation is still responsible for a high morbidity and mortality. The objective of this study was to analyse the diagnostic difficulties and its impact on the prognosis of this malformation in our work environment. PATIENTS AND METHODS: We conducted a retrospective study over 4 years on 49 patients diagnosed with esophageal atresia in the 2 Paediatric Surgery Departments in Dakar. RESULTS: The average age was 4 days (0-10 days), 50% of them had a severe pneumonopathy. The average time of surgical management was 27 h (6-96 h). In the series, we noted 10 preoperative deaths. The average age at surgery was 5.7 days with a range of 1-18 days. The surgery mortality rate is 28 patients (72%) including 4 late deaths. CONCLUSION: The causes of death were mainly sepsis, cardiac decompensation and anastomotic leaks.

Traumatic posterior sternoclavicular joint dislocation in a child: a case report.

Sternoclavicular joint dislocation is a rare event. It occurs most often in a violent trauma. The authors report the case of a10 years old child, received at emergencies for right shoulder blunt trauma after been punched by another child. He presented with right shoulder pain, right upper limb functional impairment and right sternoclavicular joint depression. Standard chest radiographs were normal. Chest CT scan showed posterior dislocation and allowed us to determine its variety. Twelve hours after the trauma, a closed reduction has been done under general anesthesia. A control CT scan showed a restoration of normal joint anatomy. After 18 months, the shoulder was painless and mobile in all directions. It is an isolated recent posterior sternoclavicular joint dislocation in a child. With this observation the authors emphasizeon the unusual mechanism of such a dislocation occurrence, the primary role of CT scan in the diagnosis and early closed reduction.