Evaluation of the use of Home Emergency in a Sub-Sahara African hospital: Example of the Hospital Principal in Dakar.

Overloaded emergency departments are common around the world. This prospective, descriptive, and analytical study evaluates the reasons for emergency room use and describes the severity of the patients' conditions and how they reach the emergency department. It took place at the emergency department of the principal hospital of Dakar (the Armed Forces Teaching Hospital) over a one-week period (from August 23 to August 30, 2016) and included a sample of 219 patients of both sexes aged 15 years and older. Data were collected about social and demographic characteristics, reasons for choosing the emergency department rather than other care, time of day, day of the week, accessibility, means of transport, diagnosis, and severity. More than half of patients (55 %) were men, with a mean age of 42 +/- 18. Only 10 % of patients lived within 5 km of the hospital. Most (84.5 %) came from the Dakar region and lived between 5 and 35 km from the hospital. Most patients reached the hospital by their own means (83 %). Only 2 % were transported by the public emergency ambulance service. The reasons for choosing the emergency unit were the opportunity for additional tests in 41.1 % of cases ; the desire to be hospitalized in 26.9 % ; fear of death in 26.5 %, no waiting list in 14.2 %, and lack of money in 11 % of cases. Patients in truly serious condition accounted for only 5 % of cases. Most (88 %) returned home after stabilization, 12 % were hospitalized, and 0.5 % died. Good practices, good organization, and improved complementarity between public, private, and emergency services are needed to reduce the use of the latter.

Syndrome occlusif au décours d'une ingestion chronique de Kaolin ("Kew"). A propos d'une observation

Le pica est un trouble du comportement alimentaire fréquemment rencontré chez les femmes et les enfants. Il se caractérise par l'ingestion d'objets ou de substances non-comestibles comme la craie, le charbon, le savon, le métal, le sable etc... Nous rapportons une observation d'une patiente de 20 ans avec notion d'autisme depuis l'enfance et d'addiction à la géophagie (Kaolin appelé "kéw" au Sénégal) depuis plusieurs années qui a eu à consulter pour des douleurs abdominales associées à des ballonnements abdominaux, une hématémèse et un arrêt complet des matières et des gaz. Son examen clinique avait objectivé un abdomen légèrement sensible sans défense ni cris de l'ombilic et le toucher rectal avait objectivé un fécalome de consistance dure. Le bilan biologique était normal en dehors d'une légère hypokaliémie, le test de Wide était négatif. La radiographie de l'abdomen sans préparation avait objectivé des micro calcifications en amas au niveau du rectum confortée par la tomodensitométrie abdomino-pelvienne qui avait en plus infirmé l'existence d'une perforation d'organe et de souffrance viscérale. Un traitement évacuateur mécanique consistant en la mise en place d'une sonde d'intubation orotrachéale charnière n°6 au niveau du rectum avec ballonnet gonflé et irrigation par 500 ml de sérum savonneux stérile suivi d'une évacuation au doigt avait permis d'évacuer la quasi-totalité des corps étrangers endorectaux confirmée par la radiographie de contrôle. Devant la constatation d'une ré-ingestion au bout d'une semaine avec une radiographie de l'abdomen sans préparation qui avait montré des images quasi-superposable, la patiente a été adressée en consultation psychiatrique pour un suivi

[Clinical and endoscopic features of solitary rectal ulcer syndrom in the digestive endoscopy unit of Hospital Aristide Le Dantec in Dakar]. / Aspects cliniques et endoscopiques du syndrome de l'ulcère solitaire du Rectum dans l'unité d'endoscopie digestive du CHU A. Le Dantec de Dakar: à propos de 11 cas.

INTRODUCTION: The solitary rectal ulcer syndrome is a rare disease. In Africa only few studies have been held on this subject. The aim of this study was to determine the epidemiological, clinical and endoscopic aspects of this syndrome in the digestive endoscopy unit of hospital Aristide Le Dantec in Dakar. PATIENTS AND METHOD: It was a retrospective study based on all the cases of solitary rectal ulcer regarding to the conclusion of endoscopic examination from January 1994 to June 2002. All the patients without histological confirmation were excluded. RESULTS: We had recruited 11 cases among 4250 endoscopic exam (0.26 %). The mean age was 40 years (extreme 23 to 63 years). Female to male ratio was 1.75 with 4 males and 7 females patients. The main indications of endoscopic examination were frequently associated and were dominated by intermittent bleeding (8 cases) chronic constipation (6 cases) and false chronic diarrhea with muco hemorrhagic discharge (4 cases). The mean duration of the symptoms was 5 years. Ulcers were ovoid or circular. Their mean diameter was 8 mm and they were located 8 cm above the anal margin. The lesion was unique in 55 % of the cases and concerned the anterior wall of the rectum in 74% of the cases. There was an internal rectal prolapse in 54% of the cases. CONCLUSION: The solitary rectal ulcer syndrome is not frequent in the endoscopy unit of hospital Aristide Le Dantec in Dakar. It affects mostly young adult female. The symptoms are chronic and non specific. In tropical areas the disease is frequently misdiagnosed as colic amoebiasis.

Aspects cliniques et endoscopiques du syndrome de l`ulcere solitaire du rectum dans l`unite d`endocospie digestive

Introduction : l'ulcere solitaire du rectum est une pathologie rare. En Afrique Noire; peu de travaux ont porte sur ce sujet. L'objectif de ce travail etait d'etudier ses aspects epidemiologiques; cliniques et endoscopiques dans un service d'endoscopie digestive a Dakar. Patients et methode : il s'agissait d'une etude retrospective dans l'unite d'endoscopie digestive du CHU Aristide Le Dantec de janvier 1994 a juillet 2002. Tous les patients qui avaient une lesion evoquant un ulcere solitaire du rectum ont ete inclus. Ceux chez qui l'histologie n'etait pas en faveur ont ete exclus. Resultats : parmi les 4250 patients ayant eu des endoscopies; 11 avaient un ulcere solitaire du rectum (soit une frequence de 0;26). Leur age moyen etait de 40 ans (extremes a 23 et 63 ans) et le sex-ratio de 0;57 (4 hommes et 7 femmes). Les indications de l'endoscopie etaient souvent associees et dominees par les rectorragies intermittentes (8 cas); la constipation chronique (6 cas) et la fausse diarrhee chronique glairo-sanglante (4 cas). La duree d'evolution des symptomes avant le diagnostic etait en moyenne de 5 ans. La lesion ulcereuse etait ovalaire ou ronde avec un diametre moyen de 8 millimetres et elle siegeait en moyenne a 8 centimetres de la marge anale. Il s'agissait d'une lesion unique dans 55des cas et la face anterieure du rectum etait interessee dans 74des cas. Un prolapsus rectal interne etait associe chez 6 patients (54des cas). Conclusion : l'ulcere solitaire du rectum est rare dans l'unite d'endoscopie digestive du CHU Aristide Le Dantec de Dakar. Il atteint souvent l'adulte jeune de sexe feminin. La symptomatologie marquee par les rectorragies et les selles glairo-sanglantes; prete souvent confusion avec l'amibiase intestinale en zone tropicale

[Senegalese case of thromboangeitis obliterans or Buerger's disease]. / Premiere observation Senegalaise de thromboangeite obliterante ou maladie de Buerger.

INTRODUCTION: Thromboangeitis obliterans (TAO) is an inflammatory, non atheromatous arteriopathy of smoking young adults. It is diagnosed on an association of non specific criteria that we discuss throughout this case. CASE REPORT AND DISCUSSION: A forty years old tabagical, Senegalese black man, had peripheral destructive lesions preceded by Raynaud phenomenon. He was admitted in our Internal Medicine department in November 2002. Actually this clinical presentation was evolving since 11 years. At that time, hypo aesthesia and ulceration of the fingers led to successive amputations in the leprology centre. The diagnosis of Hansen disease had been suspected but there were no evidence of mycobacterium. At the admission in our service, biological tests showed a moderated non-specific inflammatory syndrome. Ultra sound Doppler and arteriography showed a peripheral arterial stenosis without atheromatous lesions, in favour of TAO. To meet all the criteria the patient didn't have any thrombotic or systemic disease. The evolution was favourable after tobacco weaning. CONCLUSION: TAO can bring to difficulties of diagnosis by its way of presentation. Physicians should practice a systematic vascular screening in case of distal arteriopathy.