[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. / Ascite urinaire, uropéritoine et péritonite urinaire chez l'enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar.

OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

[Bladder neck traumatic rupture in children]. / Rupture traumatique du col vésical chez l'enfant.

Transverse rupture of the bladder neck injury is rare in children. We report a new case in a 10-month boy with urinary peritonitis. Diagnosis was intraoperative. Surgical treatment in emergency with urethrovesical anastomosis protected by a perivesical drain and a large-bore urinary catheter was performed without urogenital complication.

[Spontaneous intraperitoneal rupture of hydronephrosis in an infant]. / Rupture spontanée intrapéritonéale d'une hydronéphrose.

Spontaneous intraperitoneal rupture of hydronephrosis is a rare complication. We report a case in a 30-month old boy admitted for fever, with a temperature up to 38.5°C, and abdominal distension. The diagnosis was made intraoperatively. The treatment consisted of an emergency internal urinary diversion and a deferred definitive cure of the pyelo-ureteral junction stenosis. Surgical management in two steps is more prudent and beneficial.

Un cas de leiomyome gastrique de decouverte fortuite

Le leiomyome digestif est une tumeur benigne rare. La localisation gastrique est la plus frequente. Nous en rapportons un cas observe chez un homme de 73 ans dans le cadre d'une hemorragie digestive haute. Malgre un traitement medical bien conduit; l'hemorragie restait active et avait motive une exploration chirurgicale. L'origine du saignement etait une tumeur sous cardiale faisant 5;5cm de grand axe. L'histologie avait conclu en un leiomyome gastrique et l'evolution etait favorable. Les difficultes de la prise en charge dans notre contexte sont discutees

Grossesse heterotopique revelee par une rupture de grossesse ampullaire: fait clinique

La grossesse heterotopique represente une affection rare; caracterisee par la coexistence d'une grossesse intra-uterine et d'une grossesse extra-uterine chez une meme patiente. Nous en rapportons un cas survenu chez une femme de 40 ans; revele par un tableau clinique d'hemoperitoine massif. L'echographie demandee en urgence avait permis de porter le diagnostic. Une salpingectomie gauche etait pratiquee. Les suites operatoires etaient marquees par la survenue d'une fausse couche malgre la tocolyse et la manipulation minime de l'uterus en peroperatoire. Les particularites diagnostiques; l'etiopathogenie ainsi que les principes du traitement sont discutes a la lumiere d'une revue de la litterature

Un cas de syndrome de la jonction pyelo-ureterale sur rein unique

Les auteurs rapportent une observation exceptionnelle de syndrome de la jonction pyelo-ureterale congenital sur rein unique. Il s'agit d'un cas decouvert chez un jeune homme de 21 ans apres une lombalgie chronique unilaterale droite evoluant depuis trois ans. La fonction renale etait toujours conservee. Le diagnostic a ete confirme par les examens d'imagerie. Une pyeloplastie a ciel ouvert a donne un excellent resultat