[Brain abscess revealing trilogy of Fallot in a child: about a case at the University Teaching Hospital of Parakou, Benin]. / Abcès cérébraux révélant une trilogie de Fallot chez un enfant: à propos d'un cas au CHU de Parakou, Bénin.

Brain abscesses can cause significant morbidity in patients with cyanogen heart disease. In countries with limited resources treatment, it is difficult and prognosis is guarded. Here we report a case of brain abscesses revealing a rare form of cyanogen heart disease, the trilogy of Fallot, in Parakou in the north of Benin. The study involved a 9-year old boy, referred to a primary hospital for left hemiparesis. Interview and physical examination revealed symptoms evolving for two months including intense headaches, fever, vomiting and functional impairment of the left hemi-corps, altered general state, generalized cyanosis, left hemiparesis, pulmonary systolic murmur. Brain CT scan showed abscesses in the right parietal region and in the left temporal region as well as hydrocephalus. Doppler echocardiography showed stiff pulmonary stenosis, atrial septal defects and right ventricular hypertrophy. Antibiotic therapy including ceftriaxone, gentamicin and metronidazole was started in emergency. Indication for surgical intervention included trepano-puncture but this could not be performed due to rapid unfavorable outcome. Brain abscesses are a common complication of cyanogen heart disease. Outcome is fatal in the absence of adequate management, hence the role of diagnosis and early treatment of these heart diseases.

Contribution of Imaging in the Diagnosis of Cholangiocarcinoma in Choledochal Cyst.

The choledochal cyst is a rare congenital malformation of the bile ducts. It is considered as a precancerous state. The incidence of cancer in choledochal cyst increases with age and occurs around 32 years old. Therefore, young adults are often involved. In adults, clinical signs are rare and unspecific. We are reporting here the case of a cholangiocarcinoma in choledochal cyst in young adult diagnosed by ultrasonography, CT scan, and MRI and confirmed by histopathological examination.

Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation.

BACKGROUND: In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. METHODS: An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. RESULTS: The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. CONCLUSION: Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.

Endocarditis tricuspid sub-aigue of post abortion: report of a case.

Tricuspid infective endocarditis is rare and represents five to 10% of all cases of infective endocarditis. It occurs predominantly in intravenous drug users, and patients with central venous catheters or intracardiac probes. We report on the case of subacute tricuspid infective endocarditis in a girl of 17 years. She had no particular cardiovascular history. She was admitted for a persistent fever with cachexy, cough and thoracic pains, and right heart failure that appeared one month after a clandestine abortion. Transthoracic echocardiography found several vegetations on the tricuspid valve with massive tricuspid regurgitation. The chest X-ray showed bilateral excavated lung abscesses and condensation areas. Blood culture was not done and broad-spectrum antibiotic therapy was given. She was apyretic after 10 days. However, the massive tricuspid regurgitation with right heart failure persisted. She was discharged from hospital after 40 days of treatment. Although rare, infective endocarditis is one of the more serious complications of gynaecological procedures, particularly clandestine abortion. Therefore any young girl with persistent fever must be suspected of clandestine abortion.

La stenose du canal lombaire : resultats chirurgicaux et fonctionnels dans une unite de neurochirurgie au Benin

Description La sténose du canal lombaire est une affection rachidienne fréquente. A Parakou, sa prise en charge neurochirurgicale est possible malgré notre modeste plateau technique.Objectif Rapporter les résultats chirurgicaux et fonctionnels des sténoses du canal lombaire opérées dans une unité de neurochirurgie au Bénin.Méthodes Il s'est agi d'une étude rétrospective et descriptive basée sur examen de dossiers. Elle a inclu tous les patients opérés pour une sténose du canal lombaire entre Janvier 2008 et Mars 2013 au Centre Hospitalier Universitaire et Départemental du Borgou/Alibori (CHUD-B/A) du Bénin. Les renseignements cliniques et l'imagerie ont permis de poser le diagnostic puis les indications opératoires. Les variables étudiées étaient les données socio démographiques, les signes cliniques, l'imagerie et l'évolution post opératoire.Résultats Durant la période de l'étude, 178 cas de sténose du canal lombaire opéré ont été retenus. Ces patients se répartissaient en 97 hommes (54,5%) et 81 femmes (45,5%). L'âge moyen des patients était de 52,36 ± 10,94 ans. La claudication neurogène (92,7%), Les radiculalgies (93, 8%) et les troubles mictionnels (59,6%) étaient les principaux signes cliniques. Leur durée moyenne d'évolution était de 3,55±2,46 ans. Le scanner lombaire a contribué au diagnostic pour 147 patients (82,6%). Les suites opératoires était simples (88,8%) et les résultats fonctionnels étaient excellents ou bons dans 84,2% des cas. Les principales complications étaient les brèches durales (5,6%) et les suppurations pariétales (3,9%). La létalité était de 1,1% (n=2).Conclusion La chirurgie de la sténose du canal lombaire est réalisable à Parakou. Les résultats post opératoires et fonctionnels sont conformes à la littérature