[Splenectomy for splenomegaly in Ivory Coast. Indications and short term results]. / Splenectomies pour splenomegalie en Cote d'Ivoire. Indications et résultats précoces.

AIM: To study the indications and evaluate the short term results of splenectomy for splenomegaly. PATIENTS AND METHODS: This retrospective analysis concerned 31 males and 21 feméles with a mean age of 30,5 yersin old, from February 1998 to December 2003. The aetiologies of splenomegaly were parasites (n=6), benign haematological diseases (n= 24), haematological malignancies (n=6), infections (n=3) and cysts (n=3). The indications were due to hypersplenism in 39 cases (79,5%), risk of splenic rupture in 46 cases (88,5%), infection or risk of infection in 3 cases and painful splenomegaly in 3 cases. 49 nine patients underwent complete splenectomy and the 3 remaining had a partial splenectomy. A spleno-renal shunt in three cases, mesenterico-adrenal shunt and mesenterico-cave shunt were associated for portal hypertension. A lengthy penicillinotherapy in all the patients and thromboembolic prevention in some were performed. RESULTS: The mean hospital stay was 6.3 days. Correction of cytopenia and permanent pain relief occurred in all cases. One patient died from intraoperative haemorrhage and 2 other from unknown cause postoperatively (09%). Morbidity was due to hyperthermy in 3 cases, abdominal haemorrhage by splenic vessel ligation leakage and bridles obstruction in one case. CONCLUSION: This study shows that hypersplenism constituted the mean indication of splenectomy. Its low mortality and morbidity suggest that it might be usually used in our practice. These results may be improve by laparoscopic splenectomy and systematic prevention of postoperative complications.

[Left colonic cancer obstruction in Ivory Coast]. / Cancers coliques gauches en occlusion en Côte d'Ivoire.

OBJECTIVE: This retrospective study comes forward to study our management of left colonic cancer obstruction by evaluating the mortality and the morbidity. PATIENTS AND METHODS: From 1984 to 2001, 21 patients with left colonic cancer obstruction were treated in emergency. They were 12 males and 9 females with a mean age of 40.6 years. All the patients had complete clinical and radiological colonic obstruction. The pre-operative neoplastic origin of the obstruction was unknown in 20 cases. Six patients had hepatic metastases and 6 ovarian metastases. Six patients were classified as Asa II and 6 other Asa III. Nineteen patients (90.5%) underwent Hartmann's operation. The 2 remaining patients had immediate anastomosis after colectomy, with diverting ileostomy. These procedures were associated with hepatectomy in 5 cases and annexectomy in 6 cases. Intestinal continuity restoration was possible in 13 cases between 6 months and 1 year. RESULTS: Operative mortality was 9.5% (2 cases). Deaths were due to evisceration caused by parietal suppuration in one case and heart failure in the other case. There was no anastomotic fistula. Mean hospital stay was 14 days (12-21). Survival was 84% at one year and 0% at 5 years. CONCLUSION: Our results suggest that Hartmann's operation is safe and may be usually performed in our conditions. However, near by amount colostomy and intra-operative colonic irrigation might be an alternating procedure in some selected patients.

[Total rectal prolapse in adults: report of 26 cases in the Ivory Coast]. / Le prolapsus rectal total de l'adulte: étude de 26 cas en milieu ivoirien.

Several studies are still in progress to improve the results of rectopexy for treatment of full thickness rectal prolapse in adults. The purpose of this study was to evaluate etiologic factors of full thickness rectal prolapse in Ivory Coast and to describe results in 26 patients treated surgically in Africa over a period of 10 years. There were 23 men with ages ranging from 30 to 45 years and 3 women with ages ranging from 45 to 50 years. All three women were multiparous. Related factors in the men were chronic constipation in 69.2%, diarrhea in 11.5%, and dysuria in 7.7%. Fifteen patients (59.7%) presented anal incontinence prior to surgery. Rectoscopy was performed in 23 cases and findings were always normal. Barium enema x-rays were performed in 3 cases and demonstrated dolicho-colon. The Orr-Loygue rectopexy procedure was performed in 23 patients and direct rectopexy in 3 patients. No operative deaths occurred and no recurrences have been observed with a follow-up of 24 months. Constipation developed following surgery in two patients and persisted in all patients who presented this symptom prior to surgery. Progressive improvement was observed in all fifteen patients with preoperative anal incontinence. Based on these results, our current management strategy includes determination of colonic transit time to select indications for direct rectopexy with sigmoidectomy.