Les malformations de Dandy-Walker : Aspects diagnostiques et apport de l’endoscopie : A propos de 77 cas

ObjectifDécrire les malformations kystiques de la fosse postérieure chez l’enfant et évaluer les indications et résultats thérapeutiques.MéthodeIl s’agit d’une étude prospective en série continue réalisée dans le service de neurochirurgie de l’hôpital national de Niamey (Niger) entre janvier 2007 et février 2012. Etaient inclus, les enfants de 0 à 5ans admis pour macrocranie ou retard psychomoteur sans antécédents de méningite chez qui un kyste malformatif de la fosse postérieure a été découvert au scanner. Une évaluation clinique et une classification scannographique a été réalisée pour chaque patient. L’indication opératoire a été retenue en présence de syndrome de la fosse postérieure associé ou non à une hydrocéphalie. En présence d’une hydrocéphalie le traitement était endoscopique de première intention (VCS + fenestration du kyste dans le ventricule latérale (VL) + cautérisation plexuelle partielle). Certains patients ont été classés selon les critères prédictifs des résultats de la VCS selon Warf. Une fontanelle non affaissée et tendue à 1mois post opératoire était considérée comme un échec. Seuls les patients suivis pendant au moins 6 mois ont été inclus dans l’étude.RésultatsLa série comportait 144 patients porteurs de kyste de la fosse postérieure soit 11,076% des enfants de 0 à 5 ans ayant réalisé un scanner en 5ans. La moyenne d’âge était de 8,7 mois (7 jours - 5 ans) avec un sexe ratio de 1,4. Il s’agissait de 67 cas de malformation de Dandy Walker (46,52%), de 21 cas de Dandy Walker variant (14,58%) et de 56 cas de kyste de la fosse postérieure considérés comme megacisterna magna ou kyste de la valecula ou Dandy Walker complex (38,88%). Sur les 144 patients porteurs de malformation kystique de la fosse postérieure l’hydrocéphalie était associée dans 128 cas soit dans 88,88% des cas. L’indication opératoire était retenue chez 77 patients suivis pendant au moins 6 mois (53,47%) dont 8 n’avaient pas d’hydrocéphalie (5,55%). Il s’agissait de 49 cas/ 67 de malformation de Dandy Walker, de 7 cas/21 de Dandy Walker variant, et de 21 cas/56 retenus comme des megacisterna magna ou de kyste de la valecula ou Dandy Walker complex. Le suivi moyen était de 16,4 mois (6 mois- 59 mois) avec au moins un scanner de contrôle à 6 mois post- opératoire. Le taux de succès du traitement endoscopique seul était de 57% à 6 mois.ConclusionLorsque l’indication opératoire est retenue pour une malformation kystique de la fosse postérieure associée à une hydrocéphalie, le traitement endoscopique peut être de première intention

Prise En Charge Des Anévrismes Artériels Dans Un Centre Africain Non Spécialisée

Introduction: Arterial aneurysms affect 7 to 8% of people over 65 in the West and are the 2nd leading cause of death in these countries. In Africa this frequency is poorly evaluated. The objective of this work is to report the management of arterial aneurysms at the National Hospital of Niamey (HNN). Patients and methods: This was a retrospective, descriptive study over a period of eight (8) years from January 2009 to December 2016, performed in the surgical departments of the National Hospital of Niamey. Included in the study were patients of both sexes, hospitalized and / or operated for arterial aneurysm. Not included were patients treated for arterial aneurysm with incomplete records or those concerning the neurosurgical sphere. Results: During the study period, 17,748 patients were hospitalized in the general surgery departments, including 16 patients for arterial aneurysm, or 0.09% of surgical pathologies. There were 13 men (81.25%) and 3 women (18.75%), or a sex ratio of 4.33. The average age was 55.75 years with extremes ranging from 25 years old to 90 years old. The circumstances of discovery of the aneurysms were swelling of the antero-internal aspect of the thigh in 7 cases (43.75%), abdominal mass 6 cases (37.50%), then 2 cases (12.50%) of chest pain and incidental discovery in 1cas (6.25%). The most common risk factor was high blood pressure with 43.75% (7 cases). The aneurysm sat on the femoral artery in 43.75% (n = 7), of which 6 on the deep femoral and 1 on the superficial femoral, on the infrarenal aorta in 31.25% (n = 5), on thoracic aorta 12.50% (n = 2), on the iliac artery 12.50% (n = 2). For the diagnosis the angioscanner is realized in all the patients and in addition Doppler ultrasound in 43, 75% of cases. Twelve (12) patients benefited from curative surgical intervention by prosthetic graft by PTFE in 58.33% of cases and by Dacron in 41.66%. The average stay was 29.75 days and the immediate operative followup was complicated by thrombosis in 12.5% and parietal suppurations in 6.25%. We recorded two (2) deaths, ie 12.5% among non-operated patients. Conclusion: Arterial aneurysms are rare diseases at the HNN. Conventional surgery is the treatment performed in our patients. The postoperative course was simple in most cases

Cholécystectomies Laparoscopiques Pour Cholécystite Aigue Lithiasique Versus Lithiase Vésiculaire Symptomatique

Introduction: The aim of this work was to highlight the therapeutic and prognostic difficulties between a laparoscopic cholecystectomy for acute gallstone cholecystitis (CAL) and uncomplicated symptomatic vesicular lithiasis (LVS) as well as the reasons for conversion to laparotomy. Patients and Methods: This was a prospective comparative and analytic study over 18 months. Patients admitted and operated for CAL or LVS in the A Surgery Department of the National Hospital of Niamey (HNN) were included. Results: The study involved 61 patients divided into two groups. Group 1 (30 patients) corresponding to patients operated for CAL, group 2 (31 patients) corresponding to patients operated for LVS. Laparoscopic cholecystectomy accounted for 61% of all cholecystectomies performed and 1.45% of surgical activity during the same period. The average age in group 1 was 43.7 years with extremes of 14 and 61 years. In group 2, the average age was 38.9 years with extremes ranging from 12 to 55 years. Women were predominantly represented with 63.3% and 96.7% respectively for groups 1 and 2. Patients were overweight in 9 cases for group 1 (30% of cases) and 12 cases in group 2 (38%), 7% of cases). Hepatic colic was the main sign of appeal in all patients in both groups. In group 1; 26 out of 30 cases or 86.7% of cases had leukocytosis, whereas in group 2, leukocytosis was normal in 30 cases, ie 96.8% of cases. Accessibility of the vesicle was difficult in 73.3% of cases in group 1 against 22.6% of cases in group 2. The vesicle was distended and necrotic in groups 1 in 76.7% and 10 respectively. % of cases. On the other hand, in 25.8% of cases, the vesicle was distended and without any necrosis in group 2. The rate of conversion to laparotomy was 6.55% (4 cases) and exclusively concerned group 1. Operative follow-up immediate outcomes were simple in 98.34% of cases. The complications involved 2 patients in group 1 (1.66% of the total), including parietal suppuration and biliary leakage. Mean operative time was 68.7 min in group 1 versus 41.6 min in group 2. Mean duration of hospitalization was 4.3 days with extremes between 2 and 10 days in group 1 versus1,7 days with extremes ranging from 1 to 7 days in group 2. Mortality was zero. Conclusion: In recent years, laparoscopic surgery has made remarkable progress in Niger. Laparoscopic cholecystectomy seems to be more difficult to perform with significant morbidity in the case of CAL than LVS. The risk of per and postoperative complications can be estimated from the clinical data (acute cholecystitis or symptomatic vesicular lithiasis) and the surgeon's experience. In a cholecystectomy that lasts more than 2 hours, the cumulative risk of complications is highe

A new case of scrotoschisis and extracorporeal ectopic testis

No Abstract. African Journal of Urology Vol. 12 (3) 2006: 139-14

Hernie de Morgagni chez l'enfant : à propos d'un cas

La hernie de Morgagni est une anomalie congénitale très rare. L’observation d’un cas a permis d’en décrire les aspects clinique et lésionnel.Un nourrisson de 8 mois de sexe féminin présentait une détresse respiratoire associée à une toux sèche et de la fièvre évoluant depuis 2 jours. Le diagnostic de hernie de Morgagni a été posé par la réalisation d'une radiographie du thorax et une tomodensitométrie thoraco-abdominale. La cure herniaire fut réalisée à travers une laparotomie médiane susombilicale. L'évolution postopératoire jusqu'à 6 mois fut favorable. L'évocation du diagnostic de hernie de Morgagni souvent rare ou tardif chez l'enfant est confirmée par l'imagerie. Le risque d'engouement et d'étranglement herniaire impose d'opérer précocement.Mots-clés: hernie de Morgagni ; hernie congénitale; enfantEnglish AbstractMorgagni’s hernia is a rare congenital anomaly. The authors report one such case and describe the clinical aspects. An eight months old female infant presented with respiratory distress associated with dry cough and fever that had been ongoing for two days. The diagnosis of Morgagni's hernia was made with a chest X-ray and a thoraco-abdominal CT scan. The hernia treatment was performed by laparotomy through a supra-umbilical midline incision. The postoperative course up to 6 months was uneventful. Morgagni's hernia is rare and thus unusually suspected childhood. The diagnosis is confirmed by radiology. Surgery should be carried out early due to the risk of entrapment and strangulation.Keywords: diaphragmatic hernia ; Morgagni'shernia ; chil

Fractures diaphysaires déplacées de l’avant-bras chez l’enfant : aspects épidémiologiques, cliniques et thérapeutiques

Le but de notre étude était d’évaluer les résultats de la prise en charge orthopédique des fractures diaphysaires déplacées de l’avant-bras chez l’enfant. Cinquante six patients ont été pris en charge pour fractures diaphysaires déplacées de l’avant-bras entre janvier 2009 et juin 2010. L’âge moyen des patients était de 7,03 ans (extrêmes : 30 mois et 14 ans) et le sex ratio était de 4/1. Trente et un patients  résidaient dans la ville de Dakar. Le délai moyen de consultation était de 9,85 heures (extrêmes : 30  minutes et 100 heures). Les accidents ludiques représentaient 53,6% des causes de fractures. Le choc indirect (chute avec réception sur la main) était le principal mécanisme (76,8%). La fracture intéressait  le membre dominant dans 51,7%. L’ouverture cutanée était associée dans 2 cas. Les  fractures    intéressaient les 2os de l’avantbras et étaient situées sur le 1/3 moyen dans 66% des cas. Les fractures en bois vert représentaient plus de la moitié des cas (58,9%). La réduction était initialement non  satisfaisante dans 9 cas. Les déplacements secondaires sous plâtres et les cals vicieux avaient été  observés respectivement chez 11 et 2 patients. Avec un recul moyen de 8 mois la pronosupination était jugée satisfaisante chez 27 patients et 6 avaient une limitation dont 2 nécessitant une reprise  chirurgicale. Le traitement orthopédique des fractures diaphysaires déplacées de l'avant-bras chez l'enfant est une indication toujours d'actualité dans notre contexte car il donne des résultats satisfaisants.Mots clés : fractures avant-bras, enfant, traitement orthopédique.The aim of this study was to assess the outcome of the orthopedic management of displaced diaphyseal forearm fractures in children. Fiftysix patients were treated for displaced diaphyseal fractures of the forearm between january 2009 and june 2010. The mean age of patients was 7.03 years (range: 30 months and 14 years) and the sex ratio was 4/1. Thirty-one patients resided in the city of Dakar. The average time of consultation was 9.85 hours (range: 30 minutes and 100 hours). The recreational accidents represented 53.6% of the causes of fractures. The indirect impact (fall with reception on hand) was the main mechanism (76.8%). The fracture interested the dominant limb in 51.7%. Skin opening was associated in 2 cases. Fractures interested the 2  bones of the forearm and were located on the medial third in 66% of cases. Greenstick fractures accounted for more than half (58.9%). The reduction was initially  unsatisfactory in 9 cases. Secondary displacement in plaster and malunion were observed respectively in 11 and 2 patients respectively. With a mean of 8 months the pronosupination was satisfactory in 27 patients and 6 had a limitation of which 2 required reoperation. Conservative treatment of displaced diaphyseal fractures of the forearm in children is an indication still relevant in our context because it gives satisfactory results.Key words: fractures forearm, child, orthopaedic treatment

Management of postoperative pain: experience of the Niamey National Hospital, Niger

Maman Sani Chaibou,1 Samuila Sanoussi,2 Rachid Sani,2 Nouhou A Toudou,1 Hadjara Daddy,1 Moussa Madougou,1 Idrissa Abdou,1 Habibou Abarchi,2 Martin Chobli31Department of Anesthesiology and Intensive Care, 2Department of Surgery, The Niamey National Hospital, Niamey, Republic of Niger; 3Department of Anesthesiology, Hubert K Maga University Teaching Hospital, Cotonou, BeninObjective: The aim of this study was to evaluate the management of postoperative pain at the Niamey National Hospital.Methods: A prospective study was conducted in the Department of Anesthesiology and Intensive Care at the Niamey National Hospital from March to June, 2009. Data collected included age, sex, literacy, American Society of Anesthesiologists (ASA) physical status classification, type of anesthesia, type of surgery, postoperative analgesics used, and the cost of analgesics. Three types of pain assessment scale were used depending on the patient's ability to describe his or her pain: the verbal rating scale (VRS), the numerical rating scale (NRS), or the visual analog scale (VAS). Patients were evaluated during the first 48 hours following surgery.Results: The sample included 553 patients. The VRS was used for the evaluation of 72% of patients, the NRS for 14.4%, and the VAS for 13.6%. Of the VRS group, 33.9%, 8.3%, and 2.1% rated their pain as 3 or 4 out of 4 at 12, 24, and 48 hours postoperatively, respectively. For the NRS group, 33.8%, 8.8%, and 2.5% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. For the VAS group, 29.3%, 5.4%, and 0% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. Conclusion: Postoperative pain assessment and management in developing countries has not been well described. Poverty, illiteracy, and inadequate training of physicians and other health personnel contribute to the underutilization of postoperative analgesia. Analysis of the results gathered at the Niamey National Hospital gives baseline data that can be the impetus to increase training in pain management and to establish standardized protocols.Keywords: postoperative pain, pain scales, Niamey National Hospita

Morbidité et mortalité des urgences chirurgicales viscérales néonatales au Niger

Le but de ce travail était de décrire la morbidité et la mortalité des  urgences chirurgicales viscérales néonatales (UCVN) dans le service de  chirurgie pédiatrique de l’Hôpital National de Lamordé à Niamey au Niger. Il s’agissait d’une étude observationnelle, prospective et descriptive conduite sur une période de 2 ans (du 1er Mars 2014 au 29 Février 2016). Les données incluaient l’âge à l’admission et le sexe des nouveau-nés, les antécédents personnels et familiaux, les aspects diagnostiques,  thérapeutiques et évolutifs des pathologies. Le test de Khi-carré et le test de Student étaient utilisés pour comparer les paramètres étudiés des patients décédés et des patients vivants. Une valeur de p inférieur à 0,05  était considérée comme statistiquement significative. Les UCVN  constituaient 12,8 % des hospitalisations (n = 106). La moyenne d’âge à l’admission était de 5,8 jours (extrêmes : 0 et 28 jours). Une  prédominance masculine était observée (69, 6 %). Le poids de naissance était en moyenne de 3000 g (extrêmes: 1700 et 4200 g). L’omphalocèle (n = 36, 33,9 %) et les malformations anorectales (n = 32, 30,1 %) étaient les pathologies les plus fréquentes. Une intervention chirurgicale avait été réalisée chez 58 patients (54,7 %). Le taux de morbidité était de 34,5 % (n = 20). Les taux de mortalité globale et de mortalité postopératoire étaient respectivement de 46,2 % (n = 49) et 46,5 % (n = 27). La  septicémie était la cause la plus fréquente de décès (n = 27; 55,1 %). Les facteurs déterminant la mortalité étaient la prématurité (P = 0,0427), le faible poids de naissance (P =0,0185), l’anémie (P = 0,0233), la leucopénie (P = 0,0004) et la morbidité (P = 0,0016). Les urgences chirurgicales viscérales néonatales étaient fréquentes. Leur mortalité était élevée et favorisée par la prématurité, le faible poids de naissance, l’anémie, la leucopénie. Une prise en charge anténale et périnatale précoce améliorerait le pronostic des urgences viscérales néonatales.Mots-clés : urgences chirurgicales viscérales, nouveau-né, morbidité, mortalité. Our objective was to describe the surgical neonatal visceral emergencies (SNVE) morbidity and mortality in the paediatric surgery department of the National Hospital of Lamordé in Niamey, Niger. It was an observational, prospective and descriptive study conducted over 2 years (from 1 March 2014 to 29 February 2016). Data included age at admission and sex of  newborns, patient and familial medical history, diagnostic, therapeutic, and evolutive aspects of conditions. Chi-square and Student’s t tests were used to compare the data of deceased and living patients. A value of p< 0.05 was considered statistically significant. SNVE accounted for 12.8 % of admissions (n = 106). The mean patient age at admission was 5.8 days (range, 0–28 days). Male predominance was observed (n = 69, 6 %). The mean birthweight was 3000 g (range, 1700–4200 g). Omphalocoele (n = 36, 33.9 %) and anorectal malformations (n = 32, 30.1 %) were the most common pathologies. Surgery was performed for 58 patients (54.7 %). The morbidity rate was 34.5 % (n = 20). The overall and postoperative mortality rates were 46.2 % (n = 49) and 46.5 % (n = 27), respectively. Septicaemia was the most common cause of death (n = 27, 55.1 %). Factors  determining mortality were prematurity (P = 0.0427), low birthweight (P = 0.0185), anaemia (P = 0.0233), leucopaenia (P = 0.0004), and morbidity (P = 0.0016). Surgical neonatal visceral emergencies are frequent. Their mortality was high and favorised by prematurity, low birthweight, anaemia, leucopaenia. An antenatal and early perinatal management would improve the outcome of neonatal visceral emergencies.Key words: visceral surgical emergencies, newborn, morbidity, mortality

The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa

Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons′ directory was used to identify paediatric surgeons in the Francophone′s countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. Results: A total of 41 paediatric surgeons (68.33%) responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%), scholarship from a non-governmental organisations in 14 (34.15%) and self-sponsorships in 20 (48.78%). The average salary was 450 Euros (€) (range: 120-1 400 Euros). Most of the paediatric surgeons (68.29%) had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80%) had no subscription to specialised scientific journals. Conclusion: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences