Les torsions du cordon spermatique chez l’enfant

Objectif: Evaluer la fréquence des torsions du cordon spermatique, décrire leurs manifestations et leur prise en charge et évaluer les résultats de cette prise en charge au CHU Tokoin de Lomé, Togo. Patients et méthodes: Il s’agit d’une étude rétrospective sur les dossiers de 17 patients pris en charge dans le service de chirurgie pédiatrique du 1er janvier 2002 au 31 décembre 2006 pour torsion du cordon spermatique de diagnostic per opératoire. Les données étudiées étaient l’âge des patients, le délai d’évolution, les symptômes, les examens diagnostiques, le traitement et les résultats postopératoires. Résultats: Durant la période d’étude, nous avons recensé 57 patients présentant une grosse bourse douloureuse dans le service de chirurgie pédiatrique. Parmi eux, 17 ont présenté une torsion du cordon spermatique (29,8%) dont 11 patients étaient âgés de 6 à 15 ans montrant une nette prépondérance de l’âge pubertaire. L’âge moyen de nos patients était de 9 ans (extrêmes de 7 jours et 15 ans). Le délai moyen d’évolution était de 30 heures (extrêmes 10 et 72 heures). La douleur était le symptôme principal chez les nourrissons et les grands enfants. Onze patients sur les 17 ont bénéficié d’un écho doppler. Les gestes chirurgicaux réalisés ont été l’exploration chirurgicale suivie d’une détorsion et d’une fixation des deux testicules. Tous les testicules (17) ont été sauvés. Avec un recul moyen de 12 mois (extrêmes 4 mois et 5 ans), les suites opératoires ont été bonnes. Conclusion: Les torsions du cordon spermatique se voient préférentiellement en période néonatale et à l’adolescence. Cependant elles peuvent se voir entre ces deux périodes. L’exploration chirurgicale doit être systématique devant toute suspicion de torsion du cordon spermatique.Mots clés: Torsion, cordon spermatique, enfant, lomé

Traitement Chirurgical Des Fractures Du Fémur De L’enfant

Objective To describe indications, different modalities and results of surgical treatment of femur fractures in children. Patients and methods This is a retrospective study from January 2004 to December 2013 in the pediatric surgery department of Lomé Sylvanius Olympio teaching hospital, from the records of patients aged 0-15 years with femur fractured treated surgically. Results There were 66.1% (39 cases) of shaft fractures of which 53.57% localized in the middle third. Of the 33.9% (20 cases) of the lower extremity fracture, epiphyseal growth fractures accounted for 13 cases including seven (7) for type II among Salter-Harris classification. The indications were: femoral fracture occurred in the context of multiple trauma (4 cases), patients over 11 years (40 cases), failure of conservative treatment (2 patients), epiphyseal growth fractures of the distal femur after failure of conservative treatment (12 patients) and an epiphyseal growth fracture type 4 of Salter and Harris where surgery was indicated immediately (1 case). The average time of surgical treatment was 32 days. The elastic stable intramedullary nailing (ESIN) was made in 66.1% of patients, the plate in 18.6%, the pinning in 11.9% and screwing in 3.4%. The average duration of hospital stay was 45.16 days. Removal of osteosynthesis material was performed in 38 patients or 64.4% of cases. The average time of this removal was 8 months.Conclusion The methods of the most widely used surgical treatment are open ESIN because of the long waiting patients associated with very limited financial resources. This method has real advantages and should be encouraged in our communities by improving the technical facilities and living conditions of the population

ECRASEMENTS DE MEMBRES DE L’ENFANT MEMBER’S CRUSH INJURIES IN CHILDREN

Objective: To describe the epidemiology, mechanisms of occurrence and therapeutic management of the crushing member’s injuries in children. Materials and methods: It was a retrospective study of the records of patients less than 15 years treated in the Pediatric Surgery Department of the Sylvanus Olympio teaching hospital (Lomé) for crushing members from January 2008 to December 2011. Results: We recorded 15 cases of crushing member’s injuries in children representing 1.7% of hospitalizations for trauma in the pediatric surgery department. The annual incidence was 3.7 cases. There were 7 males and 8 females. The average age of the patients was 8.8 years. Older children accounted for 10 cases (66.7%). Occurrences of accidents were the mechanisms of the public highway with 53.3% (8 cases) and 46.7% (7 cases) for domestic accidents. Five (5) patients had hemodynamic shock at admission. Treatment was radical in 10 patients (66.7%). It was an amputation. Conservative treatment consisted to the cast immobilization in three patients and intra focal osteosynthesis in two (2) patients. A suppuration of amputation stumps was recorded. The average length of hospital stay was 23.17 days (extremes: 1 and 60 days). Conclusion: Members’ crush injuries are relatively uncommon in pediatric units in Togo

ECRASEMENTS DE MEMBRES DE L’ENFANT MEMBER’S CRUSH INJURIES IN CHILDREN

Objective: To describe the epidemiology, mechanisms of occurrence and therapeutic management of the crushing member’s injuries in children. Materials and methods: It was a retrospective study of the records of patients less than 15 years treated in the Pediatric Surgery Department of the Sylvanus Olympio teaching hospital (Lomé) for crushing members from January 2008 to December 2011. Results: We recorded 15 cases of crushing member’s injuries in children representing 1.7% of hospitalizations for trauma in the pediatric surgery department. The annual incidence was 3.7 cases. There were 7 males and 8 females. The average age of the patients was 8.8 years. Older children accounted for 10 cases (66.7%). Occurrences of accidents were the mechanisms of the public highway with 53.3% (8 cases) and 46.7% (7 cases) for domestic accidents. Five (5) patients had hemodynamic shock at admission. Treatment was radical in 10 patients (66.7%). It was an amputation. Conservative treatment consisted to the cast immobilization in three patients and intra focal osteosynthesis in two (2) patients. A suppuration of amputation stumps was recorded. The average length of hospital stay was 23.17 days (extremes: 1 and 60 days). Conclusion: Members’ crush injuries are relatively uncommon in pediatric units in Togo

Emergency treatment of a ruptured huge omphalocele by simple suture of its membrane

Background: The rupture of a huge omphalocele is an emergency that threatens the newborn baby’s life. It constitutes a therapeutical concern in the absence of prosthesis especially in developing countries. Methods: We are reporting herein the case of a newborn baby that we managed in emergency successfully thanks to a simple treatment. Results: It was a huge omphalocele, ruptured during delivery, in a male newborn baby. We conducted a simple and conservative surgical treatment without prosthesis, which consisted of reconstruction of the omphalocele’s membrane by closing it with absorbable suture materials. The suture of the omphalocele’s membrane was followed by treatment with the Grob’s method. This treatment saved the newborn baby’s life. The total skinning was obtained after 3 months. Conclusions: In case of rupture of huge omphalocele in absence of prosthesis, it is better to suture the membrane, and continue the treatment according to the Grob’s method; the residual disembowelment can be repaired later. Keywords: Ruptured omphalocele, Huge omphalocele, Grob’s method, Developing countries Backgroun

Plune-belly syndrome : Aspects epidemiologiques et therapeutiques, a propos de six nouveaux cas au Chu-Tokoin

Six cases of prune belly syndrom in peadiatric service of CHU-Tokoin. All the children were seen one day to fourteen years after their birthday. Clinical signs were, absence of testicular gland and hypoplasic abdominal muscles with a difference of degree: hypoplasic abdominal muscles were general in three cases, localized in three cases, in wich two were on the right side and one on the middle line and iliac passages. The chromosome abnormalities were rare. The urinary tract abnormalities were variable: two cases of big bladder and big ureter, one case oh hydronephrosis and one case of double ureter.Conclusion: In our study, we did not find the etiology of the prune belly syndrome. Six cas de syndrome de PRUNE-BELLY colligés en milieu pédiatrique au CHU-Tokoin. Tous les enfants ont été vus après la naissance et dans un délai allant de un jour à quatorze ans. Cliniquement,ces patients avaient présenté tous une ectopie testiculaire et une hypoplasie musculaire mais à des degrés divers : généralisée dans 3 cas puis localisée dans trois cas (dont deux à droite et un cas au niveau de la ligne blanche et des fosses iliaques). Les anomalies chromosomiques ont été rares. Les anomalies urinaires ont été également variées : deux cas de méga vessie et méga uretère, un cas d’hydronéphrose et un cas de bifidité urétérale. Conclusion : dans notre série, aucune étiologie du syndrome de PRUNEBELLY n’a été retrouvée 

Particularites dans la prise en charge des fractures de la palette humerale (FPH) de l’enfant au Chu Campus de Lome : Particularities in management of humeral pallet fractures in children in Lome Campus Teaching Hospital.

Introduction : Le pronostic des fractures de la palette humérale (FPH) est lié à la précocité du diagnostic et d’un traitement adéquat ainsi qu’à la disponibilité d’un équipement optimal. L’objectif de l’étude était de décrire les particularités de la prise en charge de la FPH et les résultats chez l’enfant dans les conditions de travail d’un hôpital public ouest africain. Matériel et méthodes : Il s’est agi d’une étude rétrospective et descriptive sur une période de 3 ans 7 mois (1er juin 2016 au 31 décembre 2019), ayant porté sur les dossiers des enfants de 0 à 15 ans, pris en charge pour FPH dans le service de chirurgie pédiatrique du CHU Campus de Lomé. Résultats : En 3 ans 7 mois, 22 garçons (57,89%) et 16 filles (42,11%), d’âge moyen de 5,59 ans étaient pris en charge pour FPH. Les accidents domestiques (13 ; 34,21%) et de jeux (18 ; 47,37%) étaient les étiologies les plus représentées. Il y avait 32 fractures supracondyliennes, 4 fractures du condyle latéral, une fracture de l’épictrochlée et une fracture de l’épicondyle latéral. Quatre patients (10,53%) avaient eu recours initialement au traitement traditionnel. Le délai moyen de prise en charge était de 7,22 jours (extrêmes de 1 et 90 jours). Le traitement était orthopédique chez 23 enfants (60,53%) et chirurgical par réduction à foyer ouvert et contention par brochage chez 15 (39,47%). La durée moyenne d’immobilisation était de 29,22 jours avec des extrêmes de 4 et 42 jours. Les résultats fonctionnels étaient excellents dans 34,21% et bons dans 50%. Conclusion : L’amélioration du pronostic des FPH reste influencée par le retard du traitement et la disponibilité d’un équipement thérapeutique adéquat. Il va nous falloir redoubler d’efforts dans la sensibilisation des populations à la consultation précoce et à l’éviction des traitements traditionnels. Introduction: Prognosis of humeral pallet fractures (HPF) is linked to an early diagnosis, an adequate treatment as well as the availability of an optimal equipment. We aim to describe the particularities in management of HPF and results in children under working conditions in a West African public hospital. Material and Methods: This was a retrospective and descriptive study over a period of 3 years 7 months (June 1, 2016 to December 31, 2019), covering children from 0 to 15 years old, cared for HPF. Results: In 3 years 7 months, 22 boys (57.89%) and 16 girls (42.11%), of average age 5.59 years old were treated for HPF. Domestic accidents (13; 34.21%) and games (18; 47.37%) were the most common etiologies. There were 32 supracondylar fractures, four lateral condyle fractures, one epictrochlea fracture and one lateral epicondyle fracture. Four patients (10.53%) had initially resorted to traditional treatment. The average time to treatment was 7.22 days (ranging; 1 and 90 days). Treatment was orthopedic in 23 children (60.53%) and surgical by open reduction and pin retention in 15 (39.47%). The average immobilization duration was 29.22 days with extremes of 4 and 42 days. Functional results were excellent in 34.21% and good in 50%. Conclusions: Improvement in the prognosis of HPF remains influenced by the delay in treatment and the availability of adequate therapeutic equipment. We will have to increase efforts to raise awareness of early consultation and to avoid traditional treatment

Transfer of surgical competences in the treatment of intersex disorders in Togo

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. Results: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French- speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities

Anomalie de développement sexuel : un cas de pseudohermaphrodisme masculin ou anomalie de développement sexuel

The feminine pseudohermaphrodism (FPH) or anomaly of the sexual development XX, rare intersexual state, represents the most frequent affection of the anomalies of the sexual development. The most frequent reason is the congenital hyperplasia of the adrenal. We return in this present work a case of feminine pseudohermaphrodism or anomaly of the sexual development XX. It was about a patient, of masculine kind, received in consultation at the age of 14 years for bilateral cryptorchidism confirmed to the clinical exam. The cytogenetic analysis indicated a normal karyotype of feminine type. The blood hormonal dosage indicated a block in 11β-OH. The analysis of this observation raises the carelessness or the ignorance of the parents facing the pathologies serious neonatal where the child's vital prognosis is not hired but to the heavy consequences for the insertion of these children in the society.Keywords : Feminine pseudohermaphrodism, anomaly of the sexual development XX, karyotype, social sexJ. Rech. Sci. Univ. Lomé (Togo), 2012, Série D14(1) : 67-7