An authentic radiological triad of Rigler allowing the diagnosis of gallstone ileus: A case report

The Rigler's Triad consists by three radiological signs, including intestinal obstruction, pneumobilia, and an aberrant gallstone in the bowel. It is an inconstant triad considered being pathognomonic of gallstone ileus. Gallstone ileus is an exceptional complication of cholelithiasis due to the passage of one or more gallstones from the bile ducts into the lumen of the bowel through a biliodigestive fistula. We report the case of an 83-year-old female patient with a history of ischemic heart disease and an asymptomatic large gallstone. The patient was admitted to the emergency department for bowel obstruction, abdominal pain, and bilious vomiting. A clinical examination found a patient with an alteration in general condition and a distended abdomen with tenderness. An abdominal CT scan revealed Rigler's triad, allowing the diagnosis of gallstone ileus. A midline exploratory laparotomy was performed to find a giant gallstone blocked in the last ileum loop. A simple enterolithotomy was performed, allowing the extraction of giant lithiasis from an 8-cm major axis. The postoperative evolution was uneventful, and the patient was discharged 4 days after surgical treatment

Appendiceal mucocele as an exceptional cause of ileocecocolic intussusception in adults: a case report

Abstract Background Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few cases have been reported in the medical literature. Case presentation We report the case of a 25-year-old black African male patient with no medical history. He presented to the emergency department for abdominal pain, nausea, and bilious vomiting. The abdominal examination revealed typical signs of acute bowel obstruction. Enhanced abdominopelvic computed tomography showed an invagination of the last ileal loop, cecum, and ascending colon into the lumen of the transverse colon, with a rounded image with hypodense content and some calcifications compatible with an appendiceal mucocele. An emergency exploratory laparoscopy was performed and confirmed the ileocecocolic intussusception. Right hemicolectomy and ileocolic anastomosis were performed. The patient recovery postoperatively was uneventful, and he was discharged 4 days later. Histological examination of the surgical specimen confirmed the diagnosis of mucinous cystadenoma. Conclusion The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to the injected abdominal computed tomography scan

Cystic hepatoblastoma in an adolescent: A case report

Introduction: Hepatoblastoma accounts for approximately 1 % of pediatric tumors. It occurs mainly between 6 months and 3 years of age and is extremely rare in adolescents and adults. Hepatoblastoma generally presents as a painless abdominal mass discovered incidentally. We report a case of painful cystic hepatoblastoma in an adolescent, that was initially thought to be an amebic liver abscess. Case presentation: A 15-year-old male with no significant medical history was admitted to the emergency department with right hypochondrium pain, fever, and vomiting for 14 days. Abdominal examination revealed hepatomegaly with a tender liver, firm surface, and well-defined inferior edge. A contrast-enhanced abdominal CT scan was done, demonstrating a suspected amebic liver abscess in segments S4 – S5. The patient was taken to the operating room. The abscess was punctured and drained, and a biopsy of the wall was taken. All this was done laparoscopically. The pathology of the cyst wall was consistent with hepatoblastoma. The patient was brought back to the operating room after 3 weeks and underwent a complete resection of the cystic tumor through a partial hepatectomy. The patient's postoperative course was uneventful, and he was discharged 5 days after the operation. Histological examination of the surgical specimen confirmed the diagnosis of hepatoblastoma. Conclusion: Hepatoblastoma is extremely rare in adolescents. Cystic hepatoblastoma should be included in the differential diagnosis of a hepatic cyst, regardless of the patient's age, even in areas where infectious hepatic cysts are widely prevalent

Associations of spousal communication with contraceptive method use among adolescent wives and their husbands in Niger.

OBJECTIVES:This study aims to examine associations between spousal communication about contraception and ever use of modern contraception, overt modern contraceptive use (with husband's knowledge), and covert modern contraceptive use (without husband's knowledge) among adolescent wives and their husbands in Niger. STUDY DESIGN:Cross-sectional data, from the Reaching Married Adolescents Study, were collected from randomly selected adolescent wives (ages 13-19 years) and their husbands from 48 randomly selected villages in rural Niger (N = 1,020 couples). Logistic regression models assessed associations of couples' reports of spousal communication about contraception with wives' reports of contraception (overall, overt, and covert). RESULTS:About one-fourth of adolescent wives and one-fifth of husbands reported spousal communication about contraception. Results showed couples' reports of spousal communication about contraception were positively associated with ever use of modern contraception. Couples' reports of spousal communication about contraception were negatively associated with covert modern contraceptive use compared to overt use. Wives' reports of spousal communication were marginally associated with covert use compared to no use but husbands' reports were not. CONCLUSION:Among a sample of couples in Niger, spousal communication about contraception was positively associated with modern contraceptive use (compared to no use) and negatively with covert use (compared to overt use) but wives' and husbands' reports showed differential associations with covert use compared to no use. Since there is little understanding of couple communication surrounding covert contraceptive use decisions, research should focus on characterizing content and context of couple communication particularly in cases of disagreement over fertility decisions

Ileocolic intussusception caused by a submucosal ileal lipoma in a teenager: A case report

Introduction: Intussusception is a rare condition in adolescents; its incidence is highest between three months and three years of age. The symptoms of intussusception are abdominal pain and bowel obstruction. Organic origin is the most common etiology of intestinal intussusception in adolescents, unlike pediatric intussusception, which is usually idiopathic. Adolescent intussusception due to ileal submucosal lipoma is infrequent, and only a few cases have been reported in the medical literature. Case presentation: A 14-year-old female patient was admitted to the emergency department with abdominal pain, nausea, and bilious vomiting. She had no significant medical history. The abdominal examination revealed typical signs of acute bowel obstruction. An enhanced abdominal CT scan showed an invagination of the distal ileal loop within the ascending colon lumen with a rounded fat aspect. Emergency laparoscopic-assisted right hemicolectomy and ileocolic anastomosis were performed. The patient recovered well and was discharged three days after surgery. Histological examination of the surgical specimen confirmed the diagnosis of intussusception due to an ileal submucosal lipoma. Conclusion: The symptoms of bowel intussusception due to an ileal submucosal lipoma in adolescents are similar to any other bowel intussusception due to other etiologies. A contrast-enhanced abdominopelvic CT scan and histopathological analysis are valuable techniques to achieve the correct diagnosis

Knowledge, attitudes, and practices related to family planning and gender equity among husbands of adolescent girls in Niger

Despite having the highest fertility rate in the world, research on Niger men and family planning (FP) is limited. We collected survey data collected in the Dosso region of Niger in 2016 from 1136 men who are the husbands of adolescent girls. We report descriptive statistics, bivariate and multivariable logistic regression on three dichotomous outcomes: (a) knowledge of modern contraceptives, (b) beliefs that only husbands should make FP decisions, and (c) current FP use. About 56% had ever heard of the pill, 6% had ever heard of an intrauterine device, and 45% had ever heard of an injectable. In our multivariable analyses, we found: a man knowing at least one modern method was significantly associated with his age, wife’s education level, gender ideology, and wife’s say in healthcare decisions; men’s belief that men alone should make FP decisions was associated with husband’s Quranic education, gender ideology, and attitudes towards violence against women; men’s reports of adolescent wives’ current family planning use was associated with men’s Quranic education, women’s involvement in her own healthcare decisions, and belief that men alone should decide about family planning. Finding suggests that interventions should target aim to reduce gender inequities to increase family planning utilisation

Can community health workers increase modern contraceptive use among young married women? A cross-sectional study in rural Niger

Abstract Contexte La République du Niger a le taux le plus élevé de mariages précoces et de fécondité des adolescentes du monde. Les récentes initiatives mondiales pour la santé, telles que Planification Familiale 2020 (FP2020), ont redynamisé les investissements dans la planification familiale dans les pays à revenu faible ou intermédiaire. Dans le cadre de cette initiative, le Niger a mis en œuvre des plans ambitieux pour accroître la prévalence de la contraception par le biais de politiques conçues pour accroître la couverture et l’accès aux services de planification familiale. Une des stratégies consiste au déploiement d’agents de santé communautaires volontaires (relais communautaires) en milieu rural pour améliorer l’accès aux services de planification familiale, en particulier chez les adolescents et les jeunes. L’objectif de cet article est. de déterminer si les visites à domicile conduites par des relais sont associées à une utilisation accrue de la contraception moderne chez les jeunes femmes mariées des zones rurales du Niger. Méthodes Les données transversales d’une enquête-ménages ont été collectées auprès de jeunes femmes mariées âgées de 13 à 19 ans dans trois districts ruraux de la région de Dosso, au Niger, de Mai à Août 2016. Une régression logistique multivariée a été menée pour évaluer la probabilité que les jeunes femmes mariées déclarant utiliser actuellement des méthodes contraceptives modernes après avoir été visitées par un relai au cours des trois derniers mois. Résultats Au total, 956 jeunes femmes mariées ont été incluses dans l’analyse finale. Parmi les participants à l’étude, 9,3% ont signalé une visite de relais pour discuter de problèmes de santé au cours des trois derniers mois et 11,4% ont déclaré utiliser actuellement une méthode de contraception moderne. En tenant compte des variables sociodémographiques, les probabilités d’utilisation actuelle de méthodes contraceptives modernes étaient plus élevées chez les jeunes femmes mariées visitées par un relai au cours des trois derniers mois par rapport à celles qui n’avaient pas été visitées par un relai au cours de cette période (AOR = 1,94 [95% IC 1,07-3,51]). Dans cette étude, les relais étaient moins susceptibles de rendre visite aux femmes nullipares et aux femmes ayant travaillé au cours des 12 derniers mois. Conclusion Les jeunes femmes mariées visitées par les relais étaient plus susceptibles d’utiliser des méthodes de contraception modernes que celles qui n’étaient pas visitées par les relais. Ces résultats concordent avec ceux d’études similaires sur la planification familiale menées en Afrique subsaharienne et suggèrent que les relais au Niger pourraient donner accès à des services essentiels de planification familiale dans les zones rurales et difficiles d’accès. Des efforts supplémentaires pour comprendre les barrières contraceptives rencontrées par les femmes nullipares et les travailleuses devraient constituer une priorité de recherche essentielle au Niger

Married very young adolescent girls in Niger at greatest risk of lifetime male partner reproductive coercion and sexual violence.

OBJECTIVE:The purpose of this analysis was to compare and contrast reproductive health (RH), gender equity attitudes, and intimate partner violence (IPV) among married very young adolescent (VYA) girls with married older adolescent girls and young women (AGYW) in rural Niger given limited literature on the topic. METHODS:We conducted an exploratory analysis of baseline data from the Reaching Married Adolescents Trial in Dosso region, Niger. We report counts and percents, by age group (13-14 years (VYA), 15-16 years, 17-19 years), of AGYW's self-efficacy to use family planning (FP), accurate knowledge of FP, current use of modern FP, and unintended last pregnancy (UIP); lifetime reproductive coercion (RC), physical IPV, and sexual IPV; and gender equity attitudes. We also assess whether percents differ between VYA and older groups using Pearson's Chi-Square and Fisher's exact p-values. Results are stratified by parity. Finally, we use logistic regression to consider associations. RESULTS:There were 49 VYA, 248 girls aged 15-16, and 775 AGYW aged 17-19 in our sample (n = 1072). Accurate knowledge of FP, self-efficacy to use FP, current use of modern FP, and UIP increased with age; all percents between VYA and AGYW 17-19 were marginally or statistically significantly different. We also saw VYA report higher lifetime RC and sexual IPV versus older groups, with sexual IPV statistically different between VYA and girls 17-19. Parous VYA reported a significantly higher percent of lifetime RC versus older AGYW. Among 17-19 year-olds, odds of current use of FP were higher among AGYW who reported physical IPV, and odds of UIP were higher among those reporting more gender equitable attitudes, both adjusted for parity. CONCLUSIONS:We observed differences in RH, RC, and sexual IPV among married VYA and older AGYW in rural Niger. VYA should be prioritized in research to confirm and further understand their RH needs

Effects of the reaching married adolescents program on modern contraceptive use and intimate partner violence: results of a cluster randomized controlled trial among married adolescent girls and their husbands in Dosso, Niger.

BackgroundNiger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger.MethodsWe conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13-19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV.ResultsBaseline and 24-month follow-up data were collected April-June 2016 and April-June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41-8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68-5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18-0.88 for Arm 2; aIRR 0.46, 95% CI 0.21-1.01 for Arm 3). No Arm 1 effects were observed.ConclusionsThe RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730

Effects of the reaching married adolescents program on modern contraceptive use and intimate partner violence: results of a cluster randomized controlled trial among married adolescent girls and their husbands in Dosso, Niger

Abstract Background Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger. Methods We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13–19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV. Results Baseline and 24-month follow-up data were collected April–June 2016 and April–June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41–8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68–5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18–0.88 for Arm 2; aIRR 0.46, 95% CI 0.21–1.01 for Arm 3). No Arm 1 effects were observed. Conclusions The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT0322673