Criteres Du Traitement Non Operatoire Des Contusions Abdominales En Milieu Sous Equipe

The criteria of non-operative operative management (NOM) of blunt abdominal trauma remains poorly defined in the context of low-income countries. Purpose: To validate a protocol for blunt abdominal trauma by specifying indications for NOM in a resource-limited setting. Material and Method: The study was prospective, carried out over a period of 12 months at Sylvanus Olympio Teaching Hospital Lomé (Togo). It included all patients over 15 years admitted for abdominal blunt trauma. Patients were subjected to NOM or surgery according to systolic blood pressure, response to resuscitation measures, clinical examination, peritoneal tap, abdominal plain radiograph and ultrasound. Results: Sixty-four patients, including 53 men and 11 women, were admitted in the study. The mean age was 27.8 years. Road traffic accidents were the circumstance of the occurrence in all cases. Pneumopéritoneum was found in 3 patients (5.45%). Abdominal ultrasound identified a solid organ injury in 24 patients (43.6%). Spleen lesions were the most frequent injuries. An extra-abdominal lesion was present in 23 patients (35.9%). NOM was initiated in 52 patients (81.25%) and effective in 46 patients (88.4%). The failure of the NOM was due to small intestine perforation in 2 patients, a bladder injury in 1 patient, active bleeding in 1 patient and hemodynamic instability resulting in nontherapeutic laparotomy in 2 patients. Death was observed in 8 patients (12.5%), 2 of whom were in the NOM group. Conclusion: criteria for the NOM of blunt abdominal trauma can be defined according to the local possibilities. Early diagnosis of digestive perforation should remain a priority during clinical monitoring

La Chirurgie Foraine : Une Solution Aux Problemes D’acces Aux Soins Chirurgicaux Des Populations Rurales

Assessment of the quality of care in surgical outreach programs is necessary to improve their reliability. Purpose: The purpose of this study is to evaluate the clinical results of a surgical outreach program involving large numbers of patients. Material and Method: Retrospective study of clinical data and outcomes of patients operated on within a surgical outreach held in Togo's Central Region was carried out. Data was collected from patient’s files with a follow-up, of 2 years. Results: Two hundred and seventy seven patients (277) underwent 304 surgical procedures within the surgical outreach. The conditions were essentially made of hernias of the abdominal wall (89%). Cases of hydroceles, endemic goiter and uterine myo-fibroids were also managed. Spinal anesthesia was the most common procedure of anesthesia (75%). Day case surgery involved 165 patients (59.5%). A post operative morbidity was observed in 31 patients (11%) essentially made of hematoma 28 cases (9.2%) and parietal abscesses 20 cases (6.5%).There were no postoperative deaths. Conclusion: outcomes in this study encourage surgical outreach programs as reliable means to address surgery accessibility issues of rural populations in low incomes countries

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