Urgences Chirurgicales Abdominales Pédiatriques Au Nord-Bénin : Aspects Epidémiologiques Et Diagnostiques

Les urgences chirurgicales abdominales pédiatriques sont relativement fréquentes surtout en Afrique. Elles posent un problème de retard de consultation dans notre contexte de travail. Objectif : L’objectif de notre travail était d’étudier les aspects épidémiologiques et diagnostiques des urgences chirurgicales abdominales pédiatriques au Nord-Bénin. Patients et méthodes : Il s’agissait d’une étude prospective descriptive et analytique réalisée au CHU de Parakou et à l’Hôpital de Zone de Tanguiéta. Elle s’est déroulée du 1er Janvier au 31 Juillet 2016. Etaient inclus tous les enfants de 0 à 15 ans admis pour une urgence chirurgicale abdominale avec une Classification Clinique des Malades aux Urgences cotée à 3 ; 4 ou 5. Résultats : Les urgences chirurgicales abdominales pédiatriques représentaient 42,8% des urgences chirurgicales pédiatriques. La moyenne d’âge était de 9,3 ± 3,5 ans. La sex-ratio était de 1,7. Les étiologies les plus fréquentes étaient les péritonites (36,8%), les traumatismes abdominaux (16,2%) et les malformations anorectales (14,7%). Le délai moyen de consultation était de 5 ± 1 jours et était lié au bas niveau d’instruction des parents (p= 0,00). Le délai moyen de diagnostic était de 3,1 heures. Au plan paraclinique, l’hémogramme et la radiographie de l’abdomen sans préparation étaient les examens les plus réalisés. Conclusion : Les enfants de sexe masculin étaient les plus touchés. Les principales urgences chirurgicales abdominales étaient les péritonites, les traumatismes abdominaux et les malformations ano-rectales. La sensibilisation des parents pour une consultation précoce est nécessaire. Pediatric abdominal surgical emergencies are relatively common especially in Africa. They pose a problem of delay in consultation in our work context. Objective: The objective of our work was to study epidemiological and diagnostic aspects of pediatric abdominal surgical emergencies in North Benin. Patients and methods: This is a prospective descriptive and analytical study conducted at Parakou teaching hospital and Tanguieta district hospital. It has been achieved from January 1st to July 31st 2016. Were included all children aged 0 to 15 years admitted for an abdominalsurgical emergency with a Clinical Classification of Emergency Patients listed from 3 to 5. Results: Pediatric abdominal surgical emergencies accounted for 42.8% of pediatric surgical emergencies. The average age was 9.3 ± 3.5 years old. The sex ratio was 1.7. The most common etiologies were peritonitis (36.76%), abdominal trauma (16.2%) and anorectal malformations (14.71%). The mean time of admission was 5 ± 1 days and was related to low parental education (p = 0.00). The mean time to diagnosis was 3.1 hours. Hemogram and abdominal X-rays were the most performed examinations. Conclusion: The boys were the most affected. The main abdominal surgical emergencies were peritonitis, abdominal trauma and anorectal malformations. Parental awareness for early consultation is necessary

Obstructive acute kidney injury in the hospital of Tanguièta. Frequency , clinical, therapeutic and evolutive aspects

INTRODUCTION Une insuffisance rénale aiguë obstructive (IRA Ob) par une obstruction des voies urinaires survenant de façon bilatérale ou sur rein unique anatomique ou fonctionnel et évoluant en mode aigü (Gordon et al., 2007) prévalence qui varie de 9à 12% (Cornet et al 2009; Cengiz et al., 2000). Elle est multifactorielle et grevée d'une mortalité élevée, 19 à 24% (Amellal, 2010; al., 1991). Le traitement dépend de la nature de l’obstacle. Une dérivation d’urgence s’avère nécessaire afin de contourner l’obstacle

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.info:eu-repo/semantics/publishedVersio

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Paediatric urologic pathologies at the national teaching hospital in Cotonou: A etiological and therapeutic aspects

Background: Urological pathologies of children are dominated by  congenital malformations of the kidneys and urinary tract. Their  management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. Patients and Methods: Data for aetiology, treatment, and results in  children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. Results: A total of 214 patients with complete  data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per  year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele,  nephroblastoma, the posterior urethral valves, ureteropelvic junction  obstructions, postcircumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations  represented 81.3%, followed neoplastic pathologies (7.9%), traumatic  pathologies (6.1%) and others (4.7%). The disorders of male genitalia  were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The  average age of the children urological pathologies at the time of  consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%. Key words: Aetiology, child, epidemiology, treatment, uropath

Motivations des médecins à se spécialiser en chirurgie à la Faculté des Sciences de la Santé de Cotonou

International audienc

Erratum: Antimicrobials: A global alliance for optimizing their rational use in intra-abdominal infections (AGORA). [World J Emerg Surg. 11, (2016) (33)] DOI: 10.1186/s13017-016-0089-y

© The Author(s). The original article [1] contains an error whereby a co-author, Boris Sakakushev has their family name spelt incorrectly as 'Sakakhushev'. The authors would therefore like it known that the correct spelling of the family name is 'Sakakushev'

The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal