Can children with sickle cell disease undergo open splenectomy without preoperative transfusion despite severe anemia? A report of three cases

Preoperative red cells transfusion to correct anaemia and to reduce the proportion of sickle red cells is part of standard preparation of children with sickle cell anaemia (HbSS) for major procedures including open abdominal surgeries. We report three children with sickle cell anaemia presenting with chronic massive splenomegaly and hypersplenism. The children were initially denied surgery because of extremely low haemoglobin levels and the inefficacy of transfusion. Subsequently, they underwent successful open abdominal splenectomy without any red cells transfusion. These observations are important to paediatricians and surgeons in settings where HbSS is common. They highlight the fact that surgery should not be withheld from children with sickle cell anaemia and massive splenomegaly purely on the basis of difficulty in correcting anaemia before the procedure.Key words: Sickle cell disease,surgery, splenectomy, transfusion

Les occlusions neonatales au Centre National Hospitalier et Universitare (CNHU) de Cotonou : Aspects épidémiologiques, cliniques et thérapeutiques

Les occlusions nonatales (ONN), les plus frquentes des urgences chirurgicales nonatales, sont des affections graves, greves d.une forte mortalit dpassant encore 50% en Afrique tropicale. Ce travail avait pour objectifs d.tudier leurs aspects pidmiologiques, cliniques et volutifs et d.analyser les problmes poss par leur prise en charge au Centre National Hospitalier et Universitaire (CNHU) de Cotonou. Il s.agit d.une tude rtrospective vise descriptive portant sur les occlusions nonatales, l.exclusion des malformations ano-rectales. 62 dossiers d.occlusions nonatales ont t colligs reprsentant 41 % des syndromes occlusifs. L.incidence annuelle moyenne tait de 4. L.ge moyen d.admission tait de 14 ± 5 jours. La sex-ratio tait de 1,4. Le dlai d.admission tait en moyenne de 11 ± 4 jours. Aucune ONN n.a t diagnostique en priode antnatale. 50% des ONN taient des atrsies intestinales. Le dlai moyen d.intervention chirurgicale tait de 7 + 3 jours. Les complications post-opratoires, observes dans 75% des cas, taient domines par la dnutrition (55%) et les occlusions post-opratoires (22%). La mortalit globale tait de 44,2%. Elle tait plus importante chez les oprs (58,3%). Les ONN ont une frquence sous estime Cotonou. Elles sont caractrises par des retards considrables l.admission, au diagnostic et l.intervention, et de fortes, morbidit et mortalit. Cette situation est en rapport avec l.absence de diagnostic antnatal, l.inexistence de services spcialiss et performants d.Anesthsie-Ranimation et de Soins intensifs en Nonatologie et l.inexistence de couverture sociale universelle. Clinics in Mother and Child Health Vol. 3(1) 2006: 457-46

Le Traitement Medical De La Stenose Hypertrophique Du Pylore A Cotonou (Benin): A propos de deux cas.

La fréquence globale de la sténose hypertrophique du pylore se situe entre 1 et 3 pour 1000 naissances vivantes et concerne 5 fois plus le garçon que la fille. Son traitement, toujours chirurgical, était une pyloromyotomie extramuqueuse mise au point par Fredet en 1907 et Ramsted en 1911. La morbidité était de 1 à 16 % avec une mortalité inférieure à 0,4 % en Occident. La morbidité et la mortalité restent lourdes en Afrique car le traitement chirurgical de la sténose hypertrophique du pylore dans les paysdéfavorisés demeure hypothéqué par des conditions difficiles de prise en charge. A l’instar des études indiennes, serbes et japonaises, les auteurs rapportent 2 cas de sténose hypertrophique dupylore traités efficacement par l’atropine en intraveineuse à Cotonou

Urethral mucosal prolapse in young girls: A report of nine cases in Cotonou

Background: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reportingthe pathology presentation and therapeutic options of urethral prolapse in girls. Materials and Methods: A retrospective study was undertaken from January2000 to December 2008. Authors analysed the clinical features and the treatment options. Results: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The mainpresentation was vaginal bleeding (five cases). Physical examination revealed a soft, non-tender mass that bleeds on touch (six cases), with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealedurinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery, one hadacute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured.Conclusion: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical

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