Tétanos du post-partum sur déchirure vaginale à propos d’un cas à l’Hôpital National de Zinder, Niger

We report an exceptional case of postpartum tetanus occurring in an unvaccinated primipara having given birth in a health center. Six days after childbirth, she had a trismus associated with generalized muscle contractions suggestive of tetanus. Obstructed labor was complicated by a vulvar tear repaired with wires under septic conditions. Functional sequelae, such as dysarthria, quadriesteria, and a decrease in visual acuity, marked the evolution. The newborn was free from neonatal tetanus. Our patient poses the problem of access to preventive care and the quality of care in health facilities in developing countries

The conservative treatment of giant omphalocele by tanning with povidone iodine and aqueous 2% eosin solutions

Aim: The aim of this work was to report the result of nonoperative management of giant omphalocele by dressing with povidone iodine and aqueous eosin in Niger.Patients and methods: This prospective study was conducted over 5 years (January 2011 to December 2015) in the Departments of Pediatric Surgery in the country. The procedure consisted of applying povidone iodine at the initial phase of the treatment as inpatient followed by aqueous eosine solution application as outpatient, which was continued up to complete epidermization. The clinical aspects, the complications and the mortality of omphalocele were discussed.Results: The study included about 13 patients; the mean age at presentation was 1.7 days (range: 3 h–8 days). The delivery was at home in 38.46% of the cases (five out of 13). The average birth weight was 2810 g. Associated congenital abnormalities were found in 46.15% of cases (six out of 13). The mean initial hospitalization duration was 8 days. The average length of complete epidermization duration was 9±2 weeks. The secondary surgical cure was realized in eight patients. The morbidity rate was 30.77% (four out of 13). The mortality rate was 23.07% (three out of 13).Conclusion: The conservative treatment of giant omphalocele through the application of povidone iodine and aqueous eosine is effective and cost-effective. This procedure should be privileged in our limited resources Health centers where pediatric intensive care unit are lacking.Keywords: conservative management, dressing, epidermization, omphalocel

Hernie interne supravésicale, cause rare d’occlusion intestinale aiguë

La hernie interne supravésicale est rare et se développe au niveau de la fossette supravésicale. Son diagnostic est très souvent fait à l'occasion d'une laparotomie pour occlusion intestinale. Dans ce travail, nous rapportons le cas d'un patient âgé de 49 ans admis aux urgences chirurgicales de l'HNZ pour syndrome occlusif. La laparotomie réalisée a permis de découvrir une anse grêle incarcérée dans une hernie interne supravésicale. Le geste chirurgical a consisté en une résection du sac associée à une fermeture en points séparés et les suites opératoires ont été simples. Devant toute occlusion intestinale aiguë, il faut avoir à l'esprit que la hernie interne supravésicale peut en être une cause inhabituelle.Pan African Medical Journal 2015; 2

Occlusion intestinale aigue révélant un lymphome T digestif associé à la maladie coeliaque, à propos d’un cas

Le lymphome T intestinal associé à une entéropathie ou Enteropathy associated T-cell lymphoma (EATL), est une complication rare de la maladie coeliaque (MC). Nous rapportons l’observation d’un lymphome T associée à une MC révélé par une occlusion intestinale aigue. Une patiente maghrébine de 38 ans, aux antécédents de stérilité et de douleurs abdominales chroniques, était admise en urgence pour occlusion intestinale aigue. L’intervention chirurgicale retrouvait une tumeur au dépend du grêle avec des adénopathies mésentériques. L’histologie et l’immunohistochimie de la pièce opératoire objectivait un lymphome T digestif CD3+ et le bilan immunologique de la maladie coeliaque était positif. Le diagnostic d’EATL était ainsi retenu. La patiente était mise sous chimiothérapie (CHOEP) et régime sans gluten avec une réponse complète au traitement. L’EATL est une complication rare de la MC qui peut être révélée par une occlusion intestinale. Son pronostic peut être amélioré par une prise en charge précoce associant chirurgie et chimiothérapie. Sa prévention passe par un diagnostic précoce de la MC et un régime sans gluten.Pan African Medical Journal 2016; 2

Profils Épidémiologiques, Cliniques et Thérapeutiques de la Sténose Urétrale de L’homme à l’Hôpital National de Zinder (HNZ), Niger

Objectif : Décrire les aspects épidémiologiques, cliniques et thérapeutiques de la sténose urétrale à L’hôpital national de Zinder (HNZ) NIGER. Patients et méthodes : Il s’agissait d’une étude rétrospective descriptive réalisée dans le service d’Urologie de l’HNZ durant la période de janvier 2016 à Décembre 2019. Nous avons colligé 116 dossiers médicaux des patients, chez qui le diagnostic de rétrécissement urétral était posé et documenté par une urétro-cystographie rétrograde et mictionnelle (UCRM) et pris en charge. Résultats : Au cours de cette étude, 116 dossiers étaient retenus sur 964 interventions durant la période soit 8, 31%.L’âge moyen des patients était de 39,53 ans avec des extrêmes de 18 ans et 74 ans. Les principaux motifs de consultations étaient la dysurie (25 ,86%), la pollakiurie (15,52%), et la rétention aiguë dans (17,24%). L’urétro-cystographie rétrograde et mictionnelle (UCRM) était le principal examen complémentaire du diagnostic. Cet examen avait permis de découvrir, 69,3% de sténose urétrale au niveau bulbaire, 17,5% au niveau pénien antérieur, 9,4% multiples, 3,8% au niveau du méat urétral. Le traitement avait consisté en une résection anastomose termino-terminale (RATT) au niveau bulbaire dans 57,21%(n=67), de dilatations urétrales (DU) aux béniqués dans 19, 01% (n=22) des cas, urétroplastie en deux temps selon Johanson dans 11, 52%(n=13), de plasties par greffe de peau glabre de la crête iliaque dans 8,42% (n=10), et une méatotomie 3,45%(n=4). Après un recul de 21 mois, les anastomoses (RATT) étaient jugées bonnes pour 61,19% (41/67). Les échecs étaient enregistrés dans 16,42% (n=11) et 22,39% (n=15) étaient perdus de vue. Pour les dilatations aux béniqués à 9 mois de recul, 59% (n= 13) étaient évaluées bonnes, et mauvaises dans 41% (n=9) des cas. Les plasties avec greffe étaient réussies dans 30% (n=3) des cas, et 70% (n=7) étaient des échecs. Les urétroplasties selon Johanson étaient jugées satisfaisantes à six mois de récul dans 23,07% (3/13) des cas, et non satisfaisantes dans 76,93% (10/13) des cas.Toutes les méatotomies étaient réussies (n=4). Un RPM ≤ 30 ml était enregistré dans 55,17% des cas et ≥ 100ml dans 31,90% des cas. Quinze patients soit 12,93 étaient perdus de vue après leur première évaluation. Conclusion : La sténose de l’urètre est une affection fréquente dans les consultations en urologie à l’HNZ. Les patients consultent souvent au stade de complications. L’UCRM est la clé du diagnostic topographique de la lésion. La résection anastomose terminoterminale donne de bons résultats. La maitrise des plasties avec greffe de muqueuse, ou cutanée reste encore un défi dans notre contexte. Objective: To describe the epidemiological, clinical and therapeutic aspects of urethral stenosis at Zinder National Hospital (ZNH) NIGER. Patients and methods: This was a descriptive retrospective study carried out in the Department of Urology of the ZNH during the period from January 2016 to December 2019. We collected 116 medical records of patients, in whom the diagnosis of narrowed Urethral donation was performed and documented by retrograde and voiding urethro-cystography and managed. Results: During this study, 116 files were retained on 964 interventions during the period, ie 8.31%. The average age of the patients was 39.53 years with extremes of 18 and 74 years. The main reasons for consultations were dysuria (25.86%), pollakiuria (15.52%), and acute retention in (17.24%). Retrograde and voiding urethro-cystography (UC) was the main complementary diagnostic examination. This examination had revealed 69.3% urethral stenosis at the bulbar level, 17.5% at the anterior penis level, 9.4% multiple, 3.8% at the urethral meatus. The treatment consisted of resection of the end-to-end anastomosis at the bulbar level in 57.21% (n = 67), from urethral dilation to the benign in 19.01% (n = 22) of the cases, urethroplasty in two stages according to Johanson in 11.52% (n = 13), of plasties by glabrous skin graft of the iliac crest in 8.42% (n = 10), and a meatotomy 3.45% (n = 4). After a 21-month follow-up, anastomoses were considered good for 61.19% (41/67). Failures were recorded in 16.42% (n = 11) and 22.39% (n = 15) were lost to follow-up. For dilations to the benign patients at 9 months of follow-up, 59% (n = 13) were rated good, and poor in 41% (n = 9) of the cases. Plasty with grafting was successful in 30% (n = 3) of the cases, and 70% (n = 7) were failed. Johanson's urethroplasty was considered satisfactory after six months of recession in 23.07% (3/13) of the cases, and unsatisfactory in 76.93% (10/13) of the cases. All meatotomies were successful (n = 4). An RPM ≤ 30 ml was recorded in 55.17% of the cases and ≥ 100ml in 31.90% of the cases. Fifteen patients (12.93) were lost to follow-up after their first evaluation. Conclusion: Stenosis of the urethra is a common condition in consultations at the NHZ. Patients often consult for complications. The UC is the key to the topographic diagnosis of the lesion. Resection with end to end anastomosis gives good results. Plasties with mucosal or skin grafting still remain a challenge in our context

Rupture Spontanee Du Tendon D’achille Sur Terrain Diabetique : A Propos Du Cas

Achilles Tendon Rupture (ATR) is a frequently described lesion in sports traumatology. It can occur following certain chronic or systemic diseases. We reported a case of a 48-year-old woman, a teacher by profession, who was consulting for lameness. Anamnesis found during a walk, a brutal sensation of blow on the heel with cowardice and sharp pain at the elective point imposing upon the resting of the patient. Clinical examination noted an increased spontaneous dorsiflexion of the affected ankle, depression corresponding to the tendon continuity solution, and a positive Thompson test. The diagnosis of Achilles Tendon Rupture was made. The patient was operated 2 weeks later by open surgery. A simple suture kept by a plaster splint was performed (the ankle in equinus). Functional rehabilitation was done for 6 weeks, and walking was allowed at the 6th week. In the absence of minimally invasive surgery, conventional surgery can provide good results in case of spontaneous Achilles Tendon Rupture at the cost of rigorous monitoring of the patient

A Case Series of Intraluminal Migration Gossypiboma in Regional Hospital of Maradi

Introduction: Textiloma or Gossypiboma is used to describe a foreign body composed of a compress (s) or surgical field (s) forgotten at an operating site. Case report: Authors reported two cases of intestinal migrant textiloma in patients all previously operated on by cesarean section. The two patients consulted for a chronic painful abdominal mass. Abdominal ultrasound showed a superficial anterior structure in favor of foreign body in the first patient. The second one concluded that there was a right ovarian cyst. The surgery discovered a greek mass in both cases. Resection of the intestinal mass was performed followed by end to end anastomosis. The enterostomy of hail mass revealed an abdominal compress in each case. Conclusion: Forgetting a compress or abdominal field during surgery is a tragedy for the surgeon not only because of its forensic aspect but also because of the suffering endured by the patient. Indeed, actions trying to prevent this type of error are implemented in most developed countries; it is time for each hospital to adopt preventive measures, even if just only the compresses counting during the procedure

RETARD DIAGNOSTIQUE ET IMPLICATION PRONOSTIQUE EN MILIEU AFRICAIN. CAS DES URGENCES EN CHIRURGIE DIGESTIVE À L’HÔPITAL NATIONAL DE ZINDER, NIGER

Purpose: this study aimed to analyze the epidemiological aspects and evaluate the impact of late diagnosis on prognosis of gastrointestinal surgical emergencies at the National Hospital of Zinder (Niger). Patients and method: this is a prospective study from 1 January to 31 December 2013. All patients underwent surgery for digestive emergency were included. Results: We collected 302 patients. Emergencies digestive surgery accounted for 22% of 1358 cases of surgical emergencies recorded over the period of the study period. The sex ratio is 3/1 in favor of men. The average age of patients was 23 years. Digestive surgical emergencies affect more children (45%) and young adults (43%). The majority (70%) of our patients did not attend school and 49% were from rural areas. The diagnosis delay rule, 171 patients (57%) arrived to emergency department more than 48 hours after onset of symptoms. Abdominal pain with or without other signs was the main reason for consultation (92% of patients). 182 patients had a poor general status. The etiologies were dominated by peritonitis (52%) followed by intestinal obstruction (28%), and abdominal trauma with 10% of cases. The parietal suppuration isolated or associated with other morbidities was the main postoperative (28%). The average length of hospital stay was 9 days. 36 patients (12%) had died. Almost half of the deaths (47%) occurred within the first 48 hours of admission. The delay of admission and the surgical management was statistically significant effect on the prognosis (P<0.006, p< 0.0001). Conclusion: The prognosis of gastrointestinal surgical emergencies is highly correlated with the speed of diagnosis leading to appropriate treatment as soon as possible. This promptness is the only guarantee of a decline in the high morbidity and mortality which is often linked to dysfunction of our hospitals and/or accessibility problems faced by patients

Péritonites Aiguës d’Origine Gynécologique à l’Hôpital National de Zinder, Niger

Introduction : les péritonites aiguës gynécologiques (PAGy) sont rares dans notre pratique chirurgicale. Un retard diagnostique et thérapeutique conduit à une laparotomie dans notre contexte. L’objectif de cette étude était de décrire les caractéristiques épidémiologiques et thérapeutiques des PAGy à l’Hôpital National de Zinder, Niger. Patientes et méthodes : il s’agissait d’une étude rétrospective allant de janvier 2013 à décembre 2016 (4 ans). Étaient incluses les patientes opérées pour péritonite dont le diagnostic de péritonite aiguë gynécologique(PAGy) était confirmé en peropératoire. Étaient exclues les péritonites d’autres causes non gynécologiques. Les patientes présentant une infection génitale non opérées n’étaient pas incluses. Résultats : Durant la période d’étude, 660 cas de péritonites étaient enregistrés, dont 190 femmes. Les péritonites aiguës gynécologiques (PAGy) représentant 2,87% (n=19) toutes les péritonites opérées. L’âge moyen de nos patientes était de 27,9±7,7 ans. Une notion d’algie pelvienne chronique était retrouvée dans 42,1% (n=8), de fièvre au long cours dans 36,8% (n=7). Les patientes étaient mariées dans 79% (n=15) et multipares dans 57,9% (n=9). Le délai médian de consultation était de 8 jours (extrêmes : 6-25 jours). La péritonite était généralisée dans 84,2% (n=16) et localisée dans 15,8% (n=3). L’origine était tubo-ovarienne dans 94,5% (n=18). Le traitement conservateur préservant les annexes était fait dans 78,9% (n=15). Les infections du site opératoire étaient enregistrées dans 21,1% (n=4). La mortalité était de 21,1% (n=4). Les facteurs associés au risque de décès étaient : le délai d’admission > 9 jours (p=0,032), la fièvre > 38,5°C et l’infection à VIH (p=0,035). Conclusion : Les péritonites aiguës gynécologiques affectent les femmes jeunes avec un statut socio-économique bas. Elles sont souvent diagnostiquées au stade de péritonites généralisées. Dans notre contexte l’origine est tuboovarienne est prédominante. La mortalité élevée pourrait être prévenue par un diagnostic et un traitement précoce des infections génitales. Introduction: Acute gynecological peritonitis is rare in our surgical practice. The diagnostic and therapeutic delay leads to a laparotomy in our context. The objective of this study was to describe the epidemiological and therapeutic characteristics of acute gynecological peritonitis at the Zinder National Hospital, Niger. Patients and methods: this was a retrospective study from January 2013 to December 2016 (4 years). Patients operated for peritonitis whose diagnosis of acute gynecological peritonitis was confirmed intraoperatively were included. Patients with peritonitis from other non gynecological causes were excluded. Patients with unoperated genital infection were not included. Results: During the study period, 660 cases of peritonitis were recorded, including 190 women. Acute gynecological peritonitis (PAGy) representing 2.87% (n = 19) all operated peritonitis. The average age of our patients was 27.9 ± 7.7 years. A notion of chronic pelvic pain was found in 42.1% (n = 8), of long-term fever in 36.8% (n = 7). Patients were married in 79% (n = 15) and multiparous in 57.9% (n = 9). The median consultation time was 8 days (range: 6-25 days). Peritonitis was generalized in 84.2% (n = 16) and located in 15.8% (n = 3). The origin was adnexal in 94.5% (n = 18). Conservative treatment preserving the appendices was done in 78.9% (n = 15). Operative site infections recorded in 21.1% (n = 4). Mortality was 21.1% (n = 4). Factors associated with the risk of death were: time to admission> 9 days (p = 0.032), fever> 38.5 ° C, and HIV infection (p = 0.035). Conclusion: Acute gynecological peritonitis affects young women with low socio-economic status. They are often diagnosed at the stage of generalized peritonitis. In our context adnexal origin is predominant. High mortality could be prevented by early diagnosis and treatment of genital infections. &nbsp

Paraurethral cysts in two female infants: When opting for surgical procedure

Paraurethral cysts (PC) or Skenes duct cysts are rare cause urogenital masse in females, particularly in newborn or infant. It arise from obstruction of Skenes ducts and diagnosis is usually easy by physical examination. The management of PC is controversial, it can be conservative or surgical. Non regression of cyst after 6 months of following or difficulty in excretion of urine was the indication for surgery. We report two cases of paraurethral cyst in female infant treated by surgical procedure