A rare case of anatomical variation of the femoral artery and vein

During a dissection of the two femoral trigons in a female corpse, about 14 years old, we discovered on the right side, the deep artery of the thigh arising from the medial side of the femoral artery and passed in front of the femoral vein above the mouth of the great saphenous vein; on both sides, there was the presence of a collateral canal which communicated the external iliac vein with the femoral vein on the right, on the left, it communicated the external iliac vein with the quadricipital vein. The lower part of the femoral vein was duplicated on both sides, but on the right, there was an interconnecting channel between the two trunks of the duplication. Variations of the femoral vessels are very frequent and can be responsible for an incident during the practice of certain gestures at the level of the femoral trigon such as: catheterization of the femoral artery or vein, the treatment of femoral hernias. Key words: Deep thigh artery, collateral venous canal, external iliac vein, anatomic variations

Prise en charge du volvulus du sigmoïde à l’hôpital régional de Mopti

En 7 ans, nous avons colligé 100 cas de volvulus du colon sigmoïde à l’hôpital Sominé Dolo de Mopti. L’anse volvulée a été trouvée sans nécrose dans 66 cas et nécrosée dans 34 cas. Soixante-seize patients ont été l’objet d'une sigmoïdectomie suivie d'une anastomose colorectale en un temps, et vingt-et-un patients d’une intervention de Hartmann. Une détorsion chirurgicale a été réalisée chez 3 patients. Tous les patients opérés par ces deux dernières techniques ont eu un rétablissement de la continuité digestive dans un délai moyen de 90 jours. Les complications postopératoires ont été représentées par 11 cas de suppuration pariétale et un cas d’éviscération. La durée moyenne de suivi a été de 210 jours. Le taux de mortalité postopératoire a été de 14%. Il s'agissait d'un choc septique avec défaillance multi viscérale (n=13), et d'une embolie pulmonaire (n=1). Le traitement du volvulus est une urgence diagnostique et thérapeutique. Dans notre milieu, il repose sur la résection du sigmoïde en urgence suivie d’une anastomose immédiate si les conditions suivantes sont accomplies: état général bon, chirurgien expérimenté et réanimation pré, per et postopératoire possible.Mots clés: volvulus, colon sigmoïde, prise en charge, Mopti-MaliEnglish AbstractIn seven years, we have compiled 100 cases (66 with necrosis and 34 without necrosis) of sigmoid colon volvulus at the regional hospital Sominé Dolo in Mopti, Mali. Treatment consisted of a colorectal anastomosis in 76 patients and Hartmann intervention in 21 patients. Three patients had digestive untwisting. Digestive continuity was re-established at 90 days post surgery on average regardless of the technique of surgery. The average  duration of follow up was 210 days. Post surgery complications consisted of 11 parietal suppurations and one evisceration with mortality rate of 14% (13 cases of heart failure with septic choc and one case of pulmonary emboli). Treatment of volvulus requires a quick diagnostic and therapeutic approach. The best treatment is the emergency resection of the sigmoid followed immediate anastomosis in the appropriate conditions (a good general condition, an experienced surgeon, adequate pre-, per- and post-surgery reanimation).Keywords: volvulus, sigmoid colon, management, Mopt

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa