Male breast cancer: 22 case reports at the National Hospital of Niamey-Niger (West Africa)

Background: Male breast cancer (MBC) is rare. The objective of the study is to report clinicopathological characteristics, treatment patterns, and outcomes of MBC. Method: This study, which includes two parts (retrospective and prospective), focused on all hospitalized male patients with breast cancer during 17 years (1992–2008) with histological confirmation. Results: The series included 22 patients. The mean age was 52.8 years (range: 28–80 years). MBC represented 5.7% of all breast cancers. Most patients had an advanced disease with skin ulceration and inflammation T3 (31.9%) and T4 (59.1%). The majority of patients came from rural areas (63.6%). The duration of signs ranged from 1 to 7 years. Histology found infiltrating ductal carcinoma in 14 cases (63.6%), sarcoma in 3 cases (13.6%), papillary carcinoma in 2 cases (9%), and lobular carcinoma, medullar carcinoma, and mucinous carcinoma in 4.6% each of the others cases. The treatment had consisted of a radical mastectomy (Halsted or Patey) in 19 cases (86.4%) with axillary clearance and incomplete resection in 3 cases (13.6%). In the retrospective study follow-up of 14 patients, we lost sight of 13 patients 6 months after surgery. In the prospective study of 8 patients 10 to 36 months after mastectomy, 4 patients were deceased (50%), 4 were alive with 1 case having a local recurrence and pulmonary etastasis. Conclusion: The advanced clinical forms of MBC are most frequent with skin ulceration and nodal enlargement. The absence of radiotherapy and the low access of chemotherapy limited the treatment to radical mastectomy (Halsted) in the majority of cases

Laparoscopic cholecystectomy in sickle cell patients in Niger

BACKGROUND: We report the results of our experience on laparoscopic cholecystectomy in sickle cell disease patients in Niger, which is included in the sickle cell belt. METHODS: A prospective study covering a period of 45 months, from July 2004 to March 2008. We included all sickle cell disease patients that underwent laparoscopic cholecystectomy. Blood transfusion was done for patients with haemoglobin (Hb) levels less than 9g/dl. Homozygous and composite heterozygous patients were admitted in intensive care unit for 24 hours or plus post operatively. RESULTS:The series included 47 patients operated by the same surgeon, 31 females (66%) and 16 males (34%) (Ratio: 0.51). The average age was 22.4 years (range: 11 to 46 years) and eleven (23.4%) of them were aged less than 15 years. The types of sickle cell disease found were 37 SS, 2 SC, 1 S beta-thalassemia and 7 AS. Indications for surgery were biliary colic in 29 cases (61.7%) and acute cholecystitis in 18 cases (38.3%). The mean operative time was 64 min (range: 42 to 103 min). Conversion to open cholecystectomy in 2 cases (4.2 %) for non recognition of Calot‘s triangle structures. The postoperative complications were: four (4) cases of vaso-occlusive crisis and one case of acute chest syndrome. The mean postoperative hospital stay was 3,5days (range: 1 to 9 days). No mortality was encountered. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure in sickle cell patients. It should be a multidisciplinary approach and involve a haematologist, an anaesthesiologist and a surgeon

Indications et Resultats de la Thyroïdectomie dans les Hopitaux Saheliens, Experience des Services de Chirurgie Generale et Viscerale a Propos de 422 (Niger)

L’objectif de ce travail était de décrire les principales indications et résultats des thyroïdectomies dans deux hôpitaux de références du Niger. Patients/Méthodes : Nous avions réalisé une étude rétrospective et prospective sur 5 ans et 6 mois dans les services de chirurgie générale et digestive de l’HGR et HNN. Elle concernait les patients des deux sexes et sans limite d’âge ayant bénéficiés d’une chirurgie pour pathologie thyroïdienne pendant la période d’étude. Résultats : une fréquence de thyroïdectomie de 4,18% était retrouvée soit chez 422 patients. Le sexe féminin prédominait avec un sexe ratio de 0,12. La tranche d’âge de 32 à 47 ans était la plus concernée (45,8%) avec un âge moyen de 44,3 ans. Le goitre hétéro-multinodulaire constituait la principale indication de la thyroïdectomie (50,10%). 85,16 % des patients avaient consulté pour une tuméfaction cervicale antérieure. L’échographie avait montré une thyroïde hétérogène dans 236 cas (64,69%.). Le principal acte chirurgical était la thyroïdectomie totale avec 308 cas soit 73,17%. La thyroïdectomie vidéo-assistée représentait 0,94% (un cas) des actes chirurgicaux. En postopératoire, la principale complication était la paralysie récurrentielle avec 2,13 % (n=9) et à moyen terme c’était l’hypocalcémie avec 1,18 % (n=5). Les résultats d’anatomie pathologie avait confirmé   qu’il s’agissait d’une pathologie bénigne dans plus de la majorité des cas (55,2%, N=233). Aucun décès n’avait été enregistré pendant la période d’étude. Conclusion : La pathologie thyroïdienne est fréquente, le geste chirurgical le plus réalisé est la thyroïdectomie totale et il existe peu de complications.   Introduction: Report main indication and result of thyroidectomy at the General Hospital of Reference and National Hospital. Methods: We did a retrospective study over 5 years and 6 months of 422 cases in the general and digestive surgery departments of the RGH and HNN. It concerned patients of both sexes without age limit who had undergone surgery for thyroid pathology during the period of our study. Results: A frequency of thyroidectomy was 4.18%. Females predominated with a sex ratio of 0.12 and the age group 32-47 years was the most concerned with a mean age of 44.3 years. Heteromultinodular goiter was the main indication for thyroid surgery (50.10%), in our series 85.16% of patients had consulted for anterior cervical swelling. The main surgical procedure was total thyroidectomy with 308 cases or 73.17%. Video-assisted thyroidectomy represented 0.94% of the surgical procedures. The recurrent laryngeal nerve was dissected and seen in 381 cases or 89.93%. In the immediate postoperative period, the main complication was dysphonia with 2.13% (n=9) and in the médium term it was hypocalcemia with 7.34% (n=31). Anatomical pathology results confirmed that it was a benign pathology in the majority of cases (55.2%). No deaths had been recorded. Conclusion: Thyroid pathology is common; the most performed procedure is total thyroidectomy. The main complications recorded were dominated by recurrent paralysis, compressive hematoma and transient hypocalcemia. the most common malignant tumor was the papillary carcinoma

Les Goitres Plongeants : Aspects Épidémiologiques, Cliniques, Radiologiques Et Thérapeutiques

Purpose: To describe the epidemiological and diagnostic aspects and surgical treatment procedures of plunging goiter in the Oto-Rhino- Laryngology and Neck Surgery Office of the National Hospital of Niamey in Niger. Materials and Methods: We analyzed the clinical and paraclinical symptoms as well as the technique and postoperative evolution of plunging goiters through a retrospective and descriptive study conducted from January 2010 to December 2015. Results: During the five years period, 15 cases of plunging goiter were registered representing 6.35% of thyroidectomy. Among the patients, there were 4 men (26.66%) and 11 women (73.34%). The mean age was 37.84 years. The character “plunging goiter” was noticed on clinical examination and confirmed by imaging. Two cases of hyperthyroidism were recorded. Eso-trachea compression that is characterized by dysphagia and dyspnea was recorded in 7 cases (46.66%), dysphonia in 2 cases (13.33%). The scanner performed in 8 cases showed a goiter with anterior superior mediastinal shift in 84.61%, driving the eso-tracheal axis in 62.5% of cases. The goiters plunged right in 5 cases (33.33%), left in 2 cases (13.33%) and were bilateral in 1 case. Complete thyroidectomy was performed on all patients by exclusive cervical way with as immediate complications, one intraoperative hemorrhage case (n = 1) and one transient hypoparathyroidism case (n = 1). Histological examination of surgical specimens shows no evidence of malignancy. Conclusion: The plunging goiters are rare and their treatment was complete thyroidectomy by exclusive cervical way. Postoperative evolution was uneventful

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

The Impact of Launching Surgery at the District Level in Niger

BackgroundIn 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery.MethodsWhereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso.ResultsDuring the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training.ConclusionsResults from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished

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

Prise En Charge Des Dermo-Hypodermites Nécrosantes Au Centre Hospitalier Régional De Diffa, Niger

Introduction : la dermo-hypodermite nécrosante (DHN) est une affection redoutable, responsable d’une morbi-mortalité importante constituant un véritable problème de santé publique dans la région de Diffa. L’objectif de cette étude est décrire la prise en charge des DHN dans le service de chirurgie du Centre Hospitalier Régional (CHR) de Diffa. Patients et méthodes : Il s’est agi d’une étude rétrospective descriptive, menée dans le service de chirurgie du CHR de Diffa, et incluant les dossiers des cas de DHN, pris en charge de Janvier 2017 à Décembre 2018. Résultats : 132 cas ont été enregistrés. L’âge médian était de 25 ans (extrêmes : 10 jours et 87 ans). Tous les patients ont bénéficié d’une antibiothérapie et dans 91,8% un traitement chirurgical était nécessaire. Le nombre de passage au bloc opératoire était compris entre 2 et 36. Une greffe de peau a été réalisée dans 25,7% des cas. Le taux d’amputation de membre était de 9,1%. La durée moyenne de séjour hospitalier était de 32,3 jours (extrêmes : 17 jours et 189 jours). La mortalité intra hospitalière était de 3,8% (n=5). Conclusion: la dermo-hypodermite nécrosante est une affection grave, fréquente dans la région de Diffa dont la prise en charge médico-chirurgicale est lourde, grevée d’un mauvais pronostic. Un accent devrait être mis sur la recherche étiologique et le contrôle des facteurs prédisposant et aggravant de la maladie. Introduction: Necrotizing dermo-hypodermatitis (NHD) is a dreaded condition, responsible for a significant morbi-mortality constituting a real public health problem in the region of Diffa. The objective of this study is to describe the management of NHD in the surgical department of the Regional Hospital Center (CHR) of Diffa. Patients and methods: This was a descriptive retrospective study, conducted in the surgery department of the CHR of Diffa, and including the records of NHD cases, taken in charge from January 2017 to December 2018. Results: 132 cases were recorded. The median age was 25 years (extremes: 10 days and 87 years). All patients received antibiotic therapy and in 91.8% of cases surgical treatment was required. The number of visits to the operating theatre ranged from 2 to 36. A skin graft was performed in 25.7% of cases. The limb amputation rate was 9.1%. The average length of hospital stay was 32.3 days (extremes: 17 days and 189 days). Intra-hospital mortality was 3.8% (n=5). Conclusion: Necrotizing dermo-hypodermatitis is a serious condition, frequent in the region of Diffa, with a poor prognosis and heavy medical and surgical management. Emphasis should be placed on etiological research and control of predisposing and aggravating factors of the disease

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