A case report of a giant fallopian tube leiomyoma mimicking a mesenteric tumor.

Leiomyomas are benign tumors usually found in the uterus although other organs such as the vagina and the ovaries can be involved. The most common etiology of tubal disorders is infection, but tubal leiomyomas remain a rare possibility. We hereby present a case-report of fallopian tube leiomyoma undiagnosed preoperatively despite the technological progress in radiologic imaging. The diagnosis was only made at laparotomy. In this case report, diagnostic measures and the difficulties encountered are discussed.KEY WORDS: Abdominal mass- Fallopian tube fibroid - Diagnosis

Intestinal helminths in some cases of acute appendicitis operated in Bamenda, Cameroon

Background: Acute appendicitis is the most frequent infectious surgical abdominal emergency and previous studies have noted the presence of parasites in the appendicular lumen.Objective: This study was done to determine the involvement of intestinal worms in the etiology of acute appendicitis.Materials and Methods: This was a prospective and descriptive study concerning cases of confirmed and operated acute appendicitis between 15th April, 2013 and 14th April, 2015 at the People’s Clinic, Ngomgham, Bamenda, Cameroon. The appendicular content was macroscopically examined for parasites and formol-ether concentration technique was carried out for ova detection.Results: A total of 112 patients were operated for acute abdominal pain within the study period. There were 74 (60.8%) cases confirmed with acute appendicitis of which 45 (60.1%) were males and 29 (39.2%) were. The most affected age group was the 21 to 40 years (50%). The removed appendices appeared congestive in 30 (40.5%) cases, suppurated in 27 (40.5%) cases and gangrenous in 17 (23.0%) cases.There was no relationship between the appearance of the removed appendix and the gender of participants (P>0.05).Three different helminth ova were identified in the 74 samples. In decreasing prevalence, the parasite trend was 8 (10.8%) Ascaris lumbricoides, 5 (6.8%) Enterobius vermicularis, 3 (6.0%), Ankylostoma duodenale, Adult Ascaris lumbricoides and Enterobius vermicularis were seen in 1 and 3 cases respectively.Conclusion: A small percentage of parasitic worm eggs were found in the appendicular content, though a good portion of patients took medications against parasites before surgery. Intestinal worms could not be incriminated in the causation of the appendicitis; nevertheless, one adult ascaris was found as an evident cause of appendicular lumen obstruction.Keywords: Intestinal Helminthes, Acute appendicitis, Bamend

Meckel’s diverticulum: a case report from the University Hospital Center Yaoundé, Cameroon

To the best of our knowledge there is no reported case of Meckel’s diverticulum (MD) in Cameroon. The prevalence of MD in the general population is 2-3 %. The aim of this paper is to recapitulate the role of this pathology in acute abdomens and abdominal pain of uncertain aetiology in young patients and to review the medical literature

Complications chirurgicales des avortements clandestins: a propos de 51 cas observés dans deux hôpitaux de Yaoundé.

Le but de cette étude était de décrire les complications des avortements provoqués dans la clandestinité et imposant un traitement chirurgical. Il s’agit d’une étude rétrospective transversale portant sur les malades opérés dans les services de Chirurgie de l’Hôpital central et du Centre Hospitalier Universitaire de Yaoundé du 1er Janvier 2004 au 31 Décembre 2008. Les variables d’étude étaient l’âge, le statut matrimonial, les antécédents gynécologiques, les antécédents d’avortement antérieur, le mode, l’indication chirurgicale et l’état général des patientes; les lésions découvertes en peropératoire, leur traitement et l’évolution postopératoire. Cinquante une patientes ont été retenues pour cette étude menée pendant une durée de quatre ans, soit une moyenne de 12,7 cas par an. L’âge des patientes variait entre 15 ans et 41 ans avec une moyenne de 30 ans; 33 patientes (64,7%) avaient un âge situé entre 15ans et 25 ans. 6 patientes (11,7%) étaient multipares et 4 patientes étaient primipares (7,8%). Treize patientes (25,42%) avaient déjà subi une interruption volontaire de grossesse sans complication. Quarante-neuf patientes (96%) étaient arrivées avec un tableau de péritonite ; 43 patientes (84,22%) étaient classées ASA III (American Association of Anesthesiologists). Les lésions chirurgicales étaient à type de perforations ou de déchirures utérines dans 20 cas (39,21%), annexielles dans 9cas (17,64%), digestives dans 16 cas (31,37%) et urinaires dans 4 cas. Le traitement a associé au traitement de la péritonite, les sutures utérines, digestives et vésicales ; les gestes d’exérèse comprenaient deux hystérectomies et cinq salpingectomies. Il a été réalisé des gestes de dérivation dont deux cystostomies et deux colostomies. La mortalité était de 15,6%. L’étude recommande une éducation des femmes en matière de contraception et de planning familial, et surtout une politique sociale permettant de réduire le nombre des avortements clandestins.MOTS CLES: Avortement clandestin- Complications - Chirurgie

Intestinal Infarctus following Dilatation and Uterine Curettage

We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case

Fistule artério-veineuse ulno-basilique pour hémodialyse au CHU de Yaoundé: à propos de deux cas

La fistule ulno-basilique est une éventualité peu sollicitée dans le choix des abords vasculaires pour hémodialyse. Elle est construite sur la veine basilique qui est souvent la seule veine épargnée par les ponctions veineuses de routine dans les services de médecine. De par l'existence de nombreuses complications comme l'infection des prothèses et des cathéters centraux, les thromboses, les patients hémodialysés chroniques nécessitent plus d'un accès veineux au cours de leur suivi médical. Les fistules artério-veineuses natives présentent moins de risques de complications que les prothèses d'une façon générale et une plus longue durée de vie. La confection d'une fistule sur une topographie proximale compromet le recourt à cette veine sur une localisation distale ultérieurement. Il existe donc une hiérarchisation dont il faut tenir compte pour une utilisation optimale du capital veineux disponible. Nous rapportons ici deux observations concernant des patients chez qui deux fistules ulnobasiliques ont été réalisées avec succès au CHU de Yaoundé.Key words: Fistule artério-veineuse, hémodialyse, ponction veineus

Diaphragmatic Injuries: A Frequent Missed Diagnosis in a Low Income Country

Objectives: To evaluate the current reported incidence of diaphragmatic injuries (DI) and to determine criteria that could help make the diagnosis of DI and improve its recognition in traumatised patients in Cameroon.Design: A retrospective study.Subjects: The cases of all diaphragmatic injuries repaired and diagnosed in two major hospitals in Cameroon.Setting: The General Hospital of Douala and the University Hospital centre of Younde, Cameroon.Results: During a ten-year period we have repaired eight diaphragmatic injuries. Five of them were consecutive to penetrating trauma and three after blunt trauma. All the patients were males. The mean age was 34. 5 years. Seven injuries occurred on the right side. The average Injury Severity Score was 37. 5 and all the patients had associated injuries to other organs. DI represents only 0.05% of all trauma cases. DI is underestimated in Cameroon and under diagnosed because physicians are not trained to think or to recognise it and autopsy is rarely performed after a traumatic death. Although there are no specific signs or symptoms, we have found some criteria which can raise suspicion of DI.Conclusion: Diaphragmatic injury is a very difficult diagnosis, and it is under diagnosed in Cameroon. We suspect that many patients severely injured may have associated DI which is not recognised and may contribute to increased mortality rate after major traum

Evisceration trans vaginale suite a une perforation uterine par manoevre abortive: A propos d'un cas.

Les auteurs rapportent ici un cas de perforation utérine reçu à la maternité du Centre Hospitalier et Universitaire (CHU) de Yaoundé au Cameroun, perforation consécutive à des manipulations endo utérines à but abortif. Après la procédure se sont installés un saignement vaginal abondant et une complication moins rencontrée : l'éviscération des anses grêles d'une longueur d'environ 50 cm par voie vaginale, suite certainement à la saisie de ces anses et à leur traction successive les ayant ramenés d'abord dans la cavité utérine, puis le vagin et enfin à la vulve. La prise en charge médico-chirurgicale a été rapide. Après une transfusion de 2 unités de sang et une triple antibioprophylaxie, une résection de l'anse grêle avec anastomose terminoterminale a été faite, de même que le curetage de la cavité utérine à travers la brèche de perforation qui a été par la suite suturée .La patiente est sortie de l'hôpital 12 jours après la chirurgie. Ce cas met en exergue la clandestinité des avortements provoqués qui sont responsables de complications multiples dont les plus redoutables sont les lisions viscérales après perforation utérine.The authors report a case of uterine perforation managed at the maternity of the Yaounde University Teaching Hospital (Cameroon), following intra uterine manoeuvres for an abortion. After the procedure, there was heavy vaginal bleeding and a 50 cm small bowel evisceration through the vagina, which is a rare complication. The small intestines might have been pulled through the uterus, vagina and the vulva. After transfusion of 2 pints of blood and triple antibiotherapy, intestinal resection with an end-to-end anastomosis was done. Uterine revision was also done with a curette sent through the opening of the perforation. This was later closed and the patient discharged 12 days after surgery. This case illustrates the amplitude of clandestine abortions whose complications are multiple, the most serious of which are deep wounds of internal organs through the perforations. Keywords: Avortement provoqué - Perforation utérine - Eviscération transvaginale. Clinics in Mother and Child Health Vol. 3(2) 2006: pp. 295-29

The management of pelvic pressure ulcers by myocutaneous flaps: a 10 years experience in Yaoundé - Cameroon.

Pressure ulcers or ischaemic necrosis of tissues over bony eminences due to pressure, heal very slowly. Vascularised tissues such as myocutaneous flaps are necessary to cover the ulcer and accelerate healing. This study was done to share our experience with methods of myocutaneous flaps in the treatment of pressure ulcers. We retrospectively reviewed the outcome of 20 myocutaneous flaps used for the surgical coverage of 24 pelvic pressure ulcers in 18 patients from 1997 to 2007 in the Yaoundé University Hospital Centre (CHUY). The mean patient age was 46.06 years (range: 19-86years). The sex ratio was 5 men for 4 women 10 sacral ulcers were treated by gluteus maximus myocutaneous flaps, 10 trochanteric and 4 ischiatic ulcers were covered by tensor fascia lata myocutaneous flaps. The cure rate was 100%. The main complications were: infection (63.5%), serous fluid discharge (21.05%), and flap edge necrosis (31.6%). Of the 18 patients in the study: 8 were lost to follow up, 1 dead after a week from another disease. The average follows up for the remaining 9 live patients was 20.6 months (range, 1-39 months). No recurrence of pressure ulcer was observed. Myocutaneous flap transposition remains a simple, reliable, effective, safe, versatile and useful method for the coverage of large pelvic pressure ulcers.Key words : Pressure ulcer, musculo-cutaneous flap, pelvic ulcer