Criteres Du Traitement Non Operatoire Des Contusions Abdominales En Milieu Sous Equipe

The criteria of non-operative operative management (NOM) of blunt abdominal trauma remains poorly defined in the context of low-income countries. Purpose: To validate a protocol for blunt abdominal trauma by specifying indications for NOM in a resource-limited setting. Material and Method: The study was prospective, carried out over a period of 12 months at Sylvanus Olympio Teaching Hospital Lomé (Togo). It included all patients over 15 years admitted for abdominal blunt trauma. Patients were subjected to NOM or surgery according to systolic blood pressure, response to resuscitation measures, clinical examination, peritoneal tap, abdominal plain radiograph and ultrasound. Results: Sixty-four patients, including 53 men and 11 women, were admitted in the study. The mean age was 27.8 years. Road traffic accidents were the circumstance of the occurrence in all cases. Pneumopéritoneum was found in 3 patients (5.45%). Abdominal ultrasound identified a solid organ injury in 24 patients (43.6%). Spleen lesions were the most frequent injuries. An extra-abdominal lesion was present in 23 patients (35.9%). NOM was initiated in 52 patients (81.25%) and effective in 46 patients (88.4%). The failure of the NOM was due to small intestine perforation in 2 patients, a bladder injury in 1 patient, active bleeding in 1 patient and hemodynamic instability resulting in nontherapeutic laparotomy in 2 patients. Death was observed in 8 patients (12.5%), 2 of whom were in the NOM group. Conclusion: criteria for the NOM of blunt abdominal trauma can be defined according to the local possibilities. Early diagnosis of digestive perforation should remain a priority during clinical monitoring

La Chirurgie Foraine : Une Solution Aux Problemes D’acces Aux Soins Chirurgicaux Des Populations Rurales

Assessment of the quality of care in surgical outreach programs is necessary to improve their reliability. Purpose: The purpose of this study is to evaluate the clinical results of a surgical outreach program involving large numbers of patients. Material and Method: Retrospective study of clinical data and outcomes of patients operated on within a surgical outreach held in Togo's Central Region was carried out. Data was collected from patient’s files with a follow-up, of 2 years. Results: Two hundred and seventy seven patients (277) underwent 304 surgical procedures within the surgical outreach. The conditions were essentially made of hernias of the abdominal wall (89%). Cases of hydroceles, endemic goiter and uterine myo-fibroids were also managed. Spinal anesthesia was the most common procedure of anesthesia (75%). Day case surgery involved 165 patients (59.5%). A post operative morbidity was observed in 31 patients (11%) essentially made of hematoma 28 cases (9.2%) and parietal abscesses 20 cases (6.5%).There were no postoperative deaths. Conclusion: outcomes in this study encourage surgical outreach programs as reliable means to address surgery accessibility issues of rural populations in low incomes countries

Prise en Charge des Hernies de l’aine : Expérience d’un Hôpital Confessionnel en Zone Rurale au Togo

Background: This paper focuses on describing the management of groin hernias in rural zone in Togo. Methodology: It is a descriptive transversal study, which include patients treated for groin hernias, at Saint Jean de Dieu Hospital of Afagnan, from January to September 2018 (9 months). Results: One hundred and sixty-one (161) patients were operated for groin hernias. They comprised of 146 men and 15 women, with an average age of 40.52 ± 20.02 years old (extremes: 1 year and 80 years old). They were mainly people involved in strenuous activities. 62.73% of the patients had inguinoscrotal hernia, 32.30% had inguinal hernia, and 4.97% had femoral hernia. The hernia was located on the right in 54.66% of cases, and on the left in 36.02% of cases. It was bilateral in 9.32% of cases. The majority of patients were operated during operating program. 13 patients (8.07%) underwent an emergency operation for strangulated hernias. Shouldice technique was used for inguinal and inguinoscrotal hernias (147 cases), and Mac Vay technique was used for femoral hernias. The postoperative course was simple in 157 cases (97.52%) and complicated in 4 cases (2.48%). Conclusion: Groin hernias are common pathologies in rural surgical practice. Classical herniorraphy techniques are used majorly for its treatment.Objectif : Décrire la prise en charge des hernies de l’aine en zone rurale au Togo. Méthodologie : Etude transversale descriptive, incluant les patients pris en charge pour hernies de l’aine à l’Hôpital Saint Jean de Dieu d’Afagnan, de Janvier à Septembre 2018 (9 mois). Résultats : Cent soixanteun patients ont été opérés de hernies de l’aine. Il y avait 146 hommes et 15 femmes, avec une moyenne d’âge de 40,52 ± 20,02 ans (extrêmes : 1 an et 80 ans). Il s’agissait essentiellement des personnes exerçant des activités de force. 62,73% des patients avaient une hernie inguino-scrotale, 32,30% avaient une hernie inguinale et 4,97% une hernie crurale. La hernie siégeait à droite dans 54,66% des cas, à gauche dans 36,02% des cas et dans 9,32% des cas elle était bilatérale. La prise en charge a été faite en chirurgie programmée pour la majorité des patients. Treize patients (8,07%) ont été opérés en urgence pour hernies étranglées. La technique de Shouldice était majoritairement utilisée pour les hernies inguinales et inguino-scrotales (147 cas) et la technique de Mac Vay pour les hernies crurales. Les suites opératoires étaient simples dans 157 cas (97,52%), et émaillées de complications dans 4 cas (2,48%). Conclusion : Les hernies de l’aine sont courantes en pratique chirurgicale rurale. Les techniques classiques d’herniorraphie constituent leur principal moyen thérapeutique