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

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

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

An authentic radiological triad of Rigler allowing the diagnosis of gallstone ileus: A case report

The Rigler's Triad consists by three radiological signs, including intestinal obstruction, pneumobilia, and an aberrant gallstone in the bowel. It is an inconstant triad considered being pathognomonic of gallstone ileus. Gallstone ileus is an exceptional complication of cholelithiasis due to the passage of one or more gallstones from the bile ducts into the lumen of the bowel through a biliodigestive fistula. We report the case of an 83-year-old female patient with a history of ischemic heart disease and an asymptomatic large gallstone. The patient was admitted to the emergency department for bowel obstruction, abdominal pain, and bilious vomiting. A clinical examination found a patient with an alteration in general condition and a distended abdomen with tenderness. An abdominal CT scan revealed Rigler's triad, allowing the diagnosis of gallstone ileus. A midline exploratory laparotomy was performed to find a giant gallstone blocked in the last ileum loop. A simple enterolithotomy was performed, allowing the extraction of giant lithiasis from an 8-cm major axis. The postoperative evolution was uneventful, and the patient was discharged 4 days after surgical treatment

Appendiceal mucocele as an exceptional cause of ileocecocolic intussusception in adults: a case report

Abstract Background Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few cases have been reported in the medical literature. Case presentation We report the case of a 25-year-old black African male patient with no medical history. He presented to the emergency department for abdominal pain, nausea, and bilious vomiting. The abdominal examination revealed typical signs of acute bowel obstruction. Enhanced abdominopelvic computed tomography showed an invagination of the last ileal loop, cecum, and ascending colon into the lumen of the transverse colon, with a rounded image with hypodense content and some calcifications compatible with an appendiceal mucocele. An emergency exploratory laparoscopy was performed and confirmed the ileocecocolic intussusception. Right hemicolectomy and ileocolic anastomosis were performed. The patient recovery postoperatively was uneventful, and he was discharged 4 days later. Histological examination of the surgical specimen confirmed the diagnosis of mucinous cystadenoma. Conclusion The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to the injected abdominal computed tomography scan

Cystic hepatoblastoma in an adolescent: A case report

Introduction: Hepatoblastoma accounts for approximately 1 % of pediatric tumors. It occurs mainly between 6 months and 3 years of age and is extremely rare in adolescents and adults. Hepatoblastoma generally presents as a painless abdominal mass discovered incidentally. We report a case of painful cystic hepatoblastoma in an adolescent, that was initially thought to be an amebic liver abscess. Case presentation: A 15-year-old male with no significant medical history was admitted to the emergency department with right hypochondrium pain, fever, and vomiting for 14 days. Abdominal examination revealed hepatomegaly with a tender liver, firm surface, and well-defined inferior edge. A contrast-enhanced abdominal CT scan was done, demonstrating a suspected amebic liver abscess in segments S4 – S5. The patient was taken to the operating room. The abscess was punctured and drained, and a biopsy of the wall was taken. All this was done laparoscopically. The pathology of the cyst wall was consistent with hepatoblastoma. The patient was brought back to the operating room after 3 weeks and underwent a complete resection of the cystic tumor through a partial hepatectomy. The patient's postoperative course was uneventful, and he was discharged 5 days after the operation. Histological examination of the surgical specimen confirmed the diagnosis of hepatoblastoma. Conclusion: Hepatoblastoma is extremely rare in adolescents. Cystic hepatoblastoma should be included in the differential diagnosis of a hepatic cyst, regardless of the patient's age, even in areas where infectious hepatic cysts are widely prevalent

Ileocolic intussusception caused by a submucosal ileal lipoma in a teenager: A case report

Introduction: Intussusception is a rare condition in adolescents; its incidence is highest between three months and three years of age. The symptoms of intussusception are abdominal pain and bowel obstruction. Organic origin is the most common etiology of intestinal intussusception in adolescents, unlike pediatric intussusception, which is usually idiopathic. Adolescent intussusception due to ileal submucosal lipoma is infrequent, and only a few cases have been reported in the medical literature. Case presentation: A 14-year-old female patient was admitted to the emergency department with abdominal pain, nausea, and bilious vomiting. She had no significant medical history. The abdominal examination revealed typical signs of acute bowel obstruction. An enhanced abdominal CT scan showed an invagination of the distal ileal loop within the ascending colon lumen with a rounded fat aspect. Emergency laparoscopic-assisted right hemicolectomy and ileocolic anastomosis were performed. The patient recovered well and was discharged three days after surgery. Histological examination of the surgical specimen confirmed the diagnosis of intussusception due to an ileal submucosal lipoma. Conclusion: The symptoms of bowel intussusception due to an ileal submucosal lipoma in adolescents are similar to any other bowel intussusception due to other etiologies. A contrast-enhanced abdominopelvic CT scan and histopathological analysis are valuable techniques to achieve the correct diagnosis