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Introduction: Due to its frequency and its complications, it constitutes a major public health problem in the world, particularly in Africa. According to the WHO, 350 million people suffer from chronic liver disease in the world, and Africa has 60 million with a quarter of deaths per year. The objective of our study was to describe the epidemiological aspects of cirrhosis at the Sominé DOLO Regional Hospital in Mopti, the first in the region. Methods and Patients: This is a descriptive cross-sectional study extending from January 1, 2021 to December 2021, carried out in the medical department of the Sominé Dolo hospital in Mopti. The diagnosis of cirrhosis was retained in the face of arguments: clinical: oedemato-ascites syndrome, portal hypertension syndrome, hepatocellular insufficiency syndrome; biologicals of hepatocellular insufficiency syndrome; ultrasound suggestive of cirrhosis (hepatic atrophy, hepatomegaly, irregular contours, heterogeneous echostructure, portal trunk greater than 15 mm in diameter, maximum portal blood flow velocity less than 15 cm/s , superior splenic vein 10 mm, splenomegaly and ascites); endoscopic (esophageal varices, cardio-tuberosity varices, antral vascular ectasia, portal hypertension gastropathy. Despite these clinical, biological and imaging arguments, the diagnosis of certainty remains the liver biopsy puncture. Result: The analysis concerned 46 patients out of the 865 hospitalized patients, ie a frequency of 5.31%. The average age was 47.5 with extremes of 21 and 70 years. The most represented age group was 46 – 65 years old. The patients were divided into 34 men (73.9%) and 12 women (26.1%) i.e. a sex ratio of 2.8. Farmers/herders and housewives accounted for 76.1% (35/46) of the patients and the majority were rural (89.1%). The clinical signs found on hospitalization were: abdominal pain (82.6%), impaired general condition syndrome (80.4%), ascites (76.1%), OMI (58.7%), Hepatomegaly (52.2%), CVC (43.8%), jaundice (32.6), ...

Blood cardiometabolic impairments are associated to high blood pressure which is a pivot cardiovascular risk factor. The objective of this study was to assess cardiometabolic risk factors rates in subjects with high blood pressure in the steady state. A total of 292subjects, 107 cases and 185 controls were enrolled in cross-sectional study. Clinical and biological data were assessed during visits and after overnight fasting. Data were analyzed on R. A p-value < 0.05 was considered for statistical significance.Univariate analysis showed thatage > 50 years, visceral obesity, metabolic syndrome and hs- CRP ≥ 3 mg/L were significant predictors of high blood pressure: OR = 2.1, 95% CI [1.3-3.5], p = 0.003; OR = 1.6, 95% CI [1.0-2.6], p = 0.05; OR = 3.3; 95% CI [2.0-5.4], p < 0.001; OR = 16.8; 95% CI [9.4-31.4], p < 0.001, respectively. Multivariate analysis showed a positive association between obesity, metabolic syndrome, hs-CRP and high blood pressure: aOR = 2.29; 95% CI [1.14-4.69], p = 0.02; aOR = 3.47; 95% CI [1.64-7.61], p = 0.001; aOR = 18.10; CI, 2.5% to 95% [9.40-36.99], p < 0.001, respectively. In contrast, female sex was negatively associated with high blood pressure aOR = 0.31; CI, 95% CI [0.13-0.72], p < 0.008. Prevention policiesshould take into account blood cardiometabolic level for subjects with high blood pressure even though in the steady sate.

Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. We report an observational study which aims to describe the epidemiological, clinical and therapeutic aspects of small bowel obstruction. This study was carried out in the General Surgery Department of Hopital Somine DOLO de Mopti from October 1, 2016 to October 1, 2018. A total of 114 patients were recorded for whom the diagnosis was related to an occlusion. The median age was 37 years with extremes ranging from 6 months to 90 years. Male sex was predominant with a sex-ratio of 1.8. The frequency of small bowel occlusions over all occlusions was 74.03%. The most encountered clinical signs were as followed: abdominal pain (100%), vomiting (88.6%), cessation of materials and gas (79.9%) and meteorism (62.3%). All patients underwent medical imaging, the most common of which was an abdomen without preparation X-ray (AWP). On the etiological level, the main causes found postoperatively were: flanges and adhesion (55.2%), strangulated hernias (28.0%), acute intussusception (6.1%), small bowel volvulus (3.5%) and small bowel tumor (1.6%). Releasing the bridles was the most common surgery process (28.0%). The morbidity of the immediate follow-up was (13.1%) and the mortality was (7.0%). This high mortality is due to ignorance of the signs of seriousness and the socio-cultural barrier (decision of the patriarch to agree to a surgical intervention), the late use of hospital facility and the limited financial capability of the patients.

Introduction: Penile skin flap urethroplasty is a technique for replacing or enlarging an obstructed urethra. We aim to report our experience in the practice of this surgical technique. Patients and method: This was a prospective and descriptive study of penile skin flap urethroplasty indicated for urethral stenosis between January 2014 and December 2019. Results: A total of 21 penile skin flap urethroplasties for urethral stenosis were performed. The average age was 38.6 years old. The stenosis was of sclero-inflammatory origin in 15 cases (71.43%). It was of bulbo-perineal, penile, and penile-bulbar topography in about a third each. A history of urethral surgery was reported in 80.95% of the cases. The average length of the stenosis was 6.8 cm. Mundy circular skin flap urethroplasty about 15 cases (71.43%), and Quartey rectangular skin penile flap urethroplasty about 6 cases (28.57%) were the surgical techniques performed. The postoperative follow-up was favorable in 19 cases (90.48%). Two cases of urethral fistula (9.52%) underwent the 2nd urethroplasty. Urination at 1 year was satisfactory. No relapse has been reported to date. However, 4 patients (19.04%) reported asthenic ejaculation, and 1 patient (4.76%) a marked decrease in sexual pleasure. Conclusion: This surgical technique is effective in terms of voiding when the surgical indications are well chosen. The sexual aspect must be taken into account and the intervention only offered to those who really need it.

Introduction: Complete cervico-urethral transection is a vesicovaginal fistula characterized by total disinsertion of the urethra from the bladder. It is a fistula of the cervico-urethral intersection threatening the mechanism of continence. The aim of this study was to describe the epidemiological and therapeutic aspects of this type of fistula. Patients and Methods: This was a descriptive retrospective study on patients who have had surgery for cervico-urethral transection from June 01, 2012 to June 01, 2015. Results: Cervico-urethral transections (n = 76) accounted for 33.77% of all urogenital fistulas admitted to our department of surgery during the study period. The average age was 25.02 ± 8, 6 years. Married patients accounted for 85.58%, 72.36% had not received any classical education. Fistulas less than one year old made up 56.58% of cases, associated lesions were perineal tears 25.0%, vaginal sclerosis, 21.05%, vaginal straps, 13.15%, rectovaginal fistula, 2.63% and the shortness of the urethra less than 2.5 cm in 42.10% of cases. All surgeries were performed vaginally with a 98.68% fistula closure rate and an average of 1.68 surgeries per patient. After closure of the fistula, 10.67% of patients presented a residual urinary incontinence. Conclusion: Complete cervico-urethral transection is a frequent vesicovaginal fistula. She sometimes exposes to urinary incontinence after closing the fistula. The results of his surgery are often good at the cost of multiple intervention.

We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.

Introduction: Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. Herein, we report a case of small bowel obstruction (SBO) following excessive consumption of wild grapes with no previous abdomen medical or surgical history. Presentation of case: A 65-year-old male farmer presented with cessation of materials and gas associated with vomiting of food and then bilious. The abdomen was bloated and painful on palpation with a moving, painful mass in the left iliac fossa. The hypothesis of acute occlusion of the colon was retained and confirmed on the X-Ray which showed a dilation of small bowel with air-fluid levels. The diagnostic of acute SBO was retained. We performed urgently a median laparotomy. We found the dilation of the loops from the jejunum to the sigmoid colon with a compact mass at the sigmoid colon of 15 cm in length and 6 cm in diameter. We proceeded to crush the mass that was made up with wild grape seed fecal, and push it back to the rectum. The phytobezoar made up with wild grape seeds was extracted through the anus with the fingers after anal dilation. After extraction of the bezoar, the patient’s complaints completely subsided. Discussion: SBO is a frequent emergency surgical pathology. SBO induced by phytobezoar often occurs in patients with abdomen surgery history. However, it is particularly rare in virgin abdomen. Conclusion: This case report aims to raise awareness of phytobezoar as a cause of SBO in elderly even though without abdomen surgery history.

To study the impacts of implementing a gender-sensitive value chain development (VCD) initiative in the agri-food sector, we conducted a mixed-methods study of a woman-owned food processing business and its associated value chain in Touba, Senegal. As a result of partnering with a USAID-funded project, the business began producing instant fortified flours, an innovative, higher-value product compared to traditional porridge, using extrusion and fortification techniques. Drawing on Senegalese women’s association networks, the business connected with local women who could work as processors and retailers. Our study’s goal was to explore how the project’s support of this food processing value chain has affected the lives of women processors and retailers, farmers, and medical personnel along the value chain. Particularly relevant to our study is the general lack of opportunities for women to earn their own incomes in the study region, especially outside of the home, and provide for their families. Through surveys, interviews, observations, and novel participatory focus group activities, our study provides qualitative and quantitative evidence of the perceived impacts of value chain development on women’s empowerment, income, and nutrition by key stakeholders in the value chain. We find an often cited barrier to women’s empowerment is the husband’s lack of understanding and limitations placed on women’s mobility, yet we also find perceptions of women’s empowerment in this conservative religious context. Our findings and discussion highlight the need for more research into VCD projects on the complex and, at times, contradictory processes of women’s empowerment. The women in our study expressed a desire for freedom to work outside of the home, and they expressed a need for childcare and contraception. Notably, the women discussed positive community changes, such as infrastructure and the creation of a childcare center, that implicate women’s collective empowerment. We also highlight a promising research opportunity in Senegal to explore the subnational variation in women’s empowerment through VCD.

We report a case of grave and rare surgical complications nowadays, which calls out to us on the necessity of a bigger raising sensitization on the coverage of the constrictions hernial at the adult. It is about a case of right inguino-scrotal hernia choked secondarily complicated with a scrotal coecostomie at a 64-year-old man. The delay in the care was in touch with a traditional treatment but also in the poverty of the patient which was a needy the total care of which was assured by the social services department of the hospital. The perioperative exploration found a cecostomy the mucous membrane of which was inverted in the opening of the stoma, an ulceration of the peristomial scrotum with a normal macroscopic aspect of the testicle homolateral. The care was made at single time: parage and scrotal suture more resection segmental of the coecum followed by an anastomosis ileocolic terminoterminal and a cure of the hernia according to Shouldice. The operating suites were simple with ablation of the threads to operating J12 comment and the liberation of the patient the next day. The clinical evolution was satisfactory with a backward movement of 4 years.

The objective was to study epidemiological and therapeutic aspects of the inguinal hernia according to the technique of Shouldice. Methodology: we realized a retrospective study, concerning the patients operated for inguinal hernia according to the technique of Shouldice in the service of general surgery of the hospital Somine Dolo of Mopti, Mali. All the patients operated during the period of study for inguinal hernia according to the technique of Shouldice were included. The patients operated for hernia by other technique than that of Shouldice were not included. Results: The study has been realized in the service of general surgery of the hospital Somine Dolo of Mopti (Mali). It was about a retrospective study which concerned 25 years from January, 1987 till December, 2012. 675 patients operated according to the technique of Shouldice were registered. The average age was of 49 years +/−17.7. There were 90.7% (612) men. The sex-ratio is 9.7. The farmers, the housewives and the workers represented 51.1% (115). In 75.2% (508) the patients consulted for inguinal tumefaction. In operating meadow, the hernia was complicated to 246 (36.4%) patients among whom 72 cases were of recurrence. The hernia constriction was the main complication operating meadow 58.5% (48/82). The operating suites in one year were simple at 94.2% (636) of the patients; they were marked by 24 cases of recurrence, 12 cases of neuralgia, 6 cases of testicular atrophy, and 3 cases of keloid. Conclusion: The technique of Shouldice is the technique of choice for the cure of the inguinal hernia in developing countries because of the good result and its little expensive cost with compared with the other techniques using medical devices.

Purpose: Our purpose was to describe the epidemiological and therapeutic aspects of the vaginal hydroceles. Methodology: It was a forward-looking and descriptive study of Mars 2014 in July, 2017, which realized in the service of general surgery of the Reference Health Center of Kati (Mali). All the patients operated in the service for hydrocele were included. Other causes of big stock exchange and hydroceles operated outside our service were not including. Results: We operated 92 hydroceles or 5.9% of the surgical activities of the service. The average age was of 34.5 years with extremes of 2 years and 82 years. The most frequent signs of hydrocele were the big painless stock exchange (100%); a transillumination positive (90%) and the effusion of the vaginal in the ultrasound (100%). The cure of hydrocele was realized according to the techniques of Bergmann (94.6%) and of Lord (5.4%). The mortality was nil and the morbidity was 3.3% (2 operating infections of the site and 1 bruise). Conclusion: The hydrocele is a frequent pathology in Africa. The therapeutic strategies are multiple and varied. However, we prefer the Bergmann technique, which is easy, fast and has few complications.

Purpose: Our purpose was to describe the anatomy of the external branch of the upper laryngeal nerve and to estimate the frequency of nerves at risk during the total thyroidectomies sub. Methodology: We realized in the CHU Point G in Bamako a forward-looking study over a period going from September 1st, 2016 till December 31st, 2017. All the patients operated by thyroidectomies subtotals for mild goiters were included to whom a systematic location of the external branch of the superior laryngeal nerve in the space avascular of Reeve was realized. Cancers and other thyroid pathologies were not included. Results: We counted and operated 120 cases of mild goiters. The external branch of the superior laryngeal nerve was seen and dissected in 80.8%; it was not seen in 19.2%. According to the classification of Cernea: the type 2 was found in 80.8% of the cases with him under typical 2b in 47.5% and under type 2a in 40 (33.3%). The global frequency of lesion of the external branch of the upper laryngeal nerve was 10.8% at 9 patients among whom 6 who presented a BENLS of Type Ni. Conclusion: The external branch of the upper laryngeal nerve of type 2 presents a risk of wound because the surgeon treats the upper pedicle at the level of the critical centimeter place over the upper pole of the thyroid. The identification of the nerve during the thyroid surgery is the solution of choice.

In 7 years, we brought together 100 cases of volvulus of the colon sigmoid to the hospital Somine Dolo of Mopti among which the handle volvule was found without necrosis in 66 cases and necrosis 34 cases. Seventy-six patients benefited from a sigmoidectomy followed by a colorectal anatomize at a time, twenty one patients of an intervention of Hartmann. A surgical distortion was realized at 3 patients. All the patients operated by these last two techniques had a restoring of the digestive continuity for an average deadline of 90 days. The post-operative complications consisted of 11 cases of parietal suppuration and a case of evisceration. The average duration of follow-up was of 210 days. The post-operative mortality was 14%. It was about a state of toxic shock with visceral multi-failure (n = 13), and of a pulmonary embolism (n = 1). The treatment of the volvulus requires a fast diagnostic and therapeutic coverage. The best treatment consists of a resection of the sigmoid as a matter of urgency followed by an immediate anastomosis if the following conditions are carried achieved: state general voucher, experimented surgeon and if the resuscitation meadow, per and post-operative can be assured.