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Abstract Background Congenital malformations are the third cause of mortality in children under five. We aimed to report sociodemographic and diagnostic aspects of gastrointestinal ones and their outcomes. Methods We conducted a descriptive cross-sectional study of patients admitted from January 2018 to January 2021 to our department at Albert Royer National Children’s Hospital Center in Dakar, Senegal. A total of 230 were included. Results The frequency of these malformations was 6.18%. The mean age was 1.9 years, with neonates representing 43.48% and males 59.56%. 64.35% of patients came from the Dakar area. Parental consanguinity was reported in 11.73%, prenatal diagnosis in 5.56% of 36 cases, and prematurity in 28.84% of 52 patients. The most typical reasons for referral or symptoms were constipation (23.91%), imperforated anus (23.91%), and vomiting (23.48%). In 93.91%, the malformation was isolated, of which Hirschsprung’s disease accounted for 30.56% and anorectal malformation for 30.09%. Esophageal atresia and anorectal malformations had more associated anomalies with 28.57% each. The VACTER-L association represented 21.42% of associated anomalies. Mortality was 27.83%, and lethality was 100% for intestinal atresia, 87.5% for esophageal atresia, and 85.71% for polymalformation. Causes of mortality were reported in 21%, with septic shock and respiratory distress in all esophageal atresia patients (Manama, Contribution à l’étude des malformations congénitales : à propos de 188 cas du service de néonatologie de l’Hôpital Aristide Le Dantec de Dakar, 1983) and hypovolemic shock in all patients with duodenal atresia (Wright et al., Lancet 398:325–39, 2021). Conclusion Congenital malformations of the gastrointestinal tract are still lately diagnosed in our environment, resulting in higher mortality. Further studies should analyze delayed presentation and mortality, and their risk factors in our settings.

Abstract Introduction Fractures specific to the pediatric age group represent a particular injury due to their pattern, diagnosis, management, and outcomes. In sub-Saharan Africa, studies on this particular injury are scarce. This study reports sociodemographic, diagnostic, and therapeutic aspects and outcomes of these fractures. Methods We conducted a descriptive cross sectional study at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Dakar, Senegal, from January 2012 to December 2015. Results A fracture specific to children was diagnosed in 180, of whom 47.7% were school-aged, with 59.4% of males. The mean time from injury to the attendance of our department was 48.2 h. Domestic accidents occurred in 51.1%. A total of 243 fractures occurred, mainly on the upper limbs (75.3%), as the most affected bones were the radius (47.3%), ulna (22.6%), and tibia (13.6%). Greenstick fractures represented 46.9%, buckle fractures, 42.8%, plastic deformations 9%, and subperiosteal fractures 0.7%. In all patients, management was orthopedic, with associated analgesic treatment. No sequel nor other complication was registered. Conclusion Fractures proper to the child are a particular entity in children’s trauma, frequently happening in boys, with greenstick and buckle fractures being the most common. Their treatment is exclusively orthopedic, with excellent outcomes.

Abstract Background Urethral prolapse is a rare disease, mainly occurring in African prepubertal girls. Its etiology remains unclear; however, some risk factors have been reported. The diagnosis is made clinically. The treatment can be conservative or surgical. Methods We report our experience in the service of pediatric surgery at Albert Royer National Children’s Hospital Centre. We conducted a retrospective descriptive cross-sectional study, on which considered patients were managed for urethral prolapse in our service from 2014 to 2019. Results Our study has included 15 girls whose mean age was 4.08 years (1.17–10). Two risk factors (chronic cough and constipation) were found in 20%. Genital hemorrhage was the main symptom (73.3%), and suspicion of sexual abuse was documented in 13.3%. The clinical finding was classical (donut-shaped vulvar mass) in all patients. All patients underwent conservative management, which was successful in 73.3%. Patients with failed conservative management were treated surgically by resection of the prolapsed mucosa on a Foley catheter. No complication was reported after surgical treatment, and after a 13-month mean follow-up, no recurrence was reported in all patients. Conclusions Conservative management is an efficient option for urethral prolapse. It has the advantage of avoiding general anesthesia with its potential complications and restricted availability in sub-Saharan Africa. Surgical management should be reserved for failed conservative management.

Objective Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department.Methods We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression.Results Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425).Conclusion The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.

Context: Choledochal cyst is a rare malformation that mainly affects girls. Aims: The aim of this work is to report the diagnostic, therapeutic and evolutionary aspects of bile duct cyst in children in Dakar. Subjects and Methods: we conducted a prospective monocentre descriptive study from 1 July, 2016, to 30 June, 2019, in the Pediatric Surgery Department of Albert Royer Children's Hospital in Dakar. The studied parameters featured clinical, biological, radiological, therapeutic and evolutionary data. Overall, ten patients, including eight girls and two boys, were selected. Results: Two patients presented the classic triple-syndrome complex featuring an abdominal pain, an abdominal mass and jaundice. Most of the patients presented a symptomatology associating abdominal pain and vomiting. Biological cholestasis syndrome was present in six cases and biological cytolysis syndrome in five cases. The abdominal ultrasound-computed tomography (CT) scan confirmed the diagnosis and helped to set the Todani classification with a predominance of Types 1 and 4. Surgical treatment by laparotomy consisted of total excision of the cyst followed by a Y-en-Roux hepatico-jejunal anastomosis in nine cases, whereas we performed a drainage of the cyst in one case. Two patients presented a morbidity of anastomotic suture release and evisceration and had a good outcome after surgical repair. There was no mortality. Conclusions: The diagnosis of choledochal cyst dilatation (CCD) can be suspected in the postnatal period on the basis of a gastro-intestinal symptomatology with or without associated to jaundice. The combination ultrasound-abdominal CT-scan helps set the diagnosis. The laparatomic approach always has its place for the management of CCD, especially in our context.

L´éviscération transanale de l´intestin grêle par empâlement est exceptionnelle chez l´enfant. Nous rapportons l´observation d´un adolescent de 11 ans reçu à 2 heures d´une issue des anses grêles à travers l´anus suite à une chute avec réception sur un morceau de bois pointu. L´examen clinique avait objectivé un bon état général, une issue, par l´anus, d´environ 25 cm d´intestin grêle viable et un abdomen sensible dans son ensemble. Le bilan biologique préopératoire était normal et aucune imagerie n´était réalisée. Après une réanimation, l´exploration chirurgicale avait mis en évidence un liquide séro-hématique (300 ml) et une issue d´environ 60 cm d´anse grêle inflammatoire à travers une brèche d´environ 5 cm de la paroi antérieure du rectum. Une réduction des anses grêles éviscérées par traction douce, une réparation de la paroi rectale par des points séparés, une toilette et un drainage ont été réalisés. Le patient était sous antibiotique à large spectre. Les suites opératoires étaient simples avec une reprise du transit à J2 post-opératoire. La sortie a été autorisée à J7 post opératoire. Après un recul d´un mois, la patiente a été revue en consultation et l´examen clinique était normal.

Background: Oesophageal atresia is a neonatal emergency surgery whose prognosis has improved significantly in industrialised countries in recent decades. In sub-Saharan Africa, this malformation is still responsible for a high morbidity and mortality. The objective of this study was to analyse the diagnostic difficulties and its impact on the prognosis of this malformation in our work environment. Patients and Methods: We conducted a retrospective study over 4 years on 49 patients diagnosed with esophageal atresia in the 2 Paediatric Surgery Departments in Dakar. Results: The average age was 4 days (0-10 days), 50% of them had a severe pneumonopathy. The average time of surgical management was 27 h (6-96 h). In the series, we noted 10 preoperative deaths. The average age at surgery was 5.7 days with a range of 1-18 days. The surgery mortality rate is 28 patients (72%) including 4 late deaths. Conclusion: The causes of death were mainly sepsis, cardiac decompensation and anastomotic leaks.

Appendiceal pathology’s management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were not founded. An abscess of Douglas pouch is noted in 2 patients with complicated appendicitis undrained. These Douglas abscesses were treated medically. No conversion of laparotomy was performed in the series. After an average of 8 months no other problems were noted.

La strangulation du pénis est une pathologie nécessitant une prise en charge en urgence. Plusieurs objets métalliques ou non, peuvent être placés sur le pénis pour augmenter les performances sexuelles ou pour des fins auto-érotiques. Nous rapportons les observations de deux patients schizophrènes de 25 et 33ans reçus aux urgences pour une strangulation du pénis par anneau métallique. L'anneau était placé au niveau du sillon balanopénien depuis 3 jours chez l'un et au niveau de la racine de la verge depuis 2 jours chez l'autre. Il n'y avait pas de trouble urinaire chez les deux patients. L'ablation de cet anneau a été réalisée par taxis sous anesthésie locale chez l'un et sous sédation à la fentanyl suivie d'une double section de l'anneau à l'aide d'un engin électrique dans le 2ème cas. A travers cette observation nous rapportons la prise en charge non chirurgicale de ces cas pathologique.