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Background/Purpose: Esophageal atresia (EA) is a congenital defect in the thoracic esophagus associated or not with a tracheoesophageal fistula (TEF). It is associated with high mortality in low-income countries such as Burkina Faso, Madagascar and Ghana. The purpose of this study was to present the recent management of newborns with EA/TEF in Benin and to identify the needs of families whose children have survived. Method: Over a period of 10 years, 54 newborns with EA/TEF operated on in the 2 largest university hospitals in Benin were included. Two groups were identified. Group A (n=33) included newborns in whom a primary repair had been performed. Group B (n=21) involved newborns who underwent staged repair. Staged repair involved cervical oesophagostomy + gastrostomy (n= 7) or upper oesophageal pouch suction + gastrostomy (n=2) or cervical esophagostomy + stoma of the lower esophageal pouch (n=12). Ten parents from group B were interviewed for the needs survey. The significance level was defined as p < 0.05. Results: There were 31 male newborns. The median for gestational age was 37 gestational weeks (range: 35 - 38). Polyhydramnios was observed in 4 cases. The mean birth weight was 2365 g. (range: 1000 g - 3500 g). The mean age at diagnosis was 3.48 days (range: 24 hours - 19 days). Surgery was performed at day 5 on average with extremes from day 2 to day 17. The surgery lasted an average of 2h12 min and the overall mortality rate was 74.07%. Mortality rate in group A was 100% and 33.33% in group B. There was a strong statistically significant difference in survival between the two groups. (p=19.10-8). Sepsis was the most common cause of death. Stress, fear and anxiety of losing the child were the difficulties frequently encountered at bedtime and every day. Four parents had to stop their activities to be available to take care of their child. All the parents had expressed the need for psychological support. Conclusion: Pending an improvement of the technical platform, staged repair remains an essential option for the survival of patients. The creation of a framework for discussion with families authorizing social actions and quality medical support is desired.

Background There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. Method This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy). Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. Results Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3–9 years] in group 1 and 6.8 ± 2.9 years [3–9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03°/month) in group 1 (median HKA 144°–171°; p = 0,001; median MMPTA 78°–87°, p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52°/month) of the correction obtained immediately postoperatively (median HKA 160°–176°(immediate post operative) to 165,5°; p = 0,31; median MMPTA = 78°–86° (immediate post operative) to 80,5°; p = 0,37). There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023). The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. Conclusion Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.

Introduction: OEIS syndrome, the most severe form of exstrophy-epispadias complex, is characterized by the existence of an omphalocele, a bladder exstrophy, an anal imperforation and a spina bifida. Case Presentation: Two clinical cases admitted at the first day of life in neonatology department are reported; one was born by caesarean section, weighing 2500 g and the other one vaginally with a weight at 1890 g. The first child’s mother was a primigravid, primiparous and the second mother was multiparous. Prenatal ultrasound was performed in one case. The clinical examination found two exstrophied hemi-bladders with two productive ureteral meatus, separated by a double intestinal orifice, a manifestation of anal imperforation, omphalocele, spina bifida and lumbar vertebral malformations; which corresponds to a typical form of OEIS syndrome. One of the babies had an associated clubfoot. The karyotype could not be performed. Both were dead; the first in the early postoperative period, the second one at 16 days of life without surgery. Conclusion: OEIS syndrome is a rare condition and represents a therapeutic challenge in developing countries. Promoting prenatal diagnosis is essential.

Bowel malrotation is an abnormality in the rotation of the primary intestinal loop during embryonic life. It is a severe abnormality exposing the patient to fatal complications. We report here a series of five patients presenting digestive malrotation with various malformative associations. The first three cases are multiple intestinal atresia on incomplete common mesentery. They underwent an intestinal anastomosis: end-lateral duodeno-ileal for one and end-to-end jejuno-jejunal for the other two with Ladd procedure. In the latter two cases, the omphalocele was the associated malformation; complications such as rupture of the omphalocele with intestinal perforation for one and occlusion by strangulation at the level of the neck for the other were recorded. Ileal resection removing the perforation with end-to-end ileo-ileal anastomosis was performed for the first, while reduction of strangulation at the origin of the occlusion was sufficient for the second. The LADD procedure was the complementary gesture in all cases. The outcome was favorable in 3 cases; two of the newborns who had jejunal atresia died, one on day 5 in a picture of acute respiratory distress, the other on day 6 in a picture of disseminated intravascular coagulation.

BACKGROUND: There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. METHOD: This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy). Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. RESULTS: Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3–9 years] in group 1 and 6.8 ± 2.9 years [3–9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03°/month) in group 1 (median HKA 144°–171°; p = 0,001; median MMPTA 78°–87°, p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52°/month) of the correction obtained immediately postoperatively (median HKA 160°–176°(immediate post operative) to 165,5°; p = 0,31; median MMPTA = 78°–86° (immediate post operative) to 80,5°; p = 0,37). There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023). The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. CONCLUSION: Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.

Background Abdominal trauma are a common cause of infant morbidity and mortality. Aim To assess the relevance of computed tomography scan for the management of abdominal trauma in children in countries with limited resources. Patients and method: It was a retrospective and descriptive study over 5 years in patients aged 0 to 15 years. Results Twenty four cases of abdominal trauma were collected. There were 14 boys and 10 girls with a sex ratio of 1.4. The average age was 8.7 years with extremes of 18 months and 15 years. The causes found were: road accidents (14 cases), home accident (6 cases), gambling accidents (3 cases) and one aggression. Traumas were divided into 83.3% (20 cases) of abdominal blunt and 16.7% (4 cases) of abdominal wound. Polytrauma accounted for 41.7% (10 cases). No computed tomography scan was ordered. The spleen was the most injured organ (11 cases) followed by the intestines (6 cases). The average length of hospital stay was 12.3 days with extremes of 3 and 15 days. The treatment was non-operative in 13 patients (54.2%) and surgical in 11 ones (45.8%). No deaths were noted in our series. Conclusion Abdominal trauma in children are potentially serious injuries. The treatment depends on the damaged organ and the patient's hemodynamic status. Computed tomography scan does not appear to be indispensable in the management of traumatized children in countries with limited resources.

Background: There are no real comparative study between guided growth and tibial osteotomy in early stage of Blount disease. The aim of this work was to compare the results of patients treated by these two techniques. Method: We had performed a multicenter retrospective, descriptive and analytical study over a period of 05 years. All children admitted for Blount disease without medial proximal tibial epiphysiodesis and treated by one of these techniques were included. Age, sex, existence of tibial torsion, radiological stage based on Catonne's classification were studied. We also evaluated preoperatively, immediately postoperatively, and at latest follow-up tibiofemoral angle, mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, and the tibial metaphyso-diaphyseal angle. Results: Seventeen (17) patients for 24 knees were included. The sex ratio was 0.54. All patients had tibial torsion. Fourteen knees (64%) were treated by guided growth at a mean age of 5.5±2.5 (range, 3-9 years). With a mean follow-up of 12 ± 3.5 months (range 6-15month); tibiofemoral, mechanical medial proximal tibial, and tibial metaphyso-diaphyseal angles were significantly corrected with normalization of the mechanical axis in 8 patients (60%). Ten patients (36%) were treated by revisited Rab osteotomy at a mean age of 7.7±4.9 years (range, 4-12 years). At a mean follow-up of 23±15 months (range, 10-48 months), only tibial metaphyso-diaphyseal angle was significantly corrected. The recurrence rate was 60%. Despite perfect correction of tibiofemoral, and mechanical medial proximal tibial angles in immediate postoperative follow-up, they gradually decrease in patients treated by Rab osteotomy, whereas they gradually increased in case of guided growth. Conclusion: Guided growth appears to be the best treatment for early stage of Blount disease. Trial registration: Retrospectively registered

The pneumoperitoneum is the abnormal presence of free air in the peritoneal cavity. In most cases it is related to the perforation of hollow organs. Nevertheless there are cases of pneumoperitoneum without obvious causes called idiopathic. We report a case of massive pneumoperitoneum of radiological discovery in a patient of 16 years old boy, sickle-cell of type SS, during the exploration of an angiocholitis. It was medically treated successfully. No obvious etiology had been found. This particular situation is a dogma which runs up against the classic interventionist spirit; therefore each of pneumoperitoneum needs to be studied case by case. The presence of signs of peritoneal irritation allows surgical exploration. Otherwise, laparoscopy seems to be a minimally invasive surgical method and allows a visual diagnosis by eliminating a hollow organ perforation.

Congenital diaphragmatic hernia is the outcome of the abdominal contents in the thorax by a breach caused by a failure to close the pleuroperitoneal canal. It is a rare and serious disease. Our teaching hospital had registered these seven last years five cases of congenital diaphragmatic hernia, operated, but never published. We report the most recent one, a case of a newborn baby seen at the 5th hour of life for respiratory distress. Initial examination revealed: an asymmetric thorax, respiratory distress with 88% oxygen saturation at ambient air, tachycardia and abolition of vesicular murmur in the left lung field. L-abdomen was flat and soft. Thoraco-abdominal radiography revealed a clear left intra-thoracic image with mass effect on the left lung parenchyma. He has benefited from a reduction of the herniated visceras and a successful closing of the breach. The operation had few after-effects after five months follow-up with a very good recovery of the cardio-pulmonary function.

Congenital diaphragmatic hernia is a common cause of neonatal respiratory distress. The right or left diaphragmatic cupola hernia is most often involved. Rarely, a retro-costo-xiphoidian or Larrey or Morgagni hernia is diagnosed as part of respiratory distress. We present a case of congenital retro-costo-xiphoid diaphragmatic hernia in a midline situation, involving the sternal portion and extending to the diaphragmatic domes on each side. The discovery was made antenatal by obstetric ultrasound from 21 weeks. At birth, there was minor respiratory distress. The management consisted of a reduction and placement of a polypropylene plate in the natal post by abdominal approach.

Tethered cord syndrome is a spectrum of neurological symptoms due to a constant or intermittent axial traction of the terminal cone of the spinal cord, fixed in abnormal caudal position. It is a rare congenital lesion whose symptoms can be observed only in adulthood. We report the case of a 10-year-old boy with tethered cord syndrome discovered due to bladder and anal incontinence and confirmed by lumbosacral magnetic resonance imaging. He underwent neurosurgical release of the terminal cone by posterior approach. Evolution was marked by improvement of sphincteric disorders. This case study has been followed by a literature review on this subject. This case study highlights the role of magnetic resonance imaging (MRI) in the diagnosis of this disorder.

Le syndrome de la moelle attachée est un ensemble de symptômes neurologiques dû à une traction axiale constante ou intermittente du cône terminal de la moelle spinale, fixé en position caudale anormale. Il s'agit d'une lésion congénitale rare dont les symptômes peuvent s'exprimer qu'à l'âge adulte. Nous rapportons un cas clinique chez un garçon de 10 ans découvert à la suite d'une incontinence vésicale et anale qui a été confirmé par une imagerie par résonnance magnétique lombo-sacrée. Il a bénéficié d'une libération neurochirurgicale du cône terminal par un abord postérieur. L'évolution a été marquée par une amélioration des troubles sphinctériens. Ce cas est suivi d'une revue de littérature sur le sujet. Ce cas met l'accent sur l'intérêt de l’imagerie par résonance magnétique (IRM) dans le diagnostic de cette affection.

Gastrointestinal perforations (GIP) in newborns are serious neonatal conditions that have significant morbidity and mortality, especially in resource constrained setups. This study was done to describe our experience of GIP in neonates and identify the factors leading to high mortality in our setup. We collected 18 cases with GIP in neonates. The average age was 5.7 days (range, 1-7 days). The sex ratio was 0.64. The average time to treatment was 3.3 days (range, 1-10 days). The etiology of GIP was perforated necrotizing enterocolitis (13 patients), spontaneous gastric perforation (2 patients), perforated ileal atresia (1 patient), ileal perforation complicating a strangulated inguinoscrotal hernia (1 patient), and peritonitis after colostomy (1 patient). Mortality was 77.8% (n=14), among which 9 newborns (64.3%) died preoperatively. Prematurity, management delay, and lack of a neonatal intensive care unit were the main poor prognostic factors. Mortality from GIP is still high in our context due to several factors, especially prematurity, management delay, and lack of a neonatal intensive care unit.

Retroperitoneal malignant teratoma is a rare congenital tumor, representing 1%–10% of retroperitoneal tumors in children.1 2 A pathological migration of primitive germ cells to the genital ridges can stop at various levels, which explains the localizations of these tumors.3 The diagnosis is done either prenatally, or later in front of an abdominal mass.4 5 We reported a case treated in our department and reviewed the diagnostic and therapeutic aspects of its management. It was a 3-year-old child, weighing 12 kg, without any particular history, examined during a foreign Non-Governmental Organisation (NGO) surgical mission. The child had an abdominal mass that gradually increased in volume over a period of 2 years. The general condition was moderately impaired. Physical examination, found a swollen abdomen with collateral venous circulation, a voluminous mass occupying almost the entire abdominal cavity except the hypogastrium, the left side and iliac fossa, without digestive or urinary disorders. Abdominal ultrasonography (figure 1) and abdominal CT (figure 2) revealed a mixed, heterogeneous right retroperitoneal tumor containing cystic areas and calcifications with a normal kidney. The alpha-fetoprotein level was up to 301 ng/mL. Figure 1 Ultrasound image showing a solid component mass (a) and fluid (b). Figure 2 CT image showing, a normal right kidney (a), well separated from …

INTRODUCTION: Le mobilier scolaire et la posture assise en classe sont souvent impliqués dans l'apparition des douleurs rachidiennes, influant de fait sur la qualité des tâches réalisées par les apprenants. Aucune étude n'a encore vérifié le degré d'adéquation entre les caractéristiques du mobilier et celles des écoliers au Bénin. L'objectif de cette étude transversale est donc de déterminer la relation entre les dimensions des table-bancs utilisées en classe et les mesures anthropométriques des écoliers au Bénin. METHODS: Elle a été réalisée avec un échantillon probabiliste de 678 écoliers, âgés de 4 à 17 ans. Les mesures anthropométriques des écoliers et les mensurations relatives aux longueurs, largeurs et hauteurs des table-bancs ont été mesurées, puis intégrées aux équations proposées dans la littérature. Les pourcentages des valeurs situées hors des limitesacceptables, dérivées de l'application des équations ont été calculés. RESULTS: La largeur et la hauteur des table-bancs utilisées par les écoliers étaient plus élevées (p = 0,05) que les valeurs de référence recommandées par les structures officielles de contrôle et de production des mobiliers scolaires au Bénin. Quel que soit le sexe, il y avait une inadéquation entre la largeur du banc et la longueur fesse-poplité, puis entre la hauteur de la table et la distance coude-bancdes écoliers. CONCLUSION: Les résultats suggèrent de prendre en compte l'évolution des mesures anthropométriques des écoliers dans la confection des table-bancs, afin de promouvoir de bonnes postures assises en classe et de réduire le risque de troubles du rachis.

Introduction Le mobilier scolaire et la posture assise en classe sont souvent impliqués dans l'apparition des douleurs rachidiennes, influant de fait sur la qualité des tâches réalisées par les apprenants. Aucune étude n'a encore vérifié le degré d'adéquation entre les caractéristiques du mobilier et celles des écoliers au Bénin. L'objectif de cette étude transversale est donc de déterminer la relation entre les dimensions des table-bancs utilisées en classe et les mesures anthropométriques des écoliers au Bénin. Methods Elle a été réalisée avec un échantillon probabiliste de 678 écoliers, âgés de 4 à 17 ans. Les mesures anthropométriques des écoliers et les mensurations relatives aux longueurs, largeurs et hauteurs des table-bancs ont été mesurées, puis intégrées aux équations proposées dans la littérature. Les pourcentages des valeurs situées hors des limitesacceptables, dérivées de l'application des équations ont été calculés. Results La largeur et la hauteur des table-bancs utilisées par les écoliers étaient plus élevées (p < 0,05) que les valeurs de référence recommandées par les structures officielles de contrôle et de production des mobiliers scolaires au Bénin. Quel que soit le sexe, il y avait une inadéquation entre la largeur du banc et la longueur fesse-poplité, puis entre la hauteur de la table et la distance coude-bancdes écoliers. Conclusion Les résultats suggèrent de prendre en compte l’évolution des mesures anthropométriques des écoliers dans la confection des table-bancs, afin de promouvoir de bonnes postures assises en classe et de réduire le risque de troubles du rachis.

Background: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. Patients and Methods: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. Results: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, postcircumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%. Key words: Aetiology, child, epidemiology, treatment, uropathy