Search

Resume Contexte Dans les pays en voie de developpement, la plupart des cures de hernie inguinale sont realisees en utilisant des techniques de Bassini ou Shouldice, ce qui entraine des taux de recidive plus eleves qu’avec la pose d’une prothese. L’objectif de cette etude etait d’evaluer la faisabilite, les suites postoperatoires et la qualite de vie des patients beneficiant d’une cure de hernie inguinale avec l’utilisation d’une prothese fabriquee a partir d’une toile de moustiquaire sterilisee en polyester en zone rurale au Cameroun lors de campagnes de sante. Methodes Les patients ont ete prospectivement inclus de janvier a novembre 2013. Les protheses ont ete fabriquees a partir d’une moustiquaire non impregnee de polyester achetee sur un marche local a Yaounde et sterilisees sur place. Resultats Le cout total d’une prothese etait de 0,21 USD. Parmi les 41 patients inclus dans l’etude, 33 (80,5 %) etaient des hommes, 30 (72 %) etaient des agriculteurs et l’âge median etait de 52 ans (21 a 80 ans). Le temps entre le debut des symptomes et la chirurgie etait de 24 (3–240) mois. Onze (26,8 %) patients avaient deja ete operes d’une hernie inguinale : 4 (9,7 %) avaient ete operes sur le cote contralateral et 7 (17,1 %) avaient une recidive. Aucun evenement intraoperatoire lie a la prothese n’a ete enregistre. Trois patients (7,2 %) avaient un serum scrotal non infecte postoperatoire et 1 patient (2,4 %) avait une infection cutanee superficielle qui a ete traitee avec des soins locaux et des antibiotiques par voie orale. Aucun rejet allergique ou une infection profonde n’a ete observe. Conclusion Les protheses fabriquees a partir de moustiquaires sterilisees sont sures et efficaces et offrent une alternative rentable aux protheses commerciales disponibles dans les pays en voie de developpement, en particulier, lors des campagnes de sante en milieu rural.

Summary Background In developing countries, most inguinal hernia repairs are performed using Bassini or Shouldice techniques resulting in higher recurrence rates than with mesh placement. Our study aimed to evaluate the postoperative course and quality of life of patients undergoing inguinal hernia repair with a polyester mosquito net meshes during non-governmental organization health campaigns in Cameroon. Methods Patients were prospectively included from January to November 2013. Meshes were made from a polyester non-impregnated mosquito net purchased at a local market in Yaounde and sterilized on site. Results The total cost of a mesh was 0.21 USD. Among the 41 patients included in the study, 33 (80.5%) were men, 30 (72%) were farmers and the median age was 52 (21–80) years. The time between the onset of symptoms and surgery was 24 (3–240) months. Eleven (26.8%) patients had a previous history of hernia repair: 4 (9.7%) had been operated on the contralateral side and 7 (17.1%) had a recurrence. No intraoperative event related to the meshes was recorded. Three patients (7.2%) had a postoperative uninfected scrotal seroma, and 1 patient (2.4%) experienced a superficial skin infection that was treated using local care and oral antibiotics. No allergic rejection or deep infection was observed. Conclusions Meshes made from sterilized mosquito nets are safe and effective and provide a cost-effective alternative to commercially available meshes in countries with limited resources especially during non-governmental organization health campaigns.

Resume But de l’etude Analyser les indications, les decouvertes operatoires, les modalites de traitement et les suites operatoires des reinterventions de chirurgie abdominale en milieu defavorise. Patients et methodes Analyse retrospective de 1998 a 2004 des dossiers de patients ayant eu une reintervention de chirurgie abdominale au cours de la meme hospitalisation ou dans les 30 jours suivant la laparotomie initiale. Resultats Parmi les 7714 patients operes par laparotomie pendant la periode d’etude, 277 (3,6 %) ont ete reoperes. Les dossiers de 238 patients (86 %) ont pu etre analyses. L’indication de reintervention etait retenue essentiellement sur des criteres cliniques (« a la demande »). Les trois principales indications de reintervention etaient une peritonite postoperatoire (50,8 %), une occlusion intestinale (23,9 %) ou une fistule digestive (10,9 %). La morbidite globale etait de 35 %, marquee essentiellement une infection postoperatoire (79 cas) ou une dehiscence de la paroi abdominale (37 cas). La mortalite etait de 18,1 %. Elle augmentait significativement avec le diagnostic de peritonite a la premiere laparotomie et une reintervention realisee pour une cause infectieuse. Conclusion En milieu defavorise, le taux de reinterventions a la demande pour complications de chirurgie abdominale ne semble pas plus eleve que dans les series occidentales, sous-reserve de facteurs pouvant biaiser l’analyse. La mortalite des peritonites postoperatoires est elevee, mais la relaparotomie a la demande peut encore etre consideree comme une strategie correcte et adaptee a ce contexte. L’amelioration des conditions de prise en charge pourrait permettre d’ameliorer les resultats.

Resume Objectif. – Determiner l'incidence des manifestations aigues chirurgicales des parasitoses digestives a Yaounde (Cameroun) et evaluer les modalites et les resultats de leur prise en charge. Materiel et methodes. – Il s'agit d'une etude retrospective de janvier 1973 a decembre 2002 incluant les patients presentant un abdomen aigu parasitaire traites dans le service des urgences chirurgicales de l'hopital central de Yaounde. Resultats. – Parmi 3464 abdomens aigus operes, 135 patients (3,9 %) avaient une etiologie parasitaire. Il s'agissait pour 59 % d'entre eux (80 patients) d'enfants âges de mois de 15 ans. Nous avons collige 63 peritonites par rupture d'abces amibien du foie (47 %), 24 occlusions par un ascaridiose (18 %), 21 appendicites d'origine parasitaire (15 %), 15 typhlites amibiennes (11 %), quatre angiocholites et/ou pancreatites aigues par migration d'un ascaris adulte dans l'ampoule de Vater (3 %), quatre perforations ascaridiennes du grele (3 %) et quatre invaginations intestinales aigues (3 %). Quatre-vingt-dix-sept patients (79 %) ont ete operes avant 1990. La mortalite des peritonites par rupture d'abces amibien du foie etait de 41 %. Conclusions. – Les urgences chirurgicales abdominales d'origine parasitaire sont peu frequentes mais pas rare au Cameroun. L'incidence de ces urgences diminue depuis quelques decennies. Cependant, la rupture intraperitoneale d'abces amibien du foie reste l'etiologie la plus frequente et est toujours associee a un taux important de mortalite. Il reste encore difficile d'affirmer lors de l'exploration chirurgicale si le parasite objective est le responsable ou le temoin passif des lesions observees. Le diagnostic preoperatoire des etiologies parasitaires pourrait permettre d'ameliorer leur prise en charge en privilegiant les modalites therapeutiques non operatoires.

We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes.Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery.During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications.In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.

Abdominal gunshot wound (AGSW) is a trauma emergency. The purpose of this report is to describe our experience with managing AGSW largely without modem investigational modalities. Data was collected retrospectively by reviewing the surgical reports and clinical charts of patients admitted to live hospitals dealing with AGSW over a 5-year period. Incomplete files and wounds not involving the abdomen were not included. A total of 86 files were analyzed. Patients ranged in age from 10 to 63 years ivith mean age of 32 years and a sex ratio of 5.5. Most patients (87%) underwent surgical exploration. Laboratory revealed no lesions in 22.5% of cases, minor lesions in 9.5% and major lesions justifying surgical repair in 68%. A total of 86 visceral lesions were found in the patients who underwent surgical exploration. The lesion involved the small intestine in 31.5% of case, colon in 24.5%, liver in 23.5%, spleen in 7%, stomach in 6%, and uterus in 2%. The kidney, pancreas, mesenteries, large momentum, and transverse mescaline each accounted for 1% of lesions. Conventional operative techniques were used with a mortality of 5.5% and morbidity of 4%. Based on our findings we conclude that when investigational tools (CT-scan, peritoneal lavage and laparoscopy) are unavailable prolonged watchful waiting increases the risk of mortality and morbidity in patients presenting AGSW associated with suspicious clinical signs. Prompt surgical treatment improves prognosis but is associated with a high rate of cases showing no lesions.

To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities.Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon).Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus).Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.

Eighteen blunt small bowel traumas were reviewed in this retrospective study (1986-1996) concerning 12.8% of laparotomies for blunt abdominal trauma. The clinical presentation at admission was peritonitis (9 cases) or hemoperitoneum (4 cases) whereas 5 cases were diagnosed lately because of non specific signs at the beginning. All patients underwent surgery: simple suture or suture after excision of edges (12 cases); resection anastomosis (6 cases). There were no post-operative complications in most of the cases. The mortality rate was 5%. Blunt small bowel traumas are not frequent in our practice. Their diagnostic is often per-operative. If the clinical signs of intraperitoneal lesion are not present, a clinical follow-up by repeated and thorough physical examination can permit an early diagnosis. The surgical treatment is simple, and the prognosis more linked to severe associated lesions than the bowel lesion.

Twenty nine patients with blunt liver trauma were recorded in the Central Hospital of Yaounde between 1986 and 1996. The average age was 23.4 years, with the 20 to 25 and 5 to 15 age groups being the most affected. The most characteristical clinical presentation was hemoperitoneum with shock. Twenty-three patients were operated (18 in emergency and 5 secondary). While 6 patients benefited from non operative treatment due to their stable hemodynamic state. Exploration of lesions revealed 16 grade I and grade II, 8 grade III and 5 grade IV and V lesions. The operation was a simple suture in 13 cases, selective ligature of hepatic artery in 2 cases and 2 tamponades while in 4 cases the treatment was inactive. The bleeding could not be controlled in 2 cases. Peri-operative mortality was 17.39% and morbidity 21.74%, made up mainly of parietal sepsis. In our practice, blunt liver trauma are generally benign and treatment should be conservative.

Forty-two cases of liver trauma were reviewed at the Central Hospital of Yaounde between 1984 and 1994. The mean patient age was 22 years, the most commonly involved age group being between 20 and 35 years. Trauma was blunt in 24 cases (57.1%) and penetrating in 18 cases (42.8%). Diagnosis was achieved most frequently by abdominal needle puncture confirming hemoperitoneum. Emergency surgery was performed in 38 cases. In the remaining 4 cases hemodynamic status was stable and surgery was not required. Lesions were classified as grade I and II in 24 cases, grade III in 5 cases, grade IV in 3 cases, and grade V in 1 case. In the remaining 9 cases the grade of the lesion was not mentioned. Management consisted of simple suture in 26 cases, debridement in one case, packing in 4 cases, and a watchful attitude in 4 cases. In 3 cases hemorrhage was uncontrollable. Overall perioperative mortality was 14.2%. The main complication was parietal sepsis which occurred in 6 cases. In the present African series liver trauma was most often benign. This finding suggests that a conservative surgical approach is indicated.

Over a 4 years period, 87 cases of primary abscesses of the psoas were treated surgically at the Central Hospital in Yaoundé. The psoas muscle was involved in 10.17% of the cases with myositis. Most patients were in young male and the abscesses were in an advanced stage. Staphylococcus was the most frequently encountered germ (78.4%) and enterobacteria were only found in 3.07%. The diagnosis was based on clinical and echographic findings. There was 1 patient with acquired immunodeficiency syndrome (AIDS). Most cases were treated by extraperitoneal drainage. Morbidity and mortality were low and generally occurred in debilitated patients (AIDS, involvement of several muscle groups, diabetes).

The authors present a case report of scrotal rupture with evisceration from abdominal contusion in a patient with a voluminous inguino-scrotal hernia. The mechanism and treatment of lesions are discussed.

At the Central Hospital of Yaoundé, Cameroon, 10 ano-rectal injuries were treated over a period of 5 years. There were the same number of men and women and all patients were young (range: 7 to 35 years). The cause was illegal abortion in 2 cases and impalement following a fall from a tree in 3. The time lapse between injury and treatment was longer than 24 hours in 5 patients. In 2 cases the lesions were minor and simple debridement was possible. In the remaining 8 cases, construction of a colostomy was required using either the Hartmann terminal-type technique (n = 5) or the exclusion technique (n = 3). Three patients died: one from traumatic shock and two from septic shock. Complications were observed in 4 patients: 2 infections and 2 mechanical complications. Two patients presented permanent sequels including one with partial fecal incontinence. This study confirms the difficulty in management of ano-rectal injuries with limited facilities and reveals the variety of situations that can lead to these injuries especially in children in Africa.

Over a period of 3 years, 49 typhoid perforations of the small intestine were treated at Yaoundé Central Hospital. These 34 men and 15 women with a mean age of 29.6 years presented sthenic peritonitis in 20 cases and more difficult to diagnose asthenic peritonitis in 29 cases. The perforation was always located at the end of the ileum and was single in 40 cases, double in 6 cases and triple in 3 cases. Surgical management in association with intensive care and multiple agent antimicrobial therapy consisted in sleeve resection in 29 cases, resections with an exteriorized anastomosis in 15 cases, and ileocolonic intubation in 5 cases. The postoperative complications were suppuration of the wall (n = 4), intestinal fistula (n = 3), evisceration, and residual abscess. There were 9 deaths (18.4%) including 4 after sleeve resection and 5 after resection with an exteriorized anastomosis. On the basis of this experience, the authors describe the diagnostic difficulties posed by typhoid perforations, discuss surgical techniques proposed in the literature, and emphasize the value of sleeve resection.