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Introduction: Pre-eclampsia is one of the major causes of maternal and neonatal morbidity and mortality in the world. The complexity of its etiopathogenesis involves, among other things, age, primi-gravidity, obesity, lack of sensitization to the partner's sperm. Objective: It was to describe the socio-clinical profile of the preeclampsia pregnant woman received in consultation in our service and to compare it with that of a control population. Methodology: We carried out a situational study of prospective descriptive and analytical type during 07 months from 01 November 2018 to May 31, 2019, in the obstetrics and gynecology department of the Laquintinie Hospital in Douala. We recruited in consultation a continuous series of 150 pregnant women including 50 preeclampsia that we matched to 100 non preeclampsia all at a gestational age greater than 20 weeks of amenorrhea. The variables of interest were age, pregnancy, parity, gestational age, marital status and body mass index. The statistical tests were considered significant for a value of p˂0.05. Results: The preeclampsia pregnant woman in our series had a mean age of 27.80±5.80, mostly in the 25-30years, pauci-gravid, nulliparous and obese grade 1 with a gestational age predominantly ≥37 weeks of amenorrhea. This profile was non-exposing and heterogeneous compared to the control group of the same racial strain and to data from the literature. Conclusion: Our preliminary study suggests the existence of certain socio-clinical peculiarities in the preeclampsia pregnant woman in the black African environment.

Background: Hysterectomy is one of the most performed surgeries through the world, even in Sub Saharan setting where indications are not rare. Objective: To study the frequency, indications, surgical methods, and complications of hysterectomies at the Douala General Hospital. Patients and methods: We carried out a cross-sectional study over a 20-year period, from the 1st January 2000 to 31st December 2019, in the department of Gynaecology and Obstetrics of the Douala General Hospital, a tertiary health facility in Cameroon, central Africa. All patients who underwent hysterectomies for gynaecological or obstetrical indications and whose files were complete were retained. Results: Out of a total of 7126 gynaecological and obstetrical surgical cases 1007 were hysterectomies, giving a frequency of 14.21%. Meanwhile, 968 files fulfilled the inclusion criteria. The average age of the patients was 45.75 ± 7.71 years (range 19 to 75 years). The indications included symptomatic fibroids 64.15% (621 cases), gynaecological cancers 13.94% (135 cases), severe cervical dysplasia 11.15% (108 cases), and endometrial hyperplasia with atypia 7.02% (68 cases), haemostatic hysterectomies 2.68% (26 cases), uterine prolapse 0.82% (8 cases), a case of post abortion uterine necrosis (0.10%) and a case of uterine endometriosis (0.10%). Laparotomy was the main surgical approach 86.05% (833 cases), followed by the vaginal route, 10.20% (97 cases) and then laparoscopy 3.92% (38 cases). The average length of hospital stay was 6.07 ± 1.92 days following laparotomy, 3 ± 1.09 days following the vaginal route, and 3.6 ± 1.04 days following laparoscopy. The main intra-operative complications included haemorrhage, 1.75% (17 cases), bladder injuries 0.82% (8 cases) and ureteral injuries 0.72% (7 patients). Post-operative complications mainly included: fever 3.61% (35 cases), anaemia 2.5% (24 cases) and abdominal wall sepsis 0.92% (9 cases). Conclusion: The frequency of hysterectomy was 14.21%. Uterine fibroid, gynaecological cancer and cervical dysplasia were the main indications. Intra-operative haemorrhage, bladder and ureteral injuries were the major complications. Increase in the practice of vaginal and laparoscopic hysterectomies could contribute to the reduction of peri and post-operative complications and hospital stay. Thus reinforcement of abilities is required.

Background: Postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. It occurs predominantly in developing countries due to poorly developed infrastructures and lack of skilled birth attendants. Objective: To identify the prevalence, causes and risk factors of primary postpartum haemorrhage following vaginal deliveries in a referral hospital (Douala General Hospital-Cameroon). Methods: This was a descriptive and analytical study carried in the Douala General Hospital (DGH) for which socio-demographic, clinical, obstetric and post-partum data were collected using a pre-tested questionnaire. Descriptive statistics, multivariate analysis and logistic regression allowed us to present and discuss our results, with a 95% confidence interval (CI) and p value 0.05. Results: The prevalence of Primary Postpartum Haemorrhage was 1.33%. Quantification of bleeding was reported in only 13.15% of cases. The main causes were: uterine atony (36.18%), placental retention (25.65%), cervical tears (12.50%), perineal tears (10.52%) and cervico-vaginal tears (08.52%). The risk factors were: age between 19 - 35 years aOR = 4.52; 95% CI = 2.65 - 7.98; p = 0.021); unemployment (aOR = 4.74; 95% CI = 2.91 - 6.02; p = 0.001); being multigravida (aOR = 9.21; 95% CI = 6.43 - 12.48; p = 0.035); history of abortion (aOR = 5.11; 95% CI = 2.05 - 7.29; p = 0.004); preterm delivery (aOR = 6.88; 95% CI = 2.72 - 9.06; p = 0.002); duration of labour > 12 hours (aOR = 4.05; 95% CI = 2.46 - 7.98; p = 0.003) and macrosomia (aOR = 3.27; 95% CI = 1.03 - 5.68; p = 0.041). Conclusion: Primary postpartum haemorrhage remains a poorly assessed obstetric complication in the maternity ward of the Douala General Hospital (DGH); Training staff on quantifying postpartum blood loss and monitoring the second and third stages of labour can help to better manage and reduce its occurrence.

Background Infertility is the inability to sustain a pregnancy in a woman with regular (2–3 times per week) unprotected sexual intercourse for a period of 1 year. This is a major public health problem that remains under-recognised in Cameroon and most countries in sub-Saharan Africa. This study aimed at identifying the risk factors associated with tubal infertility in a tertiary hospital in Douala, Cameroon. Methods We conducted a case-control study at the Obstetrics, Gynaecology and Radiology Departments of the Douala Referral Hospital from October 1, 2016, to July 30, 2017. We recruited 77 women with tubal infertility diagnosed using hysterosalpingography and 154 unmatched pregnant women served as controls. Data on socio-demographic, reproductive and sexual health, and radiologic assessments were collected using a pretested questionnaire. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 24.0. Logistic regression models were fitted to identify demographic, reproductive health factors, surgical, medical and toxicological factors associated with tubal infertility. The adjusted odds ratios (AOR) and their 95% confidence interval were interpreted. Statistical significance set at p Results Sixty-one per cent of respondents had secondary infertility. Following multivariate logistic regression analysis, respondents who were housewives (AOR 10.7; 95% CI: 1.68–8.41, p = 0.012), self-employed (AOR 17.1; 95% CI: 2.52–115.8, p = 0.004), with a history of Chlamydia trachomatis infection (AOR 17.1; 95% CI: 3.4–85.5, p = 0.001), with Mycoplasma infection (AOR 5.1; 95% CI: 1.19–22.02, p = 0.03), with ovarian cyst (AOR 20.5; 95% CI: 2.5–168.7, p = 0.005), with uterine fibroid (AOR 62.4; 95% CI: 4.8–803.2, p = 0.002), have undergone pelvic surgery (AOR 2.3; 95% CI: 1.0–5.5, p = 0.05), have undergone other surgeries (AOR 49.8; 95% CI: 6.2–400, p = 0.000), diabetic patients (AOR 10.5; 95% CI 1.0–113.4, p = 0.05) and those with chronic pelvic pain (AOR 7.3; 95% CI: 3.2–17.1, p = 0.000) were significantly associated with tubal infertility while the young aged from 15 to 25 (AOR 0.07; 95% CI: 0.01–0.67, 0.021), those in monogamous marriages (AOR 0.05; 95% CI: 0.003–1.02, p = 0.05), as well as those with a history of barrier contraceptive methods (condom) (AOR 0.17; 95% CI: 0.03–1.1, p = 0.06) were less likely to have tubal infertility. Conclusion The following factors were independently associated with tubal infertility: being a housewife, self-employed, history of Chlamydia trachomatis, Mycoplasma infection, and uterine fibroid. Furthermore, a history of pelvic surgery and other surgeries, diabetes mellitus, and chronic pelvic pain were also associated with tubal infertility. Young age, persons in monogamous marriages and users of barrier methods of contraception (condom) were less likely to have tubal infertility. Identification of these factors will be a target of intervention to avoid tubal infertility.

Background: Maternal mortality was insufficiently reduced in Cameroon in 2015 despite the adoption of Millennium development goals. To tackle the situation and meet the sustainable Millennium goals target of 140/100,000 live births by 2030, the Government adopted the strategies of building reference hospitals where high quality obstetric care, timely and optimal management of obstetric emergencies will be offered. The objective of this study was to describe the patterns of obstetric emergencies in Douala Gynaeco-obstetric and Paediatric Hospital, evaluate the outcomes of their management and the contribution to maternal mortality. Patients and Methods: 418 patients with obstetric emergencies were included in a two-phase cross-sectional study. Data were retrieved from patients’ case notes during the retrospective phase and a questionnaire filled for each case received during the prospective phase. Patterns of obstetric emergencies were determined and for each, the following were analysed: patient managed in this hospital or referred from other hospitals, management according to hospital guidelines, timing of care, result of management (recovery with no admission in ICU (intensive care unit), admission in ICU, death). Factors associated with each case of death were analysed. Results: The patterns of obstetric emergencies (OE) were dominated by HDP (hypertensive diseases in pregnancy) (20.57%), abortions (14.83%), Ectopic pregnancies (13.87%), Acute foetal distress (13.15%) and Obstructed labour (9.56%). PPH (post partum haemorrhage) represented 7.65% and Sikcle cell crisis (SCA) 0.91%. 40% of cases were referred from other hospitals. Six cases of deaths were recorded with a global case fatality of 1.43%. The causes of death were PPH, HDP, and Sickle cell anaemia 33.33% each. The case fatality of SCA was 50%, disclosing our worst performance. Conclusion: Management of OE following standardized hospital guidelines, reinforcement of referral systems, upgrading obstetrical services with ICU will result in least adverse maternal outcomes and especially reduced maternal mortality.

Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.

Introduction: The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. Overall objective: To describe and understand the clinical burden of patients managed for COVID-19 in pregnancy or post-partum at the DGOPH. Methodology: Cross-sectional and descriptive study covering four months—March 24th to July 24th 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet. Results: A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%, and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30 - 39 years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were: fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%. Conclusion: The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.

PURPOSE Cervical cancer constitutes a public health problem in Cameroon where it represents 13.8% of cancers in women. We wanted to evaluate compliance with cervical cancer care with a focus on patients who are lost to follow-up from the time that symptoms suggestive of cervical cancer are clinically recognized to treatment. PATIENTS AND METHODS Sociodemographic data, attitude toward diagnosis and treatment, and reason for discontinuing care were recorded and analyzed for a period of 5 years from January 2010 to December 2015. RESULTS One hundred twenty-six patients had symptoms suggestive of cervical cancer, but only 110 (87.30%) could pay for biopsy, 29 (26.36%) of those did not collect their results, 17 (18.7%) denied their results, and 20 (19%) did not benefit from treatment. Only 44 of 110 patients were able to finish their cancer care treatment program. Reasons for discontinuing the cancer care included lack of financial means to pay for it, distance from the care center, and belief in alternative treatments. CONCLUSION This study highlights the magnitude of the difficulties of accessing and receiving cancer care in semiurban areas in Cameroon. Poverty, belief in alternative treatment options, and unequal distribution of care services determined which patients would be lost to follow-up. Redistribution of resources and cancer care providers is mandatory to improve this situation.

Objectives Uterine fibroids are common among the black race and associated with adverse outcomes in pregnancy. The aim of this study was to determine the prevalence, clinical presentation and maternal and foetal outcomes of birth among pregnant women with leiomyoma in two secondary care hospitals in Limbe and Buea, Cameroon. Results The prevalence of fibroid in pregnancy was 16.7%. Respondents with leiomyoma were older than those without (p

Background\ud Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.\ud \ud Methods\ud In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.\ud \ud Findings\ud Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.\ud \ud Interpretation\ud Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.\ud \ud Funding\ud London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.

Introduction Nonobstetrical genital injuries are gradually becoming a common cause of genital injuries. Consensual sex has been reported to be a possible cause of this type of injuries, but its contribution to traumatic lesions of the female genital tract is not well known. It has been suggested that injury consecutive to consensual sex can be extensive and life-threatening. Aim The aim of this study was to analyze the clinical features, treatment modalities, and the outcome of injuries to the female genital tract consecutive to a consensual sexual intercourse. Methods A retrospective review of records of female patients admitted in our institution with a complaint of genital injury over a 5-year period. We collected data regarding patient and injury characteristics, findings of the gynecologic examination, modalities of management and final outcome. Main Outcome Measures Anatomic location and nature of injury, modalities of management, admission rate and mortality rate. Results Forty six cases could be analyzed. Their mean age was 25.6 years. Almost 35% of patients sustained the injury during their first sexual contact. The majority presented with bleeding, often combined with pain. One patient presented with features of peritonitis. During examination, no anatomic lesions could be identified in 16 (34.8%) of patients. When a lesion was present, it concerned mostly the posterior fornix (28.3%) and the lateral vaginal wall (10%). The most frequently described lesion was a laceration. The majority of patients (83%) were treated with suturing under local anesthesia. The admission rate was 28%, and was significantly higher in patients with a laceration of the posterior fornix. No death was recorded. Conclusions Coital injuries following consensual sex often present in the form of a life-threatening condition and young female with no previous sexual experience are particularly exposed. Most lesions can be treated with a simple suture.

Introduction: Cancer of the cervix is the second most common gynecologic malignancy in the world due to lack of awareness and poor uptake of cervical cancer screening services especially in low income countries. In Cameroon, though there is a national cervical cancer-screening program the service has been limited to some main cities without an appreciable impact. Aims: The objectives of this study were to determine the knowledge, attitude, practice towards Pap smear screening, thus evaluating its suitability as a screening procedure in Cameroon, through this pilot study in the Buea Health District. Methods: The study was a community-based cross-sectional descriptive survey that involved 309 women. Women from 18 years were enrolled for the study from 9th October to 20th November 2013. Results: The mean age of the participants was 32.3 years (SD = 11.7 years). Most of the women (29.5%) who had gone for the Pap test were in the 41 - 50 years age group. Only 3.6% of the study participants had “good” knowledge of cervical cancer and Pap smear screening. Approximately 20% of the women had a previous Pap smear test with 55.7% of them having the test just once. Eighty two percent of those who had secondary and tertiary levels of education had never had a Pap smear test. Awareness of risk factors for cervical cancer was low. Fear of pain, positive results after screening, non-curability of cervical cancer were some factors associated with a low Pap test uptake (p < 0.05). Conclusion: There is poor knowledge and perceived barriers by women about Pap smear screening and follow-up services. For an impact to be made in the prevention of cervical cancer, Pap smear screening is not the preferred method because of these limitations in this community.

Introduction Access to laparoscopy is low in Cameroon where customers' satisfaction has not been reported so far. We assessed patients' satisfaction with the process of care during laparoscopic surgery in a new tertiary hospital. Methods A questionnaire was addressed to consenting patients (guardians for patients under 18) with complete medical records who underwent laparoscopy at the Douala Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from November 1, 2015 to July 31, 2016. The following modified Likert's scale was used to assess satisfaction: very weak: 0-2.5; weak 2.6-5; good: 5.1-7.5; very good: 7.6-10. Only descriptive statistics were used. Results Response rate was 90% (45/50). Of the 45 respondents, 39 (86.7%) were female, 14(31.1%) were referred and 39 (86.7%) paid by direct cash deposit. Mean age was 36.8±11.9 years. Laparoscopies were carried out in emergency for 3 (6.7%) patients. Digestive abnormalities indicated 13 (28.9%) laparoscopies while gynaecologic diseases accounted for 32 (71.1%) cases. Perception of the overall care process was good with a mean satisfaction score of 6.8 ± 1.4. Scores in categories were: 0% (Very weak); 13.3% (weak); 57.8% (good) and 28.9% (very good). Specifically mean satisfaction scores were: 7.8 ± 1.0 with doctors' care; 7.1 ± 1.3 with hospital administration; 7.0 ± 1.2 with nursing and 4.7 ± 1.4 with the costs. Main complaints were: long waiting time (73.3%), constraining geographical access (66.7%) and expensiveness (48.9%). Conclusion Patients were globally satisfied with the process of care but financial and geographical barriers should be addressed.

Chronic pains of the right lower quadrant of the abdomen (RLQA) remain a challenging problem worldwide, especially in areas with limited technical background; chronic appendicitis is still a subject of controversy. The aim of this study was to analyze the clinical and paraclinical data of patients with chronic pains of RLQA who had an appendectomy performed. During a period of 4 years, all patients presenting with a chronic pain of the RLQA were selected for our study and underwent clinical assessment and systematic ultrasonography of the abdomen; these served as a basis of selecting candidates for appendectomy. The intraoperative findings, histology results, and outcome after appendectomy were analyzed. Three hundred nineteen patients presented with chronic pains of the RLQA of which 213 could be finally analyzed; their mean age was 15.3 years; 192 patients were females. They had pains for 2-8 years. Echography showed a heterogeneous lesion in the RLQA in 87% of the cases. The operative findings displayed adhesions and other signs of chronic inflammation in 182 cases. Pathological analysis frequently revealed fibrosis and lymphoplasmocytic infiltration indicative of chronic inflammation. Eighty-seven percent of the patients were cured by appendectomy. There is a chronic process involving the appendix that occurs in the RLQA of patients with chronic pains, typically the adolescent female. Appendectomy usually solves the problem. The criteria for selection of candidates still need to be identified, but in the absence of laparoscopic facilities, we recommend appendectomy when no other cause for the pain has been identified.

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.

Background: Retained abdominal sponge after surgery is a quite rare condition which can have heavy medico-legal consequences; its frequency is generally underestimated. Few reports of these conditions are available in African environment with specific technical and medico-legal background. We present our local experience of retained sponges after abdominal surgery and review current literature. Methods: A retrospective analysis of the medical files of 14 consecutive patients with a retained surgical sponge after abdominal and urological surgery. Results: The incidence was 1every 677 abdominal operations; no metallic foreign body described, only sponges; the female sex predominated with 10/14 patients. 85.71% of retained sponge occurred after an emergency procedure and 64.28% were gynecological or obstetrical procedures. Most cases presented as intestinal obstruction, localized persistent pain or abdominal mass and pre-operative diagnosis could be done only in 28.57% of cases. A falsely correct sponge count was reported in 71.42% of cases. 92.85% of patients were re-operated and the morbidity was low; no death was reported. None of our cases ended in a medico-legal claim despite proper counseling. Conclusion: The incidence of retained sponge might be significantly higher in an environment with reduced medico-legal threat; most cases of retained sponges are still related to human errors; the incidence will probably be reduced by a greater awareness about the condition.