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Abstract Objective To report the diagnostic and therapeutic approach for the management of abdominal masses in the General Surgery department of the Niamey General Reference Hospital (HGR). Materials and methods This were a retrospective and preliminary study of 2 years and 3 months on patients operated for abdominal masses in the General Surgery department of the HGR. A palpable mass and/or its size on imaging (40 mm) were the inclusion criteria. Results Abdominal masses accounted for 6.7% (n = 53) of other pathologies. The average age of the patients was 41.26 years, with a standard deviation of 14.2 and a female predominance of 75.5% (n = 40) with a sex ratio of 0.32. The abdominal mass was clinically palpable in 75.5% (n = 40). Abdominal pelvic ultrasound was performed as a first step in all patients and in 75.5% (n = 40) it specified the origin of the mass. Contrast-enhanced abdomino-pelvic CT scan, performed in 52.8% of patients (n = 28) and in 89.3% (n = 25) specified the preoperative diagnosis. The most frequent etiologies were uterine fibroids, 35.8% (n = 19). In 5.6% (n = 3) the diagnosis was not precise preoperatively despite the two imaging studies, and these patients had underwent exploratory laparotomy. Surgery was the initial therapeutic approach for all patients, and laparoscopy accounted for 22.6% (n = 12). Postoperative complications occurred in 7.5% (n = 11). The death rate was 5.6% of cases (n = 3). Conclusion Imaging remains important in the etiological research for abdominal masses. Definitive treatment remains surgical; mortality would be linked to the malignant nature and the significant volume of the mass.

Abstract Background Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few cases have been reported in the medical literature. Case presentation We report the case of a 25-year-old black African male patient with no medical history. He presented to the emergency department for abdominal pain, nausea, and bilious vomiting. The abdominal examination revealed typical signs of acute bowel obstruction. Enhanced abdominopelvic computed tomography showed an invagination of the last ileal loop, cecum, and ascending colon into the lumen of the transverse colon, with a rounded image with hypodense content and some calcifications compatible with an appendiceal mucocele. An emergency exploratory laparoscopy was performed and confirmed the ileocecocolic intussusception. Right hemicolectomy and ileocolic anastomosis were performed. The patient recovery postoperatively was uneventful, and he was discharged 4 days later. Histological examination of the surgical specimen confirmed the diagnosis of mucinous cystadenoma. Conclusion The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to the injected abdominal computed tomography scan.

Background: Rectal prolapse is a public health problem that affects all sexes at different ages. It is one of the most frequent reasons for consultation in pediatric surgery. The main causes are chronic constipation and diarrhea or both. The increase in abdominal pressure, whatever its cause, is an essential factor favoring the occurrence of rectal prolapse. The anatomical factors related to the morphology of the pelvis and sacrum are unknown. The objective of this work was to compare the morphometric variations of the pelvis in children aged from 0 to 15 years with and without rectal prolapse. Methods: This was a case-control study of 128 children (64 males) living in Niger, children without rectal prolapse (controls) were paired to those with rectal prolapse by age for both sexes. Morphometric parameters were measured on computed tomography scans. The length, concavity and slope of the sacrum were measured. Antero-posterior, bi-ischiatic, and sub-sacro-sub-pubic diameters were measured on the pelvis. Results: In girls and boys with rectal prolapse, with the generalized linear model the sacral length was significantly increased with p = 0.0005 and sacral concavity decreased as compared with controls with p = 0.0007. The sacral slope has probably also an effect but impaired by large variations. There were no significant changes in other pelvic parameters. Conclusion: The morphology of the sacrum is an anatomical factor probably related to the occurrence of rectal prolapse in children.

Intussusception is a common emergency of children, resulting in a mixed intestinal occlusion by obstruction and strangulation. The diagnosis which is often difficult must be done early as well as the treatment to avoid the risk of fatal complications. We report a series of four (04) infant with intussusception exteriorized through the rectum, aged between 4 and 24 months. They are all treated in our department. On the basis of clinical arguments, differentiation with rectal prolapse in this context is not always obvious. Hence the need to perform ultrasonography for early diagnosis. The treatment of these clinical forms, which is always surgical, should be guided by the patient's local and general conditions. The prognosis is worsened by the delay in diagnosis and treatment.

BackgroundIn 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery.MethodsWhereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso.ResultsDuring the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training.ConclusionsResults from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished.

Background In our context, hernial strangulation has a high incidence. The aim of this work was to investigate prognostic factors in adults diagnosed with strangulated groin hernia. Patients and Methods This was a retrospective cross-sectional study conducted at Zinder National Hospital between 1 January 2016 and 31 December 2022 (7 years). Clinical and prognostic data were collected. Results Out of 568 patients who underwent surgery for groin hernia, 230 cases were strangulated (40.49%). Mean age was 47.8±16.6 years. The proportion of males was 86.65%, i.e. the sex ratio was 5.96. Inguinal hernia accounted for 85.2% (n=196). The median operative time was 7 h. The Bassini procedure was the most common with 83.5% (n=192). Small bowel was the content of the hernia sac in 80% (n=184). Intestinal necrosis occurred in 10.9% (n=25). This was associated with femoral location (OR=5.39, P=0.00003). Intestinal resection was performed in 13.9% (n=32) and stoma in 1.7% (n=4). Postoperative complications occurred in 25.2% (n=58). The overall mortality (grade V) was 6.5% (n=15). Mortality was statistically associated with age > 60 years (OR=5.16; P=0.0016), admission time (OR=3.20; P=0.028), time to surgery > 8 h (OR=4.20; P=0.005) and occurrence of necrosis (OR=9.39; P=0.000). Conclusion Strangulated groin hernia is a common surgical emergency.Its prognosis is associated with advanced age, femoral location, and diagnostic and therapeutic delay [ABSTRACT FROM AUTHOR]

Background: Mortality from peritonitis due to typhoid intestinal perforation (TIP) in sub-Saharan Africa is high. Objectives: This study aimed to determine the predictive factors of mortality, propose a prognostic score, and determine the appropriate surgical treatment for TIP in low-resource settings. Materials and Methods: This was a retrospective data collection of peritonitis due to TIP admitted at Zinder National Hospital from 2014 to 2021. To build a typhoid intestinal perforation prognostic score (TIPPS), patients were randomised into two groups: a score-building group and a validation group. Univariate and multivariate analyses were performed to identify risk factors of mortality. The value of P <0.05 was assigned significant for all analyses. Results: TIP accounted for 52.4% (n = 1132) of all cases of peritonitis (n = 2159). The median age was 12 years. Rural provenance represented 72.2% (n = 817). Deaths accounted for 10.5% (n = 119). The factors influencing mortality were respiratory rate ≥24/min (odds ratio [OR] = 2.6, P = 0.000), systolic blood pressure <90 mmHg (OR = 0.31, P = 0.002), serum creatinine >20 mg/L (OR = 2.6, P ≤ 0.009), haemoglobin (OR = 2.1, P = 0.000), comorbidity (OR = 3.5, P = 0.001), the American Society of Anesthesiologists score IV&V (OR = 3.3, P = 0.000), admission and management delay > 72 h (OR = 3.2, P = 0.001), and a number of perforations (OR = 2.4, P = 0.0001). These factors were used to build a "TIPPS" score, which ranged from 8 to 20. The risk of mortality was associated with increased TIPPS. The performance of this score was good in the two groups (area under receiver operating characteristic > 0.83). According to the severity and mortality risk of TIP, we classified TIPS into four grades: grade I (low risk: 8–10), grade II (moderate risk: 11–13), grade III (high risk: 14–16) and grade IV (very high risk: 17–20). Conclusion: The TIPPS is simple. It can describe the severity of the disease and can predict the risk of death. The study highlights the importance and impact of timely and adequate perioperative resuscitation in more complicated cases. [ABSTRACT FROM AUTHOR]

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BACKGROUND: We report the results of our experience on laparoscopic cholecystectomy in sickle cell disease patients in Niger, which is included in the sickle cell belt. METHODS: A prospective study covering a period of 45 months, from July 2004 to March 2008. We included all sickle cell disease patients that underwent laparoscopic cholecystectomy. Blood transfusion was done for patients with haemoglobin (Hb) levels less than 9g/dl. Homozygous and composite heterozygous patients were admitted in intensive care unit for 24 hours or plus post operatively. RESULTS:The series included 47 patients operated by the same surgeon, 31 females (66%) and 16 males (34%) (Ratio: 0.51). The average age was 22.4 years (range: 11 to 46 years) and eleven (23.4%) of them were aged less than 15 years. The types of sickle cell disease found were 37 SS, 2 SC, 1 S beta-thalassemia and 7 AS. Indications for surgery were biliary colic in 29 cases (61.7%) and acute cholecystitis in 18 cases (38.3%). The mean operative time was 64 min (range: 42 to 103 min). Conversion to open cholecystectomy in 2 cases (4.2 %) for non recognition of Calot‘s triangle structures. The postoperative complications were: four (4) cases of vaso-occlusive crisis and one case of acute chest syndrome. The mean postoperative hospital stay was 3,5days (range: 1 to 9 days). No mortality was encountered. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure in sickle cell patients. It should be a multidisciplinary approach and involve a haematologist, an anaesthesiologist and a surgeon.

BACKGROUND: Male breast cancer (MBC) is rare. The objective of the study is to report clinicopathological characteristics, treatment patterns, and outcomes of MBC. METHODS: This study, which includes two parts (retrospective and prospective), focused on all hospitalized male patients with breast cancer during 17 years (1992–2008) with histological confirmation. RESULTS: The series included 22 patients. The mean age was 52.8 years (range: 28–80 years). MBC represented 5.7% of all breast cancers. Most patients had an advanced disease with skin ulceration and inflammation T3 (31.9%) and T4 (59.1%). The majority of patients came from rural areas (63.6%). The duration of signs ranged from 1 to 7 years. Histology found infiltrating ductal carcinoma in 14 cases (63.6%), sarcoma in 3 cases (13.6%), papillary carcinoma in 2 cases (9%), and lobular carcinoma, medullar carcinoma, and mucinous carcinoma in 4.6% each of the others cases. The treatment had consisted of a radical mastectomy (Halsted or Patey) in 19 cases (86.4%) with axillary clearance and incomplete resection in 3 cases (13.6%). In the retrospective study follow-up of 14 patients, we lost sight of 13 patients 6 months after surgery. In the prospective study of 8 patients 10 to 36 months after mastectomy, 4 patients were deceased (50%), 4 were alive with 1 case having a local recurrence and pulmonary metastasis. CONCLUSION: The advanced clinical forms of MBC are most frequent with skin ulceration and nodal enlargement. The absence of radiotherapy and the low access of chemotherapy limited the treatment to radical mastectomy (Halsted) in the majority of cases. OBJECTIF : Le cancer du sein chez l’homme (CSH) est une affection rare .Le but de cette étude est de déterminer les caractéristiques clinicopathologiques, les résultats du traitement et l’évolution du CSH. Méthodologie : Il s’agit d’étude comportant 2 volets (rétrospectif et prospectif). Etaient inclus tous les patients de sexe masculin présentant un cancer de sein pendant 17 ans de 1992 à 2006 avec preuve histologique. RESULTATS : La série comportait 22 cas. L’age moyen était de 52,8 ans (Extrêmes : 28 et 80 ans). Le CSH représentait 5,7% des cancers du sein. Les tumeurs étaient cliniquement avancées avec des formes ulcéro-hémorragiques et inflammatoires T3 (31.9%) and T4 (59.1%). La majorité des patients provenaient des zones rurales (63.6%). Les signes évoluaient de 1 à 7 ans. L’examen histologique a retrouvé un carcinome canalaire infiltrant dans 14 cas (63,6%), le fibrosarcome dans 3 cas (13,6%), le carcinome papillaire dans 2 cas (9%) et les autres types dans 1 cas chacun (4,6%) : le carcinome lobulaire, carcinome médullaire, le carcinome épidermoïde .La mastectomie radicale (Patey ou Halsted) avec curage ganglionnaire axillaire été réalisée dans 19 cas (86,4%), et dans 3 cas (13,6%) une exérèse incomplète. L’évolution : dans l’étude rétrospective 13 patients perdus de vue 6 mois après la mastectomie. Dans l’étude prospective après un recul de 10 à 36 mois il a été enregistré 4 décès (50%) et 4 patients sont vivant et un cas avec de récidive locale et métastases hépatiques. CONCLUSION : Le CSH est rare mais non exceptionnel. Le stade est évolué au moment diagnostic et le pronostic est grave. Dans notre environnement la mastectomie radicale constitue dans la plupart des cas le seul moyen thérapeutique lié au faible accès de la radio chimiothérapie.