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Blunt abdominal trauma being one of the most common abdominal emergencies; they explain the patient's indication of armed expectation in the absence of any notion of hemodynamic instability. The objectives were to determine the hospital frequency, to identify the etiologies and to analyze the therapeutic modalities. The study was retrospective and prospective from January 1, 2010 to December 31, 2018 involving 45 patients treated for hemoperitoneum in the general surgery department of Sikasso hospital. All patients admitted to the department for blunt abdominal trauma with hemoperitoneum were included. We collected 45 patients whose mean age was 18.7 years (extreme 3 - 55 years). The sex ratio was 4.6 in favor of men (37 M, 8 F). We found 23 (51.12%) cases of AVP, 13 (28.89%) cases of falls from a height, 11 (7.7%) cases of aggression, hoof kick 1 (2.22%). 19 (42.22%) patients had low haemoperitoneum, 16 (35.56%) medium abundance, 10 (22.22%) high abundance. 32 (71.11%) provided non-operative treatment with a mean hospital stay of 13.7 days (range 5 to 20). 1 patient was unstable, it was activated 24 hours later. We immediately had 12 patients (26.67%) with an average hospital stay of 16.5 days (extreme 10 -24) and the postoperative course was simple in 66.67% (8 cases). We recorded 1 death (2.22%).

In our surgical practice we have experienced abdominal trauma by stretcher. The case we are reporting to you was a 65-year-old subject who was the victim of a motor-cart type traffic accident with piercing of the abdomen. by stretcher and taken to Sikasso hospital. A laparotomy made it possible to discover mesenteric contusions, hemoperitoneum without visceral lesion. We aspirated 200ml of hemoperitoneum after extraction of the stretcher, closure of the abdominal wall. We propose to review the literature in order to discuss the therapeutic modalities.

Introduction: Darier and Ferrant dermatofibrosarcoma is a rare malignant cutaneous mesenchymal tumour, representing less than 0.1% of malignant tumours and less than 5% of soft tissue sarcomas in adults. The aim of this study was to describe the evolutionary profile of cases of dermato fibrosarcoma of Darier et Ferrant reported in the dermato-venereology department of the National Centre for Disease Control (CNAM). Patients and methods: This was a descriptive cross-sectional study conducted in the dermatology department of the National Centre for Disease Control Support between 1991 and 2016, a period of 25 years. Was included, all patient with a histologically confirmed dermatofibrosarcoma notified in the registers of the CNAM histology laboratory or in the patient's medical file during the study period. Results: In total we collected 23 cases out of 5520 biopsied patients, i.e. a proportion of 0.41%. Males represented 60.8% with an average age of 40 years. The lesions were simple nodular in 12 of the 23 patients (52.2%), multi-nodular in 7 of the 23 patients (30.4%), nodulo-ulcerous and in patches in 4 of the 23 patients (17.4%). The lesions were located on the trunk in 60.8% of cases (image 1), on the head in 21.7% of cases and on the limbs in 17.5% of cases. The mean size of the lesions was 10×8cm with extremes of 3cm×3cm to 25cm×20cm. Management was exclusively surgical. Conclusion: DFSP is a rare tumour with a slow evolution, characterised by its rare metastasis but above all by its strong tendency to recurrence. The diagnosis is often evoked clinically and confirmed by histological study. The treatment of DFSP is surgical based on a large and deep lesion removal. Clinical monitoring allows early detection of recurrence, which is frequent in this disease.

Introduction: The purpose of this study was to conduct an analysis of the diagnostic and therapeutic aspects of prostate abscess and a review of the literature. Clinical Observation: We report the case of a 24-year-old patient; admitted to our ward for acute detention associated with a febrile state at (38°C). On physical examination, the digital rectal examination could not assess the condition of the prostate due to severe pain and the rest of the examination was unremarkable. We formulated the following diagnostic hypotheses: prostate abscess, prostate cyst, acute prostatitis. Ultrasound allowed the diagnosis of a prostatic intraparenchymal cyst. The CBC reveals hyperleukocytosis and the ECBU came back positive for Escherichia coli. The diagnosis of a prostate abscess was retained after a guided echo puncture. Treatment consisted of transperineal drainage combined with antibiotic therapy suitable for ECB of pus aspirated during ultrasound-guided puncture. The evolution was favourable. Conclusion: Prostatic abscess is a rare pathology. Faced with a prostate collection in a febrile context, a puncture under ultrasound guidance could confirm the diagnosis. His treatment of choice remains endoscopic drainage and adapted antibiotic therapy.

Summary: Sister Mary Joseph nodule is a metastatic localization with a generally abdominal-pelvic origin and secondary to a primary adenocarcinoma in 90% of cases. We report an observation of Sister Mary Joseph nodule revealing a primary adenocarcinoma of the colon in a young adult with multiple pathologies. Observation: A 57-year-old patient, followed for hepatitis B, HIV1+, and benefiting from a therapeutic regimen (Tenofovir+Lamivudine+Dolutegravir) since 2019 and later a hyperthyroidism of incidental discovery. For one year he has had a firm nodular ulceration measuring 07 cm in its longest axis, with a reddish-pink appearance and whitish deposits, a haemorrhagic ooze on contact, and located at the umbilicus. Also, a tongue laden with whitish coatings that are easily removed with a tongue depressor and the inner surface of the cheeks and palate are erythematous. Bilateral exophthalmos abolished vocal vibrations in both lung bases; two hard left inguinal adenopathies adhering to the deep plane, painless, 3 cm in diameter each. He also described episodes of alternating constipation and diarrhoea accompanied by abdominal pain, coughing, physical asthenia and weight loss (40% loss in 2 years). Anatomopathology of a fragment of the nodule revealed a well-differentiated adenocarcinoma whose tumour cells were of colorectal origin and expressed CK20 and CK8/18. Colonoscopy revealed a multilobed polyploid tumour of the ascending colon and histology concluded that it was a liberkuhnian adenocarcinoma. A chest CT scan revealed pulmonary and abdominal-pelvic metastases and the diagnosis of a Sister Mary Joseph nodule revealing a colonic and metastatic adenocarcinoma was made. The patient was referred to the oncology department for palliative care after the surgical opinion. Conclusion: The nodule of Sister Marie Joseph is a cutaneous metastasis revealing a cancer of the abdominopelvic sphere. This rare and characteristic tumour deserves to be known by practitioners .......

Introduction: Fibrothecal group tumours are part of the gonadal stromal and sex cord tumours (GSST) and represent 1-4.7% of all organic ovarian tumours and are usually benign. We felt it important to report a case in order to share our experience in the management of fibrothecal tumours of the ovary. Observation: This was a 51-year-old postmenopausal patient who was referred to the hospital for abdominal pain in the context of an abdominal mass. A clinical examination and abdominal ultrasound concluded that the left ovarian tumour was benign. A left annecxectomy was performed and the histological examination concluded that the tumour was benign. No tumour marker was measured and no CT scan was performed. The postoperative course was simple and the patient was followed for 3 months.

Objective: To determine the X-ray, ultrasound, and epidemiological profile of the victims of the attacks of March and April 2019 received at the Mopti hospital. Materials and Methods: This was a cross-sectional study of the victims of the armed attacks of March and April 2019 received at Mopti hospital. The study included all stroke victims who had an x-ray or ultrasound during this time. The variables were the socio-demographic profile, the etiological mechanism, the imaging means and their results. Data analysis was done with SPSS version 25 and Excel 2016 software. Results: The most common age group was 15-29 years old at 35.4%. Men predominated with 66.7%. Civilians were more affected, 83.3%. Firearms accounted for 93.8% of the etiologies. The x-ray was no longer performed, ie 66.7%. The lower limbs were more affected with 31.8%. Fractures of the limbs and the presence of bullets were anomalies most frequent with 25% each one. Conclusion: The majority of the injured were predominantly young and male civilians. Firearms were the most common etiology with predominant involvement in the lower extremities. Radiography was the most used imaging method, and the most common abnormalities were fractures and the presence of ballistic fragments. Gastrointestinal perforation was the most suspected lesion on ultrasound.

Objective: To investigate the outcomes of different dose-splitting radiotherapy regimens after radical or modified radical surgery for early-stage breast cancer. Material and methods: Between 2015 and 2020, 412 patients treated with radiotherapy after radical or modified radical surgery for early-stage breast cancer were allocated into 3 groups according to different dose-splitting regimens of postoperative radiotherapy. Conventional radiotherapy group157 cases, 2Gy/ fraction, once/day, 5 times/week, DT50 Gy; Alternate-day radiotherapy group 202 cases, 3 Gy/fraction, 3 times/week, DT45Gy; Fast radiotherapy group 53 cases, Days 1 and 3, 5Gy/fraction, Days 15 and 17, 6.5 Gy/fr, DT23Gy. Overall, 318 cases were treated with chemotherapy and/or hormone therapy. For the whole group, the 5-year overall and disease-free survival rates were 87.4% and 89.6% respectively. The 5-year disease-free survival rates for the Conventional radiotherapy group, the Alternate-day radiotherapy group, and the Fast radiotherapy group were 90.8%, 86.5%, and 84.6% (P=0.13).The locoregional recurrence rates were 7.0%, 9.9 and 5.7 respectively. There was no significant difference between the three groups in terms of local control. Conclusion: With similar 5-year disease-free-survival rates, and the same efficacy, Alternate-day radiotherapy has the advantage of giving fewer fractions, which is suitable for a unit with limited resources. Fast radiotherapy shortens the duration of the treatment, and its efficacy and toxic effects deserve further study.

The aim of the work was to describe the epidemiological, clinical and therapeutic aspects of peritonitis by gastroduodenal perforation. Patients and methods: the study was retrospective, and descriptive from January 2010 to December 2013.It was carried out in the general surgery department of the hospital of Sikasso (Mali). Patients operated for gastric and/or duodenal perforation were included. The parameters studied were frequency, age, sex, clinical aspects, and treatment, postoperative. Results: The clinical records of 54 patients were collected. Gastroduodenal perforations accounted for 9.2% of digestive perforations. The mean age of the patients was 34.8 years, with a sex ratio =9.8 at the risk of men. The notion of taking non-steroidal anti-inflammatory drugs was found in 72.2%, an ingestion of plant decoction in 18.5%, a history of gastritis in 7.4%, a history of peptic ulcer in 8%. Abdominal pain was present in all patients; vomiting in 19 patients. The average duration of evolution of the symptomatology was 36 hours. On physical examination the most frequent signs were abdominal contracture in 96.2% of patients; a disappearance of prehepatic dullness in all patients. On digital rectal examination Douglas-fir was bulging and painful in 24 patients. X-ray of the abdomen without preparation found pneumoperitonea in 77.7% of patients. An excision, suture plus omentoplasty were performed in 52 patients. Surgical follow-ups were simple in 77.9% patients, with a morbidity of 12.9% and a mortality of 9.3%. Conclusion: Peritonitis by gastroduodenal perforation is a frequent pathology in our context. It can cause a high mortality. Early diagnosis and treatment could improve outcomes.

Plummer Vinson syndrome is a rare condition characterized by cervical dysphagia associated with iron deficiency anemia and a ring on the upper esophagus. Sometimes its unusual presentation can lead to misdiagnosis. We report the observation of a patient with Plummer-Vinson syndrome, revealed by upper dysphagia.

Introduction: The aim of this study was to analyze the epidemioclinical aspects of iatrogenic urological lesions, to describe the anatomical lesions and to establish a link between surgery and these lesions. Materials and methods: Descriptive and retrospective study carried out in the urology department of Sikasso hospital from January 2016 to December 2018. Results: In total, 26 patients suffering from iatrogenic urological lesions secondary to gyneco-obstetric surgery were recruited, ie 2.86% of our activities and 17.74% of female urogenital lesions. Average age: 31, 88 ± 11, 54 years old; Average age at 1st marriage: 15.00 ± 1.87 (12 - 20). Almost all of our patient was out of school, homemaker, in unpaid jobs and 83.33% from rural Sikasso. Seventeen patients (65, 38%) were 1.55 m shorter and of these 25% had not received antennal care. Labor stagnation (mean duration: 47, 22 ± 20, 48 hours) was the main indication with 90.47% of stillbirths. The main complaint (92, 30%) of our patients was leakage of urine, followed by abdominal-lumbar pain and abdominal distension associated with anuria. Urogenital fistulas (91.66%); urinary tract infection (20.83%) and acute renal failure 11.53% were common complications. The most common causal operation (76.91%) was cesarean section, often performed by general practitioners. The bladder was more frequently (65, 40%) affected by these injuries than the ureter (34, 60%). Regarding the surgical approach, an open transvesical fistulorrhaphy in two planes or a vesicoureteric reimplantation was performed. The result was excellent in 88, 46% of cases and bad in 11 and 53%. Conclusions: Iatrogenic urologic complications of gyneco-obstetric surgery were not uncommon. Early diagnosis and appropriate management could improve its prognosis. The preventive measures are based on the promotion of girls' education and socio-economic life, good antennal care and the continuing training of health care providers in charge of managing obstetric

Introduction: Uterine rupture is one of the main causes of maternal and fetal mortality in Mali. Method: This was a descriptive cross-sectional prospective study in the Gynecology - Obstetrics department of the Sikasso hospital from January 01, 2018 to June 30, 2019, i.e. eighteen months. The study covered all cases of childbirth recorded in the Gynecology - Obstetrics Department of Sikasso Hospital during the study period. Results: During these 18 months of study, we recorded 68 cases of uterine rupture out of a total of 4,815 deliveries, ie a frequency of 1.41%. Regarding the mode of admission, 93% were evacuated against 7% who came on their own. For the evacuated patients, 82.4% arrived by ambulance against 13.2% by personal car and 4.4% by public transport. The duration of labor was ≥ 12 hours in 22.1% of cases. Lesions were associated with rupture in 19.1% of cases. The use of uterotonics was responsible for uterine rupture in 54.4% of cases and 7.4% of patients had a generally narrowed pelvis. Simple hysterorrhaphy was performed in 30%, hysterorrhaphy associated with tubal ligation resection in 50% and subtotal hysterectomy in 20% of cases. Lack of schooling, the lack and poor quality of prenatal care have been factors that increase maternal and perinatal morbidity and mortality. The maternal-fetal prognosis was poor with 11.7% maternal deaths and 86.8% perinatal deaths. Conclusion: Better screening of populations at risk, quality ANC, early diagnosis and rapid and adequate management will improve the maternal-fetal prognosis.

Goiter is the most common endocrine pathology in the world [2]. Its medical treatment is based on hormone therapy, iodotherapy and its surgical treatment is based on thyroidectomy. Familial goiter appeared to be more common in the gotrigenic regions of Europe, rarer in North America. In Africa, particularly in Mali, there have been few studies on familial goiter. The purpose of this study was to report 4 cases of goiter in the same siblings with a history of goiter in the mother and paternal grandmother to review the literature.

Antibiotics remains an issue in intensive care units (ICUs), because of its overuse and the emergence of bacterial resistance. The objective of the study was to evaluate the prescription of antibiotics in ICUs at university teaching and the regional hospitals in Mali. PATIENTS AND METHODS: It was a cross sectorial retrospective and multicentric study over six months. The inclusion criteria were, all the patients hospitalized in ICUs at least for 48 hours with antibiotic treatment. We also included the cost of the daily consumption of antibiotics. The Microsoft excel was used for data entry and the data analysis was done with the software Epi info version 3.5.2. RESULTS: Five hundred sixty-and-six (566) patient les responded to the inclusion criteria. The antibiotics prescription rate was 43.3%. The mean age of the patients was 36.8 ± 20.7. The women were more represented (59.7%). The monotherapy (60.6%) was the most common concept use. The third-generation cephalosporin (3GC) was used in monotherapy (27.7%). The average volume of consumption of antibiotics in monotherapy was the highest. The analysis of the data showed that the volume consumption of antibiotics was different according to grade of the prescribers which was respectively 98972.3 for anaesthesia & intensive care residents and 74990.7 for anaesthetist-intensivist. The treatment was reviewed during the rst 48 hours (99.8%) and was readapted in 106 of the patients (18.7%). We mainly increased the doses of antibiotics 77.4%. The average duration of the treatment was 5.2 ± 3.7 (days). CONCLUSION: The use of antibiotics remains high and uncontrol in intensive care units in Mali, which could be explain by the limited blood culture testing and insufcient of qualied human resource in some of the regional hospitals.

Appendicular mucocele is a rare appendicular tumor characterized by dilation of the appendicular lumen with linear changes in the mucosa and hypersecretion of mucus. We report a case of appendicular mucocele in a 73-year-old patient. Clinically, there was pain in the right iliac fossa, nausea, sometimes vomiting, and a poorly defined mass palpated in the right iliac fossa. The abdominal ultrasound found an appendicular plastron and the complete blood count showed leukocytosis. The patient underwent an appendectomy and the operative consequences were simple, the pathological examination of the operative specimen concluded that there was a mucinous cystadenoma of the appendix.

Clitoral cyst remains a common pathology in our regions given the persistence of traditional female genital mutilation practices. Cyst forms in the bed of clitoris carried entirely by excision. In our case the consultation was motivated by the size of the cyst, psychological trauma, discomfort and gravity caused by the tumor. Our gesture consisted of surgical exeresis with attempt to restore little lips. The operating procedures were simple and the result was satisfactory. Through this case we want to highlight the complications of excision and the treatment of clitoral scar cyst.