Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune fu...Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: Splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the rule.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Sigmoid colon volvulus is a medico-surgical emergency which represent...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Sigmoid colon volvulus is a medico-surgical emergency which represents a common cause of colonic occlusion,</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">it is characterized by strangulation of the sigmoid loop around its meso colic axis producing low mechanical occlusion </span></span></span><span><span><span style="font-family:" color:#c45911;"=""><a href="#ref1" target="_blank"><span style="font-family:Verdana;">[1]</span></a></span><span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. Apart from this form conventionally described, the volvulus of the sigmoid colon can occur along an organoaxial axis. This form has been highlighted in the literature thanks to the diagnostic contribution of multi-detector scanners </span></span></span><span><span><span style="font-family:;" "=""><span style="color:#C45911;"><a href="#ref2" target="_blank"><span style="font-family:Verdana;">[2]</span></a></span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the hospital frequency of sigmoid colon volvulus;to write the clinical and para-clinical aspects of sigmoid colon volvulus;write down the different treatments used for the management of sigmoid colon volvulus</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Material and methods:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> This was a retrospective and prospective study that took place from January 2008 to December 2020 in the General Surgery Department of Gabriel Touré. The retrospective phase ran from January 2008 to December 2019 and the prospective phase from January 2020 to December 2020.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2008 to December 2020, we collected 320 cases of patients operated on for sigmoid colon volvulus out of 7989 surgical emergencies over a 12-year period, or 3.64%. In our study, the most represented age group was between 16 and 60 years old, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 81.88%. The mean age was 42.6 ± 17.4 years with extremities of 16 and 90 years. The male sex was the most represented, 89% with a sex ratio of 8.41. The surgical history was found in 13.75% of our patients. The clinic was dominated by abdominal pain (100%), meteorism (100%), and gas and matter arrest (91.3%). The most common radiological image found in the ASP was the double jamb, </span><i><span style="font-family:Verdana;">i</span></i></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 74.69% of cases. We found sigmoid necrosis in 18.13% of cases. We found an absence of necrosis in the majority of cases, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 91.56%. The most performed operative procedure in our patients was the RACR, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 75.63% of cases. The reoperation was performed in only 5.94% of our patients. Complications were grade V in 42.55% according to the Clavin Dindo classification.</span></span></span>展开更多
In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of ...In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of any motivated surgical team. <strong>Objective:</strong> To analyze the rate and the main causes of mortality in the General “A” surgical department of the Point “G” CHU. <strong>Patients Method:</strong> Our study was retrospective, descriptive and covered a period of 5 years from 01/01/2014 to 12/31/2018. We collected 152 deaths for 2011 hospitalized patients. The data were collected from the files of these deaths on pre-established investigation forms. The deceased patients were classified as operative and non-operative death, death from non-cancerous and cancerous diseases, deaths occurring in emergencies and deaths in regulated surgery. <strong>Results:</strong> We recorded 152 cases of death for 2011 hospitalized patients, either an overall mortality rate of 7.55%. The average age of deaths was 44.20 years +- 17.51 years with extremes ranging from 7 years to 85 years. The sex ratio was 1.62 in favor of men. The causes of death were represented by cancerous pathologies (69 deaths or 34.67%), non-cancerous pathologies (83 deaths or 4.58%). <strong>Conclusion:</strong> The mortality rate in general surgery remains high and is mainly linked to cancerous pathologies and the delay in taking care of patients.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Emergency medico-surgical ileosigmoid node is a rare cause of intesti...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Emergency medico-surgical ileosigmoid node is a rare cause of intestinal obstruction. Diagnosis and treatment must be prompt. <b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the frequency of NIS, to describe the diagnostic aspects, therapeutic aspects and to analyze the postoperative effects. </span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">Retrospective</span> an<span style="font-family:Verdana;">d prospective study from January 2006 to December 2020 including all patients operated on for ileosigmoid node confirmed by the intraoperative diagnosis at the CHU Gabriel Touré. </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2006 to December 2020 (15 years), 30 cases of ileo-sigmoid node were recorded in the service. During this period NIS accounted for 0.19% of surgeries. Abdominal pain was present in (100%) of cases, vomiting was present in 80% and cessation of materials and gas (57%). All of our patients underwent ASP and CT (1 case). All of our patients were operated on, and exploration revealed intestinal necrosis in 97%. The surgical procedures performed were colostomy according to </span><span style="font-family:Verdana;">HARTMANN (63%), anastomosis resection (16%), devolvulation (10%). Restoration of continuity was achieved in (73%). The postoperative consequences were straightforward in (80%). Morbidity was 17% including infection of the lining. Mortality was 3% (1 case). <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">NIS is an emergency, the diagnosis and the management must be fast and precise.</span>展开更多
The objective of this study is to determine the epidemiological, clinical, paraclinical, therapeutic aspects, and the sensitivity to antibiotics for acute peritonitis at CHRAB Franceville. This was a prospective, desc...The objective of this study is to determine the epidemiological, clinical, paraclinical, therapeutic aspects, and the sensitivity to antibiotics for acute peritonitis at CHRAB Franceville. This was a prospective, descriptive and analytical study, between September 2015 and December 2021. Generalized acute peritonitis was one of the digestive surgical emergencies. There were 167 patients operated on for acute peritonitis, including 116 men (69.46%) and 51 women (30.34%). The majority of patients came from Franceville (n = 62) 37.12%. The average age was 33.4 years (extreme 4 years and 75 years). The admission time was on average +6.15 or -6.54 hours. The main etiology was acute appendicitis with (n = 122) 73.05%, followed by gastric perforations (n = 26) 15.56%, bowel perforations (n = 5) 2.99%. Some post-surgical cases (n = 4) 2.39%. Biological examinations found: hyperleukocytosis in 64.67% of cases, anemia in 52.9% of cases, and hematocrit down in 28.3% of cases. Ultrasounds found 17.36% peritoneal effusions and 12.57% acute appendicitis. The abdomen without preparation revealed 13.17% cases of pneumoperitoneum. Anatomy pathology found acute appendicitis, gastroduodenal ulcers, peritoneal tuberculosis, and peritoneal carcinomatosis. Biliary drainage choledotomy with Kher drain, supernumerary spleen splenectomy, hysterectomy. The average duration in intensive care was 6.5 days with extremes of 5 to 10 days. The average stay in inpatient surgery was 10.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication. We had recorded 2 cases of fistula and 4.19% of deaths.展开更多
Acute appendicitis is an acute inflammation of the appendix. It is a surgical emergency. It was a prospective, descriptive and analytical study, between September 2015 and October 2021, focusing on acute appendicitis....Acute appendicitis is an acute inflammation of the appendix. It is a surgical emergency. It was a prospective, descriptive and analytical study, between September 2015 and October 2021, focusing on acute appendicitis. It is seen mainly in young subjects and in children, but not exclusively. Its diagnosis is essentially clinical. These were 124 patients operated on for acute appendicitis, with a male predominance: 78 men (62.90%) against 46 women (37.10%). The majority of patients came from Franceville (n = 66) 53.22%. The average age was 29.4 years (extremes 4 years and 54 years). The average admission time was +5.16 or -5.58 hours. Abdominal pain was the main reason for consultation. Physical signs were dominated by MAC Burney sign positivity in 91.1% of cases. Faced with certain doubtful cases, we requested an abdominal ultrasound. Phlegmonous appendicitis was the most frequent (n = 47) 45.96%. The ileocecal localization represented (n = 82) 66.12%, and other particularities in particular: Claudius AMIAND (n = 6), an appendicular duplication, appendicitis and pregnancy a case of crural appendicitis. Conventional appendectomy with burial by Mac Burney was the most used technique (n = 119) 95.42%. Anatomy pathology was rarely performed. The postoperative course was simple in 95.4% of cases. The average stay in inpatient surgery was 4.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication.展开更多
Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the differe...Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the different therapeutic strategies. This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years. The study involved 87 women with an average age of 33.2 years. Patients consulted 66 times or 75.9% for breast mass. The size of the tumor was greater than or equal to 5 cm in 62 patients;it was localized in the supero external quadrant 41 times or 47.1%. Molecular classification revealed the following results: Luminal A 21.4%;receptive (HER2) positive 28.6%, and triple negative 42.9%. Stage II was the most represented with 47.4%. Histology found infiltrating carcinoma of non-specific type in 76 patients. The treatment was mastectomy axillary dissection in 66 patients, quadrantectomy + axillary dissection in 6 cases (6.9%) associated with radiotherapy in 6 patients, chemotherapy was performed in 79 of our patients and hormone therapy in 10 patients. Conclusion: Breast cancer is frequent in our country. Patients generally consult us at a late stage. The possibility of determining certain receptors and carrying out certain non-surgical treatments on site would improve the prognosis.展开更多
<strong>Introduction:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. <strong>Methodology:</strong&...<strong>Introduction:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. <strong>Methodology:</strong> The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. <strong>Result:</strong> We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. <strong>Conclusion:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and management. In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery “A” department of the Point G Hospital.展开更多
<strong>Introduction:</strong> Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is th...<strong>Introduction:</strong> Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4<sup>th</sup> most common cancer in men, the 5<sup>th</sup> in women, and the third leading cause of cancer death in men, the 5<sup>th</sup> in women. <strong>Patients and Methods:</strong> This was an analytical, prospective and descriptive study. <strong>Study Framework:</strong> Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. <strong>Study Period:</strong> August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). <strong>Inclusion Criteria:</strong> All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. <strong>Result:</strong> The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%);Stage III (21 cases, or 27.27%);Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases;cardiac fundus in 2 cases;antrum in 24 cases;antro-pyloric in 28 cases;Pylorus in 1 case;great curvature in 5 cases;small curvature in 2 cases. Postoperative complications were: parietal infection in 12 cases or 17.40%;digestive fistula in 3 cases and evisceration is 1.40%. The overall three-month survival rate was 51.90% and at 6 months was 48.10%. <strong>Conclusion:</strong> Stomach cancer is the most common digestive cancer in Mali. In Africa the diagnosis is usually late and the R1 lymph node dissections remain the basic technique, despite the results obtained in the Japanese series. The results of several major series argue for their effectiveness in improving patient survival.展开更多
<strong>Introduction:</strong> Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or ...<strong>Introduction:</strong> Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis;it’s a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. <strong>Patients-Method:</strong> This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019;conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. <strong>Results:</strong> During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%;morbidity and high mortality were related to delayed consultation. <strong>Conclusion:</strong> Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.展开更多
<strong>Introduction:</strong> Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemo...<strong>Introduction:</strong> Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemorrhoidal anatomical disease and the symptoms described by patients. Our objective was to assess the incidence of hemorrhoidal disease, to diagnose it and to propose therapeutics. <strong>Patients and Method:</strong> This was a prospective and descriptive study based on a pre-established protocol that had taken place over a 12-month period. All patients (92 cases) underwent a general examination and a proctological examination. Anoscopy has often been associated with rectoscope with or without biopsy of the rectal mucosa. The inclusion criteria were the finding of hemorrhoidal disease, associated or not with other proctological diseases and the criteria for non-inclusion was any other anorectal pathology. <strong>Results:</strong> Among our patients there were 69 men or 75% of cases and 23 women or 25% of cases. The sex ratio was 3 in favor of men, the average age was 35.42. The duration of progression of the disease was between 0 - 2 years in 59.78%. Constipation (60 cases or 66.3%) and diarrhea (60 cases or 22.8%) were the factors that triggered the disease. Hemorrhoids with 3 packets were the most common (49 cases or 53.26%). 56 patients were treated medically and 36 patients were operated on. The surgical technique was simple hemorrhoidectomy according to MILLIGAN and MORGAN. It was associated with a fissurectomy in 8.33% of cases, a fistulectomy in 13.90% of cases or a thrombectomy in 33.33%. Early surgical sequels were dominated by pain in all patients, rectorragie, and urine retention. We did not deplore any deaths. <strong>Conclusion:</strong> Hemorrhoidal disease is an anatomoclinical entity that is still poorly elucidated and no direct link between the nature of the lesions and symptomatology can be established.展开更多
<strong>Introduction:</strong> Appendicular abscess is a progressive complication of acute appendicitis in which the spread of infection is contained by the greater omentum and the slender loops resulting ...<strong>Introduction:</strong> Appendicular abscess is a progressive complication of acute appendicitis in which the spread of infection is contained by the greater omentum and the slender loops resulting in the formation of a true septate abscess of the large peritoneal cavity. <strong>Materials and Methods:</strong> This was a retrospective study from January 2010 to December 2019 carried out at the Bocar Sidi Sall University Hospital in Kati (CHU BSS in Kati) in general surgery. It concerned all patients operated on for appendicular abscess in the department. <strong>Results:</strong> 75 cases of appendicular abscess were collected, which represented 5.76% of surgical emergencies and 25% of acute appendicitis. The average age of the patients was 29 years. The male sex represented 67% of our patients with a sex ratio of 2. The average consultation time was 5 days. Abdominal pain was noted in all patients. It was localized in the right iliac fossa in 80% (n = 60) and diffuse in 2.7% of cases (n = 2). It was accompanied by nausea and vomiting in 93% of cases (n = 70), urinary disorders in 20% (n = 15), fever in 94% (n = 71), cessation of materials and gas in 1.33% (n = 1). Abdominal ultrasound was performed in 86% (n = 65). It made it possible to suggest a peri-appendicular effusion. Biological examination revealed a neutrophilic hyperleukocytosis greater than 20,000/mm3 in 47 patients, or 63%. All the patients were operated on by laparotomy (Marc Burney or midline subumbilical) under general anesthesia. The length of hospitalization was 6 days. We have not recorded any deaths. Morbidity was 8% (n = 6) represented by parietal suppuration. The postoperative course was straightforward in 92% of cases (n = 69). <strong>Conclusion:</strong> Appendicular abscess is a frequent medico-surgical emergency, the prognosis of which depends greatly on early diagnosis and adequate and immediate management.展开更多
Objectives were to determine the frequency, describe the epidemiological and clinical aspects, therapeutic and analyze the postoperative course. Methodology: This was a retrospective study that covered 08 years (Janua...Objectives were to determine the frequency, describe the epidemiological and clinical aspects, therapeutic and analyze the postoperative course. Methodology: This was a retrospective study that covered 08 years (January 2009-December 2017). Inclusion criteria: all patients operated for obstruction of the small bowel by hail and/or flanging. Exclusion criteria: other types of occlusion and non-operated patients. Result: We recorded a total of 162 cases of hail obstruction by adhesions and/or flanges at 2.87%. The average age was 32.04, the sex ratio was 1.2. The average consultation time was 4 days. Abdominal pain associated with stopping of material and gas was present in all our patients. X-ray of the abdomen without preparation carried out in all the patients made it possible to objectify in 150 patients (92.6%) of the hydro-hail levels. Inoperative occlusion of hail on flange was present in 80 patients (49.4%). Occlusion of the small bowel on flange and adhesion was present in 69 patients. Adhesion obstruction of hail accounted for 6.8% (11 cases). The most commonly used surgical technique was flange resection in 91 patients (56.2%). The follow-up was simple in 151 patients (93.2%). Mortality was 1.2% of cases, i.e. 2 deaths. The average duration of hospitalization was 6 days. Conclusion: Occlusion of the small bowel by flanging and/or adherence is a surgical emergency whose prognosis depends on early management.展开更多
In Mali, breast cancer remains a real health problem in the absence of an adequate and adapted health policy for their early diagnosis and their often late or even non-existent treatment. Objectives: This study aimed ...In Mali, breast cancer remains a real health problem in the absence of an adequate and adapted health policy for their early diagnosis and their often late or even non-existent treatment. Objectives: This study aimed to study the epidemiological, diagnostic, and therapeutic aspects of breast cancer to write the clinical aspects of breast cancer in the gynecology-obstetrics department of the CHU Gabriel Touré from 2020 to 2022. Methodology: This was a retrospective and descriptive study of 219 cases of breast cancer that were diagnosed in the gynecology and obstetrics department of the CHU Gabriel Touré in Bamako, from 2020 to 2022. Results: The annual frequency was 77.2 cases per year, the average age 45.55 years with extremes of 16 to 85 years;housewives represented 92.7%;multiparas were reported at 57%. Considering the history, the personal history of benign breast pathology was 55.6%. Regarding the localization, the left breast was the most affected with 53.9%, and the tumor was found in the supero-external quadrant in 53.9%. The cancer was metastatic in 81.28%. The diagnosis biopsy + histology contributed to 98.6%. The histological type was invasive carcinoma of non-specific type in 95%. As for the histoprognostic grade of SBR studied, grade II was predominant at 46%, grade III at 34.95%. The therapeutic strategy was chemotherapy in 83.1%. Neoadjuvant chemotherapy followed by surgery in 10%, primary surgery in 6.4%, radiotherapy in 0.5%. Conclusion: The major challenges in the fight against breast cancer in Mali remain a better organization of the system for early diagnosis, the establishment of a screening program, early diagnosis in women from the age of 40 and also adequate care.展开更多
We report a case of pharyngeal foreign body with cutaneous migration in the form of a fishbone in a 24-year-old rural resident, presented with odynophagia, dysphagia, pain and left antero-latero-cervical swelling fist...We report a case of pharyngeal foreign body with cutaneous migration in the form of a fishbone in a 24-year-old rural resident, presented with odynophagia, dysphagia, pain and left antero-latero-cervical swelling fistulated to the skin following ingestion of a fishbone during a meal that had been evolving for 2 weeks. Vital parameters were normal, with an unremarkable psychological examination. Clinical examination revealed a left antero-latero-cervical swelling that was painful to palpation, fistulous to the skin and draining frank pus, revealing a sharp fishbone. A standard X-ray showed that the foreign body had exited the pharynx and was located in the soft tissues of the lower neck. An exploratory cervicotomy was performed, allowing extraction of a serrated fishbone. The post-operative course was favorable.展开更多
Objectives:The rate of obesity has been increasing globally,so is the number of obese patients undergoing bariatric surgery.The relationship between brain-derived neurotrophic factor(BDNF)and body weight has been high...Objectives:The rate of obesity has been increasing globally,so is the number of obese patients undergoing bariatric surgery.The relationship between brain-derived neurotrophic factor(BDNF)and body weight has been highlighted in recent years,but there are few related studies in China.The purpose of this study was to investigate the changes of BDNF in obese patients before and after bariatric surgery and to provide evidence for obesity-related mechanisms.Methods:The BDNF levels in 44 obese patients who underwent bariatric surgery were measured by enzyme-linked immunosorbent assay(ELISA)before and 4.5 months after surgery.SPSS 27.0 was used for statistical analysis.Results:Among the 44 patients,30 were female and 14 were male.The body mass index(BMI)decreased significantly after bariatric surgery(P<0.001);the serum BDNF of the patients significantly increased(P<0.001)after surgery.There was no significant difference in BDNF among patients with different degrees of obesity before and after surgery(P>0.05).There were no significant differences in BMI and BDNF levels between different sexes before and after surgery(P>0.05).Conclusion:The BDNF levels of obese patients increased significantly after bariatric surgery,which proved that bariatric surgery has an effect on BDNF levels.展开更多
Thyroidectomy is a complete or partial surgical removal of the thyroid gland. The aim was to review the particularities of thyroid surgery in children, to review our operative indications and our working method as wel...Thyroidectomy is a complete or partial surgical removal of the thyroid gland. The aim was to review the particularities of thyroid surgery in children, to review our operative indications and our working method as well as the results by comparing them with the data in the literature. This was a retrospective study covering a sixteen-year period from January 2003 to December 2018. We collated 29 patient records from 3 to 15 years of age. The epidemiological aspect, the indication and the operative gesture, the anatomopathological result were studied. Data were processed using Epi Info version 3.5.4 and Microsoft Excel 2010. Our study shows that thyroid surgery in children accounted for 2% of all thyroidectomies performed (1350 cases). Females were most affected, with a sex ratio of 0.16. The mean age was 12 years, with extremes of 3 and 15 years. Three indication groups: Graves’ disease 62%, heteromulti nodular goiter (HMNG) 28%, thyroid nodule 10%. Thyroid surgery was total in 65.5% of cases;subtotal thyroidectomy in 20.7%. Partial thyroidectomy was performed in 13.7% of cases. We dissected 54 recurrent nerves, and the parathyroids were controlled. Drainage was systematic. We noted one complication (3.4%). It involved immediate postoperative dyspnea requiring a life-saving tracheotomy, and decanulation was performed 48 hours after surgery.展开更多
BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatecto...BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatectomy in patients with biliary tract cancer.METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023.Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging.The incidence,severity,timing,location,and treatment of the bile leaks were recorded.The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses.RESULTS The incidence of bile leak was 16.7%(20/120),and most cases were grade A(75%,15/20)according to the International Study Group of Liver Surgery classification.The median time of onset was 5 d(range,1-14 d),and the median duration was 7 d(range,2-28 d).The most common location of bile leakage was the cut surface of the liver(70%,14/20),followed by the anastomosis site(25%,5/20)and the cystic duct stump(5%,1/20).Most bile leaks were treated conservatively with drainage,antibiotics,and nutritional support(85%,17/20),whereas some required endoscopic retrograde cholangiopancreatography with stenting(10%,2/20)or percutaneous transhepatic cholangiography with drainage(5%,1/20).Risk factors for bile leakage include male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion.CONCLUSION Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer.However,most cases are mild and can be conservatively managed.Male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion were associated with an increased risk of bile leak.展开更多
目的旨在通过系统综述,确定针对复杂慢性病患者增强自我管理的干预措施,以改善慢性呼吸困难,为护理人员促进该类人群的自我管理提供依据。方法2023年12月,系统检索Medline、Scopus、Web of Science、CINAHL、Cochrane图书馆和乔安娜布...目的旨在通过系统综述,确定针对复杂慢性病患者增强自我管理的干预措施,以改善慢性呼吸困难,为护理人员促进该类人群的自我管理提供依据。方法2023年12月,系统检索Medline、Scopus、Web of Science、CINAHL、Cochrane图书馆和乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证实践数据库。对纳入研究进行数据提取和综合,研究人员采用Rayyan文献管理软件筛选标题及摘要,并依据JBI研究质量评估工具进行方法学质量评估。结果共纳入18项研究。这些研究探讨了针对慢性呼吸困难的各种干预措施,包括药物干预(氧气疗法和吸入疗法)和非药物方法(教育计划、呼吸练习、液体摄入管理、身体感知技术、同伴支持、情商培训和网络应用程序的使用)。这些干预措施减轻了患者情绪困扰,可以使患者在自我管理方面变得独立自主。结论促进复杂慢性病患者对慢性呼吸困难的自我管理需要采取综合方法,但目前研究中没有充分考虑到针对患者行为改变的干预措施,需要进一步开展相关研究完善干预措施。展开更多
BACKGROUND Gastric IgG4-related disease(IgG4-RD)is rarely encountered in clinical practice,and especially more so among pediatric patients.To our knowledge,this is the first report of IgG4-RD presenting as a calcifyin...BACKGROUND Gastric IgG4-related disease(IgG4-RD)is rarely encountered in clinical practice,and especially more so among pediatric patients.To our knowledge,this is the first report of IgG4-RD presenting as a calcifying gastric mass in a child.We describe how this entity was difficult to differentiate from a gastrointestinal stromal tumor(GIST)imaging-based approaches.Therefore,this case highlights the importance of considering IgG4-RD in the differential diagnosis of gastric tumor before performing surgical resection,especially to distinguish it from malignancy to avoid unnecessary surgery.CASE SUMMARY The patient suffered from epigastric pain for several days.Panendoscopy and computed tomography scan revealed a submucosal tumor.Differential diagnoses included GIST,leiomyoma,teratoma,and mucinous adenocarcinoma.However,laparoscopic proximal gastrectomy allowed for the definitive diagnosis of IgG4-related stomach disease.CONCLUSION We emphasize the importance of considering IgG4-RD in the differential diagnosis of gastric submucosal tumors before performing surgical resection.展开更多
文摘Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: Splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the rule.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Sigmoid colon volvulus is a medico-surgical emergency which represents a common cause of colonic occlusion,</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">it is characterized by strangulation of the sigmoid loop around its meso colic axis producing low mechanical occlusion </span></span></span><span><span><span style="font-family:" color:#c45911;"=""><a href="#ref1" target="_blank"><span style="font-family:Verdana;">[1]</span></a></span><span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. Apart from this form conventionally described, the volvulus of the sigmoid colon can occur along an organoaxial axis. This form has been highlighted in the literature thanks to the diagnostic contribution of multi-detector scanners </span></span></span><span><span><span style="font-family:;" "=""><span style="color:#C45911;"><a href="#ref2" target="_blank"><span style="font-family:Verdana;">[2]</span></a></span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the hospital frequency of sigmoid colon volvulus;to write the clinical and para-clinical aspects of sigmoid colon volvulus;write down the different treatments used for the management of sigmoid colon volvulus</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Material and methods:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> This was a retrospective and prospective study that took place from January 2008 to December 2020 in the General Surgery Department of Gabriel Touré. The retrospective phase ran from January 2008 to December 2019 and the prospective phase from January 2020 to December 2020.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2008 to December 2020, we collected 320 cases of patients operated on for sigmoid colon volvulus out of 7989 surgical emergencies over a 12-year period, or 3.64%. In our study, the most represented age group was between 16 and 60 years old, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 81.88%. The mean age was 42.6 ± 17.4 years with extremities of 16 and 90 years. The male sex was the most represented, 89% with a sex ratio of 8.41. The surgical history was found in 13.75% of our patients. The clinic was dominated by abdominal pain (100%), meteorism (100%), and gas and matter arrest (91.3%). The most common radiological image found in the ASP was the double jamb, </span><i><span style="font-family:Verdana;">i</span></i></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 74.69% of cases. We found sigmoid necrosis in 18.13% of cases. We found an absence of necrosis in the majority of cases, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 91.56%. The most performed operative procedure in our patients was the RACR, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 75.63% of cases. The reoperation was performed in only 5.94% of our patients. Complications were grade V in 42.55% according to the Clavin Dindo classification.</span></span></span>
文摘In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of any motivated surgical team. <strong>Objective:</strong> To analyze the rate and the main causes of mortality in the General “A” surgical department of the Point “G” CHU. <strong>Patients Method:</strong> Our study was retrospective, descriptive and covered a period of 5 years from 01/01/2014 to 12/31/2018. We collected 152 deaths for 2011 hospitalized patients. The data were collected from the files of these deaths on pre-established investigation forms. The deceased patients were classified as operative and non-operative death, death from non-cancerous and cancerous diseases, deaths occurring in emergencies and deaths in regulated surgery. <strong>Results:</strong> We recorded 152 cases of death for 2011 hospitalized patients, either an overall mortality rate of 7.55%. The average age of deaths was 44.20 years +- 17.51 years with extremes ranging from 7 years to 85 years. The sex ratio was 1.62 in favor of men. The causes of death were represented by cancerous pathologies (69 deaths or 34.67%), non-cancerous pathologies (83 deaths or 4.58%). <strong>Conclusion:</strong> The mortality rate in general surgery remains high and is mainly linked to cancerous pathologies and the delay in taking care of patients.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Emergency medico-surgical ileosigmoid node is a rare cause of intestinal obstruction. Diagnosis and treatment must be prompt. <b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the frequency of NIS, to describe the diagnostic aspects, therapeutic aspects and to analyze the postoperative effects. </span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">Retrospective</span> an<span style="font-family:Verdana;">d prospective study from January 2006 to December 2020 including all patients operated on for ileosigmoid node confirmed by the intraoperative diagnosis at the CHU Gabriel Touré. </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2006 to December 2020 (15 years), 30 cases of ileo-sigmoid node were recorded in the service. During this period NIS accounted for 0.19% of surgeries. Abdominal pain was present in (100%) of cases, vomiting was present in 80% and cessation of materials and gas (57%). All of our patients underwent ASP and CT (1 case). All of our patients were operated on, and exploration revealed intestinal necrosis in 97%. The surgical procedures performed were colostomy according to </span><span style="font-family:Verdana;">HARTMANN (63%), anastomosis resection (16%), devolvulation (10%). Restoration of continuity was achieved in (73%). The postoperative consequences were straightforward in (80%). Morbidity was 17% including infection of the lining. Mortality was 3% (1 case). <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">NIS is an emergency, the diagnosis and the management must be fast and precise.</span>
文摘The objective of this study is to determine the epidemiological, clinical, paraclinical, therapeutic aspects, and the sensitivity to antibiotics for acute peritonitis at CHRAB Franceville. This was a prospective, descriptive and analytical study, between September 2015 and December 2021. Generalized acute peritonitis was one of the digestive surgical emergencies. There were 167 patients operated on for acute peritonitis, including 116 men (69.46%) and 51 women (30.34%). The majority of patients came from Franceville (n = 62) 37.12%. The average age was 33.4 years (extreme 4 years and 75 years). The admission time was on average +6.15 or -6.54 hours. The main etiology was acute appendicitis with (n = 122) 73.05%, followed by gastric perforations (n = 26) 15.56%, bowel perforations (n = 5) 2.99%. Some post-surgical cases (n = 4) 2.39%. Biological examinations found: hyperleukocytosis in 64.67% of cases, anemia in 52.9% of cases, and hematocrit down in 28.3% of cases. Ultrasounds found 17.36% peritoneal effusions and 12.57% acute appendicitis. The abdomen without preparation revealed 13.17% cases of pneumoperitoneum. Anatomy pathology found acute appendicitis, gastroduodenal ulcers, peritoneal tuberculosis, and peritoneal carcinomatosis. Biliary drainage choledotomy with Kher drain, supernumerary spleen splenectomy, hysterectomy. The average duration in intensive care was 6.5 days with extremes of 5 to 10 days. The average stay in inpatient surgery was 10.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication. We had recorded 2 cases of fistula and 4.19% of deaths.
文摘Acute appendicitis is an acute inflammation of the appendix. It is a surgical emergency. It was a prospective, descriptive and analytical study, between September 2015 and October 2021, focusing on acute appendicitis. It is seen mainly in young subjects and in children, but not exclusively. Its diagnosis is essentially clinical. These were 124 patients operated on for acute appendicitis, with a male predominance: 78 men (62.90%) against 46 women (37.10%). The majority of patients came from Franceville (n = 66) 53.22%. The average age was 29.4 years (extremes 4 years and 54 years). The average admission time was +5.16 or -5.58 hours. Abdominal pain was the main reason for consultation. Physical signs were dominated by MAC Burney sign positivity in 91.1% of cases. Faced with certain doubtful cases, we requested an abdominal ultrasound. Phlegmonous appendicitis was the most frequent (n = 47) 45.96%. The ileocecal localization represented (n = 82) 66.12%, and other particularities in particular: Claudius AMIAND (n = 6), an appendicular duplication, appendicitis and pregnancy a case of crural appendicitis. Conventional appendectomy with burial by Mac Burney was the most used technique (n = 119) 95.42%. Anatomy pathology was rarely performed. The postoperative course was simple in 95.4% of cases. The average stay in inpatient surgery was 4.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication.
文摘Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the different therapeutic strategies. This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years. The study involved 87 women with an average age of 33.2 years. Patients consulted 66 times or 75.9% for breast mass. The size of the tumor was greater than or equal to 5 cm in 62 patients;it was localized in the supero external quadrant 41 times or 47.1%. Molecular classification revealed the following results: Luminal A 21.4%;receptive (HER2) positive 28.6%, and triple negative 42.9%. Stage II was the most represented with 47.4%. Histology found infiltrating carcinoma of non-specific type in 76 patients. The treatment was mastectomy axillary dissection in 66 patients, quadrantectomy + axillary dissection in 6 cases (6.9%) associated with radiotherapy in 6 patients, chemotherapy was performed in 79 of our patients and hormone therapy in 10 patients. Conclusion: Breast cancer is frequent in our country. Patients generally consult us at a late stage. The possibility of determining certain receptors and carrying out certain non-surgical treatments on site would improve the prognosis.
文摘<strong>Introduction:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. <strong>Methodology:</strong> The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. <strong>Result:</strong> We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. <strong>Conclusion:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and management. In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery “A” department of the Point G Hospital.
文摘<strong>Introduction:</strong> Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4<sup>th</sup> most common cancer in men, the 5<sup>th</sup> in women, and the third leading cause of cancer death in men, the 5<sup>th</sup> in women. <strong>Patients and Methods:</strong> This was an analytical, prospective and descriptive study. <strong>Study Framework:</strong> Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. <strong>Study Period:</strong> August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). <strong>Inclusion Criteria:</strong> All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. <strong>Result:</strong> The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%);Stage III (21 cases, or 27.27%);Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases;cardiac fundus in 2 cases;antrum in 24 cases;antro-pyloric in 28 cases;Pylorus in 1 case;great curvature in 5 cases;small curvature in 2 cases. Postoperative complications were: parietal infection in 12 cases or 17.40%;digestive fistula in 3 cases and evisceration is 1.40%. The overall three-month survival rate was 51.90% and at 6 months was 48.10%. <strong>Conclusion:</strong> Stomach cancer is the most common digestive cancer in Mali. In Africa the diagnosis is usually late and the R1 lymph node dissections remain the basic technique, despite the results obtained in the Japanese series. The results of several major series argue for their effectiveness in improving patient survival.
文摘<strong>Introduction:</strong> Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis;it’s a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. <strong>Patients-Method:</strong> This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019;conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. <strong>Results:</strong> During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%;morbidity and high mortality were related to delayed consultation. <strong>Conclusion:</strong> Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.
文摘<strong>Introduction:</strong> Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemorrhoidal anatomical disease and the symptoms described by patients. Our objective was to assess the incidence of hemorrhoidal disease, to diagnose it and to propose therapeutics. <strong>Patients and Method:</strong> This was a prospective and descriptive study based on a pre-established protocol that had taken place over a 12-month period. All patients (92 cases) underwent a general examination and a proctological examination. Anoscopy has often been associated with rectoscope with or without biopsy of the rectal mucosa. The inclusion criteria were the finding of hemorrhoidal disease, associated or not with other proctological diseases and the criteria for non-inclusion was any other anorectal pathology. <strong>Results:</strong> Among our patients there were 69 men or 75% of cases and 23 women or 25% of cases. The sex ratio was 3 in favor of men, the average age was 35.42. The duration of progression of the disease was between 0 - 2 years in 59.78%. Constipation (60 cases or 66.3%) and diarrhea (60 cases or 22.8%) were the factors that triggered the disease. Hemorrhoids with 3 packets were the most common (49 cases or 53.26%). 56 patients were treated medically and 36 patients were operated on. The surgical technique was simple hemorrhoidectomy according to MILLIGAN and MORGAN. It was associated with a fissurectomy in 8.33% of cases, a fistulectomy in 13.90% of cases or a thrombectomy in 33.33%. Early surgical sequels were dominated by pain in all patients, rectorragie, and urine retention. We did not deplore any deaths. <strong>Conclusion:</strong> Hemorrhoidal disease is an anatomoclinical entity that is still poorly elucidated and no direct link between the nature of the lesions and symptomatology can be established.
文摘<strong>Introduction:</strong> Appendicular abscess is a progressive complication of acute appendicitis in which the spread of infection is contained by the greater omentum and the slender loops resulting in the formation of a true septate abscess of the large peritoneal cavity. <strong>Materials and Methods:</strong> This was a retrospective study from January 2010 to December 2019 carried out at the Bocar Sidi Sall University Hospital in Kati (CHU BSS in Kati) in general surgery. It concerned all patients operated on for appendicular abscess in the department. <strong>Results:</strong> 75 cases of appendicular abscess were collected, which represented 5.76% of surgical emergencies and 25% of acute appendicitis. The average age of the patients was 29 years. The male sex represented 67% of our patients with a sex ratio of 2. The average consultation time was 5 days. Abdominal pain was noted in all patients. It was localized in the right iliac fossa in 80% (n = 60) and diffuse in 2.7% of cases (n = 2). It was accompanied by nausea and vomiting in 93% of cases (n = 70), urinary disorders in 20% (n = 15), fever in 94% (n = 71), cessation of materials and gas in 1.33% (n = 1). Abdominal ultrasound was performed in 86% (n = 65). It made it possible to suggest a peri-appendicular effusion. Biological examination revealed a neutrophilic hyperleukocytosis greater than 20,000/mm3 in 47 patients, or 63%. All the patients were operated on by laparotomy (Marc Burney or midline subumbilical) under general anesthesia. The length of hospitalization was 6 days. We have not recorded any deaths. Morbidity was 8% (n = 6) represented by parietal suppuration. The postoperative course was straightforward in 92% of cases (n = 69). <strong>Conclusion:</strong> Appendicular abscess is a frequent medico-surgical emergency, the prognosis of which depends greatly on early diagnosis and adequate and immediate management.
文摘Objectives were to determine the frequency, describe the epidemiological and clinical aspects, therapeutic and analyze the postoperative course. Methodology: This was a retrospective study that covered 08 years (January 2009-December 2017). Inclusion criteria: all patients operated for obstruction of the small bowel by hail and/or flanging. Exclusion criteria: other types of occlusion and non-operated patients. Result: We recorded a total of 162 cases of hail obstruction by adhesions and/or flanges at 2.87%. The average age was 32.04, the sex ratio was 1.2. The average consultation time was 4 days. Abdominal pain associated with stopping of material and gas was present in all our patients. X-ray of the abdomen without preparation carried out in all the patients made it possible to objectify in 150 patients (92.6%) of the hydro-hail levels. Inoperative occlusion of hail on flange was present in 80 patients (49.4%). Occlusion of the small bowel on flange and adhesion was present in 69 patients. Adhesion obstruction of hail accounted for 6.8% (11 cases). The most commonly used surgical technique was flange resection in 91 patients (56.2%). The follow-up was simple in 151 patients (93.2%). Mortality was 1.2% of cases, i.e. 2 deaths. The average duration of hospitalization was 6 days. Conclusion: Occlusion of the small bowel by flanging and/or adherence is a surgical emergency whose prognosis depends on early management.
文摘In Mali, breast cancer remains a real health problem in the absence of an adequate and adapted health policy for their early diagnosis and their often late or even non-existent treatment. Objectives: This study aimed to study the epidemiological, diagnostic, and therapeutic aspects of breast cancer to write the clinical aspects of breast cancer in the gynecology-obstetrics department of the CHU Gabriel Touré from 2020 to 2022. Methodology: This was a retrospective and descriptive study of 219 cases of breast cancer that were diagnosed in the gynecology and obstetrics department of the CHU Gabriel Touré in Bamako, from 2020 to 2022. Results: The annual frequency was 77.2 cases per year, the average age 45.55 years with extremes of 16 to 85 years;housewives represented 92.7%;multiparas were reported at 57%. Considering the history, the personal history of benign breast pathology was 55.6%. Regarding the localization, the left breast was the most affected with 53.9%, and the tumor was found in the supero-external quadrant in 53.9%. The cancer was metastatic in 81.28%. The diagnosis biopsy + histology contributed to 98.6%. The histological type was invasive carcinoma of non-specific type in 95%. As for the histoprognostic grade of SBR studied, grade II was predominant at 46%, grade III at 34.95%. The therapeutic strategy was chemotherapy in 83.1%. Neoadjuvant chemotherapy followed by surgery in 10%, primary surgery in 6.4%, radiotherapy in 0.5%. Conclusion: The major challenges in the fight against breast cancer in Mali remain a better organization of the system for early diagnosis, the establishment of a screening program, early diagnosis in women from the age of 40 and also adequate care.
文摘We report a case of pharyngeal foreign body with cutaneous migration in the form of a fishbone in a 24-year-old rural resident, presented with odynophagia, dysphagia, pain and left antero-latero-cervical swelling fistulated to the skin following ingestion of a fishbone during a meal that had been evolving for 2 weeks. Vital parameters were normal, with an unremarkable psychological examination. Clinical examination revealed a left antero-latero-cervical swelling that was painful to palpation, fistulous to the skin and draining frank pus, revealing a sharp fishbone. A standard X-ray showed that the foreign body had exited the pharynx and was located in the soft tissues of the lower neck. An exploratory cervicotomy was performed, allowing extraction of a serrated fishbone. The post-operative course was favorable.
基金supported by the Shanghai Jiaotong University School of Medicine:Nursing Development Program(No.Shanghai Jiaotong University School of Medicine[2021]21)the Program of Shanghai Hospital Development Center(SHDC2022CRS011B)the Shanghai Jiaotong University School of Medicine“High Level Local University Innovation Team”(SHSMU-ZDCX20212802)。
文摘Objectives:The rate of obesity has been increasing globally,so is the number of obese patients undergoing bariatric surgery.The relationship between brain-derived neurotrophic factor(BDNF)and body weight has been highlighted in recent years,but there are few related studies in China.The purpose of this study was to investigate the changes of BDNF in obese patients before and after bariatric surgery and to provide evidence for obesity-related mechanisms.Methods:The BDNF levels in 44 obese patients who underwent bariatric surgery were measured by enzyme-linked immunosorbent assay(ELISA)before and 4.5 months after surgery.SPSS 27.0 was used for statistical analysis.Results:Among the 44 patients,30 were female and 14 were male.The body mass index(BMI)decreased significantly after bariatric surgery(P<0.001);the serum BDNF of the patients significantly increased(P<0.001)after surgery.There was no significant difference in BDNF among patients with different degrees of obesity before and after surgery(P>0.05).There were no significant differences in BMI and BDNF levels between different sexes before and after surgery(P>0.05).Conclusion:The BDNF levels of obese patients increased significantly after bariatric surgery,which proved that bariatric surgery has an effect on BDNF levels.
文摘Thyroidectomy is a complete or partial surgical removal of the thyroid gland. The aim was to review the particularities of thyroid surgery in children, to review our operative indications and our working method as well as the results by comparing them with the data in the literature. This was a retrospective study covering a sixteen-year period from January 2003 to December 2018. We collated 29 patient records from 3 to 15 years of age. The epidemiological aspect, the indication and the operative gesture, the anatomopathological result were studied. Data were processed using Epi Info version 3.5.4 and Microsoft Excel 2010. Our study shows that thyroid surgery in children accounted for 2% of all thyroidectomies performed (1350 cases). Females were most affected, with a sex ratio of 0.16. The mean age was 12 years, with extremes of 3 and 15 years. Three indication groups: Graves’ disease 62%, heteromulti nodular goiter (HMNG) 28%, thyroid nodule 10%. Thyroid surgery was total in 65.5% of cases;subtotal thyroidectomy in 20.7%. Partial thyroidectomy was performed in 13.7% of cases. We dissected 54 recurrent nerves, and the parathyroids were controlled. Drainage was systematic. We noted one complication (3.4%). It involved immediate postoperative dyspnea requiring a life-saving tracheotomy, and decanulation was performed 48 hours after surgery.
文摘BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatectomy in patients with biliary tract cancer.METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023.Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging.The incidence,severity,timing,location,and treatment of the bile leaks were recorded.The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses.RESULTS The incidence of bile leak was 16.7%(20/120),and most cases were grade A(75%,15/20)according to the International Study Group of Liver Surgery classification.The median time of onset was 5 d(range,1-14 d),and the median duration was 7 d(range,2-28 d).The most common location of bile leakage was the cut surface of the liver(70%,14/20),followed by the anastomosis site(25%,5/20)and the cystic duct stump(5%,1/20).Most bile leaks were treated conservatively with drainage,antibiotics,and nutritional support(85%,17/20),whereas some required endoscopic retrograde cholangiopancreatography with stenting(10%,2/20)or percutaneous transhepatic cholangiography with drainage(5%,1/20).Risk factors for bile leakage include male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion.CONCLUSION Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer.However,most cases are mild and can be conservatively managed.Male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion were associated with an increased risk of bile leak.
文摘目的旨在通过系统综述,确定针对复杂慢性病患者增强自我管理的干预措施,以改善慢性呼吸困难,为护理人员促进该类人群的自我管理提供依据。方法2023年12月,系统检索Medline、Scopus、Web of Science、CINAHL、Cochrane图书馆和乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证实践数据库。对纳入研究进行数据提取和综合,研究人员采用Rayyan文献管理软件筛选标题及摘要,并依据JBI研究质量评估工具进行方法学质量评估。结果共纳入18项研究。这些研究探讨了针对慢性呼吸困难的各种干预措施,包括药物干预(氧气疗法和吸入疗法)和非药物方法(教育计划、呼吸练习、液体摄入管理、身体感知技术、同伴支持、情商培训和网络应用程序的使用)。这些干预措施减轻了患者情绪困扰,可以使患者在自我管理方面变得独立自主。结论促进复杂慢性病患者对慢性呼吸困难的自我管理需要采取综合方法,但目前研究中没有充分考虑到针对患者行为改变的干预措施,需要进一步开展相关研究完善干预措施。
文摘BACKGROUND Gastric IgG4-related disease(IgG4-RD)is rarely encountered in clinical practice,and especially more so among pediatric patients.To our knowledge,this is the first report of IgG4-RD presenting as a calcifying gastric mass in a child.We describe how this entity was difficult to differentiate from a gastrointestinal stromal tumor(GIST)imaging-based approaches.Therefore,this case highlights the importance of considering IgG4-RD in the differential diagnosis of gastric tumor before performing surgical resection,especially to distinguish it from malignancy to avoid unnecessary surgery.CASE SUMMARY The patient suffered from epigastric pain for several days.Panendoscopy and computed tomography scan revealed a submucosal tumor.Differential diagnoses included GIST,leiomyoma,teratoma,and mucinous adenocarcinoma.However,laparoscopic proximal gastrectomy allowed for the definitive diagnosis of IgG4-related stomach disease.CONCLUSION We emphasize the importance of considering IgG4-RD in the differential diagnosis of gastric submucosal tumors before performing surgical resection.
