Reasons for Elective Surgery Cancellations in a Senegalese Pediatric Surgery Department

Introduction: Cancellation of elective surgery is common in developing countries. This decision is difficult to make as it generates economic and organizational consequences for the healthcare facility and an additional source of stress for patients and their caregivers. This study aimed to analyze the various aspects of this medical problem. Patients and Methods: We conducted a prospective and descriptive study over six months (from January 1st, 2017, to June 30th, 2017) at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Senegal. Results: Ninety-one cases were collected. The cancellation rate was 20.8%. Infants were affected in 36.3% of cases. Among anesthesiologists, 83.5% were residents, and 16.5% were specialists. Cancellation in nephroblastoma children with an indication for extended nephrectomy represented 15.4% of cases. Concerning reasons for cancellation, comorbidities, dominated by respiratory infections, accounted for 28.5% of cases, patient absences for 24.2%, and issues related to the anesthesiologist for 17.6%. Cancellations were avoidable in 33% of cases. Patients were responsible for cancellation in 37.4% of cases, the healthcare system in 33%, and medical reasons in 29.7%. Conclusion: Our findings suggest that one-third of cancellations could have been avoided with improvements in the healthcare system. Actions should be taken to reduce the cancellation rate in our context.

Domestic Accidents in Under-Fives: Epidemiology, Diagnosis, Management, and Outcomes

Introduction: Domestic accidents are a public health problem, and under-fives are particularly affected. We report these accidents’ epidemiology, diagnosis, management, and outcomes through this study. Patients and Methods: We conducted a prospective descriptive study for four months in the Albert Royer National Children’s Hospital Center pediatric surgery department in Dakar, Senegal. Of the 149 cases of domestic accidents, 109 were included in this study. Results: Infants (59.6%) were the most affected, with a slight male predominance (50.5%). Accidents occurred on Tuesday in 22.9% of cases and the afternoon in 38.5% of cases. Playing (59.6%) was the main activity, and falling (44%) was the most found mechanism. 78.9% of accidents occurred in the house, with the bedroom (27.5%) being the most represented place. In most cases (67.9%), the consultation was done within the first 24 hours. The upper limbs (48.6%) were the most affected, and fractures (31.2%) were the most frequent injuries. The outcomes were unremarkable in 94.5% of cases, as complications occurred in five patients with three who had an infection, one a persistent limping, and the last, a dental avulsion. No mortality was recorded. Conclusion: Domestic accidents among under-fives are frequent in our environment. Compared to those in older children, they occur similarly in both sexes, more often in the bedroom, and have a better prognosis.

Persistent Congenital Paraurethral Cyst, a Rare Cause of Dysuria in a Girl

Congenital paraurethral cyst rarely occurs. Its natural history is spontaneous regression, leading to conservative management adoption. We report an exceptional case of a 13-year-old female with a persistent congenital paraurethral cyst, leading to dysuria. We surgically excised the cyst, and the outcomes were unremarkable 20 months postoperatively.

Delayed Management of High-Grade Renal Trauma in a Child with Bilateral Lower Polar Artery: A Case Report

High-grade renal trauma rarely occurs due to low-velocity mechanisms. With its clinical presentation, delayed diagnosis rarely happens. We report the case of a 12-year-old girl diagnosed seven days post-trauma with grade IV renal trauma complicated with infected urinoma and bilateral lower polar vessels. She was non-operatively managed with ultrasound-guided percutaneous drainage of the urinoma, which resolved, and had unremarkable six months follow-up. We discuss the role of preexistent hydronephrosis in low-velocity impact, pitfalls of diagnosis in resource-constrained settings, and management of high-grade trauma.

Management and Outcome of Ureteropelvic Junction Obstruction in Senegalese Children

Introduction: The ureteropelvic junction obstruction is a rare congenital malformation of the upper urinary tract. We report its management and outcome at Senegal’s main pediatric surgical department. Patients and Methods: We conducted a descriptive review of all patients managed in our pediatric surgical department at Albert Royer National Children’s Hospital Centre from January 1st, 2013 to December 31st, 2017. Results: Thirty patients were included in our study. The mean age was three years. Males were more affected (sex ratio of 2.75). The prenatal diagnosis was made in 23% of cases using prenatal ultrasonography. An abdominal mass was the circumstance of discovery in 36% of cases, and lumbar contact and renal sloshing were found in 66% of cases. There was no renal function impairment in 93% of cases. Urinary tract infection occurred in 50% of cases. Ultrasonography (100%) and urinary computed tomography (56%) were used to diagnose. A temporary nephrostomy was performed in 23% of cases, and as definitive treatment, an open Anderson-Hynes procedure was performed in 96% as a nephrectomy was made in a patient. Early postoperative complications were encountered in 56% of cases: urinary tract infection (36%), surgical site infection and anastomotic stenosis (6% both), and urinoma and textiloma (both in 3%). A patient died from sepsis. After a mean follow-up of 12 months, no additional complication was reported. Conclusion: Ureteropelvic junction obstruction was frequently diagnosed late, and its management carried unneglectable morbidity in our environment. A laparoscopic approach would be a solution to improve its outcome.

Abdominal Cerebrospinal Fluid Pseudocyst—A Rare Complication of Ventriculoperitoneal Shunt

An abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunt. Several theories have been suggested to explain its occurrence. The main symptoms are painful abdominal distension and vomiting, abdominal distension on examination, as abdominal ultrasound and computed tomography confirm its diagnosis. The treatment involves drainage associated with drain relocation and resection of the pseudocyst’s wall. We report two patients diagnosed with this condition who underwent surgical treatment. The first patient had an unremarkable 12-month follow-up, while the second died on the seventh postoperative day due to intravascular disseminated coagulation. In these patients, the cause has not been identified;however, an infection cannot be ruled out.

Obstructive Uropathies: Epidemiological Features and Diagnostic Approaches in Dakar

Introduction: Obstructive uropathies refer to anatomical impediments to normal urinary flow. They are predominantly caused by congenital malformations of the urinary tract and occasionally complicated by obstructive urinary stones. This study aims to elucidate the epidemiological and diagnostic facets of obstructive uropathies. Patients and Method: This retrospective, descriptive study was conducted over six years, from January 1, 2018, to December 31, 2023, at the pediatric surgery department of Albert Royer Children’s Hospital in Dakar, Senegal. The study focused on the frequency of obstructive uropathies, the sex ratio, discovery contexts, types and locations of uropathies, and associated malformations. Results: Among the 29,935 children received in the department during the study period, 130 cases of obstructive uropathies were documented, equating to a hospital incidence of 0.43%. The mean age of patients was 42.53 months, ranging from one day to 15 years. Infants constituted the largest affected group, at 47.69%. The cohort included 106 males and 24 females, rendering a sex ratio of 4.41. The antenatal diagnosis was confirmed in 27 patients (20%). Uretero-hydronephrosis emerged as the predominant clinical indication. Postnatally, urinary disorders prompted consultation in 36% of cases. Ultrasound examinations were performed universally. Additionally, VUCG was conducted in 49% of patients to identify lower urinary tract obstructions, while 39% underwent urological CT scan for upper tract obstruction etiology. Renal distress with electrolyte imbalance was evident in 8% of cases. Concurrent urogenital pathologies were present in 18% of cases. Notably, posterior urethral valves accounted for 39%, pyeloureteric junction obstruction for 31%, obstructive caliceal and pelvic lithiasis at 8%, and obstructive ureteral lithiasis at 6%. Other obstruction causes included obstructive megaureter on simple systems (3%), ectopic ureter in duplex systems (2%), urethral stenosis (2%), obstructive urethral lithiasis (2%), obstructive bladder lithiasis (2%), obstructive megaureter in duplex systems (1%), ureterocele in duplex systems (1%), ureteral stenosis (1%), and ureterocele with obstructive bladder lithiasis (1%). Conclusion: Predominantly malformative in origin, obstructive uropathies necessitate ultrasound of the urinary tract as a primary diagnostic tool. Their etiologies are posterior urethral valves, pyeloureteric junction obstruction, and obstructive urolithiasis.

Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal

Objective Patients with congenital malformations(CMs)of the gastrointestinal tract(GIT)have a very high mortality.However,the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa.The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department.Methods We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021.Patients were subdivided into two groups based on the outcomes,and variables with a significant difference were analyzed by logistic regression.Results Our review included 226 patients,63 of whom died(27.88%).Patient age ranged from 0 to 15 years.Taking into account statistical significance,mortality was more frequent in neonates than in older patients(57.30%vs 6.15%),in patients coming out of the Dakar area than in those from the Dakar area(43.75%vs 19.18%),in patients with abnormal prenatal ultrasound than in those with normal ultrasound(100%vs 26.67%),in premature children than in those born at term(78.57%vs 21.87%),in patients with an additional malformation than in those with an isolated malformation(69.23%vs 25.35%),and in those with intestinal,esophageal,duodenal and colonic atresia than in those with other diagnoses(100%,89%,56.25%and 50%,respectively).Referred patients died more than those who changed hospitals or came from home(55.29%vs 25%and 9.09%,respectively).On multivariable logistic regression,two independent factors of mortality were identified:presence of associated malformation[odds ratio(OR)=13.299;95%Confidence interval(CI)1.370 to 129.137]and diagnosis of esophageal atresia(OR=46.529;95%CI 5.828 to 371.425).Conclusion The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.