Sigmoid Colon Volvulus: Surgical Management at Kati BSS Hospital (Mali)

The objective of this study was to describe the therapeutic aspects and to evaluate the surgery results of sigmoid Volvulus in the Kati (MALIA) General Surgery Department. Patients and Methods: This was a descriptive study conducted in our General Surgery Department. It took place in two phases for six years: A retrospective phase from January 1st, 2010 to December 31st, 2015 and a prospective phase from January 1st, 2016 to December 31st, 2017. This study has been approved by the Ethics Committee. It’s concerned all the patients operated in the department for colon Volvulus. Results: We collected 70 patients’ files. The Sigmoid Volvulus represented 7.8% of emergency surgery activities and 37.2% of intestinal obstruction. The male sex predominated with 98.57% against 1.43% of the female sex. The average age was 42.11 years old with limits of 18 to 70. The average deadline evolution was 2.53 days with limits of 1 to 3. The sigmoidectomy with immediate anastomosis was performed in 66% of patients, colectomy with 2-times anastomosis: according to Hartman 20% and Bouilly Volkman 11%, detorsion with colopexy 3%. The early morbidity rate was 5.71%. The average duration of hospitalization was 10.8 days with limits of 5 to 40 days. Two deaths were recorded. Conclusion: Sigmoid Volvulus is frequent in young adult sex male in Africa. We did not find any significant difference between the surgical technique and the advent of complications. The Colectomy with immediate anastomosis seems to be ideal to us that anytime the conditions are appropriate.

Ileal Occlusion on Bezoars at Kati BSS Hospital

Bowel occlusions by bezoars are rare pathologies. They are due to an ob-struction of the intestinal lumen by a solid mass of fruits or undigested vegetable fibers. They are seasonal (wild fruit season from March to June) in the Sahel Zone. We report a case of small bowel obstruction in a 35-year-old rural man after swallowing a significant amount of wild grapes (Lannea microcarpa). We proceeded to the resection of the occluded ileal segment and performed an ileal terminal ileal anastomosis. There weren’t any complications during the postoperative site.

Volvulus of the Sigmoid Colon without Necrosis: Therapeutic Aspects in Hospital Fousseyni Daou Hospital in Kayes, Mali

The volvulus of the sigmoid is known since ancient Egypt. In the 5th century BC, hippocrates laid the foundations for its management. The first observation of this condition was not reported until 1836 by Von Rokitansky, and then in 1859, Melchior described its physiopathological consequences. It was the Norwegian Brusgaard who reported, for the first time, in 1947, the effectiveness of a non-operative treatment. Purpose: Describe morbidity, mortality and the impact of co-morbidity factors on the choice of operative techniques. Patients and Methods: This is a retrospective cross-sectional study performed at the Fousseyni Daou Hospital in Kayes from January 2014 to December 2021. We included all patients operated for sigmoid volvulus without necrosis. The parameters studied were the comorbidity factor, surgical modalities, morbidity and mortality. Results: We collected 31 patients, of whom 29 were men and 2 were women, for a sex ratio of 14.5. The mean age was 55 years with extremes (29 - 78 years). Sigmoidectomy with colorectal anastomosis was performed in 19 cases (61.3%), the average age of these patients was 46.16 years, the comorbidity factor was 1 case (3.2%), the postoperative course was simple in 12 cases (63.1%), the morbidity was 6 cases (26.3%) and mortality 1 case (3.2%). Untwisting with colopexy was performed in 11 cases (35.5%), the average age was 65.91 years, comorbidities were present in 9 cases (82%), the postoperative course was simple in 9 cases (82%), morbidity was 1 case (9%) and mortality 1 case (9%). Hartman colostomy was performed in 1 case (3.2%), the age was 60 years, the morbidity was nil. Overall, the postoperative course was simple in 22 cases (71%), the overall morbidity was 7 cases (22.6%) and mortality 2 cases (6.4%). Conclusion: At the end of our study, we can note that the choice of the operative technique for the volvulus of the sigmoid without necrosis can be influenced by the presence of major comorbidity and the morbi-mortality depends on it.

Ulcero-Necrotic Wound: Socio-Economic Impact, Kayes, Mali

The issue of wound care has always played an important role in the practice of medicine. This is evidenced by Ambroise Paré’s decision to publish his first work on this subject, “La manière de traiter les Plaies” (The Way of Treating Wounds) in 1545. Objective: To evaluate the therapeutic methods we practice and to describe the impact of the pathology on socio-economic and professional development. Patients and Method: This was a retrospective study carried out at the Fousseyni Daou Hospital in Kayes from January 1, 2018, to December 31, 2020. We included all patients with an ulcero-necrotic wound on immunocompetent terrain hospitalized in the department. Patients with ulcerative necrotic wounds of diabetes, HIV, or cancerous origin were not included. The parameters studied were: etiologies, local care, sequelae, and socio-economic and professional aspects. Results: We collected 57 patients of whom 43 were men and 14 were women, i.e. a sex ratio of 3. The mean age was 40.7 years with a standard deviation of 8.4 with extremes (7 years and 80 years). The average consultation time was 25.1 days. The most represented socio-professional stratum was agropastoralism in 37 cases (65%). The predominant etiological factor was neglected traumatic wounds in 34 cases (59.6%). The site was the lower limb in 39 cases (68.5%). The germ found was Staphylococcus aureus in 21 cases (36.8%). The particularity during local care was the use of table sugar in 9 cases (15.7%) and maggot therapy in 2 cases (3.5%). Hyperthermia was the clinical sign of aggravation in 22 cases (38.6%) and we diagnosed 2 cases (3.5%) of tetanus. The mortality rate was 15.7% (9 cases) and 30 cases (52.7%) of sequelae after recovery. The average length of hospitalization was 38 days. Hospital care was provided by the social welfare service in 35 cases (61.4%). Nineteen (19) patients (39.5%) were unable to resume their socio-professional activity. Conclusion: Ulcero-necrotic wounds are complex to manage and can have a lifelong influence on the socio-professional and economic activity of patients.

Anatomical Dissection of the External Branch of the Superior Laryngeal Nerve to the Laboratory of Anatomy of the Faculty of Medicine of Bamako(Mali)

Aim: This study aimed at describing the anatomical variations of the external branch of the superior laryngeal nerve and at estimating the frequency of nerves at risk during the thyroid surgery. Methodology: We realized a forward-looking study from September, 2016 in May 31st, 2018 in the laboratory of anatomy of the Faculty of Medicine and Odontostomatology of Bamako in Mali. All the fresh anatomical subjects not carrying trauma and or a scar at the level of the previous region of the neck were held. The anatomical subjects were not included presenting a traumatic lesion and\or a scar of the previous region of the neck. Results: We realized 34 dissections of the external branch of the superior laryngeal nerve to 17 deathly subjects (11 men and 6 women with a sex-ratio of 1.8). The average age of the subjects was of 42 years (extremes: 18 and 70 years). Our study allowed highlighting in 100% of the cases, the external branch of the superior laryngeal nerve and the superior thyroid artery so to the right as to the left. On 34 dissected external branch of the superior laryngeal nerve, none had a previous route. However we found 28 nerves (82.4%) having a later route, stuck to the external face of the lower constrictor of the pharynx. These were not mixed with the superior thyroid artery and its branch of division and were situated outside the thyroid capsule. In 17.6% of the cases (6 cases), the nerve had a route mixed in the branch of the superior thyroid artery. These were found inside of the capsule (11.8% adhered to the artery and 5.8% crossed its branch of division). Conclusion: The risk of injury of the external laryngeal nerve during thyroid surgery procedure is never zero. It is more important on the left side.

Adventitial Rupture of the Ascending Thoracic Aorta Extended to the Buttock by Thoracic Crushing between Two Tanks at the Thoracic and Cardiovascular Surgery Department at the Besançon CHRU

Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.

Traumatic Break of the Ascending Aorta: About a Case

The traumatic break of the ascending aorta is rare. We bring report the case of a 40-year-old man, a victim of accident of the public highway having caused a break of the posterior face of the ascending aorta. The explorations scanno graphique and per operating highlighted this break. The treatment consisted of an edge-to-edge direct suture of the ascending aorta.

The Pericarditis in CHU of Point G and Luxembourg: Clinical Aspects and Etiologies

The authors bring back 70 cases of pericarditis brought together between 2012 and 2017 in the service of surgery B of the CHU Point G and to the Hospital Mother-Child, the Luxembourg in Mali. The average age of the patients is 31.5 years with extremes of 2 years and 84 years. The tubercular etiology widely comes to mind with 49 cases. The diagnostic contributions of the echocardiography are analyzed. The accent is put on good tolerance hemodynamic of the tubercular pericarditis. The forecast depends essentially on the etiology and on the diagnostic delay;indeed the tamponade pericardium can be inaugural or complicated;the evolution of the pericarditis is burdened of a heavy mortality (4.2% in our series). On the other hand the passage in the chronicity complicates essentially pericarditis seen late (8.6% in our series).