Digestive Bleeding by Rupture of Esophageal Varicose Veins and Prognosis Value of Blood Transfusion in the Hepatogastroenterology Department of the Gabriel Toure Hospital

Digestive hemorrhage by rupture of esophageal Varices is common and has a pejorative prognosis in our context. Purpose: The main purpose of this work was to study the digestive bleeding by esophageal varices and prognosis value of blood transfusion in the Hospital of Gabriel Touré. Methodology: It was a prospective study that took place in the service of Hepato-gastroenterology of Gabriel Touré Hospital from June 2016 to May 2017 and from November 2017 to August 2018. Results: At the end of the study, 77 patients met the inclusion criteria out of 1396 patients hospitalized during the same period. Varices bleeding represented a prevalence of 5.5% among hospitalized patients during the same period. The average age of our patients was 46.58 ± 15.09 years. The male sex was more reported in our study with a prevalence of 67.5%. At admission, 63.2% had clinical anemia, 58.4% low arterial pressure and 50.6% hemoglobin rate less than 7 g/dL. Blood transfusion was indicated in 47 patients (61%). The mortality rate was 23.4% and was comparable in both groups (p = 0.0990). Early rebleeding was significantly observed in the case of transfusion (p = 0.0452). Hepatic encephalopathy was the leading cause of death of our patients with 72.2%. Conclusion: Digestive bleeding by esophageal varices is a worsen complication in cirrhosis in hospital setting. Transfusion has not significantly improved the prognosis of our patients.

Splenectomy in the Surgery Department “A” at the University Hospital Point G Bamako

We conducted a retrospective study that included patients with erythrocyte and hemolytic pathology justifying a splenectomy and patients presenting splenic trauma for which hemostasis splenectomy is required. We performed 27 total splenectomy in which 26 are by laparotomy (92.86%) and 1 by laparoscopy (3.57%). A partial splenectomy was performed by laparoscopy. The morbidity was marked by 2 cases of infectious syndrome and 1 case severe anemia. The mortality was 7.14% (n = 2). Splenectomy is part of the therapeutic arsenal for benign or malignant hematological disorders that constitute the main indication for elective splenectomy. Splenectomy was one of the most common operations in abdominal surgery. During the past decade, an increased rate of late complications, specially septic and thromboembolic complications are well documented. The risk is related to the indication of splenectomy, and is less than 1% in adults without immunodeficiency. However, these overwhelming postsplenectomy infections are associated with a high mortality rate. The best treatment of these infections is preventive measures which are based on vaccination and education of asplenic patients.

Acute Upper Digestive Bleedings in Hospital in Bamako

The main objective of this work was to update the data on the epidemiological, clinical, etiological and prognostic aspects of these acute upper digestive hemorrhages. It was a prospective study for a period of 11 months (from March 2013 to January 2014) at the digestive endoscopy center of Gabriel Touré University Hospital in Bamako. At the end of this study, 63 patients had acute upper digestive bleeding (AUDB) among 954 hospitalized patients, that is to say a frequency of 6.7%. The sex ratio was 3.5. The average age of our patients was 45 ± 16.57 years with extremes of 15 and 84 years. A notion of smoking, epigastralgia and none steroid anti-inflammatory drugs (NSAIDs) were more reported in the history with respectively 14 patients (22.3%), 10 patients (15.9%) and 4 patients (6.3%), but haematemesis had occurred in 24 (38.1%) patients without any antecedent. The main causes of hemorrhage were rupture of oesophageal varices in 34 (57.6%) patients and peptic ulcers in 18 (30.5%) patients. Early recurrence occurred in 7 (11.1%) patients resulting in the death of 5 patients for an overall mortality of 9 patients among 63 (14.3%). Acute high digestive hemorrhages are always serious. The correct management of the hemorrhagic episode by haemostatic gestures when available and the causes of haemorrhage improve the prognosis.

Perforations of Gastro-Duodenal Ulcers in the Surgery Department “A” at the University Hospital Point G Bamako

The purpose of this study was to investigate the clinical and therapeutic aspects of peritonitis by perforation of gastric and duodenal ulcer. This was a retrospective and descriptive study over 8 years (2010-2018) which allowed to collect 54 cases of peptic ulcer. Included in the study were all patients with confirmed gastroduodenal perforation on histology or laparotomy. We collected 54 cases of peptic ulcer perforated s. The age group of 30 - 49 years was the majority. The male sex was dominant with 90.7% of cases;the clinical picture was dominated by abdominal contracture associated with pain in 74.07% of cases. X-ray of the abdomen without preparation (AWP) revealed in 87.03% of cases of pneumoperitoneum. The perforation was in 68.52% of cases on the gastric antrum and in 31.48% on the duodenum. The surgical procedure used was the bank of excision, and a suture reinforcement epiploic in 68.52% of cases, a simple suture made in 31.48% of cases, the disease was marked by a fistula (1.90%) and mortality was 5.55% of cases. The gastroduodenal ulcer perforation is potentially serious and responsible peritonitis whose surgical treatment involves the peritoneal toilet and sutures the puncture.

The Lithiasis of Choledoque: Epidemiological Aspects, Clinics and Therapeutiques in the Surgery Department “A” at the University Hospital Point G

Considered as rare in Africa lithiasis of the main bile duct (MBD) is a potentially serious pathology, diagnosis is facilitated by imaging tests (ultra-sound, CT, MRI cholangiopancreatography). Its surgical management is improved by laparoscopy coupled with interventional endoscopy. However, laparotomy remains the only way in Mali. This was a 14-years retrospective and descriptive study (2010-2014). All patients with BPV lithiasis were included. We studied the field, antecedents, clinical, biological, radiological, therapeutic and outcome aspects. 40 cases of stones in the main bile duct were collected during the study period. The hospital frequency was 2.8 cases per year, the clinical signs dominated by the Charcot triad (pain, fever, jaundice) found in 40 cases (100%). The average age was 60 years, female represented 70% of cases. Ultrasonography was the most requested review in 40 cases (100%). The procedure performed was cholecystectomy associated with choledochotomy with calculation extraction in all patients (100% of cases). One case of biliary fistula and one case of wall abscess were observed. The mortality was 5% and the simple suited in 90% of the cases. The lithiasis of the main bile duct is an infrequent pathology in Mali and potentially serious. This diagnosis is assisted in our context by ultrasound and CT. Laparotomy remains the only route of entry in Mali.