Isolated Caeco-Vesical Fistula: A Case Report

Congenital uro or genito-digestive fistulas are frequently found in the context of caudal pole malformations. Isolated congenital forms without associated anorectal malformation have not been reported until now. We report the first case we know a 9 year old female child received in a pediatric surgery consultation for fecaluria evolving since birth with a permeable anus. She presented a good general condition, a good staturo-ponderal and psychomotor development, a vulva soiled by stool and a permeable anus with a tonic sphincter. A retrograde urethrocystography revealed a caeco-vesical fistula. Surgery consisted of ligation-section of the caeco-vesical septum. A follow-up urethrocystography at three months post-surgery no longer visualized the fistula. Our post-operative follow-up is 4 years. Isolated congenital caeco-vesical fistula is an unknown pathology whose late diagnosis can have serious repercussions.

Rare Neonatal Digestive Surgical Emergencies at the Brazzaville University Hospital Center

The purpose of our study was to evaluate the morbidity-morality of rare neonatal digestive emergencies in order to improve their management. Observations: 7 newborns ranging in age from 6 hours to 3 weeks were treated for rare digestive pathologies between January 2013 and July 2017 (a period of 3 years and 6 months) in the Department of Pediatric surgery of Brazzaville University Center, Congo. Males were predominant (5 versus 2 females). Pathologies listed were: 1 antenatal volvulus of the small intestine, 1 annular pancreas and 5 gastric perforations. The average time of care in the operating room was 12 hours. The newborns were hospitalized in the pediatric surgery department in 28.6% of cases (n = 2), and 71.4% (n = 5) in the neonatology department. The antenatal volvulus of the intestine and annulus pancreas were integrated into a nosologic entity named neonatal occlusion (NNO). The postoperative outcomes were simple for 4 patients (57.14%) while 3 patients died immediately after surgery (42.86%). Conclusion: Neonatal surgical emergencies are still difficult to manage in our context. The lack of knowledge of these rare pathologies, which delays their management, considerably increases morbidity-mortality. The critical analysis of this series highlights diagnostic and therapeutic difficulties particularly with gastric perforations, hence the interest of better popularization of pediatric surgery.