Appendicular Abscess in General Surgery at the Bocar Sidi Sall University Hospital in Kati

Introduction: 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. Materials and Methods: 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. Results: 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). Conclusion: Appendicular abscess is a frequent medico-surgical emergency, the prognosis of which depends greatly on early diagnosis and adequate and immediate management.

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.

Liver Abscesses: What Diagnostics and Therapeutics in the Kati Reference Health Center (Mali)?

The objectives were to determine the frequency of hepatic abscess, and to describe the clinical and para-clinical aspects and the therapeutic modalities. Method and material: This is a prospective study covering 24 months (January 2016-December 2017). Results: This was a prospective study of 30 cases of liver abscess, ranging from January 2016 to December 2017, a period of 12 months. Inclusion criteria: What were included in this study were all patients hospitalized and treated for liver abscess. Criteria for non-inclusion: Abscess cases have not been treated in the service. The sex ratio was 2.3 and the average age was 35 years old. The main clinical signs were: fever (56.7%), hepatitis (73.3%) and hepatomegaly (26.7%). Hepatic collections objected to abdominal ultrasonography were localized in the right lobe in 70%. Surgical treatment was performed in 10% of cases. Medical treatment alone was performed in the majority of cases (56.7%);eclocated puncture was required in 10 cases (33.3%). The follow-up was simple in all our patients and we did not register deaths;the average duration of treatment was 5 days. Conclusion: Topical pathology in surgical practice in our country, liver abscess is common in our department;medical treatment is curative in the absence of complications.

Postoperative Occlusion of the Small Bowel with Flanges and/or Adhesions in General Surgery of Kati BSS CHU

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.