Scapula Fracture in a Child: Report of a Rare Injury

Scapular fracture is exceptional in children, mainly occurring after high-energy trauma. Radiologic investigations help its diagnosis and classification, which determines its management. We report the case of a 14-year-old patient admitted for blunt trauma of the left shoulder after falling from a speeding car. The diagnosis of a displaced fracture of the body of the scapula was made, and non-operative treatment was indicated and carried out for four weeks, followed by physiotherapy for another four weeks. Nine weeks after the trauma, the mobility of the affected shoulder was equivalent to that of the contralateral shoulder.

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.

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.

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.