Appendicular Abscess: Epidemio-Clinical and Therapeutic Aspects in the General Surgery Department of the Reference Health Center of Commune III (C.s.ref CIII) of the District of Bamako

Objectives: The main goal of this study is to determine the hospital frequency of appendicular abscess, to describe the diagnostic and therapeutic aspects and to analyze the postoperative follow-up. Methodology: This was a descriptive and analytical prospective study from January 1, 2020 to June 30, 2021 including patients admitted to our department for appendicular abscess diagnosed pre- and or intraoperatively and confirmed to histology. Results: We collected 30 appendicular abscesses that accounted for 18.75% of emergency interventions. The 16 - 25 age group was the most represented at 53%. The average age was 24 years with extremes of 10 and 58 years. The male sex was mostly represented (60%) with a sex ratio of 1.5. The majority of our patients were students (53.3%). The main clinical signs found were abdominal pain and vomiting (100%). The pain was localized in the Right Iliac Fossa (RIF) in 80% of cases. Fever was present in all our patients with a temperature between 38&#730C and 38.5&#730C. The physical examination found pain with defense of the right iliac fossa in 93.3% of cases. A painful mass was present in 27 patients (90%). Treatment consisted of appendectomy with abscess drainage in all patients. Postoperative follow-up was simple in 83.3% of cases;we recorded three cases (10%) of parietal suppuration, one case of fistula (3.3%) and one death. Conclusion: Appendicular abscess is a medical-surgical emergency frequent surgery in our context because of the delay in diagnosis. It is a condition with low morbidity and mortality subject to early diagnosis and prompt and appropriate treatment.

Epidemiological-Clinical and Therapeutic Aspects of Acute Appendicitis at the Reference Health Center of Commune III (C.S.Ref CIII) of the District of Bamako

Objectives: It was to determine the epidemiological-clinical and therapeutic aspects of acute appendicitis at the Reference Health Center of Commune III of the district of Bamako. Methodology: This was a prospective study from January 1 to December 31, 2020 including patients operated for acute appendicitis and confirmed at histology and cases of abscess and appendicular plastron. Results: We collected 60 cases of acute appendicitis. They accounted for 17.29% of surgical indications. The average age of our patients was 25.5 years. The male sex was the most represented at 63% with a sex ratio of 1.72. The Pain in the right iliac fossa was the most represented reason for consultation with 76.7%. It was at the type of bite 70% of the cases. On physical examination the defense of the right iliac fossa was present in 96.7%. Digestive signs were marked by nausea 28.4% (17 patients) and vomiting 25% (15 patients). The digital rectal exam was painful to the right of the Douglas fir in 76.7% of our patients. In biology a complete blood count (CBC) performed in all our patients has objectified hyper leukocytosis in 80% of cases. The reactive protein (CRP) performed in 36 patients was elevated with values between 18 and 46 mg/ml. The imaging performed was an abdominal ultrasound that found a roundel image of the appendix with increased size in 65%. Surgical treatment consisted of classical Mac Burney appendectomy in 54 patients (90%). The gesture performed was an appendectomy in all our patients. All our appendectomy parts were sent for pathological examination. This examination classified the parts as non-specific appendicitis in 60%, phlegmonous appendicitis in 22% and catarrhal appendicitis in 18% of cases. Surgical follow-up was simple in 98.4% (59 patients) and morbidity was marked by digestive fistula in one patient. We recorded one case of death (1.6%). Conclusion: Acute appendicitis remains the most common surgical emergency in commune III of the district of Bamako. It is a pathology that can be found at all ages of life. Its morbidity and mortality are low subject to early diagnosis and management.

Damage to the External Genitalia by Traction Following Assault and Battery at the C.H.U Gabriel Touré: About a Case

Trauma to the external genitalia by tearing is rare. We report the case of a 30-year-old patient, admitted to the emergency room for trauma of the external genitalia by traction following a blow and intentional injury. The authors highlight the lesions that can occur during this type of trauma and insist on the systematic search for urethral and cavernous lesions. Conclusion: Trauma to the external genitalia by intentional assault and battery is rare in our context. They occur most often in a young person and are frequently associated with damage to the corpora cavernosa and urethra.

Synchronous Volvulus of the Sigmoid Colon and the Transverse Colon: A Case Report at Gabriel Toure University Hospital in Mali

Synchronous transverse and sigmoid colon volvulus are very rare. We report the case of a 23-year-old man who underwent emergency surgery for sigmoid colon volvulus. An intraoperative finding of transverse colon volvulus associated with sigmoid colon volvulus was made. Left and transverse colectomy was performed followed by colorectal anastomosis. The postoperative period was uneventful. Synchronous volvulus of the transverse and sigmoid colon is a surgical emergency. The clinical signs are not specific and the discovery is often intraoperative. It is necessary to know how to evoke the diagnosis in a case of sigmoid colon volvulus, to avoid inadequate management with dramatic consequences.

Primitive Umbilical Endometriosis in a Young Woman at the District Health Center (CSREF) in Commune II in Bamako

Umbilical endometriosis, also called Villar’s nodule, has rarely been described in the literature. It represents only 0.5% to 1% of all cases of endometriosis. We report a case in a 28-year-old nulligest, nulliparous woman who consulted at the CSREF CII in Bamako. The diagnosis was suspected with the presence of umbilical swelling with cyclic, painful, dark hemorrhage of firm consistency. We performed an omphalectomy with an uncomplicated postoperative course. She was released from the hospital three days post-surgery. Anatomo-pathological examination of the resected specimen confirmed the diagnosis of umbilical endometriosis.

Diverticular Fistula of the Female Urethra on Lithiasis at the District Health Center (CSREF) in Communeii, Bamako, Mali

The diverticulum of the female urethra or sub-urethral pouch is in the form of a cul-de-sac lined with mucous membrane through the muscular layer of the urethra. Thus, it is a site of stasis, urinary infection, formation of calculus or even malignant tumor. The diverticula of the urethra or sub-urethral pouches in women have a prevalence of 0.5% to 6% depending on the series. We report the case of a 61-year-old patient operated for a diverticulum on fistulized urethra complicated lithiasis. Our patient had five pregnancies and five births when she consulted for dysuria, urinary burns evolving since a year. The urogenital examination revealed a partially stenotic urethral meatus and a 3-cm large fistulized intravaginal peri-urethral mass allowing urine leak. The mass was painful and hard at palpation. We performed transvaginal diverticulectomy. The follow-up was simple and the probe was removed two weeks after the surgery. An atomo-pathological examination of the resected diverticulum concluded an aspect compatible with lithiasis urethritis.