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 Me...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 1<sup>st</sup>, 2013 to December 31<sup>st</sup>, 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.展开更多
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-Saha...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.展开更多
文摘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 1<sup>st</sup>, 2013 to December 31<sup>st</sup>, 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.
文摘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.