Perforations of Gastro-Duodenal Ulcers in the Surgery Department “A” at the University Hospital Point G Bamako

The purpose of this study was to investigate the clinical and therapeutic aspects of peritonitis by perforation of gastric and duodenal ulcer. This was a retrospective and descriptive study over 8 years (2010-2018) which allowed to collect 54 cases of peptic ulcer. Included in the study were all patients with confirmed gastroduodenal perforation on histology or laparotomy. We collected 54 cases of peptic ulcer perforated s. The age group of 30 - 49 years was the majority. The male sex was dominant with 90.7% of cases;the clinical picture was dominated by abdominal contracture associated with pain in 74.07% of cases. X-ray of the abdomen without preparation (AWP) revealed in 87.03% of cases of pneumoperitoneum. The perforation was in 68.52% of cases on the gastric antrum and in 31.48% on the duodenum. The surgical procedure used was the bank of excision, and a suture reinforcement epiploic in 68.52% of cases, a simple suture made in 31.48% of cases, the disease was marked by a fistula (1.90%) and mortality was 5.55% of cases. The gastroduodenal ulcer perforation is potentially serious and responsible peritonitis whose surgical treatment involves the peritoneal toilet and sutures the puncture.

Evaluation of 15 Years Practice of Coelioscopic Treatment of Ectopic Pregnancy in the Surgery Department“A”at the University Hospital Point G

Aim: To evaluate 15 years practice of coelioscopic Treatment of ectopicpregnancy in the Surgery Department “A” at the University Hospital Point G. Material and Methods: We conducted a descriptive retrospective study at the Surgery Department “A” at the University Hospital Point G from January 2001 to August 2015. Inclusion criteria were all pregnant women with ectopic pregnancy treated with coelioscopy. Sociodemographic, clinical, paracclinical and therapeutic aspects were recorded. Results: In 15 years, 42 cases of ectopic pregnancy out of 3840 gynecologic coelioscopies (1.04%) were collected. The average age was 28.5 years old with the extremes of 16 and 41 years old. Metrorragia was associated to pain in 83.3% (35/42);amenorrhea was found in 66.7% (28/41). Physical exam revealed pain with abdominal defense in 59.5% (25/42), adnexal mass in 31% (13/42), and pelvic contracture in 9.5% (4/42). In pre-operative, ectopic pregnancy was diagnosed complicated in 71.4% (30/42) and uncomplicated in 28.6% (12/42). Patients underwent salpingectomy in 85.7% (36/42), delivery from the fallopian tube in 9.8% (4/42), and hemostatic salpingectomy in 4.4% (2/42). The average duration of hospital stay was 1.88 day with the extremes of 1 and 7 days. The postoperative evolution was favorable in 97.6% (41/42), infection at the site of surgery was reported in 2.4% (1/42). Not a single death was registered. Conclusion: Treatment of ectopic pregnancy is of routine at the surgery department “A” in Point G. Fertility is preserved in the future.

The Lithiasis of Choledoque: Epidemiological Aspects, Clinics and Therapeutiques in the Surgery Department “A” at the University Hospital Point G

Considered as rare in Africa lithiasis of the main bile duct (MBD) is a potentially serious pathology, diagnosis is facilitated by imaging tests (ultra-sound, CT, MRI cholangiopancreatography). Its surgical management is improved by laparoscopy coupled with interventional endoscopy. However, laparotomy remains the only way in Mali. This was a 14-years retrospective and descriptive study (2010-2014). All patients with BPV lithiasis were included. We studied the field, antecedents, clinical, biological, radiological, therapeutic and outcome aspects. 40 cases of stones in the main bile duct were collected during the study period. The hospital frequency was 2.8 cases per year, the clinical signs dominated by the Charcot triad (pain, fever, jaundice) found in 40 cases (100%). The average age was 60 years, female represented 70% of cases. Ultrasonography was the most requested review in 40 cases (100%). The procedure performed was cholecystectomy associated with choledochotomy with calculation extraction in all patients (100% of cases). One case of biliary fistula and one case of wall abscess were observed. The mortality was 5% and the simple suited in 90% of the cases. The lithiasis of the main bile duct is an infrequent pathology in Mali and potentially serious. This diagnosis is assisted in our context by ultrasound and CT. Laparotomy remains the only route of entry in Mali.

Splenectomy in the Surgery Department “A” at the University Hospital Point G Bamako

We conducted a retrospective study that included patients with erythrocyte and hemolytic pathology justifying a splenectomy and patients presenting splenic trauma for which hemostasis splenectomy is required. We performed 27 total splenectomy in which 26 are by laparotomy (92.86%) and 1 by laparoscopy (3.57%). A partial splenectomy was performed by laparoscopy. The morbidity was marked by 2 cases of infectious syndrome and 1 case severe anemia. The mortality was 7.14% (n = 2). Splenectomy is part of the therapeutic arsenal for benign or malignant hematological disorders that constitute the main indication for elective splenectomy. Splenectomy was one of the most common operations in abdominal surgery. During the past decade, an increased rate of late complications, specially septic and thromboembolic complications are well documented. The risk is related to the indication of splenectomy, and is less than 1% in adults without immunodeficiency. However, these overwhelming postsplenectomy infections are associated with a high mortality rate. The best treatment of these infections is preventive measures which are based on vaccination and education of asplenic patients.

Total Thrombosis of Bifurcated Endoprosthesis: A Rare Complication of Endovascular Treatment of Abdominal Aortic Aneurysm

Background: Aortic stents are a therapeutic alternative to open surgery of abdominal aortic aneurysms. We report a case of treatment of an abdominal aortic aneurysm with a bifurcated stent, complicated by total thrombosis. Aim: The purpose of this presentation was to understand the causes, mechanisms, incidents and accidents that contributed to this complication. Case Presentation: A 48-year-old man patient with a history of high blood pressure, ischemic heart disease, chronic obstructive pulmonary disease, who was found during a surveillance check-up, an infra-renal abdominal aorta aneurysm measured at 56 mm in diameter, asymptomatic but progressive. The indication of an endovascular treatment by the placement of a bifurcated prosthesis was posed and accepted. Thrombosis of the two limbs was intra-operative, upper-end migration without endoleak at 4 months postoperative, total thrombosis of the stent at 13 months postoperatively. Explantation of the stent followed by aortobi-iliac bypass was finally performed in the 15th month. Conclusion: The cardiopulmonary antecedents, the anatomical and evolutionary characteristics of the aneurysm could have played a role in the occurrence of the complications observed in this patient.

Incidence and management of colonoscopic perforations: 8 years' experience

瞄准：与诊断、治疗学的 colonoscopies 考察一个主要医药教学中心的经验并且估计相关结肠的穿孔的发生和管理。方法：所有 colonoscopies 在 1994 年 1 月之间表现了， 2001 年 12 月被学习。病人， colonoscopic 报告和过程相关的复杂并发症上的数据从部的计算机化的数据库被收集。有柱子的病人的医药记录程序的结肠的穿孔被考察。结果：120067 colonoscopies 的一个总数在学习的 8 年期间被执行。七个 colonoscopic 穿孔(4 女性， 3 男性) 被诊断(0.058%) 。五发生了在期间诊断并且二在治疗学的结肠镜检查期间。六在结肠镜检查以后被怀疑在期间或立即。除了都，一有弥漫的温柔的符号并且经历了立即的操作，主要修理在 4 个病人做。没有死亡被报导。结论：穿孔率在结肠镜检查期间是低的。不过，它是严肃的复杂并发症和它的早识别，治疗是必要的优化结果。在有早起作用的弥漫的腹膜炎的病人，干预使主要修理成为一种安全选择。

Interval to surgery after neoadjuvant treatment for colorectal cancer

The current standard treatment of low-lying locally advanced rectal cancer consists of chemoradiation followed by radical surgery.The interval between chemoradiation and surgery varied for many years until the1999 Lyon R90-01 trial which compared the effects of a short(2-wk)and long(6-wk)interval.Results showed a better clinical tumor response(71.7%vs 53.1%)and higher rate of positive and pathologic tumor regression(26%vs 10.3%)after the longer interval.Accordingly,a 6-wk interval between chemoradiation and surgery was set to balance the oncological results with the surgical complexity.However,several recent retrospective studies reported that prolonging the interval beyond 8or even 12 wk may lead to significantly higher rates of tumor downstaging and pathologic complete response.This in turn,according to some reports,may improve overall and disease-free survival,without increasing the surgical difficulty or complications.This work reviews the data on the effect of different intervals,derived mostly from retrospective analyses using a wide variation of treatment protocols.Prospective randomized trials are currently ongoing.

Risk of malignancy in Caroli disease and syndrome: A systematic review

BACKGROUND Congenital intrahepatic bile duct dilatation without fibrosis is called Caroli disease(CD),and is called Caroli syndrome(CS)when it has fibrotic and cirrhotic liver morphology.The development of intrahepatic carcinoma is described in both conditions,but the reported incidence varies extensively.Potential risk factors for the malignant transformation were not described.Furthermore,conservative or surgical treatment is performed depending on the extent of cystic malformation,hepatic dysfunction and structural hepatic changes,but little is known about which treatment should be offered to patients with CD or CS and cancer.AIM To further investigate the malignant transformation in these conditions.METHODS A systematic review of the current literature until January 2019 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.A search using Medline(PubMed)was performed using a combination of Medical Subject Headings terms“caroli disease”,“caroli syndrome”,“tumor”,“malignant”,and“cholangiocarcinoma”.Only human studies published in English were used for this systematic review.The following parameters were extracted from each article:year of publication,type of study,number of patients,incidence of malignant tumor,duration of symptoms,age,sex,diagnostics,identification of tumor,surgical therapy,survival and tumor recurrence.RESULTS Twelve retrospective studies reporting the courses of 561 patients(53%females)were included in this systematic review.With a mean age of 41.6 years old(range 23 to 56 years old),patients were younger than other populations undergoing liver surgery.Depending on the size of the study population the incidence of cholangiocarcinoma varied from 2.7%to 37.5%with an overall incidence of 6.6%.There were only few detailed reports about preoperative diagnostic work-up,but a multimodal work-up including ultrasound of the liver,computed tomography,magnetic resonance imaging and endoscopic retrograde cholangiopancreatography was used in most studies.Disease duration was variable with up to several years.Most patients had episodes of cholangitis,sepsis,fever or abdominal pain.Tumor detection was an incidental finding of the surgical specimen in most cases because it is currently often impossible to detect tumor manifestation during preoperative diagnostics.Liver resection or liver transplantation was performed depending on the extent of the biliary pathology and additional alterations of the liver structure or function.No postoperative adjuvant chemotherapy was reported,but chemotherapy was administered in selected cases of tumor recurrence.Overall survival rates after one year were low at 36%and a high recurrence rate of up to 75%during the observation period.CONCLUSION Only few retrospective studies reported a low tumor incidence.Despite the high rate of mortality and tumor recurrence,definite surgical treatment should be offered as soon as possible.

Comparative Study between Cholecystectomy in Sickle Cell Patients and Non-Sickle Cell Patients

Introduction: Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones and lithiasis cholecystitis. It reduces post-operative complications especially in sickle cell patients. Aim: The aim of this work was to compare the results of laparoscopic cholecystectomy in sickle cell and non-sickle cell patients. Methods: Sixty-six patients including 25 sickle cell patients and 41 non-sickle cell patients were identified from March 2013 to November 2014 (20 months). The χ2 test was used for comparisons. Values of p < 0.05 were used for a statistically significant difference threshold. Results: The mean age was 25.76 years for the sickle cell group and 45.61 years for the non-sickle cell group (p = 0.00008). There were 14/25 female patients in the sickle cell group and 28/41 in the non-sickle cell group. In per op, the diagnosis of acute cholecystitis was retained for 4/25 sickle cell patients and for 10/41 non-sickle cell patients. Diagnoses such as pyocholecyst (2 cases), porcelain vesicle (2 cases), hydrocholecyst (2 cases) were found in the group of non-sickle cell patients. Operative difficulties such as tight perivicular adhesions were encountered 9/25 times in the sickle cell group and 11/41 times in the non-sickle cell group. The average overall operative time was 55 min. There was no statistically significant difference between the different groups in mean operative time, occurrence of postoperative complication and average length of hospital stay. The mortality is not statistically different according to the group of patients. Conclusion: There is no significant difference between the cholecystectomy performed in sickle cell patients and that performed in non-sickle cell patients. The multidisciplinary perioperative management of sickle cell patients reduces the risk of complications arising from this pathology.

VNUS Closure^®FAST Radiofrequency of the Great Saphenous Vein for Superficial Venous Insufficiency: Experience of the CH of Cholet in France

Background:The objective of this work was to evaluate the first results of the radio ablation of the great saphenous vein in the processing of chronic venous insufficiency. Method: This is a monocentric retrospective study of radio ablation of the great saphenous vein using VNUS Closure® FAST for superficial venous insufficiency of the great saphenous vein, between January 2012 and December 2014. Results: 42 patients (57 limbs) were operated on with this technology. There were 33 women and 9 men (mean age: 46.5 years). Thirty-nine patients (92. 8%) were symptomatic. Thirty-two patients (76.1%) were classified CEAP 2. The average diameter of the saphenous vein was 8.5 ± 1.5 mm. Three patients (7.1%) had a percutaneous approach. A perfect occlusion of the saphenous vein was observed in all patients. No incident or undesirable event was observed during the procedure. One case of delayed deep-vein thrombosis was observed. At one month of follow-up, six patients (14.2%) had induration opposite to the occluded vein. Forty-three percent of the patients stated they were very satisfied with the procedure. Conclusion: The effectiveness, security and simplicity of the closure method are real. More studies are necessary to assess the long-term results of this procedure.

Pericardial Drainage by Xyphoidian Route at the Chu Point G

Tuberculosis is a public health problem in Mali. Pulmonary localization is the most frequent and extra-pulmonary involvement, in particular serous, is possible. In this study, we analyze our results of surgical pericardial drainage in tuberculous pericarditis. Methodology: We carried out a retrospective study at the CHU Point G over a period of five years from January 2012 to December 2017. The histological examination carried out on all the surgical specimens made it possible to retain the diagnosis of tuberculous pericarditis. Results: We identified and operated on 49 cases of tuberculous pericarditis, i.e. 70% of the pericardial drainage performed during the same period. The average age was 31.5 years (28 men and 21 women). The most common clinical signs were dyspnea (61.2%), chest pain (26.6%) and fever (12.2%). Pericardial drainage with pericardial biopsy was performed by xiphoid route in all of our patients. The mortality and morbidity rates were 4.1% and 8.2%, respectively. Conclusion: Pericardial tuberculosis attacks are frequent in Mali. The etiological diagnosis is based on the histology of the pericardial biopsy which can only be obtained surgically.

COVID-19-associated gastrointestinal and liver injury:clinical features and potential mechanisms

Coronavirus disease-2019(COVID-19)is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).The infection is spreading globally and poses a huge threat to human health.Besides common respiratory symptoms,some patients with COVID-19 experience gastrointestinal symptoms,such as diarrhea,nausea,vomiting,and loss of appetite.SARS-CoV-2 might infect the gastrointestinal tract through its viral receptor angiotensin-converting enzyme 2(ACE2)and there is increasing evidence of a possible fecal–oral transmission route.In addition,there exist multiple abnormalities in liver enzymes.COVID-19-related liver injury may be due to drug-induced liver injury,systemic inflammatory reaction,and hypoxia–ischemia reperfusion injury.The direct toxic attack of SARS-CoV-2 on the liver is still questionable.This review highlights the manifestations and potential mechanisms of gastrointestinal and hepatic injuries in COVID-19 to raise awareness of digestive system injury in COVID-19.

经皮电刺激系统对标准剂量质子泵抑制剂无应答患者食管酸暴露的治疗效果:概念验证性研究

背景:胃食管反流病(GERD)是一种常见病。有接近35%的GERD患者无法通过标准剂量质子泵抑制剂(PPI)治疗控制症状。考虑到PPI治疗的高失败率和低满意度,GERD患者需要一种新的治疗方法。本研究旨在评估经皮电刺激系统(TESS)能否减轻标准剂量PPI治疗失败的GERD患者的食管酸暴露。方法:我们前瞻性入组了10例标准剂量PPI治疗失败、具有烧心和反流症状且食管酸暴露异常的GERD患者。在放置了食管pH胶囊后,所有患者予以TESS治疗。主要研究终点是24小时内pH<4时长占比下降和/或DeMeester评分减少50%。结果:最终7例GERD患者完成研究,其中男性2例,女性5例,年龄(49.3˘10.1)岁。治疗前24小时内pH<4时长占比为(12.0˘4.9)%;TESS治疗后14天,该占比分别为(5.5˘3.4)%、(4.5˘2.6)%、(3.7˘2.9)%和(4.4˘2.5)%。治疗前平均DeMeester评分为39.0˘18.5;TESS治疗14天,该评分分别降至15.8˘9.2、13.2˘6.8、11.2˘9.4和12.0˘6.8。结论:对于标准剂量PPI治疗失败的GERD患者,TESS是一种安全且潜在有效的治疗方法,可以减轻食管酸暴露。需要大样本前瞻性对照研究来验证上述初步结果。