Sigmoide Volvulus on Pregnancy in the General Surgery Service of the Sikasso Hospital,Mali

Sigmoid volvulus on pregnancy is a rare surgical emergency. We report two cases treated in the General Surgery Department of Sikasso Hospital between January 2009 and December 2017. The mean age was 34.8 years and the gestational age ranged from 28 to 30 weeks. The evolution time was 4 days. The 2 patients were referred to us by gynecologist-obstetricians. They were operated after a short-term resuscitation. Inoperative the volvulus of the sigmoid was alone in 1 case;he was associated with a hail volvulus in the other. The volvated loop was necrotic in 1 case (small and sigmoid). A patient benefited from the Hartmann operation associated with a small bowel resection with end-to-end anastomosis. Simple sigmoidal detorsion was performed in one patient. We did not register a maternal death. The follow-up was simple in the 2 patients who gave birth vaginally.

Adventitial Rupture of the Ascending Thoracic Aorta Extended to the Buttock by Thoracic Crushing between Two Tanks at the Thoracic and Cardiovascular Surgery Department at the Besançon CHRU

Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.

Adenocarcinoma of gastric cardia in the elderly: Surgical problems and prognostic factors

AIM: To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors.METHODS: From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors' institution. They were divided into three groups with regard to age. Patients <70 and >60 year old (31) were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly (≥ 70 year old)and 58 younger patients (≤ 60 year old). The treatment was esophagectomy for type Ⅰ tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions.RESULTS: Laparotomy was carried out in 91 patients (83.4%), 38 in the elderly (74.5%) and 53 in younger patients (91.3%, P＜0.05). Primary resection was performed in 811 cases (89%) without significant differences between the two groups. Postoperative death was higher in the elderly (12.1%) than the other group (4.1%, P＜0.05), while morbidity was similar in both groups. A curative resection (R0) was performed in 59 patients (72.8%), 69.6% in the elderly and 75% in the younger group (P＞0.05). The overall 3- and 5-year survival rates were 26.7% and 117.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients (P = 0.1544). Survival rates were significantly associated with R0 resection,pathological node-positive category and tumor differentiation in both groups.CONCLUSION: As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.

External Branch of the Superior Laryngeal Nerve: Anatomy and Operating Hurts

Purpose: Our purpose was to describe the anatomy of the external branch of the upper laryngeal nerve and to estimate the frequency of nerves at risk during the total thyroidectomies sub. Methodology: We realized in the CHU Point G in Bamako a forward-looking study over a period going from September 1st, 2016 till December 31st, 2017. All the patients operated by thyroidectomies subtotals for mild goiters were included to whom a systematic location of the external branch of the superior laryngeal nerve in the space avascular of Reeve was realized. Cancers and other thyroid pathologies were not included. Results: We counted and operated 120 cases of mild goiters. The external branch of the superior laryngeal nerve was seen and dissected in 80.8%;it was not seen in 19.2%. According to the classification of Cernea: the type 2 was found in 80.8% of the cases with him under typical 2b in 47.5% and under type 2a in 40 (33.3%). The global frequency of lesion of the external branch of the upper laryngeal nerve was 10.8% at 9 patients among whom 6 who presented a BENLS of Type Ni. Conclusion: The external branch of the upper laryngeal nerve of type 2 presents a risk of wound because the surgeon treats the upper pedicle at the level of the critical centimeter place over the upper pole of the thyroid. The identification of the nerve during the thyroid surgery is the solution of choice.

Volvulus of Sigmoid Colon at Sikasso Hospital

The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Objectives: Determine the frequency of sigmoid colon volvulus, describe clinical and para-clinical signs, describe treatment, and determine morbidity and mortality. Methodology: This was a retrospective and prospective study performed in the General Surgery Department of Sikasso. This study concerned patients admitted and operated for sigmoid volvulus from January 1, 2014 to December 31, 2017. Retrospective Phase: We have created survey cards to study the following parameters: 1) The age and the sex;2) The clinical signs and associated defects;3) The radiological examinations, endoscopic;4) The established treatment whether medical, or surgical;5) The evolution and the postoperative consequences;6) The admission period. Prospective Phase: At the admission each patient to benefit: a complete interrogation, a complete physical examination, additional examinations including radio of the abdomen without preparation, the rate of hemoglobin and hematocrit, grouping/rhesus. Support: Our data were collected from medical records and operating records of patients in the department. Results: We collected 54 cases of sigmoid volvulus (the annual frequency was 13.5 cases for year), which accounted for 58.1% of colonic occlusions 19.6% of intestinal occlusions and 5.9% of operative operations in emergency. The average age was 47.13 with extremes of 18 and 102 years, The sex ratio is 4.40% in favor of men. Abdominal pain, vomiting, stopping of materials and gases were present in 32 (59.3%) patients. Von Wahl’s triad was present in 36 patients (66.7%), the rectal ampoule empty in 92.6%. On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg. The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and necrotic hail in 7.4% of cases. We found a simple sigmoid volvulus in 61% of cases. We performed an immediate anastomosis resection in 63%, a Hartmann resection in 29.6%, an immediate anastomosis resection plus an ileostomy in 7.4%. Operative follow-up was simple in 85.2%, with a morbidity of 11.1%, and a mortality of 14.8%. Conclusion: Sigmoid volvulus is a serious surgical emergency requiring early diagnosis and management to improve prognosis. Pre-, postoperative and postoperative resuscitation associated with immediate anastomosis resection, or resection plus Hartmann, would reduce morbidity and mortality.

Liposarcoma of the Back:Case Report

Liposarcoma is a particular form of soft tissue sarcoma. First described by Virchow in 1860, liposarcoma is a rare mesenchymal tumor [1]. It represents 14% to 18% of all malignant tumors of the soft tissues and constitutes the most frequent soft tissue sarcoma [2]. For the majority of authors, it affects adult after the fourth decade. Because of the unusual age, we report a case of largeliposarcoma of the dorsal surface of the trunk. The appearance of the operative part made us think of a possible malignancy. A 35-year-old man without a notable patient history was admitted for a mass of the back discovered three years before without any notion of trauma. The patient affirms the recent appearance of an induration motivating the consultation. There were no associated signs such rectorrhagia, hematemesis, emaciation, pain. The physical examination finds a patient in good general condition. Locally, there is a swelling of the right lateral part of the 1/3 middle part of the back. It is an oval swelling of 25 cm long axis. Any fat tumor having a size more than 5 cm must therefore receive special attention even before the fourth decade.

Volvulus Acute of the Colonist Sigmoid to Mopti:Diagnostic and Therapeutic Aspects

In 7 years, we brought together 100 cases of volvulus of the colon sigmoid to the hospital Sominé Dolo of Mopti among which the handle volvule was found without necrosis in 66 cases and necrosis 34 cases. Seventy-six patients benefited from a sigmoidectomy followed by a colorectal anatomize at a time, twenty one patients of an intervention of Hartmann. A surgical distortion was realized at 3 patients. All the patients operated by these last two techniques had a restoring of the digestive continuity for an average deadline of 90 days. The post-operative complications consisted of 11 cases of parietal suppuration and a case of evisceration. The average duration of follow-up was of 210 days. The post-operative mortality was 14%. It was about a state of toxic shock with visceral multi-failure (n = 13), and of a pulmonary embolism (n = 1). The treatment of the volvulus requires a fast diagnostic and therapeutic coverage. The best treatment consists of a resection of the sigmoid as a matter of urgency followed by an immediate anastomosis if the following conditions are carried achieved: state general voucher, experimented surgeon and if the resuscitation meadow, per and post-operative can be assured.

Epidemiological and Therapeutic Aspects of the Vaginal Hydroceles

Purpose: Our purpose was to describe the epidemiological and therapeutic aspects of the vaginal hydroceles. Methodology: It was a forward-looking and descriptive study of Mars 2014 in July, 2017, which realized in the service of general surgery of the Reference Health Center of Kati (Mali). All the patients operated in the service for hydrocele were included. Other causes of big stock exchange and hydroceles operated outside our service were not including. Results: We operated 92 hydroceles or 5.9% of the surgical activities of the service. The average age was of 34.5 years with extremes of 2 years and 82 years. The most frequent signs of hydrocele were the big painless stock exchange (100%);a transillumination positive (90%) and the effusion of the vaginal in the ultrasound (100%). The cure of hydrocele was realized according to the techniques of Bergmann (94.6%) and of Lord (5.4%). The mortality was nil and the morbidity was 3.3% (2 operating infections of the site and 1 bruise). Conclusion: The hydrocele is a frequent pathology in Africa. The therapeutic strategies are multiple and varied. However, we prefer the Bergmann technique, which is easy, fast and has few complications.

The Technique of Shouldice in the Treatment of the Inguinal Hernias at the Hospital Somine Dolo of Mopti(Mali)Subject of 675 Cases

The objective was to study epidemiological and therapeutic aspects of the inguinal hernia according to the technique of Shouldice. Methodology: we realized a retrospective study, concerning the patients operated for inguinal hernia according to the technique of Shouldice in the service of general surgery of the hospital Sominé Dolo of Mopti, Mali. All the patients operated during the period of study for inguinal hernia according to the technique of Shouldice were included. The patients operated for hernia by other technique than that of Shouldice were not included. Results: The study has been realized in the service of general surgery of the hospital Sominé Dolo of Mopti (Mali). It was about a retrospective study which concerned 25 years from January, 1987 till December, 2012. 675 patients operated according to the technique of Shouldice were registered. The average age was of 49 years +/&minus;17.7. There were 90.7% (612) men. The sex-ratio is 9.7. The farmers, the housewives and the workers represented 51.1% (115). In 75.2% (508) the patients consulted for inguinal tumefaction. In operating meadow, the hernia was complicated to 246 (36.4%) patients among whom 72 cases were of recurrence. The hernia constriction was the main complication operating meadow 58.5% (48/82). The operating suites in one year were simple at 94.2% (636) of the patients;they were marked by 24 cases of recurrence, 12 cases of neuralgia, 6 cases of testicular atrophy, and 3 cases of keloid. Conclusion: The technique of Shouldice is the technique of choice for the cure of the inguinal hernia in developing countries because of the good result and its little expensive cost with compared with the other techniques using medical devices.

Choked Inguino-Scrotal Hernia and Fistulising in the Scrotum at the Hospital Somine DOLO of Mopti:A Clinical Observation

We report a case of grave and rare surgical complications nowadays, which calls out to us on the necessity of a bigger raising sensitization on the coverage of the constrictions hernial at the adult. It is about a case of right inguino-scrotal hernia choked secondarily complicated with a scrotal coecostomie at a 64-year-old man. The delay in the care was in touch with a traditional treatment but also in the poverty of the patient which was a needy the total care of which was assured by the social services department of the hospital. The perioperative exploration found a cecostomy the mucous membrane of which was inverted in the opening of the stoma, an ulceration of the peristomial scrotum with a normal macroscopic aspect of the testicle homolateral. The care was made at single time: parage and scrotal suture more resection segmental of the coecum followed by an anastomosis ileocolic terminoterminal and a cure of the hernia according to Shouldice. The operating suites were simple with ablation of the threads to operating J12 comment and the liberation of the patient the next day. The clinical evolution was satisfactory with a backward movement of 4 years.

Can Necrosis and Ovarian Vein Thrombus Be a Serious Complication in Morbidly Adherent Placenta?

We report a case of a 40-year-old woman, second pregnancy, previous cesarean section due to intrauterine growth restriction and placenta accreta spectrum disorders. She was 25 weeks gestational age, admitted to the hospital 25 weeks gestational age, diagnosed with fetal death. Initial conservative management attempt with uterine preservation progresses to complications requiring total hysterectomy followed by a rare outcome: pelvic thrombi with uterine necrosis, with its associated clinical complications.