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Traumatic Diaphragmatic Injury at Gabriel Toure University Hospital, Mali

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Surgical Science 2022年第3期13卷 110-118页

作者： Amadou Traoré Madiassa konaté Abdoulaye Diarra Idrissa Tounkara Mohamed Traoré Arouna Doumbia Amadou Bah Boubacar Yoro Sidibé Amadou Maïga Tani koné Boubacar Karembé Zakari Saye koniba Kéita Yacouba Bouaré assitan koné Ibrahim Diakité Lassana Kanté Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo General Surgery Department of Gabriel Touré University Hospital Bamako Mali Surgery Department of Kati University Hospital Kati Mali Reference Health Center of Commune II Bamako Mali Reference Health Center of Commune III Bamako Mali

Traumatic diaphragmatic injury (TDI) is rare and is most often the result of a traffic road accident (TRA) or an assault. We initiated this study with the aims of determining the epidemiological, clinical and therapeutic aspects of TDI at Gabriel Toure University Hospital. This was a retrospective study from January 1999 to June 2021 that included all patients who presented a diaphragmatic injury consecutive to abdominal and/or thoracic trauma. In 22 years and 6 months, 46 cases of TDI were collected. They represented 0.17% of hospitalizations, 0.26% of surgical emergencies and 5.5% of thoraco-abdominal traumas. The average age was 31.69 years with a sex ratio of 3.2. Criminal stabbings accounted for 56.5% and TRA for 19.6%. Penetrating injuries accounted for 78.3% of cases. The parietal lesion was thoracic in 21 cases (45.7%), abdominal in 19 cases (41.3%) and thoraco-abdominal in 6 cases (13%). The chest X-ray, performed in 15 patients, showed an intrathoracic gas bubble (4 cases) and hemothorax (6 cases). Diagnosis of diaphragmatic lesion was preoperative in 21.7% (10 cases). The diaphragmatic breach was on the left side in 65.2% (30 cases) and the average size was 3.17 cm. Laparotomy was performed in 89.1%, thoracotomy in 4.4% and thoraco-laparotomy in 6.5% of cases. The surgical procedure consisted of reduction of the herniated viscera in 15.2% (7 cases) and closure of the diaphragmatic breach with non-absorbable sutures in 82.6% (36 cases). Chest tube drainage was performed in 73.9%. The average length of hospital stay was 9.8 days. Mortality was 13.04%. Conclusion: Traumatic diaphragmatic injury is rare but its frequency is increasing in our country. It most often affects the young man victim of assault or TRA. This type of trauma is rarely isolated;you have to think about it in case of any thoraco-abdominal trauma. The treatment is surgical. The prognosis depends on the severity of the associated lesions.

关键词： Diaphragmatic Injury Trauma Surgery Gabriel Toure

Fascist Leg Necrosis at the Bocar Sidi Sall University Hospital (BSS) in Kati (Mali)

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Surgical Science 2022年第3期13卷 119-123页

作者： Abdoulaye Diarra assitan koné Amadou Traoré koniba Kéïta Idrissa Tounkara Tounkara Issa Traoré Oumou Traoré Boubacar Karembé Madiassa konaté Oulématou Coulibaly Modibo Togola Daouda Diallo Alhassane Traoré Bkary Tientigui Dembélé Ibrahim Diakité Adégné Togo Department of General Surgery Kati University Hospital Kati Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Anesthesia and Resuscitation CHU of Kati Kati Mali

Necrotizing fasciitis is a bacterial dermo-hypodermitis of necrotizing type with involvement of the superficial fascia of the muscles. We report the case of a 50-year-old patient with necrotizing fasciitis of the left leg following erysipelas. Clinical Case: A 50-year-old patient, received at the emergency department for necrotizing wound of the left leg, evolving for 25 days. The examination of the patient made it possible to find: an alteration of the general condition with a WHO score classified stage II. A necrotizing wound of the lower 2/3 of the left leg and the dorsal side of the left foot allowing pus to flow in places, the pedious pulse was well perceived, lymphadenopathy at the root of the homolateral thigh. The complete blood count made it possible to objectify a predominantly neutrophil hyperleukocytosis greater than 10,000/mm3. We first carried out a complete debridement of the necrotic tissues, in a second time we took the patient back to do the autocutaneous graft. The surgical follow-up was simple. Conclusion: Necrotizing fasciitis is a serious infection, management is multidisciplinary.

关键词： Necrotizing Fasciitis Lower Limb Kati Mali

Ectopic Pregnancy Combined with Intra-Uterine Pregnancy with a Full-Term Live Baby: A Case Report and Review of Literature

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Case Reports in Clinical Medicine 2019年第1期8卷 29-34页

作者： Mamadou Almamy Keita Daouda Camara Abdoulaye Kanté assitan koné Abdoulaye Diarra Bréhima Coulibaly Zoseph koné Seydou Fané Cheick Fantamady Camara assitan Traoré Bakary Danfaga Moussa Sogoba Ismaila Simaga Bakary Keita Moussa konaré Jules Sangala Drissa Traoré Nouhoum Ongoiba General Surgery Service of the Kati-Mali Reference Health Centre Kati Mali Gynecology and Obstetrics Service of the Kati-Mali Reference Health Centre Kati Mali Service of Surgery “B” of CHU Point G Bamako Mali Service of Anesthesia and Resuscitation of Reference Health Centre Kati Mali Service of Gynecology and Obstetrics of CHU-Gabriel Touré Faculty of Medicine and Odontostomatology Bamako Mali Service of Anesthesia and Resuscitation of CHU-Gabriel Touré Bamako Mali

Heterotopic pregnancy is no more a medical breakthrough. It combines intrauterine pregnancy and extra-uterine pregnancy regardless of location. We report a case of intra-uterine pregnancy associated with a ruptured abdominal ectopic pregnancy located on the pelvic colon in a 29-year-old patient, third gestation, primigravida, having a live baby and a prior history of two abortions. She has blood group O negative of Rhesus. It has been diagnosed at the stage of the rupture of ectopic pregnancy. An emergency laparotomy performed under blood transfusion has revealed heavy hemoperitoneum (1100 ml), a ruptured abdominal extra-uterine localized on the pelvic under blood transfusion and a bulging uterus. We have proceeded with the aspiration of hemoperitoneum, the ablation of the extra-uterine pregnancy and the hemostasis of the section part. The post-operative follow-up has been easy. The intra-uterine pregnancy has developed normally and has given birth to a full-term live, and healthy baby.

关键词： Heterotopic Pregnancy Diagnosis Maternal and Fetus Prognostic

Appendicular Abscess in General Surgery at the Bocar Sidi Sall University Hospital in Kati

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Surgical Science 2020年第12期11卷 479-485页

作者： Abdoulaye Diarra koniba Keita Amadou Traoré assitan koné Idrissa Tounkara Issa Traore Souleymane Thiam Fadima K. Tall Daouda Diallo Madiassa konate Aboubacar koné Deborah Sanra Sanogo Ismaël konare Alhassane Traoré Adégné Togo Department of General Surgery CHU of Kati Kati Mali General Surgery Department CHU Gabriel Touré Bamako Mali Department of Anesthesia and Resuscitation CHU of Kati Kati Mali Gastroenterology Department Point G Hospital Bamako Mali

Introduction: Appendicular abscess is a progressive complication of acute appendicitis in which the spread of infection is contained by the greater omentum and the slender loops resulting in the formation of a true septate abscess of the large peritoneal cavity. Materials and Methods: This was a retrospective study from January 2010 to December 2019 carried out at the Bocar Sidi Sall University Hospital in Kati (CHU BSS in Kati) in general surgery. It concerned all patients operated on for appendicular abscess in the department. Results: 75 cases of appendicular abscess were collected, which represented 5.76% of surgical emergencies and 25% of acute appendicitis. The average age of the patients was 29 years. The male sex represented 67% of our patients with a sex ratio of 2. The average consultation time was 5 days. Abdominal pain was noted in all patients. It was localized in the right iliac fossa in 80% (n = 60) and diffuse in 2.7% of cases (n = 2). It was accompanied by nausea and vomiting in 93% of cases (n = 70), urinary disorders in 20% (n = 15), fever in 94% (n = 71), cessation of materials and gas in 1.33% (n = 1). Abdominal ultrasound was performed in 86% (n = 65). It made it possible to suggest a peri-appendicular effusion. Biological examination revealed a neutrophilic hyperleukocytosis greater than 20,000/mm3 in 47 patients, or 63%. All the patients were operated on by laparotomy (Marc Burney or midline subumbilical) under general anesthesia. The length of hospitalization was 6 days. We have not recorded any deaths. Morbidity was 8% (n = 6) represented by parietal suppuration. The postoperative course was straightforward in 92% of cases (n = 69). Conclusion: Appendicular abscess is a frequent medico-surgical emergency, the prognosis of which depends greatly on early diagnosis and adequate and immediate management.

关键词： Appendicular Abscess Surgery Kati Mali

Postoperative Occlusion of the Small Bowel with Flanges and/or Adhesions in General Surgery of Kati BSS CHU

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Surgical Science 2018年第9期9卷 293-299页

作者： Abdoulaye Diarra koniba Keita Amadou Traore assitan koné Issa Traore Idrissa Tounkara Abdoulaye Kante Fadima K.Tall Daouda Diallo Moustaph Issa Magané Madiassa konate Aboubacar koné Deborah Sanra Sanogo Ismael konare Alhassane Traoré General Surgery Department KatiMali Anesthesia Service and Resuscitation Department KatiMali Gastroenterology Department KatiMali

Objectives were to determine the frequency, describe the epidemiological and clinical aspects, therapeutic and analyze the postoperative course. Methodology: This was a retrospective study that covered 08 years (January 2009-December 2017). Inclusion criteria: all patients operated for obstruction of the small bowel by hail and/or flanging. Exclusion criteria: other types of occlusion and non-operated patients. Result: We recorded a total of 162 cases of hail obstruction by adhesions and/or flanges at 2.87%. The average age was 32.04, the sex ratio was 1.2. The average consultation time was 4 days. Abdominal pain associated with stopping of material and gas was present in all our patients. X-ray of the abdomen without preparation carried out in all the patients made it possible to objectify in 150 patients (92.6%) of the hydro-hail levels. Inoperative occlusion of hail on flange was present in 80 patients (49.4%). Occlusion of the small bowel on flange and adhesion was present in 69 patients. Adhesion obstruction of hail accounted for 6.8% (11 cases). The most commonly used surgical technique was flange resection in 91 patients (56.2%). The follow-up was simple in 151 patients (93.2%). Mortality was 1.2% of cases, i.e. 2 deaths. The average duration of hospitalization was 6 days. Conclusion: Occlusion of the small bowel by flanging and/or adherence is a surgical emergency whose prognosis depends on early management.

关键词： Postoperative Occlusion Hail Bridle/Adherence Mali

Rare Case of Acute Peritonitis by Perforation of an Appendicular Schistosomiasis at the CHU BSS in Kati

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Surgical Science 2020年第12期11卷 385-392页

作者： koniba Keita Abdoulaye Diarra Sidiki Keita Oulématou Coulibaly assitan koné Salia Coulibaly Amadou Traoré Idrissa Tounkara Lamine Soumaré Mamadou Diallo Bourama Togola Drissa Traoré Pierre A. Togo Department of General Surgery CHU BSS Kati Mali Department of General Surgery CHU Point-G Bamako Mali Reference health center of the commune VI of the district of Bamako Bamako Mali Medical Imaging Department CHU BSS Kati Mali General Surgery Department CHU Gabriel Touré Bamako Mali

Perforation of a pseudo appendicular tumor of bilharzial origin (bilharzia) is a rare etiology of acute peritonitis. His diagnosis is histopathological. The existence of comorbid malaria and surgical pathology is frequent in having a positive thick drop with Schistosoma mansoni eggs in his stool. After 3 months, the patient is doing well. In conclusion, we recommend the histopathological analysis of the surgical specimen after appendectomy and the detection of haematozoa for malaria in any case of fever in a surgical environment.

关键词： Acute Peritonitis Bilharzia Ileocecal Appendix

Prevention of Venous Thromboembolism in General Surgery at Gabriel TouréUniversity Hospital in Mali

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Surgical Science 2021年第3期12卷 67-75页

作者： Amadou Traoré Madiassa konaté Abdoulaye Diarra koniba Keïta Kadia Traoré Zakari Saye Youssouf koné Boubacar Yoro Sidibé Amadou Maïga Amadou Bah Bouréima Kelly Tani koné Boubacar Karembé Souleymane Thiam assitan koné Drissa Bagayogo Bakary Tientigui Dembélé Alhassane Traoré Ibrahim Diakité Lassana Kanté Adégné Togo Gabriel Touré University Hospital Bamako Mali

Through its impact on morbidity and mortality and the cost of medical care, Venous Thromboembolism (VTE) has a significant influence on the quality of care in a surgical environment. The objectives were to determine the risk of postoperative venous thromboembolism and to assess its prophylactic management in the general surgery department of Gabriel Toure University Hospital. This was a prospective observational study from May 01, 2018 to December 31, 2018. It included all patients of 18 years old and over, operated in regulated surgery, under general anesthesia in the department. For all of these patients, Caprini score was used to assess the risk of VTE. The ninth American College of Chest Physicians’ Consensus was used as guidelines to assess Thromboprophylaxis practices in the ward. The Caprini score was evaluated in 80 patients for 8 months. The average age was 50.2 years. The sex ratio was 0.48. The risk level of VTE was low in three patients (3.8%), moderate in 13 patients (16.3%), high in 34 patients (42.5%) and highest in 30 patients (37.5%). The main risk factors found were major surgery (87.5%), age > 40 years (72.5%), cancer (33.8%), bed rest (31.2%), obesity (27.5%) and minor surgery (12.5%). Early mobilization was performed in all patients. Pharmacologic prophylaxis was required in 80% of our patients but only 38.8% had received low molecular weight heparin. VTE complicated 5 procedures, including 3 cases of deep vein thrombosis of the limbs and 2 cases of pulmonary embolism who died. Venous thromboembolism is serious and common in surgical settings. Its prevention remains insufficient in our context.

关键词： Venous Thromboembolism Prevention Surgery Mali

Liver Abscesses: What Diagnostics and Therapeutics in the Kati Reference Health Center (Mali)?

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Surgical Science 2018年第9期9卷 344-350页

作者： Abdoulaye Diarra koniba Keita Amadou Traore assitan koné Madiassa konate Idrissa Tounkara Mamadou A. Keita Issa Traore Modibo Togola Fadima K. Tall Daouda Diallo Moustaph Issa Magane Deborah Sanra Sanogo Aboubacar koné Ibrahim Diakite Alhassane Traore Adégné Togo General Surgery Department Kati Mali Anesthesia Service and Resuscitation Department Kati Mali Gastroenterology Department Kati Mali

The objectives were to determine the frequency of hepatic abscess, and to describe the clinical and para-clinical aspects and the therapeutic modalities. Method and material: This is a prospective study covering 24 months (January 2016-December 2017). Results: This was a prospective study of 30 cases of liver abscess, ranging from January 2016 to December 2017, a period of 12 months. Inclusion criteria: What were included in this study were all patients hospitalized and treated for liver abscess. Criteria for non-inclusion: Abscess cases have not been treated in the service. The sex ratio was 2.3 and the average age was 35 years old. The main clinical signs were: fever (56.7%), hepatitis (73.3%) and hepatomegaly (26.7%). Hepatic collections objected to abdominal ultrasonography were localized in the right lobe in 70%. Surgical treatment was performed in 10% of cases. Medical treatment alone was performed in the majority of cases (56.7%);eclocated puncture was required in 10 cases (33.3%). The follow-up was simple in all our patients and we did not register deaths;the average duration of treatment was 5 days. Conclusion: Topical pathology in surgical practice in our country, liver abscess is common in our department;medical treatment is curative in the absence of complications.

关键词： Abscess Liver Mali

Epidemiological and Clinical Profile and Immediate Outcome of Neonates Transferred from the Maternity Unit to the Neonatology Unit of the CSREF in Commune V of Bamako District, Mali

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Open Journal of Pediatrics 2024年第3期14卷 547-557页

作者： Maimouna Kante Ya Traoré Balilé Harber Beydari Mamadou Traoré Issiaka koné Diéneba Sacko Maimouna Haidara Korotoumou Bamba assitan Farota Abdoulaye Kassogué Mohamed Diarra Dramane Touré Abdoul Salam Diarra Leyla Maïga Dicko Fatoumata Paediatric Ward CSR&#233f CV Bamako Mali Paediatric Ward of Nianankoro Fomba Hospital S&#233gou Mali Paediatric Ward of Kalaban CoroCSREF Bamako Mali Pediatric Department of the Mopti Reference Health Center Mopti Mali National Centre for Scientific and Technological Research Bamako Mali Paediatrics Department Mohamed VI Perinatal Clinic Bamako Mali Department of Paediatrics Gabriel Tour&#233 University Hospital Bamako Mali

Introduction: Neonatal mortality remains a major public health concern. According to the World Health Organisation (WHO), the number of newborns dying each year has fallen from 5 million in 1990 to 2.4 million in 2019. The aim of our study was to describe the main morbid conditions and their lethality in newborns admitted to the paediatric ward of the CSREF in Commune V. Methodology: We conducted a 12-month prospective descriptive and analytical study from August 2020 to July 2021. Results: During the 12 months of the study, out of 2654 neonates admitted to hospital, 216 met our inclusion criteria, i.e. 8%. Newborns admitted in the first few hours of life represented 99.54% of cases. Full-term newborns accounted for 65.74% of the total. Forty-eight percent of newborns had hypothermia on admission. The most common diagnosis was asphyxia in 55.56% of cases, followed by neonatal infection in 27.78% and prematurity in 10.65%. Death was recorded in 22.2% of cases. Asphyxia was the main cause of neonatal death, followed by prematurity in our context. Conclusion: Improving the prognosis of newborn babies will require a thorough understanding of neonatal pathologies and the implementation of a pre- and perinatal prevention policy.

关键词： Newborns Morbidity Mortality