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Perception and Management of Hemorroid Disease at the CSREF of the Commune Bamako Mali

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Surgical Science 2024年第2期15卷 89-97页

作者： Tounkara Cheickna Diarra Mohamed Hassimy Diarra Issaka Sanogo Keita bakary dembele bakary Tientigui Traore Alhassane Togo Pierre Adégné Lassana Kante Department of General Surgery The Cs Ref of Commune I of Bamako Bamako Mali Department of General Surgery The Gabriel TOURE University Hospital in Bamako Bamako Mali

This work was a prospective transversal study over 6 (six) months from May 2 to December 31, 2017 at the Reference Health Center of Commune I and the Chérif la Confessional Health Center in Bamako. The aim was to study the knowledge, attitudes and behavioral practices linked to hemorrhoids in Commune I of the Bamako district, to evaluate the frequency of hemorrhoidal disease, to determine the knowledge, attitudes and behavioral practices linked to hemorrhoids among patients, their companions and traditional therapists in Commune I of the district of Bamako and the factors which influence the motivations and decisions to resort to medical-surgical care and traditional medicine in patients suffering from hemorrhoids in order to analyze the results of the management of hemorrhoidal disease at Cs Ref CI. We collected 36 patients with hemorrhoidal disease, 25 caregivers and 15 traditional hemorrhoidal disease therapists. The sex ratio was 1.25 for patients;6.5 for traditional therapists and 1.5 for accompanying people. The average age of the patients was 32.75 years;49 years for traditional therapists and 28.76 years for those accompanying them. 55.6% of patients claim to know about hemorrhoidal disease;100% of traditional therapists and 80% of accompanying people. The dietary factor of hemorrhoidal disease was mentioned by 90% of patients;66.7% of traditional therapists and 100% of caregivers. Most patients initially resorted to traditional treatment out of fear of surgery and its after-effects. The patients were treated medically and surgically.

关键词： Hemorrhoidal Disease Caregivers Traditional Therapists Patients Surgery CS Ref CI

Digestive Surgical Emergencies at the Commune II Reference Health Centre in the District of Bamako

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Surgical Science 2022年第5期13卷 258-264页

作者： Idrissa Tounkara Abdoulaye Diarra Amadou Traore Boubacar Karembe Sayon Diakite Konimba Keita Oumar Ongoiba Madiassa Konate Seydou Sangare bakary Coulibaly bakary Tientigui dembele Adegne Togo Reference Health Center of the Municipality II Bamako Mali Hospital-University Center of Kati Kati Mali University Hospital Gabriel Touré Bamako Mali Reference Health Center of the Municipality III Bamako Mali Timbuktu Regional Hospital Timbuktu Mali

We conducted a prospective descriptive study from January 1 to December 31, 2018 with the objectives of determining the frequency of digestive surgical emergencies, describing the clinical and para-clinical aspects of the management of digestive surgical emergencies, evaluating the therapeutic aspect of digestive surgical emergencies and analysing the post-operative follow-up of patients operated on in emergencies. We counted 120 patients operated on for digestive surgical emergencies, which corresponds to 5.80% of all consultations and 44.80% of all surgical interventions. The male sex was the most represented with a ratio of 1.80. The average age was 27.5 years. The majority of patients were from Bamako. Abdominal pain was the reason for consultation in 80% of cases. The diagnosis was essentially clinical and paraclinical in doubtful cases. These included ultrasound, unprepared abdomen and sometimes abdominal CT scans. Acute appendicitis was the most common pathology with 42.5%. General anaesthesia and spinal anaesthesia were used with 50% each. The majority of patients were operated on between 30 minutes and 12 hours after their admission to the department (71.7%). Acute peritonitis accounted for 67% of deaths from sepsis. The surgical technique was decided according to the pathology and the surgeon’s choice. The postoperative course was simple in the majority of cases. The prognosis is good when the management is early. The treatment is medical-surgical.

关键词： Surgical Emergencies Digestive Tract General Surgery CSRéf CII

Postoperative Complications in the General Surgery Department of the Cs Ref of Commune I of the District of Bamako Mali

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Surgical Science 2024年第6期15卷 409-419页

作者： Tounkara Cheickna Samake Hamidou dembele Lamine Diarra Issaka Togola Modibo Sanogo Modibo dembele bakary Tientigui Traore Alhassane Togo Adégné Pierre Kante Lassana Department of General Surgery Reference Health Center of Commune I of Bamako Bamako Mali Directorate of Social and Health Services of the Armies Bamako Mali Department of General Surgery CHU Gabriel Tour Bamako Mali

Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of post-operative complications, to identify the factors of occurrence, to describe the clinical aspects, diagnostic and therapeutic in order to assess the additional cost linked to post-operative complications. This study was prospective, carried out in the general surgery department on 300 cases of surgical interventions. It covered all patients aged at least 15 years, operated on and hospitalized or not, and who presented complications during the 30 days postoperatively. Patients under the age of 15 were not included (our general surgery department is not a pediatric surgery department). We collected 300 patients among whom 199 (66.33%) were men and 101 (33.66%) women, i.e. a sex ratio = 1.9. The average age was 38 years with extremes of 15 and 87 years. The main initial diagnoses were: acute appendicitis, peritonitis, occlusions, wall hernias, hemorrhoids, uterine prolapse, uterine myomas, ovarian cysts and acute cholecystitis. Emergencies represented 43% (N = 129) of interventions with 6.98% post-operative complications (POC). Postoperative complications were dominated by surgical site infections, 75% of cases (N = 20), wall hemorrhage 5% (N = 1), testicular necrosis 5% (N = 1) and testicular calcification 5% (N = 1), wire rejection 5% (N = 1) and death 5% (N = 1). The management of postoperative complications was surgical in 95% and medical in 100%. Their occurrence extended the hospital stay by 3.65 days and increased the average cost of care by 60541.85 CFA francs. The mortality index lowered by efficient management of complications (IMAGE) calculated in relation to deaths was 95% of cases. Anemia, ASA score ≥ III, Alteimeir II and IV classes, duration of surgery and post-operative hospitalization were

关键词： Complications Post Opératoires Chirurgie Cs Ref CI Bamako Mali

Acute Appendicities in the Reference Health Center of Municipality II of Bamako District

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Surgical Science 2022年第5期13卷 251-257页

作者： Idrissa Tounkara Boubacar Karembe Sayon Diakite Abdoulaye Diarra Amadou Traore Konimba Keita Oumar Ongoiba Madiassa Konate Moussa L. Coulibaly bakary Coulibaly bakary Tientigui dembele Adegne Togo Reference Health Center of the Municipality II Bamako Mali Reference Health Center of the Municipality III Bamako Mali University Hospital of Kati Kati Mali University Hospital Gabriel Touré Bamako Mali Timbuktu Regional Hospital Timbuktu Mali

This was a prospective study from January 2019 to December 2019 in the reference health center of municipality II of the Bamako district. During this period, we operated on 73 patients for acute appendicitis, including 51 men and 22 women, for a sex ratio of 1.7. The average age was 25.5 with extremes of 1 and 40 years. Abdominal pain was the main reason for consultation. The physical signs were dominated by the positivity of the Blumberg sign in 97.3% of the cases, the defense of the right iliac fossa in 79.5%, and the Rovsing sign in 61.6% of the cases. This physical examination made it possible to make the diagnosis in the majority of cases. In the face of some doubtful cases, we requested an abdominal ultrasound. Locoregional anesthesia was the most used anesthesia technique at 72.6%. The classic anterograde appendectomy with stump burial by Mac Burney was the most commonly used technique, respectively. The postoperative consequences were straightforward in 87.6%. Anatomopathology examination was performed on 69 surgical specimens and 4 appendectomy specimens were not subjected to an anatomo-pathological examination. Phlegmonous appendicitis was the most common at 63% of cases. Appendicitis remains the most common surgical emergency in a community setting. The early diagnosis and the speed of treatment guarantee improvements in the prognosis. The treatment is mainly surgical.

关键词： Acute Appendicitis Clinical Aspects Appendectomy Postoperative Effects

Digestive Surgical Emergencies in the General Surgery Department of the Reference Health Center in Commune I of the District of Bamako in Mali

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Surgical Science 2023年第10期14卷 646-657页

作者： Cheickna Tounkara Yacouba Fane Oumar Amadou Malle Siaka Diarra Modibo Sanogo Modibo Togola bakary Keita Hamidou Samake bakary Tientigui dembele Alhassane Traore Adégné Pierre Togo Lassana Kante Zimogo Zié Sanogo Djibril Sangare Department of General Surgery and Anesthesia-Resuscitation of the Reference Health Center of Commune I Bamako Mali Directorate of the Social Health Service of the Armed Forces of Mali Bamako Mali Department of General Surgery of CHU Gabriel TOURE Bamako Mali Department of General Surgery “A” of Point G Hospital Bamako Mali

Digestive surgical emergencies concern all patients admitted urgently and for whom a decision for surgical intervention may be necessary within 24 hours. They are on guard duty day and night. To carry out this work we have set ourselves the following objectives: Study digestive surgical emergencies in the general surgery department of the Cs ref CI of Bamako;Determine the frequency of digestive surgical emergencies;Describe the clinical and therapeutic aspects, and Analyze the results of treatment. From January 2016 to December 2016, the general surgery department of the Cs ref CI of Bamako carried out 200 digestive surgical emergencies whose files were usable;119 men and 81 women, a sex ratio of 1.5. The average age was 32.67 years;66% medical evacuation. Abdominal pain was the main reason for consultation. In the majority of cases, the physical examination made it possible to make the diagnosis. Faced with certain doubtful cases, we requested paraclinical examinations (ultrasound, ASP and the rhesus group). The main etiology was acute appendicitis with 59% of cases. The frequency of digestive surgical emergencies was 35.1% of all activities of the general surgery department of the Cs ref CI of Bamako. The postoperative course was complicated in 4% of cases. Surgical site infections were the most common postoperative complications, accounting for 3% of our patients. One death was noted, i.e. 0.5% of our sample. Acute peritonitis was the cause of death in 100% of cases.

关键词： Emergency Digestive Surgery Post-Operative Complication

Acute Intestinal Occlusions at the Cs Ref of Commune I of Bamako

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Surgical Science 2023年第12期14卷 748-757页

作者： Tounkara Cheickna Samake Hamidou Diarra Issaka Sanogo Modibo Traore Fousseyni Togola Modibo Traore Alhassane dembele bakary Tientigui Togo Pierre Adégné Kante Lassana Department of General Surgery Cs Ref of Commune I Bamako Mali Directorate of the Social Health Service Armed Forces of Mali Mali Department of General Surgery Gabriel Toure University Hospital Bamako Mali

Acute intestinal obstructions are defined as a complete and persistent cessation of materials and gases in a segment of the digestive tract. They constitute a medical-surgical emergency. Our work aimed to study acute intestinal obstructions, to determine the hospital frequency, to describe the aspects (epidemiological, clinical and therapeutic), to analyze the surgical consequences and to evaluate the cost of the management of obstructions. acute intestinal infections in the general surgery department of the reference health center of commune I of Bamako in Mali. Our retrospective, longitudinal and descriptive study took place from January 1, 2015 to December 31, 2019 in the general surgery department of the reference health center in commune I of Bamako. The average age was 47.72 years with extremes of 15 and 78 years and a standard deviation of 16.07. Our sex ratio (56 men/15 women) was 3.38. The clinical signs were dominated by abdominal pain (100%), vomiting (52.9%), cessation of materials and gases (25.4%) and meteorism (35.3%). The main etiologies found intraoperatively were strangulated hernia (54.9%), bands and/or adhesions (21.1%), sigmoid volvulus (12.7%), colorectal tumor (7%), small bowel volvulus (2.8%) and acute intestinal intussusception (1.4%). Hernia repair was the most performed surgical procedure, i.e. 54.9%. The overall mortality rate was 1.4%.

关键词： Acute Intestinal Obstructions Surgery Cs Ref CI Bamako Mali

Clinical and Therapeutic Aspects of Inguinal Hernia in Children in the General Surgery Department of Reference Health Center in Commune I of Bamako Mali

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Surgical Science 2024年第2期15卷 54-63页

作者： Tounkara Cheickna Samake Hamidou Simpara Mama Diarra Issaka Sanogo Modibo Sidibe Souleymane Togola Modibo dembele bakary Tientigui Coulibaly Yacaria Togo Pierre Adégné Kante Lassana Department of General Surgery the Reference Health Center of Commune I Bamako Mali Directorate of Social Health Service the Armed Forces of Mali Bamako Mali Department of Pediatric Surgery Mali Hospital Bamako Mali Department of General Surgery the Gabriel TOURE University Hospital Bamako Mali Department of Pediatric Surgery Gabriel TOURE University Hospital Bamako Mali

Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of ca

关键词： Inguinal Hernia Child Surgery Cs Ref C I Bamako Mali

Acute Peritonitis at the Reference Health Center of Commune I of the District of Bamako: Epidemiological, Clinical and Therapeutic Aspects

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Surgical Science 2023年第12期14卷 728-737页

作者： Tounkara Cheickna Samake Hamidou Maïga Amadou Cisse Alou Hamadoun Diarra Issaka Sanogo Modibo Togola Modibo dembele bakary Tientigui Traore Alhassane Togo Pierre Adegne Kante Lassana Department of General Surgery Cs Ref of Commune I of Bamako Bamako Mali Central Directorate of Social Service of Army Health Bamako Mali Department of General Surgery Gabriel Toure University Hospital Bamako Mali

Acute peritonitis is most often secondary to perforation of the digestive organ and/or the spread of an intra-abdominal septic focus. The objectives of this work were to study acute peritonitis in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of peritonitis, to describe the epidemiological, clinical and therapeutic aspects in order to analyze the surgical consequences and to assess the additional cost of treating acute peritonitis. This study was prospective, descriptive, cross-sectional involving 40 patients received in the surgery department of the Cs ref of commune I for acute peritonitis from January 1, 2018 to December 31, 2018. There were 40 patients among whom 28 (70%) were men and 12 were women (30%), i.e. a sex ratio = 2.3. The average age was 25 years with extremes varying between 16 and 54 years and a standard deviation of 11.78. Abdominal pain was the main reason for consultation. Clinical examination alone made it possible to make the diagnosis in 75% of cases. Surgical treatment depended on the intraoperative etiology. The clinical diagnosis was supported by ASP and abdominal ultrasound;performed respectively in 10% and 90% of patients. Appendiceal peritonitis was the intraoperative diagnosis observed in 50% of cases. All our patients benefited from a peritoneal toilet with drainage. We noted a morbidity rate of 5% dominated by parietal suppuration. The average cost of care was 175,000 FCFA.

关键词： Acute Peritonitis Epidemiology Diagnostic Therapy Surgical Emergencies Cs Ref CI Bamako Mali

Intestinal Invagination in Adults: About a Case at the “Mother-Child” Hospital Le Luxembourg in Mali

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Surgical Science 2023年第9期14卷 583-589页

作者： Cheickna Tounkara Oumar Amadou Malle Amara Coulibaly A. Boubacar Maiga Sory Ibrahim Diawara Kassim Kayentao bakary Tientigui dembele Alhassane Traore Adégné Pierre Togo Lassana Kante Department of general surgery of the Hospital “Mother Child” Le Luxembourg Bamako Mali University of Sciences of Techniques and Technologies of Bamako Mali (USTTB) Bamako Mali Department of General Surgery of the CHU Gabriel Touré Bamako Mali

Intussusception is a pathology of infants and young children. Its occurrence in adults is very unusual. In the vast majority of cases, it is secondary to a benign or malignant tumor. Small bowel malignancies are relatively rare, 1% - 5% of malignant tumors of the gastrointestinal tract. Acute intussusception, a rare pathology in adults, often presents with non-specific symptoms. Contrary to children, the organic origin remains preponderant in the elderly, where the origin of neoplasia must be suspected in first intention. We report the case of a 49-year-old patient admitted urgently from the Luxembourg “Mère Enfant” hospital center in Bamako, Mali, for an occlusive syndrome. Several abdomino-pelvic ultrasounds were performed in several clinics with mixed conclusions: Hydro-aeric distension and a cessation of matter and gas without a clearly visible mass (04/09/2022);Demonstration of the central hydro-aeric levels wider than high containing fine and regular folds corresponding to connivents whose aspect is in factor of left acute small intestine occlusion, to be completed by the surgical opinion (06/09/2022) and a third ultrasound showed a normal appearance of the liver, gallbladder, kidneys, pancreas, spleen, bladder and prostate;diffuse aero-colic distention without lesion of secondary appearance (21/11/2022). A frontal standing ASP dated 11/25/2022 showed hail-like hydro-aeric levels. Surgical management consisted of an open oncological resection of an obstructive bowel tumor with ileo-ileal invagination. The anatomopathological and immunohistochemical study of the surgical specimen concluded to diffuse small cell non-Hodgkin’s lymphoma, without vascular embolism. The resection limits pass into the healthy zone.

关键词： Acute Intestinal Intussusception Organic Etiology Digestive Lymphoma Mali