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Giant Lactant Adenoma: About a Case

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Surgical Science 2022年第12期13卷 561-565页

作者： Amadou Bah Amadou Maiga boubacar Y. Sidibé Ibrahim Diakité Tani Koné Zakari Saye Arouna Doumbia Amadou Traoré Madiassa Konaté Pierre Coulibaly Amadou A. Traoré Bakary T. Dembélé Lassana Kanté boubacar karembé Assitan Koné Andre Kassogue Amidou Almeimoune Adegne Togo General Surgery Department CHU Gabriel Touré Bamako Mali Resuscitation Anesthesia Department CHU Gabriel Touré Bamako Mali

Affecting young women, lactating adenoma is a rare benign tumor of the breast. It is seen mainly in the third trimester of pregnancy and in the postpartum period. Clinically, it is a solid mass, mobile typically benign but its character of rapid evolution is reminiscent of phyllodes tumors, sarcomas and galactoceles. The definitive diagnosis is histological. We report a case of lactating adenoma in a 26-year-old lactating woman, third procedure, second pare, with a history of tumor resection of the outer quadrants of the left breast, 9 months ago, whose histology evoked a fibrotic disease, cystic breast associating non-specific subacute mastitis with suppuration. Received for recurrence of a tumor in the left breast which was the site of a polylobed mass of about 10/5 cm occupying 3/4 of the breast with mobile ipsilateral axillary adenopathies. A micro tru-cut biopsy was performed and the histology was in favor of a lactating breast adenoma with no signs of malignancy. She underwent surgical excision, the consequences of which were simple.

关键词： Lactating Adenoma Breast Histological Malignancy Surgical Excision

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

The Factors of the Failure in the Treatment of Congenital Equinus Clubfoot Varus by the Ponseti Method at the Reference Health Care Center (CSREF) of Commune III of Bamako

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Surgical Science 2023年第5期14卷 398-404页

作者： Seydou Sanogo Soumaila Diallo boubacar karembé Lassine Cissé Almami Kire Moussa Cissé Abdoulaye Coulibaly Aboubacar Touré Boureima Traoré Moustapha Yossi Moussa Samaké Drissa Diarra Mohamed Traore Seydou Mariko Mariko Issa Fomba Layes Touré Adégné Togo Department of Orthopedic-Traumatology CSREF CIII Bamako Mali

Clubfoot malformation is the most common serious congenital anomaly affecting the foot in children. Its treatment by the Ponseti method is simple, profitable and widely used in the world. Objective: The objective of this study was to identify the factors of the failure of its treatment by the Ponseti method. Material and Method: We carried out a retrospective and descriptive study of cases of congenital equinus clubfoot varus at the Reference Health Care Center of Commune III of Bamako over 26 months from September 2020 to November 2022. Data were treated with the utmost anonymity. Result: This study was performed on 44 children seen for clubfoot: male (68%) and female (32%), with a sex ratio of 2.1. We obtained 13 cases of recidivism including 7 boys and 6 girls. We found 21 cases of unilateral and 23 bilateral;among which 9 recurrences were found against 4 in the unilateral forms. 85% of recurrences did not have good adherence to the splint and 62% did not come regularly for follow-up consultation. We obtained 33 children with idiopathic clubfeet (75%) with a recurrence of 24%, and 7 children with secondary clubfeet with 71 % recurrence. There was no recurrence in the postural type. Among the recurrences, 38.5% started treatment between 1 and 6 months, 23.1% from 0 to 1 month and 15.4% at 2 years and more. 85% of recurrences had a Pirani score between 4.5 to 6 at the start of treatment and 15% at a score of 2.5 to 4. Conclusion: The factors of the failure of the Ponseti method are mainly non-compliance with treatment, secondary clubfeet, and a high Pirani score at the start of treatment.

关键词： Chess’ Factors Club Foot Ponseti Method Pirani Score

Male Breast Cancer: Diagnostic and Prognostic Features in Mali

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Journal of Cancer Therapy 2022年第2期13卷 71-79页

作者： Iriss A. Darar Zakari Saye Bourama Diarra Madiassa Konaté Amadou Traoré Seydou Pamateck Abdillahi I. Ismail Arouna Adama Doumbia boubacar karembé Bakary Tientigui Dembélé Lassana Kanté Drissa Traoré Zimogo Zié Sanogo Alhassane Traoré Adégné Togo Department General Surgery CHU Gabriel Toure Bamako Mali

Introduction: Male breast cancer is rare;representing 1% of breast cancers and less than 1% of all male neoplasia worldwide. We here analyzed the clinical, histological, therapeutic and prognostic characteristics of male breast cancer in Bamako, Mali. Patients and methods: A retrospective descriptive study was conducted on 14 male patients with breast cancer who visited two university hospitals in Bamako (Hospital Gabriel TOURE and Hospital du Point G) in Mali, from January 2005 to December 2018. Results: Male breast cancer represented 0.63% of all breast cancers and 0.23% of all male cancers. The following was observed: the mean age of 53 years (range: 23 - 82);a family history of cancer in 2;breast pain in 9;the average time to consultation of 8 years (6 - 24);gynecomastia found in 1;the tumor palpable in all 14 (size of 5 cm [3 - 10]);ulceration in 5. The most common histological type was non-specific infiltrating carcinoma with 92.8%. SBR II grade was found in 78.5% of cases. Of 8 patients with immunohistochemistry, hormone receptor positive was in 13 and Her2 positive was in 5. Metastases were found in 4, 2 pulmonary and 2 hepatic. Treatment: Neoadjuvant chemotherapy in 21.4%;radical surgery in 13 cases;surgery + radiotherapy in 2;surgery + hormonal therapy in 4. After an average follow-up of 36 months, 1 patient developed a lung metastasis and another patient had a lymph node recurrence. Conclusion: Male breast cancer was detected at relatively later stages. Physicians must be aware of this condition.

关键词： Breast Cancer Diagnostic Aspect Male Mali Therapeutic Aspect

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

Traumatic Perforation of the Small Intestine in General Surgery of the CHU Gabriel Touré

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Surgical Science 2017年第9期8卷 414-421页

作者： Alhassane Traoré Bakary Tientigui Dembélé Ibrahima Diakité Adégné Togo Lassana Kanté Amadou Traoré Madiassa Konaté boubacar karembé Abdoulaye Diarra Amadou Bah boubacar Sidibé Tany Koné Astan Koné Nouténé Koné Djibo Mahamane Diango Gangaly Diallo Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Anesthesia and Intensive Care CHU Gabriel Touré Bamako Mali

Goal: To determine hospital frequency, to describe the clinical and therapeutic aspects and to determine the prognosis. Patients and Methods: This was a retrospective and prospective study carried out in the General Surgery Department from 1 January 1999 to 31 December 2015. Inclusion criteria: 1) open or closed trauma of the abdomen with perforation of the small bowel;2) clinical examination (abdominal pain, vomiting, fever, abdominal contracture, evisceration, intraoperative findings);3) paraclinical examinations: pneumoperitoneum on the abdominal X-ray without preparation (ASP) and CT scan. Exclusion Criteria: Abdominal trauma without perforation of the small bowel. We selected 128 patients operated for traumatic perforation of the small bowel. The data was entered and analyzed using Word, Excel 2007 and Statistical Package and Social Science Windows 16.0. The statistical analysis consisted in the calculation of the different frequencies of the variables studied. We used the Khi2 test with significance level P Results: We recorded 119 men versus 9 women and the sex ratio was 13.22. The mean age was 25 years with extremes varying between 15 and 70 years. The majority of patients 57.7% (74 cases) came from the capital, 46.1% (59 cases) were workers, 26.6% (34 cases) of the students. The average time to admission was 29 hours. The main etiologies were road traffic accidents 36.7% (47 cases), stabbing 21.9% (28 cases), firearm 14.8% (19 cases), and sports accidents 10.1% (13 cases). The main clinical signs were abdominal pain 48.44% (62 cases), abdominal contracture 60% (76 cases), disappearance of pre-liver dullness 66.36% (84 cases), and Douglas painful 74.4% (94 cases). The abdominal X-ray without preparation (A.S.P) allowed to objectify a pneumoperitoneum in 45.31% and the scanner a liquid effusion in 45.31% with the associated lesions in 37.5% (48 cases). The surgical treatment consisted of 60.15% suture excision (77 cases), 25% anastomosis resection (32 cases) and a 15% stoma (19 cases). The average length o

关键词： Abdominal Trauma Small Perforation Surgery Mali

Operating Site Infections at General Surgery Department of Gabriel Toure Training Hospital

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Surgical Science 2015年第2期6卷 59-64页

作者： Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo Lassana Kanté Ibrahim Diakité Bourama Diarra Amadou Traoré Madiassa Konaté boubacar karembé Yacaria Coulibaly Mamby Keita Souleymane Diallo Souleymane Diallo Gangaly Diallo Faculty of Medicine and Odonto-Stomatology Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Biology and Laboratory CHU Gabriel Touré Bamako Mali

The operating site infections constitute the major postoperative issue in surgery. Our objectives were to determine the hospital frequency, the risk factors, the involved germs as well as the cost generated by the operating site infections. Method: Our three months prospective survey run from September the 1st to November the 30th 2013 has included all department patients being operated on and hospitalized. The criteria have been set by CDC d’Atlanta. Results: 374 files were involved, among them 229 (61.2%) were emergencies and 145 (38.8%) were scheduled. The average age was 41 (extremes 7 and 95 standard deviation 17.46), the sex ratio 1.67. The infective risk according to Altmeier has found 17.5% type 1, 25.1% type 2, 11.2% type 3 and 46.3% type 4;according to NNISS, 96 (25.7) were NNISS 0;94 (51.9%) NNISS 1;80 (21.4%) NNISS 2;and 4 (1.1%) NNISS. In the Altmeier class I have not got antibiotic before infection signs appearances. Our overall rate of operating site infections was 7.9% (29 cases), with 24 (82.8%) emergency cases. According to Altmeier’s class of infective risk, the rate of operating site infections was 1.54% making 1 out of 65 type I patients;4.3% making 4 out of 93 type II patients;11.9% making 5 out of 42 type III patients;10.9% making 19 out of 174 type IV patients. According to NNISS, the infective risk has been assessed and was 2.08% for score 0, we have got 8.25% score 1, and 12.5% for score 2, and 25% for score 3. The bacteriology has been dominated by Escherichia colii(51.7), Proteus mirabilisi(13.8), and Klebsiella pneumoniaei(10.34). The germs have been resistant to the combination Amoxicillin-clavulanic Acid between 50% and 87% of cases. The most active antibiotics on the germs have been Cephalosporin, Polypeptides, and aminoglycosides. The hospital stay has been delayed to 12 days on average by operating site infections, making 2.5 times greater than those uninfected. The infection has increased the cost of management around 600 Euro.

关键词： Infections Operating Sites Bamako

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

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Surgical Science 2014年第8期5卷 363-367页

作者： Alhassane Traoré Bakary Tientigui Dembélé Adégné Togo Lassana Kanté Madiassa Konaté Ibrahima Diakité Simo Notue Fabienne Laurence boubacar karembé Abdoulaye Diarra Amadou Traoré Mahamane Djibo Diango Gangaly Diallo Department of General Surgery CHU Gabriel Touré Bamako Mali Faculty of Medicine and Odonto-Stomatology Bamako Mali

Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.

关键词： Peritonitis Postoperative Morbidity and Mortality Surgery

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