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Epididymo-Testicular Tuberculosis: A Case Report from Bamako

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Surgical Science 2023年第3期14卷 197-202页

作者： Coulibaly Amara Mamadou Almamy Keita Moussa Sissoko Drissa Kaloga Bagayoko Cheickna tounkara idrissa tounkara Abdoul Karim Simaga Bakary Coulibaly Sidiki Konaré Adama Drabo Seydou Sissoko Sekou Koumaré Abdoulaye Diarra Keita Soumaila General Surgery Department Reference Health Center of The Second Municipality of Bamako Bamako Mali Department of Surgery of The CHU du Point G Faculty of Medicine and Odontostomatology of Bamako Bamako Mali

We report a case of epididymo-testicular tuberculosis in a 31-year-old man in the surgical department “A” at the University Hospital Point G of Bamako. Epididymitis or orchi-epididymitis is an infection of the epididymis and/or testis. It is the most frequent reason for consultation in urology and affects mainly young people between 30 and 50 years of age. Mycobacterium tuberculosis is very rarely incriminated (2% to 3% of cases). The main problem with genital tuberculosis lies in the diagnosis, which is often difficult and delayed in the absence of other suggestive locations, a notion of contagion or a history of tuberculosis. In the absence of germs in the urine or semen, the diagnosis of certainty is based on histological examination of biopsy fragments of the testicle or epididymis. Delayed treatment results in impaired fertility, such as oligospermia or azoospermia due to reversible or irreversible organic damage to the genitalia.

关键词： Tuberculosis Epididymis Testicle

Parietal Infiltration for Postoperative Analgesia

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Surgical Science 2023年第2期14卷 72-76页

作者： Kanté Lassana Issiaka Diarra idrissa tounkara Maiga Amadou Traore Amadou Madiassa Konaté Ibrahima Diakite Dembélé Bakary Tientigui Alassane Traore Adegné Togo Faculty of Medicine and Odonto Stomatology (FMOS) General Surgery Department Gabriel Touré University Hospital Center Bamako Mali General Surgery Department of the Reference Health Center of Commune 1 of Bamako District Bamako Mali General Surgery Department of the Reference Health Center of Commune 2 of Bamako District Bamako Mali

The parietal component of pain occupies an important place in the management of postoperative analgesia. Parietal infiltration is a technique that fits into a concept of multimodal analgesia using several analgesic products simultaneously. This simple and reliable technique makes it possible to reduce the use of opioids and therefore their adverse effects;without increasing the risk of infection. It reduces the length of hospitalization.

关键词： Parietal Infiltration Analgesia Surgery

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

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

Clinical and Therapeutic Aspects of Inguinal Hernia at the Reference Health Centre of Commune II of the District of Bamako

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Surgical Science 2022年第5期13卷 265-271页

作者： idrissa tounkara Boubacar Karembe Souleymane Thiam Sayon Diakite Abdoulaye Diarra Amadou Traore Konimba Keita Oumar Ongoiba Moussa Sanogo Moussa L. Coulibaly Bakary Tientigui Dembele Adégné Togo Reference Health Center of Commune II Bamako Mali Commune III Reference Health Centre Bamako Mali University Hospital Center of Gao Gao Mali University Hospital Center of Kati Kati Mali University Hospital of Gabriel Touré Bamako Mali Regional Hospital of Tombouctou Tombouctou Mali

Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 January 2016 to 31 December 2016 of 84 patients operated on for inguinal hernias in the general surgery unit of CSRéf CII. Results: Inguinal hernia accounted for 8% of surgical consultations and hernia repair accounted for 30.22% of surgical procedures. Hernia repair accounted for 30.22% of surgical procedures. The male sex was the most represented with a ratio of 7.40. The average age of our patients was 43.19 years. Recurrence occurred in 10% of cases. The right side was most affected in 71.43% of cases, 19.05% on the left side in;it was bilateral in 09.52%. Local anaesthesia was used in 67.86% of our patients, general anaesthesia in 13.09% of cases and locoregional anaesthesia in 19.05% of cases. The hernia was external oblique in 75% of cases. Shouldice’s technique was the most used with 88%;Bassini’s technique was used in 7% and Mac Vay’s in 5% of cases. The postoperative course was simple in 96.43% of cases, with an early postoperative morbidity rate of 3.57%, one case of wall abscess and two cases of parietal haematoma. No deaths were observed during our study. Conclusion: The new methods of tension-free cure should be used more and more by our users in our facilities.

关键词： Inguinal Hernias Strangulation Management CSRéf CII

Spontaneous External Digestive Fistula of Tuberculosis Origin, Medical Treatment: About a Case at the Timbuktu Hospital

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Surgical Science 2021年第1期12卷 17-22页

作者： Oumar Ongoïba idrissa tounkara Thiam Souleymane Charles Dara Jacques Saye Karim Dao Djibril Kassogué Timbuktu Mali Regional Hospital Mali Timbuktu Mali Reference Health Center of Commune II Bamako Mali Gao Regional Hospital Gao Mali Point G University Hospital Center Bamako Mali

In the literature, the management of enterocutaneous fistula of tuberculosis origin is rare. The aim of this work was to report a case of external digestive fistula of tuberculosis origin in a 10-year-old girl in northern Mali in a situation of armed conflict. She was a 10-year-old patient who was admitted to our general surgery ward for external digestive fistula evolving for more than (4) four years, at admission the general. The karnofsky index was at 40%, she could not sit or hold a cup to drink water. A 3 cm enterocutaneous fistula deafened foul-smelling liquid stools, on clinical examination, the conjunctivas were pale, the lips were dry, the eyes were sunk in the eye sockets, the ribs visible from a distance. The paraclinical aspects (Itra-Dermo-Reaction (IDR) to tubercria, anatomopathology) were positive, specifying the place of medical treatment and evolution under medical treatment. Digestive fistula of tuberculosis origin is a rare condition in surgical settings.

关键词： Spontaneous External Digestive Fistula Non-Surgical Treatment Timbuktu

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

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

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