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Jejuno-Ileal Ruptures after Blunt Abdominal Trauma at the Teaching Hospital of Bouake

Surgical Science 2022年第3期13卷 124-134页

作者： Kouakou Ibrahim Anzoua Kouamé Bernadin Kouakou Mamadou Traoré kalou ismael leh bi Alassane binaté Venance Dago Aloka Blaise Amos Kouakou Amos Serge Ekra Roger Lebeau Bamourou Diané Department of General and Digestive Surgery Teaching Hospital of Bouake Bouake C&#244te d’Ivoire

Objective: The aim of this study is to determine the causes, pattern, management, and outcome of jejunal-ileal rupture following blunt abdominal trauma at the teaching Hospital of Bouake. Methods: The study included 27 patients who underwent laparotomy for jejunoileal injuries from blunt abdominal trauma at the Teaching Hospital of Bouake over a period of 14 years from January 2007 to December 2020. A retrospective study was conducted and the patients were analyzed with respect to patient demographics data, cause, injury mechanisms, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and outcomes. Results: During the 14 year period from 2007 to 2020, 27 patients with blunt small bowel injuries were treated at our Teaching Hospital. That is 2.9% of all blunt abdominal trauma. Male to female ratio was 4.4:1 and the average age was 26.3 years (range: 15 and 50 years). The majority (66.7% 18 cases) were Victims of road traffic accident. Median delay between injury and arrival at hospital for these patients was 10.1 hours (range: 1 - 72 h). A single intestinal injury was present in 22 patients, while 5 patients suffered from 2 injuries. There were 32 perforations of the small intestine in 27 patients with two perforations being transection. All perforations were located on the antimesenteric border of the intestine. Out of the 32 jejuno-ileal ruptures 18 were located on the jejunum while 14 were located on the ileum. Associated intra-abdominal injuries were present in 6 patients and nineteen associated extra-abdominal injuries were present in 10 (70.4%) patients. A one-stage therapeutic strategy was performed in 20 cases (74.1%) and a two-stage strategy was performed in seven cases (25.9%). Intestinal continuity was restored 93.8 days later (range 60 and 140 days). The average length of hospital stay of the operated patients was 11.4 days. The operative morbidity was 25.9%. Conclusion: Jejuno-ileal ruptures are rare and characterized

关键词： Rupture Jejunum Ileum Blunt Abdominal Trauma Peritonitis Hemoperitoneum

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A Review of Privacy and Security of Edge Computing in Smart Healthcare Systems: Issues, Challenges, and Research Directions

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Tsinghua Science and Technology 2024年第4期29卷 1152-1180页

作者： Ahmad Alzu’bi Ala’a Alomar Shahed Alkhaza’leh Abdelrahman Abuarqoub Mohammad Hammoudeh Department of Computer Science Jordan University of Science and TechnologyIrbid 22110Jordan Cardiff School of Technologies Cardiff Metropolitan UniversityCardiff CF52YBUK Department of Information and Computer Science King Fahd University of Petroleum and MineralsDhahran 31261Kingdom of Saudi Arabia

The healthcare industry is rapidly adapting to new computing environments and technologies. With academics increasingly committed to developing and enhancing healthcare solutions that combine the Internet of Things (IoT) and edge computing, there is a greater need than ever to adequately monitor the data being acquired, shared, processed, and stored. The growth of cloud, IoT, and edge computing models presents severe data privacy concerns, especially in the healthcare sector. However, rigorous research to develop appropriate data privacy solutions in the healthcare sector is still lacking. This paper discusses the current state of privacy-preservation solutions in IoT and edge healthcare applications. It identifies the common strategies often used to include privacy by the intelligent edges and technologies in healthcare systems. Furthermore, the study addresses the technical complexity, efficacy, and sustainability limits of these methods. The study also highlights the privacy issues and current research directions that have driven the IoT and edge healthcare solutions, with which more insightful future applications are encouraged.

关键词： edge computing fog computing data privacy healthcare systems intelligent edges

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Acute Bowel Obstructions of the Elderly in a Low African Country

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Surgical Science 2022年第3期13卷 164-173页

作者： Kouame Bernadin Kouakou Kouakou Ibrahim Anzoua Mamadou Traore ismael kalou leh bi Ahou Bernadette N’Dri Aka Gerard Kakou Serge Amos Ekra Blaise Amos Kouakou Inza Bamba Djahou Ezechiel Akowendo Roger Lebeau Bamourou Diane General and Digestive Surgery Department University Hospital of Bouaké Bouake Ivory Coast

Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our study was to identify the causes of these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients and Methods: Retrospective and analytical study of patients aged 65 years and over, operated on between January 2013 and December 2019 for acute bowel obstruction at the University Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data were analysed. Results: The study involved 36 men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6 years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III (33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due to colonic volvulus (38.9%), colonic cancer (22%), postoperative adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia (3.3%). Volvulated or necrotic bowel and resectable cancers were resected followed by immediate anastomosis or stoma. Near upstream stomas were performed for unresectable cancers. A herniorrhaphy for groin hernias and a mesenteric breach suture for internal hernia were performed after bowel disinterment. Adhesions were released. The time to surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus. The high mortality is related to various factors highlighting the frailty of the elderly. A multidisciplinary management i

关键词： Acute Bowel Obstruction Elderly Etiology Morbi Mortality Surgery

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Spectrum of Acute Non Traumatic Diffuse Secondary Peritonitis in the Tropics

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Surgical Science 2020年第5期11卷 89-98页

作者： Mamadou Traore Kouakou Ibrahim Anzoua Kouamé Bernadin Kouakou ismael kalou leh bi Ahou Bernadette N’dri Aka Gerald Kakou Serge Amos Ekra Blaise Amos Kouakou Inza Bamba Roger Lebeau Bamourou Diane General and Digestive Surgery Department Bouaké Teaching Hospital Bouaké Republic of C&ocirc te d’Ivoire

Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA > II, Age ≥ 60 years, M PI > 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment o

关键词： Peritonitis Appendicitis Typhoid Perforation Gastrointestinal Ulcer Perforation Prognostic

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Retro Placental Hematoma: Maternal and Fetal Prognosis at the Maternity of the University Hospital of Bouake

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 44-56页

作者： Samake Yaya Djanhan Lydie Estelle Menin-Messou Benie Michele Kouadio Kouadio Narcisse Akanji Iburaima Alamun M’bro Clausen Georgie Boko Dagoun Dagbesse Elysee Camara Sokhona N’guessan Kouadio ismael Foua bi Paul Hyacinthe Keita ismael Vaho Magnificat Marina Kone Minzata Yasmine Doumbia Yacouba Gynaecology-Obstetrics Department Centre Hospitalier Universitaire de Bouaké Bouake Ivory Coast Mother and Child Department Alassane Ouattara University Bouake Ivory Coast

Introduction: Retroplacental haematoma (RPH) is a very serious complication of pregnancy, with life-threatening consequences for both the mother and foetus. The aim of this study is to determine the incidence and epidemiological characteristics of patients with retroplacental haematoma (RPH) and describe the maternal-foetal complications at Bouaké University Hospital. Methods: This was a cross-sectional prospective, descriptive and analytical study carried out at Bouaké University Hospital over a period of 3 years, from January 1, 2019 to December 31, 2021. All parturients with RPH whose delivery took place at the hospital were included in the study. Data were entered and analysed using EPI INFO software version 7.***.2.6. Results: We recorded 2,0959 deliveries, including 202 cases of RPH, representing an incidence of 0.96%. The 21 to 35 age group accounted for 64.4%, multigestas and large multigestas accounted for 58.5% and multiparas accounted for 41.6%. The main signs on clinical examination were metrorrhagia (100%), arterial hypertension (84.6%) and cervical cerclage (79.7%). Preeclampsia accounted for 50% of per-gestational pathologies. Maternal mortality was 12.9%. Morbidity was dominated by anaemia in 64.1%, followed by disseminated intravascular coagulation (DIC) in 21.8%, and the factors associated with this maternal prognosis were multiple gestations, multiparity, Sher grade IIIb and the occurrence of complications such as DIC, shock, renal complications and HELLP syndrome. Neonatal mortality was 79.2%, and the factors associated with these fetal prognoses were cup size ≥ 5 cm and hematoma weight ≥ 500 g. Conclusion: Better screening of at-risk populations, early diagnosis and treatment in an organised and equipped medical and surgical facility would improve prognosis.

关键词： Retroplacental Haematoma Lethality Bouaké and Prognosis

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Parietal Hernias in Adults at Bouaké University Hospital: Epidemiological and Diagnostic Aspects

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Surgical Science 2023年第12期14卷 720-727页

作者： leh bi kalou Ismaèl Bamba Inza Akowendo Ezéchiel Kouakou Blaise Amos Ekra Amos Serge N’Dri Ahou Bernadette Diané Bamourou Department of General and Digestive Surgery Bouaké University Hospital Bouaké Ivory Coast

Introduction: A hernia of the abdominal wall is defined as the externalization of a viscera of the abdominal cavity in relation to a deficiency of the components of the wall. Topographies are diverse and diagnosis is based on clinical practice. The objective of this study was to describe the epidemiological and diagnostic aspects of abdominal wall hernias at the University Hospital of Bouaké, Côte d’Ivoire. Patients and Methods: This was a descriptive retrospective study that ran from January 2010 to December 2022. It concerned all patients admitted for abdominal wall hernias. Results: We collected 497 records of patients admitted for abdominal wall hernia. Abdominal wall hernias accounted for 7.6% of patients admitted to the ward (n = 6512) and were the fourth most common patient. These were males (79%;n = 392) and females (21%;n = 105). The mean age was 43 years [range: 17 and 70 years]. The occupation was dominated by forced labourers with 73% (n = 372) more specifically farmers (42%;n = 209). The average consultation time was 2 days (extreme 1 and 8 days). The main clinical signs were abdominal pain for strangulated hernias with or without occlusive signs (n = 397;79.8%) and reducible bothersome swelling with intermittent pain (n = 100;20.2%) for non-strangulated hernias. Hernias of the groin (inguinal and femoral hernia) were the most frequent with 85% (n = 422) followed by hernias of the white line (epigastric, umbilical and hypogastric) with 14% (n = 71) and lumbar hernias (Spiegel, Jean-Louis Petit and Grynfeltt) with 1% (n = 4), we did not note any cases of pelvic hernia (obturator and ischiatic). Conclusion: Parietal hernias are a common surgical condition at the Ivory Coast University Hospital, particularly in Bouaké. Groin hernia is the most common topographic variety. Strangulation is the main complication.

关键词： Hernia Wall Topography Surgery

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Surgical Management of a Giant Hydrocele of the Vagina in Adult

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Surgical Science 2020年第9期11卷 274-280页

作者： Anzoua Kouakou Ibrahim Kouakou Kouame Bernadin Traore Mamadou Gnangoran Koffi Marcelin leh bi kalou ismael N’Dri Ahou Bernadette Ekra Amos Kouakou Amos Bamba Inza Avion Kouassi Patrick Assohoun Krahibouet Toussaint Lebeau Roger Diane Bamourou General and Digestive Surgery Department Bouaké Hospital and University Center Bouaké C&ocirc te d’Ivoire General and Digestive Surgery Department Yopougon Hospital and University Center Yopougon C&ocirc te d’Ivoire

Introduction: Vaginal hydrocele is an amber-colored, sterile collection found between the parietal and visceral testis. It is said to be giant when it is larger than the patient’s skull or when it contains more than two liters of liquid. Objective: To report our method and the result of the surgical treatment. Observation: The authors reported an observation of a 50-year-old patient who consulted for a painless large left bursa. Clinical and paraclinical investigations, in particular scrotal ultrasound, have made it possible to diagnose a giant hydrocele of the vagina. The patient had surgical treatment which consisted of resecting of the vagina with hemostatic suture of the resected vaginal slice. The post-operation effects were not complicated. After a six-month setup, we did not notice any recurrence. Conclusion: Resection of the vagina with hemostatic suture of the resected vaginal slice in case of giant hydrocele could certainly give good results.

关键词： Giant Hydrocele Surgical Treatment

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Unusual Cause of Acute Appendicitis: Bone Fragment

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Surgical Science 2023年第3期14卷 221-224页

作者： leh bi kalou Ismaèl Anzoua Kouakou Ibrahim N’Dri Ahou Bernadette Ekra Amos Serge Kouakou Blaise Amos Dager Nahed bittar Issam Emmanuel Gruss University Hospital of Bouaké Bouake Ivory Coast Centre Hospitalier Intercommunal de Villeneuve Saint-Georges Paris France

Foreign bodies are a rare cause of appendicitis, because in most cases these ingested foreign bodies cross the digestive tract asymptomatically [1] [2] [3]. However, some penetrate the lumen of the appendix causing its inflammation. We report an unusual observation of acute appendicitis induced by a foreign body namely a bone fragment in the visceral surgery department of the Centre Hospitalier Intercommunal de Villeneuve Saint-Georges.

关键词： Acute Appendicitis Bone Fragment Emergency

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Hydatid Cyst of the Liver: About a Case at the Digestive and General Surgery Department of the University Hospital of Bouaké(Côte d’Ivoire)

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Surgical Science 2023年第1期14卷 10-16页

作者： leh bi kalou Ismaèl N’Dri Ahou Bernadette Ekra Amos Serge Kouakou Blaise Amos Bamba Inza Kouakou Kouamé Bernardin Anzoua Kouakou Ibrahim Traore Mamadou Lebeau Roger Diané Bamourou Department of General and Digestive Surgery CHU of Bouaké Bouake Ivory Coast

Hydatid cyst of the liver (KHF) is a parasitic condition caused by the development of the larval form of the dog tapenia Echinococcus granulosus. In sub-Saharan Africa, few writings are interested in this pathology, which remains common and constitutes a public health problem in highly endemic countries [1] [2]. We report the observation of a 61-year-old hypertensive patient owner of a dog admitted for abdominal pain without abdominal mass. In whom ultrasound and computed tomography have made it possible to make the diagnosis of hydatid cyst of the liver (KHF). The patient underwent surgery. We performed an associated conservative treatment post-operative albendazole. The post-operative follow-up was simple. In our patient the evolution was good after a setback of more than 2 months. Through this observation and a review of the literature, we insist on the contribution of imaging in diagnosis and treatment, which is essentially surgical.

关键词： Liver Hydatid Cyst Diagnosis Treatment

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An Inahbitual Etiology of Acute Intestinal Obstruction: The Giant Fecalome

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Surgical Science 2023年第3期14卷 225-230页

作者： leh bi kalou Ismaèl Traoré Mamadou N’Dri Ahou Bernadette Ekra Amos Serge Akowendo Ezéchiel Kouakou Blaise Amos Bamba Inza Kouakou Kouamé Bernadin Anzoua Kouakou Ibrahim Lebeau Roger Diané Bamourou Department of General and Digestive Surgery CHU of Bouaké Bouake Ivory Coast

The authors report an observation of a 20-year-old patient, who was referred by the medical emergency department for abdominal distention. The disease would have started with the appearance of abdominal pain, a stop of materials without stopping gases appeared gradually and evolving for 4 months. The patient was chronically constipated. She administered daily enemas with homemade products to have a bowel movement. She never had rectal bleeding, there was no alteration diarrhea—constipation. Mother of 3 children alive and apparently healthy. On clinical examination the abdomen was enlarged in size, painless but of firm consistency. The hernial orifices were free. Hard and abundant stools were noted on digital rectal examination. The abdominal CT scan revealed a large endorectal fecal impaction going up into the left colon, an absence of abdominal mass. We retained the diagnosis of giant fecal impaction. The patient was hospitalized and we instituted paraffin oil therapy combined with an evacuator enema with glycerin. The evolution was marked by a resumption of transit in the form of stool and gas (3 to 4 stools per day). At Day 8 of hospitalization the abdomen had decreased in volume the transit was regular and the patient was discharged on Day 10. Reviewed 3 months later, she maintained a regular transit made of one bowel movement a day. After a setback of 3 years the transit is still preserved. The authors discuss the etiologies of fecal impaction and their respective treatments.

关键词： Intestinal Obstruction Giant Fecal Impaction

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