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

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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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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Acute Volvulus of a Wandering Spleen on Pregnancy: A Case Report

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Open Journal of Obstetrics and Gynecology 2018年第4期8卷 300-305页

作者： Traoré Mamadou Kouakou Kouamé Bernadin Anzoua Kouakou Ibrahim Menin Messou Benié Michelle Djahan lydie Estelle leh bi kalou ismaêl N’Dri Ahou Bernadette Ekra Amos Serges Kouakou Blaise Amos Zouan Freddy Junior lebeau Roger Diané Bamourou Digestive Surgery Department University Hospital of Bouaké Bouaké Cote d’Ivoire Gyneco-Obstetrics Department University Hospital of Bouaké Bouaké Cote d’Ivoire

Wandering or ectopic spleen is a rare congenital or acquired abnormality due to a defect in the anatomical fixity of the spleen with the surrounding organs. Pedicle twisting is its most common complication. It is an anatomo-clinical entity most often described in children, but rare in adults. It is a serious condition, especially when it occurs on a pregnancy putting at stake maternal and fetal prognosis. Authors report a case of acute volvulus of wandering spleen in a 26-year-old patient admitted for abdominal pain on an active pregnancy of 15 weeks of amenorrhea. Abdominal ultrasound scan helped to set the diagnosis. At laparotomy, the enlarged spleen was in an ectopic position, in the iliac fossa with a pedicle abnormally twisted in several spiral turns. Splenectomy was performed. The post-operative period was simple and the pregnancy progressed well to term.

关键词： Wandering Spleen Volvulus Pregnancy Splenectomy

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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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Delayed Diagnosis of Isolated Traumatic Rupture of Bladder

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Open Journal of Urology 2022年第1期12卷 69-73页

作者： Mamadou Traoré N’diamoi Akassimadou Kouakou Ibrahim Anzoua Kouame Bernadin Kouakou Inza Bamba Kouassi Patrice Avion Brice Aguia kalou ismaë l leh bi Ahou Bernadette N’Dri Serge Amos Ekra Blaise Amos Kouakou Roger lebeau Bamourou Diané Department of General and Digestive Surgery University Hospital of Bouaké Bouaké C&#244 te d’Ivoire Department of Urology University Hospital of Bouaké Bouaké C&#244 te d’Ivoire

Traumatic ruptures of the bladder are relatively rare lesions. They are associated in more than 80% of cases with a fracture of the pelvic girdle. The lesion mechanism is usually a sudden compression on the full bladder. Hypogastric pain and macroscopic hematuria suggest the diagnosis, which is confirmed by cystography. This diagnosis can be difficult and delayed in the absence of these call signs. We report a case of isolated traumatic intraperitoneal rupture of the bladder, diagnosed 24 hours after a public road accident in a 44-year-old patient.

关键词： Contusion Cystography Rupture Bladder

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

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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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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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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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