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

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

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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

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Consent and Quality of Information for Patients in Laparoscopic Surgery at the Academic Hospital Point“G”(Mali)

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Surgical Science 2018年第12期9卷 502-508页

作者： Soumaila Keita madiassa konate Mamadi Coulibaly Abdoulaye Kante Traore Amadou Diarra Mamadou Salia Marius Sanou Aboubacar Sidiki Sangare Lamine Soumare Sekou Koumare Oumar Sacko Brahima Dicko D. Kanikomo Zimogo Zie Sanogo Service de Chirurgie A CHU du point GBamakoMali

Objectives: To evaluate the quality of the information provided to patients for their consent to be operated laparoscopically in the “A” surgery service of Point “G” University Hospital in Bamako (Mali). Methodology: The study was transversal, descriptive and prospective from November 1, 2016 to December 31, 2017 (14 months). It was performed at the general and laparoscopic surgery department of the Point “G” University Hospital in Bamako. Laparoscopically operated patients in scheduled or emergency programm whom consented the study and answered the questions before and after the surgical procedure were included. Results: One hundred patients were retained. The sex ratio was 4.2 for women. The surgery was scheduled in 93% (programmed surgery) of cases versus 7% (urgent surgery). Gynecological and obstetric surgery was performed in 54%, digestive surgery in 43% and laparoscopic exploration in 3%. The information was provided by surgeons, anesthetists, fellowship and students in respec-tively 63%, 6%, 11% and 9%. The reflection period before consenting to the act was greater or equal to 3 days in 90%. The media used were found to be suitable in 62%. The information was considered satisfactory preoperatively in 54% and postoperatively in 88%. Patients wanted additional information on post-surgery outcomes in 21%. Conclusion: The establishment of an information system and a free and informed consent form is a prerequisite for the quality of care in laparoscopic surgery.

关键词： Laparoscopy Information Consent

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Postoperative Occlusion of the Small Bowel with Flanges and/or Adhesions in General Surgery of Kati BSS CHU

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Surgical Science 2018年第9期9卷 293-299页

作者： Abdoulaye Diarra Koniba Keita Amadou Traore Assitan Koné Issa Traore Idrissa Tounkara Abdoulaye Kante Fadima K.Tall Daouda Diallo Moustaph Issa Magané madiassa konate Aboubacar Koné Deborah Sanra Sanogo Ismael Konare Alhassane Traoré General Surgery Department KatiMali Anesthesia Service and Resuscitation Department KatiMali Gastroenterology Department KatiMali

Objectives were to determine the frequency, describe the epidemiological and clinical aspects, therapeutic and analyze the postoperative course. Methodology: This was a retrospective study that covered 08 years (January 2009-December 2017). Inclusion criteria: all patients operated for obstruction of the small bowel by hail and/or flanging. Exclusion criteria: other types of occlusion and non-operated patients. Result: We recorded a total of 162 cases of hail obstruction by adhesions and/or flanges at 2.87%. The average age was 32.04, the sex ratio was 1.2. The average consultation time was 4 days. Abdominal pain associated with stopping of material and gas was present in all our patients. X-ray of the abdomen without preparation carried out in all the patients made it possible to objectify in 150 patients (92.6%) of the hydro-hail levels. Inoperative occlusion of hail on flange was present in 80 patients (49.4%). Occlusion of the small bowel on flange and adhesion was present in 69 patients. Adhesion obstruction of hail accounted for 6.8% (11 cases). The most commonly used surgical technique was flange resection in 91 patients (56.2%). The follow-up was simple in 151 patients (93.2%). Mortality was 1.2% of cases, i.e. 2 deaths. The average duration of hospitalization was 6 days. Conclusion: Occlusion of the small bowel by flanging and/or adherence is a surgical emergency whose prognosis depends on early management.

关键词： Postoperative Occlusion Hail Bridle/Adherence Mali

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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

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Treatment of Operative Pain in Visceral Cancer Surgery at CHU Gabriel Toure

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Surgical Science 2017年第1期8卷 47-51页

作者： Dembélé Bakary Tientigui Traoré Alhassane Togo Adégné Kante Lassana Diakité Ibrahim konate madiassa Traore Amadou Diakité Boubacar Bah Amadou Sidibé Yoro Koné Tany Diop Thiorno Madani Django Djibo Diallo Gangaly Department of General Surgery CHU Gabriel-Touré Bamako Mali

The objectives were to determine the frequency of pain in cancer patients and its intensity in cancer pathologies and to evaluate the evolution of pain intensity after analgesic treatment;the effectiveness of its management study involved 121 cases of operated gastrointestinal cancers, which accounted for 85.82% (141) of operated cancers and 16.78% (721) of all operated patients;the average age of our patients was 49.93 years with extremes 17 and 78 years. Standard deviation: 15.75;with a sex ratio of 1.46. The majority of our patients had WHO III (54/121) or 44.6%;46.3% (56/121) of patients were in stage IV of the TNM classification. The main digestive cancers were cancer of the esophagus 4 cases (3.3%);of the stomach 61 cases (50.4%);of the pancreas 7 cases (5.8%);of the liver 4 cases (3.3%);gall bladder 2 cases (1.6%);colon 33 cases (27.3%);rectum 6 cases (4.9%) and hail 4 cases (3.3%). The average pain intensities were 3 to 6 hour;2 to 24 hour;1.6 to 48 hour;and 1.2 to 72 hour. The majority of our patients had a treatment protocol involving nefopam, and paracetamol was 58%. The pain was exacerbated especially during exercise. Vomiting and vein burning were the main side effects encountered.

关键词： Pain Cancer Bamako Surgery Mali

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Benin Goitre in the General Surgery Department at Teaching Hospital Gabriel Touré

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Surgical Science 2022年第1期13卷 15-22页

作者： madiassa konate Amadou Traore Moussa Samake Abdoulaye Diarra Boubacar Karembé Amadou Bah Boubacar Yoro Sidibé Kadiatou Doumbia Tany Koné Amadou Maiga Zakari Saye Arouna Doumbia Ibrahim Diakite Bakary T. Dembelé Alhassane Traore Lassana Kante Adegné Togo General Surgery at Teaching of Gabriel Toure Bamako Mali

Introduction: Goitre is an increase in the volume of the thyroid gland. Goiters may be congenital or acquired, diffuse or nodular, functional or non-functional, benign or malignant. Purpose: The objectives of this work were to study and determine the frequency of benign goitre in the general surgery department of CHU Gabriel Touré, and to study epidemiological, clinical and therapeutic aspects. Patients and Method: This was a retrospective and prospective study conducted in the general surgery department of CHU Gabriel Touré, from January 1999 to December 2019. Included in the study were all patients with benign goiter confirmed in histology, hospitalized and treated in the service. Patients with thyroid malignant tumours, strumite, thyroid tract cyst, cervical abscess and neck trauma were not retained. Socio-demographic, clinical, para-clinical, therapeutic and post-operative aspects were the study parameters. Word processing and tables were done with Microsoft Word and Excel 2016 software. Data analysis was performed with Epi info7 software, the statistical test used was the Khi2 test and a value of P 0.05 was considered statistically significant. Results: A total of 253 patient files were collected. Thyroidectomy represented 5.02% (253/5036) of surgical pr

关键词： Benign Goitre Epidemiological Clinical and Therapeutic Aspects

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Stomach Cancer in the General Surgery Departement at the Teaching Hospital Gabriel Toure

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Surgical Science 2022年第4期13卷 188-197页

作者： madiassa konate Amadou Traore Moussa Samake Abdoulaye Diarra Idrissa Tounkara Boubacar Karembé Amadou Bah Boubacar Yoro Sidibé Tany Koné Amadou Maiga Zakari Saye Sana Kouriba Arouna Doumbia Ibrahim Diakite Bakary T. Dembelé Alhassane Traore Lassana Kante Adegné Togo General Surgery at Teaching of Gabriel Toure Bamako Mali

Introduction: Stomach cancer is a malignant tumor developed at the expense of the gastric wall. Gastric cancer is a common cancer occupying the 5th rank of cancers in the world, or 5.7% of all cancers. Purpose: To study epidemiological, diagnostic, therapeutic, and prognostic aspects of stomach cancer. Methodology: This was a retrospective and prospective study, which was carried out in the General Surgery Department at the teaching hospital Gabriel Touré between January 1, 1999, and December 31, 2020, and all cases of stomach cancer were confirmed by histological examination. Result: We recorded 857 cases of stomach cancer or 40.1% of digestive cancers. The sex ratio was 1.6. The average age was 55 years ± 13 years. The main clinical signs were epigastralgia (98.6%), vomiting (93.34%), weight loss (96.03%), and anorexia (46.1%). It was adenocarcinoma (97.55%), and antropyloric location (78.64%). Patients were Stage IV (72.817%) cases. Among the 857 patients, 722 were operated on, accounting for 84.25% of the cases. Surgery was palliative in 60.66% and curative in 25.62%. Gastrectomy of 4/5 plus D2 type curage was the most performed in curative surgery. The median overall postoperative survival was 5 months. Conclusion: Stomach cancer is the most common digestive cancer in our department, the diagnosis is most often late, so palliative surgery occupies an important place.

关键词： Cancer Stomach Surgery Survival

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Liver Abscesses: What Diagnostics and Therapeutics in the Kati Reference Health Center (Mali)?

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Surgical Science 2018年第9期9卷 344-350页

作者： Abdoulaye Diarra Koniba Keita Amadou Traore Assitan Koné madiassa konate Idrissa Tounkara Mamadou A. Keita Issa Traore Modibo Togola Fadima K. Tall Daouda Diallo Moustaph Issa Magane Deborah Sanra Sanogo Aboubacar Koné Ibrahim Diakite Alhassane Traore Adégné Togo General Surgery Department Kati Mali Anesthesia Service and Resuscitation Department Kati Mali Gastroenterology Department Kati Mali

The objectives were to determine the frequency of hepatic abscess, and to describe the clinical and para-clinical aspects and the therapeutic modalities. Method and material: This is a prospective study covering 24 months (January 2016-December 2017). Results: This was a prospective study of 30 cases of liver abscess, ranging from January 2016 to December 2017, a period of 12 months. Inclusion criteria: What were included in this study were all patients hospitalized and treated for liver abscess. Criteria for non-inclusion: Abscess cases have not been treated in the service. The sex ratio was 2.3 and the average age was 35 years old. The main clinical signs were: fever (56.7%), hepatitis (73.3%) and hepatomegaly (26.7%). Hepatic collections objected to abdominal ultrasonography were localized in the right lobe in 70%. Surgical treatment was performed in 10% of cases. Medical treatment alone was performed in the majority of cases (56.7%);eclocated puncture was required in 10 cases (33.3%). The follow-up was simple in all our patients and we did not register deaths;the average duration of treatment was 5 days. Conclusion: Topical pathology in surgical practice in our country, liver abscess is common in our department;medical treatment is curative in the absence of complications.

关键词： Abscess Liver Mali

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Urgent Surgical Management of Acute Lower Gastrointestinal Bleeding with Intraoperative Colonoscopy: A Case Report

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Surgical Science 2018年第9期9卷 300-305页

作者： Traore Amadou konate madiassa Diarra Abdoulaye Keita Soumaila Kone Tani Karembe Boubacar Amadou Issa Sidibe Boubacar Bah Amadou Maiga Amadou Diakite Ibrahim Dembele Bakary Tientigui Traore Alhassane Togo Adegne Kante Lassana Samake Moussa Mangane MoustaphaIssa Diop Thierno Madane Diakite Adama Diallo Gangaly Gabriel Toure University Hospital Bamako Mali

Lower gastrointestinal bleeding (LGIB) is defined as bleeding from a source distal to the Ligament of Treitz. The primary step is to identify severe hemorrhages that may be life-threatening for patients (10% of cases of LGIB). The management depends on the severity of the bleeding, the diagnostic and therapeutic means of the patient’s reception center. Patient with acute LGIB, in case of negativity of endoscopic and radiological examinations, can be a surgical indication with possibility of intraoperative colonoscopy. We report a case of urgent surgical management with intraoperative colonoscopy in a patient with severe acute LGIB.

关键词： Lower Gastrointestinal Bleeding Surgery Gabriel Toure

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