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Indications and Techniques of Digestive Anastomoses at the Hospital in Koutiala District, Mali

Surgical Science 2020年第11期11卷 379-384页

作者： mahamadou coulibaly Drissa Traoré Birama Togola Souleymane Sanogo Bréhima Bengaly Drissa Ouattara Department of Surgery Koutiala Hospital Bamako Mali Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali

Purpose: Describe the indications and techniques of digestive anastomoses at the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study conducted in the general surgery department of the Koutiala District Hospital. Patients who benefited from digestive anastomosis between the hollow organs of the digestive tract during the period from August 1, 2017 to September 30, 2020 were included. The anastomoses with solid organs were not selected in this study. Results: One hundred and thirty-two patients were registered. Digestive anastomosis accounted for 11.5% of all surgical procedures. The average age was 38.6 years. Men were in the majority with 70.5%. The Karnofsky index was estimated to be less than 50% in 12 patients. Digestive anastomoses were indicated after resection of ileal necrosis in 43 patients (32.6%) followed by tumor resection in 32 patients (24.2%) and typhic perforations in 20 patients (15.1%). There were also 12 cases of digestive stoma (9.1%), 15 cases of volvulus of the sigmoid colon (11.4%), 7 cases of rectal prolapse (5.3%) and 3 cases of Hirschprung’s disease (2.3). Digestive anastomosis was performed in 89 patients in an emergency and was manual in all patients. Post-operative morbidity was 18.9%. These recorded complications, classified grade I (10 cases), grade II (3 cases), grade IIIa (2), grade IIIb (6 cases) and grade IV (4 cases) according to Clavien-Dindo, consisted of 8 cases of postoperative peritonitis (6.1%), 3 cases of external digestive fistula (2.3%), 2 cases of evisceration (1.5%), 12 cases of parietal suppuration (9.1%) and 4 cases of death (3.0%). Conclusion: Young male subjects are the most affected. Anastomoses are performed more often after the removal of the island necroses. Morbi-mortality is high. Success depends on several factors, including the general condition of the patient and the mastery of the anastomosis techn

关键词： Digestive Anastomosis Surgery Indications Technical

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Acute Appendicitis: Epidemio-Clinical and Therapeutic Aspects in Koutiala, Mali

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Surgical Science 2020年第8期11卷 216-221页

作者： mahamadou coulibaly Drissa Traoré Bréhima Bengaly Birama Togola Drissa Ouattara Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali

Purpose: To assess the epidemiological, clinical and therapeutic aspects of acute appendicitis at the Koutiala Reference Health Centre. Methods: This was a prospective study conducted in the general surgery department of the Koutiala Reference Health Centre. Patient records admitted for simple and complicated appendicitis during the period from August 1, 2017 to August 31, 2018 have been collected. Patients operated on for simple and complicated acute appendicitis were included in the study. Patients who did not have surgery were excluded. Results: We collected records of 62 patients who had surgery for simple and complicated acute appendicitis. They accounted for 11.9% of surgical procedures (n-520) and 27.3% (n-227) of surgical emergencies. The average age was 33.1 years-15.7. Men were in the majority with 72.5%. Simple acute appendicitis accounted for 56.4% of cases (n-35) and complicated appendicitis 43.6% of cases (these were 16 cases of appendicular peritonitis, 09 cases of appendicular abscess and 02 cases of appendicular plastron). Therapeutically, appendectomy was performed in 58 patients. In 4 patients the appendix was completely necrotized. The average length of hospitalization was 3.3 days-0.8 for single acute appendicites and 6 days-2.7 for complicated appendicites. Postoperative morbidity of complicated appendicitis was 6.4% (no. 4) and mortality was zero. Conclusion: Simple acute appendicitis is more common. Laparotomy remains the only way at present. Postoperative morbidity is high in complicated appendicitis and mortality is zero.

关键词： Appendix Abscess Peritonitis Plastron Surgery

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Skin Graft in the Surgery Department “B” of the CHU du Point “G” about 50 Cases

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Surgical Science 2020年第7期11卷 187-193页

作者： mahamadou coulibaly Bréhima Bengaly Drissa Ouattara Traoré Drissa Diallo Siaka Souleymane Sanogo Birama Togola Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali

Aim: To analyze the practice of skin grafting in the surgery department “B” of the CHU of Point “G” in Bamako. Patients and Methods: This was a retrospective and prospective study carried out between 1980 and 2014, covering all patients who underwent a skin graft and hospitalized. It covered all patients who underwent a skin transplant and were hospitalized in the department during the study period. Result: There were 50 patients including 25 women and 25 men. The mean age was 25.2 ± 19 years. The average duration of lesion evolution was 1 year. The lesions to be grafted were located in the lower limbs in 60%. The average area of substance loss was 13.2 cm2. The indication for skin graft was asked for loss of substance following scar bridles in 40%, ulcerative-necrotic wounds of infectious or traumatic origin (32%), malignant skin tumor (14%). In pathology, there were 5 cases of malignant melanoma and 2 cases of squamous cell carcinoma. Thin skin grafting was the most used technique (62%). The postoperative follow-ups were simple in 94%. There were 3 cases of graft necrosis. The average length of hospital stay was 28 days. The esthetic result was judged satisfactory in 84% of the cases (n = 42), average in 14% of the cases (n = 7) and unsatisfactory in 2% of the cases (n = 1). The sensitivity was good in 36 patients (72%), average in 12 patients (24%) and poor in 2 patients (4%). Conclusion: They mainly affect young people. The reduction of accidents on the public highway, good management of burn injuries, wounds and good hygiene of the population will considerably reduce the rate of its affections.

关键词： Skin Graft Surgery Postoperative Operations

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Ileal Occlusion on Bezoars at Kati BSS Hospital

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Surgical Science 2019年第1期10卷 39-43页

作者： Keita Koniba Abdoulaye Diarra Sidiki Keita Issa Traore Salia coulibaly Fadima Tall Daouda Diallo Oulematou coulibaly Assitan Kone Boubacar Kone mahamadou Bacary coulibaly Daouda Konate Ismael Konare Drissa Traore General Surgery Department Kati Mali Medical Imaging Department Kati Mali Anesthesia Resuscitation Department Kati Mali Ophthalmology Department Kati Mali

Bowel occlusions by bezoars are rare pathologies. They are due to an ob-struction of the intestinal lumen by a solid mass of fruits or undigested vegetable fibers. They are seasonal (wild fruit season from March to June) in the Sahel Zone. We report a case of small bowel obstruction in a 35-year-old rural man after swallowing a significant amount of wild grapes (Lannea microcarpa). We proceeded to the resection of the occluded ileal segment and performed an ileal terminal ileal anastomosis. There weren’t any complications during the postoperative site.

关键词： Bezoars Occlusion Jejunum Season

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Acute Peritonitis Generalized at the Koutiala Reference Health Center, Mali: Epidemiological, Etiological and Therapeutic Aspects

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Surgical Science 2020年第6期11卷 111-116页

作者： mahamadou coulibaly Birama Togola Traoré Drissa Bréhima Bengaly Souleymane Sanogo Drissa Ouattara Diallo Siaka Madiassa Konaté Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali

History: In Mali, several studies have been carried out on acute peritonitis but in the Koutiala circle it is a first. Aim: To evaluate the epidemiological, etiological and therapeutic aspects of generalized acute peritonitis at the Koutiala reference health center. Method: This was a 14-month prospective and descriptive study from August 1, 2017 to November 30, 2019, covering all patients admitted and operated for generalized acute peritonitis. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and postoperative operations. Result: The number was 93 cases, 72 men and 21 women. The average age was 34.2 years (Extremes: 2 - 75 years). The hospital frequency was 2.0%. The incidence rate of generalized acute peritonitis in the circle was 12.4 cases per 100,000 population. The clinical picture was still of peritonitis. The Widal-Félix serology was positive in 19 cases. Perioperative bacteriological sampling was systematic. The etiologies were dominated by digestive perforations in 81 cases (87%) of which 33 were located at the ileal level, postoperative peritonitis (6 cases) and ruptured pyocholecyst (2 cases). There were also 3 cases of primary peritonitis and 1 case of gynecological peritonitis. Excision-suturing was the most used surgical technique with 35.5% (n = 33). Postoperatively, we identified 10 cases of parietal suppuration (10.8%), 6 cases of postoperative peritonitis (6.5%), 2 cases of external digestive fistula (2.2%) and 7 cases of death (7.5%). Conclusion: Acute peritonitis occupies second place in abdominal surgical emergencies in the Koutiala circle. The etiologies are multiple and varied and are dominated by the ileal perforation which is secondary to typhoid fever more often. In most cases the surgical treatment is done by excision-suturing of the perforation. Mortality and morbidity remain high.

关键词： Generalized Acute Peritonitis Emergency Koutiala

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Total Thrombosis of Bifurcated Endoprosthesis: A Rare Complication of Endovascular Treatment of Abdominal Aortic Aneurysm

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Surgical Science 2019年第9期10卷 338-345页

作者： Birama Togola Bréhima Bengaly Madiassa Konaté Laurent Muller Olivier Szymoniak mahamadou coulibaly Drissa Traoré Bréhima coulibaly Skaiste Vaitkevicienne Michel Peret Nouhoum Ongoiba Jean Louis Debrux Department of Surgery “B” CHU Point “G” Bamako Mali Department of General Surgery Hospital Gabriel Touré Bamako Mali Department of Vascular and Thoracic Surgery of CH Cholet France Department of Vascular Surgery in Park Polyclinic of Cholet Cholet France Department of Thoracic and Cardiovascular Surgery Angers CHU Angers France

Background: Aortic stents are a therapeutic alternative to open surgery of abdominal aortic aneurysms. We report a case of treatment of an abdominal aortic aneurysm with a bifurcated stent, complicated by total thrombosis. Aim: The purpose of this presentation was to understand the causes, mechanisms, incidents and accidents that contributed to this complication. Case Presentation: A 48-year-old man patient with a history of high blood pressure, ischemic heart disease, chronic obstructive pulmonary disease, who was found during a surveillance check-up, an infra-renal abdominal aorta aneurysm measured at 56 mm in diameter, asymptomatic but progressive. The indication of an endovascular treatment by the placement of a bifurcated prosthesis was posed and accepted. Thrombosis of the two limbs was intra-operative, upper-end migration without endoleak at 4 months postoperative, total thrombosis of the stent at 13 months postoperatively. Explantation of the stent followed by aortobi-iliac bypass was finally performed in the 15th month. Conclusion: The cardiopulmonary antecedents, the anatomical and evolutionary characteristics of the aneurysm could have played a role in the occurrence of the complications observed in this patient.

关键词： Aneurysm Abdominal Aorta Endovascular Complications Stent Thrombosis

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Mortality Observed in the General Surgery Department “A” at the University Hospital Center of Point “G” in Bamako

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Surgical Science 2021年第4期12卷 119-126页

作者： Sidiki Keita Koniba Keita Moussa Sissoko mahamadou coulibaly Lamine Soumare Oumar Sacko Oulématou coulibaly Sekou Koumaré Adama Keita Adama K. Koita Soumaîla Keita Zimogo Zié Sanogo General Surgery “A” Department Hospital Point-G Bamako Mali General Surgery Department Hospital BSS Kati Mali Reference Health Center of Commune VI Bamako Mali

In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of any motivated surgical team. Objective: To analyze the rate and the main causes of mortality in the General “A” surgical department of the Point “G” CHU. Patients Method: Our study was retrospective, descriptive and covered a period of 5 years from 01/01/2014 to 12/31/2018. We collected 152 deaths for 2011 hospitalized patients. The data were collected from the files of these deaths on pre-established investigation forms. The deceased patients were classified as operative and non-operative death, death from non-cancerous and cancerous diseases, deaths occurring in emergencies and deaths in regulated surgery. Results: We recorded 152 cases of death for 2011 hospitalized patients, either an overall mortality rate of 7.55%. The average age of deaths was 44.20 years +- 17.51 years with extremes ranging from 7 years to 85 years. The sex ratio was 1.62 in favor of men. The causes of death were represented by cancerous pathologies (69 deaths or 34.67%), non-cancerous pathologies (83 deaths or 4.58%). Conclusion: The mortality rate in general surgery remains high and is mainly linked to cancerous pathologies and the delay in taking care of patients.

关键词： Mortality General Surgery Cancer Non-Operated Operated

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Management of Adult Rectal Prolapse in the Department of Chirurgie A of the University Hospital Center of Point G about 40 Cases

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Surgical Science 2023年第6期14卷 436-440页

作者： Sacko Oumar Soumare Lamine Soumare Ganda Traore Mamadou Salia Traore Issa Dianessy Yely Keita Sidiki Sissoko Moussa coulibaly Bruno Soulemane coulibaly mahamadou Traore Adama Famoussa Keita Soumaila University Hospital Center of Point-G Bamako Mali University Hospital Center of Kati Bamako Mali Hospital of District Commune IV Bamako Mali

Aim: Reporting the department’s experience in managing adult rectal prolapse. Methods: A descriptive study was conducted in the department of chirurgie A of the chu of point G. All patients operated on for rectal prolapse in the Department of Surgery “A” were included. Technics used were altemeier procedure and anoplasty. Results: 40 cases of complete rectal prolapse were identified. The sex ratio was 1.42. Average age was 50 years. During the study period, rectal prolapse accounted for 0.13% of all pathologies encountered (n = 40) and 3.37% of anorectal pathologies. Locoregional anesthesia was performed in all patients. In the series, 36 patients (90%) were operated on using the Altemeier procedure, anal cerclage was performed in 3 patients (7.5%), and anoplasty was performed in one patient (2.5%). Postoperative mortality was 2.5% (n = 1). The postoperative follow-up was simple in 95% of cases (n = 38). Anal stenosis was found in one patient (2.5%). Conclusion: Low-way surgery remains one of the preferred options for weakened patients exposed to anesthetic risks.

关键词： Rectal Prolapse Surgery Low-Way Surgery

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Epidemiological Profile of Intestinal Obstructions in Koutiala, Mali: About 65 Cases

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Surgical Science 2020年第6期11卷 117-121页

作者： mahamadou coulibaly Drissa Traoré Birama Togola Souleymane Sanogo Bréhima Bengaly Drissa Ouattara Siaka Diallo Madiassa Konaté Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali

Aim: To assess the epidemiological profile of intestinal obstructions at the Koutiala district hospital. Patients and Method: This was a prospective and descriptive study taking place from August 1, 2017 to April 30, 2020. The files of patients with acute intestinal obstruction in the general surgery department of the Koutiala district hospital were collected. In this study, patients operated on for acute intestinal obstruction were included. Non-operated patients were not included in the study. Result: The records of 65 patients operated on for acute intestinal obstruction were collected. The mean age was 32 ± 22 with extremes of 1 year and 94 years. 7 infants (10.8%) and 1 4-year-old child (1.5%) were identified. The 16 to 59 age group was more common. Males were the majority with 70.8% (n = 46). The sex ratio was 2.4. The rate of bowel obstruction in the general population in the circle was 8.1 cases per 100,000 population. According to provenance, patients came from inside the circle (rural areas) in 87.7% of the cases (n = 57) and from the city of Koutiala in 12.3% (n = 8). 33.9% of our patients had undergone laparotomy (n = 22). Patients consulted urgently in 93.8%. The etiologies are dominated by post-operative straps (33.8%) and volvulus (24.6%). We noted 12 cases of intestinal necrosis. Postoperative morbidity was 13.8% of cases (n = 9) and mortality of 6.1% of cases (n = 4). Conclusion: Bowel obstruction is one of the most frequent surgical emergencies in our circle. They most often affect young subjects and young adult males. The etiologies are dominated by the post-operative flanges. Complications remain elevated.

关键词： Epidemiology Intestinal Obstruction Koutiala

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Spontaneous Pneumothorax Complicating Miliary Tuberculosis: About a Case at the “Centre Medical Principal De La Gendarmerie Nationale Du Mali”

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Journal of Tuberculosis Research 2023年第2期11卷 67-73页

作者： Souleymane coulibaly Marius Pembé Sanou Kassim Sidibe Ladji Mohamed Diaby Lassina Diallo Daouda Amara Traore Salif Kone Ami Diarra Salif Sow Abasse Sanogo Salif Satao Mamadou Cherif Kante mahamadou coulibaly Aminata Bagayoko Soumaila Keita Polyclinique des Armées Kati Mali Centre Médical Principal de la Gendarmerie Nationale Bamako Mali Centre Médico-Chirurgical des Armées Bamako Mali Service de Pneumologie CHU Point G Bamako Mali

Introduction: Spontaneous pneumothorax is a rare but serious complication of tuberculosis. Miliary tuberculosis (MT) is a severe form of tuberculosis secondary to hematogenous spread of Mycobacterium tuberculosis. Objective: To report a case of MT complicated by pneumothorax. Methodology: This was a 25-year-old patient, farmer, followed up at the Pneumo-phtisiology department of the CHU du Point G for MT whose condition was improving after the introduction of anti-tuberculosis chemotherapy. He consulted again after experiencing chest pain. Clinical and imaging revealed a Spontaneous pneumothorax complicating MT. The treatment combined anti-tuberculosis chemotherapy, chest drainage and respiratory physiotherapy. Outcome was favorable with improvement of clinical and radiological signs. Conclusion: Pneumothorax complicating MT requires a reflective diagnostic approach and rapid management to improve its prognosis.

关键词： Spontaneous Pneumothorax Miliary Tuberculosis Antituberculous Chemotherapy Pleural Drainage Respiratory Physiotherapy

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