Hubert Tekou

Acute cholecystitis from typhic origin in children

Background: To evaluate the particularities of typhoid cholecystitis in children. Materials and Methods: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings, confirmed by operative findings at cholecystectomy. Results: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females). Their ages ranged from five to 13 years (median 8.8 years). The mean duration of symptoms was six to 21 days. The clinical signs were fever, abdominal pain, which predominated at the right upper abdominal quadrant, and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal′s test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3), perforation (2) and empyema (1). All the patients made an uneventful recovery, and have remained symptom free one and three months on follow-up. Conclusion: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice.

La circoncision : pourquoi et comment est-elle pratiquée chez le nouveau-né et le nourrisson au CHU de Lomé ? ☆

OBJECTIVE To identify the different indications, to analyze the conditions of realization of the circumcisions and to evaluate the results. PATIENTS AND METHOD It is about a prospective survey study done in the operative room of the Tokoin teaching hospital (Lomé) and on a period of 12 months (15th June 2007 to 15th June 2008). It was about newborns and infants circumcised in the operative block by a pediatric surgeon. One hundred and thirty-four newborns and infants were circumcised during the period of our study. The medan of age was of 5.86 months (range: 1 to 27 months). RESULTS One hundred and seven newborns and infants (79.85%) were circumcised for religious motive, 20 (14.92%) for hygiene motive, one (0.75%) for a lesion of the foreskin (burn of the foreskin by hot water), five (3.73%) for a phimosis and one (0.75%) for a paraphimosis. One hundred newborns and infants (74.63%) were circumcised under anesthesia by the fluothane associated to a caudal block, 29 (21.64%) were under local anesthesia (infiltration of anesthetic to the base of the penis) and five (3.73%) under general anesthesia by fluothane only. One hundred and two children (76.12%) were circumcised by the technique using the clamps and 32 (23.88%) by the technique using the Gomco clamp. CONCLUSION The circumcision is a surgical act whose indications are variable in our surroundings. It is mainly practiced for a religious motive.

Les diverticules de Meckel chez l’enfant : à propos de 11 cas

Resume Nous rapportons 11 cas de diverticule de Meckel pris en charge dans le service de Chirurgie Pediatrique du Centre Hospitalier Universitaire de Tokoin de Lome (Togo). Aucun des signes cliniques ou paracliniques n’avait permis d’evoquer le diagnostic avant l’intervention. Un des enfants est decede de complications du diverticule. Le traitement a consiste dans tous les cas en une resection segmentaire.

Emergency treatment of a ruptured huge omphalocele by simple suture of its membrane.

BackgroundThe rupture of a huge omphalocele is an emergency that threatens the newborn babys life. It constitutes a therapeutical concern in the absence of prosthesis especially in developing countries.MethodsWe are reporting herein the case of a newborn baby that we managed in emergency successfully thanks to a simple treatment.ResultsIt was a huge omphalocele, ruptured during delivery, in a male newborn baby. We conducted a simple and conservative surgical treatment without prosthesis, which consisted of reconstruction of the omphaloceles membrane by closing it with absorbable suture materials. The suture of the omphaloceles membrane was followed by treatment with the Grobs method. This treatment saved the newborn babys life. The total skinning was obtained after 3 months.ConclusionsIn case of rupture of huge omphalocele in absence of prosthesis, it is better to suture the membrane, and continue the treatment according to the Grobs method; the residual disembowelment can be repaired later.

La circoncision chez le nouveau-né et le nourrisson au bloc opératoire du CHU de Lomé : technique utilisant le Gomco clamp versus technique utilisant uniquement des pinces

OBJECTIVES To describe the various techniques used for the circumcision in newborns and infants in the operating room of the Lomé Teaching Hospital (Togo) and to compare their results. PATIENTS AND METHODS It is about a prospective study carried out in the operating room of the Lomé Teaching Hospital from June 15th, 2007 to December 15th, 2008 (18 months). It concerned newborns and infants circumcised according to two techniques: the technique using grips only (group A: n=138; 69%) and the technique using Gomco clamp (group B: n=62; 31%). The Khi(2) test with the threshold 5% was used for the statistical analysis. RESULTS According to the duration of the intervention, 34 newborns and infants (24.6%) were circumcised within less than 15 minutes in the group A and 27 (43.5%) in the group B (p<0.05). According to the importance of the bleeding and to the type of material used, 28 newborns and infants (20.30%) had bled much in the group A and one (1,61%) in the group B (p<0.05). According to the postoperative complications and to the technique used, nine newborns and infants (9.4%) had postoperational complications in the group A and two (3.2%) in the group B. The wound had healed within less than 6 days in one infant (0.7%) in the group A and six (9.7%) in the group B (p<0.05). One hundred penises (72.46%) were considered to be very satisfying in the group A and 55 (88.7%) in the group B (p<0.05). CONCLUSION The technique using Gomco clamp for circumcision had more advantages than that using only the grips. It was much more safe for the child.

Congenital giant epulis obstructing oral cavity: newborn emergency

The congenital epulis is a benign congenital granular cell tumor arising most often of the alveolar ridge of the jawbone. When giant, it is source of digestive discomfort disabling feeding. We report the case of a newborn female, vaginal delivery, presented with a giant intraoral tumor. Tumor obstructing the mouth of the newborn and prevent the attachment and feeding. The treatment consisted of excision of the tumor under general anesthesia. The histology of the tumor was revealed that it was an epulis.

Faits cliniquesInvagination intestinale avec boudin prolabé par l’anus chez le nourrissonRectal prolapse of intussusception in infants

Rectal prolapse is a rare complication of intussusception in infants. This complication is most often secondary to a side by side placing defect of the caecum and a long mesenter. Three cases of rectal prolapse of intussuception are reported herein and the pathologic and therapeutic aspects of the intussucseption complicated by rectal prolapse, as well as the particularities of intussusception diagnosis in an African country, are reviewed.

Classification of Umbilical Hernia

Umbilical hernias occur frequently in children. The treatment is closure of the umbilical ring and may or may not include umbilicoplasty. The authors devised a classification of the hernias that includes base diameter and height describing small and huge hernias and includes groups as well as types. The type of surgery depends on how it is classified by base diameter.

Cardiac Injury in Child Managed Successfully in Underprivileged Hospital of Africa

Cardiac injuries are rare and the associated mortality is high. Their prognosis can be ameliorated by early diagnosis and management in a specialized hospital with appropriate resuscitation care. This report describes a case of cardiac penetrating injury in a child managed successfully in an underprivileged hospital of Africa.

Osteoarthritis of the hip in children at the Lome´ Teaching Hospital

ObjectivesThe aim of this study was to describe the epidemiological and therapeutic aspects of osteoarthritis of the hip in children, analyze the outcome, and describe the techniques for its diagnosis in a hospital with poor working conditions. Materials and methodsThis was a retrospective study including children in the age group of 0–15 years, who were managed for osteoarthritis at the Pediatric Surgery Department of the Lomé Teaching Hospital (Togo) between July 2000 and June 2008. The data were collated from patients’ records and analyzed for epidemiology, clinical features, treatment, and outcome of osteoarthritis. ResultsA total of 30 children were included in this study, of whom 17 (24.4%) were girls and 13 (43.3%) were boys. Their mean age was 4 years (range: 1–15 years). Children in the age range of 0–6 years accounted for 73.33% of patients included. Fifteen patients were of the homozygous sickle cell genotype (SS). Treatment included antibiotic therapy and immobilization of the joint. The outcome was excellent in eight AA patients (26.67%); good in three (10%), including one SS, one AS, and one SC; and fair in 19 patients (63.33%), including 14 SS, four AS, and one SC. The average duration of hospital stay was 18 days (range: 2–35 days). ConclusionSickle cell disease (SS genotype) is the predominant cause of osteoarthritis in children presenting to the Pediatric Surgery Department of the Lomé Teaching Hospital. Early diagnosis and appropriate treatment are necessary for a complete cure.