Mamadou Cissé

Appendicular peritonitis in situs inversus totalis: a case report

IntroductionSitus inversus is a congenital anomaly characterized by the transposition of the abdominal viscera. When associated with dextrocardia, it is known as situs inversus totalis. This condition is rare and can be a diagnostic problem when associated with appendicular peritonitis.Case presentationWe report the case of a 20-year-old African man who presented to the emergency department with a 4-day history of diffuse abdominal pain, which began in his left iliac region and hypogastrium. After examination, we initiated a surgical exploration for peritonitis. We discovered a situs inversus at the left side of his liver, and his appendix was perforated in its middle third. A complementary post-operative thoracic and abdominal tomodensitometry revealed a situs inversus totalis.ConclusionAppendicular peritonitis in situs inversus is a rare association that can present a diagnostic problem. Morphologic exploration methods such as ultrasonography, tomodensitometry, magnetic resonance imaging, and laparoscopy may contribute to the early management of the disease and give guidance in choosing the most appropriate treatment for patients.

Internal supravesical hernia as a rare cauase of intestinal obstruction: a case report

IntroductionSupravesical hernias develop at the supravesical fossa between the remnants of the urachus and the left or right umbilical artery. They are often the cause of intestinal obstruction. We describe the anatomical variant of the supravesical hernia in this case and discuss the pre-operative findings revealed by computed tomography. We discuss diagnostic and therapeutic procedures, and review other anatomical variants.Case presentationA 60-year-old Senegalese man was admitted with a two-day history of small bowel obstruction. A physical examination showed abdominal distension. An abdominal X-ray revealed dilated small bowel loops. A computed tomography scan showed an image at the left iliac fossa that suggested an intussusception. A median laparotomy showed a left lateral internal supravesical hernia. The hernia was reduced and the defect was closed. The patient recovered uneventfully.ConclusionsSupravesical hernia is a possible cause of intestinal obstruction and diagnosis is very often made intraoperatively. Morphological examinations, such as computed tomography scanning, can lead to a preoperative diagnosis. Laparoscopy may be useful for diagnosis and therapy.

Giant splenic pseudocyst, a rare aetiology of abdominal tumor: a case report

IntroductionSplenic pseudocysts are nonparasitic cyst without epithelial lining. We report this case especially by its way of revelation, its large size and its per operative presentation which needed total splenectomy. To this opportunity, we discuss the diagnostic procedure and therapeutic indications.Case presentationA twenty-year old Senegalese woman, was admitted with a three-month history of spontaneous abdominal mass associated with a pain. Ultrasonography and CT scan found the giant splenic pseudocyst with a diameter of 20 cm which needed a total splenectomy by median laparotomy.ConclusionUsually, symptomless splenic cysts are untreated. When surgical treatment is indicated, recommendations are to preserve splenic parenchyma by partial splenectomy or fenestration especially by laparoscopy. Total splenectomy retains some guidance.

Premiers résultats de la cœlioscopie gynécologique au Centre hospitalier universitaire (CHU) de Dakar : série prospective de 128 cas

OBJECTIVES To analyze the results of, and to evaluate, gynaecologic laparoscopy in Dakar Teaching Hospital. METHODS This exploratory and descriptive study deals with a continuous series of 128 gynaecologic laparoscopies carried out between January 1, 2006, and December 31, 2009. In each operative case, sociodemographic and clinical parameters,operative data, and outcomes were studied. RESULTS Laparoscopies represented 14.37% of the programmed operative activities. The average age of the patients was 32 years,and the average parity was 1.2. The interventions were most frequently undertaken because of infertility (78.9%). A history of pelvic infections was found in 39.8% of the cases. The most frequent pathologies were tubal anomalies (70% of infertility cases) followed by ovarian cysts (10.1%) and endometriosis. The operative interventions included adhesiolysis in 35.1% of cases,and tubal surgery in 30.4%. A conversion, necessary in 7% of cases, was necessitated by the extent of adhesions (3 cases),the treatment of an associated pathology (4 cases), or a technical difficulty (2 cases).The main complications were vascular wounds and uterine perforations. The average operating times for diagnostic and operative laparoscopies were 56 minutes and 107 minutes,respectively. Outcomes were simple in 91.8% of cases. During the immediate postoperative period, a death occurred due to an acute pneumopathy. The average length of hospital stay was 3 days. We observed a pregnancy rate of 4.6%. Assisted reproduction was indicated in 28.7% of infertility cases. CONCLUSION Given its many advantages, diagnostic and operative laparoscopy must be integrated and developed by gynaecology departments in developing countries. This necessity is emphasized by the prevalence of tubal infertility of infectious origins, which, if diagnosed and treated early by laparoscopy,could have a better prognosis.

Léiomyome géant de la trompe utérine : une cause rare de tumeur abdominale

Leiomyomas of the fallopian tube are extremely rare. They are often managed with autopsy or surgery. We report a revealed case by a voluminous-abdominal mass in a 35-year-old woman. Neither the tomodensitometry nor, even, the laparoscopy did not permit specifying the tubal origin of the tumor. The diagnosis has been finally carried to the laparotomy. An annexectomy had been achieved. The histological examination concluded to a leiomyoma without malignant-cellular atypia.

Diverticules de Meckel compliqués: à propos de 15 cas

Le diverticule de Meckel (DM) est une persistance du canal omphalo-mésentérique. Généralement bénin et asymptomatique, il est surtout découvert fortuitement. Sa découverte se fait souvent à l’occasion de complications. Le but de notre étude est de décrire les aspects épidémiologiques, cliniques, anatomopathologiques et thérapeutiques des complications des DM. Il s’agissait d’une étude rétrospective sur 13 ans (Janvier 2003-Juin 2016) portant sur 15 cas de diverticules de Meckel compliqués pris en charge aux urgences chirurgicales de l’Hôpital Aristide Le Dantec de Dakar. Il s’agissait de 10 hommes et de 5 femmes dont l’âge moyen était de 27,8 ans avec des extrêmes de 1 mois et 73 ans. Les 2 principales circonstances de découverte étaient le syndrome occlusif et l’irritation péritonéale. La laparotomie en urgence avait permis d’affirmer l’implication d’un DM dans le tableau clinique. Dans les cas d’occlusion, le mécanisme était toujours une bride. Dix patients présentaient une nécrose intestinale avec perforation au moment du diagnostic. Tous les 15 patients avaient eu une résection segmentaire du grêle emportant le diverticule. Cette résection était suivie d’une anastomose immédiate dans 12 cas. La morbidité était constituée par 2 cas de fistules et 2 cas de péritonites post opératoires. Un décès par choc septique a été noté. Trois cas d’hétérotopie muqueuse ont été constatés dont une hétérotopie gastrique, une colique et une association d’hétérotopies colique et gastrique chez le même patient. Les complications de DM constituent des urgences digestives nécessitant une prise en charge chirurgicale précoce et adaptée. Cette dernière est greffée d’une morbidité non négligeable.

Adult ileocecal intussusception induced by adenomatous ileal polyp: case report and literature review

Abstract Intussusception is a rare cause of bowel obstruction in adults, and has generally an organic etiology. However, adenomatous polyp of the small bowel is an uncommon etiology. Moreover, there’s a great difference with childhood intussusception in its presentation, etiology and management. We describe herein a case of adult ileocecal intussusception due to an adenomatous ileal polyp with a preoperative diagnosis made on computed tomography. We performed a right hemicolectomy, without attempting to reduce the intussusception, and an end-to-end ileotransverse anastomosis. The pathological examination of the surgical specimen revealed an adenomatous polyp with a high grade dysplasia on the terminal ileum, being the cause of the ileocecal intussusception.

Using the SPEM 2.0 kind-based extension mechanism to define the SPEM4MDE metamodel

The objective 1 of the OMGs standard SPEM is to propose shared concepts for describing software and even systems processes. The SPEM 2.0 metamodel proposes concepts that are quite generic to describe model-driven development processes. Indeed, the artifacts of those processes are essentially models and relationships between them are numerous (e.g. impact, matching, overlap and so on). We notice that is difficult to have a process modeling language that is suitable to define any kind of process including MDE ones. To overcome this lack, we propose in this paper an extension of SPEM4MDE based on the SPEM 2.0 kind-based extension mechanism. It allows process designer to refine SPEM concepts in order to define the model-driven processes. To illustrate our approach, the MDE-based VUML process for models composition has been used.

Cervical cancer screening in pregnancy at the maternity clinics of Nabil Choucair health center and the Institute of Social Hygiene of Dakar, Senegal: a study on 67 cases

Background: This study aims were to develop the epidemiological profile of patients who received Pap smears during pregnancy, to describe aspects of cytological smears performed in pregnant women and to describe the therapeutic management in case of anomalies in the cervical smear during pregnancy. Methods: This was a prospective, descriptive and analytical study conducted from January 15, 2015 to June 31, 2015 at maternity of Nabil Choucair Health Centre and the Institute of Social Hygiene in Dakar. The Pap smear was performed in all patients who had given their consent to the experience. The parameters studied concerned sociodemographic aspects, gynecological and obstetric background, gestational age at the time of collection, cervicovaginal smear results, diagnostic and therapeutic management of cytological and histological abnormalities. The data collected on a survey sheet prepared for this purpose were entered and analyzed through the version 3.5.3 of Epi info software. Results: During the study period, 67 pregnant women had received a Pap smear. The epidemiological profile of our patient was a paucipare gestity with an average of 3 with extremes ranging from 1 to 7, an average parity of 2.4 with extremes ranging from 1 to 7. The mean age of pregnancy was 15.4 weeks of amenorrhea (range of 6 and 32 weeks). Only 5 patients (7.4%) had already received a cervical-vaginal swab before the study. The smear was normal in 88.7% of the cases but got abnormalities in 11.3% of the cases. The abnormalities were mainly found in squamous cells and were divided into low-grade lesions (57.1%) and skew-cell abnormalities whose meaning was undetermined (42.1%). Colposcopy was performed in 8 patients. Colposcopy was normal and satisfactory in 4 patients (50%) and identified as atypical grade 1 transformation in 2 patients (25%) and an atypical grade 2 transformation in 2 patients (25%). From a therapeutic point of view, diathermic loop conduction associated with strapping was performed in one patient (12.5%) for severe dysplasia. In postpartum, all dysplastic cervical lesions diagnosed during pregnancy had declined. Conclusions: In the context of our study, where there is no organized screening policy for cervical cancer, antenatal clinics are an excellent screening opportunity to seize.

Hemoperitoneum due to spontaneous uterine rupture of varicose veins in a twin pregnancy at term: A clinical case study presentation

Introduction: spontaneous rupture of uterine vessels during pregnancy is an exceptional situation. case report: We report a case of massive hemoperitoneum due to spontaneous rupture of uterine varicose veins, occurring in a patient with twin pregnancy at 38 weeks gestation. the patient presented abdominal pain associated with a sudden drop in blood pressure and severe decompensated anemia. Ultrasound scan revealed in-utero fetal demise of the twins with a peritoneal effusion. An emergency laparotomy followed by a cesarean section confirmed the diagnosis, etiology and management with a favorable maternal outcome. Mariétou Thiam1, Mouhamadou Mansour Niang2, Papa Abdoulaye BA3, Lamine Gueye4, Marie Edouard Faye Diémé5, Mamadou Lamine Cissé6 Affiliations: 1MD, Assistant Professor, Department of Obstetrics and Gynecology of the Thiès Regional Hospital, Faculty of Medicine, Thiès University, Thiès, Senegal; 2MD, Assistant Professor, Department of Obstetrics and Gynecology, Cheikh Anta Diop University, Dakar, Senegal; 3MD, Assistant Professor Department of General Surgery, Faculty of Medicine, Thiès University, Thiès, Senegal; 4MD, Department of Obstetrics and Gynecology, regional hospital Thiès, Senegal; 5MD, Professor, Department of Obstetrics and Gynecology, Cheikh Anta Diop University, Dakar, Senegal; 6MD, Professor, Department of Obstetrics and Gynecology of the Thiès Regional Hospital, Senegal, Thiès University, Thiès, Senegal. Corresponding Author: Mariétou Thiam, MD, Assistant professor, Department of Obstetrics and Gynecology of the Thiès Regional Hospital, Faculty of Medicine, Thiès University, Thiès, Senegal. BP 34 A Thiès; E-mail: maricoulibaly10@gmail.com Received: 19 December 2015 Accepted: 25 April 2016 Published: 24 May 2016 conclusion: spontaneous rupture of uterine varicose veins during pregnancy is a rare condition. clinicians should be aware with this rare condition as delayed diagnosis can be fatal for mother and fetus. the definitive diagnosis of this condition is often made intraoperatively. However, the clinical presentation with ultrasound scanning is very important in planning the management of this condition.