Ousmane Thiam

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.

Faisabilité et pertinence de la check-list de sécurité au bloc opératoire central du Centre Hospitalier Régional de Saint Louis du Sénégal

Introduction La check-list (CL) de sécurité au bloc opératoire est un outil de qualité qui permet de réduire la morbimortalité péri opératoire. C’est une des exigences de la Haute Autorité de Santé (HAS) française dans la procédure de certification des établissements de santé. L’objectif de ce travail est de réaliser une évaluation quantitative et qualitative de l’utilisation de cet outil au sein du bloc opératoire central du centre hospitalier Régional de Saint Louis. Méthodes Une évaluation prospective des indicateurs de l’utilisation pratique de la check-list et de son apport dans l’amélioration des pratiques chirurgicales au bloc opératoire du centre hospitalier régional de Saint-Louis a été entamée depuis son lancement en mars 2016. Résultats Le taux d’utilisation de la CL était de 75%, le taux de conformité était de 60%; le taux de renseignements était de 99% pour les items pré-induction, 93% pour les items pré-incision et 88% pour les items postopératoires. Seules 73% des CL analysées avaient été remplies avec une communication orale effective aux trois temps. La CL a permis de détecter des dysfonctionnements matériels et/ou des événements indésirables dans 15% des cas. Aucune erreur d’identification de patient ni de coté opéré ne furent objectivées dans notre étude. Conclusion La CL participe au développement de la culture de sécurité dans les blocs opératoires, et a débouché sur la mise en place d’une cartographie des risques au bloc opératoire. Certes importante, elle ne doit néanmoins pas être présentée comme l’outil magique pour éviter les erreurs, mais s’intègre dans l’amélioration de la qualité des soins avec d’autres programmes comme le signalement d’évènements indésirables et les revues de morbi-mortalités.

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.

Place de la césarienne vaginale dans l’obstétrique moderne

OBJECTIVE To report the experience of our unit with vaginal cesarean deliveries. PATIENTS AND METHODS This is a retrospective, descriptive study of seven vaginal cesarean deliveries performed in the maternity unit of the Centre Hospitalier Regional Universitaire de Saint-Louis in Senegal during the third quarter of 2012. The womens clinical characteristics were studied and indications for cesarean sections discussed. RESULTS The seven vaginal cesareans accounted for 3.2% of the cesarean deliveries performed during the study period (219) and 0.6% of all births (1428). The womens average age was 31 years. Gestational age ranged from 17 to 34 weeks of gestation. The principal indication for surgery was placental abruption, in 5 (72%) cases). The fetus was dead in 4 of the 7 cases. The mean 5-min Apgar score at birth for the liveborn infants was 5 (of an optimum score of 10). Mean fetal weight at birth was 1700 g. The mean operative time was 20.7 minutes. In one case, the incision extended to the uterine corpus. The postoperative course was uneventful in all cases. CONCLUSION Vaginal cesarean is safe, fast, but not without complications. It requires perfect mastery of vaginal surgery.

Perforated mesenteric Meckel's diverticulum in an adult: a real variant?

A Meckels diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a real diverticulum that is usually located on the anti-mesenteric edge in the last meter of the ileum. Its location on the mesenteric edge has been rarely reported. It may lead to several complications including perforation that may be life-threatening for the patient. We report herein a case of perforated mesenteric Meckels diverticulum in an adult patient. Upon surgical exploration by laparotomy, we found a perforated Meckels diverticulum located on the mesenteric edge of the ileum 60 cm from the ileocoecal junction and 400 ml of seropurulent peritoneal fluid. The patient underwent a segmental ileal resection and an end-to-end anastomosis. The postoperative outcomes were marked by a persistent peritonitis that required successful revision surgery.

The intra-uterine device (IUD) of the immediate postpartum a comparative study between the caesarean IUD and the IUD inserted after a natural delivery

This study aims to determine the epidemiological profile of patients who have been placed IUDs per caesarean section after vaginal delivery and assess the complications of the IUD put in after caesarean section and vaginal delivery. This was a prospective randomized study of cases of IUD placed during caesarean section and after vaginal birth in the service of Obstetrics and Gynecology, at the Centre Hospitalier de Ndioum. The study was conducted from January 1 to December 31, 2013. We included all patients who met the WHO IUD eligibility criteria. The variables studied were the socio-demographic characteristics, pregnancy and delivery peculiarities, the inserting and monitoring methods of the IUD. We used the 3.5.3version of software EPI6 info and software R3.0.2 for data analysis. Inserting an IUD Tcu 380 A was performed in103 women among whom 52 during caesarean section (50.5%) and 51 in the immediate postpartum see low (49.5%). 4 cases of expulsion was noted, 3.9% of cases. Pain after IUD insertion in per-Caesarean section was found in 11.8% against 25% in postpartum M1; M3 was 32% against 46.6% and M62% against 0%. IUD insertion per-cesarean has an acceptable expulsion and no increased risk of adverse events rates. This technique should be popularized. Correspondence to: Ousmane Thiam, Regional hospital of Ndioum, Senegal, Tel: 00 (221) 77 5085071; E-mail: cassoumane@yahoo.fr