Pascal Foumane

A case report of bicornis bicollis uterus with unilateral cervical atresia: an unusual aetiology of chronic debilitating pelvic pain in a Cameroonian teenager

BackgroundCongenital uterine anomalies like bicornis or bicornuate uterus are relatively rare in sub-Saharan Africa. They are associated with an increased rate of spontaneous abortion, preterm delivery, and infertility. The occurrence of bicornis bicollis uterus with unilateral cervical atresia is exceptional and its management is controversial. We hereby report a rare cause of chronic pelvic pain in a Cameroonian teenager due to unilateral obstructive hematometra and hematosalpinx in the non-communicating horn of a bicornis bicollis uterus.Case presentationA 13-year-old premenarchal non-virgin female presented with chronic and severe cyclical crampy pelvic pain. On clinical examination, she had a perforated hymen, a single vagina, and one uterine cervix. A two-dimensional pelvic ultrasonography revealed hematometra but missed out the underlying anomaly. Failure to drain the hematometra by serial cervical dilatations prompted an exploratory laparotomy which revealed: bicornis bicollis uterus with a right rudimentary uterine horn communicating with the vagina and a left non-communicating uterine horn distended by hematometra due to a homolateral cervical atresia. She underwent utero-vaginal canalization and a left hemi-hysterotomy with drainage of the hematometra. The postoperative period was uneventful. Regular cyclic menses occurred thereafter beginning at the first postoperative month. She had complete resolution of symptoms without recurrence after six months.ConclusionDue to the risk of compromised fertility from bicornis uterus and the diagnostic challenges akin to resource-limited settings, we highlight the need for a high index of suspicion by healthcare providers when faced with chronic pelvic pain in premenarchal adolescents.

Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes

BackgroundLittle evidence exists on the efficacy and safety of the different surgical techniques used in the treatment of postpartum haemorrhage (PPH). We aimed to compare uterus preserving surgery (UPS) versus hysterectomy for refractory PPH in terms of perioperative outcomes in a sub-Saharan African country with a known high maternal mortality ratio due to PPH.MethodsThis was a retrospective cohort study comparing the perioperative outcomes of all women managed by UPS (defined as surgical interventions geared at achieving haemostasis while conserving the uterus) versus hysterectomy (defined as surgical resection of the uterus to achieve haemostasis) for PPH refractory to standard medical management in two tertiary hospitals in Cameroon from January 2004 to December 2014. We excluded patients who underwent hysterectomy after failure of UPS. Comparison was done using the Chi-square test or Fisher exact test where appropriate. Bonferroni adjustment of the p-value was performed in order to reduce the chance of obtaining false-positive results.ResultsWe included 24 cases of UPS against 36 cases of hysterectomy. The indications of surgery were dominated by uterine rupture and uterine atony in both groups. Types of UPS performed were seven bilateral hypogastric artery ligations, seven hysterorraphies, six bilateral uterine artery ligations, three B-Lynch sutures and one Tsirulnikov triple ligation with an overall uterine salvage rate of 83.3%. Types of hysterectomies were 26 subtotal hysterectomies and 10 total hysterectomies. UPS was associated with maternal deaths (RR: 2.3; 95% CI: 1.38–3.93.; p: 0.0015) and postoperative infections (RR: 1.96; 95% CI: 1.1–3.49; p: 0.0215). The association of UPS with maternal death was not attenuated after Bonferroni correction. Hysterectomy had no statistically significant adverse outcome.ConclusionHysterectomy is safer than UPS in the management of intractable PPH in our setting. The choice of UPS as first-line surgical management of PPH in resource-limited settings should entail diligent anticipation of these adverse maternal outcomes in order to lessen the perioperative burden of PPH.

Le vécu du premier examen gynécologique en milieu africain : cas du CamerounQuels ajustements apporter à son déroulement pour un meilleur vécu ?

UNLABELLED The gynecological examination is a key element in the diagnosis of the most genitourinary disorders. Improving how women experience the first gynecological examination (FGE) should have a significant impact on their perception of this examination and on their general feeling about it afterwards. OBJECTIVE The aim of our study was to describe the general feeling of Cameroonian women towards the FGE and to identify the factors associated with negative feelings. METHODOLOGY In this one-month survey study, we asked patients to complete a questionnaire about how they had experienced the FGE. The answers have been analyzed and the factors influencing the way they experience this examination determined. RESULTS At the end of the FGE, 41.5% of the women had negative feelings, and 38.6% reported that the examination had been painful. The average age of women who experienced pain was younger than that of those who did not [19.4 vs 20.39 years, P = 0.029], as was that of women with negative feelings lower [19.41 vs 20.43 years, P = 0.024]. A negative experience was significantly associated with a painful examination [P≤0.001], an examiner not specialized in gynecology [P = 0.04], lack of information [P = 0.001], and lack of a separate room to undress [P = 0.038]. The rate of subsequent refusals of a gynecological examination was higher among women with a negative first experience [56.2% vs. 35.9%, P = 0.008]. CONCLUSION The FGE is experienced by Cameroonian women as very difficult. Their feelings at the end of this examination significantly influences their behavior towards gynecological examinations in general.