Simultaneous bilateral femoral fracture in children

Introduction

Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting facilities are unknown. This study aims to describe our experience in managing BFFC.

Patients and Methods

A 10-year ongoing study spanning from 2010 to 2020 was held in a level-1 paediatric facility. We included all cases of BFFC on a bone-free disease with at least 10 months of follow-up time. Data were collected and analysed with statistical software.

Results

A total of eight patients with ten BFFC were collected. It involved mainly boys (n = 7/8) with median age of 8 years. Mechanism of injury were a road traffic accident (n = 4), a fall from height (n = 3), and been crushed by a falling wall (n = 1). Associated injuries were frequent (n = 6/8). Patients were managed nonoperatively with spica cast (n = 5) and by elastic intramedullary nails (n = 3). After 6.11 years of mean follow-up time, all fractures healed. The outcome was excellent and good in 7 cases. One patient sustained knees stiffness.

Conclusion

Non-operative management of BFFC showed satisfactory outcomes. Early surgical care must be developed in our low-income settings to reduce in-hospital stay and encourage early weight-bearing.

Caustic oesophageal stricture treated by instrumental dilatation: A review of 6 years of practice at the pediatric university hospital charles de gaulle of Ouagadougou

Background

Oesophageal stricture is one of the most important and redoubtable complications following caustic ingestions in children. Instrumental dilatation is usually considered the first line of treatment.

Aims and Objectives

This study aims to evaluate the outcomes of caustic stenosis treatment when using Lerut dilatators.

Materials and Methods

This is a descriptive retrospective study from May 2014 to April 2020. All children under 15 years hospitalised in our department for caustic oesophageal stricture and had a gastrostomy and oesophageal dilatation with insertion of an endless wire were included.

Results

A total of 83 patients were included. The sex ratio was 2.2. The mean age was 4 years. The mean time from caustic ingestion to presentation was 90 days. Oesophageal stricture was mostly caused by caustic soda (n = 41) and potash (n = 15). We performed in total 469 dilatations and had only three oesophageal perforations. After a mean follow-up of 17 months, we had 60.2% good results (n = 50) and 7.2% (n = 6) failures. The mortality rate was 13.2% (n = 11).

Conclusion

The results of the dilations by Lerut dilatators give encouraging results in our department. It is easy to perform and its complications remain rare. Mortality could be reduced by adequate nutritional support.

Acute intestinal intussusception among children under five years of age admitted in an Ouagadougou hospital, Burkina Faso, 2008-2013: epidemiological, clinical and therapeutic aspects

Introduction

acute intestinal intussusception is a life-threatening surgical condition. In some settings, rotavirus vaccines have been associated with a low-level increased risk of intussusception. We describe the epidemiology, clinical manifestations and management of intussusception in a tertiary referral hospital in Burkina Faso prior to the introduction of rotavirus vaccine in October 2013.

Methods

we retrospectively reviewed medical records of all children under 5 years of age treated at the Charles de Gaulle Pediatric Hospital for intussusception meeting the Brighton level 1 diagnostic criteria, from October 31st, 2008 to October 30th, 2013. We report the incidence of intussusception as well as descriptive characteristics of these cases.

Results

a total of 107 Brighton level 1 intussusception cases were identified, representing a hospital incidence of 21.4 cases / year. There were 69 males and 38 females (sex ratio of 1.8), with a median age of 8 months (range 2 months to 4 years). Sixty-two percent of intussusception cases occurred among infants (n = 67 cases). The average time from symptom onset to seeking medical consultation was 3.8 days +/- 2.7 (range 0 to 14 days). Treatment was mainly surgical (105 patients, 98.1%) with 35 patients (32.7%) undergoing intestinal resection. Thirty-seven patients (35.5%) experienced post-operative complications. The mortality rate was 9.3%. Intestinal resection was a risk factor for death from intussusception.

Conclusion

in this review of intussusception hospitalizations prior to rotavirus vaccine introduction in Burkina Faso, delays in seeking care were common and were associated with mortality.

Appendicular bilharzioma: An unusual cause of acute intestinal obstruction in childhood (a case report at Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou)

The authors report the case of a 12-year-old boy admitted to the surgical emergency department of Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou for acute abdominal pain. A strangulation of the terminal ileum by a tumour-like appendix wound around the bowel loop was seen during operation. The histological examination of the removed appendix disclosed eggs of Schistosoma haematobium and concluded to bilharzian appendicitis. A course of praziquantel treatment was instituted, and the patient underwent an event-free recovery. Such cases report are infrequent, even in areas where bilharzia-related diseases are endemic. It is important to recognise them and to treat them in an aetiological manner so as to prevent any potential complications. The diagnosis is always an operatory and histological curiosity. Appendectomy and treatment with a course of praziquantel seem quite suitable for this situation.

Penetrating chest wound of the foetus

Traumas of the foetus caused by stabbings are rare but actually life-threatening for both the foetus and the mother. We report a case of penetrating chest wound on a baby taken from the obstetrics unit to the paediatric surgical department. His mother was assaulted by his father, a mentally sick person with no appropriate follow-up. The foetus did not show any sign of vital distress. Surgical exploration of the wound has revealed a section of the 10 th rib, a laceration of the pleura and a tearing of the diaphragm. A phrenorraphy and a pleural drainage were performed. The new-born and its mother were released from hospital after 5 days and the clinical control and X-ray checks 6 months later showed nothing abnormal. We insisted a medical, psychiatric follow-up be initiated for the father. As regards pregnant women with penetrating wounds, the mortality rate of the foetus is 80%. The odds are good for our newborn due to the mild injuries and good professional collaboration of the medical staff. Penetrating transuterine wounds of the foetus can be very serious. The health care needed should include many fields due to the mother and the foetus' lesions extreme polymorphism. In our case, it could have prevented by a good psychiatric followed up of the offender.

Left posterolateral strangulated congenital diaphragmatic hernia in children: About a case at the Charles de Gaulle Paediatric Teaching Hospital in Ouagadougou (Burkina Faso)

Late presentation of congenital diaphragmatic hernia is uncommon. It poses considerable diagnostic challenges when it strangulates. The authors report a case of a left posterolateral strangulated congenital diaphragmatic hernia in a 5-year-old child diagnosed at the stage of acute intestinal occlusion with intestinal necrosis and managed successfully. A strangulated congenital diaphragmatic hernia should be suspected in the case of an association of sudden-onset respiratory and digestive manifestations with no sign of trauma or specific pulmonary history. It then requires an antero posterior thoracic X-ray or, even better, a thoracic-abdominal scan to confirm the diagnosis.

[Epidemiology of neonatal surgical emergencies in Ouagadougou]

OBJECTIVE

The purpose of this study was to determine the rate of neonatal surgery emergencies and to highlight the main causes and difficulties related to better handling of these emergencies.

PATIENTS AND METHODS

We conducted a 1-year descriptive prospective study from September 2009 to September 2010 based on 102 cases collected. At admission, we studied the patients' age, the pathologies encountered, the related malformations, the terms for better management, and prognosis.

FINDINGS

In 1 year, we registered 102 cases of neonatal surgical emergencies affecting the digestive tract (63.7%), the anterior side of the abdomen (24.5%), trauma (6.7%), and tumors (2%). Males comprised 60.8% of the cases. The sex-ratio was 1.55. The frequency of such cases was 3.94%. The average age of patients was 5 days with the 0- to 5-day-old age group presenting most frequently. The average hospitalization lasted 2.75 days and the admission method was the reference in 75.5%. Congenital pathology accounted for 95.5% of cases with anorectal malformations (ARM) (35; 95%) and omphaloceles (28.1%). Hirschsprung disease was the main cause of bowel obstruction other than ARM (50%). The average time to surgery was about 2.54 days. The overall mortality of neonatal surgical emergencies was 30.3% and postoperative mortality 32.35%. The late consultation, poverty, a shortage of qualified staff, prematurity, low birth weight, congenital disease, and related malformations were the leading factors of a poor prognosis. Acquisition of effective technical means, staff training, measures to combat poverty, and better prenatal care would improve the management of neonatal surgical emergencies.

CONCLUSION

Neonatal surgical emergencies include conditions that require immediate and adequate support. The continuous training of healthcare workers at all levels in the detection of neonatal emergencies and equipping healthcare facilities are an absolute necessity to provide better management and reduce the mortality rate.

Hernie diaphragmatique post-traumatique de l’enfant: à propos d’un cas au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou

La hernie diaphragmatique post-traumatique est une urgence chirurgicale rare chez l’enfant mais pouvant mettre rapidement en jeu le pronostic vital. Les auteurs rapportent le cas d’un garçon de 04 ans admis aux urgences pour douleur abdominale suite à une contusion thoraco-abdominale par accident de la voie publique. Le bilan radiologique initial a consisté en une échographie abdominale qui a révélé un hémopéritoine de petite abondance sans lésion focale. Douze heures après son admission, le patient a présenté une détresse respiratoire avec tableau clinique de pneumothorax gauche qui a nécessité une exsufflation en urgence. Le diagnostic de hernie diaphragmatique gauche a été posé à la radiographie du thorax réalisée après la ponction. L’enfant a bénéficié d’une cure chirurgicale. L’évolution a été favorable. La hernie diaphragmatique post traumatique, bien que rare chez l’enfant, devrait être systématiquement recherchée par une radiographie thoracique ou un scanner thoraco-abdominal devant tout traumatisme abdominal avec hyper pression. Son traitement est chirurgical.

[Morgagni hernia: Concerning 2 pediatric cases in Sub-Saharan Africa]

Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far, very limited data is available about them. We report two cases of repaired successfully Morgagni hernias using a transabdominal approach. The aim of this study is to illustrate the diagnostic difficulties and the excellent post operational prognostic observed following the transabdominal procedure. Both patients were female, one 8 months old and the other 3 months old. The presenting symptom was recurrent chest infection. Chest x-rays were carried out on both patients, which showed a pre-cardiac gas mass. A transabdominal surgical approach enabled surgeons to sow the defect with non resorbable suture material in one patient, and a prolene plate in the other. The patients fully recovered and no postoperative difficulties were reported.

The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa

BACKGROUND

This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine.

PATIENTS AND METHODS

This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons' directory was used to identify paediatric surgeons in the Francophone's countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research.

RESULTS

A total of 41 paediatric surgeons (68.33%) responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%), scholarship from a non-governmental organisations in 14 (34.15%) and self-sponsorships in 20 (48.78%). The average salary was 450 Euros (€) (range: 120-1 400 Euros). Most of the paediatric surgeons (68.29%) had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80%) had no subscription to specialised scientific journals.

CONCLUSION

The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.

Hirschsprung's disease: management problem in a developing country

BACKGROUND

The management of Hirschsprung's disease remains a problem in developing countries. Our aim is to identify the main epidemiological, clinical, and therapeutic characteristics of Hirschsprung's disease at the University Child Hospital Charles De Gaulle of Ouagadougou (CHUP-CDG).

PATIENTS AND METHOD

It is a retrospective study carried out in the period from January 2001 to December 2007 in the Surgery Unit at CHUP-CDG, which is a reference centre for Paediatric Surgery in Burkina Faso.

RESULTS

There were 52 patients (M: F=3.3:1). The annual incidence was seven cases. Age at presentation and diagnosis ranged from two days 10 years (median 20 months). Twenty five patients were from poor socio-economic conditions. Presentations were mainly intestinal obstruction, chronic constipation and enterocolitis. There were two cases of associated trisomy 21. Average age at operative intervention was 3.17 months. The rectosigmoidal form was the most frequently encountered. Over two-thirds (67.31%), with no complications at presentation, had benefited from nursing before their final treatment. A temporary colostomy was requested in case of complication. Swenson's technique was practiced for all the patients who underwent surgery operation. The assessment of functional results in eight patients after an average decrease of 3.5 years gave excellent results. Post-surgery complications were mainly enterocolitis in 12% of patients. Mortality rate was 16%.

CONCLUSION

Management of Hirschsprung's disease is a problem in Burkina Faso. It is characterised by its late presentation and difficult diagnosis due to inaccessibility and the non-availability of some investigation services (barium enema, histochemistry, and histology), resulting in high morbidity and mortality rates. Effective technical capacities, adequate staff training, and public education will be necessary to improve care quality.

[Warm saline enema for reduction of intestinal invagination under the ultrasonographic guidance: preliminary results apropos of 2 cases]

The authors describe the use of isotonic normal saline enema under US guidance in the treatment of acute uncomplicated intestinal intussusception in infants. The technique was successfully used in two patients aged respectively 18 and 16 months, with 11 and 9-month follow-up. The various steps of this technique and the results are analyzed and discussed. It is a valuable alternative to surgical treatment or hydrostatic reduction with opaque x-ray contrast under fluoroscopic guidance.

[Burn-induced contraction cicatrix in children. Review of 79 cases]

Post-burn flexion contractures of the hands are evaluated in this retrospective study concerning eighty-six hands of seventy-nine children in the pediatric surgery unit of the University hospital of Dakar from 1971 to 1995. A peak frequency was found among 2-months-old males. Fire (flames or embers) is the most frequent etiology (49.5%). The initial treatment of these burns is more often inadequate because it is performed in dispensaries (small clinics) or at home and then causes severe sequelae. Among the methods of treatment, excision with graft gives the best results in short flexion contractures. Isolated Z plasty can be used successfully. Our follow-up is short (6 months) but the results are relatively good. Among the factors influencing the results, the seriousness of the lesions, the type of surgical treatment, immobilization and physiotherapy are the most significant.

[Duodenal diaphragm in children (two cases)]

Duodenal diaphragm is a rare cause of intestinal obstruction. Two pediatric cases are reported in which vomiting of bile-stained material and distension of the epigastrium were the main clinical signs. Roentgenograms and sonograms were highly suggestive. Duodenal bypass was easy to perform and effective. Nevertheless, it must be kept in mind that associated anomalies are frequent and may be severe.

[Contribution of medical imaging in osteoarticular manifestations of sickle cell anemia in the child]

Drepanocytosis is one of the qualitative hemoglobinopathies which are the most widespread in the word. In a retrospective study on 16 drepanocytary patients observed at the Bordeaux Children's hospital, 7 patients showed medullar hyperplasia, 10 patients showed vaso-occlusive, and 4 patients showed infections. Medullar hyperplasia: bone demineralisation was the current appearance (47%), cortical thinning down (40.5%). They touch long bone. Thrombosis: bone demineralisation was the current appearance (86.3%) and touch long bone, 1 first appearance right femoral head infarct. Some particular appearances we found. 2 cases of "hand foot syndrome", 1 case ischemic aseptic arthritis and 1 case of vertebra "step staircase". Three salmonella pandiaphysite and 1 tuberculosis spondylodiscite were observed. The authors analyse the major radiological appearances of this hemoglobinopathy and recall the interest in knowing this disease even in low endemicity countries.

[Osteogenesis imperfecta diagnoses early, apropos of a case at the Yalgadou Ouédraogo National Hospital Center of Ouagadougou]

Osteogenesis imperfecta which represents a family tragedy for parents, a curiosity for physicians and radiologists, constitutes a real constitutional osteoporosis, usually rare with dominant autosomic transmission. Authors report a case of a 37 week amenorrhea living foetus, presenting an osteogenesis imperfecta. This affection, with early in utero manifestations, has a bad prognosis (baby deceased 72 hours after birth). Diagnosis was suspected at echography and conformed by x-rays investigations. The new born got also clinical and pathological examinations. Authors emphasize the unusualness and the gravity of these early clinical features. They insist on doing echography and radiography for the location of osseous and visceral lesions before and afterbirth.

[Cervical teratomas in the child (apropos of 8 cases)]

Eight cases of cervical teratomas in children are reported including 4 boys and 4 girls. Six patients presented within the first 10 days of life. The tumor was congenital in 7 cases. In 3 neonates it produced severe respiratory distress. Neural and chondral tissues were predominant but all three germ layers were represented. All patients were operated upon, with a 2/8 mortality. The main clinical and histopathological features of these rare tumors are reviewed. Early total surgical removal is the cornerstone of treatment.

[Congenital urachal fistulas: apropos of 2 cases in children]

Two paediatric cases of patent urachus are reported. In one of these cases, the anomaly was isolated whereas in the other case an omphalocele was also noted. Radical excision of the urachus with segmental resection of the bladder was easy and highly effective. Anatomy, complications and therapeutic aspects of this rare condition are discussed.

[Thyroid tumors. 83 operated cases]

The existence of a thyroïd tumour causes serious diagnostic problems. The retrospective analysis of 83 files collected between 1988 and 1993 (i.e. 6 years) allowed reviewing various diagnostic and therapeutic problems related to thyroid tumoral pathology in Burkina Faso. This pathology is more frequent in women (the sex ratio is 0.22). Clinical data show a high frequency of nodular goitre (87.95%) dominated by the multinodular form. The tumoral volume often proved impressive in most of our patients. Yet, at the histological analysis, 92.68% of thyroid tumours are benign, adenoma being in the lead (68.29% of cases). On the therapeutic level, in the absence of an isotopic exploration and extemporane analysis, surgical gesture was straightaway wide (60% of total or subtotal exerese). The post surgeries were satisfactory in general.

[Small-bowel duplication, apropos of a case in a child]

A pediatric case of small bowel duplication is reported. Non-specific abdominal pain was the main complain. A fixed hypogastric mass was found. Abdominal palpation under general anesthesia disclosed a movable intraperitoneal mass which proved at laparotomy to be a cystic duplication of the small bowel. The cyst was excised according to Norris procedure. Recovery was uneventful. Complications and therapeutic aspects of this rare condition are discussed.

[Complications of thyroid surgery, apropos of 104 thyroidectomies at the Ougadougou University Hospital Center]

We report a series of 104 thyroidectomies collected in Surgery and ENT departments of the University Hospital Center (UHC) of Ouagadougou. This study was composed of 85 women (81.73%) and 19 men (18.27%) 8 to 73 years old. 49 unilateral resection and 85 bilateral one were realized. Histopathologic examination has been done for 54 specimen only: 49 benign lesions (95.20%) and 5 malignant lesions (4.80%) were noted. We have observed: 7 cases of hemorrhagic complications (6.73%) with 1 death, 10 cases of unilateral laryngeal recurrent nerve palsy, permanent in 4 cases (3.85%), 2 cases of upper laryngeal nerve palsy (1.92%), 2 cases of permanent hypoparathyroidism (1.92%), 5 cases of post operative infection (4.80%). There were 2 deaths (1.92%). These results are similar with other authors results but the frequency of thyroidectomy complications is still important. Improvements in clinical practice, more specialists and great experience would improve post operative results of thyroidectomy.

[Male breast cancer in Africa, Apropos of 5 cases at the Ouagadougou University Teaching Hospital (Burkina Faso)]

A retrospective study of male breast cancer was undertaken at Ouagadougou University Teaching Hospital over a 3 year period (1993-1996). Authors report 5 cases representing 4.16% of all breast cancers. The patients' mean age was 61 years. The average duration of signs and symptoms before the diagnosis was 13 months. Clinically all the 5 cases presented advanced cancers (4 T4N2M0, 1 T4N2M1 according to UICC TNM System) with size ranging from 5.5, to 11.5 cm. Histology found: 2 medullary infiltrating carcinoma, 1 canalar infiltrating carcinoma, 1 colloid mucous carcinoma and 1 lobular infiltrating carcinoma. All patients had mastectomy associated with axillary clearance in 4 cases. Radiotherapy, chemotherapy and hormonotherapy were not associated because unavailable in Burkina Faso. Three patients died: the first, 10 days after surgical treatment and the 2 others respectively after 14 and 17 months. We have lost sight 1 patients. The last one is still alive. Authors find that to get better prognosis, it is important to improve medical and technical means, to increase information and to promote early detection.

[Problems after thyroid gland surgery in Burkina Faso, 83 cases]

Management of thyroid tumor can be problematic in developing countries due to poor diagnostic and therapeutic facilities. This is true in Burkina Faso where there are no facilities for radioisotope scans and intraoperative biopsy is usually unfeasible due to a shortage of histologists. The purpose of this retrospective analysis of the files of 83 patients who underwent surgery of the thyroid between January 1988 and December 1993 at the National Hospital Center of Ouagadougou was to obtain information necessary to define suitable pre-, per-, and post-operative strategies for these conditions. The mean delay to consultation for the 83 patients studied was 8 years. The fact that dysphonia and/or dysphagia was present at the first examination in 68 cases and that paralysis of the recurrent laryngeal nerve was observed in 17 cases testifies to the advanced stage at which patients were seen. Cancer was confirmed in only 3 of the 41 surgical specimens that were examined (7.3%). In cases involving only one nodule with no signs of malignancy, resection of the nodule is justifiable (18.1% of cases). In other cases radical resection is indicated either by lobo-isthmectomy or subtotal thyroidectomy for diffuse or multinodular goiter (74.7% of cases) or by total thyroidectomy (7.2% of cases). The immediate postoperative period was marked by the occurrence of hemorrhage (n = 7), transient paralysis of the recurrent laryngeal nerve (n = 4), and infection of the surgical wound (n = 5). There were 2 deaths.

[Indications for arthrodesis of the knee in Africa (apropos of 24 cases)]

29 knees arthrodesis was performed in 24 patients at the Orthopaedic Department in Dakar. The indications were: post-operative complications following poliomyelitis knee contractures in 11 cases, knee fusion following septic arthritis in 9 cases. The miscellaneous indications were tuberculosis of the knee (5 cases), post traumatic injuries (3 cases) and 1 case of knee osteo-arthritis. The authors pointed out the nature and diversity of those different indications and, now uncommon in developed countries, where knee arthroplasty is primary indication, whereas, arthrodesis is indicated for failures. They also point out the interest of the CHARNLEY procedure for this operation.