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PURPOSE: The aim of this study was to describe the epidemiologic, diagnostic, and therapeutic aspects of surgical abdominal emergencies in a teaching hospital in a developing country (Togo). MATERIAL AND METHOD: This retrospective study included the medical files of all patients managed for surgical abdominal emergencies from March 1, 2002, to March 1, 2012. RESULTS: The study included 594 patients, with a mean age of 30.3 years (range: 1 month to 80 years) and a 2.1 male:female sex ratio. The emergencies were acute generalized peritonitis (54.5%), intestinal obstruction (26.6%), acute appendicitis (14.5%), and abdominal trauma (4.4%). Plain abdominal radiographs were taken for 414 patients with acute generalized peritonitis (324 cases) and intestinal obstructions without a strangulated hernia (90 cases). Nine patients had abdominal ultrasounds for abdominal trauma (5 cases) and appendicular abscess (4 cases). No abdominal CT scan was performed. All patients underwent surgery, 316 (53.2%) by physician assistants and 278 (46.8%) by surgeons. Resuscitation and anesthesia were performed by nurse-anesthetists. The postoperative course was complicated in 182 cases (30.7%). These complications included parietal suppurations (18.2%), eviscerations (5.1%), ileal fistulas (4.4%), and postoperative peritonitis (3%). The death rate was 11.4%. CONCLUSION: Surgical abdominal emergencies at the Kara teaching hospital were both common and serious. Their particularly high morbidity and mortality might be reduced through the adoption of reasonably practicable measures: paramedical personnel training, public awareness, establishment of management protocols, and improvement of technical equipment (laboratory).

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UNLABELLED: The iatrogenal lesion of the inferior laryngeal nerve (ILN) during thyroid surgery is an incident, which can have greatest functional after-effects. Its research is recommended during cervicotomy for thyroidectomy and it can be easily found by the presence of Zuckerkandl tubercle, which is a postero-lateral excrescence of the thyroid gland. OBJECTIVES: The main objective of our study was the researching of the presence of this Zuckerkandl tubercle and appreciating the reports with the ILN. PATIENTS AND METHODS: From 1st October 2010 to 30th September 2012, we realized a continuous prospective study on a mono-operator series of 48 patients operated on for thyroidectomy. The Zuckerkandl tubercle has been researched from all the patients and classified according to the classification of Pelizzo et al. RESULTS: From 21 patients (43.75%), the Zuckerkandl tubercle has been well identified and it was grade 3 and grade 2. In those cases, the ILN was very closed to the tubercle. For the 27 other patients (56.25%), the tubercle was practically undetectable or reduced to a small glandular mound (grades 0 and 1). The connections with the nerve in this case were less evident. CONCLUSION: The zuckerkandl tubercle is comparatively frequent and is refound more than one time over 3 in our study. Its presence makes easier the identification of the ILN, which entertains a dangerous connection with the thyroid gland.

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PURPOSE: To evaluate the means for diagnosis and treatment of secondary hyperparathyroidism in patients with end-stage renal disease undergoing regular hemodialysis. METHODS: This prospective investigation studied patients with chronic renal kidney disease requiring and receiving hemodialysis at the Tokoin University Hospital in Lomé, from January 21, 2008, through December 31, 2008. RESULTS: The study population comprised 42 patients: 24 men and 18 women ranging in age from 20-82 years (mean: 42.62 years). Hyperparathormonemia was found in 20 of 24 patients for whom parathormonemia was assayed. Two patients with hyperthyroidism received a phosphorus chelator, and another went to Egypt for renal transplantation. The various other treatments we applied were not efficacious. We noted three cases of pathological fractures and one case of sudden death. CONCLUSION: The risk of parathyroidism in patients receiving hemodialysis is unavoidable. Its course is marked by a risk of sudden death due to the cardiovascular damage it causes. Numerous factors impede its effective management in Togo.

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OBJECTIVE: to see whether there was a difference in the risk of local infection for surgical wounds in a tropical setting depending on whether a wound was dressed or left open beyond 48 hours post-operatively. METHOD: Over a four month period, 102 patients undergoing intra-abdominal surgery classified as clean or clean-contaminated were randomized into two equal groups. The "with dressing" group underwent a wound dressing change and re-application every two days. In the "without dressing" group, the wound was left open to the air after a first dressing change at 48 hours. RESULTS: There was no difference in post-operative temperature curve; post-operative wound infection rate was 2% in each group. Suture removal was performed two days earlier in the "without dressing" group and hospital stay was decreased by two days. The expense of repeated dressing changes was also lessened. CONCLUSION: There is no benefit to leaving a wound dressing in place longer than 48 hours after surgery; costs related to prolonged hospitalization and expenses of dressing changes are decreased by a policy of leaving incisions undressed after 48 hours.

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UNLABELLED: D Dosseh Ékoué, A Doleaglenou, Y-K Fortey, A-E Ayite Objective: to see whether there was a difference in therisk of local infection for surgical wounds in a tropical settingdepending on whether a wound was dressed or left open beyond 48hours post-operatively. METHOD: Over a four month period, 102 patients undergoingintra-abdominal surgery classified as clean or clean-contaminatedwere randomized into two equal groups. The "with dressing" groupunderwent a wound dressing change and re-application every two days.In the "without dressing" group, the wound wasleft open to the air after a first dressing change at 48 hours. RESULTS: There was no difference in post-operative temperaturecurve; post-operative wound infection rate was 2% in eachgroup. Suture removal was performed two days earlier in the "withoutdressing" group and hospital stay was decreased by twodays. The expense of repeated dressing changes was also lessened. CONCLUSION: There is no benefit to leaving a wound dressingin place longer than 48 hours after surgery; costs related to prolongedhospitalization and expenses of dressing changes are decreased bya policy of leaving incisions undressed after 48 hours.

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Une etude retrospective des cas de volvulus pelvien operes dans le service de Chirugie Generale du CHU de Lome-Tokoin a ete entreprise dans le but d'en degager les caracteristiques epidemiologiques; etio-pathologiques; cliniques et pronostiques. Au nombre de 26; les volvulus du colon pelvien 30;95 pour cent des volvulus intestinaux ont represente 50 pour cent des causes d'occlusion colique mecanique. Ils ont ete marques par une nette predominance masculine (96;15 pour cent) avec un age moyen de 47; 65 ans. Sur le plan pathogenique; des facteurs constitutionnels affectant la morphologie du colon et une meso-sigmoidite retractile ont ete trouves a l'origine des volvulus. La radio de l'abdomen sans preparation; pratiquee dans tous les cas; a montre chez 22 patients une image typique de volvulus pelvien du colon pelvien. Le traitement a consiste en une detorsion simple (8 fois); une detorsion avec geste associe (7 fois); colectomie ideale (10 fois); et une hemicolectomie gauche (1 fois). Les auteurs ont deplore 4;76 pour cent de deces et 11;54 pour cent de redicives

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Une enquete retrospective a ete menee sur les cas de volvulus de l'intestin grele operes dans le service de Chirurgie Generale du CHU de Lome dans le but de se faire une idee des caracteristiques etio-pathogeniques; cliniques; et du pronostic de cette affection peu etudiee dans notre sous-region. Le volvulus du grele; 55 cas; correspondant a 65;47 pour cent des volvulus intestinaux; a represente 14;66 pour cent des causes d'occlusion intestinale aigue mecanique. Il a ete d'une nette predominance masculine (67;27 pour cent) avec un age moyen de 40 ans. Sur le plan pathogenique; il y avait une legere predominance des volvulus secondaires (52;73 pour cent) qui etaient dus dans 82;75 pour cent des cas aux brides et adherences spontanees ou post-operatoires. Tous les patients ont ete operes avec le diagnostic d'occlusion intestinale aigue. Dans aucun cas le diagnostic de volvulus du grele n'a ete pre-operatoire. Le retard therapeutique a ete responsable; dans 31 cas; de gangrene intestinale obligeant a une resection chez des patients en mauvais etat general: d'ou une lourde mortalite de 34;54 pour cent. Il faut convaincre les patients de consulter plus tot pour esperer une amelioration du pronostic

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Une etude retrospective sur les cas de volvulus du caecum operes dans le service de chirurgie du C.H.U. de Lome du 1er janvier 1977 au 31 decembre 1986 est presentee. Le volvulus caecal s'est avere une affection tres rare : 3 cas en 10 ans et tous les 3 patients etaient de sexe masculain; ages respectivement de 20; 35 et 72 ans. Il y avait 2 cas de volvulus caeco-colique et 1 cas de volvulus ileo-caeco-colique. Les methodes therapeutiques utilisees etaient une detorsion; suivie de fixation; et une fois l'hemicolectomie droite. Un deces a ete deplore (patient de 72 ans)

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