INTRODUCTION:A urethro-rectal fistula is an abnormal communication between the urethra and the rectum. It is a rare entity. It is most often an iatrogenic lesion during prostate surgery. We present here the case of a post-traumatic urethro-rectal fistula secondary to a road accident. Surgical cure was via a perineal approach with gracilis flap interposition. CASE PRESENTATION:This is a 15-year-old patient who consulted for a urethro-cutaneous fistula. Retrograde urethrography (RUG) with voiding cystourethrography (VCUG) showed a urethro-rectal fistula, with contrast leakage and opacification of the rectum. The fistula was cured using an anterior perineal approach with interposition of a gracilis flap. The post-operative course was uneventful. DISCUSSION:Urethro-rectal fistula is a rare entity and most often iatrogenic. Due to the rarity of this entity, the literature concerning its description, and its treatment is poor. Tailored approach should be considered for each patient. The use of gracilis flap interposition is describe as a good technique for managing urethro-rectal fistulas. CONCLUSION:Urethro-rectal fistula is a rare pathology, especially when it occurs following a road accident. Perineal cure with gracilis flap interposition appears to be a reliable technique.

INTRODUCTION : La prise en charge chirurgicale des tumeurs cutanés pose le plus souvent un problème de couverture du fait de son caractère délabrant et du siège de la tumeur. Différentes options de couverture sont préconisées allant de la greffe de peau aux lambeaux. L’objectif de ce travail est de rapporter les aspects de cette prise en charge chirurgicale à propos de deux observations. OBSERVATION : Cas 1 : Nous rapportons le cas d’un patient de 20 ans sans antécédents pathologiques particuliers qui présente une tuméfaction pariéto-occipitale évoluant depuis l’enfance sans notion de douleurs ni de saignements retrouvés. L’aspect clinique retrouvait une tuméfaction bourgeonnante, de consistance ferme, rosée avec quelques surélévations par endroits. La biopsie effectuée a objectivé un synrigo-cystadénome papillifère. Après réunion de concertation pluridisciplinaire, l’exérèse et la reconstruction en un temps a été préconisé. La prise en charge chirurgicale a consisté en une exérèse large avec des marges d’un cm. Un lambeau de rotation cutané a été utilisé permettant de couvrir la perte de substance. Les suites opératoires ont été marqués par la survenue d’une nécrose de la pointe du lambeau. L’évolution été favorable et on notait une cicatrisation satisfaisante. Cas 2 : Nous rapportons le cas d’une patiente de 66 ans sans antécédents pathologiques présentant une volumineuse masse de la cuisse gauche évoluant depuis 20 ans. L’aspect clinique retrouve une masse ulcéro-bourgeonnante de la cuisse gauche de 12x8x10 cm saignant au contact. La biopsie effectuée objective un rhabdomyosarcome alvéolaire. L’IRM effectue objective la masse au contact du muscle tenseur sans infiltration. Après réunion de concertation pluridisciplinaire, une exérèse a été définie, associée à une reconstruction plus radiothérapie. La prise en charge chirurgicale a consisté à un lambeau d’avancement fascio-cutané. Les suites opératoires ont été simples. On notait une cicatrisation satisfaisante à six mois de recul. CONCLUSION : La prise en charge chirurgicale de ces tumeurs cutanées présente un double défi carcinologique et cosmétique d’où l’intérêt de la multidisciplinarité dans la prise en charge de ces tumeurs.

Object. - Plexiform neurofibroma is a characteristic lesion of Von Recklinghausen's disease. Conservative surgery is the most widely adopted treatment. However, it is very challenging because of its hemorrhagic nature and the infiltrative aspect of the lesions. The aim of this study was to evaluate our management. Patients and method. - A retrospective study over 16 years was realized and during this period 35 patients with neurofibroma with cervico-facial location were included. Results. - There were 18 men and 17 women with an average age of 23 years (3-50 years). The familial form was found in 9% of patients. Aesthetic discomfort was noted in all patients and functional impairment only occurred in 10% of patients. The NFP was localized at the hemiface in 11 cases, periorbital in 6 cases, naso-labial in 5 cases, scalp in 4 cases, jugal in 4 cases and cervico-chin in 5 cases. Size of the lesions averaged 11.6 cm (4-45 cm). Eighteen patients (51.4%) were operated including 10 by modeling resection, 05 cervico-facial lifting and 3 complete resections. Complication rate was 28% dominated by disunion wound. The average number of procedures was 1.6 (1 to 5). After 3 years average follow-up, aesthetic et functional results was assessed as good over 75 per cent of patients. Conclusion. - Cervico-facial plexiform neurofibromas is challenging. Conservative surgery should be the gold standard and long time follow-up is recommended. (C) 2020 Published by Elsevier Masson SAS.

•Axillary contractures are common sequela of chest and shoulder burn.•Treatment remain surgical by flaps or skin graft, according to the severity and the healthy surrounding skin.•Physiotherapy is an important part of the treatment.

La gynecomastie est la pathologie mammaire la plus frequente chez l’homme. EnAfrique et au Senegal en particulier, son traitement a fait l’objet de peu de publications. Nous rapportons une etude retrospective de 13 cas de gynecomastie operes de 2006 a 2010 a l’Hopital Le Dantec et dans certaines cliniques privees de Dakar. La quasi-totalite des patients etait adressee par des medecins generalistes ou endocrinologues. L’âge moyen etait de 30ans. Dans 10 cas, la gynecomastie evoluait depuis la puberte. La forme bilaterale predominait dans 9 cas. Tous les patients avaient un bilan hormonal normal. L’echographie mammaire et la mammographie n’avaient pas decele de signes suspects de malignite dans tous les cas ou elles etaient prescrites. La mastectomie sous-cutanee etait realisee en premiere intention dans 11 cas, soit par voie peri-areolaire ou par voie sous-mammaire prolongee d’une incision verticale. Deux patients avaient beneficie de lipo-aspiration seule. Peu de complications etaient retrouvees : il s’agissait d’un cas de serome et d’un cas d’infection de la plaie operatoire. Deux patients avaient beneficie d’une mastectomie sous-cutanee complementaire pour residu glandulaire apres lipo-aspiration.Aucun cas de deces ou de necrose de la plaque areolo-mamelonnaire n’avait ete note. Apres un recul moyen de 7 mois, aucun cas de recidive n’avait ete note. Le resultat esthetique etait juge tres bon dans 12 cas. Le traitement des gynecomasties est le plus souvent chirurgical du fait de nombreux echecs du traitement medical et des repercussions psychologiques parfois importantes chez les patients.

Aims. - The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallee, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication.Patients and method. - Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallee. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237 cm(3) (extremes 60 cm(3)-12 L).Results. - The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment.Conclusion. - The authors insist on certain rare forms met in Africa in particular the "virtual form'', the ancient forms and the too plentiful forms (12 L). They plead for use deep fascial fenestrations by Ronceray for these last ones. (C) 2010 Elsevier Masson SAS. All rights reserved.

The management of patients with a cleft lip in developing countries is often the prerogative of humanitarian missions from developed countries. The goal of our work is to conduct a first epidemiological, clinical and therapeutic assessment of the management of cleft lips by a local team and to evidence the difficulties faced by us in our working conditions. In a retrospective study covering a period of about five years (January 2004 to March 2009), 205 cases of nasolabial clefts are assembled. The mean age at the time of the first visit is 17 months. A slight female predominance is observed. The majority of patients are from the capital city. A close relative with a cleft is found in 6.8% of them. In 44.9% of cases, it is a simple cleft lip. A cleft palate is associated in 47.8% of cases. Associated malformations are observed in 10.5% of cases. We operated on 110 patients. The mean age at the first surgery is two years. Millard's technique is our technique of choice. No operative mortality is observed. In 17.4% of cases, operative morbidity occurred in the form of suppuration with partial or complete early suture release. The esthetic result is satisfactory in 67.7% of cases. This management could be improved by creating a multidisciplinary team including--in addition to surgeons--dentists, speech-language pathologists, psychologists, etc.

Le nodule de Sœur Marie-Joseph est une entité rare. Elle représente un mode de découverte de tumeurs abdominales dont la plupart sont représentées par les adénocarcinomes gastriques. Nous rapportons un cas exceptionnel d’une tumeur ombilicale type Sœur Marie-Joseph survenue chez un patient de 61 ans, sans antécédents particuliers. Il s’agissait d’un mode de révélation tardive d’un adénocarcinome de la tête du pancréas. La clinique notait un nodule ombilical prurigineux et fistulisé sans altération de l’état général. Le scanner abdominal retrouvait une masse tissulaire en continuité avec les muscles grands droits. La cytoponction était en faveur d’un carcinome envahissant la paroi abdominale. Le patient avait bénéficié d’une résection tumorale emportant les muscles larges, grands droits de l’abdomen, et le péritoine pariétal, suivie d’une reconstruction pariétale. Elle utilisait deux plaques prothétiques reposant sur l’épiploon suturé aux berges de résection de la paroi abdominale, la fermeture cutanée étant réalisée grâce à six lambeaux de rotation. Les suites opératoires étaient marquées, huit mois plus tard, par la découverte d’une tumeur de la tête du pancréas. Le patient décédait trois semaines après une tentative de drainage biliaire par cholangiopancréatographie rétrograde endoscopique (CPRE).

We report a case of caudal duplication in a 5 month old Senegalese girl. She presented a surnumerary femur articulating with a surnumerary pelvis and a rudimentary knee. This case of dipygus was treated surgically. However the child did not walk up to the age of 3 because of a sacral abnormality.

Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children.

The Pectorals Major Pedicle Flap has been described by ARIYAN in 1979. Authors expound the anatomic basis of this flap and case's experience .The study carried out in the laboratory concerned 14 corpses (11 men and 3 women). Concerning Clinical cases, from January 1st 1994 to December 31st 2003, 26 patients have had a pectoralis major flap in the Otorhinolaryngology and Head and Neck department of the University of Dakar.The average year was 51 and the sex ratio was 2 women (7.69%)out of 24 men (92.31%). We repaired the pharyngostoma in 20 cases, the oropharynx in 3 cases, the mucosal defect in the mouth in 2 cases and the parotid gland in 1 case. The pectoralis major flap was favourable in 9 cases . We noted 8 cases of partial necrosis and 5 cases of total necrosis. Four (4) cases of death were to be deplored in post operative immediate.Reconstruction by pectoralis major flap is scarce in our practice. The improvement of the results goes through the indications choice and the acquisition of more efficient technical stools.

Les hernies ombilicales de l’enfant sont une pathologie fréquente dans nos régions. Les excès cutanés après cure de ces hernies posent un problème esthétique important. C’est ainsi que nous avons réalisé une étude prospective chez 77 patients porteurs de hernies ombilicales entre 1998 et 2000. Nous avons été amenés à réaliser 55 plasties cutanées ombilicales pour résorber l’excès cutané. Pour cela, nous avons utilisé trois techniques chirurgicales selon l’importance de l’excès cutané : la plastie latérale gauche, la plastie cutanée en « fer à cheval », la greffe ombilicale. Nous avons classé les résultats en trois groupes : 40 cas de bons résultats, sept cas de résultats moyens et trois cas de mauvais résultats. Vingt-sept patients ont été perdus de vue. Ces techniques chirurgicales permettent d’apporter une solution simple et efficace au problème de l’excès cutané dans les hernies ombilicales.

Umbilical hernia is as frequent pathology in our country. The skin excess is a real problem for the surgeon because it is inesthetical. We report 77 cases of children with umbilical hernia who we operated between 1999 and 2000. Fifty-five of them have a umbilical plasty. For this, we used three surgical techniques: lateral left plasty, "horseshoe" plasty and umbilical graft. We classed our results into three groups: 40 good results, seven middle results and three bad results. Twenty-seven patients are lost. These three surgical techniques are a simple and safe solution to this problem of skin excess in the umbilical hernia.