Les jumeaux conjoints du groupe des thoracopages sont des monstres doubles qui resultent d’une anomalie malformative au cours de la grossesse gemellaire et qui presentent un cordon ombilical avec une fusion au niveau de la region thoracique. De tout ce groupe des teratopages, les thoracopages et les omphalopages sont les plus frequemment rapportes dans la litterature. Ce sont des malformations rares qui representent 1 pour 50000 naissances. Le diagnostic morphologique peut etre fait par un examen echographique antenatal. Observations :Nous rapportons deux cas de jumeaux thoraco-omphalopages nes vivants dans deux structures sanitaires du Togo. Il s’agissait de jumelles nees a terme par cesarienne. Chez les premieres, l’examen radiologique et surtout post-mortem a mis en evidence deux foies matures accoles l’un contre l’autre et deux coeurs enveloppes par un meme pericarde. Chez les deuxiemes, il s’agissait d’un coeur et d’un foie unique malforme. Conclusion :Le developpement des techniques chirurgicales et surtout des mesures de reanimation neonatale, permet de nos jours de realiser une separation chirurgicale lorsque ces jumeaux conjoints naissent vivants et surtout lorsque les elements anatomiques thoraco-abdominaux sont bien constitues. Mot cles : Jumeau conjoint, monstre double, teratopage. ABSTRACT Joint twins of the thoracopagus group are dual monsters that result from malformative abnormality during the twin pregnancy and that show one umbilical cord with a fusion over the thoracic area. Among the teratopages, thoracopages and omphalopages are the most frequently reported in the literature. That are rare malformations representing 01 over 50 000 births. The morphologic diagnosis can be done by antenatal sonography. Observations : We report two cases of thoraco-omphalopagus twins born alive in two hospitals in TOGO. That was twins born over time by C-section. For the first case, the radiologic and post-mortem examinations shew two mature livers placed side by side and two hearts wrapped in the same pericardium. For the second case, that was one heart and one liver, both malformed. Conclusion : The surgical techniques development and especially neonatal resuscitation measures allow nowadays achieving a surgical separation when that joint twins are born alive and especially when thoraco-abdominal organs are well constituted. Key words : Conjoined twins, dual monster, teratopagus.

OBJECTIVES:To describe the various techniques used for the circumcision in newborns and infants in the operating room of the Lomé Teaching Hospital (Togo) and to compare their results. PATIENTS AND METHODS:It is about a prospective study carried out in the operating room of the Lomé Teaching Hospital from June 15th, 2007 to December 15th, 2008 (18 months). It concerned newborns and infants circumcised according to two techniques: the technique using grips only (group A: n=138; 69%) and the technique using Gomco clamp (group B: n=62; 31%). The Khi(2) test with the threshold 5% was used for the statistical analysis. RESULTS:According to the duration of the intervention, 34 newborns and infants (24.6%) were circumcised within less than 15 minutes in the group A and 27 (43.5%) in the group B (p<0.05). According to the importance of the bleeding and to the type of material used, 28 newborns and infants (20.30%) had bled much in the group A and one (1,61%) in the group B (p<0.05). According to the postoperative complications and to the technique used, nine newborns and infants (9.4%) had postoperational complications in the group A and two (3.2%) in the group B. The wound had healed within less than 6 days in one infant (0.7%) in the group A and six (9.7%) in the group B (p<0.05). One hundred penises (72.46%) were considered to be very satisfying in the group A and 55 (88.7%) in the group B (p<0.05). CONCLUSION:The technique using Gomco clamp for circumcision had more advantages than that using only the grips. It was much more safe for the child.

BACKGROUND:To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries.MATERIALS AND METHODS:This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo.RESULTS:There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French-speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar.CONCLUSION:This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities.

Purpose. To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. Methods. Records of 12 patients aged 11 to 17 (mean, 14) years with avulsion fractures of the tibial tubercle presenting to our hospital from April 1998 to September 2004 were studied. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. Results. Eight patients injured the right side, 3 the left side, and one both sides. They all engaged in sports or active play during the injury. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. Three patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. The remaining 9 fractures were treated with open reduction and internal fixation. The mean follow-up period was 39 (range, 23–59) months. No complications were noted. Ten patients had excellent results and 2 had fair results. Conclusion. Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes.

Objective. - To evaluate morbidity and mortality following excision-suture and resection-anastomosis for single non traumatic perforations of small bowel (SNTPB).Methods. - from July 2002 to June 2003, a simple blind randomized study comparing excision-suture with resection-anastomosis SNTPB.Results. - Of the 125 patients included, 112 were operated by surgeons on training (89.6%). The perforation sat on the antimesenteric edge of the last ileal portion with an average diameter of 0.8 cm (extreme 0.1 and 4 cm). An excision-suture was performed 66 times (52%) including 5 times by an experienced Surgeon. 56 patients had simple continuations (45.2%). Morbidity concerned 68 patients (54,8%). 06 patients died of general complications (4.8%). The technique did not influence the mortality. All dead patients were operated by surgeons on training, P = 0.25. The complications were significantly more frequent after resection-anastomosis (79.7%) than after excision-suture (32.3%). The difference was significant for the parietal abscesses (P = 0,01), the exteriorized fistulas (P = 0.04), the septic shocks (P = 0.05).Conclusion. - Whereas mortality was not influenced by the technique, the postoperative course was more complicated after resection-anastomosis (performed in majority by less experienced surgeons). We recommend excision-suture to repair SNTPB. (c) 2005 Elsevier SAS. Tous droits reserves.

OBJECTIVE:To evaluate morbidity and mortality following excision-suture and resection-anastomosis for single non traumatic perforations of small bowel (SNTPB).METHODS:From July 2002 to June 2003, a simple blind randomized study comparing excision-suture with resection-anastomosis SNTPB.RESULTS:Of the 125 patients included, 112 were operated by surgeons on training (89.6%). The perforation sat on the antimesenteric edge of the last ileal portion with an average diameter of 0.8 cm (extreme 0.1 and 4 cm). An excision-suture was performed 66 times (52%) including 5 times by an experienced surgeon. 56 patients had simple continuations (45.2%). Morbidity concerned 68 patients (54,8%). 06 patients died of general complications (4.8%). The technique did not influence the mortality. All dead patients were operated by surgeons on training, P=0.25. The complications were significantly more frequent after resection-anastomosis (79.7%) than after excision-suture (32.3%). The difference was significant for the parietal abscesses (P=0,01), the exteriorized fistulas (P=0.04), the septic shocks (P=0.05).CONCLUSION:Whereas mortality was not influenced by the technique, the postoperative course was more complicated after resection-anastomosis (performed in majority by less experienced surgeons). We recommend excision-suture to repair SNTPB.

L'etude rapporte les cas de cholecystite aigue alithiasique d'origine typhique operes chez les enfants au CHU de Lome-Tokoin, entre 1987 et 1994. La frequence de cette complication a ete de 0,6%. Elle a atteint 3 garcons et 2 filles, âges de 7 a 14 ans (moyenne a 8,6 ans). La symptomatologie fonctionnelle comportait dans 4 cas sur 5 une diarrhee febrile et dans tous les cas une douleur abdominale. L'examen physique a decele 2 fois une defense generalisee, 2 fois une defense de l'hypochondre droit, et une fois une douleur provoquee de l'hypochondre droit. Tous les patients avaient un serodiagnostic de Widal positif Le traitement a ete la cholecystectomie associee au traitement medical de la maladie causale. Les suites operatoires ont ete simples avec une mortalite nulle. Il faut savoir penser a cette complication dans un contexte evoquant la typhoide.