La lithiase de la voie biliaire principale (LVBP) est une pathologie rare et potentiellement grave. L’échoendoscopie, la bili-IRM et la cholangiographie peropératoire ont amélioré la prise en charge. La laparoscopie couplée à l’échoendoscopie ont remplacé la laparotomie en Occident. Cependant, la laparotomie reste la voie d’abord au Sénégal. Le but de notre étude était d’évaluer les aspects épidémiologiques, diagnostiques et thérapeutiques de la lithiase du cholédoque au CHU Aristide-Le-Dantec.

A Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a real diverticulum that is usually located on the anti-mesenteric edge in the last meter of the ileum. Its location on the mesenteric edge has been rarely reported. It may lead to several complications including perforation that may be life-threatening for the patient. We report herein a case of perforated mesenteric Meckel's diverticulum in an adult patient. Upon surgical exploration by laparotomy, we found a perforated Meckel's diverticulum located on the mesenteric edge of the ileum 60 cm from the ileocoecal junction and 400 ml of seropurulent peritoneal fluid. The patient underwent a segmental ileal resection and an end-to-end anastomosis. The postoperative outcomes were marked by a persistent peritonitis that required successful revision surgery.

Background: The management of pancreatic pseudocyst involves several treatment options. Among them figure predominantly the surgical, endoscopic and percutaneous drainages. Conservative management is a therapeutic alternative especially for small sized pseudocysts. Larger cysts, more than 6 cm in diameter, are usually treated surgically. However, it had been reported some cases of large-sized pancreatic pseudocyst that had regressed spontaneously. It raises the question about the systematic treatment in large-sized pancreatic pseudocyst. Case presentation: A 55-year-old man who had a 40-year history of alcoholism and a medical history of acute pancreatitis 3 weeks prior to his presentation was sent for an abdominal exploration by CT scan. The CT scan showed a pancreatic pseudocyst of 13 cm in diameter. Meanwhile the patient was just complaining of epigastric pain that was well managed by analgesics. A conservative management was then decided. At the follow-up, CT scan was realized at the 1st, the 3rd and the 5th month. It showed a decreasing of the size of the cyst. Moreover, the CT scan done 3 years after the onset, showed a strictly normal pancreatic parenchyma. Conclusion: Conservative management is a feasible alternative therapy in large pancreatic pseudocysts, bearing in mind a rigorous clinical and radiological monitoring of the patient.

La maladie hémorroïdaire est une pathologie dont le traitement chirurgical fait l’objet de débat quant au choix de la technique. Nous rapportons les résultats de la cure de cette maladie hémorroïdaire selon le procédé décrit par Milligan et Morgan.

Le volvulus gastrique aigu sur éventration diaphragmatique est une affection rare et une urgence diagnostique et thérapeutique. Sa présentation clinique est peu spécifique et la tomodensitométrie abdominale permet de confirmer le diagnostic. Nous rapportons le cas d'un patient de 22 ans qui présentaitun syndrome occlusif et une voussure épigastrique. A la radiographie de l'Abdomen Sans Préparation, on notait 2 niveaux hydro-aériques sous la coupole diaphragmatique gauche qui était surélevée. Une dévolvulation et une gastrectomie atypique ont été réalisées devant un volvulus gastrique aigu avec nécrose du fundus mis en évidence à la laparotomie. Les suites opératoires ont été simples.

Internal hernia is an unusual pathology. They are underestimated becauseit is usually asymptomatic. The diagnosis is usually done during a complication like the acute intestinal obstruction. We report a case of left paraduodenal internal hernia. He was received at the emergency in a clinical presentation of acute intestinal obstruction. The abdomino- pelvicCT scan could not confirm the diagnosis in preoperative. The laparotomy confirms the diagnosis. The treatment consisted in the reduction of intestines and the closing of the bag. The post-operative was simple after a year of follow-up.

Cystic tumors of the pancreas arise problems preoperative diagnosis. Now this is the diagnostic certainty that determines surgical indications. Aim: To report our support diagnosis and treatment of these tumors. Patients and methods: it is a retrospective study of six patients with a mean age of 32 years with extremes of 22 and 61 years. The parameters studied were the diagnostic and therapeutic data. Results: The reason for consultation was a mass of epigastric or left upper quadrant in 3 cases and abdominal pain in 3 cases. The tumor marker Ca19.9 was normal in 2 cases and the ACE marker slightly elevated in 1 case. The scanner evoked a cystic mass in the tail of the pancreas in 5 cases and magnetic resonance imaging (MRI) intrapapillary mucinous tumor of the pancreas probably degenerate of the pancreas’s head in 1 case. Preoperative presumptive diagnosis was mucinous cystadenoma in 3 cases, a solid pseudopapillary tumor in 1 case, an degenerated in 1 case and a false cyst of the pancreas in 1 case. The surgical exploration showed 5 cases of tumor developed at the expense of the tail and 1 case at the expense of the pancreatic head, peripheral lymph nodes were found in 2 cases. We performed a caudal pancreatectomy (CP) in 4 cases whose 1 case after a cyst-jejunal bypass first, cephalic duodeno-pancreatectomy (CDP) in 1 case and surgical abstention with lymph node biopsy in 1 case. Adjuvant chemotherapy was associated in 1 case. The histology of surgical specimens found 1 case of mucinous cystadenoma, 1 case of solid pseudopapillary tumor of the pancreas and 1 case of IPMT degenerated into adenocarcinoma. The postoperative course was uneventful. Conclusion: The diagnostic certainty of cystic tumors of the pancreas is necessary to allow a conservative or radical gesture. In our context, the preoperative diagnosis is difficult. Scanner, MRI and tumor markers intra cystic can help in the diagnosis.

Cecal volvulus is an acute or chronic and recurrent cecum twisting. This is the second location after the sigmoid colon. It is a surgical emergency. Preoperative diagnosis is difficult and surgical treatment is controversial. We report our experience in the management of 2 cases of cecal volvulus in our department in Dakar. Case 1: A 38 year old female patient with no pathological individual history was admitted for an occlusive syndrome lasting for 5 days. Abdominal examination revealed a symmetrical bloating without defense or contracture. Digital rectal examination found feces in the rectum. Blood cell count (BCC) objectified hyper leukocytosis at 11,900 / mm3 with neutrophil predominance (89%). An abdomen X-ray revealed small bowel and colic air-fluid levels. During clinic surveillance the patient presented secondary fever of 38 °C and diffuse abdominal sensibility. The hemodynamic status remained stable and hourly urine output was estimated at 1.5ml/kg/hour. Exploration by midline laparotomy objectified cecal volvulus in a clockwise spiral turn, the cecum was completely free, distended, left projected with lesions of ischemic nature. A cecal and 10 cm of terminal ileum resection with end-toend ileocolic anastomosis was performed. Abdominal cavity drainage was performed with a Delbet drain. The postoperative course was uneventful with digestive laxation at the 3rd postoperative day. The patient was sent back home on the 8th postoperative day. Case 2: A 40 year old male patient was admitted for an occlusive syndrome lasting for 3 days. Examination on admission had objectified a patient in fairly good condition without fever. The abdomen was distended with diffuse sensibility without defense or contracture. A blood cell count showed leucopenia with 4700 white cells/ mm3. Abdominal X-ray highlighted many small bowel type hydro-aeric levels. A rectal enema was performed without improvement. The patient underwent laparotomy. During exploration an objectified cecal volvulus was found with ileal involvement. the cecum was distended with ischemic lesions. We performed ileo cecal resection. Restoration of continuity was done immediately by end-to-end ileocolic anastomosis. The postoperative course was uneventful. The patient was discharged on the 5th postoperative day. Conclusion : The cecal volvulus is a rare abdominal emergency. The surgical resection (ileocecal resection and right hemicolectomy ) gives the best immediate and long term results. Early diagnosis and prompt management before complications occurrence manage to reduce the mortality rate.

Décrire les aspects épidémiologiques et anatomo-cliniques des plaies digestives traumatiques à Dakar.

Cystic tumors of the pancreas represent less than 10 % of all the cystic hurts of this organ. Among them, mucinous cystadenomas constitute a very particular anatomo-pathological entity with malignant potential. The purpose of this work is to report a particular case by its clinical presentation display, its size, and the surgical treatment which ensued. We discuss the diagnostic and therapeutic aspects of this condition.

Le but de notre etude etait de rapporter notre experience dans la prise en charge des fistules entero-cutanees post-operatoires (FECPO). Il s’agissait d’une etude retrospective qui s’est deroulee au CHU A Le Dantec sur 10 ans (2000- 2010). Les criteres d’inclusion etaient les patients qui presentaient une FEC PO durant la periode d’etude. Les parametres etudies etaient les suivants : le terrain, l’intervention initiale, les circonstances de decouverte, le delai d’apparition et les caracteristiques de la FEC PO, l’evolution sous traitement medical, les indications et les resultats du traitement chirurgical. Ont ete inclus dans l’etude 25 patients d’âge moyen de 30 ans. Il s’agissait de 17 hommes et de 8 femmes avec un sex-ratio de 2,1. Six patients (24%) avaient au minimum un antecedent de laparotomie. Sept cas de denutrition (28%) ont ete notes. L’intervention initiale concernait le grele dans 40% des cas et le colon dans 32% des cas ; elle avait ete realisee dans un contexte d’urgence chez 17 patients (68%). Des incidents et difficultes operatoires avaient ete rapportes chez 7 patients (28%). Les circonstances de decouverte de la fistule etaient a type d’ecoulement anormal de liquide digestif a travers l’incision dans 72% des cas. Les fistules etaient semi-precoces dans 56% des cas ; elles etaient ileales dans 13 cas (52%), et de bas debit dans 19 cas (76%). Sous traitement medical, 15 patients (60%) avaient evolue vers une guerison spontanee. Un traitement chirurgical etait indique chez 9 patients (36%) avec evolution favorable dans 66 % des cas. La mortalite globale etait de 12% (n=3), par defaillance multi viscerale. Dans notre service, les FEC PO sont surtout des complications du sujet jeune, de type semiprecoce, de siege invariablement ileal et colique, a bas debit et a trajet lateral qui guerissent majoritairement sous traitement medical dans un delai moyen de 3 semaines. Le traitement chirurgical est surtout indique devant le sepsis intra abdominal qui explique la mortalite rapportee. Mots cles : Fistule entero-cutanee, traitement, chirurgie.

The management of breast hypertrophy has become a new and increasing need in Senegal. The files of 47 patients presenting with breast hypertrophy were collated over twelve years. The mean age was 33,9 years. Three surgical techniques were used. The average sternal notch to nipple measurement was 33 cm. Surgery was performed on twenty-two patients, or 42 breast. The surgical technique of Mac Kissock was used in 50% of the cases, the inferior pedicle technique in 13.6% of the cases and the technique of Thorek in 36.4% of the cases. The average weight of tissue removed was 1.3 kg per breast. Our rate of post-operative complications was 9.5% , mostly suppurations. Close to 91% of the patients expressed being satisfied with the aesthetic result obtained. The surgery of breast hypertrophy is increasing in our activity.

La parietoplastie prothetique tend a etre le traitement de reference pour les eventrations abdominales, quelque soit leur taille. Le but de cette etude etait d’evaluer les resultats a moyen terme de la cure par prothese de ces eventrations au niveau du Centre Hospitalier Regional de Saint-Louis. Il s’agissait d’une etude prospective portant sur 15 cas d’eventration abdominale colliges a l’Hopital Regional de Saint-Louis, durant la periode de janvier 2011 a juin 2012. Tous les patients avaient beneficie d’une cure par prothese au polyester non resorbable. L’âge moyen de nos patients etait de 52,6 ans. La serie etait majoritairement composee de femmes (n=10). Les antecedents chirurgicaux etaient domines par la cesarienne avec abord median sous ombilical (53,3 %). Les eventrations etaient pour la plupart de moyenne dimension, dans 73,3 % des cas. La prothese etait posee dans 14 cas en premusculo- aponevrotique, et dans un cas en retro-musculaire. Un drainage aspiratif etait toujours effectue, le drain etait enleve en moyenne apres 4,2 jours. Un cas de suppuration etait note dans la serie, traite par des pansements quotidiens et une antibiotherapie dirigee contre le staphylocoque, ainsi que deux cas de seromes qui s’etaient resorbes spontanement. Apres un suivi moyen de 6,7 mois, aucune recidive n’a ete remarquee. L’alloplastie par prothese pour eventration de la paroi abdominale semblait etre a moyen terme une cure efficace sur le plan des recidives. Une plus grande serie avec un recul suffisant pourrait permettre de confirmer ces resultats. Mots cle s: eventration abdominale, prothese, recidive.

Aim. To report our experiment of the use of Desarda's technique, which consists on a plasty using the large oblique muscle aponevrose, in the treatment of inguinal hernias.Patients and methods. It is about a prospective study go to March 2009 to March 2011, concerning 100 cases of inguinal hernias among 94 patients operated by Desarda's technique at the Department of General surgery of the University hospital Aristide Le Dantec of Dakar. They were 88 men (94%) and 6 women (6%) with an average age of 44.7 years. The studied parameters were the operational data, the postoperative pain and the recurrence.Results. The hernia was indirect in 71% of the cases, direct in 25% of the case and mixed in 4% of the cases. The acute postoperative pain was absent among 62 patients (66%). The evaluation of the pain beyond the third month show four cases of light chronic pain (EVA< 2). Postoperative complications were noted among 11 patients (11.7%): most frequent was wound infection ( 4 cases [4.3%]), followed by acute retention of urines (3 cases [3.2%]), scrotal hematoma (2 cases [2.1%]) and vomiting (2 cases [2.1%]). No recurrence was noted in our study, the mean follow-up period was 17 months with extremes of 3 and 27 months.Conclusion. The aponevrotic plasty of the large oblique according to Desarda constitutes a reliable and inexpensive alternative to the treatment using prosthesis in the management of inguinal hernias; however, a longer follow-up period could allow assessing its real efficiency.

Les bezoards intestinaux sont de rares causes d’occlusion. Leur traitement est chirurgical et consiste en une extraction par enterotomie. Nous rapportons un cas d’occlusion du grele sur phytobezoard traite par expression manuelle. Il s’agit d’une patiente de 17 ans, sans antecedents medico-chirurgicaux particuliers, qui a ete admise pour un tableau de douleurs abdominales intermittentes sans trouble du transit. La radiographie de l’abdomen sans preparation retrouvait des niveaux hydro-aeriques greliques. Le bilan biologique etait normal. L’evolution clinique a ete marquee par la degradation de l’etat hemodynamique et installation d’un tableau occlusif franc. L’exploration chirurgicale a retrouve un phytobezoard obstructif du grele qui a ete traite par expression manuelle sans enterotomie. Mots cles : occlusion intestinale ; phytobezoard ; chirurgie.