The persistent sciatic artery is a rare congenital anomaly. Its clinical presentation may be related to an aneurysmal degeneration witch complications such as sciatic compression with neuralgia, thrombosis or distal embolization. A 56-year- old tailor was referred to our department for a painful right gluteal mass radiating to the posterior aspect of the thigh and ankle that was considered as sciatic L5-S1. Three weeks before his admission, limb edema with a cyanotic aspect of the foot was associated with the clinical signs. An ultrasound duplex revealed an aneurysm of the Superior gluteal artery. The CT angiography concluded an aberrant aneurysmal sciatic artery mean vascularized the limb. Revascularization surgery by saphenous vein femoro-popliteal bypass associated with aneurysmal resection was performed in a timely. With a follow of 4 years, the patient is well. Ultrasound duplex and CT angiography control shows perfect suppression of the aneurysm with vascular patency of the limb. The rarity, the diagnostic and therapeutic difficulties motivated this case report.

Little is known about patient profile changes in medical facilities in our country, leading to this study to describe and compare patient profiles in 2010 and 2022. This was a cross-sectional study with new outpatients aged 15 years and more seen in the cardiology department of the UH-GT. Measurements included height, weight and body mass index (BMI). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. Quantitative data are presented as the mean with standard deviation, and categorical one as proportions. Statistical tests were the t test to compare means and chi-test for categorical variables. The level of significance was set to 0.05. The sample consisted of 515 new patients (199 in 2010 and 316 in 2022) with 59.1

Purpose: To describe the therapeutic aspects of digestive surgical emergencies at the Tominian referral health center. Methodology: This was a prospective cross-sectional study from December 1, 2022 to November 30, 2023, i.e. 12 months, in the general surgery department of Tominian CS Réf. We enumerated 116 patients during our study period, and included in this study all patients received and operated on for digestive surgical emergencies. The parameters studied were etiologies, duration of disease evolution, treatment and postoperative follow-up. Results: Digestive surgical emergencies (n=116) accounted for 22.97% of all procedures (n=505). Men accounted for 73.3% (n=85) and women 26.7% (n=31), with a sex ratio of 2.74. Mean age was 29.25 years, with extremes of 4 and 71 years. 61.2% (n=71) consulted between 49 and 72 hours of disease evolution. The main etiologies were acute appendicitis 47.4% (n=55), acute peritonitis 29.3% (n=34). The surgical procedures performed were appendectomy 47.4% (n=55), appendectomy + lavage 13.8% (n=16), perforation suture 12.9% (n=15). Postoperative follow-up was uncomplicated 87.9% (n=102), complicated by surgical site infection 7.8% (n=9). There were 3.4% (n=4) deaths. Hospital stay was 8 to 14 days in 49.1% of cases (n=57). Conclusion: Digestive surgical emergencies are numerous in Tominian. Their management requires multiple and varied therapeutic means, the rapid initiation of which guarantees a good oronostic outcome.

Objectives: To study delayed primary closure in ballistic and explosive device injuries by describing the clinical, therapeutic and evolutionary aspects. Methodology: This was a prospective study running from August 1, 2022 to May 31, 2023 including all patients of all ages presenting a ballistic or explosive device injury. Results: In 10 months, we collected 190 cases of ballistic and explosive device trauma, or 35.9%. The average age was 31.89 ± 14.026 years with a sex ratio of 12. Intercommunity conflicts were the most frequent causes (61.1%). Limb injuries represented 78.9 %, of which isolated wounds without fracture were the most frequent (59.5%). Standard radiography was ’the most used medical imaging (94%). DPC (Deferred Primary Closure) was performed in 71.2% followed by DPC + external fixator in 19%. We recorded 2 cases of death. Conclusion: Well-conducted delayed primary closure helps reduce the risk of complications, give the patient every chance of survival and shorten the hospital stay.

The left para-duodenal internal hernia, whose origin is generally embryological, is a rare etiology of intestinal obstruction found mainly in young adults. We report here the case of acute intestinal obstruction by left para-duodenal internal hernia in a 36-year-old young man. It was a patient who consulted urgently for occlusive syndrome with cessation of materials and gases. Abdominal percussion noted abdominal tympanism and pre-hepatic dullness was preserved. The flow and icicle signs were negative. Palpation did not objectify hepatosplenomegaly and did not find any organomegaly either. On the other hand, she found an epigastric defense. The abdominal X-ray without preparation showed water levels that were wider than high, hail-like. We performed a median above and below umbilical laparotomy and intraoperatively, it was an internal hernia with incarceration of small loops in a voluminous left paraduodenal sac of 12 cm. They were not necrotic and quickly recolored after extrication. We resected the hernial sac and closed the hernial orifice with separate stitches with absorbable suture 0. The postoperative course was simple. The patient was discharged from the hospital on the 4th postoperative day. After 18 months of hindsight, he is doing well.

Purpose: This paper aims to assess the incidences and risk factors for surgical site (ISO) infections in the general surgery department of the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study from August 1, 2017 to October 31, 2020 involving all patients who underwent laparotomy in the general surgery department of the Koutiala District Hospital. Patients who were not operated on and who did not have a laparotomy were not included. Age, sex, frequency, patient history, National Nosocomial Infections Surveillance (NNIS) index, time to occur, bacteriological test results and course of infection were analyzed. Results: Fifty patients were registered. The average age was 34.2 ± 21.2 years old. Eleven patients were 60 years old or older. The hospital incidence rate was 4.3% and the community incidence rate was 6.1 cases per 100,000 population. The concept of smoking was noted in 15 patients. Patients were operated on in emergency 84% of cases. Peritonitis was the most common initial lesion with 32% of cases. Our patients had an NNIS index greater than 0 in 84% of cases. The time to develop infection from the surgical site was less than 3 days in 8 patients (16% of cases). Depending on the depth of the infection, it was superficial (cutaneous) in 39 patients (78%) and deep (subcutaneous and organic) in 11 patients (22%). Escherichia coli was the most common germ with 72% followed by staphylococcus aureus at 24%. We noted 22% morbidity. The median length of hospitalization was 9 ± 2.2 days. Conclusion: ISO is common in our service. Prevention and mastery require knowledge of risk factors.

Gigantomastia is a rare benign mastopathy of unknown aetiology. It usually occurs in women during puberty or during pregnancy. It is characterized by excessive breast growth, which is psychologically and physically disabling. It is a pathology little studied because of its rarity. In order to describe the epidemiological, clinical, diagnostic and therapeutic aspects, we report the case of four young women. The study was longitudinal over a period of 3 months. We collected data for 6 years from October 1, 2016, to October 31, 2021, at the surgery department B of the "Centre Hospitalier Universitaire du Point G". All patients who consulted for gigantomastia were included. At the end of our study, we found three cases of juvenile gigantomastia and one case of prepubertal gigantomastia. The couple mammography ultrasound performed in two patients, adenofibroma was associated with breast hypertrophy in one patient. The treatment was essentially surgical in our study. Reduction mammoplasty according to the technique of Mc Kissock and modified Mc Kissock was used. We did not note any complication such as nipple-areolar necrosis. All our patients were satisfied with the result.

Objective: To evaluate the contribution of pericardial biopsy in the etiological research of pericarditis. Methods: This study was carried out in the University Hospital Centers of Point G and Luxembourg. This was a descriptive study with retrospective collection from January 2012 to May 2015. It concerned all patients operated on for pericarditis in whom the histological examination was carried out. Results: We operated on a total of 70 patients for pericarditis, representing a frequency of 2.3% of all surgical interventions (3044) and 49.6% of cardiac interventions (141). The average age of the patients was 31.5 years with the extremes ranging from 2 years to 84 years. The most common signs of pericarditis were chest pain (27.1%), fever (7.1%) and dyspnea (12.9%). Pericardial drainage was performed in 91.4% of patients. On histological examination, tuberculosis represented 70% and pericardial cancer metastases 4.3%. Immediate post-operative complications were marked by three (03) deaths. Conclusion: The histology of pericardial samples was decisive in the etiological diagnosis. The popularization of biopsy during pericardial drainage is promising in our work contexts.

Introduction: According to the WHO, digestive surgical emergencies are abdominal pain lasting a few hours or days (les s than three) and which are related to a surgical pathology requiring emergency treatment. Digestive surgical emergencies are pathologies which occupy an important place in surgery due to their high frequency, their difficult management, and their high mortality and morbidity rate. Objective: Study the epidemio-clinical and therapeutic aspects of digestive surgical emergencies à the Fousseyni Daou in Kayes Hospital. Patients et Method: This was a prospective and descriptive study from March 2022 to March 2023 in the general surgery department of Fousseyni Daou Hospitol in Kayes. We included in this study all patients operated on for a digestive surgical emergency without distinction of sex or age. Results: The frequency of digestive surgical emergencies was 42.53%. The 10-20 year old age group was most represented with 37%. Abdominal pain was the most fréquent reason for admission with 87%. The site of pain was the right iliac fossa in 35% of cases. Acute appendix was the most common preoperative diagnosis with 37%. In our series, 54% of patients were operated on in les s than 24 hours. Therapeutically, 47% of patients benefited from an appendectomy. In our series, 30% of patients presented with a postoperative complications. We observed 3 cases of death. Conclusion: Digestive surgical emergencies occupy an important place in digestive pathology due to their high frequency at the Fousseyni Daou Hospitol in Kayes. The etiologies are multiple and varied, hence the need for close multidisciplinary collaboration for treatment.

The organisation of the evacuation referral system is an important strategy for reducing maternal and perinatal mortality in Mali. Objective: To study obstetric evacuations received in the gynaecology and obstetrics department of the "Major Moussa DIAKITE" referral health centre in Kati. Method: We conducted a cross-sectional, descriptive and analytical study. Data were collected retrospectively and prospectively over a 12-month period (from 1 January to 31 December 2020). Sampling was exhaustive and included all cases of obstetric evacuation received and managed on site during the study period. Results: Out of a total of 3050 deliveries, we received and managed 352 cases of obstetric evacuation, representing a frequency of 11.5%. The average age of the patients was 25 years, with extremes of 15 and 44 years, although the 20-34 age group was dominant, accounting for 73.6% of cases. The majority of evacuees were housewives (86.4%), married (92%), nulliparous and primiparous (52%). Dystocic labour was the most common reason for evacuation (51.1%), followed by ante-partum haemorrhage (13.4%). Nearly nine out of ten women evacuated came from Community Health Centres (89.8%) and the most common means of evacuation was by ambulance (52.1%). The average time from admission to the start of care was 26.5 minutes, with extremes of 3 and 50 minutes. Delivery by the vaginal route was carried out in almost eight out of ten cases (79%). Newborns were resuscitated alive (7.9%); stillbirths were fresh (3.7%) and stillbirths were macerated (06%). We recorded 2 cases of maternal death (0.6%) and the causes of maternal death were haemorrhage due to uterine rupture and eclampsia. Conclusion: The improved organisation of the evacuation referral system in our facility has improved the maternal and, above all, foetal prognosis of obstetric evacuations, but more needs to be done.

Goal: To study the management of postoperative pain in the general surgery department of the Fousseyni DAOU hospital in Kayes. Patients and Method: We conducted a prospective 6-month study from November 2022 to May 2023, involving 107 surgical patients, aged 15 to 81 years, who met the inclusion criteria. We assessed pain using the Visual Analogue Scale (VAS) at patient admission, at the second hour, and then every eight hours until seventy- second hours after analgesic use. Multimodal analgesia was the most widely used in the study. Administration of paracetamol alone and/or in combination with nefopam and/or ketoprofen and/or morphine. The evolution of pain as well as adverse effects after administration of analgesics were investigated. Results: The mean age of our patients was 35.9 years with extremes of 15 and 81 years. Male sex was the most represented at 64.5% with a sex ratio of 1.82 and the majority of patients were classified as ASA 1 (82.2%). VAS less than 3 (VAS≤ 4) was most observed during the first 2 hours postoperatively, i.e. 41.1% for VAS 0-2 and 28.9% VAS 3-4 at rest, respectively, and respectively 33.6% and 30.8% for no pain and mild pain. At 24 hours postoperatively, 87.2% of patients did not feel pain after the resting assessment, this figure increased from 89.8% at the 48th postoperative hour at rest, still after the use of analgesics. At the 72nd hour, we observed cases of pain, i.e. 0.9% of patients, which was related to a postoperative complication. The average cost of pain management was estimated at 23580 FCFA. Side effects observed were vomiting in 3 patients and drowsiness in one patient. Conclusion: Postoperative pain is still understudied, the evaluation with the visual analogue scale of patients before and after the use of analgesics has allowed us to better understand patients' pain and to improve pain management in the surgical department.

Objectives: To study surgical site infections (SSI) in the general surgery department of the Fousseyni Daou Hospital in Kayes. Material and method: This was a prospective study carried out from November 1, 2015 to April 30, 2016 on patients who underwent surgery and were hospitalized for at least 48 hours in the general surgery department. Results: During the study period we consulted 677 patients, of which 325 were hospitalized and 300 operated. of the 297 patients who survived after surgery, 12 developed a surgical site infection, a frequency of 4.16%. Of the 12 patients, 11 were male, the mean age was 39 years with a standard deviation of 14.9. The most common type of infection was superficial infection of the surgical wound with 66.66% of cases followed by deep infection in 33.3% of cases. We proceeded to local care with antiseptic such as Dakin, polyvidone iodine, association (Chlorhexidine + Chlorocresol + Hexamidine) and hydrogen peroxide. Conclusion: Surgical site infections are frequent and serious because of their morbidity and mortality and the cost of their management. The rigorous respect of the measures of asepsis per and post operative as well as a good antibiotic therapy based on the antibiogram allow to minimize them.

Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood.We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula.This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure.Hypothermia at 32˚C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula.We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries.The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC.The clamping time was 71 minutes and the SCC lasted 141 minutes.There was no homologous transfusion in the operating room.It turns out that the input/output balance is zero at the end of the CEC.The postoperative course was simple.