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PAPSA 2008 Abstracts Annals of Pediatric Surgery, Vol 4, No 3,4, July& October, 2008 PP 110-123 PAPSA 2008 Abstracts Papers presented at the 7th Biennial Meeting of Pan African Pediatric Surgical Association (PAPSA) August 17-23 2008 Accra, Ghana 7th Biennial Meeting of Pan African Pediatric Surgical Association *(PAPSA) August 17-23 , 2008 Accra, Ghana Surgical Presentations of HIV Positive Children Sarcoma of Kaposi witch involve intussusception, an other boy had psoas abscess. The third boy had urethral stenosis, and the Bankolé Sanni R., Nandiolo R., Vodi L., Yebouet Eric, Coulibaly last boy had anal fistula. D., Kirioua B., Mobiot L., HIV treatment was not available in our country before 2003 for children, 10 of girls with acquired rectovaginal fistula died and the Introduction: Human immunodeficiency virus (HIV) disease is an others did not come for follow-up after colostomy. increasingly common infection in children in Sub Sahara Africa. Acquired recto vaginal fistula is the more frequent surgical The five boys have received anti retroviral therapy. The urethral condition, but other disease can reveal this infection in children. stenosis resolved with the HIV treatment. Methods: From January 1999 to December 2006, a retrospective Conclusion: Different presentations can reveal HIV disease in study found 37 children presenting with HIV relative disease. children. With the available of HIV treatment in our country, a They were 32 females’ patients and 5 males’ patients with age precocious diagnosis and treatment can save these children. ranging from 4 week to 15 years. Background/purpose: The aim of this study was to evaluate the functional outcome specifically continence after a one-stage Results: Among the female children, 30 had acquired recto transanal pull-through operation for Hirschsprung's disease in vagina fistula, 2 had perianal and perineal condyloma. One of the children. five boys had a perianal condyloma, an other one had intestinal ------------------------------------------------------------------------------------------------------------------------------------------------------------------- Abstracts Papers presented at the 7th Biennial Meeting of Pan African Pediatric Surgical Association *(PAPSA) August 17-23 , 2008 Accra, Ghana Mortality audit in an urban paediatric surgery setting The Treatment Of neonates With Oesophageal Atresia in a developing country At The University Hospital Of Treichville (Abidjan). Hesse AAJ, Bankole Sanni R., Nandiolo R., Yebouet E. ; Bosson K., Coulibaly Paediatric Surgery Unit, Korle-Bu Teaching Hospital, Accra, D., Vodi L., Mobiot L. Ghana Treichville Medical University Center, Côte D'ivoire Aim: The World Health Organisation estimates that the risk of Purpose: The objective of this study is to analyse the result of the neonatal death is 6 times higher in developing countries than in treatment of neonates with oesophageal atresia in our country developed countries. This study aims to review the mortality rate Methods: It was a retrospective study of 20 cases of infant with at the Paediatric surgery Unit for causes of death especially those oesophageal atresia treated from January 1984 to December of neonatal patients to the unit. 2007. Method: The mortality data for 2 years, 2006 and 2007 were Results: They were 13 females and 7 males. The diagnosis was reviewed. Data was compiled for sex, age, cause of death, time made before 72 hours for 5 patients and between 3 days and 15 between presentation and death and postmortem findings when days for the other infants. Five of these infants had associated these were performed. malformations (ano-rectal malformation, duodenal atresia, cardiac Results: 38 deaths were noted in 2006 out of 4172 patients seen malformation). Twelve of these infant had type III oesophageal during the year and 42 deaths out of 4684 in 2007. These atresia (distal tracheo-oesophageal fistula) . We performed end to constitute 0.91 % and 0.9 % of all cases seen in the Paediatric end oesophageal anastomosis by right thoracotomy in twelve surgery unit during those periods. cases and in five cases we performed gastrostomy. Three infants died before surgery. We observed one case of anastomotic leak 21 deaths occurred in neonates in 2006 and 22 deaths in 2007. which closed spontaneously. The mortality’s rate was 75%. Six These constituted 55.3% of deaths in 2006 and 52.4% in 2007. patients are alive. The number of deaths in neonates with oesophageal atresia, Tracheo-oesophageal fistula, intestinal atresia, exomphalos major Conclusion: The frequency of this malformation is and Hirschsprung’s disease is detailed out. underestimated in our country. The mortality’s rate was high because of the absence of intensive care facilities. 10 deaths occurred in patients aged 1 month to 1 year and 10 deaths in patients over the age of 1 year in 2006 and 8 deaths and 7 deaths respectively in 2007. Small Intestinal Atresias: A Preliminary Report Of 22 Conclusion: Overall paediatric surgical mortality figures in this Cases setting is less than 1% annually on the average. The majority of *Mohammad AM, *Sani AA, Dr Musa I. deaths (>50 %) occur in neonates and much more needs to be *Department of Surgery Bayero University and Aminu Kano done to reverse this trend in our setting. Teaching Hospital and Murtala Mohammed Specialist Hospital, Kano Nigeria Introduction: In this study, the author reviews cases of small Surgical Site Infection In A Paediatric Surgical Unit intestinal atresias to evaluate their pattern of presentation, surgical treatment strategy and outcome of treatment. Dan Poenaru, Edita Stepita-Poenaru, Peter Nthumba BethanyKids at Kijabe Hospital, Kijabe, Kenya Methods: This is a prospective study of 22 consecutive cases. Data was taken on patients with intra-operative diagnoses of small intestinal atresia. Age at presentation, symptoms and signs, Introduction: Surgical site infection (SSI) is reported in 2-5% of preoperative preparation, intraoperative findings, type of atresia, patients in developed countries, and in 14-25% in African settings. postoperative complications and outcome of treatment. Patients These infections cause significant morbidity and are very costly, with small intestinal atresias, who underwent surgical repair, were especially in resource-poor countries. We investigate the extent, grouped into one of four groups, base on the type of lesion: Group nature and distribution of SSI in a paediatric surgical unit in I, membranous, Group II, interrupted, Group III, apple-peel and Kenya. Group IV, multiple. Group I patients were treated with an enterotomy, excision of the membrane and transverse closure, Methods: A prospective analysis of all consecutive clean and Group II with resection of the dilated bowel and one anastomosis, clean-contaminated surgeries performed at AIC Kijabe Hospital group III with minimal bowel resection and single anastomosis, between January and November 2007 was undertaken. Intra- Group IV with single (when atresias are close to each other) or operative data was collected, and clinical follow-up of all patients multiple anastomoses to preserve bowel length,. During surgery, attempted up to 30 days post-operatively. a uniform protocol was applied to minimize bowel resection and to perform an end-to-end anastomosis. Mortality, morbidity, and Results: Out of 3,330 patients qualified for the study, 1008 were duration of recovery were included in the review. children (less than 18 years). The overall SSI rate was 7.7%, 5.6% for clean cases and 11% for clean-contaminated. SSIs were Results: Group I, membranous (n = 6), Group II, interrupted (n = divided between superficial (69%%), deep (29%), and organ / 10) one of which is a case of annular pancreas, Group III, apple- space (2%). Median age at diagnosis of SSI was 16 days. Rates peel (n = 4) and Group IV, multiple (n = 2). Of the 22 patients, varied among specialties, with lower rates for orthopaedics and three patients had re-operation for leakage (n =2) and plastic surgery. SSI was significantly correlated to surgical anastomotic stenosis (n = 1). Oral feeding commenced on day 4 - contamination and the length of surgery, but not to age or 12 and full caloric intake via the enteric route on day 8 – 21 in specialty. most patients. Eight patients would have benefited from short or long-term intravenous nutrition if available. Mortality of 18.2% Conclusions: SSI is a significant cause of morbidity and cost. (n=4), two of which died of causes unrelated to operation (short Careful attention to its causative factors can reduce SSI bowel syndrome), while the other two died of severe sepsis significantly in developing world settings. flowing anastomotic dehiscence and re-operation. 111 Vol 4, No 3,4, July- October, 2008 Conclusion: It was found out that the higher the type of atresia Findings: 86 patients were enrolled in the study. The duration of the more likely to be complicated. We also conclude that efforts symptoms was between 1 to 17 days. The length of hospital stay are made to preserve bowel length to avoid the short bowel varied depending on symptoms. Bowel resection rate was about syndrome that is difficult to treat in our environment without 30%, and overall mortality was less than 10 %. parenteral nutrition. Preservation of bowel length and single layer anastomosis contributes to early recovery of bowel function. Conclusions: The majority of patients seen in the Paediatric Surgery Unit of the KorleBu Teaching Hospital are managed by surgical reduction without resection and therefore laparotomy may not be required in most intussusceptions. Other non-operative Intestinal Atresia Treatment at The Teaching Hospital manoeuvre will thus need to be explored. Of Treichville (Abidjan-Cote D’ivoire) Jb Kirioua, Sr Bankole, Rk Nandiolo, E Yebouet, D Coulibaly, L Vodi, As Sika, L Mobiot Treichville Medical University Center, Côte D'ivoire Management of Intussusception In Children – The Role Of Pneumatic Reduction Purpose: the objective of this study is to describe the F. A. Abantanga1,2, B. Nimako2, M. Amoah2, K. P. Yankey2 epidemiologic, clinic, paraclinic, therapeutic and evolutive aspects 1School of Medical Sciences, College of Health Sciences, Kwame of the intestinal atresia.
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