Cases Of Evisceration Research Articles

Penetrating Abdominal Wounds “Selective Abstentionism versus Systematic Laparotomy”

The management of penetrating wounds of the abdomen is still, at present, a subject of controversy. The aim of this study was to analyse the results of the management of penetrating abdominal wounds. This retrospective study was carried out over a period of 5 years, from January 2017 to January 2021. It covered 90 cases of penetrating abdominal wounds collected at the level of the Surgical Emergency Department of the Mohammed VI University Hospital of Marrakech. It involved 88 men and 2 women, with an average age of 27 years. Two groups of patients were identified. A first group of 61 patients (group I) where the diagnosis of penetration was based on the following findings: epiplocele, evisceration, flow of abdominal fluid, and in which laparotomy was systematically performed. Group II included 29 patients, with no signs of severity, who received simple wound trimming under local anaesthesia with plane-by-plane closure and simple monitoring. Age, gender, causative agent and circumstances of injury were comparable in both groups. The overall mortality was 2.2% (2 cases) and concerned only group I patients. The overall morbidity was 13.3% and consisted of: - 6 cases of peritonitis of which 5 cases were in group II, giving a secondary intervention rate of 17.2%; the other cases of morbidity concerned only group I patients with 3 cases of parietal suppuration, 2 cases of delayed transit resumption and 2 cases of evisceration. The rate of unnecessary or blank laparotomies was 25% in Group I. Laparotomy from the outset in the case of any penetrating wound of the abdomen has the advantage of making a precise assessment of the injury, hence its medico-legal interest, especially in the case of an assault. However, "selective abstentionism" has the advantage of avoiding unnecessary laparotomies. In short, there is no dogma in this matter.

Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital

Introduction: The aim of this study is to investigate, the etiologies, the results of management of acute generalized peritonitis of appendicular origin. Acute generalized peritonitis of appendicular origin is defined as acute inflammation of the peritoneum resulting from either perforation of the appendix or spread of a peri-appendicular abscess. Methodology: The visceral surgery department of the Sino-Guinean Friendship Hospital served as the framework for this work. All patients admitted and operated on for acute generalized peritonitis of appendicular origin whose records were complete were included in this study. Results: During our study we recorded 23 cases of appendicular peritonitis, the sex ratio of nearly 3.6 reflected a clear male predominance of the condition. We noted 15 cases of appendicular perforation, 8 cases of appendicular gangrene, 2 cases of surgical site infection, 2 cases of evisceration and 2 cases of death. Conclusion: Appendicular peritonitis is a frequent disease, the management is medico-surgical.

Oncological Outcomes and Morbidity of Radical Cystectomy for Bladder Cancer: Experience of a Senegalese Centre

The purpose of this paperwork is to assess the oncological findings and the morbidity rate after complete cystectomy in our department. Patients and methods: We conducted a backward and descriptive study during a 80-month-period range from September 2011 to May 2018, in the Urology Department of Aristide Le Dantec Teaching Hospital standing as a referral structure in our country (Senegal). Results: Nineteen patients were included accounting for 13 men and 6 women corresponding to a sex ratio of 2. The mean age was at 58 years old (extremes range from 32 to 77 years old). Radical cystectomy consisted of an anterior pelvectomy and transileal cutaneous ureterostomy by Bricker approach in 6 women, a radical cystoprostatectomy with transileal cutaneous ureterostomy by Bricker approach in 12 men and a radical cystoprostatectomy followed by Studer orthotopic neobladder in 1 patient. Early post-operative morbidity consisted of one case of parietal suppuration (grade I), two cases of evisceration (grade IIIb), one case of digestive fistula (grade IIIb), and uroperitoneal peritonitis (grade IIIb) secondary to suture loosening of the uretero-ileal anastomosis (which occurred in the patient who had Studer neobladder). This patient died in resuscitation ward after surgical repair of the uretero-iliary anastomosis. Late complications were a case of acute pyelonephritis three months after cystectomy and a case of flanged occlusion. Two patients with urothelial carcinoma had received adjuvant chemotherapy using the M-VAC protocol. After an average follow-up of 15 months we recorded 13 deaths, three patients were lost of sight and three others respectively lived 4 years and 2 months, 5years and 8 months and 6years and 8 months after radical cystectomy. Mean overall survival was 15 months (4.2 to 25.8 months) with a median survival of 6 months. The only patient who had Studer neobladder died one week after cystectomy. The mean overall survival after previous pelvectomy was 17.2 months and that after cystoprostatectomy was 15.18 months. Conclusion: This work highlights the very poor prognosis of bladder cancers in our context linked to the advanced stage of tumours at the time of diagnosis, the rarity of endoscopic equipment essential for the diagnosis, treatment and monitoring of bladder cancers, the frequency of radiochemically resistant squamous cell carcinoma, the unavailability of chemotherapy in urothelial carcinoma to enable multimodal treatment, and the heaviness and complexity of radical cystectomy.

Post-Operatory Acute Eviscerations in Teaching Hospitals of Bamako (Mali)

Introduction: Post-operative acute evisceration is defined as a total dehiscence of the abdominal wall of all the constituents of the abdominal wall. The objective is to determine hospital frequency, identify favorable factors and key etiologies, and assess the rate of morbi-mortality. Patients and Method: This is a retrospective and descriptive study carried out in the general surgery departments of the Teaching Hospitals of Point “G”, Gabriel TOURE and the pediatric surgery department of the Gabriel TOURE University Hospital in Bamako, involving 53 patients. The study ran from January 1, 2005 to December 31, 2007. Inclusion Criteria: All cases of postoperative acute evisceration operated. Non-Inclusion Criteria: All cases of evisceration of other etiologies. Results: The average age was 34.2 years with extremes of 6 and 75 years, the sex ratio was 1.12 in favor of women. The initial clinical picture was peritonitis in 26 cases or 49.1%, occlusion in 16 cases or 30.2% and tumors in 6 cases or 11.3%. The post-operative complications responsible for evisceration were: parietal suppuration 28 cases or 52.8%; digestive fistulas 15 cases or 28.3%; post-operative ascites 4 cases or 7.5%. Conclusion: Post-operative acute evisceration is a rare but serious condition due to morbidity and mortality.

Indications and Techniques of Digestive Anastomoses at the Hospital in Koutiala District, Mali

Purpose: Describe the indications and techniques of digestive anastomoses at the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study conducted in the general surgery department of the Koutiala District Hospital. Patients who benefited from digestive anastomosis between the hollow organs of the digestive tract during the period from August 1, 2017 to September 30, 2020 were included. The anastomoses with solid organs were not selected in this study. Results: One hundred and thirty-two patients were registered. Digestive anastomosis accounted for 11.5% of all surgical procedures. The average age was 38.6 years. Men were in the majority with 70.5%. The Karnofsky index was estimated to be less than 50% in 12 patients. Digestive anastomoses were indicated after resection of ileal necrosis in 43 patients (32.6%) followed by tumor resection in 32 patients (24.2%) and typhic perforations in 20 patients (15.1%). There were also 12 cases of digestive stoma (9.1%), 15 cases of volvulus of the sigmoid colon (11.4%), 7 cases of rectal prolapse (5.3%) and 3 cases of Hirschprung’s disease (2.3). Digestive anastomosis was performed in 89 patients in an emergency and was manual in all patients. Post-operative morbidity was 18.9%. These recorded complications, classified grade I (10 cases), grade II (3 cases), grade IIIa (2), grade IIIb (6 cases) and grade IV (4 cases) according to Clavien-Dindo, consisted of 8 cases of postoperative peritonitis (6.1%), 3 cases of external digestive fistula (2.3%), 2 cases of evisceration (1.5%), 12 cases of parietal suppuration (9.1%) and 4 cases of death (3.0%). Conclusion: Young male subjects are the most affected. Anastomoses are performed more often after the removal of the island necroses. Morbi-mortality is high. Success depends on several factors, including the general condition of the patient and the mastery of the anastomosis technique.

Prognostic Factors of Postoperative Morbidity and Mortality of Adult Strangulated Groin Hernia.

The aim of this work is provide the results of the surgical treatment of strangulated groin hernias and determine morbidity and mortality risk factors. It is a retrospective study related to the 288 records of patients aged 15years and more, who underwent emergency surgery for strangulated groin hernia from January 2007 to December 2012. Postoperative evolution was assessed on the morbidity, mortality, and length of hospital stay. Mortality and morbidity risk factors were studied. The statistical analysis was conducted with the chi-square test and Fischer's exact test with a significance level of 5%. Strangulated groin hernias account for 42.2% of the overall groin hernia operations conducted during the study period (288/697). Necroses were present in 59 (20.5%) patients. The mortality rate was 6.2% (n = 18). Admission time superior or equal to 48h (p = 0.002), American Society of Anesthesiologists (ASA) class superior or equal to III (p = 0.002), presence of preoperative strangulated groin hernia complication (peritonitis, occlusion, hernia abscesses) (p = 0.001), bowel necrosis (p = 0.000), and bowel resection (p = 0.000) were statistically related to a high risk of death. Forty-two (n = 42) postoperative complications were recorded in 34 (11.8%) patients. These complications were outnumbered by postoperative parietal suppuration (n = 26) which led to three cases of evisceration. Bowel necrosis was related to a high risk of postoperative complications (p = 0.002). Reoperation was necessary for 13 patients. The length of stay in hospital was 4days (range between 1 and 28days). The average follow-up period was 7months. No recurrence was noticed during this period. Delay in consultation, high ASA class, and moreover, bowel necrosis requiring bowel resection are the factors of unfavorable postoperative results. Groin hernias are an avoidable death cause provided that early treatment of strangulated hernias and the elective treatment of non-complicated hernias are conducted.

À propos de deux observations d’éviscération après césariennes réalisées selon la technique de Stark

Two cases of evisceration after caesarean sections performed according the Misgav Ladach General Hospital procedure (Stark's procedure) are reported. In these cases, omentum was sutured between the edges of fascia recti, creating a weakness of the abdominal sheath. These cases claim about a strict procedure for fascia suture. Also, these cases question about the parietal peritoneal closure and the drawing of rectus muscles, which are vertical breaks; so, these sutures close transversal incision of the abdominal wall with cross sutures, which are very secure.

Evisceration and avulsion of abdominal wounds

Increased intra-abdominal pressure is the primary factor in the etiology of evisceration and avulsion of abdominal wounds. Other causes mentioned under etiology play only a contributory part. Eight cases of evisceration are reported in all of which increased intra-abdominal pressure was conspicuous. Prophylaxis entails a close observance of the fundamentals of surgical technic and principles. The symptomatology and treatment are presented.