Medico-surgical Treatment Research Articles

Can the use of whole-body CT be reduced in cases of kinetic-based polytrauma patients without a clinical severity criterion? A bi-center retrospective study

ObjectiveTo identify clinical and biological criteria predictive of significant traumatic injury in only kinetic-based polytrauma patients without clinical severity criteria.To propose a decisional algorithm to assist the emergency doctor in deciding whether or not to perform a WBCT in the above population. MethodsRetrospective bi-center study. 1270 patients with high velocity trauma without clinical severity criteria, for whom a WBCT was performed in 2017, were included. Patients with hemodynamic, respiratory or neurological severity criterion or those requiring pre-hospital resuscitation measures were excluded.Our primary endpoint was the identification of a significant lesion, i.e. any lesion that led to hospitalization > 24 h for monitoring or medico-surgical treatment. Data collected were age, sex, mechanism of injury, Glasgow Coma Scale score, number of symptomatic body regions, blood alcohol level, and neutrophil count. ResultsMultivariate analysis found independent predictors of significant injury: fall > 5 m (OR: 14.36; CI: 2.3–283.4; p = 0.017), Glasgow score = 13 or 14 (OR: 4.40; CI:1.30–18.52; p = 0.027), presence of 2 symptomatic body regions (OR: 10.21; CI: 4.66–23.72; p = 0.05), positive blood alcohol level (OR: 2.81; CI: 1.13–7.33; p = 0.029) and neutrophilic leukocytosis (OR: 8.76; CI: 3.94–21.27; p = 0.01).A composite clinico-biological endpoint predictive of the absence of significant lesion was identified using a Classification and Regression Tree: number of symptomatic regions < 2, absence of Neutrophilic leukocytosis and negative blood alcohol concentration. ConclusionA simple triage algorithm was created with the objective of identifying, in high velocity trauma without clinical severity criteria, those without significant traumatic injury.

Granulosa tumor: two spontaneous pregnancies after combined medico-surgical treatment: case report and review of the literature

BackgroundGranulosa tumor is a rare tumor that arises from the mesenchyme and the sexual cord of the ovary. The prognosis is generally excellent, and treatment is mainly based on surgery, followed by chemotherapy depending on the extension of the disease. However, “the obstetrical prognosis” is compromised.Case presentationWe report the case of a 32-year-old Caucasian patient who was diagnosed during a primary infertility assessment with an ultrasound image of a 39 mm organic left ovarian cyst confirmed on pelvic magnetic resonance imaging with infiltration of the uterosacral space. Tumor markers, including cancer antigen 125, alpha fetoprotein, and β-human chorionic gonadotropin, were normal. Histological study of biopsies of the ovarian lesion taken during exploratory laparoscopy confirmed the diagnosis of adult granulosa tumor. After a normal extension assessment including a thoracoabdominopelvic computed tomography scan and a positron emission tomography scan, the patient underwent complete conservative surgery and the disease was classified as stage Ic. Three cycles of adjuvant chemotherapy according to the “BEP” protocol combining bleomycin, etoposide, and cisplatin were performed after oocyte cryopreservation. After a 5-year follow-up period, the patient had no sign of tumor progression and had two spontaneous pregnancies, the first occurring 3 months after the end of chemotherapy and the second 14 months later.ConclusionGranulosa cell tumor remains a rare tumor whose management considerably compromises fertility and reduces the chances of having a spontaneous pregnancy. The particularity of our observation is that the diagnosis of the granulosa tumor was made following a primary infertility assessment and that the patient had two spontaneous pregnancies 3 months after the end of a medico-surgical treatment known to be very gonadotoxic.

Acrometastases to the Hand and Wrist: A Series of 9 Cases and Review of the Literature

Abstract Introduction Acrometastases are extremely rare in the hand, with a prevalence of around 0.1% according to the literature. They are normally associated with advanced tumor stages, especially in lung cancer. The present article shows the experience of our center in the management and treatment of these pathologies. Materials and Methods We report a series of 9 cases treated between 1992 and 2020 in the hand and wrist. Data regarding the primary tumor, the target organ, and survival are analyzed. A review of the cases of acrometastasis reported in the literature is also carried out, emphasizing in how many of then the acral lesion was the first sign of an unknown tumor. Results Acrometastases predominantly affect male patients aged around 60 years, and the primary tumor that is the cause in most cases is lung cancer, with a very low survival rate after the diagnosis (of approximately 8 months). Discussion and Conclusions In cases of acral lesion of non-traumatic origin, acrometastases should be considered, especially in patients who have a known primary tumor. In the present series, there were three cases in which the acrometastases were the first sign of a tumor in the patient, and in one of them it was initially treated as whitlow. In the literature, in approximately 50% of the cases, acrometastases are the first sign of the presence of a tumor.Once diagnosed, multidisciplinary medicosurgical treatment is essential to improve the patient's function and pain as much as possible.

Head and Neck Cellulitis of Dental Origin and HIV Infection: 24 Cases

Cervico-facial cellulitis is a serious poly-microbial infection of the deep fascial spaces of the face and neck which may be life-threatening. The existence of an underlying ground that causes immune failure may promote or complicate this infection. The aim of this work was to describe the socio-demographic and clinical aspects of dental cervicofacial cellulitis associated with HIV in our context. It was a descriptive cross-sectional study that concerned all cases of cervico-facial cellulitis with positive HIV serology encountered at the CHU-CNOS of Bamako from May 2017 to January 2018. Twenty-four cases were collected. Cellulite with positive HIV accounted for 1.14% of consultations in the service. Females accounted for 67.66% of cases with a sex ratio of 0.5. The average age was 33.58 years old. Housewives accounted for 33.33% of cases. The bride and groom represented 83% of the cases. The triad (pain, swelling, and trismus) was the most common reason for consultation with 41.7% of cases. The tooth 37 was involved in 25% of the cases. In 87% of cases, patients were screened in the service. HIV-1 was found in 75.0% of cases. Complications such as peripheral facial palsy were found in three cases. The medico-surgical treatment was performed in 23 cases with a favorable evolution. The search for an underlying ground, in particular HIV infection, must be systematic in the face of diffuse cervicofacial cellulitis.

Chronic Purulent Otorrhea in the South of the Sahara: Epidemiological, Clinical and Therapeutic Profiles about 135 Cases

Objective: To study the clinical and therapeutic epidemiological profile of chronic purulent otorrhea in the ENT and CCF departments of the Gabriel Touré university hospital. Materials and Method: This was a retrospective study from May 2019 to April 2021. We made an exhaustive sampling of all patients who consulted for chronic purulent otorrhea with a complete medical file. All ages were included (except from 0 to - 5 years), and all sexes combined. The data medium was the patient records and the department’s operating report register. The non-inclusion criteria were patients with incomplete files and patients who were less than 5 years old. Results: In total, we collected 135 cases. The average age of our patients was 29.27 years. The most represented age group was 16 to 25 years old. We noted a male predominance in 60.7%. The associated signs found were hearing loss, earache, tinnitus, ear pruritus, vertigo, headache and facial paralysis. The main pathology involved is chronic otitis media (CMO) in 55.5%, the most serious of which is dangerous chronic otitis (8.1%). All of our patients have received medical treatment. The treatment was surgical in 64% of patients after medical treatment. With the mean follow-up of 6 months, tinnitus and reperforation were the most common complications found in 6.2% and 3.1% respectively. Conclusion: Chronic purulent otorrhea is the most common ear discharge in ENT consultation. The main pathology involved is CMO, the most formidable of which is cholesteatoma. Medico-surgical treatment.

Diffuse Cervico-Facial Cellulitis: Epidemiological, Diagnostic and Therapeutic Aspects at the Teaching Hospital CNHU HKM of Cotonou

Purpose of the work: to study the epidemiological, clinical and therapeutic aspects of diffuse cervico-facial cellulitis collected within the ENT-CCF surgery department of the CNHU of Cotonou. Materials and method: the study was a descriptive retrospective carried out from January 1st, 2018 to December 31st, 2020. It concerned new cases of diffuse cervico-facial cellulitis identified during the period. Results: in 3 years, 55 cases of diffuse cervico-facial cellulitis were identified out of 1101 hospitalized patients. The frequency was 4.99%. Per year, 18 cases of cervico-facial cellulitis are recorded. The mean age of the patients was 41.3 years with extremes of 15 years and 85 years. A clear male predominance was noted with a sex ratio of 1.29. Painful cervico-facial swelling was the most common reason for medical consultation (47 patients or 85.5% of cases). Thirty patients (54.5%) showed a deterioration in general condition. Several clinical forms of diffuse cervico-facial cellulitis have been described, in particular the gangrenous form, the suppurative, necrotizing form and LUDWIG’s angina. The portal of entry was dental in 50 patients (91% of cases), favored by poor oral hygiene and self-medication with non-steroidal anti-inflammatory drugs (NSAIDs). The medico-surgical treatment implemented was favorable for 47 patients (85.5%). Conclusion: Diffuse cervico-facial cellulitis remains a frequent medical-surgical emergency in the CCF ENT department at the Teaching Hospital of Cotonou. Mainly of odontogenic origin, it is encountered in different clinical forms.

Medico-Surgical treatment of mycetoma in the Somine Dolo hospital of Mopti (Mali)

RésuméObjectifL'objectif de cette étude était de décrire les aspects épidémiologiques, cliniques et thérapeutiques des mycétomes.Matériel et méthodesIl s'agit d'une étude rétrospective incluant les patients traités pour mycétome de janvier 2016 à décembre 2018 dont deux ans de recrutement et un an de suivi (2019) à l'hôpital de deuxième niveau (Sominé Dolo de Mopti). Elle a concerné 19 patients hospitalisés et traités dans le service de chirurgie.RésultatsL’étude portait sur 11 hommes et huit femmes. L’âge moyen de nos patients était de 38 ans, avec des extrêmes de 15 - 70 ans. Le délai médian de consultation était de dix ans après le début des symptômes (1 - 40 ans). Les éleveurs et les cultivateurs étaient concernés dans huit et sept cas respectivement’ avec la notion de traumatisme dans 14 cas. Le pied était la zone de prédilection dans 13 cas. Une atteinte osseuse et ostéoarticulaire était notée chez 12 des patients. Des grains noirs étaient présents dans 16 cas attribués à Madurella sp. Nous avons réalisé 12 amputations, six exérèses carcinologiques et des soins locaux pour un patient.ConclusionLes mycétomes doivent être évoqués et diagnostiqués à un stade précoce chez les sujets prédisposés particulièrement les agriculteurs et les éleveurs. La prévention est d'une grande importance, elle repose sur la désinfection des plaies et le port de chaussures protectrices.

Rectovaginal fistula in Crohn's disease treatment: a low long-term success rate and a high definitive stoma risk after a conservative surgical approach.

Management of rectovaginal fistula (RVF) in Crohn's disease (CD) is challenging. Available studies are heterogeneous and retrospective, with short-term follow-up. The aim of this study was to assess the overall long-term medico-surgical treatment results in women with RVF due to CD. A retrospective study was conducted on consecutive patients operated on for RVF in CD from September 1996 to November 2019 at a tertiary teaching hospital. All surgeries were classified as preliminary, closure, or salvage procedures. Primary outcome was fistula remission defined as the combination of fistula closure and no stoma, at least 6months since last procedure. Thirty-two patients (median age 34 [range 21-55] years), with a median follow-up of 11.3years (0-23.7) after first surgery, were included. Altogether, 138 procedures were performed; 36 (26%) preliminary, 80 (58%) closure, and 13 (9%) salvage procedures. RVF remission was obtained in 7/32 patients (22%). At the end of follow-up, a stoma was present in 13/32 patients (41%). The percentage of time on biologics was 86% for patients in remission, versus 36% for the others (p = 0.0057). After univariate analysis, only anti-TNF-α was significantly related to successful closure techniques (p = 0.007). The RVF remission rate in CD was low in the long term. However, patients underwent a succession of interventions, and the stoma rate was high. Combination of biologics with surgical management was crucial.

Prise en charge des symptômes rhinosinusiens des asthmatiques sévères avec inflammation de type 2: Management of patients with severe asthma and sino-nasal type 2 inflammation

Management of patients with severe asthma and comorbid sino-nasal type 2 inflammation is challenging; many studies highlight the need of a perfect treatment of sinonasal diseases in order to improve the control of asthma; the most common CRS with type 2 inflammation is the Nasal Polyposis; NP reaches from 2 % to 5 % of the general population in France; other pathologies like allergic rhinitis or chronic eosinophilic rhinitis can also coexist. Clinical diagnosis is based on physical exam with naso-endoscopy. CT-SCAN is often necessary. First-line treatment combines nasal douche and local corticosteroids. If this strategy fails a surgery can be perform. Biological treatments could profoundly modify the management of patients with severe type 2 sino-nasal inflammation in failure of medico-surgical treatment.© 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Integrated multidisciplinary approach to hidradenitis suppurativa in clinical practice,.

BackgroundThe European hidradenitis suppurativa (HS) guidelines recommend a multidisciplinary approach for patients with HS and management of comorbidities.ObjectiveWe aimed to describe the organization of a multidisciplinary HS program and characterize the patient population.MethodsWe conducted a retrospective study of patients with HS undergoing prospectively defined multidisciplinary work-up including examinations by a dermatologist, plastic surgeon, smoking specialist, and nutritionist in our outpatient unit between October 2015 and January 2017.ResultsThe study included 49 patients with a sex ratio of 1:1. A total of 73.4% of patients were smokers, 20.4% were overweight, 48.9% were obese, and 30.6% had symptoms of depression. The mean Sartorius score was 30.4 (±17.6). The outcome of plastic surgery consultation was as follows: 16 patients had operations, 5 were excluded based on medical history, 9 refused surgery, and 16 remained undecided. The refusal rates for consulting with the smoking cessation and nutrition specialists were 55.8% and 69.5%, respectively. Twelve patients received antibiotics, 9 received biologics, 9 underwent medico-surgical treatment, 9 underwent surgery, and 10 were lost to follow-up. The mean visual analogue scale score for satisfaction was 8.3 (±1.6; n = 28).ConclusionAn integrated multidisciplinary care model for HS is associated with high patient satisfaction. Adherence to the proposed comorbidity management was higher in female patients and related to empathetic interactions with physicians.

Emphysematous Cystitis Responsible for a Bladder Perforation

Emphysematous cystitis is a rare form of lower urinary tract infection characterized by the presence of gas in the lumen and / or bladder wall. We report a case of a 64 year old patient hospitalized for an acute abdominal table. The diagnosis of emphysematous cystitis complicated by bladder perforation was made after performing an abdominal scan. Medico-surgical treatment has been initiated.

Intracranial Suppuration at the Brazzaville Academic Hospital

Background: Intracranial suppurations (ICS) due to banal germs are medical-surgical emergencies, despite their little removed frequency. Represented by abscesses and empyemas, their management has been improved by the combined contributions of new diagnostic and therapeutic methods. Objective: Appreciate the management of intracranial suppurations banal germ in our service. Material and methods: A retrospective study of 41 cases of intra-cranial suppurations was conducted at Brazzaville University Hospital, from January 2007 to June 2019. Diagnostic, therapeutic and evolution aspects have been studied. Results: They are divided into 24 empyemas, 8 abscesses and 9 associations abscess-empyema. The average age was 20.2 years old in general. The male predominance is noted in all groups. The sex ratio is 3.1 for all of these intracranial suppurations (ICS). They frequently complicated Oto-Rhino-Laryngology (ORL) infections (41.4%). The clinic was mostly represented by the Bergman’s triad 51.2%, followed by headache 14.6% and seizures 12.2%. The lesions were predominant in supratentorial 97.5%. Frontal location was found in 67.4%. Germs were isolated in 29.4% of samples. There were 5 Streptococci, 3 Staphylococci and 2 Gram-negative Bacilli. The medico-surgical treatment indicated in 80.5% combined often probabilistic tri-antibiotherapy with the evacuation of the pus by the trepano-puncture. Evolution under this treatment was marked by healing in 90.2%. The lethality was 9.7%. Conclusion: The pursuit of the improvement of these infections requires the adequate treatment of their gateways, most of them loco-regional.

1425. Treatment Outcomes in Patients with Pyogenic Vertebral Osteomyelitis Who Have Cirrhosis

BackgroundThe mortality in liver cirrhosis was reported to be greater than that in the five major cancers. Infection further increases the mortality of patients with cirrhosis by four fold. Considering the greatly increased mortality from infection in patients with cirrhosis, early diagnosis and prompt treatments should be compulsory to save patients’ lives. However, adherence to such basic principle for patients with cirrhosis is not easy for clinicians engaged in the treatment of pyogenic vertebral osteomyelitis (PVO). Therefore, the mortality rate is expected to be high. However, no reports have described the mortality rate in this patient group.MethodsA retrospective study was conducted to investigate the treatment outcome in PVO patients with cirrhosis, and to identify the predictors of their mortality. Mortality was divided into two categories, 30-day and 90-day mortality. A stepwise multivariate logistic regression model was used to identify predictors of mortality. Due to high mortality rate, the clinical outcome was investigated in patients with at least 90-day survival.ResultsEighty-five patients were identified after initial exclusion. The patients’ mean age was 60.5 years, and 50 patients were male. The early mortality rates within 30 and 90 days were 17.6% and 36.5%, respectively (Table 1). Multivariate analysis revealed that increased age, CTP class C, and bacteremia at the time of PVO diagnosis were predictors of 30-day mortality while higher MELD score, presence of combined infection, and multiple spinal lesions were predictors of 90-day mortality (Figure 1, Table 2). The duration of antibiotic treatment and the length of hospital stay (from the PVO diagnosis) were longer in CTP C patients; however, they were statistically insignificant (Table 3). Recurrence of PVO was more common in CTP C patients (P = 0.028) (Table 3).ConclusionAttention should be paid to the high mortality between 30 and 90 days after PVO diagnosis (18.8%), which was higher than the 30-day mortality. Liver function was consistently strong predictor of mortality in PVO patients with cirrhosis. The high-risk patients should be targeted for an aggressive diagnostic approach using spinal MRI and intensive medicosurgical treatment. Disclosures All authors: No reported disclosures.

Reasons for Litigation in Arthroplasty Infections and Lessons Learned.

Infections complicate a minority of orthopaedic arthroplasties but are the leading cause of malpractice claims. The basis for the claims is unclear. The objective of this study was to identify the main deviations from current recommendations by reviewing patient files recorded by a major French medical liability-specialized insurance company for private practitioners (MACSF [Mutuelle d'Assurance du Corps de Santé Français]) and to analyze legal claims and outcomes of litigation. All claims data for periprosthetic joint infections were analyzed retrospectively from 2010 to 2014. Treatment strategies were compared with therapeutic guidelines published by medical societies. Forty-five claims for periprosthetic joint infection were recorded; 82% of patients were men and the mean patient age was 63 years. Twenty-one patients (47%) had a knee arthroplasty, 21 had a hip arthroplasty, 2 had a shoulder arthroplasty, and 1 had an ankle arthroplasty. Twenty-three infections (51%) occurred within 1 month postoperatively. Staphylococcus aureus was isolated from intraoperative samples in 36% of the cases (including 25% of these with methicillin-resistant strains), and coagulase-negative staphylococci were isolated in 51% (44% methicillin-resistant strains) of the cases. Treatment lasted for a median of 9.5 months (range, 1.5 to 96 months), with a median of 6 months (range, 1.5 to 20 months) of antibiotics and 3 surgical procedures (range, 0 to 7 surgical procedures). A total of 18% of patients had antibiotic-related side effects, 2% of patients died, and 76% of patients had persistent sequelae. An infectious disease specialist's advice was required for 56% of the patients. Discordances with therapeutic guidelines were found in 76% of the patient files, including delay in diagnosis (44%) and inadequate medical treatment (18%) or medico-surgical treatment (13%). Late diagnosis of early postoperative infections appears to be the major cause of inappropriate management and malpractice litigation. Discordance with current guidelines was identified. Early consultation with an infectious disease specialist may help to reduce malpractice claims. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Living Donor Liver Transplantation for Hepatocellular Carcinoma: An Asian Perspective.

Despite advancements in early diagnosis and medico-surgical treatment, hepatocellular carcinoma (HCC) is still a major cancer that causes substantial mortality in Asian countries. Liver transplantation (LT) has been accepted worldwide as the most effective treatment modality for patients with HCC; however, with the high incidence of HCC and low organ donation rate, Asia has developed distinctive features of indications and strategies for the application of LT. Unlike Western countries, living donor liver transplantation (LDLT) accounts for most LT cases for HCC in Asian countries, and most major transplantation centers perform LDLT for HCC patients with extended criteria. This article reviewed the current practice and outcome of LDLT for HCC from an Asian perspective and summarized the strategies that the high-volume LT centers in Asia use to obtain satisfactory oncologic results.

Acute invasive fungal rhinosinusitis: our 2 year experience and outcome analysis

The incidence of Acute invasive fungal rhinosinusitis (AIFRS) is on the rise considering the multitude of comorbidities present in a single patient.The delay in suspecting the fungal etiology, presentation of the patient for an Otorhinolaryngology consult and lack of defined protocols affects outcome.This study looks in to the various aspects of treatment of AIFRS including sample collection, diagnosis and medicosurgical treatment. We propose a protocol for the management of these patients crafted from our outcome. Between September 2015-September 2017, 14 patients presented with AIFRS. Targeted samples were taken for Potassium hydroxide mount, histopathological studies and fungal culture. Management was initiated with antifungals and multi-approach surgical debridement. Six of these patients had multiple comorbidities and most were uncontrolled diabetics. The average delay in presentation was 9days. Potassium hydroxide mount was the screening test of choice. A minimum of two sittings of debridement was essential. In an average follow-up period of 15.12months, all the patients are alive and disease free. A high index of suspicion, awareness among medical fraternity and precise sample collection aids a firm diagnosis. Simultaneous initiation of surgical debridement and anti-fungals is fundamental.

Endocardite infectieuse mitro-aortique compliquée de perforation valvulaire, d’anévrisme mycotique et d’infarctus spléno-rénal

L'endocardite infectieuse est considérée comme une pathologie potentiellement grave malgré tous les progrès en diagnostic et traitement. Les valves du cœur gauche sont plus touchées et les évènements emboliques, les anévrismes mycotiques, les abcès ainsi que les perforations des valves en sont des complications redoutables. Nous rapportons le cas d'une endocardite ayant atteint les valves aortique et mitrale et qui s'est compliquée d'infarctus splénique et rénale, d'anévrisme mycotique cérébral et d'une perforation de la grande valve mitrale. L'intérêt du cas est souligné suite à la bonne évolution au décours d'un traitement médico-chirurgical en dépit de la multitude des complications.

Complications of Cervicofacial Cellulitis Supported in University Hospital Yalgado Ouedraogo

Introduction: The complications of cervicofacial cellulitis are one of the most serious emergencies Oto-Rhino-Laryngology (ORL). These complications are still observed in our context despite the advent of antibiotics. The aim of our study was to describe the clinical presentation and management of patients admitted to our institution for complications of cervicofacial cellulitis. Patients and Methods: It came from a retrospective study in the ORL service, a department of Yalgado Ouedraogo Hospital of Ouagadougou, between January 2005 and December 2014, during which all patients with cervicofacial cellulitis complications were identified. Results: We collected over 10 years, 69 cases of complicated cellulitis, a frequency of 54.3% of cervicofacial cellulitis and 2.3% of all hospitalizations. The group included 33% women and 67% men to 29 years of average age. The non-steroidal anti-inflammatory isolated was the main factor contributing 59.4%. The front door was mainly dental 43.5% and pharyngeal 36.2%. The most frequent complications were mediastinitis thoracic dissemination 24.6%, sepsis 21.7% and spontaneous fistula 20.3% with orostome or pharyngostome. Medico-surgical treatment was associated with a reanimation in most cases. The outcome was favorable in 79.7% of cases. Mortality was 17.4%. Conclusion: The complications of cervicofacial cellulitis are frequent and often life-threatening. Their management is done in a multidisciplinary framework. The prevention and early treatment remain the pledge of their control.

Isolated Streptococcus agalactiae tricuspid endocarditis in elderly patient without known predisposing factors: Case report and review of the literature

Group B streptococcal (GBS) tricuspid infective endocarditis is a very rare clinical entity. It affects intravenous drug users, pregnant, postpartum women, and the elderly. We report the case of a 68-year-old patient without known predisposing factors who presented a GBS tricuspid endocarditis treated by penicillin and aminoglycosides with no response. The patient was operated with a good evolution. Our case is the 25th reported in the literature. GBS disease is increasing in the elderly and is mainly associated to comorbid conditions. Tricuspid infective endocarditis with Group B streptococcus predominantly presents as a persistent fever with respiratory symptoms due to pulmonary embolism. Therefore, it requires a medicosurgical treatment and close follow-up.

Cétose de jeûne chez une femme allaitante

IntroductionBovine ketosis is a rare cause of metabolic acidosis. It is a starvation ketosis that appears in lactating woman. Case reportA 29-year-old woman had a previous gastric surgery one month ago while breastfeeding her 6-month child. She presented to emergency with dyspnea, fatigue, weight loss and anorexia. The explorations revealed a serious metabolic acidosis with a high anion gap, for which all other causes have been eliminated. ConclusionA restrictive diet in lactating patients is a major risk of ketosis or bovine ketosis. Medico-surgical treatment of obesity during lactation seems unreasonable. Breastfeeding should be systematically sought before a medical and surgical management of obesity. With the spread of bariatric surgery, starvation ketosis is a cause of metabolic acidosis not to ignore.