Gastrointestinal perforations (GIP) in newborns are serious neonatal conditions that have significant morbidity and mortality, especially in resource constrained setups. This study was done to describe our experience of GIP in neonates and identify the factors leading to high mortality in our setup. We collected 18 cases with GIP in neonates. The average age was 5.7 days (range, 1-7 days). The sex ratio was 0.64. The average time to treatment was 3.3 days (range, 1-10 days). The etiology of GIP was perforated necrotizing enterocolitis (13 patients), spontaneous gastric perforation (2 patients), perforated ileal atresia (1 patient), ileal perforation complicating a strangulated inguinoscrotal hernia (1 patient), and peritonitis after colostomy (1 patient). Mortality was 77.8% (n=14), among which 9 newborns (64.3%) died preoperatively. Prematurity, management delay, and lack of a neonatal intensive care unit were the main poor prognostic factors. Mortality from GIP is still high in our context due to several factors, especially prematurity, management delay, and lack of a neonatal intensive care unit.

RésuméLe diverticule de Meckel est l'anomalie congénitale la plus fréquente de l'intestin grêle. Bien qu'il s'agisse d'une anomalie courante dans la population générale, sa présence dans un sac herniaire, en particulier au niveau ombilical est une situation peu fréquente et constitue la hernie de Littré. Nous rapportons le cas d'un nourrisson de 6 mois de sexe féminin, admis pour une tuméfaction ombilicale douloureuse et irréductible. Le diagnostic de hernie ombilicale étranglée a été posé. En per opératoire, il était découvert dans le sac herniaire un diverticule de Meckel inflammatoire. On procéda à une résection cunéiforme du diverticule suivie de la fermeture de la brèche intestinale par une suture en surjet et de la réfection pariétale. Le diagnostic clinique de la hernie de Littré est difficile et l'attitude thérapeutique varie selon les équipes.

Background: Gastroschisis often has a fatal outcome in developing countries. Its outcome is taken as an indicator of the level of healthcare in a particular healthcare facility. The aim was to study the outcome of the management of gastroschisis and to identify the main challenges of its treatment in a country with limited resources. Methods: This is a prospective and descriptive study conducted over a period of 4 years (2016-2020). It included all the neonates admitted to the two referral hospitals of our country with the diagnosis of gastroschisis. Each of the university hospitals had a neonatology unit. Parenteral nutrition and assisted ventilation were not available. Results: Twenty patients were admitted to our hospitals with an annual frequency of five cases. The sex ratio (M:F) was 1.5. Only one of the 20 mothers (5%) of the patients had an antenatal diagnosis and was the only one born in a university hospital. The remaining (19-95%) were referred to a university hospital after their birth. None of the 20 patients had received parenteral nutrition. Surgically, seven babies (35%) had benefited from the placement of a silo with progressive reduction of the bowels. The mortality of gastroschisis was 100% and the average life span of the patients was 4.5 days [1-20 days]. Conclusion: It is important to act appropriately on the whole chain of management of gastroschisis from antenatal diagnosis to treatment so that this pathology is no longer fatal for newborns in countries with limited resources.

Background/Purpose: Esophageal atresia (EA) is a congenital defect in the thoracic esophagus associated or not with a tracheoesophageal fistula (TEF). It is associated with high mortality in low-income countries such as Burkina Faso, Madagascar and Ghana. The purpose of this study was to present the recent management of newborns with EA/TEF in Benin and to identify the needs of families whose children have survived. Method: Over a period of 10 years, 54 newborns with EA/TEF operated on in the 2 largest university hospitals in Benin were included. Two groups were identified. Group A (n=33) included newborns in whom a primary repair had been performed. Group B (n=21) involved newborns who underwent staged repair. Staged repair involved cervical oesophagostomy + gastrostomy (n= 7) or upper oesophageal pouch suction + gastrostomy (n=2) or cervical esophagostomy + stoma of the lower esophageal pouch (n=12). Ten parents from group B were interviewed for the needs survey. The significance level was defined as p < 0.05. Results: There were 31 male newborns. The median for gestational age was 37 gestational weeks (range: 35 - 38). Polyhydramnios was observed in 4 cases. The mean birth weight was 2365 g. (range: 1000 g - 3500 g). The mean age at diagnosis was 3.48 days (range: 24 hours - 19 days). Surgery was performed at day 5 on average with extremes from day 2 to day 17. The surgery lasted an average of 2h12 min and the overall mortality rate was 74.07%. Mortality rate in group A was 100% and 33.33% in group B. There was a strong statistically significant difference in survival between the two groups. (p=19.10-8). Sepsis was the most common cause of death. Stress, fear and anxiety of losing the child were the difficulties frequently encountered at bedtime and every day. Four parents had to stop their activities to be available to take care of their child. All the parents had expressed the need for psychological support. Conclusion: Pending an improvement of the technical platform, staged repair remains an essential option for the survival of patients. The creation of a framework for discussion with families authorizing social actions and quality medical support is desired.

Introduction In Africa, frequent delays in seeking medical attention due to cultural considerations and lack of financial support could explain some particular clinical presentations. An enteroscrotal fistula following an incarcerated inguinal hernia is a rare condition in neonates. Presentation of case A 21-day-old infant was brought to our consultation for persistent stool discharge from the right scrotum for three days. The parents reported an inguinoscrotal swelling that had been evolving for ten days before admission and became painful two days later. He was diagnosed with a case of enteroscrotal fistula. After correction of electrolytes disorders, a laparotomy was performed through a right lower transverse incision. Operative findings were strangulated inguinal hernia with ileal perforation. Resection and end-to-end ileo-ileal anastomosis was performed. He was discharged from the hospital on the 6th post-operative day. No recurrence within the first year of follow-up. Discussion Thirteen cases have been reported in the literature until now. Most of them were from developing countries, including ours. Conclusion Early seeking medical attention of incarcerated inguinal hernias is necessary to reduce their morbidity and mortality. Paediatricians should emphasize providing adequate information, education and communication during routine examinations of neonates. We advocate the popularization of universal health insurance to facilitate health care.

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Background Abdominal trauma are a common cause of infant morbidity and mortality. Aim To assess the relevance of computed tomography scan for the management of abdominal trauma in children in countries with limited resources. Patients and method: It was a retrospective and descriptive study over 5 years in patients aged 0 to 15 years. Results Twenty four cases of abdominal trauma were collected. There were 14 boys and 10 girls with a sex ratio of 1.4. The average age was 8.7 years with extremes of 18 months and 15 years. The causes found were: road accidents (14 cases), home accident (6 cases), gambling accidents (3 cases) and one aggression. Traumas were divided into 83.3% (20 cases) of abdominal blunt and 16.7% (4 cases) of abdominal wound. Polytrauma accounted for 41.7% (10 cases). No computed tomography scan was ordered. The spleen was the most injured organ (11 cases) followed by the intestines (6 cases). The average length of hospital stay was 12.3 days with extremes of 3 and 15 days. The treatment was non-operative in 13 patients (54.2%) and surgical in 11 ones (45.8%). No deaths were noted in our series. Conclusion Abdominal trauma in children are potentially serious injuries. The treatment depends on the damaged organ and the patient's hemodynamic status. Computed tomography scan does not appear to be indispensable in the management of traumatized children in countries with limited resources.

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