Transverse facial cleft or congenital macrosomia is a rare facial malformation. It is more common in men than in women. Unilateral form is the most frequent and appears to be associated in most cases with additional facial deformities. Bilateral form is rare and is more often isolated. The cosmetic damage it causes can be source of psychological stress. Sever form can cause oral functional disorders. These consequences justify early repair. We report two cases of isolated bilateral transverse facial cleft in a 6 month old girl and a 5 month old boy. The straight-line technique was used. Mucosal flaps from the lower lip were used to reduce the suture of the labial mucosa to 5 mm from the commissures on the upper lip. The aesthetic and functional outcomes were satisfactory.
Inguinal hernia is one of the most common surgical pathologies in children. The main risk is the evolution towards strangulation especially before the age of one year. Our study reports our experience on the management of strangulated hernias in children at the University Hospital Center of Antananarivo - Joseph Ravoahangy Andrianavalona (CHUA - JRA). This is a 12-month retrospective study. The parameters studied are the age of onset of strangulation, gender, the side concerned, clinical manifestations, therapeutic methods, outcomes. Of 74 cases collected, 96% were male. The right side predominated with 71.62% of cases. More than 70% of the cases were less than a year old, of which 50% were less than 3 months old. Besides the signs of strangulation, 10 cases presented an evident occlusive syndrome and 5 cases had come with a deterioration of the general state. Among 56 cases of initial reduction, 49 cases were reduced and their surgical treatment was postponed from 2 to 7 days. Cases with evident signs of complications, reduction failure, and cases of ovarian hernias had emergency surgery. Two cases of immediate post-operative death, 6 cases of testicular necrosis and two cases of recurrence over a three-month follow-up were deplored in patients operated on immediately. In case of strangulated hernia, delayed surgery after an immediate reduction offers a better prognosis. The main factor limiting this method is the late consultation responsible for advanced visceral complications.
Neonatal peritonitis is burdened with high morbidity and mortality despite progress in pediatric intensive care. The causal pathologies are multiple. Their knowledge is an important tool for improving care. The objective of our study is to determine the causes of neonatal peritonitis treated in our center. This is a retrospective, descriptive study of 72 months. The inclusion criteria were newborns less than 28 days old operated for peritonitis. The parameters studied were age, gender, perinatal history, site of perforation, causal pathologies. Eighteen patients were collected. The average age was 8 days, with extremes of 3 and 25 days. There was a male predominance with a sex ratio of 8. In the prenatal history, 1 case of gestational diabetes and 2 cases of gravidic hypertension were found. The average birth weight was 2730 g with extremes of 2500 g and 3500 g. The site of perforation was at the small intestine (7 cases), the colon (5 cases) and the stomach (4 cases) and there were 2 cases of multiple perforation. Ulcerative-necrotizing enterocolitis and mechanical causes represented the two main etiologies, each representing 44.44% of cases. Mechanical etiologies which represent 44% of cases could have been prevented by early management of the causal pathologies.
Appendico-cutaneous fistula is a very rare condition. The few cases reported in the literature follow an initial appendicular pathology or an abdominal infectious process including the appendix. We report an exceptional case of appendico-cutaneous fistula as part of a drainage complication of planned abdominal surgery. This was a 6 week old baby who had been operated on for biliary atresia. An abdominal drain was installed at the end of the surgery. Removal of the drain created an orifice centered by a bud. The healing achieved after the use of silver nitrate was short-lived, giving way to spontaneous digestive fistula. Surgical treatment with a perifistulous approach found a normal appendix in the path of the drain with the tip open to the skin. A simple appendectomy gave an excellent result.
Cystic lymphangioma is a benign malformations of the lymphatic system. Most of them are found in the head and neck. The abdominal localization represents 2 to 5% of cases and poses a preoperative diagnostic difficulty. Most of the diagnosis is made following laparotomy indicated because of signs of complications. We report one case of mesenteric cystic lymphangioma in children. The revealing manifestation was chronic vomiting with repercussions on the general condition. The diagnosis was not established until after the histopathology examination of the resection piece. Resection was complete. No recurrence was observed. The quality of resection determines the postoperative outcome and prognosis of abdominal cystic lymphangiomas.
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