Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

The purpose of this study was to investigate the clinical and therapeutic aspects of peritonitis by perforation of gastric and duodenal ulcer. This was a retrospective and descriptive study over 8 years (2010-2018) which allowed to collect 54 cases of peptic ulcer. Included in the study were all patients with confirmed gastroduodenal perforation on histology or laparotomy. We collected 54 cases of peptic ulcer perforated s. The age group of 30-49 years was the majority. The male sex was dominant with 90.7% of cases; the clinical picture was dominated by abdominal contracture associated with pain in 74.07% of cases. X-ray of the abdomen without preparation (AWP) revealed in 87.03% of cases of pneumoperitoneum. The perforation was in 68.52% of cases on the gastric antrum and in 31.48% on the duodenum. The surgical procedure used was the bank of excision, and a suture reinforcement epiploic in 68.52% of cases, a simple suture made in 31.48% of cases, the disease was marked by a fistula (1.90%) and mortality was 5.55% of cases. The gastroduodenal ulcer perforation is potentially serious and responsible peritonitis whose surgical treatment involves the peritoneal toilet and sutures the puncture.

Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 years) in Central Hospital of University of Point G in Bamako (Mali). The diagnosis of large goiters was based on the measurements of the anterior neck swelling. Thus large goiter was defined as any goiter including the height or width was greater than or equal to 10 cm (centimeters). Results: We operated 115 cases of large goiters on 760 goiters operated either 15.1%. The average age of patients was 44, 43 years ±14, 3 with extremes of 9 and 80 years. There was 101 women (87.8%) and 14 men (12.2%) with a sex ratio of 7.2 in favor of women. The signs of compression were dyspnea in 40% of cases (46/115), dysphonia in 13.0% (15/115), and dysphagia in 8.6% (10/115). The average height of goiter was 12.1 cm ± 3.5 cm with extremes of 10 and 29 cm and the average width was 14.4 cm ± 5.4 cm with extremes of 10 and 32 cm. Thyroid ultrasound found large goiters multinodular in 100%. Cervical radiography found the tracheal deviation in 48.2% (42/87), tracheal compression in 20.6% (18/87), plunging goiters in 11.5% (10/87). Cytology found a benign goiter in 97.4% of cases (112/115), malignant (thyroid cancer) in 2.6% of cases (3/115). Conclusion: Diagnosis of large goiters was based on the measurement of the swelling in our context. The signs of compression are the severity of this condition.

Plummer Vinson syndrome is a rare condition characterized by cervical dysphagia associated with iron deficiency anemia and a ring on the upper esophagus. Sometimes its unusual presentation can lead to misdiagnosis. We report the observation of a patient with Plummer-Vinson syndrome, revealed by upper dysphagia.

Bowel occlusions by bezoars are rare pathologies. They are due to an obstruction of the intestinal lumen by a solid mass of fruits or undigested vegetable fibers. They are seasonal (wild fruit season from March to June) in the Sahel Zone. We report a case of small bowel obstruction in a 35-year-old rural man after swallowing a significant amount of wild grapes (Lannea microcarpa). We proceeded to the resection of the occluded ileal segment and performed an ileal terminal ileal anastomosis. There weren't any complications during the postoperative site.