The place of presumptive diagnosis in the management of peritoneal tuberculosis: A case report from rural Togo

INTRODUCTION AND IMPORTANCE

Tuberculosis is a major public health problem in developing countries. Its main abdominal form is peritoneal. The diagnosis of this peritoneal form is complex and difficult. We describe the role of presumptive diagnosis in the management of this condition in Togo, based on a case study.

CASE PRESENTATION

A security guard with no previous pathological history was seen in consultation with febrile ascites. Investigations revealed the exudative and lymphocytic nature of the ascites. The other investigations did not reveal any other organic lesion, particularly hepatic, or the germ. This typical ascites picture had for us a strong diagnostic value in favour of a tubercular origin. The patient was treated with antituberculosis drugs for 6 months. The evolution was satisfactory.

CLINICAL DISCUSSION

The diagnosis of peritoneal tuberculosis is difficult. Biological explorations are rather disappointing in this approach. Laparoscopy coupled with histological examination represents the best means of diagnosing peritoneal tuberculosis to date. However, in developing countries, the absence of these resources poses a real problem. Clinical and biological arguments are always at the forefront of the diagnosis in endemic countries. The latter is based on the demonstration of febrile, exudative and lymphocytic ascites.

CONCLUSION

The difficult diagnosis of peritoneal tuberculosis coupled with the lack of technical facilities gives the presumptive diagnosis an important place in the management of this condition in endemic countries.

Psoas primary abscess: A case report in an immunocompetent subject

INTRODUCTION

Primary psoas abscess is a rare disease characterised by a purulent collection in the thickness of the psoas muscle. Its incidence and etiopathogenesis are not well defined. It is mainly encountered in developing countries in weakened conditions. The involvement of an immunocompetent subject is exceptional. We report a case of primary psoas abscess in an immunocompetent patient in Togo.

CASE PRESENTATION

A 67-year-old retired teacher with no previous medical history was seen in the emergency room with acute and severe abdominal pain. The clinical examination revealed an infectious syndrome and a painful abdominal mass in the right iliac fossa. CT scan showed a heterogeneous fluid collection in the right psoas muscle. Surgical drainage was indicated and performed. The patient was treated postoperatively with dual antibiotics with a favourable outcome. No germs were isolated from the collection.

CLINICAL DISCUSSION

Rare infectious disease, its real incidence is unknown. The most common germ is staphylococcus aureus. Its etiopathogenesis is also poorly understood. Immune deficiency is a predisposing factor for the condition. Diagnosis of the disease is difficult due to a lack of specificity of the signs encountered. Imaging is the key to positive diagnosis with a high sensitivity of CT scan. Treatment is medical-surgical with drainage and antibiotic therapy.

CONCLUSION

Primary psoas abscess is a potentially serious disease requiring early diagnosis and management.

Poland syndrome: Fortuitous discovery of a familial case in Togo

INTRODUCTION AND IMPORTANCE

Poland syndrome is a rare malformative disease. It is characterized by agenesis or hypoplasia of the pectoralis major muscle associated or not with a malformation of the ipsilateral thoracic limb. The authors report the fortuitous discovery of a familial case of Poland syndrome in Togo.

CASE PRESENTATION

He was a 25-year-old young man, with no known pathological history, examined as part of a physical fitness assessment and who presented with thoracic asymmetry. The clinical and radiological explorations made it possible to conclude to a Poland syndrome in its minor form without any other associated malformation. In addition, three other paternal uncles of the patient presented with the same clinical symptomatology. In the absence of a clear indication, the patient received no treatment.

CLINICAL DISCUSSION

Poland syndrome is a rare congenital malformation. The abnormalities encountered are cutaneous-glandular, osteo-cartilaginous and muscular. The etiopathogenesis of the disease is unknown. The diagnosis is clinical and is based on the demonstration of agenesis of the pectoralis major muscle. The disease does not often lead to functional discomfort; therefore the treatment is not systematic and has only aesthetic value.

CONCLUSION

A rare congenital disease, Poland syndrome can occur sporadically or in families. Its treatment depends above all on the psychological repercussion of the disease.

A case of prune belly syndrome: Experience from a regional hospital in Togo

INTRODUCTION AND IMPORTANCE

Prune Belly syndrome is a rare congenital condition first reported in 1939. It is a malformative disease associated with high mortality. We report a neonatal case in a regional hospital in Togo.

PRESENTATION OF CASE

A 4-month-old male infant was brought to the hospital by his uncle because of a "deformity of the abdomen and absence of testicles". The examination revealed hypoplasia of the abdominal wall associated with bilateral cryptorchidism. Abdominal and urinary tract ultrasound revealed a left pyelocaliceal dilatation and a right megaureter. All these data allowed the diagnosis of Prune Belly syndrome.

CONCLUSION

Prune Belly syndrome is a rare and complex disease with a high mortality rate.

Unusual form of inguinal hernia: A case report of Littré's hernia strangled

Introduction

Littré's hernia is a rare condition related to Meckel's diverticulum. Its diagnosis is per operative and its treatment is surgical. We report a case of Littre's hernia strangled, discovered in a 67-year-old adult in Togo.

Case report

A 67-year-old farmer was seen in the emergency room for a painful right inguinoscrotal swelling. The diagnosis of strangulated right inguinoscrotal hernia was retained and a surgical indication was given. Intraoperatively, a Meckel's diverticulum was found in the hernia sac and an intraoperative diagnosis of Littre's hernia was made. The patient underwent a T-shaped resection with terminal ileo-ileal anastomosis. The postoperative course was simple.

Conclusion

Littré's hernia is a rare and exceptional disease whose preoperative diagnosis is difficult. Surgery is the therapeutic modality for this condition.

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Meckel's diverticulum is rare but is the most common malformation of the digestive tract.

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Littré's hernia is an exceptional form of Meckel's diverticulum.

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Diagnosis is difficult preoperatively.

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Management is surgical.

Haemorrhagic rupture of hepatocellular carcinoma: Management of a case in a resource-constrained hospital in TOGO

INTRODUCTION

Hepatocellular carcinoma (HCC) is the major malignant tumour of the liver. Its rupture is a serious and fatal complication. Its diagnosis and management are a major challenge in sub-Saharan Africa. The peri-hepatic packing: the only alternative for the management of hepatic tumour ruptures in resource-constrained hospitals.

CASE REPORT

We are reporting the case of a 45 years old man, carrier of viral hepatitis B and poorly followed up, who presented a sudden picture of hemodynamic instability. A laparotomy allowed finding a hepatic tumour rupture. He benefited from a damage control by peri hepatic packing.

CONCLUSION

Peri hepatic packing is a major solution in the management of ruptured liver tumour in Africa.