Difficultés et Défis de la Prise en Charge de la Hernie Diaphragmatique Congénitale à Madagascar

Content Provider	Semantic Scholar
Author	Razafimanjato, Narindra Njarasoa Mihaja Ralijaona, Herilala S. Randrianambinina, Fanomezantsoa Hanitrala, Jean Louis Rakotovao Hunald, F. A.
Copyright Year	2017
Abstract	Objectifs. Le pronostic de la hernie diaphragmatique congenitale (HDC) est severe, avec un taux de mortalite neonatale de 30 a 60%. Notre objectif etait de decrire le profil clinique des patients porteurs d’une HDC et de discuter les resultats des modalites therapeutiques en milieu defavorise. Patients et methodes. Il s’agit d’une etude retrospective descriptive durant une periode de 3 ans, allant de janvier 2008 a decembre 2011 au sein du CHU/JRA a Madagascar. Sept dossiers d’enfants porteurs d’une hernie diaphragmatique ont ete colliges durant cette periode dont cinq hernies de Bochdalek et deux hernies de Larrey-Morgagni. Les parametres analyses etaient les donnees cliniques et radiologiques, les modalites therapeutiques et l’evolution apres traitement. Resultats. L’âge median des sept enfants (cinq garcons et deux filles) etait de 14,71 mois. Aucun diagnostic antenatal n’a ete pose. Le diagnostic clinique a ete suggere par la presence d’un syndrome de detresse respiratoire chez six enfants et de signes digestifs chez un patient. La radiographie thoraco-abdominale avec sonde nasogastrique en place a retrouve des signes directs chez six enfants et indirects chez quatre enfants. L’opacification digestive et le scanner ont ete utilises chez deux enfants pour confirmer le diagnostic et faire un bilan anatomique precis. Il y avait cinq cas de hernie de Bochdalek et deux cas de hernie de Larrey-Morgagni. Une chirurgie conventionnelle a ete effectuee chez cinq enfants. Quatre nouveau-nes sont decedes dont deux en preoperatoire et deux autres en postoperatoire dont un a cause d’une infection nosocomiale. Conclusion. La HDC est une malformation congenitale severe, de prise en charge difficile. Le taux de mortalite en est eleve dont la moitie des cas en periode postoperatoire, justifiant la mise en place de protocoles therapeutiques et l’organisation d’un suivi multidisciplinaire. ABSTRACT Aim. The prognosis congenital diaphragmatic hernia (CDH) is often severe, with neonatal mortality rate between 30 to 60%. The goal of the study was to describe the clinical profile of children with CDH and discuss the results of treatment modalities in underdeveloped countries. Patients and methods. This retrospective study of seven cases of congenital diaphragmatic hernia that were managed at the pediatric surgery unit and surgical intensive care unit of the University Teaching Hospital of JRA was carried out between January 2005 and December 2010. Collected and analyzed data included clinical and radiological features, treatment modalities and postoperative issues. Results. The seven patients (five boys and two girls) were aged one day to six years (mean age: 14.7 months). Clinical manifestations were mainly respiratory and digestive. Chest X rays was the main tool to establish the diagnosis. Digestive opacification and CT were used to confirm the diagnosis and obtain precise anatomical features for two children. There were five cases of Bochdalek hernia and two cases of Larrey-Morgagni hernia. The main treatment was curative laparotomy and no early postoperative complication was recorded. Four children died. All of them were newborn, and two of them died before surgery. One postoperative death was secondary to nosocomial infection. One child had a relapse seven months after the first intervention and was re operated with placement of a synthetic graft. Conclusion. CDH is a severe congenital malformation with a high mortality rate. This justifies the development of therapeutic protocols adapted and implemented by multidisciplinary teams.
File Format	PDF HTM / HTML
Volume Number	18
Alternate Webpage(s)	http://www.hsd-fmsb.org/index.php/hsd/article/download/764/pdf_403
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article