Diagnostic and therapeutic approach to abdominal masses in a country with limited resources

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Materials and methods: This were a retro-prospective and preliminary study of 2 years 3 months on patients operated for abdominal mass in the general surgery department of the RGH. Palpable mass and/or imaging size (40 mm) were the criteria for inclusion. Results: Abdominal masses accounted for 6.7% (n=53) of other pathologies. The average age of patients was 41.26 years, standard deviation 14.2 and a female predominance in 75.5% (n=40) with a sex ratio of 0.32. The abdominal mass was clinically palpable in 75.5% (n=40). The abdominal pelvic ultrasound was performed in all patients and in 75.5% (n=40) it had specified the origin of the mass. The injected abdominal-pelvic scanner, performed in 52.8% of patients (n=28) and 89.3% (n=25), had specified the pre-operative diagnosis. The most common etiologies were uterine myomas in 35.8% (n=19). In 7.5% (n=4) the diagnosis was not accurate in pre-operative despite both imaging, and these patients had benefited from an exploratory laparotomy. Surgery was the initial therapeutic gesture for all patients and coelioscopy was 22.6% (n=12). Post-operative complications were 7.5% (n=11). The death rate was 5.6% of cases (n=3). Conclusion: Imaging remains important in the etiological research of abdominal masses. The definitive treatment remains surgical; mortality would be related to the malignant nature and the large volume of the mass. Masses abdominals Imaging Coelioscopy Niamey Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Abdominal masses correspond to an increase in the volume of an organ or region of the abdomen; they include all the intra-abdominal masses and the antero lateral wall of the abdomen. It may be benign, malignant, malformative or infectious ( 1 ). Abdominal mass can be detected by a good physical exam, sometimes the discovery is incidental to an imaging exam ( 1 ). Clinical manifestations are variable depending on location, mass size, and can sometimes be asymptomatic or result in complications. Imaging, endoscopy, and biology play an important role in the diagnostic process, as well as surgery that contributes to both diagnosis and treatment ( 2 ). It is essential to distinguish between the masses to be treated immediately ( 1 ). The etiological diagnosis depends on the age of the patient and the site of the mass; nevertheless, it is always the histological examination that gives a diagnosis of certainty ( 2 , 3 ). The treatment is primarily surgical, the modalities of this surgery depend on the pathology, its extension, and its topography. What is the contribution of imaging in the diagnosis of these abdominal masses? The objective of this study is to report the experience of the Reference General Hospital (RGH) in the diagnostic and therapeutic approach of abdominal masses with limited means in the department of general and digestive surgery. Materials And Methods It was a preliminary, prospective, and retrospective, descriptive, and analytical study carried out over 2 years 3 months (January 1, 2018, to March 31, 2020) in the Department of General and Digestive Surgery of the RGH of Niamey; it is a new third level hospital opened on 26 November 2017 to serve as a reference for all other hospitals in Niger. Study population was all patients treated for abdominal mass in the ward. After the clinical exam, the ultrasound (Mindray DC 70, commissioned in 2019) was the first-line imaging exam requested, followed by the scanner (Neusoft, 16 Barrettes, commissioned in 2016) in second position if needed. Sometimes the ultrasound and the scanner were needed for the same patient. The scanner was systematically injected with contrast. MRI was not yet available in the hospital at the time of the study. This included patients of any age with a peritoneal, retroperitoneal, abdominal-pelvic, or clinically palpable abdominal wall mass, and a height greater than or equal to 40 mm at imaging; patients treated in emergency or scheduled surgery. The parameters studied were epidemiological, clinical, para-clinical, diagnostic, therapeutic and evolutionary aspects. Results Abdominal masses accounted for 6.7% (n=53) among 790 patients treated in the General and Digestive Surgery department at the same time. The female sex was predominant with 75.5% (n=40) giving a sex ratio of 0.32. The average age was 41.8 years 14.2 with extremes of 10 and 69 years. The 30-45 age group was the most represented with 41.5% (n=22). Patients with a body mass index (BMI) greater than 25 kg/m² accounted for 17% (n=9). Abdominal pain was the reason for consultation reported by 84.9% of patients (n=45). The mass was clinically palpable in 77.3% of patients (n=40) and the exclusively pelvic location accounted for 32% (n=17). The mass was hard and irregular in 47.5% of cases (n=19), deep-seated in 60% (n=24) and sensitive in 62.5% of patients (n=25). The abdominal-pelvic ultrasound was performed in all patients and in 75.5% (n=40) she had specified the origin of the mass by giving a contributory diagnosis that was confirmed in surgery. It allowed guided puncture in 4 cases (7.5%). The injected abdominal-pelvic scanner, performed in 52.8% of patients (n=28); it was contributory, and the diagnosis was per operative in 89.3% (n=25). In these images, solid masses were most common in 70% of cases (n=37), followed by cystic masses in 26.3% of cases (n=14) and mixed masses in 3.7% of cases (n=2). Retroperitoneal masses represented 13.2% (n=7) and abdominal pelvic 86.8% (n=46). The most represented pre-operative diagnoses were uterine myomas in 35.8% (n=19), ovarian cyst in 11.3% (n=6), ovarian tumors in 9.4% (n=5). Ultrasound was more accurate, and the diagnosis was consistent pre-operative in uterine myomas, ovarian cysts and renal and adrenal tumors, splenomegaly, hydronephrosis; On the other hand, the diagnosis was less accurate in the cases of tumor of the pancreas tail, gastric tumor, caecum (shown in blue in Table 1 ) and these diagnoses were made by the injected abdominal pelvic scanner in the second position. It was necessary to pair this ultrasound with the scanner in 47.17% (n=25). The two images combined, the origin of the mass was not well specified in 10.71% (n=3) and an exploratory laparotomy was indicated ( Table 2 ): the first case involved a 32-year-old nulligest patient with a pelvic abdominal mass. An injected pelvic abdominal CT scan was performed ( figure 1 ) after non-contributory ultrasound, and the diagnosis was unlikely between an ovarian tumor or a uterine tumor. Per operative, it was a polymyomated uterus necrobiosis with calcifications occupying the entire abdominal pelvic cavity. A total hysterectomy with unilateral annexectomy was performed ( figure 2 ). The second case involved a 12-year-old child with a pelvic mass ( figure 3A ). The injected abdominal pelvic scanner showed a pelvic budding mass with fluid tissue content ( figure 3B ) with urinary tract compression resulting in bilateral hydronephrosis uretero ( figure 3C ). An exploratory laparotomy was performed ( figure 4A ) and a complete resection of the tumor was performed ( figure 4B ) complicated by a tumor break-in (blue circle) and a left ureteral invasion (resected and re-installed to the bladder on a JJ probe); The operative part of the ureter resected ( figure 4B , orange arrow). Histological examination of the operating room confirmed intra-abdominal soft tissue sarcoma resection “R1”. The third 58-year-old patient had an abdominal mass (figure 5A ), and an injected abdominal CT was performed, suggesting a mesenteric mass ( figures 5 B and C ). The per operative diagnosis was a non rececable abdominal tumor with peritoneal carcinosis, a biopsy was performed confirming an ovarian carcinomatous tumor with peritoneal carcinosis. In addition to the etiological diagnosis, the scanner was performed for an extension assessment for digestive tumors such as colorectal, gastric, adrenal, kidney, and pancreatic tumors. Neoadjuvant chemotherapy was performed in 23.1% of patients (n=3). Each case involved left kidney tumour, pancreatic head tumor and right colon tumor. General anesthesia was performed in 96.2% of patients (n=51). The first route was laparotomy in 69.8% of cases (n=37), laparoscopy ( Table 3 ) in 22.6% of cases (n=12) and lombotomy in 7.6% (n=4). The most performed surgical procedures were myomectomy, hysterectomy and annexectomy in 22.6%, 18.9% and 17% of cases, respectively. The average length of hospital stay was 9.5 4.3 days with extremes of 3 and 21 days. For laparoscopic patients, the average hospitalization time was 2.3 days. Adjuvant chemotherapy was performed in 9.4% of patients (n=5). These were two cases of gastric tumor, two cases of right colon tumor and soft tissue sarcoma. Histological nature was known in 56.6% of patients (n=30), uterine leiomyoma is reported in 20.7% of cases (n=11). The complication rate was 20.7% (n=11) of which 7.5% (n=4) classified grade III b according to Clavien-Dindo (2 cases of collection under phrenic, one case each of peri pancreatic and right sub-phrenic collection) all re-operated. The mortality rate was 5.6% (n=3), Clavien-Dindo V, it was a case of tumor of the right colon died after the 5th course of adjuvant chemotherapy, a case of dead pancreatic head tumor in a table of liver metastasis and sarcoma of intra-abdominal soft tissue died after local recurrence and lung extension. Discussion Abdominal masses are a reason for frequent consultation in surgery. They hide behind several diseases, both benign and malignant. We report a study on abdominal masses, regardless of the etiology and age group in a new hospital, of reference in Niger, which has not fully completed the installation of its imaging devices. We reported a frequency of 6.7% abdominal mass among all the overall activities of the HGR digestive surgery department during the study period. Our results are higher than those reported by Okoko A-R. et al ( 4 ) in Brazzaville in 2012 who had worked only on children, with 1.3%. We note a female predominance with 75.5% and a sex ratio at 0.32. This female predominance was reported by Akkoca M. et al ( 5 ) in Turkey in 2017 (60%), Mahamoud G. et al ( 6 ) in Morocco in 2010 (54.1%). The average age of our patients was 41.8 years 14.2 with extremes of 10 and 69 years; very few studies had been reported on all ages like ours; Children’s studies are generally found in the literature ( 7 ); The prevalence of abdominal masses by age was little discussed. But classically, abdominal masses of neoplastic origin are rare in the first year of life, but very common between the ages of 1 and 6 ( 4 ). Abdominal pain was the main indicator in most of our patients (84.9%). Lower rates were found by Akkoca M and al, and Mahamoud G and al., respectively 61%, 57.5% of cases ( 5 , 6 ). In the older patient, the primary mode of abdominal mass disclosure is incidental discovery by a parent ( 7 ). In our study, the physical examination found palpable abdominal mass in 77.3% of cases, although 17% of patients were obese. The consistency of the mass was hard and irregular in 47.5% of cases, painful sensitivity in 62.5% of cases, and the mass was fixed relative to the deep plane in 60% of cases. Akkoca M. et al ( 5 ) in a series of 43 cases in Turkey in 2017 had recovered abdominal mass on physical examination in 62.2% of cases. This difference in frequency could be justified because our study focused only on large abdominal masses, therefore accessible for examination. Abdominal pelvic ultrasound is currently the reference technique for abdominal mass diagnosis. It allows the topographical diagnosis of the mass, to attach it to an organ, to determine with precision the tumor volume, and to define its solid or liquid character ( 8 ). In an American journal of the literature published in 2019, the authors stated that 88–91% of the ultrasound was accurate in determining the original organ and 77–81% in diagnosing the underlying pathology ( 9 ). In our study, ultrasound was performed in 100% of cases. It specified the location of the mass and the original organ in 75.47% of cases (uterine myomas, ovarian cyst, renal tumors, etc.) and contributed to the realization of ultrasound biopsy punctures in 4 cases. Our results are similar to those of Kathryn J.F et al ( 9 ) in the USA in 2019 who reported ultrasound achievement rates in 100% of their series. In case of clinical suspicion of abdominal mass, the ultrasound requested in 1st intension is justified (strong professional agreement), and it is a first-line examination requested in the literature, it is less expensive, non-invasive and very well supported by the patient ( 8 ). However, its performance may decrease because it is an operator-dependent examination, in addition to in the context of abdominal emergencies, the sensitivity of the ultrasound is often much lower than that of the scanner which will be preferred in most indications ( 10 ). On the other hand, as one author pointed out, “the effectiveness of the ultrasound depends on the relevance of the application” ( 2 ) means that the better the clinical information on the application is reported, the better it is to guide the operator. Abdominal CT is the key examination of abdominal mass balance. It brings valuable elements in the localization by anatomical compartments, organ localization, characterization and evaluation of the extension of these masses ( 2 ). Over the past 15 years, it has undergone a rapid technological evolution, moving from sequential to spiral, mono- and multidetector modes. This evolution currently allows to investigate an abdomen in a few seconds with a spatial resolution less than 1 mm allowing routinely multiplanar reconstructions of quality equal to the initial scans ( 10 ). In our series, CT was performed in 52.8% of cases. It had contributed to the etiological diagnosis in 89.29% of cases. Our results are lower than those found by Akkoca M. and al ( 5 ) in Turkey in 2017 which had reported 62.2%. The low achievement of the scanner compared to the ultrasound could be explained by the high cost of this examination, especially in our context where most patients do not have social security and by the fact that it is not indicated in first intention, especially in young patients because of its irradiance (often need injection of iodized contrast agent). The etiologies of the abdominal masses were diverse, we had reported three cases where the scanner could not establish a diagnosis of pre-operative abdominal mass. The etiologies of the abdominal masses were diverse, we had reported three cases where the scanner could not establish a diagnosis of pre-operative abdominal mass. The diagnosis of this intra-abdominal soft tissue sarcoma could not be established pre-operative by CT in our study. MRI remains the reference exam for the local Soft Tissue Sarcoma because it has excellent tissue contrast ( 11 ). The tumor was compressing both ureters and the possibility of a neoadjuvant treatment such as radiotherapy in Niger was almost impossible at a time when the country did not have it. It was necessary to request a medical evacuation outside that would have lasted several months. Exploratory laparotomy was indicated and R0 resection could not be obtained due to tumor invasion of the left ureter. Despite the adjuvant chemotherapy, the recurrence had been very rapid and overwhelming. The 2nd case involved a tumour occupying the entire abdominal cavity, and it is reported that the scanner is ineffective in determining the origin of the organ in these cases of giant tumor of the abdomen (interest of multiplanar reconstruction) ( 2 ). And per operation, it was a large poly myomatous uterus and necropolis. The last case concerned a suspicion of a mesenteric tumor at the injected scanner and the discovery of a peritoneal carcinosis from an ovarian tumor per operative was accidental. Diagnosis of peritoneal carcinosis is easy in diffuse and macronodular forms with ascites. Rough shapes are difficult to diagnose. Imaging peritoneal carcinoses ( 12 ) remains first and foremost a technical challenge in radiology: because it requires high spatial resolution (especially in small lesions) and high contrast resolution (nodules have low spontaneous contrast with no significant enhancement) and finally there is a minimization of motion artifacts due to the contact of the handles that are moving. Secondly, it is a radiological challenge because peritoneal carcinoses have low reproducibility, and most are seen only in surgery. However, the scanner is still the reference tool, but it has limited sensitivity per organ site, especially at the pelvic level ( 13 ). The FDG-PET scan and/or diffusion MRI is recommended ( 12 ). However, our hospital did not have an MRI at the time of the study and the entire country does not have a Pet scan. In our study, we found a more significant frequency of uterine myomas (35.8%), followed by ovarian cysts in 11.3% of cases and ovarian tumors in 9.7% of cases. This may be related to the female predominance (75.5%) and young age (41 years of average age) of our study population. As reported by most authors, uterine myomas and ovarian cysts represent the main etiologies of abdominal-pelvic masses in black women during genital activity and pre-menopausal period ( 13 , 14 ). The choice of therapeutic approach depends on the histological type, mass extension and age of the patient ( 15 ). For our patients, two methods of treatment have been used: chemotherapy and surgery, radiation therapy not yet available in Niger. These methods were in some cases well-suited and in others adapted to the work context. Surgery was the main therapeutic remedy (100%). We reported an exceptional case of total hysterectomy in a 32-year-old nulligeste patient with a large uterine myoma in necropsy and having occupied almost the entire abdominal cavity. He was responsible for severe anemia with vomiting (by gastric compression). The hysterectomy piece (retaining an ovary), measured 29mmx23m height. n our series, the evolution was favorable for the majority of patients. Nevertheless, a 5.6% mortality rate was reported for all abdominal masses. All deceased patients had malignant tumours. Most of these patients had consulted at an advanced stage of their illnesses. Our results are superior to those found by Akkoca M and al ( 5 ) which reported a mortality rate of 4.4%. Conclusion Abdominal masses occupy an important place in the activity of the general and digestive surgery department of the HGR. Imaging plays an important role in the research and etiological orientation of abdominal masses. It made it possible to make the pre-operative diagnosis in the majority of cases. Ultrasound was the first-line examination of choice, followed by CT. Surgery sometimes remains our only diagnostic and therapeutic option by default of a more efficient technical platform. The evolution seems favorable in most cases, nevertheless, the mortality would be related not to the diagnostic defect, but to the malignant nature, the extension of the disease and the large volume of the mass. Abbreviations RGH : Reference General Hospital, BMI : body mass index, MRI : Magnetic resonance imaging, CT scan : computerized tomography scan , FDG-PET : F-fluorodeoxyglucose-positron emission tomography. Declarations Acknowledgements : Not applicable Author contributions: SA (study design, manuscript writing); MLAAB, ZOA , BID, KI, YH, JDL , SR : All authors had participated in the writing of the manuscript and its critical revision and had all read and approved its final version. Funding : None Availability of data and materials : All data generated or analysed during this study are included in this article. Ethics approval and consent to participate : This study was conducted in accordance with the Helsinki Declaration and with the approval of the Ethics Committee of the General Reference Hospital of Niamey (Department of Surgery, General Surgery Service) ; Being a retrospective study reporting anonymous and depersonalized data, the need for informed consent is deemed unnecessary by the ethics committee (Department of Surgery, HGR Niamey, Niger). Consent for publication : Not applicable Conflict of interest declaration : The authors state that they have no conflict of interest. Author details :1 Reference General Hospital, Department of Surgery and Surgical Specialties, BP 12674, Niamey. 2 Reference General Hospital BP 12674 Niamey, a: Department of Pathology and Anatomy, b. Radiology and Medical Imaging Department. 3National Hospital BP 238 Niamey, Niger. 4Amirou Boubacar Diallo Hospital BP 10146 Niamey, Niger. c Faculté des Sciences de la santé, Université Abdou Moumouni, BP : 10896 Niamey Niger. References American College of Surgeons ACS. Surgery Principal and Practice. Abdominal masses, p 488–500, 2012. HANAFI I, IVAN I, PALOT J-P DEJUGNATL, et al. Adult abdominal masses: how to arrive at the diagnosis. J de Radiol Reims. 2004;85(9):P1505. DUYCKAERTS C, FOURET P, HAUW JJ. Anatomy-pathology. Pierre and Marie Curie University, January 2003. available on http:www.chups.jussieu.fr/polys/anapath/Cours/anapath.pdf . OKOKO A-R, EKOUYA BOWASSA G, OKO A-P-G, MBIKA-CARDORELLE A. Epidemiology of palpable abdominal masses in children in Brazzaville Archives de Pédiatrie 2012; 19:878–9. AKKOCA M, TOKGOZ S, YILMAZ BK, AKINCI M, et al. Diagnosis and treatment approaches for intraabdominal masses in adults. Ankara Universities Tip Fakultesi Mesmuasi Turquie. 2017;70(3). 10.1501/Tıpfak_000000987 . MAHAMOUD G, AFIFI R, ESSAID A, et al. Ultrasound biopsy puncture guided in abdominal mass diagnosis about 523 cases. J Afr Hepato Gastroenterol. 2010;4:220–4. NICHOLAS M, POTISEK AND JAMES W. Abdominal Masses. Antoon Pediatr Rev. 2017;38(2):10–03. Good Use Guide of medical imaging tests. Recommendations for health professionals Transposition of European Directive 97/43 Euratom French Society of Radiology, French Society of Biophysics and Nuclear Medicine, 1st edition – 2005; P 102. KATHRYN, J-F, EVELYN M-G, DAVID H-K, et al. Palpable abdominal mass- suspected neoplasm. Appropriateness Criteria. J Am Coll Radiol. 2019;16:384–S391. HAINAUX B, BORENS-FEFER B. Imaging of adult abdominal emergencies, Radiology of acute abdominal pain in adult patients Services de Radiologie, 1C.H.U. Saint- Pierre. Rev Med Brux. 2010;31(4):209–440. CROMBÉ A, BUY X. KIND M. Imaging of soft tissue sarcomas. The Cancer Expert’s Letter 2018; 27 (9). DE BREE E, KOOPS W, VAN RUTH S KRGERR. Peritoneal carcinomatosis from colorectal or appendiceal origin: Correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg oncol. 2004;1(2):64–73. JACQUET P, JELINEK J S, STEVES M A, SUGARBAKER P H. Evaluation of computed tomography in patients with peritoneal carcinomatosis. Cancer. 1993;1(5):1631–6. LANSAC J. MARRET H. Uterine myomas. Gynecology for the practitioner, 9th edition, Paris Elsevier Masson 2018, 65–82. KOUAME N, BAKARY YN, MANEWA FS et al. Abdominal-pelvic masses in geriatric: a report on 2 cases explored at CT. Int J Radiol Radiat Oncol 2: 001–003. 10.17352/ ijrro.000009, 2640–7566. Tables Table 1: Ultrasound Evoked Pre-Operative Diagnostics Échographie Localization Diagnosis Effective Percentage% Intra péritonéale Retro péritonéale Uterine myomas 18 33,9 Ovarian cyst 6 11,3 Ovarian tumor 5 9,4 Ovarian tumor ? 1 1,9 Tropical spleen 1 1,9 Liver abscess 4 7,5 Right colon tumor 4 7,5 Gastric tumor 2 3,8 Caecum tumor 1 1,9 Appendicular abscess 1 1,9 Mesenteric cyst 1 1,9 Mesenteric tumor 1 1,9 Pelvic tumor 1 1,9 Kidney tumor 3 5,7 Pancreatic tail cyst 2 3,8 Left hydronephrosis 1 1,9 Left adrenal tumor 1 1,9 Total 53 100 Table 2: Patients in whom the ultrasound coupled to the scanner, the diagnosis was not accurate. Diagnosis Imageries Radiological diagnostics Per-operative diagnostics Context or review allowed diagnosis Ultrasound + CT Ovarian tumor? uterine? Géant myome utérin per operative, histology Pelvic tumor ? Pelvic mass Histology: Sarcoma tissue Soft tissue Is that a mesenteric tumor? Abdominal tumor + Peritoneal carcinosis Histology : Ovarian carcinoma Table 3: Indications of laparoscopy Laparoscopic indication Laparoscopic gestures Effective Percentage % Liver abscess Drainage, washing 3 25 Mesenteric cyst Resection 2 16,6 Bilateral ovary cysts Resection 2 16,6 Right ovarian tumor Right ovariectomy 1 8,3 Right colon tumor Right hemicolectomy 1 8,3 Appendicular abscess Appendectomy, washing 1 8,3 Pancreatic cyst Drainage 1 8,3 Adrenal tumor Adrenalectomy 1 8,3 Total 12 100 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Mar, 2024 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 27 Jan, 2024 Reviews received at journal 16 Jan, 2024 Reviewers agreed at journal 16 Jan, 2024 Reviewers agreed at journal 11 Jan, 2024 Reviewers agreed at journal 09 Nov, 2023 Reviewers agreed at journal 01 Oct, 2023 Reviewers invited by journal 25 Sep, 2023 Editor assigned by journal 25 Sep, 2023 Editor invited by journal 24 Sep, 2023 Submission checks completed at journal 24 Sep, 2023 First submitted to journal 06 Sep, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3332539","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":235596531,"identity":"554038fa-63dc-43df-8d8e-8780e2385a6a","order_by":0,"name":"Saïdou Adama","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYFACxgYJMH2A+eCDD0CajZ14LWzJhjNAWpiJsAeqhcdMmAfEIKRFvv1w442PbQzyfMcbzJhtfm2T52NmYPzwMQe3FoMzic2WM9sYDGeeOZD2OLfvtmEbMwOz5MxteLQwJLZJ87YxMG64kXDcOLfnNiNQCxszLx4t8v0PwVrsN9wHMix7btsT1MJwA2JL4oYbzGzSDD9uJxLUYnDjYbPljHMSyTPPpDEb9jbcTm5jZmzG6xf5/vSHNz6U2dj2HT//8cGPP7dt57c3H/zwEZ/DIAASNQyMbWCygaB6JPCHFMWjYBSMglEwUgAAai9UGXzw9AYAAAAASUVORK5CYII=","orcid":"","institution":"Reference General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Saïdou","middleName":"","lastName":"Adama","suffix":""},{"id":235596532,"identity":"89cbd3c4-2d71-4da9-a078-e6c28d4dd0b8","order_by":1,"name":"Mohamed Lamine Abani Aïchatou Balaraba","email":"","orcid":"","institution":"Reference General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Lamine Abani Aïchatou","lastName":"Balaraba","suffix":""},{"id":235596533,"identity":"25903e2d-744a-4b2b-a521-03c0881be993","order_by":2,"name":"Zabeirou Oudou Aliou","email":"","orcid":"","institution":"Reference General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zabeirou","middleName":"Oudou","lastName":"Aliou","suffix":""},{"id":235596534,"identity":"df3b0ddd-1e35-415c-8f89-1aabc73cfbf9","order_by":3,"name":"Bako Inoussa Daouda","email":"","orcid":"","institution":"Reference General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bako","middleName":"Inoussa","lastName":"Daouda","suffix":""},{"id":235596535,"identity":"74c651f4-862a-4a28-afdf-d9ea71b18d47","order_by":4,"name":"Ide Kadi","email":"","orcid":"","institution":"National Hospital BP 238 Niamey","correspondingAuthor":false,"prefix":"","firstName":"Ide","middleName":"","lastName":"Kadi","suffix":""},{"id":235596536,"identity":"981072dd-e777-4abc-8807-9b22b58a8cac","order_by":5,"name":"Younssa Hama","email":"","orcid":"","institution":"Amirou Boubacar Diallo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Younssa","middleName":"","lastName":"Hama","suffix":""},{"id":235596537,"identity":"7d6afa42-53bf-4f6c-99a9-e41c9061c1cb","order_by":6,"name":"James Didier Lassey","email":"","orcid":"","institution":"Reference General Hospital","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"Didier","lastName":"Lassey","suffix":""},{"id":235596538,"identity":"77808be7-cd03-49fe-b081-c95ec1a5afdb","order_by":7,"name":"Rachid SANI","email":"","orcid":"","institution":"National Hospital BP 238 Niamey","correspondingAuthor":false,"prefix":"","firstName":"Rachid","middleName":"","lastName":"SANI","suffix":""}],"badges":[],"createdAt":"2023-09-06 22:44:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3332539/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3332539/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-024-02371-w","type":"published","date":"2024-03-23T15:03:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":43914133,"identity":"920054e6-cb35-43ea-87f8-d513b97c74bc","added_by":"auto","created_at":"2023-09-29 22:44:42","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22483,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCT abdomino pelvis injected with a large mass abdominal cavity:\u003c/strong\u003efrontal section (\u003cstrong\u003eA)\u003c/strong\u003e Poly nodular fluid tissue mixed tumor process occupying virtually the entire abdominal cavity, with thick and even wall taking contrast; a calcified tissue nodule (red arrow). The measurements were 210,64x172,69x229 mm (\u003cstrong\u003eB\u003c/strong\u003e) axial section: The lesion exerts a mass effect on the urinary tract and the bladder giving a right hydronephrosis uretero, pyelic diameter 18, 89 mm (blue arrow).\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3332539/v1/e1b1a3eb5eb59d6de0510b48.jpeg"},{"id":43914135,"identity":"f32650bf-392c-4996-9f7c-7f5088a26596","added_by":"auto","created_at":"2023-09-29 22:44:42","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":10057,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOperative part of figure 1\u003c/strong\u003e: total hysterectomy part and unilateral annexectomy.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3332539/v1/51362d43dcfd4cdfbd0a642f.jpg"},{"id":43914618,"identity":"6824cc4a-ad53-4e99-8596-62a2fff34146","added_by":"auto","created_at":"2023-09-29 22:52:42","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":40436,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePelvic mass in a 12-year-old child\u003c/strong\u003e \u003cstrong\u003e(A\u003c/strong\u003e): represented by the axial slice CT image \u003cstrong\u003e(B\u003c/strong\u003e) of an irregular pelvic mass with tissue and fluid content, resulting in a bilateral compression hydronephrosis uretero (\u003cstrong\u003eC\u003c/strong\u003e blue fleches).\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3332539/v1/39b62e21e51d0e0f980a64ae.jpg"},{"id":43914132,"identity":"1085bd29-9d45-4b6a-bc90-f7163160e550","added_by":"auto","created_at":"2023-09-29 22:44:42","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":29876,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePer operative images of young 12-year-old patient:\u003c/strong\u003e Per-operative view of a pelvic mass in a 12-year-old child (\u003cstrong\u003eA\u003c/strong\u003e); A residual resection “R1” by tumor break-in and left ureteral invasion. Secondary ureteral resection (\u003cstrong\u003eB\u003c/strong\u003e) and bladder re-installation was performed.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3332539/v1/1131718bc3f4a1dbe6b3ab72.jpg"},{"id":43914136,"identity":"9165d224-5309-4622-8c4d-26ef08f1cc8b","added_by":"auto","created_at":"2023-09-29 22:44:42","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":45942,"visible":true,"origin":"","legend":"\u003cp\u003ePelvic mass installation (\u003cstrong\u003eA\u003c/strong\u003e) in a 58-year-old patient; axial section of an irregular pelvic mass with fluid tissue content (\u003cstrong\u003eB\u003c/strong\u003e), sagittal section, it goes up in contact with the mesenteric tumor \u003cstrong\u003e(C\u003c/strong\u003e)?\u003c/p\u003e","description":"","filename":"Figure5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3332539/v1/d55b0ae61ac5669d67171d09.jpeg"},{"id":53403759,"identity":"e681d118-987c-4c2b-a1d1-830f6ebe6ce1","added_by":"auto","created_at":"2024-03-25 15:14:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":508873,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3332539/v1/71dfc517-adb2-4ff7-9983-83bedf59e606.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic and therapeutic approach to abdominal masses in a country with limited resources","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAbdominal masses correspond to an increase in the volume of an organ or region of the abdomen; they include all the intra-abdominal masses and the antero lateral wall of the abdomen. It may be benign, malignant, malformative or infectious (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Abdominal mass can be detected by a good physical exam, sometimes the discovery is incidental to an imaging exam (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Clinical manifestations are variable depending on location, mass size, and can sometimes be asymptomatic or result in complications. Imaging, endoscopy, and biology play an important role in the diagnostic process, as well as surgery that contributes to both diagnosis and treatment (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is essential to distinguish between the masses to be treated immediately (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The etiological diagnosis depends on the age of the patient and the site of the mass; nevertheless, it is always the histological examination that gives a diagnosis of certainty (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The treatment is primarily surgical, the modalities of this surgery depend on the pathology, its extension, and its topography. What is the contribution of imaging in the diagnosis of these abdominal masses? The objective of this study is to report the experience of the Reference General Hospital (RGH) in the diagnostic and therapeutic approach of abdominal masses with limited means in the department of general and digestive surgery.\u003c/p\u003e "},{"header":"Materials And Methods","content":"\u003cp\u003eIt was a preliminary, prospective, and retrospective, descriptive, and analytical study carried out over 2 years 3 months (January 1, 2018, to March 31, 2020) in the Department of General and Digestive Surgery of the RGH of Niamey; it is a new third level hospital opened on 26 November 2017 to serve as a reference for all other hospitals in Niger. Study population was all patients treated for abdominal mass in the ward. After the clinical exam, the ultrasound (Mindray DC 70, commissioned in 2019) was the first-line imaging exam requested, followed by the scanner (Neusoft, 16 Barrettes, commissioned in 2016) in second position if needed. Sometimes the ultrasound and the scanner were needed for the same patient. The scanner was systematically injected with contrast. MRI was not yet available in the hospital at the time of the study. This included patients of any age with a peritoneal, retroperitoneal, abdominal-pelvic, or clinically palpable abdominal wall mass, and a height greater than or equal to 40 mm at imaging; patients treated in emergency or scheduled surgery. The parameters studied were epidemiological, clinical, para-clinical, diagnostic, therapeutic and evolutionary aspects.\u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003eAbdominal masses accounted for 6.7% (n=53) among 790 patients treated in the General and Digestive Surgery department at the same time. The female sex was predominant with 75.5% (n=40) giving a sex ratio of 0.32. The average age was 41.8 years 14.2 with extremes of 10 and 69 years. The 30-45 age group was the most represented with 41.5% (n=22).\u0026nbsp;Patients with a body mass index (BMI) greater than 25 kg/m\u0026sup2; accounted for 17% (n=9).\u0026nbsp;Abdominal pain was the reason for consultation reported by 84.9% of patients (n=45). The mass was clinically palpable in 77.3% of patients (n=40) and the exclusively pelvic location accounted for 32% (n=17). The mass was hard and irregular in 47.5% of cases (n=19), deep-seated in 60% (n=24) and sensitive in 62.5% of patients (n=25). The abdominal-pelvic ultrasound was performed in all patients and in 75.5% (n=40) she had specified the origin of the mass by giving a contributory diagnosis that was confirmed in surgery. It allowed guided puncture in 4 cases (7.5%). The injected abdominal-pelvic scanner, performed in 52.8% of patients (n=28); it was contributory, and the diagnosis was per operative in 89.3% (n=25). In these images, solid masses were most common in 70% of cases (n=37), followed by cystic masses in 26.3% of cases (n=14) and mixed masses in 3.7% of cases (n=2). Retroperitoneal masses represented 13.2% (n=7) and abdominal pelvic 86.8% (n=46).\u003c/p\u003e\n\u003cp\u003eThe most represented pre-operative diagnoses were uterine myomas in 35.8% (n=19), ovarian cyst in 11.3% (n=6), ovarian tumors in 9.4% (n=5). Ultrasound was more accurate, and the diagnosis was consistent pre-operative in uterine myomas, ovarian cysts and renal and adrenal tumors, splenomegaly, hydronephrosis; On the other hand, the diagnosis was less accurate in the cases of tumor of the pancreas tail, gastric tumor, caecum (shown in blue in \u003cstrong\u003eTable 1\u003c/strong\u003e) and these diagnoses were made by the injected abdominal pelvic scanner in the second position. \u0026nbsp; It was necessary to pair this ultrasound with the scanner in 47.17% (n=25). The two images combined, the origin of the mass was not well specified in 10.71% (n=3) and an exploratory laparotomy was indicated (\u003cstrong\u003eTable 2\u003c/strong\u003e): the first case involved a 32-year-old nulligest patient with a pelvic abdominal mass. An injected pelvic abdominal CT scan was performed (\u003cstrong\u003efigure 1\u003c/strong\u003e) after non-contributory ultrasound, and the diagnosis was unlikely between an ovarian tumor or a uterine tumor. Per operative, it was a polymyomated uterus necrobiosis with calcifications occupying the entire abdominal pelvic cavity. \u0026nbsp;A total hysterectomy with unilateral annexectomy was performed (\u003cstrong\u003efigure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe second case involved a 12-year-old child with a pelvic mass (\u003cstrong\u003efigure 3A\u003c/strong\u003e). The injected abdominal pelvic scanner showed a pelvic budding mass with fluid tissue content (\u003cstrong\u003efigure 3B\u003c/strong\u003e) with urinary tract compression resulting in bilateral hydronephrosis uretero (\u003cstrong\u003efigure 3C\u003c/strong\u003e). An exploratory laparotomy was performed (\u003cstrong\u003efigure\u003c/strong\u003e \u003cstrong\u003e4A\u003c/strong\u003e) and a complete resection of the tumor was performed (\u003cstrong\u003efigure 4B\u003c/strong\u003e) complicated by a tumor break-in (blue circle) and a left ureteral invasion (resected and re-installed to the bladder on a JJ probe); The operative part of the ureter resected (\u003cstrong\u003efigure\u003c/strong\u003e \u003cstrong\u003e4B\u003c/strong\u003e, orange arrow). Histological examination of the operating room confirmed intra-abdominal soft tissue sarcoma resection \u0026ldquo;R1\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe third 58-year-old patient had an abdominal mass \u003cstrong\u003e(figure 5A\u003c/strong\u003e), and an injected abdominal CT was performed, suggesting a mesenteric mass (\u003cstrong\u003efigures 5 B and C\u003c/strong\u003e). The per operative diagnosis was a non rececable abdominal tumor with peritoneal carcinosis, a biopsy was performed confirming an ovarian carcinomatous tumor with peritoneal carcinosis.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition to the etiological diagnosis, the scanner was performed for an extension assessment for digestive tumors such as colorectal, gastric, adrenal, kidney, and pancreatic tumors. Neoadjuvant chemotherapy was performed in 23.1% of patients (n=3). Each case involved left kidney tumour, pancreatic head tumor and right colon tumor. General anesthesia was performed in 96.2% of patients (n=51). The first route was laparotomy in 69.8% of cases (n=37), laparoscopy (\u003cstrong\u003eTable 3\u003c/strong\u003e) in 22.6% of cases (n=12) and lombotomy in 7.6% (n=4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most performed surgical procedures were myomectomy, hysterectomy and annexectomy in 22.6%, 18.9% and 17% of cases, respectively.\u003c/p\u003e\n\u003cp\u003eThe average length of hospital stay was 9.5 4.3 days with extremes of 3 and 21 days. For laparoscopic patients, the average hospitalization time was 2.3 days.\u003c/p\u003e\n\u003cp\u003eAdjuvant chemotherapy was performed in 9.4% of patients (n=5). These were two cases of gastric tumor, two cases of right colon tumor and soft tissue sarcoma.\u003c/p\u003e\n\u003cp\u003eHistological nature was known in 56.6% of patients (n=30), uterine leiomyoma is reported in 20.7% of cases (n=11).\u003c/p\u003e\n\u003cp\u003eThe complication rate was 20.7% (n=11) of which 7.5% (n=4) classified grade III b according to Clavien-Dindo (2 cases of collection under phrenic, one case each of peri pancreatic and right sub-phrenic collection) all re-operated.\u003c/p\u003e\n\u003cp\u003eThe mortality rate was 5.6% (n=3), Clavien-Dindo V, it was a case of tumor of the right colon died after the 5th course of adjuvant chemotherapy, a case of dead pancreatic head tumor in a table of liver metastasis and sarcoma of intra-abdominal soft tissue died after local recurrence and lung extension.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAbdominal masses are a reason for frequent consultation in surgery. They hide behind several diseases, both benign and malignant.\u003c/p\u003e \u003cp\u003eWe report a study on abdominal masses, regardless of the etiology and age group in a new hospital, of reference in Niger, which has not fully completed the installation of its imaging devices. We reported a frequency of 6.7% abdominal mass among all the overall activities of the HGR digestive surgery department during the study period. Our results are higher than those reported by Okoko A-R. et al (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) in Brazzaville in 2012 who had worked only on children, with 1.3%. We note a female predominance with 75.5% and a sex ratio at 0.32. This female predominance was reported by Akkoca M. et al (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) in Turkey in 2017 (60%), Mahamoud G. et al (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) in Morocco in 2010 (54.1%). The average age of our patients was 41.8 years 14.2 with extremes of 10 and 69 years; very few studies had been reported on all ages like ours; Children\u0026rsquo;s studies are generally found in the literature (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e); The prevalence of abdominal masses by age was little discussed. But classically, abdominal masses of neoplastic origin are rare in the first year of life, but very common between the ages of 1 and 6 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Abdominal pain was the main indicator in most of our patients (84.9%). Lower rates were found by Akkoca M and al, and Mahamoud G and al., respectively 61%, 57.5% of cases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In the older patient, the primary mode of abdominal mass disclosure is incidental discovery by a parent (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, the physical examination found palpable abdominal mass in 77.3% of cases, although 17% of patients were obese. The consistency of the mass was hard and irregular in 47.5% of cases, painful sensitivity in 62.5% of cases, and the mass was fixed relative to the deep plane in 60% of cases. Akkoca M. et al (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) in a series of 43 cases in Turkey in 2017 had recovered abdominal mass on physical examination in 62.2% of cases. This difference in frequency could be justified because our study focused only on large abdominal masses, therefore accessible for examination.\u003c/p\u003e \u003cp\u003eAbdominal pelvic ultrasound is currently the reference technique for abdominal mass diagnosis. It allows the topographical diagnosis of the mass, to attach it to an organ, to determine with precision the tumor volume, and to define its solid or liquid character (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In an American journal of the literature published in 2019, the authors stated that 88\u0026ndash;91% of the ultrasound was accurate in determining the original organ and 77\u0026ndash;81% in diagnosing the underlying pathology (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In our study, ultrasound was performed in 100% of cases. It specified the location of the mass and the original organ in 75.47% of cases (uterine myomas, ovarian cyst, renal tumors, etc.) and contributed to the realization of ultrasound biopsy punctures in 4 cases. Our results are similar to those of Kathryn J.F et al (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) in the USA in 2019 who reported ultrasound achievement rates in 100% of their series. In case of clinical suspicion of abdominal mass, the ultrasound requested in 1st intension is justified (strong professional agreement), and it is a first-line examination requested in the literature, it is less expensive, non-invasive and very well supported by the patient (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, its performance may decrease because it is an operator-dependent examination, in addition to in the context of abdominal emergencies, the sensitivity of the ultrasound is often much lower than that of the scanner which will be preferred in most indications (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). On the other hand, as one author pointed out, \u0026ldquo;the effectiveness of the ultrasound depends on the relevance of the application\u0026rdquo; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) means that the better the clinical information on the application is reported, the better it is to guide the operator.\u003c/p\u003e \u003cp\u003eAbdominal CT is the key examination of abdominal mass balance. It brings valuable elements in the localization by anatomical compartments, organ localization, characterization and evaluation of the extension of these masses (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Over the past 15 years, it has undergone a rapid technological evolution, moving from sequential to spiral, mono- and multidetector modes. This evolution currently allows to investigate an abdomen in a few seconds with a spatial resolution less than 1 mm allowing routinely multiplanar reconstructions of quality equal to the initial scans (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In our series, CT was performed in 52.8% of cases. It had contributed to the etiological diagnosis in 89.29% of cases. Our results are lower than those found by Akkoca M. and al (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) in Turkey in 2017 which had reported 62.2%. The low achievement of the scanner compared to the ultrasound could be explained by the high cost of this examination, especially in our context where most patients do not have social security and by the fact that it is not indicated in first intention, especially in young patients because of its irradiance (often need injection of iodized contrast agent).\u003c/p\u003e \u003cp\u003eThe etiologies of the abdominal masses were diverse, we had reported three cases where the scanner could not establish a diagnosis of pre-operative abdominal mass. The etiologies of the abdominal masses were diverse, we had reported three cases where the scanner could not establish a diagnosis of pre-operative abdominal mass. The diagnosis of this intra-abdominal soft tissue sarcoma could not be established pre-operative by CT in our study. MRI remains the reference exam for the local Soft Tissue Sarcoma because it has excellent tissue contrast (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The tumor was compressing both ureters and the possibility of a neoadjuvant treatment such as radiotherapy in Niger was almost impossible at a time when the country did not have it. It was necessary to request a medical evacuation outside that would have lasted several months. Exploratory laparotomy was indicated and R0 resection could not be obtained due to tumor invasion of the left ureter. Despite the adjuvant chemotherapy, the recurrence had been very rapid and overwhelming. The 2nd case involved a tumour occupying the entire abdominal cavity, and it is reported that the scanner is ineffective in determining the origin of the organ in these cases of giant tumor of the abdomen (interest of multiplanar reconstruction) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). And per operation, it was a large poly myomatous uterus and necropolis. The last case concerned a suspicion of a mesenteric tumor at the injected scanner and the discovery of a peritoneal carcinosis from an ovarian tumor per operative was accidental. Diagnosis of peritoneal carcinosis is easy in diffuse and macronodular forms with ascites. Rough shapes are difficult to diagnose. Imaging peritoneal carcinoses (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) remains first and foremost a technical challenge in radiology: because it requires high spatial resolution (especially in small lesions) and high contrast resolution (nodules have low spontaneous contrast with no significant enhancement) and finally there is a minimization of motion artifacts due to the contact of the handles that are moving. Secondly, it is a radiological challenge because peritoneal carcinoses have low reproducibility, and most are seen only in surgery. However, the scanner is still the reference tool, but it has limited sensitivity per organ site, especially at the pelvic level (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The FDG-PET scan and/or diffusion MRI is recommended (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, our hospital did not have an MRI at the time of the study and the entire country does not have a Pet scan. In our study, we found a more significant frequency of uterine myomas (35.8%), followed by ovarian cysts in 11.3% of cases and ovarian tumors in 9.7% of cases. This may be related to the female predominance (75.5%) and young age (41 years of average age) of our study population. As reported by most authors, uterine myomas and ovarian cysts represent the main etiologies of abdominal-pelvic masses in black women during genital activity and pre-menopausal period (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The choice of therapeutic approach depends on the histological type, mass extension and age of the patient (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). For our patients, two methods of treatment have been used: chemotherapy and surgery, radiation therapy not yet available in Niger. These methods were in some cases well-suited and in others adapted to the work context.\u003c/p\u003e \u003cp\u003eSurgery was the main therapeutic remedy (100%). We reported an exceptional case of total hysterectomy in a 32-year-old nulligeste patient with a large uterine myoma in necropsy and having occupied almost the entire abdominal cavity. He was responsible for severe anemia with vomiting (by gastric compression). The hysterectomy piece (retaining an ovary), measured 29mmx23m height. n our series, the evolution was favorable for the majority of patients. Nevertheless, a 5.6% mortality rate was reported for all abdominal masses. All deceased patients had malignant tumours. Most of these patients had consulted at an advanced stage of their illnesses. Our results are superior to those found by Akkoca M and al (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) which reported a mortality rate of 4.4%.\u003c/p\u003e"},{"header":"Conclusion ","content":"\u003cp\u003eAbdominal masses occupy an important place in the activity of the general and digestive surgery department of the HGR. Imaging plays an important role in the research and etiological orientation of abdominal masses. It made it possible to make the pre-operative diagnosis in the majority of cases. Ultrasound was the first-line examination of choice, followed by CT. Surgery sometimes remains our only diagnostic and therapeutic option by default of a more efficient technical platform. The evolution seems favorable in most cases, nevertheless, the mortality would be related not to the diagnostic defect, but to the malignant nature, the extension of the disease and the large volume of the mass.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eRGH\u003c/strong\u003e: Reference General Hospital,\u0026nbsp;\u003cstrong\u003eBMI\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003ebody mass index, \u003cstrong\u003eMRI\u003c/strong\u003e:\u0026nbsp;Magnetic resonance imaging,\u0026nbsp;\u003cstrong\u003eCT scan\u003c/strong\u003e:\u0026nbsp;computerized tomography\u0026nbsp;\u003cem\u003e\u003cstrong\u003escan\u003c/strong\u003e\u003c/em\u003e, \u003cstrong\u003eFDG-PET\u003c/strong\u003e: F-fluorodeoxyglucose-positron emission tomography.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSA\u003c/strong\u003e (study design, manuscript writing); \u003cstrong\u003eMLAAB,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eZOA\u003c/strong\u003e\u003cstrong\u003e, BID, KI,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eYH, JDL\u003c/strong\u003e\u003cstrong\u003e, SR\u003c/strong\u003e:\u0026nbsp;All authors had participated in the writing of the manuscript and its critical revision and had all read and approved its final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: All data generated or analysed during this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Helsinki Declaration and with the approval of the Ethics Committee of the General Reference Hospital of Niamey (Department of Surgery, General Surgery Service) ; Being a retrospective study reporting anonymous and depersonalized data, the need for informed consent is deemed unnecessary by the ethics committee (Department of Surgery, HGR Niamey, Niger).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest declaration\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors state that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e:1 Reference General Hospital, Department of Surgery and Surgical Specialties, BP 12674, Niamey. \u0026nbsp;2 Reference General Hospital BP 12674 Niamey, a: Department of Pathology and Anatomy, b. Radiology and Medical Imaging Department. 3National Hospital BP 238 Niamey, Niger. 4Amirou Boubacar Diallo Hospital BP 10146 Niamey, Niger. \u003csup\u003ec\u003c/sup\u003e Facult\u0026eacute; des Sciences de la sant\u0026eacute;, Universit\u0026eacute; Abdou Moumouni, BP : 10896 Niamey Niger.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican College of Surgeons ACS. Surgery Principal and Practice. Abdominal masses, p\u0026nbsp;488\u0026ndash;500, 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHANAFI I, IVAN I, PALOT J-P DEJUGNATL, et al. Adult abdominal masses: how to arrive at the diagnosis. J de Radiol Reims. 2004;85(9):P1505.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDUYCKAERTS C, FOURET P, HAUW JJ. Anatomy-pathology. Pierre and Marie Curie University, January 2003. available on \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp:www.chups.jussieu.fr/polys/anapath/Cours/anapath.pdf\u003c/span\u003e\u003cspan address=\"http:www.chups.jussieu.fr/polys/anapath/Cours/anapath.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOKOKO A-R, EKOUYA BOWASSA G, OKO A-P-G, MBIKA-CARDORELLE A. Epidemiology of palpable abdominal masses in children in Brazzaville Archives de P\u0026eacute;diatrie 2012; 19:878\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAKKOCA M, TOKGOZ S, YILMAZ BK, AKINCI M, et al. Diagnosis and treatment approaches for intraabdominal masses in adults. Ankara Universities Tip Fakultesi Mesmuasi Turquie. 2017;70(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1501/Tıpfak_000000987\u003c/span\u003e\u003cspan address=\"10.1501/Tıpfak_000000987\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMAHAMOUD G, AFIFI R, ESSAID A, et al. Ultrasound biopsy puncture guided in abdominal mass diagnosis about 523 cases. J Afr Hepato Gastroenterol. 2010;4:220\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNICHOLAS M, POTISEK AND JAMES W. Abdominal Masses. Antoon Pediatr Rev. 2017;38(2):10\u0026ndash;03.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGood Use Guide of medical imaging tests. Recommendations for health professionals Transposition of European Directive 97/43 Euratom French Society of Radiology, French Society of Biophysics and Nuclear Medicine, 1st edition \u0026ndash; 2005; P 102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKATHRYN, J-F, EVELYN M-G, DAVID H-K, et al. Palpable abdominal mass- suspected neoplasm. Appropriateness Criteria. J Am Coll Radiol. 2019;16:384\u0026ndash;S391.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHAINAUX B, BORENS-FEFER B. Imaging of adult abdominal emergencies, Radiology of acute abdominal pain in adult patients Services de Radiologie, 1C.H.U. Saint- Pierre. Rev Med Brux. 2010;31(4):209\u0026ndash;440.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCROMB\u0026Eacute; A, BUY X. KIND M. Imaging of soft tissue sarcomas. The Cancer Expert\u0026rsquo;s Letter 2018; 27 (9).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDE BREE E, KOOPS W, VAN RUTH S KRGERR. Peritoneal carcinomatosis from colorectal or appendiceal origin: Correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg oncol. 2004;1(2):64\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJACQUET P, JELINEK J S, STEVES M A, SUGARBAKER P H. Evaluation of computed tomography in patients with peritoneal carcinomatosis. Cancer. 1993;1(5):1631\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLANSAC J. MARRET H. Uterine myomas. Gynecology for the practitioner, 9th edition, Paris Elsevier Masson 2018, 65\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKOUAME N, BAKARY YN, MANEWA FS et al. Abdominal-pelvic masses in geriatric: a report on 2 cases explored at CT. Int J Radiol Radiat Oncol 2: 001\u0026ndash;003. 10.17352/ ijrro.000009, 2640\u0026ndash;7566.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 1: \u0026nbsp; Ultrasound Evoked Pre-Operative Diagnostics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.071310116086234%\" rowspan=\"18\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Eacute;chographie\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.734660033167497%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.509121061359867%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.940298507462687%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.744610281923716%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.385245901639344%\" rowspan=\"17\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIntra p\u0026eacute;riton\u0026eacute;ale\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRetro p\u0026eacute;riton\u0026eacute;ale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.9344262295082%\" valign=\"top\"\u003e\n \u003cp\u003eUterine myomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.754098360655737%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.92622950819672%\" valign=\"top\"\u003e\n \u003cp\u003e33,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eOvarian cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e11,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eOvarian tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e9,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eOvarian tumor\u0026nbsp;?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eTropical spleen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eLiver abscess\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eRight colon tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eGastric tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e3,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eCaecum tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eAppendicular abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eMesenteric cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eMesenteric tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003ePelvic tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eKidney tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e5,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003ePancreatic tail cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e3,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eLeft hydronephrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.49051490514905%\" valign=\"top\"\u003e\n \u003cp\u003eLeft adrenal tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.99728997289973%\" valign=\"top\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"70.36423841059603%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.920529801324504%\" valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.71523178807947%\" valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 2:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePatients in whom the ultrasound coupled to the scanner, the diagnosis was not accurate.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"688\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.157205240174672%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eImageries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.308588064046578%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiological diagnostics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.308588064046578%\" valign=\"top\" style=\"width: 28.9227%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePer-operative diagnostics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.22561863173217%\" valign=\"top\" style=\"width: 25.8738%;\"\u003e\n \u003cp\u003eContext or review\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eallowed diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.157205240174672%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUltrasound + CT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.308588064046578%\" valign=\"top\"\u003e\n \u003cp\u003eOvarian tumor? uterine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.308588064046578%\" valign=\"top\" style=\"width: 28.9227%;\"\u003e\n \u003cp\u003eG\u0026eacute;ant myome ut\u0026eacute;rin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.22561863173217%\" valign=\"top\" style=\"width: 25.8738%;\"\u003e\n \u003cp\u003e\u0026nbsp;per operative,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;histology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.993055555555557%\" valign=\"top\"\u003e\n \u003cp\u003ePelvic tumor ?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.993055555555557%\" valign=\"top\" style=\"width: 28.9227%;\"\u003e\n \u003cp\u003ePelvic mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.013888888888886%\" valign=\"top\" style=\"width: 25.8738%;\"\u003e\n \u003cp\u003eHistology: Sarcoma tissue \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Soft tissue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.993055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eIs that a mesenteric tumor?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.993055555555557%\" valign=\"top\" style=\"width: 28.9227%;\"\u003e\n \u003cp\u003eAbdominal tumor +\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePeritoneal carcinosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.013888888888886%\" valign=\"top\" style=\"width: 25.8738%;\"\u003e\n \u003cp\u003e\u0026nbsp;Histology :\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Ovarian carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 3:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIndications of laparoscopy\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"582\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic indication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003egestures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003eLiver abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eDrainage, washing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003eMesenteric cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eResection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e16,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003eBilateral ovary cysts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eResection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e16,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003eRight ovarian tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eRight ovariectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003eRight colon tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eRight hemicolectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003eAppendicular abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eAppendectomy, washing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003ePancreatic cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eDrainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45704467353952%\"\u003e\n \u003cp\u003eAdrenal tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.460481099656356%\" valign=\"top\"\u003e\n \u003cp\u003eAdrenalectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"63.97941680960549%\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.46655231560892%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.554030874785592%\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Masses abdominals, Imaging, Coelioscopy, Niamey","lastPublishedDoi":"10.21203/rs.3.rs-3332539/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3332539/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eReport the diagnostic and therapeutic approach for the management of abdominal masses in the General Surgery Department of the Reference General Hospital (RGH) of Niamey.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods: \u003c/strong\u003eThis were a retro-prospective and preliminary study of 2 years 3 months on patients operated for abdominal mass in the general surgery department of the RGH. Palpable mass and/or imaging size (40 mm) were the criteria for inclusion.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eAbdominal masses accounted for 6.7% (n=53) of other pathologies. The average age of patients was 41.26 years, standard deviation 14.2 and a female predominance in 75.5% (n=40) with a sex ratio of 0.32. The abdominal mass was clinically palpable in 75.5% (n=40). The abdominal pelvic ultrasound was performed in all patients and in 75.5% (n=40) it had specified the origin of the mass. The injected abdominal-pelvic scanner, performed in 52.8% of patients (n=28) and 89.3% (n=25), had specified the pre-operative diagnosis. The most common etiologies were uterine myomas in 35.8% (n=19). In 7.5% (n=4) the diagnosis was not accurate in pre-operative despite both imaging, and these patients had benefited from an exploratory laparotomy. Surgery was the initial therapeutic gesture for all patients and coelioscopy was 22.6% (n=12). Post-operative complications were 7.5% (n=11). The death rate was 5.6% of cases (n=3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eImaging remains important in the etiological research of abdominal masses.\u003cstrong\u003e \u003c/strong\u003eThe definitive treatment remains surgical; mortality would be related to the malignant nature and the large volume of the mass.\u003c/p\u003e","manuscriptTitle":"Diagnostic and therapeutic approach to abdominal masses in a country with limited resources","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-29 22:44:37","doi":"10.21203/rs.3.rs-3332539/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-27T15:56:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-01-16T19:25:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0fa82c15-a08c-48e1-94d1-2d054bce2aa0","date":"2024-01-16T09:49:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2e06a077-470c-4a2a-b43d-4a86de93f8ec","date":"2024-01-11T19:51:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5bf91060-f465-476c-b22f-17440c9ea1b6","date":"2023-11-09T10:58:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d2b2a29a-d048-491d-82ec-e650c8b63478","date":"2023-10-01T11:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-09-25T08:10:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-09-25T08:04:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-09-24T06:37:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-09-24T06:35:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2023-09-06T22:31:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d8cab1cc-d7fb-430e-bcb7-6221a0dda8b7","owner":[],"postedDate":"September 29th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-25T15:09:03+00:00","versionOfRecord":{"articleIdentity":"rs-3332539","link":"https://doi.org/10.1186/s12893-024-02371-w","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2024-03-23 15:03:02","publishedOnDateReadable":"March 23rd, 2024"},"versionCreatedAt":"2023-09-29 22:44:37","video":"","vorDoi":"10.1186/s12893-024-02371-w","vorDoiUrl":"https://doi.org/10.1186/s12893-024-02371-w","workflowStages":[]},"version":"v1","identity":"rs-3332539","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3332539","identity":"rs-3332539","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}