Imagerie Tomodensitométrique de la Carcinose Péritonéale et Problématique de sa Prise en Charge au Centre Hospitalier Universitaire Sourô Sanou de Bobo Dioulasso

RESUME Objectif. Decrire les aspects tomodensitometriques de la carcinose peritoneale et discuter de la problematique de sa prise en charge au CHU Souro Sanou de Bobo-Dioulasso. Materiels et methodes. Il s’agit d’une etude transversale descriptive retrospective concernant tous les patients adultes ayant eu une exploration tomodensitometrique (TDM) au CHU Souro Sanou et presentant des signes de carcinose peritoneale. L’etude couvre une periode de 3 ans et 1/2 allant du 01/01/2015 au 30/06/2018. L’appareil utilise etait un appareil de marque Siemens SOMATOM definition AS de 64 barrettes. Resultats. Nous avons collige un total de 23 cas de carcinose peritoneale. L’âge moyen des sujets etait de 41,6 ± 13,4 ans et le sex ratio de 0,64. L’amaigrissement etait manifeste chez tous les patients et le syndrome tumoral abdomino-pelvien etait present dans 86,36% des cas. Les principales lesions TDM observees etaient l’ascite (95,45%) et les atteintes tissulaires peritoneales (86 ,36%). Les nodules sous peritoneaux, l’ascite et l’infiltration diffuse peritoneale etaient l’association la plus frequente soit 30% des cas. L’etiologie de la carcinose peritoneale etait connue dans 81,82% des cas. Il s’agissait de cancers de l’ovaire dans 36,36% des cas. Les metastases a distance etaient presentes dans 45,45%. La mortalite etait lourde (95 %). Conclusion. La carcinose peritoneale atteint surtout la femme et son etiologie dominante est le cancer de l’ovaire. Les principales lesions TDM sont l’ascite, les nodules peritoneaux et l’infiltration peritoneale diffuse. Il s’agit d’une pathologie grave avec une mortalite tres elevee. La prise en charge est rendue difficile du fait du retard diagnostique, corollaire des consultations tardives, de l’accessibilite limitee du scanner et du traitement. ABSTRACT Objective. To describe computed tomography (CT) features of peritoneal carcinosis and discuss its management challenges at Souro Sanou Teaching Hospital, Bobo-Dioulasso. Materials and methods. This was a cross sectional descriptive retrospective study at Souro Sanou Teaching Hospital concerning adult inpatients over a period of 3 and half years (from 1/01/2015 to 30/06/2018). Participants were all patients having signs of peritoneal carcinosis. CT scans was done with a 64 slices SOMATOM Definition AS, Siemens. Results. We studied 23 cases of peritoneal carcinosis. The average age of patients was 41.6 ± 13.4 years and the sex ratio M/F was 0.64. Weight loss was constant and abdominopelvic tumour syndrome was present in 86.36% of cases. The main CT lesions were ascites (95.45%) and peritoneal tissular lesions (86.36%). Sub-peritoneal nodules, ascites, and diffuse peritoneal infiltration were the most common association, accounting for 30% of cases. The aetiology of peritoneal carcinosis was known in 81.82% of cases and ovarian cancer was the leading cause (36.36%). Distant metastasis was found in 45.45% of patients. Mortality rate was 95%. Conclusion. Peritoneal carcinosis affects mainly women and the first aetiology is ovarian cancer. The main CT presentation associates ascites, peritoneal nodules and diffuse infiltration. The prognosis is dim. The management is challenging due to delayed diagnosis, a corollary of late consultation and ; limited accessibility to CT.