Intestinal obstruction in older children in Komfo Anokye Teaching Hospital: A tertiary referral centre in Kumasi, Ghana

Background Childhood intestinal obstruction can either be congenital or acquired and both types result in high morbidity and mortality in  developing countries, mainly as a result of late presentation and diagnosis.Patients and methods From January 2007 to December2010, a retrospective analysis of all older children with  intestinal obstruction admitted to Komfo Anokye Teaching Hospital (Kumasi, Ghana) was carried out. This was to establish the causes of intestinal obstruction and to determine its morbidity and mortality among the children studied.Results There were 98 children who were treated with a diagnosis of intestinal obstruction during the period. The mean age of the children, in months, was 34.7 ±5.0 SEM (range 3–180, median age 10 months), with a male : female ratio of 1.5 : 1. About 70.6% of the children were  admitted with acquired causes of intestinal obstruction and 29.4% with congenital causes of intestinal obstruction. In all, 21.2% of the children, treated for intestinal obstruction, underwent bowel resection as a result of nonviability of a segment of the intestine; the majority of the bowel resections were performed in the intussusception group. The mean length of hospital stay, in days, was 8.2± 5.7. There were 15 children (15.3%) with various postoperative complications, mainly surgical site infections; the mortality rate was 11.2%. Here again, most of the deaths occurred in the intussusception group of children.Conclusion Intestinal obstruction is a serious emergencyin children and must be diagnosed early and treated  promptly to avoid high morbidity and unnecessary deaths among children in our subregion

Typhoid ileal perforation: Analysis of morbidity and mortalityin 89 children

Typhoid ileal perforation is still prevalent in many developing countries. Despite the advances in The management, the outcome in children is still very poor. To determine the morbidity and mortality of childhood typhoid ileal perforation in a tertiary referral centre in southeast Nigeria Retrospective evaluation of 89 children operated for typhoid ileal perforation over a 10-year period (January 1, 1995 through December 31, 2004) at the University of Nigeria Teaching Hospital, Enugu. There were 54 (60.7%) boys and 35 (39.3%) girls aged 1 15 years (mean 9.1 years). Thirty-nine (43.8%) were >10 years. Fever and generalized abdominal pain were the predominant symptoms for 5 21 days (mean 13.4 days) and 2 13 days (mean 8.8 days) respectively before presentation. Seventeen (89.5%) of thos

Spontaneous scrotal faecal fistula in a Nigerian adult: review of literature and proposal for management protocol

We report a 28-year-old Nigerian who presented with four days history of spontaneous scrotal ulceration and faecal discharge. This symptom was preceded by features of intestinal obstruction which got relieved after the faecal discharge from the scrotum. He was resuscitated and had segmental resection and anastomosis of the ileum, debridement of the scrotal skin for secondary closure and delayed repair of the hernia

Megaloblastic Anemia Associated with Small Bowel Resection in an Adult Patient

Megaloblastic anemia is characterized by macro-ovalocytosis, cytopenias, and nucleocytoplasmic maturation asynchrony of marrow erythroblast. The development of megaloblastic anemia is usually insidious in onset, and symptoms are present only in severely anemic patients. We managed a 57-year-old male who presented at the Hematology clinic on account of recurrent anemia associated with paraesthesia involving the lower limbs, 4-years-post small bowel resection. Peripheral blood film and bone marrow cytology revealed megaloblastic changes. The anemia and paraesthesia resolved with parenteral cyanocobalamin. Keywords: Bowel resection, megaloblastic anemia, neuropathy, paraesthesi

Irreducible Inguinal Hernias in the Paediatric Age Group

BACKGROUND: An inguinal hernia is said to be irreducible when the content fails to return into the peritoneal cavity without surgical intervention. Irreducibility is an ever present risk in untreated inguinal hernias and its management remains an important part of pediatric surgery practice. When a hernia is irreducible , morbidity and mortality increase.This risk of irreducibility is more in some patient groups.METHODS: A retrospective analysis of all irreducible inguinal hernias in children of both sexes from neonatal age to 15years who presented at the University of Nigeria Teaching Hospital from January 2000 to June 2010 and needed emergency groin exploration when reduction failed on conservative management.RESULTS: There were 25 irreducible inguinal hernias requiring emergency groin exploration. This represents 10.2% of all inguinal hernias managed within the period ,with a male :female ratio of 11.5 :1. Nineteen(76%) were on the right while six(24%) were on the left. Forty percent(40%) of the irreducible hernias were in older infants. Sixty-seven(67%) of the neonatal hernias presented as irreducible. There were 3 bowel resections(12% bowel resection rate), 2 testicular losses(8% testicular loss rate) and one death(4% mortality).CONCLUSION :There is a high rate of irreducibility of inguinal hernias in neonates , and in right-sided hernias .Identification of risk factors in and risk stratification of patients with uncomplicated inguinal hernias will helpreduce the rate of irreducible inguinal hernias and their attendant morbidities.KEY WORDS: Irreducible ; Inguinal hernia ;Pediatri

Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria

Background: Surgical abdomen traverses all age groups. We sought to define the aetiology, patients’ characteristics, and outcome of management amongst children Methods: Two years prospective review of patients aged 5-15 years managed for surgical abdomen at the Wesley Guilds Hospital Ilesa and Mishmael Medical Centre Akure, Nigeria. Results: Fifty two patients were treated. The male: female ratio was 1:1. The age range was 5years to 15years (mean=11.25 ±2.24years). Mean duration of illness was 29.5hours (range 2-72hours). Gut perforation was the most common aetiology (n=39; 75%); with perforations due to infections most prevalent (n= 34; 87.2%). Ten cases (19.2%) were trauma related and showed male predominance. Obstructed gut accounted for 15.4% (n=8) of cases; and showed female predominance. Five out of the eight small bowel obstructions (62.5%) were due to post operation adhesions. Pre-operative and post-operative diagnoses were congruent in 90.4% (n=47) of cases. Major post-operative complications were surgical site infection (20; 38.5%), and pneumonia (5; 9.6%). The average hospital stay was 9days (range 4-21days). Mortality rate was 1.9% (n=1). Conclusion: Acute abdomen requiring surgical intervention is mainly infective origin. The male child is more at risk of abdominal trauma while gut obstruction was more common in females.Keywords: Surgical, Abdomen, Children, Emergenc

Pediatric intestinal obstruction in Malawi: characteristics and outcomes

Abstract Background Intestinal obstruction (IO) is a common pediatric surgical emergency in sub-Saharan Africa with high morbidity and mortality, but little is known about its etiopathogenesis in Malawi. Methods Retrospective analysis of patients seen from February 2012 to June 2014 at Kamuzu Central Hospital in Lilongwe, Malawi (n = 3,407). Pediatric patients with IO were analyzed (n = 130). Results Overall, 57% of patients were male with a mean age of 3.5 ± 4.1 years. A total of 52% of patients underwent operative intervention. The overall mortality rate was 3%. Leading causes of IO were Hirschprung's 29%, anorectal malformation 18%, and intussusception 4%. Neonates and patients with congenital causes of IO underwent surgery less frequently than infants and/or children and patients with acquired causes, respectively. These groups also demonstrated increased number of days from admission to surgery. Conclusions Increasing pediatric-specific surgical education and/or training and expanding access to resources may improve mortality after IO in poor medical communities within sub-Saharan Africa

Sclerosing mesenteritis: A case of acute abdomen and intestinal obstruction

Sclerosing mesenteritis (SM) is a rare idiopathic disorder characterized by chronic non-specific inflammation involving the adipose tissue of the bowel mesentery. It may be asymptomatic but it commonly presents with abdominal pain. Some individuals may have a palpable abdominal mass and affected individuals may develop small bowel obstruction or acute abdomen.We report a case of 27-year old man who presented to the Surgery Department at Chukwuemeka Odimegwu Ojukwu University Teaching Hospital (COOUTH),Amaku Awka,Anambra State with acute abdomen and intestinal obstruction. He subsequently, had a surgical resection, which was histologically confirmed as a sclerosing mesenteritis.Sclerosing mesenteritis is a rare disorder and this is the first case being reported in the literature from South-East,Nigeria.It is therefore,important to alert physicians,more especially the surgeons on the need to have a high index of suspicion in every case of intestinal obstruction

Pattern Of Intestinal Obstruction In A Semiurban Nigerian Hospital

Intestinal obstruction remains one of the commonest causes of acute abdomen worldwide. The pattern of intestinal obstruction varies from one place to another. We report the pattern of intestinal obstruction observed in a semi urbanNigerian hospital over a 5 year period. Records of patient admitted and managed for intestinal obstruction between April 2001 and April 2006 at the federal medical centre, Owo, Southwestern Nigeria, were reviewed. Demographic data as well as parameters relating to the symptoms, duration, onset, type, diagnosis, intraoperative findings, aswell as postoperative outcomes were retrieved. All datawas entered into a personal computer and analyzed using SPSS forwindows version 11. Atotal of 95 patientsweremanaged during the period. Themean agewas 39 years.The male female ratio was 1.8:1. Adhesive intestinal obstruction was the commonest cause of symptoms in 44%, followed by volvulus in14% and external hernias in 11%of the patients. Acorrect preoperative diagnosis was made in over 70% of the patients. Out of thosewith adhesive obstruction, 75% had a previous abdominal or groin operation while 57% had surgical exploration for failed conservative management. The mean duration of hospital stay was 6 days and the overall mortality rate was 20%. Adhesive intestinal obstruction is the commonest cause in this semi-urban population which was studied. Obstructed hernia is becoming increasingly less common as a cause of intestinal obstruction. Keywords: Pattern, Intestinal Obstruction, Semiurban Hospital. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 347-35

Pattern of adult intestinal obstruction at Tenwek hospital, in south-western Kenya

Introduction: acute mechanical intestinal obstruction (IO) is one of the leading causes of surgical admissions in most emergency departments worldwide. The causes of IO vary significantly depending on geographical location. The aim of this study was to identify the etiology, management and outcomes of patients with acute mechanical IO presenting in south-western Kenya. Methods: a 4 year (November 2009–October 2013) retrospective review of all adult patients admitted with acute mechanical IO at Tenwek Hospital in Bomet, Kenya. Results: a total of 303 male and 142 female patients, presented with acute mechanical IO during the study period. Mean patient age was 40.6 years (range 17-91), with peak  incidence in those aged 31-40 years. The foremost signs and symptoms were abdominal pain (89.4%), abdominal tenderness (81.6%), vomiting (78%), abdominal distension (65.4%) and constipation (50.8%). Sigmoid volvulus (25.6%), adhesions (23.1%), small bowel volvulus (21.3%), and ileo-sigmoid knotting (8.5%) were the leading causes of IO. Laparotomy was undertaken in 361 (81.1%) cases, with bowel gangrene noted in 112 (30.4%). The overall morbidity and mortality rates were 15% and 4.5% respectively. Patients with gangrenous bowel at laparotomy had a higher morbidity rate (22.3% vs 9.6%, P=.001), a higher mortality rate (9.8% vs 3.2%, P=.02) and a longer duration of stay (9.9 days vs 7.6 days,  P=.0001) compared to those with viable bowel. Conclusion: the most common causes of IO in this study were sigmoid volvulus, adhesions, small bowel volvulus and ileo-sigmoid knotting. Presence of bowel gangrene was associated with higher morbidity and mortality rates