Gastrointestinal Injuries Following Blunt Abdominal Trauma In Children

Purpose: Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. Patients and Methods: From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. Results: There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries , one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice. Keywords: Gastrointestinal injury, Blunt abdominal trauma, children. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 250-25

Congenital anomalies in low- and middle-income countries: the unborn child of global surgery.

Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability

Management of the mass casualty from the 2001 Jos crisis

Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001.Materials and Methods: Aretrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care.Results: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients.  Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside.Conclusion: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better  chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.Key words: Challenges, civilian conflicts, crisis, disaster, mass casualty, trauma, violenc

Colostomy closure: how to avoid complications

Purpose: Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. Methods: The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48-72 h after the operation. Results: The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung\u27s disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality. Conclusion: Based on this experience we believe that colostomy closure can be performed with minimal morbidity provided a meticulous technique is observed. © 2010 The Author(s)

Endoscopic procedures for removal of foreign bodies of the aerodigestive tract: The Bugando Medical Centre experience

<p>Abstract</p> <p>Background</p> <p>Foreign bodies in the aerodigestive tract continue to be a common problem that contributes significantly to high morbidity and mortality worldwide. This study was conducted to describe our own experience with endoscopic procedures for removal of foreign bodies in the aerodigestive tract, in our local setting and compare with what is described in literature.</p> <p>Methods</p> <p>This was a prospective descriptive study which was conducted at Bugando Medical Centre between January 2008 and December 2009. Data were collected using a structured questionnaire and analyzed using SPSS computer software version 15.</p> <p>Results</p> <p>A total of 98 patients were studied. Males outnumbered females by a ratio of 1.1:1. Patients aged 2 years and below were the majority (75.9%). The commonest type of foreign bodies in airways was groundnuts (72.7%) and in esophagus was coins (72.7%). The trachea (52.2%) was the most common site of foreign body's lodgment in the airways, whereas cricopharyngeal sphincter (68.5%) was the commonest site in the esophagus. Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality performed in 87.8% of patients. The foreign bodies were successfully removed without complications in 90.8% of cases. Complication rate was 7.1% and bronchopneumonia was the most common complication accounting for 42.8% of cases. The mean duration of hospital stay was 3.4 days and mortality rate was 4.1%.</p> <p>Conclusion</p> <p>Aerodigestive tract foreign bodies continue to be a significant cause of childhood morbidity and mortality in our setting. Rigid endoscopic procedures under general anesthesia are the main treatment modalities performed. Prevention is highly recommended whereby parents should be educated to keep a close eye on their children and keep objects which can be foreign bodies away from children's reach.</p

Laparoscopic paediatric surgery: A potential for paradigm shift in developing countries

Background: Until recently, surgical conditions in children requiring operation were managed by the traditional open method. The introduction of the laparoscopic surgical technique seems to be reversing this trend in many centres. We are pioneering some laparoscopic surgery procedures in our environment and the aim of this study was to document our experience with laparoscopic paediatric surgical procedures in a developing country. Materials and Methods: This was a prospective analysis of all consecutive children that had laparoscopic surgery at 5 hospitals in Northern Nigeria from June 2008 to February 2011.Results: Twenty-one patients had laparoscopic surgeries during the study period with a mean age of 12.5 ± 2.6 years and age range of 10–16 years. There were 14 females and 7 males with a M:F ratio of 1:2. Seven patients (33.3%) had cholecystectomies and 13 (61.9%) had appendicectomies and the remaining one patient (4.8%) had adhesiolysis for partial adhesive intestinal obstruction following previous open appendicectomy. The mean operating time was 89 min with a range of 45–110 min for appendicectomies, 55–150 min for cholecystectomies and the adhesiolysis took 50 min. The mean hospital stay was 2 days except for the conversions that stayed up to 7 days. There were 2 (9.5%) conversions with no mortality. Conclusion: We solicit a paradigm shift in our approach to surgical management and implore other centres to embrace laparoscopic surgery in the management of surgical conditions in children since it confers obvious advantages over open surgery.Key words: Developing nation, laparoscopic paediatric surger

Association of midgut malrotation with intussusception

Background: The cause of intussusuception in most infants is unclear. Intestinal malrotation has been postulated as a possible cause in some infants. Waugh,s syndrome is the association of intestinal malrotation with intussusception.Patients/Methods: Of 18 children with intussusception managed in the Paediatric Surgical Unit of our hospital over a 3-year period, eight had abnormality of intestinal rotation and fixation. Their case notes, operation notes and discharge summary sheets have been retrospectively reviewed.Results: There were five boys and three girls. Their ages ranged from 13 days – 12 months (median 10 months). The main clinical features were bilious vomiting, blood stained diarrhoea and abdominal distension. In two infants, the intussusceptions had prolapsed through the anus at presentation. One neonate had ruptured omphalocoele minor containing a caeco-colic intussusception that had perforated at presentation. Two other infants had mid gut volvulus, one as a simultaneous finding with intussusception while the other one 72 hours after operative reduction of intussusception. All had laparotomy. In six infants, the intussusception was ileo-colic while in two it was caeco-colic. There was no lead point in any infant. Four infants had successful operative reduction while four had bowel resection with end-to-end anastomosis. All had Ladd's procedure. One child died of overwhelming sepsis following resection of gangrenous bowel. Conclusion: Intestinal malrotation may be associated with idiopathic intussusception. It is important to look for this association when managing infants with intussusception. Keywords: Waugh's syndrome, intussusception, malrotation, midgut volvulus, Ladd's procedure Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 159-16

Hirschsprung’s disease presenting in the neonatal period in Jos,Nigeria

Background: While most cases of Hirschsprung’s disease are diagnosed during the neonatal period in developed countries, majority of the cases present outside the neonatal period in developing countries.We reviewed our experience with Hirschsprung’s disease presenting during the neonatal period to document the presentation and management.Patients/Methods: A retrospective analysis of the presentation and management of 31 neonates with Hirschsprung’s disease over a nine year period in a Tertiary pediatric surgical centre in Nigeria wasperformed.Results: From January 1996 – December 2004, 78 children were managed for Hirschsprung’s disease in our unit. Thirty-one (39.7%) were aged 30 days or below. The median age at presentation was eight days (range 2-30 days). There were 23 boys and 8 girls. The median weight at presentation was 2.8kg (range 2.3 – 4.5kg). Fifteen weighe