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

Open hemorrhoidectomy under local anesthesia for symptomatic hemorrhoids; our experience in Ile –Ife, Nigeria

Background: Ligation-excision hemorrhoidectomy is considered the gold-standard treatment for prolapsed hemorrhoids. The procedure is commonly done under general or regional anesthesia. This study is aimed to assess the feasibility and tolerability of open – hemorrhoidectomy under local anaesthesia in our setting.Methods: This is a prospective study carried out in Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria, over a 5-year period. All consenting adult patients with prolapsing hemorrhoids were offered Milligan – Morgan hemorrhoidectomy under local anesthesia. They were assessed for tolerance and complications.Results: More than 95% of patients tolerated the procedure with manageable complications.Conclusions: Open excisional hemorrhoidectomy under local anesthesia is feasible, safe and well tolerated in our environment and may encourage early presentation of patients with piles to hospital.Keyword: Open hemorrhoidectomy, local anesthesia, Nigeria

Ambulatory Epigastric Hernia Repair Using Local Anaesthesia: A Pragmatic Approach In A Resource Poor Society

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A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

Background: Gastro-duodenal perforations are common and may complicate peptic ulcer disease. Management is often by surgical closure.Objective: To determine the patterns of presentation and mode of management of duodenal ulcer perforations.Methods: Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011. Patients’ records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications. Data obtained was analyzed using SPSS 15.0.Result: Forty- five patients were reviewed. There were 37 males (82.2%). Mean age was 39.7years (range 15-78years). There were 10 (22.6%) students and 8(17.8%) farmers. NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases. Seven (16%) patients presented less than 24 hours of onset of illness. Forty one perforations (91.1%) involved the first part of duodenum. Twenty two (49%) patients had Graham’s omental patch. We had one (2.2%) failed repair and six (13.3%) mortalities. Conclusion: Late presentation of duodenal ulcer perforation is common with high mortality. Pragmatic surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.Keywords: Duodenal ulcers, perforations, management, NigeriaAfrican Health Sciences Vol 13 Issue 4 December 201

Metastatic breast cancer in a Nigerian tertiary hospital

Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome.Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital.Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were reviewed.Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3% (6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63%), lung parenchyma (51%), pleura (26%) and contralateral breast in 25%. On immunohistochemistry, basal like tumours were found in 46.1%. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27%.Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation

Metastatic breast cancer in a Nigerian tertiary hospital

Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome.Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital.Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were reviewed.Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3% (6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63%), lung parenchyma (51%), pleura (26%) and contralateral breast in 25%. On immunohistochemistry, basal like tumours were found in 46.1%. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27%.Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation