Delayed presentation of blunt traumatic diaphragmatic hernia: A case report

Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in poly-traumatized patients. Diagnosis is often difficult resulting in delayed presentation and increased morbidity. We report a case of blunt traumatic diaphragmatic hernia in a 39-year-old man presenting 10 years after the initial abdomino-thoracic injury sustained in a road traffic accident. He had herniation of the spleen and stomach. Through a left thoracotomy, the herniated organs were reduced and diaphragmatic defect closed with interrupted nylon sutures. A high index of suspicion would minimize the morbidity and mortality associated with delayed diagnosis. Keywords: trauma, diaphragmatic hernia, delayed presentation Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 323-32

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

Lower limb amputation in Jos, Nigeria

Objective: To determine the pattern of lower limb amputation (LLA) and highlight preventable causes in our hospital. Design: A retrospective study. Setting: University Teaching Hospital, Jos, Nigeria. Subjects: Eighty seven patients who had LLA over a five and a half year period. There were 62 males and 25 females aged between three and 83 years (mean±SD = 44.5 ± 21.1). Main outcome measures: Indications, morbidity and mortality. Results: A total of 94 LLA were performed in the 87 patients managed. Trauma, diabetic foot sepsis and malignant conditions of the limb were the main indications for LLA in 26(29.9%), 23(26.4%) and 20(23%) patients respectively. Others were peripheral vascular gangrene (PVG) in eight (9.2%) patients; chronic osteomyelitis, three (3.5%); chronic leg ulcers, three (3.5%); Ainhum, three (3.5%) and snake bite in one patient (1.1%). Above knee amputation (AKA) was the most common procedure performed (48.9%) followed by below knee amputation (BKA) in 37.2%. There were 11 deaths (12.6%), out of which eight were due to sepsis with multiple organ failure following diabetic foot sepsis, two cases of clostridial myonecrosis complicating compound fractures and a case of metastatic osteosarcoma in a child. Conclusion: Majority of the cases of LLA could have been avoided with early presentation and appropriate management. A case is made for community health education on the need for early presentation to hospital for limb lesions. East African Medical Journal Vol.81(8) 2004: 427-42

Amputations Following Traumatic Limb Injuries In Jos, Nigeria

AIM: To describe the pattern of amputation following trauma in our institution with the view to identify preventable causes and suggest ways of reducing post-traumatic limb loss. PATIENTS AND METHODS: A retrospective study of all cases of limb amputations following traumatic injuries seen in Jos University Teaching hospital over a 5-year period (March 1992 – February1997). RESULTS: A total of 65 amputations were performed in 55 patients with traumatic limb injuries over the study period. There were 45 males and 10 females (M:F = 4.5:1). There ages ranged from 3 years to 70 years ( mean ±SD = 21.6 ±12.5). The peak age incidence of 49.1% occurred in the first decade of life. Vehicular injuries and falls were the leading causes of trauma accounting for 32.7% and 27.3% respectively. Late presentation was common. Initial treatment by traditional bone setters was noted in 21of the 27 children aged 16 years and below compared to seven of the 28 adults above 16 years (x2 = 15.33;

Outcome of traditional bone setting in the Middle belt of Nigeria

Background: This hospital based study was designed to elucidate the outcome of Traditional Bone Setting (TBS) practice in four states of the middle belt of Nigeria, via complications presenting in select hospitals.Methods: A combination of retrospective and prospective study of complications arising from traditional bone setting in Plateau and Nasarawa States and southern parts of the Kaduna and Bauchi States was undertaken.Results: Fifteen patients were retrospectively studied in the one year period between December 1999 and November 2000 inclusive, while seventy-six patients were recruited into a 1 year prospective study(January 2001 to December 2001). There were sixty-nine males and twenty-two females giving a male: female ratio of 3.1:1. The mostfrequently encountered patients were children in the first decade of life (34.1%), while the 3rd and 4th decades accounted for 20.9% and 18.7% respectively. 61.5% of the study population were residents inJos, Plateau State, and 19.8% were admitted from Nasarawa State. 12.1% came from Kaduna State while 6.6% were recruited from Bauchi State. The study population cut across all social strata with a preponderance of illiterates, children and primary school certificate holders. The presenting injuries clustered around femur, tibia and fibula, humerus and forearm with 19.61 each. These were followed by dislocations of hip, elbow and shoulders (15.2%). The presentation of complications included non union (13.1%), mal union (21.5%), volkman’s ischaemic contractures and compartment syndrome (8.4%), infections (24.4%), stiffness/ankylosis (15.9%) and gangrene (8.4%) among others. Eight two orthopaedic interventions were carried out ranging from minor procedures to open reduction and internal fixations (15.9%), amputations (7.3%) and arthroplasties (4.9%). Five  portalities were recorded giving a mortality rate of (5.5%).Conclusion: 91 complications with 5 mortalities, largely avoidable in two years calls for a serious look at traditional bone setting practice in the Middle Belt of Nigeria. We recommend that other zones undertake similar studies so that a national picture would emerge and policy dialogue initiated

Long survival ( 21 years) after portoenterostomy for biliary atresia: A case report and review of complications

Long term survival for decades after portoenterostomy (Kasai procedure) for biliary atresia is rare and the association of portoenterostomy with liver cirrhosis is well known. Not much attention was given in the evaluation of the imaging features of cirrhosis caused by portoenterostomy as received by other known usual causes of cirrhosis. We presented a case of a Nigerian with confirmed biliary atresia at birth, that suvived portoenterostomy performed at two months of age for 21years. The cirrhotic presentation at imaging was that of prominent volume redistribution with less parenchymal changes in the liver. The long term survival and the type of cirrhotic presentation on imaging in this case is worthy of note for the record

Children In Civil Crisis: The Jos Experience

OBJECTIVE: This article examines the effects of the September 2001 and May 2002 civil crises in Jos, Nigeria, on children and their health in order to make recommendations. METHODS: Between 7th and 12th September 2001, and on 2nd May 2002, Jos town and its environs experienced intense civil crises that were orchestrated by religious and ethnic grievances. The victims of those crises that were managed at the Jos University Teaching Hospital were studied. We retrospectively reviewed the victims' accident and emergency notes, operation registers and case files. Information extracted included demographic data, mechanism, nature and site of injury, type of weapons, treatment and outcome of management. RESULTS: A total of 463 patients were managed as a result of the crises, but complete data were available for analysis in 389. Out of the 389, 61 (15.7%) were children

The acute scrotum: Aetiology, management and early outcome-preliminary report

No Abstract. Nigerian Journal of Medicine Vol. 14(3) 2005: 267-27

Acute appendicitis in inguinal hernia: report of two cases

We report two cases of acute appendicitis in right incarcerated inguinal hernia (Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy. Posterior wall was repaired using nylon darn in both cases. Acute appendicitis should be considered in the differential diagnosis of obstructed right inguinal hernia. East African Medical Journal Vol.81(9) 2004: 490-49