Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria

Objective: To determine the incidence, pattern and outcome of obstructed abdominal wall hernia in a semi-urban and rural community.Design: A proforma was drafted to study all consecutive patients operated for obstructed anterior abdominal wall hernia over a period of five years. Clinical findings, preoperative treatment, operative findings and postoperative outcome were documented.Setting: Teaching hospital located in a semi-urban community comprising mostly agrarian population.Patients: A total 110 adult patients with obstructed anterior abdominal wall hernia who had operative intervention and other postoperative management.Results: There were 110 patients with 111 obstructed hernias, accounting for 26.4% of all abdominal wall hernias. The age ranged from 19 - 79 years with mean of 49.7 years. Males accounted for 81%. Inguinoscrotal hernia was the commonest occurring in 75.7%, 16.2% patients presented with inguinal hernia and five patients with femoral hernia. The greater proportion of inguinal hernia occurred in female. Eighty seven patients (79%) had emergency operations and elective in 23 patients (21%) who had spontaneous reduction while awaiting surgery. Ninety two percent of inguinoscrotal/ inguinal hernia were indirect. Omentum was trapped in 52 hernias (47.%), while in 15 patients (13.6%), gangrenous bowel segments were discovered. Scrotal oedema was the commonest complication accounting for 21%, while wound infection occurred in 20%. There were three deaths in elderly men with clinical symptoms and signs of acuteintestinal obstruction and gangrenous bowel segments, accounting for 2.7% of the patients. Twenty eight per cent of patients were discharged within the first and second postoperative days. Two patients spent 36 and 56 days each in the hospital.Conclusion: This study showed that 26.4% of abdominal hernia presented with obstruction. With inguinoscrotal hernia predominating: male accounted for 81% and 13.6% of the obstructed hernia contained gangrenous bowel segments. Post-operative complications were common, mortality occurring mainly in elderly patients with late presentation

Pattern of pathogens from surgical wound infections in a Nigerian hospital and their antimicrobial susceptibility profiles

Background: In surgical patients, infection is an important cause of morbidity and mortality. A prospective study to find the pattern of microorganisms responsible for post operative wound infections and their antibiotic susceptibility profile was therefore conducted.Setting and Methods: Surgical wards in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Isolation, identification and antimicrobial susceptibility screening of organisms were done employing standard microbiological techniques.Results: Bacterial pathogens were isolated from all the specimens while the yeast Candida species (spp) was isolated from 12.4%. Staphylococcus aureus was the most frequent organism isolated accounting for 23 (18.3%) of a total of 126 isolates. Other organisms were Pseudomonas aeruginosa and Bacillus spp 11.1% each; Escherichia coli 10.3%; Candida spp 8.7%; Coagulase negative staphylococci 8.7%; Pseudomonas spp 6.3%; Serratia odorifera 4.7%; Bacteroides 4.0%; Enterococcus spp 3.2%; the remaining isolates were other enterobacteria. Sensitivity of the bacterial isolates to antibiotics varied. In general, resistance to the β-lactam antibiotics was above 98%, whilst more than 70% of isolates were resistant to erythromycin, fusidic acid and tobramycin.Conclusions:The infections were polymicrobic and multidrug resistant. The quinolones, ciprofloxacin and ofloxacin, should be used as frontline drugs in the management of surgical wound infections at the hospital.Keywords: surgical wound infections, susceptibility, bacterial pathogens, antibiotic

Relations of the neck of groin hernia to pubic tubercle

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The Pattern and Outcome of Chest Injuries in South West Nigeria

Objective: The pattern and management outcome of chest injuriespresenting to our tertiary university hospital located in a semi-urbanpopulation in the South West of Nigeria, has not been documentedpreviously. We therefore sought to identify factors that may contributeto mortality.Method: We analyzed 114 patients presenting to the Accident andEmergency Unit with chest trauma, prospectively entered into a database over a two year period.Results: Chest trauma accounted for 6% of all trauma admissionswith a male preponderance (M:F = 3.6:1). Rib fractures were the mostcommon injury (46.3%) while limb fractures were the most commonassociated injury (35.8%). Associated head injury accounted for mostdeaths (56%) in those with severe ISS. Majority of patients (51.8%)required only analgesics, while additional closed tube thoracostomydrainage was necessary (41.8%) in the others who suffered blunttrauma. Thoracotomy was indicated for only 5 (4.5%) penetratinginjuries. There is a rising trend towards penetrating gunshot injuries,with mortality increasing with age (p=0.03) and severity of associatedinjuries (ISS) (p=0.003).Conclusion: Majority of the patients required only minimal interventionwith chest drainage or analgesics, with low mortality. Increasingage and severity of injury contributed significantly to mortality. Initiationof care for chest trauma victims is still delayed in our centre

Foreign Trade-Foreign Exchange Nexus in Nigeria: a Vector Error Correction Modelling Approach

This study investigates trade foreign exchange nexus in Nigeria. This study is also done with a view to detecting the kind of relationship that exists between the two and also to investigate their co-integration. Annual time series data for the period 1996 – 2010 was used for the study. The Vector Correction Model (VECM) approach was employed to determine both the short and long run relationships. Results showed that the series becomes stationary after second difference. The co – integration test reveals five co – integrating vectors in the model, implying that the variables have the same stochastic drift. The study concludes that a long-term relationship exists between foreign trade and exchange rates implying that foreign trade flows have a strong link with exchange rates in Nigeria

Indirect inguinal hernia: the implication of occupation in a semi-urban centre

Inguinal hernia is the commonest anterior abdominal wall hernia and increased intra-abdominal pressure is one of the risk factors of inguinal hernia formation. The objective of this study was to determine the effect of occupation on types of indirect inguinal hernia and its associated posterior wall defect in adult male patients in a semi-urban hospital. This was a prospective descriptive hospital based study conducted between February 2004 and February 2006 among ninety-two adult male patients. Patients were classified into three work groups based on their exposure to heavy lifting: the unskilled, the artisan and the professional. Types of indirect inguinal hernia were classified intra-operatively based on distal extent of fundus of the hernia sac into: bobunocoele, funicular and inguinoscrotal and their associated posterior wall defects was classified using Nyhus classification. All data were analysed using SPSS version 15 for windows with level of significance put at p < 0.05 for nonparametric tests. There were 38 Unskilled, 18 Artisan and 36 Professional. Comparing levels of occupation with types of indirect inguinal hernia was not statistically significant (x2 = 1.09, df = 2; p = 0.580). However, comparing levels of occupation with the posterior wall defect was statistically significant (x2 = 7.48; df = 2; p = 0.024); follow-up tests evaluating pairwise differences between the three levels of occupation and the posterior wall defect only show significant difference between the Unskilled and the Professional (p = 0.008). Levels of occupation in our environment appears unrelated to the types of indirect inguinal hernia, however, it has an influence on the degree of posterior wall defect in the Unskilled. There is a need to evaluate the optimal convalescent period in this group of workers post surgery, to allow for adequate wound healing before returning to active work; especially, where tension repair is still the main modality of treatment

Emergency non–obstetric abdominal surgery in pregnancy

Background: Despite recent advances in anaesthetic, perinatal and preoperative care, surgical intervention during pregnancy may still result in fetal loss from either spontaneous abortion (especially in the first trimester) or premature labor (especially in the third trimester). This study was aimed at determining the factors that affect fetal and maternal outcome following emergency non-obstetric abdominal surgery in pregnancy.Methods: We reviewed all cases of emergency non-obstetric abdominal surgery performed on pregnant women at Obafemi Awolowo University Teaching Hospital complex from January 1991 and December 2006. The socio-demographic characteristics, obstetric history, diagnosis and outcome of management were documented and analyzed.Results: A total of 46 pregnant patients presented with various conditions necessitating emergency non-obstetric abdominal surgery during the study period. Their ages ranged from 23 to 39 years with a mean age of 29.33 +/-4.904. Six (13%) of the patients presented during the first trimester, 32 (69.6%) patients during the second trimester and 8 (17.4%) were seen in the third trimester. Thirty-two (69.6%) patients presented with features of acute appendicitis out of 12 had ruptured appendicitis and 8 had appendicular abscess. Eight (17.4%) had intestinal obstruction, 5 (10.8%) had haemoperitonueum from abdominal injury and 1 (6.7%) had an ectopic foetus in bladder. Four (8.8%) mothers and 20(43.5%) babies died. Factors affecting maternal outcome included parity (P=0.010), duration of symptoms (P<0.0001) and delay in surgery (P<0.0001) while the factors affecting fetal outcome include maternal age (P<0.0001), booking status (P<0.0001), educational status (P<0.010), parity (P<0.040), gestational age (P=0.048) and delay in surgery (P=0.016).Conclusion: Complicated appendicitis is the most common indication for abdominal surgery in pregnancy in our center. High foetal loss seen in this study can be reduced by early presentation of the patients, early booking and high index of suspicion and prompt treatment by the attending surgeon

Crepe bandage in the management of soft tissue limb abscesses

Objective: To determine the necessity of continuous gauze packing of abscess cavities following incision and drainage of limb abscesses.Methods: Limb abscesses managed between January, 2001 and December, 2005 were prospectively studied. The wounds were packed for the first 24hrs for heamostasis after which the limbs were randomized into two groups. The first group had daily wound dressing with packing of the abscess cavity while the second group had daily dressing of the stoma only with external crape bandaging of the abscess cavity. The wounds were inspected weekly for healing and complications. Analysis was done using SPSS 13.0. The level of significance was put at p < 0.05Results: Eighty-seven limbs were studied in 33 patients, 19 were in the right upper limb, 16 in the left upper limb, 23 in the left lower limb and 29 in the right lower limb. The mean duration for the gauze packed wounds to heal was 7.0 ±1.08 weeks while the bandaged wound took 5.2 ± 1.71 weeks to heal. This was statistically significant (p < 0.000).Conclusion: Continuous wound packing in limb abscesses after the first 24hrs should be avoided. External crepe bandaging of the abscess cavity achieve faster healing

Generalized peritonitis secondary to typhoid ileal perforation: Assessment of severity using modified APACHE II score

BACKGROUND: Generalized peritonitis from typhoid ileal perforation is a common cause of surgical emergency in the developing countries, associated with high morbidity and mortality. The severity assessment of a disease condition is often useful to prioritise treatment and reduce morbidity and mortality. High severity scores are usually associated with high morbidity and mortality; therefore, these patients may require more intensive treatment than those with low severity scores. AIM: The purpose of this study was to assess the severity of generalized peritonitis from typhoid ileal perforation using modified APACHE II score. SETTING AND STUDY DESIGN: A teaching hospital unit serving the rural and semi-urban Nigerian community. It is a prospective study of patients with generalized peritonitis from typhoid ileal perforation. MATERIALS AND METHODS: Over a period of 7 years, patients had severity of illness assessed using modified APACHE II score. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Each patient had postoperative outcome and severity of illness were compared to determine the significance of the severity of illness on postoperative outcome. RESULTS: The mean age was of 23.6 \ub1 15.5 years, with 4:1 male: female ratio. Morbidity rate ranged from 8.8-71.3% and mortality in 17.5%. Modified APACHE II score ranged from 0-19, with a mean of 8.2 \ub1 4, 7.6 \ub1 4 for survivors and 9.4 \ub1 2 in those who died. There was no death among the patients who scored 0-4, whereas mortality was 13% in those who scored 5-9, 41.2% in those who scored 10-14, and 50% in patients who scored 15-19 (P<0.05). The modified APACHE II Score significantly influenced mortality, but did not influence the incidence of other postoperative complications. CONCLUSION: A high APACHE II score was associated with high mortality, but did not predict morbidity rate in the patients studied. More study is needed involving a larger number of patients to further validate our findings

Evaluation of patients' adherence to chemotherapy for breast cancer

The study aimed to establish the common reasons for non-adherence to drug treatment among breast cancer patients at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a ten-year period (Jan 1993 - Dec 2002). Patients' adherence and reasons for non-adherence to chemotherapy were evaluated using descriptive statistics. Two hundred and twenty-five breast cancer patients including 199 females and 6 males with breast cancer were recruited. 12(5.3%) patients had Stage I disease while 126 (56%) were in stage IV. The non-adherence rate was 80.9% and 111(73%) of the non-adherent patients were eventually not seen again. Of the one hundred and one patients who gave reasons for non-adherence, 45% complained of financial difficulties; 18% thought they were well enough; 15% were fearful of subsequent operation and 11% were unable to further bear the drug side effects. In conclusion, the study demonstrated poor economic status of the patients as one of the major reasons for non-adherence to cancer chemotherapy in Nigeria. Government subsidy of breast cancer treatment, improved health education and advocacy complemented by home visiting to encourage hospital attendance would be required for better adherence to chemotherapy