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

Relations of the neck of groin hernia to pubic tubercle

No Abstract

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

Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

<p>Abstract</p> <p>Background</p> <p>Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting.</p> <p>Methods</p> <p>A cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software.</p> <p>Results</p> <p>A total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97). There were 37 (29.1%) males and 90 (70.9%) females (M: F = 1:2.4). All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9%) and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females). The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3%) and 90.4% (males 92.9% and females 89.7%) respectively. The Positive Predictive Value and Negative Predictive Value were 95.2% (males 95.5% and females 90.6%) and 88.4% (males 89.3% and females 80.1%) respectively. The accuracy of MASS was 92.9% (males 91.5% and females 87.6%).</p> <p>Conclusion</p> <p>The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and can be employed at Bugando Medical Centre to improve the diagnostic accuracy of acute appendicitis and subsequently reduces negative appendicectomy and complication rates. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.</p

The Management of Acute Pancreatitis

No Abstract. IFEMED Journal Vol. 14 (1) 2008: pp. 55-6

Breast fine needle aspiration cytology in a Nigerian tertiary hospital

Objectives: Breast disease remains a major public health issue worldwide. It is the most common cancer among Nigerian women. Fine needle aspiration cytology (FNAC) is an important preoperative assessment tool along with clinical and mammography examination in both screen detected and symptomatic breast disease. This study provide opportunity to determining the accuracy of FNAC and factors affecting false negative rate in Obafemi Awolowo University Teaching Hospital complex, Ile-Ife, Osun state NigeriaMethod: All patients seen in the breast clinic with lump were sent to the pathology department for FNAC from January 1997 to December 2004.The sociodemographic data; cytology result, final histology result and the clinical staging for breast cancer were analyzed.Results: Eight hundred and sixty-four patients had FNAC during the studied period, however only 632 cases had available final histological report. Of these, 20 (3.2%) were male while 612 (96.8%) were female, the age ranged from 15 years to 99 years, median of 36.50. We found that absolute sensitivity for malignancy to be 70.8%. The false negative rate was 14.9%, while the false positive rate was 1.8%. The suspicious rate was 9.8% while the inadequate rate was 5.4%.Conclusion: FNAC remains the least invasive, the most rapid and the most cost effective method to confirm clinical and radiological suspicion of malignancy, however, the test has high false negative rate. We recommend that consultation between pathologists and the clinicians should be facilitated and encouraged to reduce the high false negative. Also, multi-disciplinary audits of difficult case should be part of the work routine