Challenges of Hirschsprung’s disease presenting in an adult: a case report

Hirschprung’s disease is rare in adults; it is often misdiagnosed or undiagnosed. We present a 34 year old man illustrating the clinical characteristic of the pathology, the diagnostic clues and assessing the therapeutic approach. Definitive diagnosis is established on histology specimen from the rectum and the disease was confined to the rectosigmoid .Treatment involved sigmoid colostomy, anterior resection with colorectal anastomosis with a posterior myotomy

Childhood Wilm’s tumour in Aba, South East Nigeria

Background: Wilm’s tumour is still a problem to paediatric oncologist in developing countries due to poverty, late presentation, high cost of chemotherapeutic drugs, ignorance and religious beliefs. Objective: To review the clinical presentation, management and outcome of Wilm’s tumour in Aba, South East Nigeria. Methods: The Demography, clinical presentation, investigation results, operative findings and outcome of patients less than 15 years old managed for Wilm’s tumour at the paediatric surgery unit of the Abia State University Aba, South East Nigeria from 2010 to 2020 were retrospectively reviewed. Results: There were 30 children (M: F 2 :1) with histological confirmed nephroblastoma over the 10 year period. Their median age was 5. Age range 4-15years. Palpable abdominal mass was the main presentation in all the patients. Treatment consisted of nephro-ureterectomy followed by adjuvant chemotherapy with Vincristine, Cyclophosphamide and Actinomycin D. Adriamycin was added for metastatic disease and anaplasia. Fifteen of the patients had stage III disease, 10 had stage II disease and 5 had stage IV disease. Stage I disease was not encountered. Five patients had inoperable tumour requiring preoperative chemotherapy. Five patients died from the complication of chemotherapy treatment. Seven relapsed with poor outcome, with a mean follow up of 20 months, 20months survival rate is 40%. Conclusion: There is high rate of morbidity and mortality from nephroblastoma in our environment due to late presentation, poverty, ignorance and poor compliance to treatment. The outcome will be improved through health enlightenment and healthcare funding

Case Report: Profile of Paediatric Umbilical Hernias Managed at Federal Medical Centre Umuahia

BACKGROUND: Umbilical hernias are common in children but many resolve spontaneously within the first five years of life .Most umbilical herniorrhaphies in our environment are due to symptomatic hernias which constitute a small percentage of all umbilical hernias.PATIENTS AND METHODS :A retrospective review of all pediatric patients with UH treated at Federal Medical Centre Umuahia ,Abia State from February 2001 to February 2011.RESULTS: There were 22 patients but only 20 of the folders were found and analyzed .They were made up of 11males and 9females with a mean age of 6.19±0.83years and median age of 6years.Nine(7 males and 2 females) had acute incarcerations ,nine(3 males and 6 females) had recurrent umbilical pains without incarceration and two(1 male and 1 female) had recurrent incarcerations .Age range for acute incarceration was 2-8years(mean:4.69years,median :4years);recurrent umbilical pains was 4months-15 years(mean:7.7years,median:8years) and for recurrent incarceration 2-10years(mean:6years).All had standard umbilical hernia repairs except one whose parents declined surgery after reduction of acute incarceration .One patient with acute incarceration had gangrenous bowel with hernia sac abscess and was offered bowel resection with end-to-end anastomosis .On short-term follow-up ,the symptoms resolved in all the patients following surgery .Five patients had six complications:1 exuberant granulation tissue,2 stitch reactions,2 superficial wound dehiscence and one superficial wound infection .There were no mortalities and no recurrence on short-term follow-up .Only one patient(5%)registered under the National Health Insurance Scheme(NHIS).CONCLUSIONS: Active observation of all umbilical hernias at all ages will ensure early detection of complications and prompt treatment .Elective repair of umbilical hernias in patients above five years with fascia defect greater than 1.5cm is encouraged .Comprehensive NHIS will ensure early presentation and reduced complications.KEY WORDS : Pediatric ;Umbilical ;Herni

Indications and outcome of childhood preventable bowel resections in a developing country

Background: While many bowel resections in developed countries are due to congenital anomalies, indications for bowel resections in developing countries are mainly from preventable causes. The aim of the following study was to assess the indications for, morbidity and mortality following preventable bowel resection in our centre. Patients and Methods: Retrospective analysis of all cases of bowel resection deemed preventable in children from birth to 18 years from June 2005 to June 2012. Results: There were 22 preventable bowel resections with an age range of 7 days to 17 years (median 6 months) and male:female ratio of 2.1:1. There were 2 neonates, 13 infants and 7 older children. The indications were irreducible/gangrenous intussusceptions (13), abdominal gunshot injury (2), gangrenous umbilical hernia (2), blunt abdominal trauma (1), midgut volvulus (1), necrotizing enterocolitis (1), strangulated inguinal hernia (1), post-operative band intestinal obstructions (1). There were 16 right hemicolectomies, 4 small bowel resections and 2 massive bowel resections. Average duration of symptoms before presentation was 3.9 days (range: 3 h-14 days). Average time to surgical intervention was 42 h for survivors and 53 h for non-survivors. Only 19% presented within 24 h of onset of symptoms and all survived. For those presenting after 24 h, the cause of delay was a visit to primary or secondary level hospitals (75%) and ignorance (25%). Average duration of post-operative hospital stay is 14 days and 9 patients (41%) developed 18 complications. Seven patients died (31.8% mortality) which diagnoses were irreducible/gangrenous intussusceptions (5), necrotising enterocolitis (1), midgut volvulus (1). One patient died on the operating table while others had overwhelming sepsis. Conclusion: There is a high rate of morbidity and mortality in these cases of preventable bowel resection. Typhoid intestinal perforation did not feature as an indication for bowel resection in this series

Right paratesticular abscess mimicking neonatal testicular torsion and caused by Proteus mirabilis

AbstractThe clinical presentation of neonatal paratesticular abscess may closely resemble that of, neonatal testicular torsion and the use of scrotal ultrasonography to differentiate the two has low, sensitivity. We propose early operative treatment of suspected neonatal testicular torsion to salvage, the testicle in cases of paratesticular abscesses. This is a report of the successful transinguinal, drainage of a right neonatal paratesticular abscess preoperatively diagnosed as testicular torsion and, caused by Proteus mirabilis. The testicle was salvaged

Acute Appendicitis- Seasonal variation in incidence in Aba, Southeast Nigeria

Background: Acute Appendicitis is one of the commonest surgical emergencies worldwide. The incidence in age, sex and relation to seasons of the year show wide variations globally.Objective: to ascertain if there is a seasonal variation in the incidence of acute appendicitis in Aba, Southeast Nigeria, using 3 Hospitals.Design: Prospective study.Setting: Abia State University Teaching Hospital, Jonex Hospital, Living Word Mission Hospital- all in Aba, Southeast Nigeria.Subjects: patients with clinical and histological diagnosis of acute appendicitis at the Abia State University Teaching Hospital, Aba, Living Word Mission Hospital and Jonex Hospital in Aba, Southeast Nigeria. These patients were recruited into this 5- year prospective study which spanned from January 2014 to December 2018. The date of admission, biodata, clinical diagnosis and histological diagnosis were captured in a proforma designed for the study. Results were analyzed using SPSS Programme Version 21 and presented in tables and figure.Results: Three hundred and twenty-one cases of acute appendicitis were seen during this period. 55% were males. There was a steady increase in the incidence of acute appendicitis over the years. In each of the years, the highest incidence was between November and March.Conclusion: This study shows a monthly variation in the incidence of appendicitis in Aba, with higher incidence in the warm and dry months of the year and lower incidence in the wet and humid months of the year