Femoral hernia at Mulago Hospital

Objective: To determine the incidence, pattern and the immediate outcome of femoral hernia surgery in Mulago Hospital.Methods: A hospital based descriptive study during which a questionnaire was drafted to study all consecutive patients operated for femoral hernia over a period of twelve months.Results: There were 13 patients with 13 femoral hernias accounting for 6.3% of all groin hernias operated on in the same period. The age ranged from 42 years to 70 years old with a mean of 54.6 years old. All the patients were females with 12 of them (92.3%) being parous. Ten (76.9%) presented with strangulation. Three had wound complications and one had chest infection post-operatively. More than fifty percent of patients were discharged within the first three post-operative days. There was no mortality.Conclusion: Though rare, femoral hernias have a high risk of strangulation and hence prone to adverse sequelae post-operatively. All medical officers should familiarize themselves with early diagnosis and operative intervention of this relatively rare but dangerous hernia

Groin hernia in Mulago Hospital, Kampala

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Pattern of major surgery among the elderly and aged patients seen in Kampala, Uganda

A cross sectional descriptive prospective study was conducted at three of  Kampala's tnain hospitals with the aim of determining the pattern of major surgery among the  elderly and aged patients over a six months period from 1" July to 31" December  1999. In the study, patients aged between 65 and 74 years were regarded as elderly while those aged 75 years and above were considered aged. A total of 196 patients  were included in the study. There were 152 (75.5%)males  and 46 (23.5%) females (M: F=3:1). More elderly patients than the aged were operated on. Only 25.3% of the emergencies. Operations on the  gastrointestinal tract were the commonest and   accounted for 36.9% of cases, followed by surgery of the genitourinary (30.8%) and cardiovascular (13.1%) systems. In 63% of cases, the operations were palliative. Wound sepsis was the commonest postoperative complication and accounted for  17.8% of all complications. There were 19 deaths, an overall mortality rate of 9.6%. Thirteen (68.4%) of all deaths occurred after operations on the gastrointestinal tract. The mean hospital stay was 11.6 days for both the elderly and aged. Both the short and long term outcome of both emergency and elective operations were good. The study confirmed that age should not be a contraindication to surgery

Childhood bone and soft tissue tumours: A review of 43 treated at two University Teaching Hospitals in Rwanda (CHUB and CHUK) in RWANDA

Back ground: Cancer represents one of the major causes of death in the world estimated at 1 out of 10 deaths. Globally, 160,000 children are diagnosed to have cancer each year. In the developing countries, one child out of two with cancer will die because of this disease mostly because they present with advanced disease or due to limited resources for proper management1,2. This study was aimed at determining the prevalence, the histological types and the management outcome of childhood bone and soft tissue tumours in RwandaMethods: A retrospective descriptive study of 43 histologically confirmed cases of bone and soft tissue tumours in children was done in the Surgery Departments of University Teaching Hospitals (CHUB and CHUK). The period of study was 6 years from January 2001 to December 2006. Only children aged 16 years or below were included in the study. Data was obtained from patients clinical files, pathology register and theatre registers. Information obtained was recorded using a special questionnaire; Data obtained was analyzed using Epidata 2.1b, SPSS 11.5 computer programs. Statistic test Pearson Chi-carré (P) was considered significant if P value was less than or equal to 0.05.Results: During 6 years period, 43 children aged 2 to 16 years were seen having bone and soft tissue tumours. Males accounted for 28 (65.1%) of the cases. The 10 to 16 year age group was predominantly affected, accounting for 72% (n=31) of all cases.. Pain and swelling were the main clinical signs in 100%of cases. Tumours were benign in 17 (40%) and malignant in 26 (60%) of cases. History of local trauma and pain was associated with malignant bone tumours (P=0.003 and P=0.000), respectively (n=23). Delay time between the onset of symptoms and consultation to hospitals was associated with death for malignant tumours (P=0.049). The bones were affected in 76.7% (n=33), being malignant in 23 (69.7%)of them. The hospital mortality rate was 18% for malignant tumours. Pulmonary and bone spread of the disease were observed in all fatal cases.Conclusion: Limitation of diagnostic and therapeutic means and lack of an oncology department that would provide chemotherapy and radiotherapy) in our University teaching hospitals (CHUB and CHUK) made the management of malignant tumours and the follow up after discharge inadequate, unsuitable and difficult

Causes and Patterns of Peritonitis at St. Francis Hospital Nsambya, Kampala - Uganda

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Surgical camps: the Ugandan experience

Over a period of one week, a surgical team visited three hospitals in two districts of Northern Uganda to offer free surgical services and to teach basic surgical skills to  up-country doctors. The team, consisting of 10 surgeons in various specialities, two anaesthetists and two surgical residents, saw 500 patients, of whom 272 had surgery. This was the frrst such surgical camp organised by the Ugandan surgeons. This paper describes the pattern of surgical operations performed and the benefits gained from such a camp

POSSUM scoring system in patients undergoing laparotomy in Mulago Hospital

Background: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction in surgery. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) was used to score and predict the outcomes of Laparotomy in Mulago Hospital. The main objective of this study was to determine the morbidity and mortality POSSUM scores for patients who underwent Laparotomy in Mulago Hospital, between September 2003 and February 2004.Methodology: Consecutive patients, who underwent a Laparotomy in the three surgical wards in Mulago Hospital, were scored using POSSUM system. For each patient the predicted risk of mortality and morbidity was calculated from POSSUM equation. Multivariate logistic regression analysis was used to determine the relationships between the predicted and observed morbidity and mortality rates. Postoperative complications and mortality within 30days were described.Results: Seventy-six patients were studied. The observed and expected mortality and morbidity rates were 14.5%, 2.6% and 35.4%, 0% respectively. Physiological scores, operative scores, co morbid condition such as Diabetes Mellitus significantly determined the outcomes.Conclusion: POSSUM scoring system can be used to predict the risk of mortality but not morbidity for patients admitted to a surgical ward in Mulago Hospital.Recommendations: The POSSUM scoring system can be used in decision-making process before a Laparotomy is carried out

Day care surgery: The norm for elective surgery

In the modern day hospitals, there is an established principle of ambulating the surgical patient as early as possible. This idea has gone a step further by discharging the post-operative patient home as soon as the critical period or immediate post-operative nursing needs have been met with. This has led to the concept of day care surgery. The notion of day care surgery goes back to the days of Dr. Nicoll, a surgeon and founder of modern ambulatory surgery, who published his landmark article on the surgery of infancy in 19091. He described a 10-year surgical experience at the outpatient clinic in the Glasgow Hospital for Sick Children in which 8988 patients were treated as outpatients after operation. Nearly onehalf of the patients were children less than 3 years of age. Dr. Nicoll performed 7392 of these operations himself. They included hare lips, cleft palates, hernias, and the like. His astounding accomplishments and philosophy, especially his criticism of hospitalization and his insistence on getting the children back to their nursing mothers as soon as possible has gained global acceptance with the result that during the last two decades, many different countries have experienced a spectacular change from inpatient to day-surgery.  Currently day care surgery is the norm rather than the exception

Peritonitis outcome prediction using mannheim peritonitis index at St.Francis Hospital Nsambya, Kampala - Uganda

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A case report of Munchausen syndrome

We report a case of a 31-year old female patient who pregented to Mulago Hospital with symptoms suggestive of intestinal obstruction and gave a complicated past history  which included thirteen previous operations in seven different hospitals over a period of about twelve years. She underwent a laparotomy at which no intestinal obstuction was found.In retrospect we diagnosed her as suffering from the rare Munchausen syndrome. The paper discusses the characteristic clinical features, differential diagnoses and management of this interesting syndrome