A Review of Posttraumatic Bowel Injuries in Ibadan

Background. Bowel injuries are a leading cause of morbidity and mortality following trauma. Evaluating patients who sustained abdominal trauma with bowel injury may pose a significant diagnostic challenge to the surgeon. Prompt recognition and timely intervention is necessary to improve outcome. Aim. This study was undertaken to evaluate treatment and outcome of patients with bowel trauma. Methods. A 5-year retrospective study of all patients presenting with abdominal trauma requiring surgical intervention seen in the UCH Ibadan, Nigeria was undertaken. Results. There were 71 patients (59 males and 12 females). The majority of cases (70%) occurred between the 3rd and 5th decades of life. Some 37 patients (52%) sustained blunt abdominal injury, while 34 patients (48%) sustained penetrating abdominal injury. There were 27 patients with bowel injuries (38%). Isolated bowel injuries occurred in 19 patients (27%). The most common surgical operation performed was simple closure. There were 3 deaths in patients with bowel injuries. Conclusion. Most cases of bowel injury can be managed by simple closure, a technique that is not so technically demanding for surgeons in less-developed countries. This study has also incidentally identified a “rule of six” for patients with bowel injuries and abdominal trauma

Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

<p>Abstract</p> <p>Background</p> <p>Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.</p> <p>Methods</p> <p>Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding.</p> <p>Results</p> <p>The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.</p> <p>Conclusions</p> <p>The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.</p

Faecal Impaction Presenting as Acute Appendicitis: A Report of 2 Cases

This paper highlights different manner in which faecal impaction presents i.e. with acute severe right lower quadrant abdominal pain. Two illustrative cases of young adult males are presented, they had clinical features suggestive of acute appendicitis, which turned out to be due to faecal impaction. Digital rectal examination and plain abdominal x-rays were helpful in the diagnosis of faecal impaction. The simple treatment of soap and water enema with oral liquid paraffin ensured that unnecessary appendicectomies were avoided. Interestingly one of the patients developed an acute appendicitis 5 months after his initial presentation when he had recurrent faecal impaction. He had an appendicectomy performed. A cause and effect relationship between faecal impaction and acute appendicitis is also discussed briefly. (Nig J Surg Res 2001; 3: 93 –99) KEY WORDS: Right Lower Quadrant Pain, Appendicitis, Faecal Impactio

HOW I DO IT: Technique of Hepatectomy for Primary Liver Cell Carcinoma in a Developing Country.

The experience in managing a 36 year-old Nigerian male with a histopathologically confirmed hepatocellular carcinoma confined to the left lobe by surgical resection of the liver, using the finger-fracture technique is presented. The literature review on the aetiopathogenesis of this disease and the role and technique of surgery in hepatocellular carcinoma is also discussed

Adenomatous Polyposis Coli in an Elderly Female Nigerian

Colorectal cancer is reported to occur in lower rates in Africans and some of the reasons adduced include a rarity of polyposis coli syndromes. Only two cases of polyposis coli have been documented in Nigeria in the last 15 years. The present case is an elderly lady who had radiologic and colonoscopic evidence of multiple colonic polyps. She had a colonic resection and the histology was reported as multiple polyposis coli, follicular hyperplasia and submucosal fibrosis in the appendix, and reactive hyperplasia in the mesenteric lymph nodes. There was no evidence of malignancy. This is the first case report of polyposis coli in a living elderly patient in Nigeria