An unusual case of rectal foreign body: Case report

Foreign bodies within the rectum are an infrequent occurrence with a wide variety of objects either inserted or swallowed. Many techniques of removal have been described to remove these objects in case series mainly in developed countries. We report a case of unusually large rectal foreign body we managed by sigmoidotomy with primary closure

Urolithiasis in Nairobi, Kenya

Background: Urolithiasis is an emerging problem in Kenya previously thought to be very rare and in which the use of modern methods of treatment has not been widely practicedObjective: To review the presentation and management of patients presenting with urolithiasis in Nairobi, KenyaDesign: A retrospective study Setting: The Nairobi hospital and Upper Hill Medical Centre a day care facility next to the Nairobi hospitalSubjects: One hundred and twenty five males and fifty three females aged 9 to 75 yearsResults: One hundred and seventy eight patients were treated for urolithiasis over a five-and- half year period. Their mean age was 44.8 years, and the median was 45 years The 178 patients required 262 procedures to achieve stone clearance. One hundred and two patients had ESWL, with an overall stone clearance rate of 95%. Twentythreepatients had PCNL; 18 as the first procedure and 5 after failed ESWL. Fifty-one patients had ureteroscopicManagement: Fourty seven had laser or pneumatic lithotripsy while four had stone removal by Dormia basket. Seven patients had bladder calculi managed by either cystolitholapaxy or forceps retrieval.Conclusions: This study demonstrates a higher annual incidence of urolithiasis in Nairobi than earlier literature. Study demonstrates that ESWL and ureteroscopic methods are highly effective in the treatment of renal and ureteral calculi as day care procedures

Cancer of the penis: case report

Two patients with penile carcinoma are presented after management at a district hospital in Kenya. Both had undergone ritual circumcision as teenagers and presented late. HR was a 73 year old who presented with a fungating penile mass for which a partial penectomy was performed after wedge biopsy confirmed malignancy. He thereafter declined to have the surgical specimen sent for histology and took the amputated stump for burial in his compound to avoid bad omen. GK was 25 years old and presented with a fungating mass and underwent partial penectomy after a histological diagnosis was made. He absconded from follow-up after being informed of the need for further surgery due to tumour infiltration of the surgical margins. The history and clinical images are presented and we discuss the difficulties of cancer management at a rural district hospital

Acute acalculous cholecystitis in an outpatient setting

Acute acalculous cholecystitis (AAC) typically affects hospitalized patients with critical illness. Outpatient AAC is reported to occur in elderly males with cardiovascular comorbidities. We report the presentation of acute acalculous cholecystitis in two young African men admitted for the first time within days of each other. They reported short histories of right upper abdominal pain and had tender gallbladders. Sonography revealed gallbladder wall thickening. Open cholecystectomy and histology confirmed AAC.The postoperative outcome was excellent. Recognition of AAC in a subset of young male patients presenting de novo with right upper quadrant pain is stressed. Cholecystectomy has good prognosis in these cases

Challenges of Parathyroidectomy in a Patient with Primary Hyperparathyroidism and End Stage Renal Disease- Case Report.

Hyperparathyroidism is an endocrinopathy affecting calcium metabolism. The leading cause of hypercalcaemia is primary hyperparathyroidism most often caused by a parathyroid adenoma. Symptomatic hyperclacemia secondary to parathyroid adenoma is usually managed by surgical excision of the adenoma1,2.We present a 54 year old female patient who presented with palpitations, general body malaise, nausea and headache on her index admission and managed for severe hypertension. She had been treated for hypertension for three years but with poor adherence to follow-up and medication. During her laboratory work up, her total calcium level was found to be elevated at 3.82mmols/l (2.2-2.5mmols/l).Her albumin level was normal. In addition, she was diagnosed with end stage renal disease and haemodialysis instituted. Parathyroid mass was diagnosed on a parathyroid 99Tc methoxyisobutylisonitrile (MIBI) scan. Parathyroidectomy was performed two months later and diagnosis of parathyroid adenoma was confirmed on histology of the excised tissues. Hypercalcemia resolved after the excision.The case report aims to highlight the challenges in the management of hyperparathyroidism in a patient with end stage renal disease scheduled for parathyroidectomy in a resource restricted tertiary hospital.Keywords: Parathyroidectomy, Hypercalcemia, Hypertension, Renal diseas

EARLY POSTOPERATIVE OUTCOMES OF PATIENTS UNDERGOING PROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA AT KENYATTA NATIONAL HOSPITAL, NAIROBI

ABSTRACTObjective: To describe early postoperative complications of prostatectomy.Design: A descriptive prospective study.Setting: Kenyatta National Hospital between 6th October 2003 and 21st June 2004.Subjects: Eighty five men undergoing prostatectomy for the relief of lower urinarytract obstruction due to benign prostatic hyperplasia. Procedures included suprapubictransvesical prostatectomy, retropubic prostatectomy and transurethral resectionof the prostate (TURP).Main outcome measures: Co-morbidity, intra-operative and early postoperativecomplications, need for re-operation, 30-day mortality, duration of postoperativecatheterisation, and duration of postoperative hospital stay.Results: Eighty five patients were included in the study and their age range was 46-85years (mean 66 years). Sixty nine (81%) of the patients underwent open prostatectomy,and sixteen (19%) underwent TURP. Twenty six patients had co-existing medicalconditions, the most common being hypertension (29%) and diabetes mellitus (13%).The most common intra-operative complication during prostatectomy washaemorrhage which occurred in ten patients (11.8%). One patient had perforation ofthe bladder during transurethral resection and required a laparotomy to repair thebladder. Wound sepsis was the most common postoperative complication followingopen prostatectomy (35%, n=69), and an association was found between wound sepsisand diabetes mellitus. Complications common to both open prostatectomy and TURPwere urinary tract infection (15%), clot retention (10%), pyrexia (10%) and pneumonia(8.2%). Three patients (4.4 %) required re-operation due to complications related towound sepsis. The duration of postoperative catheterisation ranged from 1-14 days(mean 6.66 days) while postoperative hospital stay ranged from 3-24 days (mean 8.16days). There was no postoperative mortality at 30 days.Conclusions: Open prostatectomy is the most performed procedure for the relief oflower urinary tract obstruction due to benign prostatic hyperplasia at KenyattaNational Hospital. Wound sepsis is the commonest early postoperative complicationand the presence of diabetes mellitus significantly increases the risk of developmentof wound sepsis

Early postoperative outcomes of patients undergoing prostatectomy for benign prostatic hyperplasia at Kenyatta National Hospital, Nairobi

No Abstract. East African Medical Journal Vol. 84 (9S) 2007: pp. S40-S4