Imperforate Hymen - a rare cause of acute abdominal pain and tenesmus: case report and review of the literature

Imperforate hymen is a rare condition that presents with amenorrhea, cyclical abdominal pains and urine retention among pubertal girls. A 14 year old girl with imperforate hymen underwent hymenotomy for  hematocolpometra, having presented with abdominal pains and tenesmus.Key words: Imperforate hymen, amenorrhea, pubertal girls, urine retentio

The Surgeon and Advocacy

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The ‘Vanishing Breast’: An Unusual Presentation of Infiltrating Ductal Carcinoma

Introduction: Breast cancer is a leading cause of cancer related morbidity and mortality world over. Most cases will present as palpable lump or bloody nipple discharge. However, there are cases of atypical presentation in the literature.Case summary: We report a case of a 50 year old female with infiltrating ductal carcinoma presenting as spontaneous reduction and complete loss of breast tissue.Conclusion: Breast cancer presentation can be atypical and non-specific. There is need for Kenyan females to take up radiological screening.Key words: Breast cancer, vanishing breast, breast self examination, pleurodesis

The Presentation Of Cryptorchidism At Consolata Hospital Nyeri

Introduction: Cryptorchidism is the commonest birth anomaly in boysbut data on the entity is scarce in Kenya. Neither population nor facilitybased study documenting the condition is available.Objective: To determine the age of presentation, presenting complaintsand findings among patients with cryptorchidism in Consolata hospital Nyeri, Kenya.Methods: We carried out an eight-year retrospective study by analysingall the cases of cryptorchidism operated on in our theatre usingthe available patients’ records.Results: A total of 54 patients with 71 undescended testes were analysed. The median age of presentation was 9.0 years (ranging from 0.58 to 80 years). Of the cases analysed, 31.48% were bilateral, 33.33% right sided and 29.63% left sided. The main presenting complaint was empty scrotum in 82.98% of the cases. Intra-operatively, 8.5% of the testes were at the deep inguinal ring, 8.5% at superficial inguinal ring and 5.6% at mid-inguinal regional. The location of the testes in 56.3% of the cases was not indicated. Orchidopexy was performed in 88.7% of the cases.Conclusion: Cryptorchidism is common a n d across all age groups with most of patients presenting to hospital late. Early diagnosis and orchidopexy is recommended

Hernia Surgery in Nyeri Provincial General Hospital, Kenya: Our 6 Year Experience

Introduction: Hernia is a common surgical condition world over. Much of hernia surgery in Africa is carried out as an emergency while elective procedures are few. Knowledge of the burden of hernia disease would facilitate optimal resource allocation. Methods: A retrospective audit between 2007 and 2012 was carried out in Nyeri Provincial General Hospital. Results: Hernia surgery accounted for 5.9% (N=239) of all surgeries excluding obstetric operations. The male to female ratio was 1.6:1 and 35.6% were aged below 5 years. Inguinal hernia was the most common type (51.4%) followed by umbilical (21.5%), epigastric (17.5%), incisional (6.2%) and hiatus hernia (3.4%). A painless abdominal or groin swelling was the most common presentation (81.6%). All cases underwent open surgical repair with 93.8% of the operations done electively. The average length of hospital stay was 3 days. Of the inguinal hernias, 81.3% were right while 18.7% were left sided. Methods of inguinal hernia repair included Modified Bassini (79%), Shouldice 4% and Mesh (19%). Surgery was done under general, spinal or local anaesthesia (86%, 12% and 2% respectively). Conclusion: Hernia disease continues to be a significant source of morbidity in our set-up. While majority of the cases can be handled as elective cases, uptake of mesh repair remains low.Key Words: Hernia surgery, Herniorapphy, Groin hernia, Mesh repai