Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria

Background. Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these.Objective. To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010.Methods. This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes.Results. Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001).Conclusion. There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade

Indirect inguinal hernia: the implication of occupation in a semi-urban centre

Inguinal hernia is the commonest anterior abdominal wall hernia and increased intra-abdominal pressure is one of the risk factors of inguinal hernia formation. The objective of this study was to determine the effect of occupation on types of indirect inguinal hernia and its associated posterior wall defect in adult male patients in a semi-urban hospital. This was a prospective descriptive hospital based study conducted between February 2004 and February 2006 among ninety-two adult male patients. Patients were classified into three work groups based on their exposure to heavy lifting: the unskilled, the artisan and the professional. Types of indirect inguinal hernia were classified intra-operatively based on distal extent of fundus of the hernia sac into: bobunocoele, funicular and inguinoscrotal and their associated posterior wall defects was classified using Nyhus classification. All data were analysed using SPSS version 15 for windows with level of significance put at p < 0.05 for nonparametric tests. There were 38 Unskilled, 18 Artisan and 36 Professional. Comparing levels of occupation with types of indirect inguinal hernia was not statistically significant (x2 = 1.09, df = 2; p = 0.580). However, comparing levels of occupation with the posterior wall defect was statistically significant (x2 = 7.48; df = 2; p = 0.024); follow-up tests evaluating pairwise differences between the three levels of occupation and the posterior wall defect only show significant difference between the Unskilled and the Professional (p = 0.008). Levels of occupation in our environment appears unrelated to the types of indirect inguinal hernia, however, it has an influence on the degree of posterior wall defect in the Unskilled. There is a need to evaluate the optimal convalescent period in this group of workers post surgery, to allow for adequate wound healing before returning to active work; especially, where tension repair is still the main modality of treatment

Splenic injuries in a semi urban hospital in Nigeria

Background: The management of splenic injury has changed dramatically over the last two decades. The objective of this study is to evaluate splenic injuries in our community and factors affecting the outcome of treatment modalities.Methods: A prospective descriptive study of 73 patients treated for splenic injuries in our surgical unit between 1991 and 2006 was carried out. Data were collected on the nature of their injuries, treatment modalities and their outcome. All the data were analyzed using SPSS 13 software for windows.Results: The ages ranged from 3 to 65 with a mean of 24.2 years. Seventy of these patients sustained their injuries from blunt trauma and road traffic accidents accounted for 55 cases. Forty of these patients sustained isolated splenic injury while the remaining thirty three were multiply injured. Majority of our patients (93.8%) were treated operatively Fifty-three (72.6%) of the 73 patients had splenectomy and twenty (27.4%) had splenic preservation. Post operative complications were recorded in sixteen patients. There were eight deaths all occurring in multiply injured.Conclusion: Only 6.8% the patients had non-operative management. Factors that significantly affected patients’ recovery and good outcome were: age of the patient, cause of injury, accident and emergency systolic blood pressure, intra-operative blood transfusion and the amount of haemoperitoneum. Vehicular motor accident remains the commonest cause of splenic injury in our community with high rate of associated injuries and the need for inter-specialty care of these patients

Challenges of Pancreatic Cancer Management in a Resource Scarce Setting

Backgrounds: Of all forms of gastrointestinal malignancy, adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence, sociodemographic characteristics, managements and management′s outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients. Material and methods: We reviewed 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex, Ile -Ife, Nigeria, from July 1989 to July 2007. Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1% of all malignancies seen and 238/100000 total admissions during the study period. The median age is 55.0. There were 62 (64.6%) male and 34 (35.4%) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1%) patients has tumor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had pancreaticoduodenectomy, one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation, had poorer prognosis than other patients. Conclusion: Pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis, screening, treatment and research

Breast Fine Needle Aspiration Cytology In a Nigerian Tertiary Hospital

Objectives: Breast disease remains a major public health issue worldwide. It is the most common cancer among Nigerian women. Fine needle aspiration cytology (FNAC) is an important preoperative assessment tool along with clinical and mammography examination in both screen detected and symptomatic breast disease. This study provide opportunity to determining the accuracy of FNAC and factors affecting false negative rate in Obafemi Awolowo University Teaching Hospital complex, Ile-Ife, Osun state Nigeria Method: All patients seen in the breast clinic with lump were sent to the pathology department for FNAC from January 1997 to December 2004.The sociodemographic data; cytology result, final histology result and the clinical staging for breast cancer were analyzed. Results: Eight hundred and sixty-four patients had FNAC during the studied period, however only 632 cases had available final histological report. Of these, 20 (3.2%) were male while 612 (96.8%) were female, the age ranged from 15 years to 99 years, median of 36.50. We found that absolute sensitivity for malignancy to be 70.8%. The false negative rate was 14.9%, while the false positive rate was 1.8%. The suspicious rate was 9.8% while the inadequate rate was 5.4%. Conclusion: FNAC remains the least invasive, the most rapid and the most cost effective method to confirm clinical and radiological suspicion of malignancy, however, the test has high false negative rate. We recommend that consultation between pathologists and the clinicians should be facilitated and encouraged to reduce the high false negative. Also, multi-disciplinary audits of difficult case should be part of the work routine

A huge low-grade fibromyxoid sarcoma of small bowel mesentery simulating hyper immune splenomegaly syndrome: a case report and review of literature

Introduction: Low-grade fibromyxoid sarcoma (LGFMS) is a rare non epithelial tumour. It usually arises from the smooth muscles of the extremities. It is, however, occasionally reported to arise from other regions of the body. Case report: We report the case of a 32 year old man who complained of a progressive abdominal swelling of 4 months duration. There was associated abdominal discomfort and weight loss. Abdominal examination revealed a non-tender intra abdominal mass filling the abdomen completely. Abdominal ultrasound suggested a massive splenomegaly. Abdomina Computerized Tomography (CT) scan was not done due to financial constraints. At laparotomy, a large, pearl-coloured mass was found within the mesentery of the proximal jejunum, with dilated, tortuous vessels. It was resected along with the overlying 60cm of jejunum. It weighed 7.5kg. Histology and immunohistochemistry confirmed the diagnosis of lowgrade fibromyxoid sarcoma. Post-operative period was uneventful and there were no features of recurrent after 2 year of follow up. Conclusion: LGFMS may cause a diagnostic dilemma, especially in a third world setting where preoperative diagnosis is hampered by lack of facilities and poverty. A high index of suspicion is needed for preoperative diagnosis, which is necessary for proper planning of the operation

Pattern of death in a Nigerian teaching hospital; 3-decade analysis

Background: In developing countries such as Nigeria, limited resources require that health priorities be selected wisely and death-related research is clearly warranted. The aim of this study is to provide a comprehensive report on the various causes of death in our center from 1978 to 2006. Methods: This was a descriptive, retrospective study of all deaths recorded at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State in Southwest Nigeria from 1978 to 2006. Result: A total number of 9,947 deaths were recorded during the study period and there were 6,277 male deaths (63.1 %) and 3,670 female deaths (36.9%) with a female to male ratio of 1:1.5. The age ranged from birth to 100 years with a median of 25years. Infection (2,594 patients; 26.1 %) was the most common cause of death and this was followed closely by trauma death (2,028 patients; 20.4%) and neonatal death (1,074 patients;10.8%). Death from infectious disease and trauma reduced from 1,048 and 1,441 in the first decade (1977 -1986) to 478 and 133 in the last decade respectively. While death from neoplasia increased from 112 in the first decade to 354 in the last decade of the study period. Conclusion: Our study shows that death from infectious disease in the present decade has reduced to almost half thatwas recorded in first decade. Similarly death from trauma has also reduced compared to the first decade of the study. Death from neoplasia is however higher in the last decade

Splenic Injuries in a Semi Urban Hospital in Nigeria

Background: The management of splenic injury has changed dramatically over the last two decades. The objective of this study is to evaluate splenic injuries in our community and factors affecting the outcome of treatment modalities. Methods: A prospective descriptive study of 73 patients treated for splenic injuries in our surgical unit between 1991 and 2006 was carried out. Data were collected on the nature of their injuries, treatment modalities and their outcome. All the data were analyzed using SPSS 13 software for windows. Results: The ages ranged from 3 to 65 with a mean of 24.2 years. Seventy of these patients sustained their injuries from blunt trauma and road traffic accidents accounted for 55 cases. Forty of these patients sustained isolated splenic injury while the remaining thirty-three were multiply injured. Majority of our patients (93.8%) were treated operatively Fifty-three (72.6%) of the 73 patients had splenectomy and twenty (27.4%) had splenic preservation. Post operative complications were recorded in sixteen patients. There were eight deaths all occurring in multiply injured. Conclusion: Only 6.8% the patients had non-operative management. Factors that significantly affected patients’ recovery and good outcome were: age of the patient, cause of injury, accident and emergency systolic blood pressure, intra-operative blood transfusion and the amount of haemoperitoneum. Vehicular motor accident remains the commonest cause of splenic injury in our community with high rate of associated injuries and the need for inter-specialty care of these patients

Emergency Non–obstetric Abdominal Surgery in Pregnancy.

Background: Despite recent advances in anaesthetic, perinatal and preoperative care, surgical intervention during pregnancy may still result in fetal loss from either spontaneous abortion (especially in the first trimester) or premature labor (especially in the third trimester). This study was aimed at determining the factors that affect fetal and maternal outcome following emergency non-obstetric abdominal surgery in pregnancy. Methods: We reviewed all cases of emergency non-obstetric abdominal surgery performed on pregnant women at Obafemi Awolowo University Teaching Hospital complex from January 1991 and December 2006. The socio-demographic characteristics, obstetric history, diagnosis and outcome of management were documented and analyzed. Results: A total of 46 pregnant patients presented with various conditions necessitating emergency non-obstetric abdominal surgery during the study period. Their ages ranged from 23 to 39 years with a mean age of 29.33 +/-4.904. Six (13%) of the patients presented during the first trimester, 32 (69.6%) patients during the second trimester and 8 (17.4%) were seen in the third trimester. Thirty-two (69.6%) patients presented with features of acute appendicitis out of 12 had ruptured appendicitis and 8 had appendicular abscess. Eight (17.4%) had intestinal obstruction, 5 (10.8%) had haemoperitonueum from abdominal injury and 1 (6.7%) had an ectopic foetus in bladder. Four (8.8%) mothers and 20(43.5%) babies died. Factors affecting maternal outcome included parity (P=0.010), duration of symptoms (P<0.0001) and delay in surgery (P<0.0001) while the factors affecting fetal outcome include maternal age (P<0.0001), booking status (P<0.0001), educational status (P<0.010), parity (P<0.040), gestational age (P=0.048) and delay in surgery (P=0.016). Conclusion: Complicated appendicitis is the most common indication for abdominal surgery in pregnancy in our center. High foetal loss seen in this study can be reduced by early presentation of the patients, early booking and high index of suspicion and prompt treatment by the attending surgeon

Global cancer surgery: delivering safe, aff ordable, and timely cancer surgery

Surgical oncolog