Incidence of Negative Appendectomy: Experience From a Company Hospital in Nigeria

Objective: The aim of this study was to determine the rate of negative appendectomy in a company hospital in Nigeria. Background: Appendicitis is one of the most common abdominal conditions requiring surgical intervention. Appendectomy, like most surgical procedures, has its complications and therefore should only be undertaken when indicated. Case series have reported the incidence of negative appendectomy in Western nations. The purpose of this retrospective study is to evaluate the incidence of negative appendectomy in a Nigerian hospital, where all the operations were carried out by consultant surgeons. Methods: All case files of patients who received an appendectomy at Chevron Hospital in Warri, Nigeria between January, 1999 and December, 2003 were reviewed. Demographic data, symptoms and signs on presentation, intra-operative findings and histological reports on the excised vermiform appendixes were extracted from the case files and analyzed. Results: The incidence of negative appendectomy in this study was 16.1%; all nine patients that had negative appendectomy were female. Conclusion: The incidence of negative appendectomy observed at Chevron Hospital in Warri, Nigeria is lower than that reported by most studies; one factor may be that all the patients in the present study were evaluated and operated on by consultant surgeons

Torsed Intraabdominal Testis: A Rarely Considered Diagnosis

Cryptorchidism, or maldescended testis, is a common problem encountered in pediatric age groups. Despite more than 100 years of research, many aspects of cryptorchidism are not well defined and remain controversial. However, cryptorchidism clearly has deleterious effects on the testis over time.1–

Emergency one-stage resection without mechanical bowel preparation for acute sigmoid volvulus

The traditional staged operation for acute sigmoid volvulus is giving way to one-stage resection. Similarly, the conventional requirement for bowel cleansing is being increasingly questioned. In this report, we reviewed the outcome of our management over a ten-year period. There were 24 patients aged 23-100 years. Of these, 21 had one-stage primary resection with no clinical anastomotic leak and only one wound infection and fascial dehiscence. The two deaths from this group were due to respiratory failure in a patient aged 100 years and overwhelming sepsis in a younger patient with bowel gangrene from ileosigmoid knotting. We conclude that emergency one-stage resection for acute sigmoid volvulus without mechanical bowel preparation is safe

Minor's healthcare: who decides?

Background: Presently in Nigeria and most other jurisdictions, healthcare providers erroneously believe that minors cannot give a valid consent to receive medical treatment.Aim: To critically appraise the current practices where minors are deemed incompetent to give valid consent for medical treatment and to provide legal authorities to buttress the point that some categories of minors can give valid informed consent. The paper also seeks to review situations involving minors indeed where parents refuse to give consent for life saving procedures.Methods: Google search was made to identify legal opinions on the subject of informed consent for medical treatment and minors. Findings from the search were analysed against the background of current practices of healthcare providers.Results: Virtually all legal authorities are in agreement that minors can indeed give valid informed consent for treatment (or make informed refusal) provided the minor is mature or emancipated. And for minors indeed, the overall best interest of the child should be taken into consideration with respect to parents or guardians who may not consent to medical procedures.Conclusion: Some categories of minors can give valid informed consent even when the parents refuse to consent to such treatment. A mature or emancipated minor can enjoy the same rights with respect to informed consent (or informed refusal) for medical treatment. However, there is need for healthcare providers to critically appraise the local challenges in order not to create hardship for the minor after he/she has given consent for treatment.Keywords: Minors, Informed consent/ refusal, Healthcare providers, Legal authorities, Local challenge

Perforated Duodenal Ulcer Presenting As Acute Appendicitis

Background: Acute appendicitis has a lot of differential diagnoses. However, when there is perforated duodenal ulcer with the contents tracking into the right iliac fossa, it is often extremely difficult to distinguish this condition from acute appendicitis. Aims of study: To evaluate the diagnostic dilemma encountered in attempting to differentiate between perforated duodenal ulcer (with gastric contents tracking into the right iliac fossa) and acute appendicitis. Patients and methods: The case files over a 5 year period of patients who were initially diagnosed as acute appendicitis, but found at operation to have perforated duodenal ulcer were reviewed. Results: There were 5 patients (3 males and 2 females) who were diagnosed to have appendicitis but at operation they were found to have perforated duodenal ulcer. The age range was between 33 and 82 years with a mean of 64.5years. Only two patients had a history of recurrent epigastric pain prior to presentation. Conclusion: It is often difficult to distinguish perforated duodenal ulcer when the contents track into the right iliac fossa from acute appendicitis. Sahel Medical Journal Vol. 11 (2) 2008: pp. 52-5

Analysis Of Gunshot Injuries In A Semi-Urban Community In Nigeria

Background: Gunshot injuries are taking a worrisome dimension in all parts of Nigeria with associated significant morbidity mortality. Most cases of gun shot injuries in our community prefer to be managed by traditional healers rather than medical doctors. The purpose of this study is to evaluate the pattern and outcome of gun shot injuries in Ikpoba Hill; a sub-urban community in Edo State. The study also seeks to determine incidence of gunshot injuries as seen at the study centre and to also determine why most patients with gunshot injuries prefer to be managed by traditional healers.Patients and Methods: The case files of all the cases of gunshot injuries managed at Our Clinic/Medical Centre over a five year (January 2003 to December 2007) period were analysed.Results: Gun shot injuries were more common in individuals in their 3rd decade of life and most injuries occurred between the hours of 1.00am and 4.00am. Pellets were the commonest offending agents and superficial soft injuries were the commonest form of injuries. Over 60% of the patients discharged themselves against medical advice. Late presentation was a prominent finding in most patients. The case fatality was 5.8%; sepsis being the commonest cause of death.Conclusion: Gunshot injuries are quite common in Benin City. Most of thepatients present very late with attendant consequence of significant morbidity and mortality. Health education is essential in this regard with a view to encouraging early presentation to hospital.Keywords: Analysis of gunshot injuries

Pattern and Outcome of Typhoid Perforation in Benin City

Over a 26-year period, there were only twenty four cases of perforated typhoid that were operated at the University of Benin Teaching Hospital. Four cases had incomplete data and were excluded from the study and only twenty cases were therefore included in the study. Of the twenty patients, there were 12 males and 8 females and the age range was between 11 and 45 years, with a mean of 25.65 years. The main complaints were fever, abdominal pain, vomiting, diarrhea or constipation. Most of the patients presented late to the hospital. Most of the patients had single perforations. Simple closure was the method of treatment in most of the patients. Wound infection was the major post operation complication. The average hospital stay was 16.3 days. We conclude that compared with other tertiary health institutions in Nigeria, the incidence of typhoid perforation is low at the University of Benin Teaching Hospital, Benin City, Nigeria and simple closure of perforations is efficient in managing typhoid perforations Keywords: Typhoid Fever, Late presentation, Wound in infection Journal of Medicine and Biomedical Research Vol. 5 (1&2) 2007: pp. 13-1

Pattern and outcome of management of fractures in a Nigerian community

Background: There has been increasing incidence of road traffic accidents and gun shot injuries in Benin City in the recent past. A major complication of these events is fracture of the bones. Various patterns of fractures are reported from different communities. Aim: To determine the pattern and outcome of fractures in Ikpoba Hill, a sub-urban community in Edo State. Methods: A retrospective study of all cases of fractures that presented to “Our Medical Centre” in Ikpoba Hill, a sub-urban community in Edo State between January 1998 and December 2004 was carried out. Parameters analysed included age, sex, and occupation, cause of fracture, site of fracture, associated injuries, treatment offered and outcome of management. Results: A total of 285 cases of fractures were seen over the period of study. There was a steady increase in the number of cases of fractures over the period of study. The 20 -29 years age group was more commonly affected (25.61%). The male: female ratio was 1.9: 1. Civil servants and business people were most commonly affected (36.49% and 24.56% respectively). The humerus was the bone most commonly affected (24.32%). Road traffic accident was the commonest aetiological factor accounting for 80%. Some 69.47% of the cases discharged themselves against medical advice to seek help with a traditional bonesetter. Head injury was the commonest cause of death (44.44%). The average duration of hospital stay was 21 days. Conclusion: Road traffic accident was a common cause of fracture. The humerus was the bone most commonly fractured. Most patients with fracture prefer to patronize the traditional bone setters. Public enlightenment campaign should be mounted to discourage the attitude of most patients with fracture seeking help in traditional bonesetters\' place. Port Harcourt Medical Journal Vol. 1(1) September 2006: 17-2

Emergency one-stage resection without mechanical bowel preparation for acute sigmoid volvulus

The traditional staged operation for acute sigmoid volvulus is giving way to one-stage resection. Similarly, the conventional requirement for bowel cleansing is being increasingly questioned. In this report, we reviewed the outcome of our management over a ten-year period. There were 24 patients aged 23-100 years. Of these, 21 had one-stage primary resection with no clinical anastomotic leak and only one wound infection and fascial dehiscence. The two deaths from this group were due to respiratory failure in a patient aged 100 years and overwhelming sepsis in a younger patient with bowel gangrene from ileosigmoid knotting. We conclude that emergency one-stage resection for acute sigmoid volvulus without mechanical bowel preparation is safe