Angiodysplasia of the colon: A report of two cases and review of literature

Angiodysplasias of the colon are enlarged and fragile blood vessels in the colon result in occasional loss of blood from the lower gastrointestinal tract. It may be observed incidentally at colonoscopy or patients may present with lower gastrointestinal bleeding. The objective of this case report is to highlight two cases of colonic vascular ectasia seen using a Pentax video colonoscope at the Endoscopy unit of Crescent hospital, Ilorin. The first patient is an 85-year-old man, who presented with constipation, left-sided abdominal pain, and weight loss of two weeks duration. There was no anorexia, abdominal swelling, diarrhea, or hematochezia. Abdomino-pelvic ultrasonography showed normal findings. Colonoscopy done, reaching the ileo-cecal valve and caecum, showed an area of dilated tortuous blood vessel (vascular ectasia) in the wall of the descending colon approximately 45 cm from the anal verge, with no features of bleeding. No ulcers or mass lesion was seen. Colonoscopy showed angiodysplasia of the colon. The second patient is a 30-year-old female trader who presented with two days history of massive hematochezia of about 7 episodes prior to presentation with an estimated blood loss per episode of about 300 ml. There were clinical features of shock. Packed cell volume at presentation was 14%. She was transfused with 4 units of fresh whole blood. Post stabilization, colonoscopy was done 5 days after bleeding had stopped, which revealed an area of erosion with mucosal blood clot about 27 cm from the anal verge. An area of angiodysplasia was seen. No hemorrhoids or mass lesion was seen anywhere in the colon. Angiodysplasia is an uncommon finding in Ilorin. These are the first reported cases of angiodysplasia of the colon from Ilorin, Nigeria.Keywords: Angiodysplasia, bleeding, colon, colonoscopyNigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

Surgical Patients\' Knowledge and Acceptance of Autologous Blood Transfusion.

Background: Homologous blood transfusion carries a well-documented array of risks especially in an HIV endemic environment like Nigeria. It is therefore imperative to consider other forms of restoring blood volume in surgical patients. Autologous blood transfusion (ABT) is one of the ways the problem of HIV transmission can be reduced among surgical patients. The knowledge and acceptability of ABT among surgical patients about ABT, especially pre-donated ABT were assessed. It also assessed whether or not surgeons inform elective surgical patients about this alternative Materials And Methods Questionnaires were distributed among elective surgical patients that presented during the study period. The knowledge, willingness and the factors influencing the willingness of the patients to participate in ABT were investigated. The data were analyzed with SPSS Version10. Results Of the 116 patients [71 males; 45 females] interviewed, 29 (25.0 %) had heard about ABT, 80 (69.0 %) patients had never heard about ABT while 7 (6.1 %) were not sure. Of the 29 respondents who had heard about ABT, only 2 had had ABT. Of the 48 patients who needed blood for current surgical problems, only 4 (9.3 %) would have ABT. There was a significant difference in the number of respondents who believed that ABT is better than homologous transfusion (x2 = 69.11, p < 0.001). Conclusion The knowledge of ABT is low among our surgical patients and surgeons should present this alternative to their patients. The acceptance of ABT may also help in reducing or eliminating HIV transmission via blood transfusion. Keywords: homologous, hepatitis, surgical procedures, blood volume.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 109-11

Pre-Operative Vocal Cord Palsy in Goitre Patient

Objectives: Determine the prevalence of vocal cord palsy and the relative prevalence of asymptomatic vocal cord palsy in pre-operative goitre patients using flexible fibreoptic laryngoscope (FFL) as a laryngeal  visualisation technique.Design: Hospital-based, cross-sectional study conducted throughout 2011 on consecutive, consenting pre-operative goitre patients referred to the E.N.T Department, University of Ilorin Teaching Hospital. Ilorin, Nigeria.Setting: University of Ilorin Teaching Hospital (U.I.T.H) Ilorin is a 600-bedded tertiary institution, serving primarily patients from Kwara State.Subjects: One hundred and ten consenting patients, age 16 and above- whose cooperation could easily be gained for an awake-laryngoscopy procedure.Results: Mean age, 42.98 ± 14.71. Female: Male = 4.5:1. Palsy rate was 2.9% and 25% in benign and malignant goitre respectively. Hoarseness was reported by 3(2.7%) patients with vocal cord palsy (p 0.001). Asymptomatic palsy was 40%.Conclusion: The prevalence of pre-operative vocal cord palsy was 4.5%; Relative prevalence was 2.9% and relative prevalence was 25% in benign and malignant goitre respectively

Serial pathologic fractures of five long bones on four separate occasions in a patient with primary hyperparathyroidism, challenges of management in a developing country: a case report

Multiple pathologic fractures secondary to parathyroid adenoma is rarely recognized and reported in the tropics. Inadequate evaluation causes worsened disability and increased psychological stress. We present a 27-year-old Nigerian male student with recurrent unexplained pathological fractures of the long bones. Primary Hyperparathyroidism was later diagnosed and he benefited from a unilateral parathyroidectomy. Primary hyperparathyroidism secondary to parathyroid adenoma is difficult to diagnose and needs a high index of suspicion. Surgery and good  postoperative biochemical control of serum calcium produce satisfying outcomesKey words: Pathologic fractures, parathyroid adenoma, Primary Hyperparathyroidism, serum calcium, surger

The Impact Of Failed Communication On The Treatment Of Cancer Of The Breast; A Case Series

Click on the link to view the abstract.The Tropical Journal of Health Sciences Vol 21 No 1 (January, 2014

Diverticulosis of the colon: A report of two cases

Background: Diverticula are bulging pouch-like herniations in the wall of the hollow organ anywhere in the gastrointestinal tract from the oesophagus to the colon. Diverticula are thought to occur more commonly in the colon than in any other segment of the gastrointestinal tract. It may be asymptomatic or complicated by diverticulitis (diverticular inflammation), bleeding, or perforation with peritonitis. It could be potentially life threatening. It was thought to be rare in this part of the world, but is increasingly diagnosed with the advent of modern imaging techniques and colonoscopy. Two cases of colonic diverticula discovered during colonoscopy were highlighted.Case ReportsCase 1This patient was a 79-year old traditional ruler who presented with 2 months history of progressive left- sided abdominal pain, dull in nature and sometimes colicky but non-radiating. There was no known aggravating or relieving factors. There was associated history of chronic constipation dating back to over 15 years relieved with use of laxatives. There was no diarrhoea, vomiting or haematochezia. He had no history of previous surgeries. Physical examination showed mild tenderness at the left iliac fossa. Digital rectal examination was normal. Plain abdominal x-ray and abdomino-pelvic ultrasound scan showed no abnormalities. Colonoscopy revealed multiple diverticula with diverticulitis at the descending and sigmoid colon 40cm-60 cm from the anal verge.Case 2This patient is a 64-year old retired military officer who presented with constipation of 5 years and rectal bleeding of 10 months. Pre-morbid bowel habit was 1-2 bowel motions per day but now once in 2 days. Constipation was characterized by recurrent passage of hard pellet-like stools. This became associated with passage of fresh blood in the stool 10months ago, and anal pain. Volume of blood was about 5 mls per episode, and this occurred only when stool was hard. The anal pain was sometimes severe enough to prevent the patient from sitting comfortably on both buttocks. There was no weight loss or constipation alternating with diarrhoea. He had no history of any chronic medical illness. Colonoscopy revealed anal fissure, internal haemorrhoids, and multiple diverticula in the sigmoid and descending colon. Both patients are being managed conservatively with dietary advice and antibiotics, and still being followed up in the clinic.Conclusion: Reports of colonic diverticula with diverticulitis in this part of the world are few. This is the first report of colonic diverticulosis from Ilorin.Keywords: Colon, Diverticula, Diverticulitis, Colonscopy, Ilori

Anaesthesia For Right Adrenalectomy In A Patient With Phaeochromocytoma In A Resource-Challenged Facility- Case Report

Click on the link to view the abstract.The Tropical Journal of Health Sciences Vol 20 No 2 (July 2013

Splenic Operations In A Teaching Hospital, South-Western Nigeria

Background/Objective: To review all Splenic operations performed at LAUTECH Teaching Hospital (LTH) over a four year period- highlighting the indications, associated injuries in trauma patients, complications, outcome of management and follow up care. Patients and Methods: Information including demographic data, indications for operation, treatment and follow up care were obtained from case notes, theatre records and histology laboratory records; these were analyzed by simple percentage. Result: Twenty-six cases (M: F-18:8) with ages ranging between two and fifty-two years (mean 24.8 years) were treated. Eighty-eight percent were done as emergencies, 95% of these were for blunt abdominal injuries. Road traffic accident was the cause in above 50% of all patients with injuries while other indications included TSS, haematological, etc. Four (17%) of trauma patients had splenic preservation procedures done. Patients with wound infection, wound dehiscence and acute gastric dilatation were seven, five and one, respectively. No case of overwhelming post-splenectomy sepsis was seen. Mortality was 15.4%. Conclusion: As trauma is the most common indication for operations on the spleen, spleen conservation should be practiced more often where open procedures are indicated. Keywords: Splenic operations, Spleen conservation surgery, Trauma, Post-operative care, Nigeria Sahel Medical Journal Vol. 11 (1) 2008: pp. 15-1