Necroturia with acute urinary retention: a rare presentation of bilateral Wilms’ tumour

Background: Wilms’ tumour is one of the most common solid abdominal tumours in children in sub-Saharan Africa. Most cases present with an asymptomatic abdominal mass. We report a 2 year old male child who presented with acute urinary retention of 6 hours duration. He had a left flank mass and ascites, with a piece of necrotic tissue protruding from the urethral meatus. The urinary retention was relieved by manual removal of the necrotic tissue and passage of a Foley’s urethral catheter. Abdominal ultrasound and computed tomographic scan revealed bilateral Wilms’ tumour.The child commenced neoadjuvant chemotherapy and he has made significant improvement.Conclusion: This is a rare mode of presentation of bilateral Wilms’ tumour which presented with a diagnostic dilemma. The need to palpate the abdomen of children who come to the hospital, cannot be over-emphasized.Keywords: Bilateral Wilms’, Tumour; Necroturia, Acute urinary retentio

Neonatal gastric perforation: a report of 3 cases and literature review

Neonatal gastric perforation (NGP) is an uncommon disease. Historical reports regard the aetiology as spontaneous while the mortality remains high. We present the report of the cases of neonatal gastric perforations who presented to our facility, its diverse aetiology and a review of the literature. Their clinical data including age, sex, weight, maternal complications, aetiology, location of perforation and the operation performed are summarized. NGP was complicated by anaemia, leukocytosis and thrombocytopaenia in all cases. The overall mortality rate was 66.7% and this was attributed to late presentation. We recommend early recognition and prompt surgical intervention as a way to salvage the condition. Also, passing a nasogastric tube and ensuring free drainage of gastric air and fluid should form part of neonatal resuscitation procedures as a way to prevent gastric over distension and subsequent perforation

Assessment of Parental Distress and Psychiatric Morbidity Before Elective Surgery in a Lagos Teaching Hospital

Background: Paediatric operation has been reported to be stressful not only to the child scheduled for operation but also to the parents and family members. In the absence of detailed information about the impending operation both mother and child may manifest preoperative distress and psychological morbidity. This study was aimed at assessing parental distress and psychiatric morbidity among parents of children scheduled for elective operation in a Lagos Teaching Hospital. Method: The study took place at paediatric surgery unit of the Department of Surgery of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. One hundred parents of children scheduled for elective surgery were asked to complete the 12th version of the General Health Questionnaire and the Hospital Anxiety and Depression Scale. Results: Of the total participants, 47 (47%) scored higher than the cut off with the GHQ indicating that they suffered from psychological distress, while 51 (51%) had probable anxiety and 19 (19%) had depression. Conclusion: The findings of this study showed a significant level of psychological distress and morbidity among mothers of children undergoing elective surgery. It is therefore suggested that psychosocial assessments of parents should be carried out before paediatric surgery to identify parents with high parental psychiatric morbidity that may need emotional support preoperatively and postoperatively. Parental psychopathology such as anxiety and depression should be a major concern of paediatric surgeons. Failure to attend to this, the paediatric surgeon may lose the essential therapeutic alliance with the parents during the care of their patients

Hydrostatic reduction of intussusception with normal saline using the gravity aided method in a Nigerian teaching hospital

Background: The non-operative treatment of intussusception has evolved over the years. One of such treatment modalities is ultrasound guided hydrostatic reduction using barium, saline and other water soluble agents. Despite the benefits of this method, surgery remains the mainstay of treatment in our hospital as well as in many other Nigerian hospitals.Aim: To evaluate the success rate of ultrasound guided hydrostatic reduction of intussusception using the gravity aided saline reduction method.Method: This is a prospective study of hydrostatic reduction of intussusception using the gravity aided saline reduction method. Patients were seen between January and December 2015.Results: Thirty five cases who were confirmed to have intussusception by ultrasonography were seen but only 12 were suitable for the procedure. Seven patients (58.3%) had successful hydrostatic gravity aided saline reductions while five (41.7%) had failed reductions. One patient had a recurrence. Bowel perforation complicated the procedure in one patient, who required a laparotomy for further management.Conclusion: Ultrasound guided hydrostatic reduction with normal saline by gravity method is a reliable and safe method of reducing intussusceptions in carefully selected cases. Thus, it should be recommended as the primary mode of treatment provided there are no features of peritonitis.Keywords: Intussusception; ultrasound guided gravity and saline reductio

Wilms' Tumour: Experience in a Developing Tertiary Centre in Nigeria

Background: Children with Wilms' tumour present early in the developed countries with correspondingly good prognosis. The same however is not true in the developing countries where the patient present rather late. This study evaluates the impact of late presentation on the management of childhood Wilms' tumour in our environment. Methods: This was a retrospective study of children aged 0-15 years managed for Wilms' tumour from January 2004 to April 2010 in a Teaching Hospital in South Western Nigeria. Results: Thirty five patients that had nephroureterectomy for Wilms' tumour with a histological confirmation were included in this study. One child had a Stage 1 disease, 9 had Stage II disease, 20 had Stage III disease, 4 had Stage IV disease and 1 child had a bilateral lesion (Stage V). Five (14.28%) patients have completed their chemotherapy and survived without clinical and radiological evidence of recurrence for a period equal to their age at diagnosis plus 9 months (Cullen's law). Therefore they have been deemed cured. Ten patients were lost to follow-up. Others are on various phases of their chemotherapy, 2 patients had Adriamycin cardiomyopathy. There were 6 (17.14%) deaths. Conclusion: Childhood Wilms' tumour presents late in our setting with its consequent management challenges. The need to educate the populace and the primary healthcare providers on the benefits of early diagnosis and treatment of this condition cannot be overemphasized