Duplication cyst of the bowel causing ileal volvulus. A case report

A10 month old male infant presents to us with features of acute intestinal obstruction and a palpable abdominal mass of five days duration. A prior ultrasound report had made a diagnosis of intussusception. Subtle butimportant details in history and examination cast doubts on the ultrasound diagnosis. Exploratory laparotomy revealed ileal volvulus secondary to duplication cyst. This case is reported because of its rarity and to show thestrength of sound clinical evaluation even in the face of technological advancements.Keywords: Duplication cyst, alimentary tract, ileal volvulu

Typhoid ileal perforation: Analysis of morbidity and mortalityin 89 children

Typhoid ileal perforation is still prevalent in many developing countries. Despite the advances in The management, the outcome in children is still very poor. To determine the morbidity and mortality of childhood typhoid ileal perforation in a tertiary referral centre in southeast Nigeria Retrospective evaluation of 89 children operated for typhoid ileal perforation over a 10-year period (January 1, 1995 through December 31, 2004) at the University of Nigeria Teaching Hospital, Enugu. There were 54 (60.7%) boys and 35 (39.3%) girls aged 1 15 years (mean 9.1 years). Thirty-nine (43.8%) were >10 years. Fever and generalized abdominal pain were the predominant symptoms for 5 21 days (mean 13.4 days) and 2 13 days (mean 8.8 days) respectively before presentation. Seventeen (89.5%) of thos

The Place of Spermatic Fascia Closure During Open Herniotomy in Male Children

Introduction: There is currently no consensus about closing or otherwise of the spermatic fascia at herniotomy in children. This stems from lack of  evidence to justify either stand, and most literatures are silent on this.  This study is an effort to evaluate the place of closure of the spermatic fascia at hernia repair. Aim: To determine if there is advantage in closing the spermatic fascia over leaving it open during herniotomy in children.Materials and Methods: Cases of inguinoscrotal hernia repaired by the same surgeon between July 2009 and June 2011 were randomly grouped into two; spermatic fascia closed (SC) and spermatic fascia open (SO) groups. They were assessed for operation duration, wound infection, scrotal hematoma, and scrotal edema post repair. The Data obtained was collated and analyzed using the SPSS 17.0.Results: Seventy.six male children with unilateral complete inguinoscrotal hernia were included in this study. The overall mean duration of operation was 32.9 min (SD = 5.7); range 21.52 min. There was hematoma  formation in 7 (17.9%) of the SC group and 9 (24.3%) of the SO group (P = 0.5). Scrotal edema occurred in 24 (64.8%) of the SO and 18 (46.2%) of the SC group (P = 0.3). No other complications were recorded duringthe period of study.Conclusion: There is no demonstrable advantage or disadvantage in  closing the spermatic fascia at herniotomy for children. We conclude that the choice to close or not to close the spermatic fascia at herniotomy for children should be at the discretion of the individual surgeon. Keywords: Children, closure, fascia, herniotomy, spermati

Pilot Study on Laparoscopic Surgery in Port‑Harcourt, Nigeria

Background: Video‑laparoscopic surgery has long been practiced in western countries; however documented practice of this minimal access surgical technique are recently emanating from Nigeria. To the best of our knowledge, this is the first documented study on laparoscopic surgery from the Niger Delta region. Aim: To evaluate the feasibility of laparoscopy as a useful tool for management of common surgical abdominal conditions in our environment. Patients and Methods: This was a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution from August 2011 to December 2012. Data on patient’s age, gender, indication for surgery, duration of hospital stay and outcome of surgery were collected and analyzed. Results: A total of 15 laparoscopic procedures were performed during this study period with age range of 2‑65 years; mean: 32.27 ± 17.86 years. There were 11 males and four females. Six laparoscopic appendicectomies, one laparoscopy‑assisted orchidopexy, five diagnostic laparoscopy ± biopsy, one laparoscopic trans‑abdominal pre‑peritoneal herniorrhaphy for bilateral indirect inguinal hernia and two laparoscopic adhesiolysis for small bowel obstruction were performed. All were successfully completed except one conversion (6.7%) for uncontrollable bleeding in an intra‑abdominal tumor. Conclusion: The practice of laparoscopic surgery in our environment is feasible and safe despite the numerous, but surmountable challenges. There is the need for adequate training of the support staff and a dedicated theatre suite.Keywords: General, laparoscopy, pediatric surger

Risk Factors for Hepatitis B Virus Infection during Pregnancy in South Eastern Nigeria

Objective: To determine the seroprevalence of hepatitis B surface antigen (HBsAg) and possible risk factors in pregnant women.Design: A cross –sectional serological survey of women attending antenatal clinics.Setting: Five antenatal clinics in Aba, South Eastern Nigeria.Subjects: Eight hundred and ten consecutive and consenting antenatal clinic attendees over the period 15 June- 15 November 2010.Main Outcome measures: For each pregnant woman, the medical and sociodemographic data were documented. Hepatitis B surface antigen seropositivity determined.Results: Twenty two (2.7%) of the 810 subjects were found to be HBsAg seropositive and asymptomatic. Maternal age, parity, educational level attained, marital status, history of blood transfusion, intravenous drug use, tattooing, jaundice in the past and Human Immunodeficiency Virus seropositivity did not show any association with HBsAg sseropositivity.Conclusion: HBsAg seropositive women in the study were asymptomatic and showed no association with the medical and sociodemographic characteristics examined. These findings affirm the recommendation for universal HBsAg screening in pregnancy and imply that screening on the basis of the presence of risk factors alone may be insufficient

Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania

Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001). Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced

Genetic Basis of Myocarditis: Myth or Reality?

n/

Time of Passage of First Stool in Newborns in a Tertiary Health Facility in Southern Nigeria

Introduction: The first stool passed by the newborn, the meconium, is different from the ordinary stool both in its nature and its implication. Delayed or non.passage of the meconium may represent a number of clinical conditions. In this study, we sought to identify what should be considered delayed passage of meconium in our babies. Aims and Objectives: To investigate the timing of passage of first stool in Nigerian neonates and whether it is influenced by gender, birth weight, maternal age, and parity.Materials and Methods: A proforma was designed to obtain the following data: Maternal age, parity, mode of delivery, Apgar score at 1 min, birth weight, gender, and interval between delivery and passage of firststool among normal newborn babies delivered at the obstetrics department of our center in August and September 2010.Results: One hundred babies out of 393 delivered during the period of the study were included in the study. There were 63 (63%) males and 37 (37%) females. The interval between delivery and passage of meconium ranged from 0.5 to 54 h; mean, 16.2 (SD = 10.57). This was not  influenced by gender, weight, maternal age, and parity. Conclusion: Non.passage of meconium beyond 48 h of life could be considered delayed. We therefore, recommend that clinicians should re.evaluate newborns, for hitherto unrecognized conditions, if after 48 hthey have not passed first stool.  Keywords: First stool, meconium, nigerian newborns, timin

Collaboration between paediatric surgery and other medical specialties in Nigeria

Background: The quality of service and success of patient care and research in most fi elds of medicine depend on effective collaboration between different specialties. Paediatric surgery is a relatively young specialty in Nigeria and such collaborations are desirable. This survey assesses the nature and extent of collaboration between paediatric surgery and other specialties in Nigeria.Materials and Methods: This is a questionnaire survey carried out in November 2008 among paediatric surgeons and their trainees practisingin Nigeria. Questionnaires were distributed and retrieved either by hand or e-mailing. The responses were then collated and analysed using the SPSS 17.0.Results: Forty-seven respondents were included in the survey. Forty-fi ve (95.7%) respondents thought that there was inadequate collaboration and that there was a need for an increased collaboration between paediatric surgery and other specialties. Anaesthesia, paediatrics and radiology are  among the specialties where collaborations were most required but notadequately received. Collaboration had been required from these  specialties in areas of patient care, training and research. Reasons for inadequate collaboration included the paucity of avenues for inter-specialtycommunication and exchange of ideas 33 (70.3%), lack of awareness of the need for collaboration 32 (68.1%), tendency to apportion blames for bad outcome 13 (27.7%), and mutual suspicion 8 (17%).Conclusion: There is presently inadequate collaboration between paediatric surgery and other specialties in Nigeria. There is a need for more inter-specialty support, communication, and exchange of ideas in order toachieve desirable outcomes.Key words: Paediatric Surgery, Collaboration, Specialtie