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

Endoscopic Evaluation of Upper and Lower Gastro‑Intestinal Bleeding

Introduction: A myriad of pathologies lead to gastro‑intestinal bleeding (GIB). The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB.Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software.Results: A total of 159 upper and lower gastro‑intestinal (GI) endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13–86 years (mean age 52.4 ± 20.6 years). The primary presentations were hematochezia, hematemesis, and melena in 44 (75%), 9 (15%), and 6 (10%) cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%). The majority of pathologies in upper GIB were seen in the stomach (39%): Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%.Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environmentKeywords: Endoscopy, diagnosis and treatment, gastro‑intestinal bleedin

Foreign body ingestion in children: case report and literature review

Foreign body (FB) ingestion is a common occurrence in children. In most cases these foreign bodies pass through the gastrointestinal tract uneventfully. The important considerations for intervention include size, shape, and composition of the FB. Also, the site of lodgement and underlying pathology in the patient with the unlikelihood of passage, are worthy of note. A 5-year old asymptomatic boy was referred to our service with a 1-week history of ingestion of a coin. A plain abdominal x-ray study done the day following the ingestion showed an oval shaped opacity in the area of the stomach. A prompt upper gastrointestinal (GI) endoscopy was performed under general anaesthesia with cuffed endotracheal intubation, following which, a two-penny British coin was retrieved from the stomach using alligator forceps passed through a flexible gastroscope. The patient was discharged a few hours after the procedure, in a stable condition. His 7th day post-procedure follow-up visit was uneventful. A prompt endoscopy for assessment and retrieval of foreign bodies in children reduces the risk of morbidity and duration of family anxiety.Keywords: Anxiety, endoscopic retrieval, paediatric age group, uneventful passag

Recent trend in management of adhesive small bowel obstruction

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Volvulus complicating jejunal diverticulosis: A case report

Introduction: Diverticular disease is uncommon among Africans though increasing number of cases is now being reported, mainly of colonic diverticulosis. This condition afflicts all parts of the gastrointestinal tract but commonly the colon. Jejunal diverticula are rare, usually asymptomatic but may lead to an acute abdomen. Case presentation: A 68 year old female trader, who was referred from a peripheral center with insidious onset of severe colicky, generalized abdominal pain, repeated vomiting of recently ingested meal, no hematemesis. There was constipation and abdominal distension. The working diagnosis was dynamic intestinal obstruction of small bowel origin. She had emergency exploratory laparotomy following resuscitation. The findings were: volvulus of the jejunum and multiple jejunal diverticula. A resection of 80 cm of the jejunum with most of the diverticula involved in the torsion was done with an end-to-end anastomosis of the jejunum. Her out-patient follow-up has been uneventful. Discussion: Jejunal diverticular disease is rare in Africa. Our patient presented with small bowel obstruction due to volvulus. Other complications are discussed. Conclusion: Intestinal obstruction from diverticular disease is not always of colonic origin. It can occur in the jejunum

Ulcerated choledochocele: A case report

Background: The cystic dilatation of the biliary tract is an uncommon anomaly. Choledochocele, a cystic dilatation of the distal common bile duct, rarely presents clinically as massive gastrointestinal bleeding. Aim: This is to report a very rare disease condition and highlight minimal access options in surgical care. Case summary: A 13 year-old boy was referred with a day history of sudden onset of passage of bright red blood per rectum with a fainting episode. There was no anal protrusion, jaundice, recurrent epigastric pain nor bleeding from any other orifice. An initial endoscopic assessment of the upper digestive tract showed profuse bleeding from a sub-mucosal mass in the region of ampulla of Vater. Emergency laparotomy revealed small intestine filled with blood from duodenum to ileum. A duodenotomy showed a cystic mass with an ulcerated mucosa at the dome containing bilious fluid in the second part of the duodenum. The cyst was de-roofed and marsupialized. Post-operative recovery was complicated by features of adhesive small bowel obstruction on the 9th post op day and treated by laparoscopic adhesiolysis. He was discharged home in good clinical state. Conclusion: Choledochocele is a differential diagnosis in the endoscopic finding of a submucosal mass in the second part of the duodenum. An initial oesophagogastroduodenoscopy endoscopy is necessary in the evaluation of massive lower gastrointestinal bleeding

Supplementary Material for: Colonic diverticulosis at colonoscopy in Africa: a systematic review and meta-analysis of pooled estimates

Background: There is need to ascertain any epidemiologic shift of diverticulosis among Africans with traditionally high fiber diet consumption patterns and rare diverticulosis prevalence. Methods: We systematically searched PubMed, Scopus, Cochrane Library, African Journal Online (AJOL) and Google Scholar. Eligibility criteria included full text observational and experimental human colonoscopy studies on asymptomatic and symptomatic African population from 1985-2022. Case reports, conference abstracts, dissertations, systematic reviews, and studies lacking colonoscopy findings were excluded. NIH quality assessment tool for observational cohort and cross-sectional studies was used to assess risk of bias. Meta-analysis was performed using the random-effect model. Heterogeneity was assessed using inconsistency (I2) statistics. Results: Thirty studies were included. Pooled prevalence rate of colonic diverticulosis was 9.1% (95%CI 7.1-11.2; I2=96.3%) with highest regional prevalence rate in West African studies at 11.3% (95%CI 7.6-14.9; I2=96.2%). Proportion of individuals with diverticulosis ≥50 years and male sex were 86.9 % (95%CI 80.5-92.1) and 65.2% (95%CI 55.0-74.8), respectively. Left colon had the highest diverticulosis frequency [37% (148/400)]. Bleeding/inflammation complications were sparingly detected [OR 0.2 (95%CI 0.03-0.75;p<0.0001)]. Conclusion: Colonic diverticulosis was most common in males aged >50. Left was colon predominantly affected. Regional variation in detection of diverticulosis was reported across Africa