Spontaneous rupture of an umbilical hernia with evisceration of small intestines in a 16-year-old girl

Background: Umbilical hernia is relatively common in African children. Most of these hernias close spontaneously as the children grow older and they are often remarkably free from complications. Aim: To report a case of spontaneous rupture of an umbilical hernia with evisceration of small bowel. Setting: Seaside Specialist Surgery, Port Harcourt. Case report: A 16-year-old girl, who had had an untreated umbilical hernia from birth, developed a severe pain at the site of the swelling. The swelling had quickly enlarged as a result of an obstructed loop of bowel within it. Traditional medicaments applied to it did not relieve the pain. Severe retching and vomiting ensued resulting in a spontaneous rupture of the umbilical skin. Subsequently, there was evisceration of loops of bowel through the defect.At operation, the eviscerated bowel loops were found to be viable and were returned into the peritoneal cavity. The abdomen was closed in layers with repair of the umbilical defect. Post operatively, her condition was satisfactory. Conclusion: Complications associated with umbilical hernia are not common but justify prevention by early repair of umbilical hernias with large defects. Keywords: Umbilical hernia, Rupture, Intestinal evisceration.Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 119-12

The Altemeier repair - a form of repair for complete rectal prolapse

The problem of full-thickness rectal prolapse is formidable. The operations proposed are broadly divided into transabdominal and perineal procedures with no clear choice of superiority. The aim of the study is to report a series of perineal sigmoidectomy (Altemeier's modification) for full thickness rectal prolapse. A retrospective review of all cases of rectal prolapse operated upon over a period of 15 years (1990-2005) by the same surgeon using hospital records. The setting is at the University of Port Harcourt Teaching Hospital. Port Harcourt and Seaside Specialist Surgery, Port Harcourt. Data extracted included: name, age, presenting symptoms, signs, investigations, diagnosis, co-morbidities, procedure, outcome and follow-up. Fifty two adults comprising 40 (76.9%) females and 12(23.1%) males with a mean age of 62.6 years were treated for full thickness rectal prolapse for a period of 15 years. They all presented with rectal prolapse and other associated symptoms. Following the surgery, they were all satisfied as there was no longer visible prolapse and they enjoyed varying improvement of other symptoms. Altemeier's mode of repair of rectal prolapse is safe and can be carried out in elderly patients with multiple co-morbidities.Key Words: Complete rectal prolapse; Altemeier repair; OutcomeNigerian Hospital Practice Vol. 2 (3) 2008: pp. 60-6

Traumatic abdominal wall hernia secondary to motorcycle handle bar injury

Background : Until recently, motorcycles became major means of transportation in Nigerian cities because they are cheaper than cars and buses to engage. Unfortunately they are responsible for several road traffic accidents causing various types of injuries including blunt abdominal injuries. Although they have long been withdrawn from the roads in most cities in Nigeria, they are a menace in the cities where they are still operating. Aim: To report 13 cases of traumatic abdominal wall hernia as a result of blunt abdominal injuries secondary to motorcycle accidents, their management and the outcome of their management. Patients and Methods: As recorded in the Accident and Emergency departments of two tertiary hospitals in Port Harcourt - University of Port Harcourt Teaching Hospital and Braithwaite Memorial Specialist Hospital, 2472 patients who had blunt abdominal trauma following motorcycle accidents were seen and treated between 2005 and 2010. Out of this number, 13 patients were admitted and treated for suspected traumatic abdominal wall hernia. Their demographic data, treatment and treatment outcome were retrieved from their case notes. Results: There were 13 cases of suspected traumatic abdominal wall hernia, who were admitted for emergency exploration. There were 10 (76.9%) males and 3 (23.1%) females with a male/female ratio of 3.3:1. The patients aged between 26 and 56 years. The mean age at diagnosis was 40.6 years. The presenting symptoms were related to the road traffic accident and the impact of the handles of the motorcycle on the anterior abdominal wall. They are abdominal pain, severe bruising of the abdominal wall, herniation of abdominal contents and scrotal haematoma. Eleven (84.6%) cases were diagnosed correctly pre- operatively while 2 (15.4%) cases were diagnosed during surgery. Conclusion: We recommend a high level of clinical suspicion for traumatic abdominal wall herniation in all patients with traumatic abdominal wall injuries. It is instructive that the area be explored with primary repair of the hernia and other tissue planes of the abdominal wall

CASE REPORT - Rectal prolapse in pregnancy: a case report

Rectal prolapse occurs when a mucosal or full thickness layer of rectal tissue slides through the anal orifice. It is relatively infrequent and occurs commonly in elderly women. This report is to bring to focus the possibility of a rectal prolapse being misdiagnosed as haemorrhoids in pregnancy. A case of a 35-year-old woman, gravida 4, para 3+0, found to have a large rectal prolapse but misdiagnosed as prolapsed haemorrhoids at 34 weeks gestation is reported. Although rectal prolapse is not a common condition during childbearing years, it is instructive for obstetricians and midwives to be vigilant in all cases of pregnant women presenting with rectal protrusion or bleeding