Circumcision mishaps: A continuing challenge in the developing countries

Objective: Circumcision has been described as the most commonly performed surgical operation in the boys and is probably the oldest surgical procedure in man. This prospective study was aimed at establishing the pattern, treatment outcome and cost of major complications of neonatal circumcision seen in a tertiary center in Nigeria.Methods: Consecutive cases of complications of circumcision presenting at the Paediatric Outpatient Department in a tertiary centre in Nigeria were prospectively studied over a period of 3 and half years from July 2003 to December 2006. Information regarding the age of the patient, time of circumcision, the surgeon, place of circumcision was recorded as well as the type of mishap; outcome and cost of management were noted.Results: Forty five patients with major complications of circumcision representing 6.2% of the patients. Their age at presentation ranged between 2 weeks to 10 years (Median = 3months). All the patients were circumcised during the neonatal period. The commonest complication reported is urethro-cutaneous fistula in 25 (56%), Meatal Stenosis in 4(8.9%), Severe bleeding in 4(8.9%), Epidermoid cyst in 3 (6.7%), and 2 (4.4%) cases each of Buried penis, penile amputation, penile degloving with glans amputation, glanular adhesions and redundant prepuce respectively. The cost of treatment for the repairs varies from 4500 -35,000NGN (40-305 Dollars)Conclusion: The prevalence of complications of circumcision is high in our environment

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study

Background: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile‑Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR).Materials and Methods: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps.Results: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2‑87 years with a median of 57 years. Forty‑three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty‑three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty‑nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010).Conclusion: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.Key words: Adenoma, hyperplastic, inflammatory, Nigeria, polyps, prevalenc

Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria

Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long‑term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty‑seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino‑pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) μmol/L and 141 (±100) μmol/L respectively, P = 0.003. Surgical interventions included trans‑vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 μmol/L after 1‑month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors.Keywords: Excision, treatment outcome, urethral valve

Ano-Rectal Conditions: An Overview

Ano-rectal diseases are arrays of disease conditions occurring within the rectum and anal canal. Diseases of the rectum and anus are common and affect a large proportion of the population. It is thought that most patients with symptoms referable to the ano-rectum do not seek medical attention and many prefer to seek alternative therapy. Most ano-rectal diseases can be diagnosed by detailed history, physical examinations and when necessary ancillary investigations. Correct diagnosis is mandatory for proper management. Ano-rectal conditions are of varying aetiology and can be classified as either Congenital or Acquired. IFEMED Journal Vol. 14 (1) 2008: pp. 92-9

Anaesthesia for neonatal surgical emergencies in a semi-urban hospital, Nigeria

No Abstract

Management of cystic lymphangiomas in Ile-Ife, Nigeria

Background: The management of cystic lymphangiomas is and challenging. Of all the available modalities of treatment, surgery remains the gold standard but it is associated with significant morbidity and mortality. Method: Retrospective analysis of 28 cases of cystic lymphangioma seen at the Obafemi Awolowo University Teaching Hospital, Ile-ife, Nigeria. Results: There were 16 boys and 12 girls with a median age of 6 months. The cervical region was most commonly involved site in 19(67.9%) children. Eight (28.6%) of the patients had morbidity at presentation. Only 24 of the 28(86%)patients had surgical excision. Complete macroscopic excision was possible in 15 (62.5%) patients. There was one death (4.2%) at induction of anaesthesia due to rupture of a cervical cyst at intubation with aspiration. Post-operative complications occurred in 10 (41.7%) patients. Recurrence was reported in 1(4.6%) patient. Conclusion: The presentation of cystic lymphangiomas in our own environment is diverse. There is a high preoperative morbidity. Surgery remains the only option available in this environment but is associated with a high e complication rate. (Nig J Surg Res 2003; 5: 32 – 37) Key words: Cystic lymphangioma, morbidity, mortalit

Day case inguinal hernia surgery in Nigerian children: Prospective study

Background: There has been an increase in day case surgery for children worldwide, but there have been few reports of the practice (most of them being retrospective) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. Materials and Methods: This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. Results: Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients, (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side, while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8%. In all, the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. Conclusion: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction. Keywords: Children, day case surgery, inguinal herniaAfrican Journal of Paediatric Surgery Vol. 5 (2) 2008: pp. 76-7

Situs inversus in association with duodenal atresia

Situs inversus in association with duodenal atresia is very rare. A high index of suspicion coupled with appropriate evaluation is necessary for diagnosis and operative planning. We report a case of a 5-day-old who presented with duodenal atresia associated with polysplenia and situs inversus with a review of the medical literature.Key words: Situs inversus, duodenal atresi