Volunteer Surgical Camp at Gombe Hospital in Uganda

Background: The Islamic University Habib Medical School in Uganda (IUIU), in collaboration with Doctors Worldwide (DWW) from Turkey, organized a surgical camp in April 2014. In this camp, different types of hernia repair, among other general surgical procedures were conducted. The target population was the population within the Gombe hospital serving districts.Methods: The defined area for the surgical camp was Butambala and neighboring districts including Mpigi; Gomba, Mityana, and parts of Wakiso district. The IUIU team and Gombe hospital team were respectful to the sensitivities of the community, district and government officials. The surgical team composed of 4 surgeons (three from DWW-Turkey and one from Uganda), 3 Anesthesiologists, (two from DWW-Turkey and one from Uganda), 2 nurses and 2 intern doctor, (one from DWW-Turkey and one from Uganda).Results: The total number of patients operated was 115; however the total number of operations performed was 130. One hundred and fourteen operations were different types of hernia repair. The ages of hernia patients ranged between 1 and 80 years (mean±SD is 27.46±24.55). Hemoglobin values ranged between 9.2 and 17 (mean±SD is 12.5±1.48). Only two (1.8%) of 114 hernia patients had positive results on HIV serology. Sixteen patients underwent circumcision. Of those, only two (12.5%) patients had positive results on HIV serology.Conclusion: Hernia is a common surgical problem in all age groups. It is more common in men. In addition to the operations conducted, the need for surgery for 187 patients was detected. This condition shows that the hernia operation is commonly accepted as a negligible condition.Keywords: Global surgery; Provincial; Hernia; World Wide Doctors; Ugand

Uganda'da Fıtık Cerrahisi: Yeryüzü Doktorları Deneyimi

Amaç: Yeryüzü Doktorları Türkiye'nin gönüllü cerrahi ekibinin Uganda'daki faaliyetleri ile ilgili deneyimlerini değerlendirerek bildirmeyi amaçladık.Gereç ve Yöntemler: Yeryüzü Doktorları Türkiye tarafından 3-8 Şubat 2015 tarihleri arasında Uganda'nın Butambala ve Kampala bölgelerinde cerrahi kamp düzenlendi. Bu kampın amacı, diğer cerrahilere ek olarak, tüm karın duvarı fıtık tipleri için fıtık tamirlerinin gerçekleştirilmesiydi. Hastaların demografik verileri ile uygulanan anestezi ve cerrahi prosedürlerin tipleri kayıt edilerek incelendi.Bulgular: Toplam 115 cerrahi hastasında operasyonlar genel, spinal ya da lokal anestezi ile yapıldı. Bunlardan 80'i (%69,57) kasık fıtığı, 15'i (%13,04) göbek fıtığı ve 9'u (%7,82) epigastrik fıtık tanısı almıştı. Ek olarak hidrosel tanısı ile 11 (%9,57) olgu ameliyat edildi. On (%8,70) hastada postoperatif minör komplikasyonlar gözlenirken, ameliyatların sonunda postoperatif mortalite gelişmedi.Tartışma ve Sonuç: Yeryüzü Doktorları; etkin bir tedavi modalitesi olarak cerrahinin, insani sağlık yardımı programlarının düzenlenmesi sırasındaki planlamalarda en önemli önceliklerden birini oluşturması gerektiği kanısındadırlar.Aim: Our aim was to evaluate, and report the experiences of the volunteer surgical team of Doctors Worldwide (DWW) Turkey during their medical activites in Uganda.Materials and Methods: A surgical camp was organized by DWW Turkey between 3-8 February 2015 in the Butambala and Kampala districts of Uganda. The surgical camp, in addition to other surgeries, was intended to conduct herniorrhaphies for all forms of abdominal wall hernias. Outcomes obtained as results of all surgical practices, including the demographic data of the patients, the types of anaesthesiological, and surgical procedures performed were recorded, and analyzed.Results: Surgical interventions were carried out under either general, spinal, or local anesthesia in a total of 115 patients with the diagnosis of inguinal hernia in 80 (69.57%), umbilical hernia in 15 (13.04%), and epigastric hernia in 9 (7.82%) cases. Additionally, operations were performed for hydrocele in 11 (9.57%) cases. Postoperative minor complications were met in 10 (8.70%) patients, and no postoperative mortality took place at the end of all operations.Discussion and Conclusion: DWW Turkey Surgical Team conclude that, as an efficacious modality of treatment, surgery should be considered as one of the most important priorities when conducting humanitarian health aid programs

Malignant sacro-coccygeal teratoma with growing teratoma syndrome

A 13-month-old female with sacro-coccygeal tumor type II by Altman, was proven by biopsy to be a malignant germ cell tumor. Serum tumor markers were normal. During neo-adjuvant chemotherapy visible tumor progression was confirmed radiologically and progressed despite changing chemotherapy. The external growing mass forced its way out of the skin. More importantly, CT showed resolution of the pelvic component. Complete tumor resection with coccygectomy was performed. Histopathology showed mature teratoma, immature cells in the coccyx and no malignant germ cells. Three months after ending her therapy she remains in remission. We report the first case of growing teratoma syndrome (GTS) in the coccygeal region. Keywords: Sacro-coccygeal teratoma, Growing teratoma syndrom

Delayed diagnosis of Hirschsprung disease presenting initially as anemia: A case report

Introduction: Hirschsprung disease (HD) is a common congenital gastrointestinal malformation in pediatric patients, with an incidence of 1 per 5000 newborn. Most cases are diagnosed in neonatal period when the patient has intestinal obstruction. Delayed diagnosis of HD beyond infancy is reported in a minority of cases, and is particularly common in developing countries. Most such cases suffer from constipation and chronic distension. Case presentation: We report a case of a 7 year old boy who presented very atypically, with anemia as the presenting sign of HD. Work up revealed iron deficiency anemia. He received iron supplements which lead to elevation of hemoglobin level transiently. Definite correction was achieved after pull through procedure. Conclusion: Anemia can be a presenting sign for HD. Although it is a very rare presentation, when combined with chronic constipation, the possibility of HD should be considered and investigated

Fetal and Newborn Management of Cloacal Malformations

Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with findings such as renal and urinary tract malformations, intraluminal calcifications, dilated bowel, ambiguous genitalia, a cystic pelvic mass, or identification of other associated anomalies prompting further imaging. Multi-disciplinary collaboration between neonatology, pediatric surgery, urology, and gynecology is paramount to achieving safe outcomes. Perinatal evaluation and management may include treatment of cardiopulmonary and renal anomalies, administration of prophylactic antibiotics, ensuring egress of urine and evaluation of hydronephrosis, drainage of a hydrocolpos, and creation of a colostomy for stool diversion. Additional imaging of the spinal cord and sacrum are obtained to plan possible neurosurgical intervention as well as prognostication of future bladder and bowel control. Endoscopic evaluation and cloacagram, followed by primary reconstruction, are performed by a multidisciplinary team outside of the neonatal period. Long-term multidisciplinary follow-up is essential given the increased rates of renal disease, neuropathic bladder, tethered cord syndrome, and stooling issues. Patients and families will also require support through the functional and psychosocial changes in puberty, adolescence, and young adulthood