Cordylobia anthropophaga cellulitis of the penis

Background: Myiasis is a condition in which fly larvae (maggots) invade living tissue. It is now considered a rare condition in humans, because of improved physical hygiene. It is imperative therefore to present a new case in order to stimulate a high index of suspicion among clinicians. Aim: To report a case of a boy who presented with furuncular cellulitis of the penis from which fly larva  was extracted. Case report: An 8-year-old boy presented with a painful swelling of the penis which was referred as a case of phimosis. A boil-like pruritic lesion was noticed prior to the penile swelling. About three-weeks prior to presentation, two live maggots were extracted  from a two-month old puppy which the child handled very often as a pet. Clinical examination revealed a single papular lesion on his penis from which a live maggot was extracted. He responded to treatment with anit-tetanus toxoid, oral paracetamol and topical gentamicin cream. The mode of infestation, prevention and management are highlighted. Conclusion: There is need to raise the level of awareness and stimulate a high index of suspicion among clinicians about this disease which is prone to misdiagnosis and from which fatal cases have been reported in children.   Key words: Cordylobia anthropophaga, Cellulitis, Penis, Children, Nigeri

Intussusception in children: Comparison between ultrasound diagnosis and operation findings in a tropical developing country

Background: Intussusception is one of the more common causes of intestinal obstruction in children. The diagnosis may be based mainly on  clinical features; however, there are no classic signs and symptoms that are common to all cases. This study reports our experience at US  diagnosis and operation fi ndings of children with intussusceptions in a tropical developing economy. Materials and Methods: This was an 8 years retrospective review of intussusceptions in children in a tertiary health facility in a tropical  developing country from January 2004 to December 2011.Results: Twenty five out of 41 children (M:F = 2.2:1) admitted with intussusceptions within the period were studied. The median age was 6.0 ± 5.57 months (range 3 months- 7 years). US positively diagnosed  intussusceptions in 20 (80%) cases. Conclusion: US can increase diagnostic confidence in intussusceptions.Key words: Children, intussusception, operation findings, tropical  developing country, ultra-sonograph

Utilization of banked blood in pediatric surgical procedures in Calabar, Nigeria

Background: Performing major surgery in a child demands that blood is cross-matched and saved to be transfused as indicated. Because the cost of crossmatching and donation of blood can be enormous and may equal or surpass the cost of surgery in our setting, it is pertinent to evaluate its  utilization. The aim of this study was to determine how banked blood meant for pediatric surgical procedures was utilized with the hope of streamlining our blood requisition policy. This may be useful to pediatric and other surgeons involved in the operative care of children in similar settings.Materials and Methods: This was a prospective study of all children who had ELECTIVE or EMERGENCY surgical procedures between January 2009  and June 2010. The age, sex, nature of surgery, blood loss, banked units of blood and amount transfused were collected and analyzed.Results:  Eighty two patients had 81 units of blood banked for them. Forty – eight and half units (59.9%) of the banked blood were for the emergency group but only 18 units (22.2%) were actually transfused at the end (P = 0.044) leading to inadequate use of the product.Conclusion: Banking large quantities of blood but utilizing only little istantamount to inadequate use and delays surgical intervention. Indirectly, it increases cost of surgery. There is need to rationalize our blood ordering habits without causing harm to patients.Key words: Banked Blood, Calabar – Nigeria, pediatrics, surgical procedures, utilizatio

Influence of social circumstance and day care surgery in children in Nigeria

Background: In order to achieve good results in day surgery and avoid pitfalls, selection of appropriate procedures and patients is required with attention given to the social circumstances among other considerations. The aim of this prospective study therefore was to evaluate the influence of the social circumstances of the patients on the performance of day surgery practice in our environment. Method: This was a prospective study carried out between April, 2004 and December, 2004, during which time 88 children aged 15 years and below with uncomplicated inguinal hernias were treated at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The parents of the patients were interviewed about their social circumstances to determine the possibility of compliance withpostoperative instructions. The data generated were then analyzed.Results: More than half (54.6%) of the patients were from Ile-Ife. A few came from towns varying in distances from 65 to 80 km and spent an average time of 75 to 90 minutes to reach the hospital. Majority of the patients used public vehicles as a means of transport to and from the hospital in escort of their mothers. Despite the long distances and difficult traveling conditions, the parents still preferred day case surgery and were willing to obey postoperative instructions. Conclusion: From the findings in this study, day case surgery in children in our environment is feasible,despite the poor social circumstances of most of them. There is, however a compelling need to raise the standard of living of the people to enable them benefit maximally from day case surgery

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Background: Abdominal wounds following surgery for typhoid perforation are classifi ed as dirty, with an infection rate of over 40%. To date, the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice, is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife, Nigeria, and advocates a multidisciplinary wound management protocol. Patients and Methods: This is a retrospective study of children aged < 1–15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria, over a period of ten years. Results: Thirty-two patients, 18 males and 14 females, in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8%) patients, while 19 (59.4%) patients had surgical site infections. Wound dehiscence, intraabdominal abscess, and faecal fi stulas were the other complications documented in the study. Conclusion: Abdominal wounds of typhoid perforation, though classifi ed as being dirty, can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs. Keywords: Children, outcome of primary closure of abdominal wounds, typhoid perforationAfrican Journal of Paediatric Surgery Vol. 6 (1) 2009: pp. 31-3

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

Omphalitis Complicated By Necrotizing Fasciitis And Abdominal Muscle Gangrene In A 33 Day Old Infant A Case Report.

Background: Necrotizing fasciitis is generally rare in the neonatal period. When it does occur, it carries a high risk of morbidity and mortality. Methods: Case records of the patient was retrieved and relevant information about clinical presentation, resuscitation, care and outcome extracted Results: A 33-day old infant presented with 24hour history of anterior abdominal wall discoloration and 8hour history of bowel evisceration. Efforts at resuscitation, challenge of skin cover and attempt at improvisation of silo are presented as well as the final outcome. Conclusion: Although necrotizing fasciitis of the anterior abdominal wall is rare in neonates, the morbidity and mortality associated with it is very high as this case report has shown. Early presentation and availability of neonatal intensive care may improve survival. Keywords: infant, necrotizing fasciitis, burst abdome

Epidemiology of external birth defects in neonates in Southwestern Nigeria

Background: There is paucity of information on the prevalence of birth defects in Nigeria, particularly in our setting. This study determined the epidemiology of external congenital anomalies in Southwest Nigerian children. Patients and Methods: This was a stratifi ed, randomized study of neonates presenting with external birth defects in Ife-Ijesha in Southwestern Nigeria, from August 2003 to July 2004. The neonates were screened for obvious congenital malformations by thorough physical examination. Results: A total of 624 neonates were screened, 43 (6.9%) of whom had external birth defects (prevalence: 3.7 ± 0.8% SD). There was a slight male preponderance (M: F= 1.4: 0.9). The overall prevalence rates of external congenital and major anomalies in Ife- Ijesa are 6.9 and 3.7% respectively. A higher prevalence for major malformations, 6.3%, was also found within the minority ethnic groups in these communities compared to the native majority. Musculoskeletal abnormalities are the most common anomaly, followed by those of abnormal external genitalia and head defects. Conclusion: Major malformations are more common amongst the minority settlers in this study, and musculoskeletal abnormalities were the most prevalent Keywords: Birth defects, epidemiology, neonates, NigeriaAfrican Journal of Paediatric Surgery Vol. 6 (1) 2009: pp. 28-3