Pattern Of Intestinal Obstruction In A Semiurban Nigerian Hospital

Intestinal obstruction remains one of the commonest causes of acute abdomen worldwide. The pattern of intestinal obstruction varies from one place to another. We report the pattern of intestinal obstruction observed in a semi urbanNigerian hospital over a 5 year period. Records of patient admitted and managed for intestinal obstruction between April 2001 and April 2006 at the federal medical centre, Owo, Southwestern Nigeria, were reviewed. Demographic data as well as parameters relating to the symptoms, duration, onset, type, diagnosis, intraoperative findings, aswell as postoperative outcomes were retrieved. All datawas entered into a personal computer and analyzed using SPSS forwindows version 11. Atotal of 95 patientsweremanaged during the period. Themean agewas 39 years.The male female ratio was 1.8:1. Adhesive intestinal obstruction was the commonest cause of symptoms in 44%, followed by volvulus in14% and external hernias in 11%of the patients. Acorrect preoperative diagnosis was made in over 70% of the patients. Out of thosewith adhesive obstruction, 75% had a previous abdominal or groin operation while 57% had surgical exploration for failed conservative management. The mean duration of hospital stay was 6 days and the overall mortality rate was 20%. Adhesive intestinal obstruction is the commonest cause in this semi-urban population which was studied. Obstructed hernia is becoming increasingly less common as a cause of intestinal obstruction. Keywords: Pattern, Intestinal Obstruction, Semiurban Hospital. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 347-35

Open hemorrhoidectomy under local anesthesia for symptomatic hemorrhoids; our experience in Ile –Ife, Nigeria

Background: Ligation-excision hemorrhoidectomy is considered the gold-standard treatment for prolapsed hemorrhoids. The procedure is commonly done under general or regional anesthesia. This study is aimed to assess the feasibility and tolerability of open – hemorrhoidectomy under local anaesthesia in our setting.Methods: This is a prospective study carried out in Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria, over a 5-year period. All consenting adult patients with prolapsing hemorrhoids were offered Milligan – Morgan hemorrhoidectomy under local anesthesia. They were assessed for tolerance and complications.Results: More than 95% of patients tolerated the procedure with manageable complications.Conclusions: Open excisional hemorrhoidectomy under local anesthesia is feasible, safe and well tolerated in our environment and may encourage early presentation of patients with piles to hospital.Keyword: Open hemorrhoidectomy, local anesthesia, Nigeria

Safety of the surgeon: ‘Double-gloving’ during surgical procedures

Background. In the face of increasing HIV/AIDS prevalence in subSaharan Africa, we evaluate the effectiveness of ‘doublegloving’ during surgery as a means of protecting the surgeon operating on patients with a known or unknown HIV status.Methods. A prospective study was conducted to determine the rate of glove puncture and intraoperative injury in categories of patients with known positive, known negative or unknown HIV status.Results. The surgeon and the first assistant double-gloved in all the 1 050 procedures performed between 2009 and 2013, and a total of 8 400 surgical gloves were used. Sixty-nine patients (6.6%) were HIV-positive, 29 patients (2.8%) were HIV-negative, and the HIV status was unknown for the remaining 952 patients (90.7%). The overall glove puncture rate in the study was 14.5%. The glove puncture rate was 0%, 31% and 15% for HIV-positive, HIV-negative and HIV status unknown, respectively, and thisdifference was statistically significant. The mean operating time in the  group with glove punctures was 148 min (95% confidence interval (CI) 135 - 161), while mean operating time in the group without glove puncture was 88 min (95% CI 84 - 92).Conclusion. Double-gloving offers protection against intraoperative injury. Knowing the HIV status of the patient offers additional protection to the operating surgeon. While we recommend routine double-gloving for surgeons working in HIVprevalent patient populations, we also advocate for the routine screening for HIV in all surgical patients

Ambulatory Epigastric Hernia Repair Using Local Anaesthesia: A Pragmatic Approach In A Resource Poor Society

No Abstract

A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

Background: Gastro-duodenal perforations are common and may complicate peptic ulcer disease. Management is often by surgical closure.Objective: To determine the patterns of presentation and mode of management of duodenal ulcer perforations.Methods: Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011. Patients’ records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications. Data obtained was analyzed using SPSS 15.0.Result: Forty- five patients were reviewed. There were 37 males (82.2%). Mean age was 39.7years (range 15-78years). There were 10 (22.6%) students and 8(17.8%) farmers. NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases. Seven (16%) patients presented less than 24 hours of onset of illness. Forty one perforations (91.1%) involved the first part of duodenum. Twenty two (49%) patients had Graham’s omental patch. We had one (2.2%) failed repair and six (13.3%) mortalities. Conclusion: Late presentation of duodenal ulcer perforation is common with high mortality. Pragmatic surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.Keywords: Duodenal ulcers, perforations, management, NigeriaAfrican Health Sciences Vol 13 Issue 4 December 201

Liver Abscess: A Review

Liver abscess can be defined as an area of liquefied infected infarct. Differentiating the etiology of the abscess is important in the diagnosis and management of the patient. The pathogenic route of infection determines the microbiology and loculation of the abscess. Presentations of liver abscesses depend on the severity of the disease, its chronicity, microbiology of the abscess, age of the patient, presence or absence of vascular compression and extension of abscess into contiguous organ(s). Investigations in a patient with liver abscess can be divided into: diagnostic; liver parenchyma status; anatomical and physiological effect of the disease on body. Management of liver abscess is dependent on available resources, expertise, disease severity and co-morbity. The prognosis of patients with liver abscess is determined solely by the functional status of the underlying liver. IFEMED Journal Vol. 14 (1) 2008: pp. 40-4

Classification Types Of Postoperative Enterocutaneous Fistula As A Determinant Of Outcome Of Treatment In Ile-Ife, Nigeria

Objective: Post operative enterocutaneous fistula, in this environment, continues to excite interest because it runs a distressing course, and it is often associated with high mortality and morbidity. Determining the classification type best suited to suggest the outcome would be helpful in guiding the management of the condition. Setting: Ife Hospital Unit, Obafemi Awolowo Teaching Hospitals Complex, Ile – Ife. Outcome Measure: To determine the clinical pattern of post operative external enterocutaneous fistula and the classification method that best predict outcome of the condition. Methodology: Consecutive patients with clinical postoperative external enterocutaneous fistula seen between 1994 and 2006 were studied. The case files were retrieved and information on demographic data, type of initial surgery, source of referral, and characteristic of the fistula in terms of effluent per day and type of intestine involved were retrieved and analyzed. Patient with incomplete clinical information were excluded from the study. Result: There were 30 patients aged 17 to 65 years, mean of 33 years ±SD 12.23 years, with male to female ratio of 2:1. Length of hospital stay ranged from 1 to 43 weeks. Majority 28 (93.3%) were referred after primary operation at the lower cadre hospitals. Enterocutaneous fistula followed intestinal resection in 15 cases (50.0%) and was post appendicectomy in 9 cases (30.06%). Three (11.1%) cases each had burst abdomen and Acquired Immunodeficiency Syndrome (AIDS) in 3 cases (11.1%) additionally. Overall mortality was 12 (40 %) was high. Compared with the other classifications considered in the study classification into high and low output highly correlated with the outcome of treatment logistic regression p < 0.006 versus p = 0.123 and p = 0.244 respectively for Sitges – Serra and schein and groups. Conclusion: In this study majority of patients with enterocutaneous fistula were referred from Private and State hospitals set up. This might be a reflection of the generally lower level of technical surgical skills at this level of healthcare facilities. Classification of enterocutaneous fistula into high and low output was still useful in our environment for predicting prognosis and may, therefore, be used to guide management strategies. Keywords: Post operative enterocutaneous fistula, Treatment outcome determinant, Classification.Sahel Medical Journal Vol. 11 (4) 2008: pp. 105-10

Metastatic breast cancer in a Nigerian tertiary hospital

Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome.Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital.Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were reviewed.Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3% (6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63%), lung parenchyma (51%), pleura (26%) and contralateral breast in 25%. On immunohistochemistry, basal like tumours were found in 46.1%. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27%.Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation

Metastatic breast cancer in a Nigerian tertiary hospital

Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome.Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital.Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were reviewed.Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3% (6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63%), lung parenchyma (51%), pleura (26%) and contralateral breast in 25%. On immunohistochemistry, basal like tumours were found in 46.1%. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27%.Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation

Avaliação epidemiológica das vítimas de trauma abdominal submetidas ao tratamento cirúrgico

OBJETIVO: avaliar o perfil epidemiológico e o desfecho das vítimas de trauma abdominal submetidas à laparotomia em hospital de urgência. MÉTODOS: estudo observacional, descritivo, longitudinal, com abordagem prospectiva, mediante entrevista de 100 pacientes com trauma abdominal submetidos ao tratamento cirúrgico e à avaliação dos seus prontuários. Período da coleta dos dados: setembro a novembro de 2011. RESULTADOS: Os pacientes mais acometidos pelo trauma abdominal foram do sexo masculino, de cor parda, na faixa etária de 25-49 anos, com baixa escolaridade, solteiros, católicos, com rendimento de um a dois salários mínimos. Houve uma predominância do trauma no ambiente urbano, no período noturno e no final de semana. O motivo mais frequente do trauma foi a tentativa de homicídio, associado ao uso de álcool e drogas ilícitas e o mecanismo a arma branca. A dor mostrou-se o sinal de alerta mais presente. A região mais afetada foi abdome superior e o fígado o órgão mais acometido. O tempo de internação hospitalar durou em torno de quatro a dez dias. A maioria teve alta sem sequela. Ocorreram dois óbitos. CONCLUSÃO: Foi marcante a associação do trauma abdominal com homens sob efeito de álcool e/ou drogas ilícitas, refletindo o contexto da violência interpessoal na sociedade atual. A despeito da magnitude do trauma, o desfecho foi satisfatório, apesar da ocorrência de óbitos, o que denota a importância dos hospitais de urgência de manter no seu corpo clínico uma equipe cirúrgica treinada