Appendicular Mass at El Obeid Hospital, Western Sudan

Background: Acute appendicitis is a common disease but some patients were only diagnosed after they develop serious complications like appendicular mass.Objectives: The objective was to study the clinical presentations, treatment and outcomes of patients with appendicular mass seen at El Obeid Hospital, Western Sudan.Materials and Methods: In a prospective study the information about all patients with appendicular mass who were admitted to the wards of the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan during the year 2012 were collected in a pre-designed questionnaire. The data were analyzed using SPSS PC packages version 17.5.Results: There were one hundred and three patients; 58 males and 45 females. The mean age was 29.5 years ± S.D. 17.8. Most of the patients (76%) came from rural areas. The delay in time of presentation varied from 3 days to two weeks, but the majority (93%) visited a clinical setting where misdiagnosed or mismanaged. 85% of the patients had appendicectomy (emergency or elective), 10% had drainage of appendicular abscess and 2% underwent right hemi-colectomy. 3% of the patients failed to re-appear for elective operation. Post-operative complications were fever (4.8%), wound infection (5.8%), paralytic ileus (1.9%) and faecal fistula (0.9%). There was no mortality among this series.Conclusions: Most of the patients with appendicular mass were misdiagnosed or mismanaged before being admitted to the surgical wards. Awareness of the health providers in this community about acute appendicitis, its complications and its management needs to be revised.Key words: Acute appendicitis, missed diagnosis, appendicular mass

Colonoscopy at El Obeid Hospital, Western Sudan

Background: Colonoscopy is effective in screening, diagnosis and treatment of colorectal problems.Objective: The objective of this study was to highlight the impact of colonoscopy service on the pattern and management of lower gastrointestinal diseases as appeared after its introduction for the first time in El Obeid, Western Sudan.Materials and methods: The records of individuals who underwent colonoscopy at El Obeid Hospital were reviewed. The data were analyzed for gender, age, indications, pathology revealed and the outcomes of the procedures.Results: Out of 160 colonoscopies performed, there were 108 males (67.5%). The age ranged between 17 and 85 years. The main indications were rectal bleeding, irregular bowel habits and lower abdominal pain. 28.1% of the individuals were found to be normal. 28.0% of the patients had colitis and 2.5% had diverticular disease. Cancer was diagnosed in 10.1% of cases while benign polyps were found in 7.5% of the patients and internal piles were seen in 14.4% of cases. 9.4% of the patients were emergency procedures for acute sigmoid volvulus. Apart from the discomfort and non-frequent nausea, no other complications like rectal bleeding or colonic perforations were encountered among the study group.Conclusion: Colonoscopy is a safe and useful procedure. Expansion of the service and more training is recommended to supplement diagnosis and facilitate therapeutic measures.Key words: Colonoscopy, Western Sudan

Acute Perforated Peptic Ulcer at El Obeid Hospital, Western Sudan

Background: The pattern of peptic ulcer disease and its complications has changed during the last two to three decades.Objectives: To state the frequency of acute peptic ulcer perforations and outcomes of their management at El Obeid Hospital, Western Sudan.Materials and Methods: This is an audit of patients with acute perforated peptic ulcer admitted to the emergency wards of the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan during the period from January 2006 to December 2012.Results: There were 53 patients, 94.3% were males. The age ranged between 18 and 77 years. Most of the patients reported late and 45.3% during Ramadan and Shawal. All patients had emergency peritoneal lavage and simple closure with omental patch followed by anti-ulcer therapy. The postoperative mortality was 7.6%.Conclusions: Perforated peptic ulcer in this community was mainly  duodenal. Emergency peritoneal lavage and simple closure with omental patch followed by anti-ulcer therapy resulted in excellent outcomes. Old age, shock, peritonitis and septicaemia were the major risk factors formortality.Key words: Perforated duodenal and gastric ulcers