Spectrum of Gunshot Injuries in Civilian Practice at a Tertiary Hospital in a Semi-rural Community in Nigeria

Background: Gunshot injuries are common. Political and ethno-religious conflicts have made injuries from ballistics now commonplace in Nigeria. Data was collected prospectively at Federal Medical Centre Owo, South Western Nigeria from September 2007 to August 2011. The objective was to highlight the nature of gunshot wounds, patients’ and gun  characteristics, and document the outcome of treatment upon discharge.Methods: All patients with gunshot injuries (GSI) admitted via the emergency room (ER) of the hospital. Outcome measures included the status upon leaving the hospital: Alive and discharged home without disability; alive and discharged home with some disability; discharged against medical advice; referral to another hospital and death. Data was analyzed using SPSS17 programfor frequencies, measure of central tendencies and relationships.Results: A total of 139 patients were seen. Males accounted for 94.2% of the victims. The ages ranged from 12 to 70 years (mean = 33.14 years); modal age group was 21-40 years (76.3%). High velocity injuries were common (59%). Armed robbery (56.1%), accidental discharge (20.1%) and assault (11.5%) were major sources. Injuries involved the limbs (54.7%), trunk (10.1%), and > one region (22.3%). About 62% of cases presented within 8hours of injury. The mortality and limb deformity rates were 5.8% and 14.4% respectively. Outcome of treatment depended on promptness of definitive care and the nature of injuries at presentation (p= 0.001 and p=0.026 respectively).Conclusion: Injuries from high velocity guns were common. Armed robbery, assault and accidental discharge from law enforcement agents were the major sources. Outcome was dependent on the nature of injuries and the promptness of intervention.Keywords: Injuries, Civilian, Gunshot

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

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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

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

Management of Patients with Obstructive Jaundice: Experience in a Developing Country

Background: Surgical Obstructive Jaundice can be lifethreatening. Management of these patients can be a major diagnostic and therapeutic challenge.Objective: The aim of this study is to determine the sociodemographicdata of patients with obstructive jaundice, clinical, laboratory and radiological findings as well as surgical procedures done and immediate postoperative outcome in a tertiary health institution.Methods: Patients who presented in a Nigerian tertiary health institution with surgical obstructive jaundice between. January 1991 and December 2004 were retrospectively studied. Information was extracted from clinical records, operation notes and histopathology records. Data was entered into SPSS version 11.0 for windows to generate frequency table, percentages,proportion, histogram and pie chart.Results: Sixty-four patients with obstructive jaundice were managed during the study period. Majority of the patients were in the 6th decade of life. More than 50% of the patients have had symptoms for more than 4 weeks before presentation. Carcinoma of the head of pancreas was the cause of obstructive jaundice in more than 60% of the patients . About 47% of the patients had cholecysto jejunostomy and operative mortality was 15.6%.Conclusion: Carcinoma head of pancreas is the commonest cause of obstructive jaundice in Nigeria with many of the patients in the 6th decade. Diagnosis and management continue to be a challenge especially as aresult of late presentation and limited radiological facilities. Patients benefited from palliative surgical intervention in form of bili-enteric diversion.Key words: Surgical Obstructive Jaundice, Palliative surgery

A 5‑year Review of Darning Technique of Inguinal Hernia Repair

Context: The Darning technique of inguinal hernia repair is a tissue‑based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome. Aims: The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting. Study Design: A descriptive retrospective study. Patients and Methods: Clinical records of all patients who had inguinal hernia repair using the Darning technique between January 2007 and December 2011 in our institution were obtained. Details of sociodemographic data, intraoperative findings and postoperative complications were reviewed. Statistical Analysis Used: simple frequencies, proportions and cross‑tabulations. Results: A total of 132 patients whose ages ranged from 15 to 84 years (mean = 49.4 years) with a male: female ratio of 12:1 were studied. Majority of the hernias were right sided (68.9%), mostly indirect (81.8%). The procedures were for emergencies in 17 (12.9%) cases whereas the rest (87.1%) were done electively. Most procedures, 110 (83.3%) were performed under local anesthesia. Surgical site infection was the most common complication occurring in six patients (4.5%), while four patients (3%) had chronic groin pain. At a mean follow‑up period of 15 months there were two recurrences (1.5%) both occurring in patients with bilateral hernias (P = 0.001). Conclusions: The Darning technique of inguinal hernia repair is a safe and effective method for inguinal hernia repair in our setting.Keywords: Darning, hernia, inguina