Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome

Background: To present this experience using the fundus-first technique during laparoscopic cholecystectomy for the management of symptomatic gall stone disease with an intra-operative finding of Fitz-Hugh-Curtis syndrome.Methods: This is a prospective review of patients who had the fundus-first dissection during laparoscopic cholecystectomy. The study was carried out at the Jos University Teaching Hospital (JUTH), and FOMAS hospital, both of which are tertiary hospitals located in Jos. Patients were recruited from January 2017 - January 2019. All patients undergoing laparoscopic cholecystectomy who had an intraoperative diagnosis of Fitz-Hugh-Curtis syndrome, and who had the fundus-first dissection, were included in the study. Patients who had fundus-first dissection for indications other than Fitz-Hugh-Curtis syndrome, were excluded from the study. Demographic and clinical information of patients included age, sex, duration of surgery, complications, and duration of hospital stay. Descriptive statistics were applied.Results: A total of 76 patients had elective laparoscopic cholecystectomies over the study period. Of that number, 17 (22.4%) patients had an intra- operative diagnosis of Fitz-Hugh-Curtis syndrome, and had the fundus-first dissection. The mean patient age was 46.3 years (SD = 11.7 years). All patients were female. The mean operating time was 70 minutes (SD = 23 minutes). The duration of hospital stay was 24 hours. There was one conversion due to uncontrollable intraoperative bleeding.Conclusions: This study revealed that the fundus-first dissection is suitable for removing the gall bladder during laparoscopic cholecystectomy in patients with gall stone disease, and an intraoperative finding of Fitz-Hugh-Curtis syndrome

Prenatal ultrasound diagnosis of anterior abdominal wall defects in sub Saharan Africa; simple but often missed

Background: Congenital anterior abdominal wall defects (AAWD) is a spectrum of abdominal wall defects that includes omphalocele, gastroschisis, bladder exstrophy, cloacal exstrophy, prune belly syndrome and pentalogy of Cantrell. Early Prenatal diagnosis of AAWD provides opportunity for abnormal karyotypes screening and planned delivery in a specialized centre. Ultrasound can detect these defects during pregnancy. This study aims to evaluate the detection rate of AAWD during routine obstetric ultrasonography in our region.Methods: A retrospective study of all patients that presented with AAWD to our centre from January 2008 to July 2020. Data included patient’s age, sex, birth weight, diagnosis, resuscitation time, outcome, maternal age, parity and antenatal ultrasound scan (USS) records. Antenatal USS before 12 weeks only, were excluded. Data analysed using excel.Results: Of the 140 with AAWD, 84.29% had omphalocele, 10% gastroschisis, 2.14% prune belly syndrome and 0.71% each with bladder exstrophy, cloacal exstrophy and pentalogy of Cantrell. There were 123 booked pregnancies. Majority (112) had antenatal care elsewhere while 11 attended our Centre. Ultrasonography of 108 pregnancies scanned at12 weeks or beyond, had 4 confirmed prenatal diagnosis of AAWD. All done in our centre. Mean gestational age at diagnosis was 24weeks. Outcome was rupture1 (25%) and 25% mortality (prenatally diagnosed) and 51.92% mortality for patients with missed diagnosis.Conclusions: Our obstetric ultrasound detection rate of AAWD is very low. There is a need for improvement in training to improve perinatal care of these defects

Jos christmas eve bomb blast: confronting new challenges with old resources

Background: Jos, Nigeria has witnessed several mass casualty incidents from sectarian crises, with mechanisms of injury mainly from blunt forces and use of machetes and less from gunshots. In December 2010, for the first time, twin bomb blasts detonated at a market generating casualties and triggering another crisis. We sought to describe peculiarities of this novel mechanism of mass casualty.Methods: A retrospective descriptive study of patients who presented to our hospital with injuries sustained following the Jos Christmas Eve bombing of 2010.Results: Of the 90 patients that presented over 4 days, 81 were males and 9 females. Age ranged from 2 to 76 years with a mean of 36.2 years, SD=± 16. There were 31 (34.4%) blast injuries and 35 (38.9%) gunshot injuries. Majority of the wounds involved the lower limbs in 39(43.3%) patients, and upper limbs in 24(26.6%). Forty three (47.8%) patients required only debridement and 13(14.4%) needed only wound dressing. Definitive procedures done were open reduction and internal fixation in 7(7.7%) patients, laparotomy in 5(5.5%), amputation and local wound exploration in 3(3.3%) each, and chest tube insertion in 2(2.2%) patients. Duration of hospital stay ranged from 0-84 days. More than half of the 14(15.5%) complications were infective in origin. There were 7(7.7%) mortalities. The hospital cost was 14 times higher than that of previous crisis that did not involve bomb blast.Conclusion: The bomb blasts generated predominantly limb injuries that required a lot of resources and prolonged hospital care..A disaster response protocol that envisages injuries arising from this mechanism is essential