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Year : 2014  |  Volume : 20  |  Issue : 1  |  Page : 42-46  

Abstracts of papers presented at the 64 th scientific meeting of NSRS held at Enugu State University Teaching Hospital, Enugu, Nigeria on December 6, 2013

Date of Web Publication14-Feb-2014

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. Abstracts of papers presented at the 64 th scientific meeting of NSRS held at Enugu State University Teaching Hospital, Enugu, Nigeria on December 6, 2013. Niger J Surg 2014;20:42-6

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. Abstracts of papers presented at the 64 th scientific meeting of NSRS held at Enugu State University Teaching Hospital, Enugu, Nigeria on December 6, 2013. Niger J Surg [serial online] 2014 [cited 2022 Jul 3];20:42-6. Available from: https://www.nigerianjsurg.com/text.asp?2014/20/1/42/127113

Endoscopic Evaluation of Gastro-intestinal Hemorrhage

Ray-Offor E, Elenwo SN, Obiorah CC 1

Departments of Surgery, and 1 Anatomical Pathology, University of Port-Harcourt Teaching Hospital, Port-Harcourt Rivers State, Nigeria

Introduction: A myriad of pathologies lead to gastro-intestinal (GI) hemorrhage. The common clinical presentations are melena, hematemesis and hematochezia. Endoscopy aids localization and treatment of some of these lesions. Aim: The aim of the following study is to report our experience in the endoscopic management of GI hemorrhage. Patients and Methods: A prospective study of patients referred to the Endoscopy unit of a Part-Harcourt-based private hospital from February 2012 to November 2013 with GI bleeding. The variables studied included: demographics, clinical presentation, American Society of Anesthetists (ASA) grade, endoscopic findings, therapeutic procedure and outcome. Data were collected and analyzed using SPSS (IBM, Seattle) version 20 software. Result: A total of 66 upper and lower GI endoscopies were performed during the study period with 28 cases of GI hemorrhage. There were 25 males and 3 females with an age range of 13-86 years (mean age 52.4 ± 20.6 years). Hematochezia, hematemesis and melena were seen in 20 (71%), 6 (21%) and 2 (8%) cases respectively. The three most common pathologies seen were: hemorrhoids 7 (25%), diverticular disease 2 (7%) and peptic ulcer disease 2 (7%). No primary source of bleeding was identified in 9 (32%) cases. Injection sclerotherapy was successfully performed in all hemorrhoids and a case of gastric varices. Conclusion: Endoscopy is vital in the management of GI hemorrhage. Hemorrhoids are the most common cause of lower GI hemorrhage with injection sclerotherapy an effective treatment modality.

Surgical Abdomen in Children and Young Adults at the Wesley Guilds Hospital Ilesa

Etonyeaku AC, Talabi A, Olasehinde O, Akinkuolie AA, Agbakwuru EA, Mosanya A

Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria

Background: Surgical abdomen has a world-wide distribution and traverses all age groups. We sought to define etiology and patients' characteristics among children and young adults in our hospital. Patients and Methods: Prospective review of surgical abdomen in patients aged 5-16 years managed at the Wesley Guilds Hospital Ilesa and Akure Clinics and Endoscopy Center Akure, Nigeria from September 2011 to August 2013. Information on age, gender, duration of illness, pre-operative and post-operative diagnoses and early complications of surgery and duration of hospital stay were entered into a spreadsheet and analyzed for averages and simple percentages. Results: A total of 52 patients were treated. The male:female ratio was 1:1. The age range was 5-15 years (mean = 11.25 ± 2.24 years). Mean duration of illness was 29 h (range 2-72 h). Gut perforation was the most common etiology (n = 39; 75%); while perforations due to infections was 87.2% (n = 34). Trauma related cases were 6 (19.2%) and were more common in males; while those due to obstructed gut was 15.4% (n = 8) and found to be more common in females. Five out of eight small bowel obstructions were due to post-operation adhesions. Pre-operative and post-operative diagnoses were congruent in 90.4% (n = 47) of cases. Mortality rate was 1.9% (n = 1) while majors post-operative complications were atelectasis (4; 7.7%), pneumonia (5; 9.6%), surgical site infection (20; 38.5%). The average hospital stay was 9 days (range 4-21 days). Conclusion: Acute abdomen requiring surgical intervention is mainly infective origin. The male child is more at risk of abdominal trauma while gut obstruction was more common in females.

Accuracy of Ultrasound-Guided Fine Needle Aspiration Cytology in the Assessment of Palpable Breast Lesions at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Anyanwu SNC, Umeh EO 1 , Ebubedike UR 1 , Ukah CO 2 , Onwukamuche ME 2 , Chianakwana GU, Ihekwoaba EC, Egwuonwu OA, Emegakor C, Okpala O 1 , Anyiam DC 2 , Ahaneku G 3

Departments of Surgery, 1 Radiology, 2 Pathology, and 3 Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Background: Fine-needle aspiration cytology (FNAC) has become established for pathologic assessment of palpable breast lesion due to accuracy, affordability and ease of use. Objectives: The objective of this study is to determine the accuracy of ultrasound-guided breast FNAC using surgical biopsy as Gold Standard and to document the inadequate smear rate among operators at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. Materials and Methods: A total of 17 consenting adults aged 18 years and above underwent ultrasound-guided FNAC and surgical biopsy for palpable breast lesions. Smears were examined at the NAUTH Histopathology Department. Results: Mean age of participants; 35.5 ± 12.5 years (range 16-60 years). Mean tumor size 20.58 mm, ±15.6 (range: 3.40-66.20 mm). Overall inadequate smear rate: 23.5% FNA - Cytological reporting categories C1, C2, C3, C4 and C5 had frequencies 4, 10, 0, 3 and 0 respectively. Ultrasound-guided breast FNAC sensitivity; 50% specificity; 86% positive predictive value; 33.3% and negative predictive value; 92.9% respectively. Conclusion: Documented sensitivity and specificity of ultrasound-guided FNAC at this stage of the study may be attributable to generally small lump sizes, high inadequate smear rates and small sample size. Future options adopted to reduce inadequate smear rates as study progresses may improve overall accuracy of the procedure.

An Additional Method of Supra-pubic Catheterization (Enugu State University Teaching Hospital Technique)

Edeh AJ, Okenwa WO, Anekpo CC, Nevo AC, Ohayi SAR

Department of Surgery, Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria

Background: We have developed successfully an additional method of supra-pubic catheterization which is rapid, safe and economic and easily accomplished at the bedside, requiring only local anesthesia; which we recommend for wider adoption. Objective: To compare our new technique of supra-pubic catheterization (Enugu State University Teaching Hospital [ESUTH] technique) to other established stab techniques. Methodology: The ESUTH technique is a careful modification of Riches' stab technique of supra-pubic catheterization. Patients presenting to ESUTH with acute urinary retention and failed urethral catheterization between 2004 and 2012 were involved in the study. Results: A total of 31 patients were used in this study. Of which, 29 males and 2 females had a successful supra-pubic catheterization using this new technique. Common complications of this technique were urinary leakage and hematuria both of which were minor. There was no incident of damage to pelvic viscera or prevesical urinoma formation. Conclusion: ESUTH technique of supra-pubic catheterization is safe. We recommend it for wider adoption.

Current Trends in Groin Hernia Repair at the Wesley Guilds Hospital Unit of the Obafemi Awolowo University Teaching Hospital: January 2008-August 2013

Etonyeaku AC, Agbakwuru EA, David O, Akinkuolie AA, Olasehinde O

1 Obafemi Awolowo University, Teaching Hospital Complex, Wesley Guilds Hospital Unit, llesa, 2 Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

Background: Hernia repair is a common surgical procedure world-wide. There has been a global change in the way groin hernia is treated. This has been in terms of techniques for surgery and anesthesia and duration of hospital stay. Objective: The objective of the following study is to determine the trends in presentation and modalities of treatment of groin hernia in our hospital. Patients and Methods: Retrospective review of adult groin hernia repair from January 2008 to August 2013 at the Wesley Guilds Hospital Ilesa, Osun State, Nigeria. Information on age, gender, occupation, duration of hernia, type of hernia, repair technique, type of anesthesia and complications of surgery and duration of hospital stay were extracted from hospital records and entered into a spread sheet; and analyzed for simple percentages and measures of central tendency. Results are presented in tables and graphs. Results : Totally 270 patients with 296 herniae were treated. There were 256 (94.8%) males and 14 (5.2%) females. Age range was 15-85 years with modal age group 41-65 years (45.6%). About 55.6% of patients had occupation involving physical exertion. Hernia was unilateral in 244 (82.4%) cases with 157 (64.3%) and 87 (35.7%) occurring on the right and left sides respectively. Bilateral hernia in 26 (8.9%) cases. Inguinal herniae were more common (99.7%) while only one femoral was treated. Of the inguinal herniae, 217 (73.3%) were indirect while 79 (26.7%) were direct and 3 (1%) pantaloon. Ten (33.8%) inguinal hernia were recurrent while 63 (21.3%) were complicated. Local anesthesia was the preferred (80.7%) choice while spinal was used in eight patients (2.7%) who had prostatectomy at the same sitting. Two hundred and six (76.3%) had day case procedure. All patients had posterior wall repair with Basini (43; 14.5%), Nylon Darn (155; 52.4%), Shouldice (4; 1.3%) and mesh hernioplasty (94, 31.8%) deployed. McEvedy technique was used for the femoral hernia. Post-operative complications were: surgical site infection (5, 1.7%), hematoma (2, 0.7%), urine retention (2, 0.7%), scrotal chemical burns (1, 0.34%,) Scrotal edema (2, 0. 7%), abdominal distention (1, 0.34). Mortality rate was 0.7%. Duration of follow-up ranged from 1 week to 5 years, no recurrence was noted. Conclusion: There is an increase in the use of mesh for hernia repair. Most repairs are now carried out using local anesthesia as day case procedures. Mortality rates are lower while follow-up remains poor.

Application of Digital Rectal Examination in Estimating Prostate Size in a Rural Hospital Setting: Ascertaining its Reliability

Ude EI, Dakum NK 1 , Aderibigbe SA, Oguuche E 1 , Edeh AJ 2

University of Nigeria Teaching Hospital, Enugu, 1 Jos University Teaching Hospital, Jos, 3 ESUT Teaching Hospital, Enugu, Nigeria

Objectives: To determine the correlation between prostate volume estimated by digital rectal examination (DRE) and that estimated by abdominal ultrasound rectal in the same patients. Patients, Materials and Methods: Men who presented to our urology out-patient clinic with lower urinary tract symptoms were recruited in this study. We estimated the prostate size by digital rectal examination using the sliding scale as a guide and subsequently measured the prostate volume by transabdominal ultrasound. Results: A total of 100 patients took part in this study. The mean age was 65.6 ± 9.84 years. The Kappa's reliability test comparing the prostate size estimated by DRE and the prostate size measured by transabdominal ultrasound was 0.579832, the Kappa's standard error was 0.097768 and Kappa's t value was 5.93. The Kappa's reliability test fell into the medium agreement range (0.4-0.75). Conclusion: There was correlation between DRE estimated prostate volume and transabdominal ultrasound estimated volume. The implication is that doctors with the aid of grading scale could apply this method of estimation in rural hospital settings devoid of exoteric laboratory facilities.

Short Segment Bulbar Urethral Strictures: Management and Outcome in 42 Patients

Anselm OO

Department of Surgery, Urology Division, Federal Teaching Hospital, Ebonyi State University, Abakaliki, Nigeria

Objective: To share our experience on the management of short bulbar urethral strictures (BUS) in our center. Methods: All short segment BUS managed by the author from January 2003 to December 2012 with at least 6 months follow-up were reviewed. Patients age, stricture etiology, mode of presentation, history of previous instrumentation, stricture characteristics, time to surgery, associated suprapubic catheter (SPC) related morbidity, post-operative outcome and complications were documented and analyzed. Results: All patients had bulbar anastomotic urethroplasty. Mean patient age was 37.46 (±13.80) years. Fall astride injuries accounted for most cases 39 (89.3%). Mean stricture length was 1.04 ± 0.49 cm and it was longer in patients who had prior urethrotomy or bouginage, 1.45 cm (±0.37) versus 0.70 cm (±0.26) (P = 0.000). Indwelling SPC related association morbidity was noted in 38 (79.2%) of patients and was higher in patıents operated on after 6 months of presentation (92.3%) compared with those operated on within 6 months (50%) (P = 0.003), but did not impact negatively on outcome of surgery (P = 0.275). Mean time to surgery was 10.20 (±4.96) months. Patients with complete strictures tended to accept surgery earlier than those with incomplete strictures (P = 0.208), with no difference in outcome between the two groups (P = 0.581). There was no difference in outcome between patients who had pericatheter urethrogram and those who did not. Overall success rate was 92.9%. Conclusion: Short BUS are easily treated by anastomotic urethroplasty with very high success rate. Prior urethral instrumentation is associated with recurrence and longer stricture length. Patients with complete strictures tend to accept surgery earlier than those with incomplete strictures. SPC related associated morbidity increases with duration of catheterization but does not impact negatively on surgical outcome.

Diabetic Foot Ulcers: Prospective Review of Pattern of Presentation at Enugu State University Teaching Hospital, Parklane, Enugu Over a 12 Months Period (December 2012-November 2013)

Isiguzo CM, Osondu CT, Okoro PE

Department of Surgery, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

Introduction: Diabetic foot ulcer (DFU) is a common complication of diabetes. This morbidity results in long hospitalization and high cost of management. It is a significant cause of non-traumatic amputation. Reduction in incidence and progression to amputation will be highly desired. Aim: The aim of this study is attempts to highlight the pattern of presentation and to emphasize the need for multidisciplinary approach in prevention by focused foot care plan. Patients and Methods: A prospective questionnaire based study. Results: A total of 36 patients were recruited with a male female ratio of 1.8:1. Mean age of presentation was 55.5 years and more common in those that have had diabetes for more than 10 years. Low level of education had a directed relationship with occurrence of DFU. Neuropathy was a common predisposing factor to DFU. More than 60% of the patients had no knowledge of foot care even though they have been educated on dietary controls. Conclusion: A comprehensive foot care program should be incorporated in the management of diabetes as soon as diagnosis is made in other to reduce the huge burden of disease.

Assault Related Limb Injuries Seen in a Tertiary Institution in Nigeria

Okenwa WO, Ohayi SAR, 1 Nevo AC, Edeh AJ, Anekpo CC, Odetunde AO

Departments of Surgery, and 1 Histopathology, Enugu State University a Teaching Hospital, Enugu, Nigeria

Background: Interpersonal violence seems to be on the increase world-wide. This is known to cause significant morbidity and mortality. The aim of this study is to evaluate limb injuries that are related to assault in ESUT Teaching Hospital Parklane, Enugu, Nigeria. The limbs are very important in economic survival and its loss or dysfunction could create serious disability and jeopardize survival. Methods: This was a prospective study carried out between March 2012 and February 2013 in the forensic Clinic of ESUT Teaching Hospital Parklane, Enugu. Interviewer administered structured questionnaire was to collect data from the victims off assault visiting the Forensic Clinic of the Hospital. Result: A total of 1928 individuals visited the Forensic Clinic during the study period. 233 of them sustained one form of injury or the other. Limb injuries occurred in 88 (37.7%) of injured victims. Upper limb and lower injures occurred in 71.6% (n = 63) and 18.2% (n = 16) respectively and 10.2% (n = 9) involving both upper and lower limbs: Male to female ratio is 1.6:1. The most common weapon of assault was knife 22.7% followed by wood 18.1% and teeth 16.0%. Workman's tools and bottle accounted for 13.6% and 11.4% respectively. The youngest victim was 15 years and the oldest 65 years. The modal age range of victims was 21-30 years 43.1% (n − 38). Laceration 44% (n - 39) was the most common soft-tissue injury and bone fracture was seen in 3.4% (n - 3) of cases. Most of the injuries occurred in business or workplace 37.5% (n - 33), closely followed by attacks in the living quarters 36.4% (n − 32). Conclusion: The upper limb is a common site of injury during assault probably because most individuals would attempt to protect themselves using their hands. Weapons used in assault are those commonly found at the point of assault and active young people are easily involved.

Facial Injuries in Victims of Assault in a Growing City in a Developing Country

Ohayi SAR, Okenwa WO 1 , Nevo AC 1 , Edeh AJ 1 , Anekpo CC 1

Departments of Histopathology, and 1 Surgery, ESUT Teaching Hospital, Enugu, Nigeria

Background: Assault causes significant morbidity and mortality the word over. Facial injuries from assault are poorly reported in the literature especially in a developing country like Nigeria. The face is important for identification and cosmesis. The aim of this study is to analyze the characteristics of assault-related facial injuries in our environment. Methods: This was a prospective study in which we used an interviewer-administered objectives structured questionnaires to obtain relevant information from all patients attending the forensic unit of ESUT Teaching Hospital Enugu who met the inclusion criteria. Result: A total of 106 patients presented with assault-related facial injuries between March 2012 and February 2013. Male to female ratio was 1.1:1. The age range was 19 months to 68 years; modal range of 21-30 years (N = 49; 46.2%). Most of the injuries occurred at home (N = 51; 48.1%) followed by work/business place (N = 30; 28.3%). There were two cases (1.9%) of intimate partner violence. A total of 141 injuries (133.3%) were recorded with 29 patients (27.4%) presenting with multiple injuries. Soft-tissue injuries constituted 132 injuries (124.5%) while hard tissue injuries were 9 (8.5%). Laceration/incision (N = 66; 62.5%) followed by contusion (N = 43; 40.6%) was most common soft-tissue injury while dentoalveolar fracture was the only encountered hard tissue injury (N = 9; 8.5%). Conclusion: The face is a common target during assault and people mostly affected are in the active period of life.

Acute Appendiceal Diseases in Enugu: Role of Histological Diagnosis

Edeh AJ, Ohayi SAR, Odetunde AO, Nevo AC, Anekpo CC, Okenwa WO

Department of Surgery, Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria

A diagnosis of appendicitis usually conjures fear in people. Pre-operative diagnostic accuracy is a challenge making histology necessary for confirmation. Objective: The goal is to correlate clinic-pathologic diagnosis of acute appendiceal diseases. Methodology: The histopathology laboratory request forms and histological reports on (108 consecutive) appendectomy specimens analyzed in the histopathology laboratory or ESUT Teaching Hospital in 2011 and 2012 were reviewed, incidental appendectomy specimens were excluded. Results: A total of 108 appendectomy specimens removed following a clinical diagnosis of acute appendicitis were reviewed. Negative appendectomy rate is 37.2% of this 23.2% was in young females. Complicated cases (rupture) accounted for 11.1%. Nearly 100% of clinic-pathologic diagnostic concordance is noted in complicated appendicitis. Conclusion: To reduce negative appendectomy, it should be appreciated that a correct diagnosis is more important than an early diagnosis.

The Challenges in Management of Pregnancies Occurring after Definitive Treatment of Advanced Breast Cancer

Edeh AJ, Okenwa WO, Nevo AC, Anekpo CC, Ohayi SAR

Department of Surgery, ESUT Teaching Hospital Parklane, Enugu, Nigeria

Background: late presentation is the norm rather than the exception in patients with breast cancer in Nigeria. The peak age involved is premenopausal. Pregnancies though not common do occur after definitive treatment and causes challenges in management. Objective: To report challenges encountered in two cases managed over a 10 year period. Method: Two case reports of pregnancies occurring after definitive treatment of advanced breast cancer. Results: No challenge encountered in one that had two successful pregnancies and deliveries of normal babies with successful breastfeeding. The second had several challenges; developed osteolytic metastasis with fracture neck of femur because she refused termination to allow for radiological studies at 16 weeks gestation. She delivered a normal baby at term but she has become bedridden to date. Conclusion: Though not common, pregnancies can occur after definitive treatment of advanced breast cancer. If metastatic disease occurs after initial therapy it is a real challenge to manager mother and baby safely until delivery.

Disrespect and Abuse During Childbirth in Enugu

Okafor II 1 , Obi SN 1],[2 , Ugwu EO 2 , Ani CO 3

Departments of Obstetrics and Gynecology, and 3 Radiology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, 2 Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria

Background: Disrespect and abuse during facility-based skilled birth attendants (SBA) childbirth care may be potential barriers to utilization of these life-saving services. Objective: To determine the impacts of SBAs disrespectful and abusive care on service utilization in Enugu. Methods: This was a questionnaire study administered to mothers within the first 6 weeks of delivery while they were accessing immunization services for their babies in Enugu State University of Science and Technology Teaching Hospital (ESUTTH), Enugu between May 1, 2012 and August 31, 2012. Results: A total of 446 mothers responded to the questionnaires; 428 (95.96%) were Igbos, 282 (63.23%) were between 18 and 35 years of age and 420 (94.17%) were married. Three hundred and thirty (73.77%) mothers booked at ESUTTH but only 79 (17.71%) delivered in the hospital while 216 (48.43%) of the mothers delivered in maternity homes. Vaginal delivery 365 (81.84%) was the most common mode of delivery and 417 (93.50%) of the babies were born healthy. Non-consented care 243 (54.48%), physical abuse 159 (35.65%), non-dignifying care 132 (29.60%), abandonment and neglect during delivery 130 (29.15%), non-confidential care 116 (26.00%), detention in the facility 98 (21.97%) and discriminations 89 (19.96%) were the disrespect and abuse during childbirth identified in this study. Only 17.71% out of the 73.77% booked women in ESUTTH deliver in the hospital. About 21.97% of the mothers were detained after facility-based childbirths. Conclusions: Disrespect and abuse may be impacting negatively on SBAs' services utilization in many facilities. Teaching the rights of childbearing women to the mothers, SBAs, the community and policy makers will reduce these malpractices, increase facility-base deliveries and utilization.

Traumatic Urethrocutaneous Fistula in a 22-year-old Nigerian Male: Management and Outcome Case Report

Anselm OO

Department of Surgery, Federal Teaching Hospital, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria

Penile injury is fortunately fairly uncommon as it represents only about 1-1.6% of all trauma cases. Severe penile trauma may be complicated by urethrocutaneous fistula. A 22-year-old male patient presented with large urethrocutaneous fistula following severe crush injury of his penis from the rollers of a baking machine. He had penile fasciocutaneous ventral on lay flap urethroplasty with satisfactory outcome. Wearing loose fitting clothing while operating industrial machinery could lead to entrapment and severe genital injury.

Upper Gastro-intestinal Endoscopy in Port-Harcourt, Nigeria: An Audit

Ray-Offor E, Obiorah CC 1

Departments of Surgery, and 1 Anatomical Pathology, University of Port-Harcourt Teaching Hospital Alakahia, Rivers State, Nigeria

Background: Accurate diagnosis of disease conditions using laboratory, imaging or endoscopic investigation is essential for appropriate treatment. There is no local data on upper gastro-intestinal (GI) endoscopy in Port-Harcourt. This audit of our early experience is needed to improve the quality of patient care. Aims: The aim of the following study is to determine the pattern of presentation and endoscopic findings of symptomatic upper GI disease conditions. Patients and Methods: All consecutive patients presenting to the endoscopy unit of a Port-Harcourt-based private hospital from February 2012 to October 2013 were prospectively studied. The socio-demographics, indications, endoscopic findings and histopathologic report from biopsies taken were collected. Data was statistical analyzed using SPSS version 20. Results: There were 44 Oesophago-gastric-duodenoscopies in 37 patients performed during the study period. Twenty two were males and 15 females. A male:female ratio of 1.5:1 and age range from 5 to 86 years (mean 46.4 ± 18.5 years). The major indications were dyspepsia 22 (50%) and dysphagia 8 (18%). Non-ulcerative gastritis was the most common endoscopic findings seen in 16 (33%) cases and more than one pathologic condition was seen in 8 (18%) cases. Conclusion: Peptic ulcer is not the most common cause of dyspepsia. Gastritis and multiple pathologies in a patient are more common thus the need for thorough endoscopic investigation in symptomatic upper GI disease.

Complicated Appendicitis in Female Children who are House helps

Odetunde OA, Edeh AJ, Onyejizu C

Department of Surgery, ESUT Teaching Hospital, Parklane, Enugu, Nigeria

Background: Appendicitis is a common surgical condition in our environment. The diagnosis is essentially clinical delays in diagnosis cause complications such as perforations gangrene, appendix abscess and generalized peritonitis. Early diagnosis is therefore very important to prevent these complications. Objective: To determine why a large percentage of female house helps with clinical acute appendicitis who presented in our center were complicated with rupture. Methods: Case notes of all females with clinical acute appendicitis over an 18 month period were retrieved. Results: Within the period, 14 females had appendectomy. Nine of the females were house helps. Of the house helps, seven had complicated appendicitis with perforation. Conclusion: We suspect that because these were house helps, early attention was not given by their guardians until perforation occurred.

Epidemiology of Clefts as Seen at the Enugu State University Teaching Hospital and National Orthopedic Hospital Enugu

Onah I, Ovusike A 1 , Jac-Okereke C 2

Departments of Plastic Surgery, National Orthopedic Hospital, Enugu, 1 University of Port Harcourt Teaching Hospital, Rivers State, Port Harcourt, 2 Enugu State University Teaching Hospital, Enugu, Nigeria

Background and Purpose: Published data on epidemiology from the south eastern part of Nigeria is over 2 decades old. Observation appears to indicate the pattern differs from what is published elsewhere and from what was previously published from the same environment. The National Orthopedic Hospital Enugu has been the institution with the highest volume of cleft surgery in the south eastern part of Nigeria for over a decade. The volume has increased in the last 5 years owing to a free treatment grant by the Smile Train Charity. The free maternal and child health care policy of Enugu state also provides the opportunity to investigate the incidence of clefting in the Public Health Institutions in our environment that majority of cleft patients are from the low socio-economic group. The study is aimed at providing current epidemiological indices for clefts in south-eastern Nigeria which will influence planning, advocacy and counseling. Methods: Retrospective data from the State Teaching Hospital from January 2007 to December 2011 was used to estimate birth incidence of clefts. All children born at the hospital are examined for anomalies and such records are kept records from the clinics of cleft children born in the hospital were also used to augment this. Totally 260 records of patients treated at the National Orthopedic, Enugu from January 2007 were accessed to determine retrospective sex incidence, birth order, cleft type and sidedness, parental age and occupation and age at presentation. Simple arithmetic analysis of data was made. Results: There were 5810 live births and five clefts recorded at the Enugu State University Teaching Hospital from January 2007 to December 2011. Two more cleft children (both involving the palate) born within the period were picked up from attendance to the plastic surgery clinic. This gave a birth incidence of 1 in 887 live births. Of the 260 cleft records obtained at the National Orthopedic Hospital Enugu from January 2007, 134 were females and 126 males. Isolated cleft palate had 25 females and 10 males. For all cleft types the first child was most commonly involved and the incidence reduced with higher birth order, however a cleft was noted in the 13 th child of a couple. A positive family history was noted in only 12 patients, predominantly those with cleft lip and palate. The average age of cleft mothers was 21.69 years (19-47 years) while that for fathers was 37.34 years (23-58 years) age at presentation varied widely from a week to over middle age. Over 80% of the parents were from a low socio-economic group. Conclusion: The birth incidence of cleft in south-eastern Nigeria differs from data published over 2 decades ago. The birth order also differs from what obtains elsewhere, but other indices as sex prevalence and types of cleft are similar to published work. The retrospective nature of the work may have influenced its accuracy, but the study indicates there are signification differences in cleft epidemiology in south-eastern Nigeria.


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