|ABSTRACTS FOR ASON CONFERENCE
|Year : 2016 | Volume
| Issue : 1 | Page : 50-52
Book of Abstracts for the 11th Congress of the Association of Surgeons of Nigeria, Yenagoa, July 2015
|Date of Web Publication||15-Feb-2016|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Book of Abstracts for the 11th Congress of the Association of Surgeons of Nigeria, Yenagoa, July 2015. Niger J Surg 2016;22:50-2
| Bilateral Gigantomastia in Pregnancy|| |
Udo IA, Umeh KU
Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
Background:Bilateral giant breast hypertrophy is very rare in pregnancy; arising from over-sensitivity of the breast tissues to or excessive circulating levels of estrogen and progesterone. Life-threatening pressure sores and sepsis could develop in the breasts and require urgent mastectomy. Objective: To highlight the challenges of managing bilateral gigantomastia in pregnancy complicated by extensive ulcerations and sepsis. Case Report: A 39-year-old pregnant woman presented at the out-patient clinic with bilateral breast enlargement with multiple wounds discharging large volume of offensive fluid. The breast enlargement started with her pregnancy and rapidly progressed in the 8th week and by the 12th week, the weight of the breast produced extreme discomfort on her chest and abdomen making breathing difficult. She developed features of sepsis in the 30th week of gestation and received antibiotic therapy, but her response was poor and therefore had bilateral mastectomy by two surgeon groups to save her life. The combined weight of the breast tissue was 22.5 kg. She lost the pregnancy, but improved markedly after the mastectomy and underwent a cesarean section to remove the dead fetus. She is since having revision surgery on her breasts and is well. Challenges encountered were controlling sepsis, positioning, hemorrhage, and salvaging the pregnancy. Conclusion: Sepsis from ulcerated gigantomastia in pregnancy increases the risk of maternal and fetal loss. Emergency mastectomy is strongly indicated.
| Overview Of Operations For External Hernias In Owerri, Nigeria|| |
Ekwunife CN, Enendu SE, Ngaikedi C, Duru O, Ugo VO, Ekperechukwu AC
Department of Surgery, Federal Medical Centre, Owerri, Nigeria
Introduction: Hernia is a very common condition in all populations, and its surgical operation constitutes a major workload for physicians worldwide. Although great numbers of these procedures are done in primary and secondary care settings as well as in private hospitals and as part of surgical missions to rural areas, a significant proportion still present to tertiary centers. Aim: To review the pattern of external hernias operated upon in Federal Medical Centre, Owerri, over a 10-year period. Methods: The theater records were searched for all patients who underwent surgical operations for hernia in the period of 2005–2014. The data on patient demographics, indication for surgery, and procedure performed were retrieved. Results: A total of 902 patients underwent operations for different types of external hernias. The overall male/female ratio was 2.6:1. Operations for inguinal hernia were the most common, accounting for 72.9% (658) of the total. Ventral hernias constituted 25.1% (n = 227) of the cases whereas 1.5% (n = 12) of patients had femoral hernia. One hundred and twelve patients (12.4%) had emergency surgery, of which 78 were for inguinal hernia. Mesh repair was started in 2009 and was utilized in 72 (8%) cases. Laparoscopic method of repair was used in only two patients. Conclusion: The pattern of operation for hernia in our center mirrors experience in other local centers. Modern methods of repair are gaining grounds.
| Glans Penis Transection From Criminal Circumcision: A case Report|| |
Ofuru VO, Nwachukwu CO1, Sapira MK
Department of Surgery, Division of Urology, University of Port Harcourt Teaching Hospital, 1Eastland Specialist Hospital, Port Harcourt, Nigeria
Background: Transection of the penis and the urethra is a very rare injury. Here, we report a case of a near total transection of the glans penis and total transection of the urethra following circumcision in an 8-day-old child. Aim: The aim of this study was to report a case of near total transection of the glans penis and total transection of the urethra in a neonate following circumcision by a traditional birth attendant. Case Report: A.D was an 8-day-old baby who was brought to a private hospital in Port Harcourt in January 2015 by parents with the complaints of injury to the phallus and bleeding during circumcision, about 16 h before presentation. The circumcision was carried out by a traditional birth attendant (TBA) at parents' home. Father was a truck pusher and family lived in a church. In course of the procedure, the proximal half of the glans was almost completely transected. The urethra was completely transected in the process and baby bled profusely from the injury site. The TBA with the excuse of going to get a drug escaped. Neighbors assisted by using crude oil and leave extracts to secure hemostasis. The child was seen at a private clinic about 16 h later, having visited three other clinics without help. Examination at presentation revealed a pyrexic and pale child. The distal stump of the glans was suspended by a tuft of spongy tissue. The urethra was completely transected. Wound was covered with slough and was septic. The wound was copiously washed with normal saline. Size six feeding tube was passed through the urethral meatus and into the proximal stump and secured. Wound was then dressed with povidone-iodine. The patient was placed on intravenous rocephin for 7 days. The plan was to do secondary corporal and urethral re-anastomosis when infection was controlled. However, parents declined definitive treatment on excuse of lack of funds. Child was taken home. When seen about 6 weeks later, the glans penis had completely healed and muco-epithelial lining restored with residual meatal stenosis. The stump of the old glans was then excised. Conclusion: Circumcision is an important and delicate surgical procedure that should be undertaken by only those having the requisite training.
| Open Repair Of Incisional Hernia At Cesarean Section|| |
Udo IA, Abasiattai AM1
Departments of Surgery and 1Obstetrics and Gynaecology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
Background: Cesarean section is the most common cause of incisional hernia in our practice. Many of these patients fail to procure repair before the next pregnancy. Simultaneous open prosthetic repair at a subsequent cesarean section is an option which must be weighed against the theoretical risk of mesh infection. Objective: We analyzed the infective potential of simultaneous open repair of incisional hernia at cesarean section using polypropylene mesh. Methods: Pregnant ladies presenting with uncomplicated incisional hernia from previous cesarean operation were referred to a general surgery service for assessment. Hernias with diameters ≥5 cm were examined to have prosthetic repair. They were scheduled for elective sectioning at 36–38 weeks' gestation and simultaneous prosthetic repair of the hernia with prophylactic antibiotic cover. Results: Ten open prosthetic repairs were done; six on-lay and four retro-rectus. Tissue dissection and fascia approximation were easier than in the nonpregnant state. No case of wound infection was recorded and the postoperative pain was not in excess of what obtained at the primary operation. Conclusion: Prosthetic repair of incisional hernia with polypropylene mesh at cesarean section is safe and saves cost. It does not increase the intensity of postoperative pain or duration of hospitalization.
| Adenocarcinoma Of The Seminal Vesicle: A case Report|| |
Ofuru VO, Sapira MK, Eke N
Division of Urology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Background: Adenocarcinoma of the seminal vesicle is a very rare tumor. Because of the location of the organ, the clinical manifestation is very indistinct and diagnosis is difficult. So far, about fifty cases have been reported in the literature. We present here a case of seminal vesicle tumor managed in our hospital. Aim: To report a case of seminal vesicle tumor managed in the University of Port Harcourt Teaching Hospital. Case Report: E.F is a 32-year-old sergeant of the Nigerian Army who presented with a history of painless hematuria of 8 months, frequency and dysuria of about 2 months. There was associated severe waist pain, difficulty in walking, and anorexia. Clinical examination at presentation revealed a young man who was ill looking. There was supra pubic tenderness. Digital rectal examination revealed a huge mass on the anterior rectal wall that was firm, which was mistaken for a prostate mass. A clinical diagnosis of bleeding benign prostatic hyperplasia was made. Serum prostate-specific antigen was 0.8 ng/ml. Abdomino-pelvic computed tomography scan showed a heterogeneously enhancing mass of volume 789 g with differentials of benign prostatic enlargement, rhabdomyosarcoma, and pelvic abscess. Abdomino-pelvic ultrasound screening was done which showed an echo complex mass measuring 82 mm by 90 mm visualized below the urinary bladder. The shadow of the urinary catheter was not seen traversing the mass, but was rather displaced to the left. The mass equally displaced the bladder anteriorly. A diagnosis of retroperitoneal mass in the pelvic cavity was made. The patient had pelvic exploration. A huge dark brown and cheesy mass was seen. Histology showed adenocarcinoma of the seminal vesicle. The patient was lost to follow-up 2 months after discharge. Conclusion: Primary adenocarcinoma of the seminal vesicle is rare and difficult to diagnose. Immunohistochemical analysis of the specimen would determine the exact tissue of origin.
| Improvization In Lower Urinary Tract Endourology: Colworths Experience|| |
Omodu OJ, Okengwu C
Department of Urology, Colworths Medical Centre, Port Harcourt, Nigeria
Background: Lower urinary tract endourology is rapidly advancing in the developed countries, but the reverse is the case in the developing countries where the cost of setting up and purchase of consumables is very expensive. Aim: To encourage the use of locally available materials as improvizations to perform the surgeries. Patients and Methods: This study was a prospective study of all endourological procedures carried out at Colworths Medical Centre between November 2012 and June 2015. Information obtained include age, gender, diagnosis, procedure, duration of surgery, prostate size, preoperative serum sodium, postoperative serum sodium, complications, duration of surgery, and were analyzed. Improvized materials include Samsung television, drip stand, kitchen sieve, water dispenser, and feeding bottle. Results: During the study, 206 endoscopic procedures were performed on 103 patients with age range of 3–89 years with mean age of 66.99. There were 98 males and five females. Initial cystoscopies were performed for all 103 patients. Fifty three transurethral resection of prostate, five transurethral resection of bladder tumor, 19 direct visual internal urethrotomy (DVIU), 15 channelization, two bladder clot evacuation, one DJ stenting, and 1 BNI were performed. One case of channelization was abandoned due to bleeding and two cases of DVIU were stopped due to false passage. Some complications were also noted, but there was no mortality recorded. Conclusion: Lower urinary tract endourology is regularly performed despite the hitches in replacing consumables and damaged instruments. We recommend the use of the several improvized materials for endoscopy.
| Delayed Diagnosis of Left Diaphragmatic Rupture Presenting as a Strangulated Hernia: A case Report|| |
Udo IA, Umeh KU
Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
Background: The defect in a diaphragmatic hernia allows communication of viscera between the abdominal and thoracic cavities and where the defect is narrow, a viscera easily gets obstructed or strangulated. Diagnosis of both hernia and strangulation of viscera could be delayed because of obscure presentation. Objective: To present a case of strangulated transverse colon from an undiagnosed traumatic rupture of the diaphragm. Case Report: A 30-year-old male presented with a 3-day history of colicky abdominal pain. He vomited before and while being transported to hospital and he was unable to pass feces or flatus. He had recurrent epigastric pain in the last 3 years. He was involved in a motor accident 3 years previously and experienced abdominal pain necessitating overnight observation. He denied having respiratory symptoms after the accident or with current illness. His abdomen was grossly distended and tender with resonance and a positive fluid thrill. A chest radiogram showed air-fluid levels in the left hemithorax with similar features in the abdomen. A clinical diagnosis of strangulated diaphragmatic hernia was made. At laparotomy, the splenic flexure of colon was identified in the left hemidiaphragm. Gangrenous bowel and omentum were freed from the chest cavity and the diaphragm closed in two layers with nylon one. Resection of the strangulated bowel with primary anastomosis was done. Conclusion: Evaluating an injured patient early with a chest X-ray can identify a diaphragmatic rupture and prevent complications arising from delayed diagnosis.
| Abdominoplasty (Tommy Tuck): Initial Colworths Experience At Port Harcourt|| |
Omodu OJ, Okengwu C
Colworths Medical Centre, Port Harcourt, Rivers State, Nigeria
Background: Abdominoplasty is a cosmetic surgery used to make the abdomen thinner and more firm. It involves the removal of excess skin and fat from the middle and lower abdomen to tighten the muscle and fascia of the abdominal wall. Aim: To establish the rapid reduction of weight and improvement of shape following abdominoplasty in overweight patient. Patients and Methods: A total of five patients, all female with age range of 35–42 years, were operated on between July 2009 and November 2012. Indications were all cosmetic, and information including age, gender, diagnosis, weight preoperative, weight postoperative, procedure, duration of surgery, weight of resected tissue, and complications were analyzed. Results: During the study, five abdominoplasties were performed on females with age range of 35–42 years with mean of 37 years. One patient had superficial site infection complication, but there was no mortality recorded. Conclusion: Abdominoplasty is regularly performed in advanced countries. It is gradually becoming accepted in our center for cosmetic reasons as it forms a foundation for diet, and exercises give the abdomen its required shape.