Nigerian Journal of Surgery

ABSTRACT
Year
: 2011  |  Volume : 17  |  Issue : 1  |  Page : 29--38

58th NSRS Conference Port Harcourt December, 2010


 

Correspondence Address:




How to cite this article:
. 58th NSRS Conference Port Harcourt December, 2010.Niger J Surg 2011;17:29-38


How to cite this URL:
. 58th NSRS Conference Port Harcourt December, 2010. Niger J Surg [serial online] 2011 [cited 2022 Jul 3 ];17:29-38
Available from: https://www.nigerianjsurg.com/text.asp?2011/17/1/29/90370


Full Text

Comparative Study of Two Pleurodesantsin Thoracic Surgical Practice

EE Ekpe* MC Ikpe **

* Cardiothoracic Surgery Unit, Department of Surgery, University of Uyo Teaching Hospital, Uyo

** Department of Radiology, University of Uyo Teaching Hospital, Uyo

Background: Pleurodesis is the obliteration of the pleural space by fusion of visceral and parietal pleural surfaces. It is indicated in thoracic pathology associated with accumulation of air or liquid resulting from incurable disease, therefore risked with a high chance of recurrence. Common indications for pleurodesis are malignant pleural effusion and spontaneous pneumothorax. Others are catamenial pneumothorax or haemothorax, and systemic inflammatory disease associated with pleural effusion.

Since CTTD and chemical pleurodesis is the option that is uniformly available to the thoracic surgeons in a country like Nigeria characterised by high levels of ignorance, poverty, and late presentation of diseases, we set out to prospectively compare the success rates of tetracycline and cyclophosphamide (which are cheap and readily available) as chemical pleurodesants.

Methods : All our patients who needed chemical pleurodesis from November 2006 to September 2010, and met the inclusion criteria were prospectively enrolled into the two groups which used 1g of tetracycline and 1g of cyclophosphamide respectively. The outcome measures compared included complication(s) and duration of drainage post instillation of sclerosant, and success of pleurodesis. Data were analysed.

Results: There were 33 patients who underwent drainage and pleurodesis of 40 pleural spaces with male female ratio of 1:2 and mean age of 49 years. Complication rates were 10% and 25%, and success rates were 80% and 85% with tetracycline and cyphophosphamide respectively.

Conclusion: Tetracycline and cyclophosphamide as pleurodesants have acceptable success rates.

Intent at Day Case Laparoscopic Cholecystectomy in Owerri: Initial Experiences

CN Ekwunife*, CI Njike **

Department of Surgery* Department of Anaesthesia** Federal Medical Centre Owerri, Imo State.

Background: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre Owerri for the past 2 years; and outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a 2-year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital.

Methods: Patients who underwent cholecystectomy and who satisfy the requirements of the pre-admission day case questionnaire administered by the anaesthetist were included in this preliminary report covering the period May October 2010.

Results : Eight patients had laparoscopic cholecystectomy within this period: 6 females and 2 males. Six of the patients left the hospital after an overnight stay whereas two left on the day of surgery. There was no conversion to open surgery, no major complications and no case of readmission to the hospital. However our operations rarely start before 9.00a.m.

Conclusion: Day case laparoscopic cholecystectomy in our environment will be dependent on increasing proficiency of highly dedicated surgical team members.

Keywords : Day case, laparoscopic cholecystectomy

RecurrentBreastCancerTreatedwithCo-60inZaria

DA Dawotola* VI Odigie** LMD Yusufu** P Abur**

Radiotherapy and Oncology Centre* Breast and Endocrine Unit**

Division of General Surgery, Ahmadu Bello University Teaching Hospital, Zaria.

Aim: Tumour response to External Beam Radio therapy at 3 months.

Patients and Methods: Between June 2008 and June 2010, fifty-five histologically-proven breast cancer patients with locoregional recurrence post mastectomy, referred to the tertiary institution, were prospectively studied. The patients were not on chemotherapy. Patients were irradiated using Co-60 photon beam. Radiation doses varied from 45Gy-50Gy given in hypofractionated or conventional courses. Tumours were measured using a tape rule. Recurrent tumours were classified as solitary (16 patients), multiple (27 patients) or matted (12 patients). Response was assessed at 3 months post-irradiation and was classified as complete, partial or no response.

Results: The patients were all females. The mean age was 42.3years. (age range 29-63years). All patients had Invasive Ductal Carcinoma. Pre-operative Stage II disease accounted for 29.1% of the patients, while Stages III was 50.1%. In 20% of patients Stages were unknown. 23.6% had chest wall recurrence only, 10.9% had regional while 65.5% had both local and regional diseases. All the patients responded to radiotherapy. Patients with solitary nodules < 2cm had a complete tumour response, while patients with multiple or matted disease had partial response. All the patients suffered radiation-induced dermatitis: hyperpigmentation 32.7%, dry-desquamation - 51%, moist-desquamation 16.3%.

Conclusion: External beam radiotherapy was most effective in treating solitary nodules. It was also observed that patients who had post-op free resection margins had better outcome. The patients are still being followed up.

Key words: Breast cancer, post-mastectomy locoregional recurrence, radiotherapy.

Pattern, Management and Outcome of Intussusception i in a Tertiary Health Facility in Southern Nigeria

N Brownson, PE Okoro, I Gbobo

Department of Surgery University of Port Harcourt Teaching Hospital Port Harcourt, Nigeria.

Background: Intussusception is an important cause of intestinal obstruction in infants and young children. There are reports of intussusceptions from other parts of the country but there is no recent PUBMED published reports from our region. We therefore reviewed our experiences with this condition in the past five years with a view to putting in perspective the current pattern of intussusception, the challenges of management and the outcome of treatment.

Aim: To review the pattern, management and outcome of intussusception in our practice.

Patients and Methods: This is a retrospective review of all cases of childhood intussusception seen between September 2005 and August 2010 at the University of Port Harcourt Teaching Hospital. Data extracted from retrieved records included age, gender, presenting features and durations, treatment offered, follow up and, outcome.

Results: A total of 57 cases, 36(63.2%) males and 21(36.8%) females were included in the study. The mean duration of symptoms at presentation was 4.3 days (΁3.4). Forty two (73.7%) presented with the triad of abdominal pain, mucoid bloody stool and abdominal mass. Exploratory laparotomy was routine. Outcome was satisfactory in 46(80.7%) patients and there was mortality in 6 (10.5%).

Conclusion: Childhood intussusception remains a challenge in our paediatric surgery service. Despite previous studies recognising late presentation as a challenge, the situation has not changed remarkably. Consequently, surgical treatment as opposed to non operative reduction is still the routine treatment in our practice.

Jejunoileal Atresia : a 3 Year Study on Presentation and Outcome

OH Ekwunife, JO Ugwu, IG Oguejiofor, V Modekwe, AN Osuigwe

Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Background: Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejuno-ileum is the commonest site of intestinal atresia. Reports on Jejunoileal atresia in developing countries are still few. The purpose of this study is to determine the presentation and management outcomes of neonates with Jejunoileal atresia treated in our hospital.

Patients and Methods: Detailed data on all babies that presented and were treated within the study period (November2008-Ocober2010) were kept and analyzed. A management protocol was put up and maintained.

Results: A total of 9 babies (7males and 2 females) were treated. They were aged 2hours to 13days. Their weight ranged from 1.7kg to 3.3kg. Apart from one baby which presented within 2hrs with prenatal ultrasound diagnosis, others had bilious vomiting from the first day of birth, abdominal distension and delayed or absent passage of meconium. Even though symptoms developed on the first day of birth, presentation to the surgical unit was delayed beyond 48hrs in most patients due to mis diagnosis and in- appropriate treatment in private hospitals of first contact.

Type I atresia is commonest (no=4). There is associated gut malrotation in 2 babies. Five babies had complications which included surgical site infection, sepsis, prolonged vomiting post operatively, aspiration, rupture of dilated proximal segment after membrane excision, entero-cutaneous fistula and malnutrition. Three babies died giving a mortality of 33.3%.Mortalityiscommonerintypes III b and IV.

Conclusion: Prenatal diagnosis which will lead to early presentation and better outcome is still uncommon in our environment. Mortality is higher in complex atresia which most times will require good neonatal intensive care and parenteral nutrition facilities. These are still lacking in our institution. Providing these facilities will further improve outcome.

Epidemiology of Acute Intestinal Obstruction in a Referral Hospital in Southern Nigeria

NJ Jebbin, JM Adotey, TE Diamond

Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Background: Intestinal obstruction is a common surgical emergency worldwide. The causes are many and vary from place to place. Over time, the causes may also change in a particular locality.

Aim: To study the current epidemiology of intestinal obstruction in Port Harcourt, Southern Nigeria.

Methods: All patients with intestinal obstruction who presented for treatment in the Accident and Emergency department of the University of Port Harcourt Teaching Hospital between April 2009 and March 2010 were prospectively studied using a proforma. The parameters studied were the patients' biodata, aetiology of intestinal obstruction, intervention, and outcome. Data analysis was by simple statistics of frequency counts and percentages.

Results : Of the 76 patients treated, 45 were male while 31 were female, giving a male to female ratio of 1.5:1. The mean age of patients was 27.1΁21.7 years. The peak age incidence was in the 0-9 years bracket. Inguinal hernia was the commonest cause of intestinal obstruction (38.2 %), followed by adhesion bands (28.9%). Of the cases of adhesions, exploratory laparotomy (36.4%), followed by caesarean section (27.3%) were the commonest predisposing primary operations. Complications of surgery occurred in 9 patients while post operative mortality was 9.1%.

Conclusion: Inguinal hernia was the commonest cause of acute intestinal obstruction, followed closely by adhesions. Intestinal obstruction was most common in children below the age of ten years, males being the predominant sex involved.

Key Words: Intestinal obstruction, Epidemiology, Inguinal hernia, Adhesions, Port Harcourt

Epidemiology of Gunshot Injuries at Imo State University Teaching Hospital (IMSUTH), Orlu, Nigeria, a Five Year Review

CC Osuagwu, KO Opara, J Ikegwuruka

Department of Surgery, Imo State University Teaching Hospital, Orlu, Nigeria

Background: Orlu is town in south eastern Nigeria. The teaching hospital (IMSUTH) is six years old. There are no published data on the pattern of gunshot injuries in this area. Globally, gunshot injuries are rising. This rise in gunshot injuries has been observed in other cities in Nigeria.

Objective : To evaluate the epidemiology of gunshot injuries presenting at our centre over a five year period and determine a baseline for comparing the changing pattern of gunshot injury in Orlu, Imo State.

Patients and Methods : The records of patients admitted into the Imo state University Teaching Hospital with gunshot injuries from 1st January 2005 to 31st December 2009 were retrieved. Victims that were sent to the mortuary without presenting to the Emergency room were excluded. Eighty five patients were seen with gunshot injuries over this period but only seventy four folders yielded most of the parameters that we wanted to evaluate.

We analyzed and presented the incidence, the age, sex, marital status, and occupational distribution of the victims.

Results: Civilian gunshot injuries are on the rise from two (2) cases seen in 2005 to twenty (20) cases in 2009. Males are the predominant victims making up 87.8% of gunshot victims seen over the five year period. The male to female ratio is 7:1.Young people between the age of 20-39 years account for about 65% of the victims.

Most of victims are businessmen accounting for 23% of the occupational group that presented with gunshot injuries. Armed robbers are responsible for inflicting about 60% of the gunshot injuries using low energy transfer guns.

Conclusion: It is important that long and short term control measures are implemented to curb this growing menace.

The Changing Pattern of Paediatric Burn Injuries in Port Harcourt, South/South Region of Nigeria

BM Kejeh

Burns and Plastic Unit, Department of Surgery, University of Port Harcourt, Port Harcourt, Nigeria.

Background : Burn injuries have been on the increase in many states in the South/South, Nigeria. Most of these are caused by flame and often involve families with adults and children. There seems to be a change in the cause and outcome of burn injuries generally and especially in children.

Aim : To determine the pattern of Paediatric burn injuries in Port Harcourt, South/South of Nigeria.

Method : Records of children with Burn injuries from January 2005 to October 2010 admitted into the Hospital were obtained from the ward admission and discharge book. Data obtained include the age, sex, Total Body Surface Area (TBSA) involved, cause of burn, length of Hospital stay (LOS), month and year of burns.

Results : Ninety two paediatric patients, aged 0 to 15years, with burn injuries were admitted from January 2006 to October 2010 out of 324 admitted patients with burn injuries within the same period, giving 28.4% of the population. The average age was 5.8 years, with age group 0 4 years as the commonest. Males had a slight preponderance with a male to female ratio of 1.4:1. Flame burns were 42(53.2%), while scald was 34(43.1%). Kerosene was the commonest cause of flame burns.

The mortality was 15% and the mean hospital stay was 3.2weeks. The older children had more flame burns and hence higher mortality.

Conclusion : There is a higher incidence of flame burns in children with the resultant higher mortality and morbidity. This is a reflection of the societal attitude of keeping petroleum products in living houses and adulteration of kerosene.

Telephony, a Viable Tool for Patient Follow-up and Research in a Resource Limited Environment

PE Okoro, E Okoro, WP Igwe, P Numbere

Department of Surgery, University of Port Harcourt Teaching Hospital Port Harcourt, Nigeria

Background: The follow up of patients is a well recognized tool for the evaluation and appraisal of patient care. In many developing countries, loss of patients to follow up is a common phenomenon. With the enormous growth of telecommunication in Nigeria, it appears that the tool of telephony may be a viable adjunct in patient follow up and research.

Aim: To evaluate the usefulness of phone calls in the follow up of children seen at the paediatric surgery unit of University of Port Harcourt.

Patients and Methods: Study was carried out at our paediatric surgical outpatient clinic between January 2008 and June 2010. Patients were recruited with their consent and or those of their parents. Contacts were established via phone calls. The age, gender, diagnosis, and how long after first contact with our clinic were record.

Results: A total of 46 randomly selected patients were enrolled into the study. The study group comprised 29(63%) males and 17(37%) females. The diagnosis of the participants included hydrocoeles, hernia, hypospadias, bilary atresia, and Hirschsprungs Disease. The age range of patients was 2 months to 18 years. All forty six(100%) patients were reachedat6months and 43(93.5%) patients were reachable at two years.

Conclusion: Telephone calls are a viable adjunct to the follow up of paediatric surgical patients. Telephony needs to be evaluated more critically in this environment as it may be a potential starting point for the practice of telemedicine in Nigeria.

Key Words: Telephony, Follow-up, Research

Pattern of Metastatic Deposits of Malignant Neoplasm to the Chest seen on Chest Radiographs in Port Harcourt

CO Maduforo*, NC Nwankwo*, MD Etawo **

Department of Radiology* Department of Surgery** University of Port Harcourt Teaching Hospital Port Harcourt, Nigeria

Background: The presence or absence of distant metastases from malignant lesions is important in their staging. Most secondary deposits occur in the lungs; this is because of its rich vascular/lymphatic supply. There is a need therefore, to recognise gross and subtle radiographic signs of metastatic deposits to the lungs as well as the emergent trend of the distribution of metastatic diseases in our environment so as to institute appropriate management protocol. Organ of origin of the malignant growth (primary) can also be determined to some extent by the radiographic appearance and distribution on the chest.

Materials and Methods: A total of 240 patients who were diagnosed with carcinomas/sarcomas of different organs and confirmed by histology between January 2008 and October 2010 were studied. Their chest radiographs were reported and analysed. Their biodata were also recorded.

Results: Sixty percent of metastasis showed as multiple rounded opacities while 20% showed pleural effusion with 40% being bilateral and 60% unilateral. Ten percent showed as lytic lesions of the ribs while 5% showed as sclerotic lesions on the ribs. Five percent showed as streaky shadows (Lymphangitis carcinomatosa).

Conclusion: Plain chest radiograph is useful as a screening imaging modality in metastatic chest diseases and rounded opacities are the commonest findings. Pleural collection and streaky shadows should raise the index of suspicion.

Key Words: Malignancy, Distant metastases, Chest radiograph

Nasogastric Tube and Urine Bag as an Improvised Chest Tube Drainage for Empyema Thoracis

I Gbobo, P Igwe

Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Tube thoracostomy of appropriate size and underwater drainage are universally accepted methods of draining blood or pus in the pleural cavity. They are also placed prophylactically following thoracotomy. Unfortunately, they are not commonly available in teaching hospitals and virtually absent in rural hospitals where these conditions are common. We designed a temporary drainage method using an appropriate size nasogastric tube and a urine bag as a temporary measure to drain the pleural cavity and improve patient condition before transferring to a referral centre.

Aims: To document the effectiveness of this procedure in the drainage of pus from the pleural cavity, complications that arise from this procedure and affordability.

Materials and Methods: A clamped nasogastric tube is introduced through the thoracostomy. The proximal end of the tube is introduced into the tube of the urine bag and secured with plaster. The NG tube is anchored to the chest wall and the site of exit dressed. The urine bag is anchored to the bed to drain by gravity. Patients vital signs are monitored and the volume of effluent measured. Following availability of funds and improvement in patients condition, the patients are then transferred to a referral centre.

Results: All five patients improved in the vital signs to warrant referral but one patient did not need referral as his condition improved.

Conclusion: Improvised thoracostomy and drainage with NG tube and urine bag is a good temporizing measure in rural areas where facilities and expertise are grossly lacking.

Urethral Sticture Disease: Port Harcourt Experience

NO Ekeke, EO Amusan

Department of Surgery University of Port Harcourt Teaching Hospital Port Harcourt, Nigeria

Background: Urethral Injuries occur frequently in Nigeria. Urethral stricture is one of the commonest complications of Urethral Injuries. Though this complication is common in all part of the country, Port Harcourt is not an exception. We present our experience in the management of urethral stricture over the past five years.

Aims and Objectives: To share our experience in the management of urethral stricture.

Materials and Method: All case notes of patients presenting to our institution with urethral stricture were reviewed. The age, sex distribution, aetiology, site of stricture, surgical modalities, complications and outcome of treatment were recorded.

Results: A total of one hundred and two cases were seen within the period, the age range from 19 82years. Most of them are males except 4 who are females. The most common cause was post traumatic, other causes are post inflammatory and iatrogenic, and one malignant urethral stricture was recorded. Fifty six percent of the stricture occurred at membranous urethral while 51% had anastomotic urethroplasty. Only 5.8% had restructure and 1.7% had wound infection while the rest had satisfactory outcome.

Conclusion: Urethral stricture is common in Port Harcourt as in other part of the Nigeria, trauma is the leading cause and treatment outcome in Port Harcourt is satisfactory.

Pattern of Ear, Nose and Throat Injuries in University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

MU Ibekwe

Otorhinolaryngology Unit, Department of Surgery, University of Port Harcourt Teaching Hospital Port Harcourt, Nigeria

Background: Injuries to the ear, nose and throat region is not uncommon in clinical practice. It occurs in all age groups, however the mechanisms and causes differ between children and adults. We aim to examine the pattern and outcome of injuries to the ear, nose and throat (ENT) regions in the university of Port Harcourt teaching hospital.

Patients and Methods: It is a 5year retrospective of patients with ENT injuries that were managed in the ear, nose and throat surgery department of UPTH from January 2004toDecember 2008.

Results: seven hundred and fifty four patients (754) with ENT injuries were seen within the period under study but four hundred and twenty eight patients (428) had complete records and these were analyzed. There were 266 males (62.15%) and162 females (37.90%) giving a ratio of 3:2. The age range 0-10 years is the most affected; 191(44.62%). The commonest overall cause of injury was foreign body (50.93%). The ear has the highest number of injury 229(53.50%) with slaps/blows occurring most in the ears (41.50%). Suppurative otitis media in 40 patients was the commonest complication in the ear while septal deviation and stenosis in the aero digestive tract were seen in the nose and throat.

Conclusion: Injuries to the ear, nose and throat regions are not uncommon and foreign bodies are the commonest cause of injury. Males are more affected.

Keywords: Ear, Nose, Throat, Injuries, Foreign body

Limb Trauma at Orlu

IC Nwagbara, KO Opara

Department of Surgery, Imo State University Teaching Hospital, Orlu.

Background: Imo state university teaching hospital is located in Orlu, a sub-urban town in Imo State, South-Eastern Nigeria. With a high prevalence of road traffic accidents commonly involving commercial motor cyclists, trauma appears to be assuming epidemic proportions.

Aim: The aim of the study was to examine the cases of trauma involving the upper and lower limbs seen at the Imo State University Teaching Hospital, Orlu, determine the causative factors, and the treatment given.

Patients and Methods : The study was a 12- month retrospective study of the adult limb traumas that presented at the accident and emergency (A&E) department of the hospital.

Results : Two hundred cases of trauma involving the upper and lower limbs were seen in the A&E within the period of the study. Road traffic accidents accounted for most of the cases seen (78%), while soft tissue injuries were the commonest injury type seen (54%). Treatment given included wound care (46.1%), closed reduction and casting (9.4%), as well as open reduction and plating (3.5%). Twenty percent (20%) of the patients left the hospital against medical advice. Of the patients that left against medical advice, 87% had fractures as their primary diagnosis.

Conclusion: Majority of trauma cases are as a result of road traffic accident, thus efforts should be directed at improving safety on our roads to reduce the burden of trauma on the health care system. There is also need to create awareness in the community on the role of orthodox medicine in the management of fractures.