Nigerian Journal of Surgery

: 2012  |  Volume : 18  |  Issue : 2  |  Page : 107--110

Abstracts from the 8 th ASON Congress, Calabar 2012


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. Abstracts from the 8 th ASON Congress, Calabar 2012.Niger J Surg 2012;18:107-110

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. Abstracts from the 8 th ASON Congress, Calabar 2012. Niger J Surg [serial online] 2012 [cited 2022 Sep 26 ];18:107-110
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 1st Scientific Session

Abdominal Impalement Injury: Report of a Case

Udo IA

Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Impalement injuries are rare, often grotesque and may present with features of blunt and penetrating abdominal injuries. They are associated with high morbidity and mortality from associated severe multiple injuries. Many patients do not get to reach the hospital; they die at the incident site. The injuries are classified into types I and II. Objective: To highlight the challenges in managing the impaled patient. Case Report: A thirty three year old male who fell from a palm tree and got impaled by the freshly cut stem of a shrub. He was evacuated from the scene of injury with the impaling stump in-situ and presented at the emergency room in 3 hours. Laparotomy showed a single ileal perforation which was treated by resection and primary anastomosis. Conclusion: With timely intervention, a severely impaled patient can be managed successfully with some ingenuity on the part of the surgeon and anaesthetist.

Gastrocolocolic Intussusception in a Five Year Old Male Patient: Case Report

Ihekwoaba EC

Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, South East Nigeria and Rembo Specialist Hospital, Nnewi

Background: Intussusception has been known as 1 of the commonest causes of intestinal obstruction in the paediatric age group. The pathology has also been well known, but there exist some aspects of this condition which have not been reported due their rarity. Gastrocolocolic intussusception is one of these rare types of the condition and it is here reported. Case Report: A.O. is 5 year old male patient who was seen on the 7 th July, 2011 at Rembo Specialist Hospital Nnewi on referral from a paediatric hospital after visiting 2 other private (general practice) hospitals in 2 nearby communities where he was being managed as a case of gastroenteritis without much improvement. He presented with complaints of a 3 day progressive severe colicky abdominal pain and vomiting with red currant jelly stool of 1 day duration. Examination revealed a moderately dehydrated young boy crying in episodes. His abdomen was full but not distended with a palpable sausage shaped mass in the left hypochondrum with limited mobility. The examining finger was stained with mucoid wine-red (red currant) stool. Patient was investigated, optimized and successfully explored same day of presentation in the facility. At laparotomy the stomach and the transverse colon were found entrapped inside the splenic flexure and upper part of the descending colon. The entrapped tissues were milked out and no resection was done as all tissues were viable. Patient was discharged home on the 8 th post operative day. He was not transfused. Follow up has been uneventful. Conclusion : Gastrocolocolic intussusception is a rare form of intussusception and needs a high index of suspicion and wide knowledge base to make early diagnosis. Over dependence on ancillary laboratory investigation may not only delay diagnosis but may also worsen the outcome of treatment.

The Prevalence of Undescended Testis in Calabar

Udosen JE, Ugare GU, Essiet A and Bassey OO

Department of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria

Background: Undescended testis is a common congenital abnormality occurring in 2-5% of full term boys at birth in western countries. However, not much had been published about the condition in Nigeria and especially in South East and South regions. This study seeks to determine the prevalence of the condition in Calabar and add to the literature on the subject in this region. Aim: To determine the prevalence. Materials and Methods: A population survey was conducted in primary school boys within the ages of 6-13 years in Calabar. Out of a total population of 11,344 boys enrolled in fourty three primary schools in Calabar, 1960 were selected by the stratified random sampling technique from fourteen primary schools that participated in the study giving a sample ratio of 1:7. Results: The mean age of the boys was 9.5 years with SD 2.23. They were thirty seven cases of undescended testis detected out of the 1960 pupils examined giving prevalence rate of 1.9%. Twenty one (56.8%) affected the left side while fourteen (37.8%) affected the right side. Two were bilateral (5.4%) showing the defect to be commoner in the left testis. Conclusion: The prevalence of undescended testis among school boys in Calabar, tends to be in agreement with figures from elsewhere. Ignorance and financial constraint is a major impediment to early presentation for detection and treatment of the condition in our locality.

Adult Pleomorphic Sarcoma: Report of a Rare tumour of the Urinary Bladder

Udo E, Enakhire G, Isiwele E, Essiet A

Department of Surgery, Division of Urology, University of Calabar Teaching Hospital, Calabar, Nigeria

Background: Pleomorphic sarcomas in the adult are rare. In the genito-urinary system they more commonly involve para-testicular tissues, the kidneys and the prostate gland. In this centre only 1 case of prostatic rhabdomyosarcoma has been seen over a 10 year period (Essiet et al 2003). In the Memorial Sloan-Kettering experience, one thousand thirty one cases were seen over 25 years-fifty seven paratesticular tissues, thirty one of prostate, twenty of bladder and 7 others (Doltan et al, 2006) The case of a thirty year old male who presented with a huge bladder tumour that turned out to be pleomorpihc sarcoma is here reported. Case Report: E.D.O, a thirty year old business man of Ekoi extraction was referred to our service with a 6 months history of terminal dysuria but no haematuria. This was followed 3 months later by a progressively increasing suprapubic swelling associated with frequency and nocturia. Examination revealed a tender suprapubic mass, the equivalent of about sixteen weeks pregnancy in size. Ultrasound scans suggested a bladder mass with right sided hydronephrosis. At exploration an extensive intramural lipoma was found embedded in the bladder wall, stretching out and creating lobulations of the mucosa without breaching it (hence the absence of haematuria). The bladder was generally distorted and disfigured. Complete excision of the mass by careful enucleation was easily achieved. Histology reported pleomorphic sarcoma. Conclusion: Sarcoma of the bladder is rare and can present without haematuria even at very large sizes. It should be suspected when a large bladder tumour presents without haematuria.

 2 nd Scientific Session

Preliminary Report of the Effectiveness of Tetracycline Sclerotherapy in Treatment of Ganglion

Ashindoitiang JA

General Hospital, Ikorodu, Lagos State, Nigeria

Background: Ganglion, a benign cyst, most common soft tissue tumor of the hand, usually occurs in the hand wrist and foot. It is difficult to treat as reoccurrence is common after surgery and also following other treatment procedures. Materials and Methods: In this study, sclerotherapy as a mode of treatment was carried out in twenty patients using a solution of tetracycline after aspiration of the ganglion. Results: Most of the patients in this study were in the age range 20-35 years. Sixteen patients had ganglion on the dorsum of the wrist, 2 patients had bilateral ganglion and 2 patients had ganglion on the dorsum of the foot. Under aseptic conditions, the ganglions were aspirated using size 21G needles and then 1ml equivalent to 100mg/ ml solution of tetracycline was injected. In the postoperative follow up ranging between eighteen months to 5 years, 2 reoccurrences was noticed and treated by a repeat of the same technique. Conclusion: This procedure is simple, safe, effective and cheap when compared to surgery and other non surgical procedure of treating ganglion.

Initial Experience with Central Line Insertion in Zaria

Edagbini SA, Delia IZ, Aminu MB,

Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University Teaching, Hospital Zaria, Nigeria

Background: Although a basic clinical tool and despite its advantages and long history, the insertion of central venous catheter is an uncommon procedure in most Nigerian hospitals. Objective: This paper presents the initial experience with central line insertion in an attempt to make it a routine clinical procedure in our institution. Materials and Methods: Patients requiring prolonged I.V. therapy and or patients who had difficult peripheral venous access. Procedures were done by consultants when anticipated to be difficult especially in children or when attempt at insertion by a less experienced hand has failed. Catheter sizes ranges from 5fr for children and 7fr for adult for I.V. therapy, while size 7fr polyurethane catheters were used for children requiring hemodialysis and sizes 12fr-14fr silicone catheters for adolescents and adults requiring hemodialysis. Data was collected prospectively using a structured proforma over a 2-year period (June 2010-May 2012) and analysed with SPSS 15. Results: A total of seventy seven lines were inserted 4 as tunneled lines and seventy three as non-tunnelled lines. Ten lines were inserted in 2010 (June-December), thirty four in 2011(January-December) and thirty three in 2012 (January-May). Fourty seven (61.0%) patients were males, thirty (39.0%) were females with age range of 1-80 years. Fifty nine (76.6%) were done on the ward, eighteen (23.4%) in theatre. Sixteen (77.9%) and seventeen (22.1%) were done under general and local anaesthesia respectively. The indications included hemodialysis thirty (39%), parenteral nutrition 3(3.9%), hydration fifteen (19.5%), perioperative fifteen (19.5%), cytotoxic 6 (7.8%), exchange blood transfusion 8 (10.4%). Fifty one (66.2%) were inserted by consultants, nineteen (24.7%) and 7 (9.1%) were inserted by senior and junior residents respectively. The procedure was performed on the right side in sixty five (84.4%) cases, in the internal jugular 6 (7.8%), subclavian sixty five (89.6%) and femoral veins 2 (2.6%). The success rate was seventy five (97.4%). The duration of stay was <72 hours 7 (9.1%), <1week fifteen (19.5%) and >1week fifty four (70.1%) of cases. The overall complication rate was 16.9%; sepsis 3 (3.9%), hemorrhage 3 (3.9%), dislodgement 3 (3.9%), hematoma 2 (2.6%), malposition 2 (2.6%). Conclusion: The insertion of central venous lines is a basic clinical bedside procedure that can be performed by any doctor and can be learnt within a short time

Septic Athritis: The Need to Strengthen the Referral Chain in a Developing Economy

Ikpeme IA, Ngim NE, Ikpeme AA 1 , Oku AO 2

Departments of Surgery, 1 Radiology and 2 Anaesthesia, University of Calabar Teaching Hospital, Calabar, Nigeria

Background: Pyogenic joint infections are surgical emergencies. They are commoner in children. The risk of rapid joint destruction, irreversible impairment of joint function and fatality, especially in neonates underscore the need for prompt diagnosis and appropriate treatment. Late presentation, injudicious intervention by traditional bone setters and illiteracy are well documented factors that influence treatment outcomes for orthopaedic ailments in the developing world. The need for judicious interventions, including prompt referrals by physicians in this condition has to be understood. Materials and Methods: A descriptive retrospective analysis of forty five joints with septic arthritis in fourty three patients who presented with septic arthritis in University of Calabar Teaching Hospital, Calabar over a 3 year period. Results: Twenty four patients were males while nineteen were females. Forty of the patients were children. Thirty three patients were urban dwellers, 8 patients were semi-urban dwellers while 2 were rural dwellers. The knee joint was the most predominantly affected. Twenty nine patients were first seen by a paediatrician, 9 by a general duty physician. Only 5 were first seen by an orthopaedic surgeon. Definitive treatment was conservative in twenty eight patients while fifteen patients had arthrotomy and washout. Conclusion: Despite a significant number of patients presenting first to hospital, only a small proportion was eventually seen by an Orthopaedic Surgeon. While patient education remains crucial, physicians also need to be targeted to address the issues of judicious interventions and strengthening the referral chain.

 3 rd Scientific Session

Subdural Empyema Managed at Enugu

Ndubuisi CA, Ohaegbulam SC, Mezue WC, Chikani MC, Erechukwu UA, Onyia EE, Orji B

Memfys Hospital for Neurosurgery, Enugu, Nigeria

Background: Subdural empyema (SDE) is a relatively uncommon but life threatening neurosurgical infection especially in developing countries. The aim of this paper is to review the cases of SDE managed at Memfys Hospital for Neurosurgery, Enugu, Nigeria. Materials and Methods: This is a retrospective analysis of data of 8 patients who presented to Memfys Hospital for Neurosurgery from 2004-2011 with clinical and radiological confirmed SDE. The patients were followed up at the outpatient for a minimum of 1 year. The case notes were used for data collection. Analysis was done using descriptive statistics. Results: SDE accounted for 19.5% (8/41) of all intracranial abscesses with an average of one case per year. The male and female ratio was 3:1 and the mean age at presentation was twenty three years (range: 6-64 years). The risk factors were mainly sinusitis and chronic otitis media (50%). The left side of the head was involved in 6 (75%) cases. The frontal lobe was involved in 6 (75%) of the cases. One patient had a posterior fossa SDE. Six (75%) patients presented following loss of consciousness. The SDE were drained for four patients through multiple burr holes and adjuvant antibiotic treatment. One of these patients had a recurrence which was managed using a craniotomy. One patient was managed conservatively and 2 patients died before any useful intervention could be offered. Five cases had very good neurological improvement after 1 year of follow up. Conclusion: Although the patients present late, appropriate treatment and long term follow up may still improve neurological outcome.

Penetrating Gunshot Injury to the Neurocranium: A Review of Twenty two Cases

Onyia EE, Ohaegbulam SC, Mezue WC 1 , Chikani MC 1 , Erechukwu UA, Ndubuisi CA, Orji B

Memfys Hospital for Neurosurgery, Enugu, 1 Neurosurgery Unit, UNTH Enugu, Nigeria

Background: Penetrating gunshot injuries to the neurocranium are not uncommon in Nigeria due to increase in firearm-related violence, armed conflicts, militancy and terrorism. They are associated with poor outcome; and at close range are frequently fatal, especially when inflicted by high velocity weapons. Prompt transfer to a competent neurosurgical service and urgent multidisciplinary intervention may improve outcome in those that are not mortally wounded. computed tomograph (CT) scan is indispensable in delineating patho-anatomy and treatment planning. Materials and Methods : Twenty two patients with penetrating gunshot wounds seen over a 7 year period (2004-2011), at Memfys Hospital for Neurosurgery were retrospectively reviewed. Their data were obtained from case notes, CT, ward and operating room records. Only patients with clinical and imaging evidence of cranial gunshot injuries who presented to the hospital alive were included. Those with additional gunshot injuries to other regions and stab wounds were excluded. The overall mortality and Glasgow Outcome Scale (GOS) and factors that impact on outcome were analyzed. Results: Twenty two patients with isolated cranial gunshot wounds were identified (19 males, 3 females, M:F = 6.3:1; mean age 30.6 years). Skull fractures were noted in all the cases. The overall mortality was 45.4%. The mortality for patients with post-resuscitation Glasgow consciousness scale (GCS) 8 was 73%. Patients with post-resuscitation GCS >8, had mortality of 18.2% and 81.8% survived. Fifteen patients (68.2%) had pupillary abnormalities. The following CT findings appeared to correlate with adverse outcome: Bi-hemispheric injuries, posterior fossa involvement (2 patients), intraventricular haemorrhage (9 patients), multiple intracranial pellets (14 patients) and severe brain swelling. Other CT findings included acute haemorrhage (18 patients), pneumocephalus (11 patients). Cushing's reflex was documented in 4 patients and this correlated with poor outcome. An aggressive surgical protocol was employed in nineteen patients. The GOS showed that 4 patients (18.2%) had good outcome. Conclusions: The complexity of cranial gunshot wounds and the attendant mortality and morbidity are confounding. Admitting GCS, bihemispheric/trans-ventricular trajectory and posterior fossa involvement, appear to, among other variables, be predictive of outcome.

Pattern and Long Term Survival of Biliary Atresia Patients: Experience in Southern Nigeria

Okoro PE, Igwe WP, Opara PI 1

Departments of Surgery and 1 Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Objective: We aim to evaluate the pattern of biliary atresia (BA) and the long term survival of BA patients seen in our practice. Materials and Methods: Cases of BA seen between January 2007 and December 2011 in 3 tertiary health facilities in South East Nigeria were included. Data obtained included age at presentation, clinical features, treatment offered and age at the time of death. Analysis was with the SPSS 17.0. Results: Twenty four patients, 10 (41.7%) males and 14 (58.3%) females were followed up to death. The mean age of presentation was 4.02 (2.14) months; range 1.75-11.0 months. Fifteen (62.5%) patients had surgery while 9 (37.5%) received medical treatment only. The mean age at death was 14.2 (8.1) months; range 2.5-30 months. Conclusion: BA poses a daunting challenge in our practice. Outcome of treatment is still discouraging. We identify late presentation, lack of facilities to make early diagnosis, lack of adequately trained manpower to manage these children and lack of post operative care and support for patients, as the major challenges in the management of BA children in the developing countries.