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ABSTRACT
Year : 2011  |  Volume : 17  |  Issue : 1  |  Page : 39-43  

5th ASON Conference, Nnewi August, 2009


Date of Web Publication21-Jul-2012

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How to cite this article:
. 5th ASON Conference, Nnewi August, 2009. Niger J Surg 2011;17:39-43

How to cite this URL:
. 5th ASON Conference, Nnewi August, 2009. Niger J Surg [serial online] 2011 [cited 2019 Oct 19];17:39-43. Available from: http://www.nigerianjsurg.com/text.asp?2011/17/1/39/90371

Appendicectomy: Rationalizing Antibiotic Usage

J Kpolugbo, U Alili, O Uhunmwagho, G Obasikene

Department of Surgery, Irrua Specialist Teaching Hospital Irrua, Edo State

Background : Surgical site infection is of great concern to the surgeon hence preventive measures such as prophylactic antibiotics in widely used for clean contaminated and contaminated surgical procedures. This study seeks to evaluate any advantage gained by administering antibiotic in uncomplicated appendicitis.

Method: A prospective randomised trial done on 70 patients admitted with appendicitis without features of peritonitis. Records were taken preoperatively and updated at the point of discharge and first clinic visit.

Results: Wound infection occurred in 1 of 34 patients (2.9%) who had no antibiotic appendectomy against 2 of 36 who had metronidazole and ciprofloxacin (CONTROL). Mean age of patients was 22.8 years with a mean hospital stayof4.6 days.

Conclusion : Routine antibiotic therapy is not necessary for patients undergoing appendectomy for uncomplicated appendicitis.

Key Words: Surgical site infection, antibiotics, prophylaxis, uncomplicated appendicitis.

Orbital Juvenile Xanthogranuloma [JXG]: Presentation; Management and Outcome

MC Okosa DCD Anyiam

Nnamdi Azikiwe University Teaching Hospital Nnewi

Background: Bilateral superior orbital masses are usually manifestations of systemic diseases. Juvenile xanthogranuloma as a cause is unreported in Africa.

Objective: Objective is to present clinical manifestations, management and outcome, of bilateral orbital mass caused by juvenile xanthogranuloma.

Material and Method: History and Physical examination were followed by Laboratory studies, and x-ray.

Incision biopsy for tissue diagnosis was followed by partial excision. Follow-up for subsequent 8 months after excision was done.

Result: 25- year old Nigerian girl with bilateral upper lid lumps of 5-month duration. These increased in size for about 1 month and stopped. Lid swellings were preceded by itching eyes, redness of conjunctiva and occasional mild pain. Lacking were visual or systemic symptoms. The lumps were firm, slightly mobile, not tender, not attached to skin, but to deeper structures. There was restriction on up-gaze but no proptosis or diplopia. Laboratory and X-ray investigations were normal. Prednisolone tablets:10mg daily for 2 weeks was not useful. Tissue biopsy disclosed juvenile xanthogranuloma., differential of Histiocytosis X Partial excision removed palpable lumps with no recurrencein8months.

Discussion: Tissue biopsy was invaluable in diagnosis of this rare condition. Partial surgical excision was the only rational procedure as total excision imposed unacceptable risks. Result in the short term was acceptable.

Conclusion: Juvenile xanthogranuloma can present as bilateral superior orbital tumor; functional and cosmetic aims were achieved by excision.

Cavernous Haemangioma of the Glans Penis - A Case Report treated with open surgical excision.

JE Raphael, EN Ekeke, MK Sapira, N Eke

Department of Surgery University of Port Harcourt Teaching Hospital Port Harcourt

Background: Haemangiomas are vascular harmatomas that can present on any part of the body. Haemangiomas of the genitourinary tract are very uncommon and that of the glans penis even more rare. Minimally invasive modalities of treatment for persistent lesions include the use steroid, laser and injection sclera therapy. Surgical excision is also an option, but is considered an invasive treatment for this uncommon benign lesion.

Objectives: To demonstrate the effectiveness of open surgical excision of haemangioma involving the glans penis. This is apt in developing countries where laser therapy and sclerosant agent may not be available, and open surgical operation may be the only treatment option.

Methods: The patient's record was obtained and the management reviewed. The literature was also reviewed.

Result: A 9 year old boy was presented by the parent with a history of painless swelling on glans penis since birth. The swelling had been increasing in size as the child grew .It also increases during penile erection. Clinical evaluation showed it to be a cavernous hamangioma of the glans penis. Open surgical excision of the lesion was done with good parent's satisfaction. Patient has been on follow up for one year without recurrence.

Conclusion: Haemangiomas of the penis are rare. In the absence of minimally invasive treatment, open surgical excision is a simple and effective treatment modality for glans haemangiomas.

Malignant Stricture of the Anterior Urethra - A Rare Indication ForTotal Penectomy.

N Eke, ON Ekeke, JE Raphael, MK Sapira

Department of Surgery, University of Port Harcourt Teaching Hospital.

Background: Malignant strictures of the anterior urethra are rare and only few cases have been reported .The commonest indication for penectomy is carcinoma of the penis, most affecting the glans. Total penectomy for anterior urethral carcinomais infrequent.

Objective: To highlight the need for a high index of suspicion for malignancy, in patients with urethral stricture disease, especially when associated with an indurated mass with or without fistulae located on shaft of penis. This is important because of the impact on the quality of life on the patient who undergoes total penectomy.

Method: The case note of the patient was retrieved and the management reviewed. Relevant literature search was also done.

Result: A 43 year old man presented with a 4 month history of progressive diminution of urine stream associated with obstructive lower urinary tract symptoms, which culminated in acute urinary retention. Clinical and imaging evaluation showed he had an anterior urethral stricture with urethrocutaneous fistula, associated with an indurated mass, at the mid- shaft of penis. He was then prepared for urethroplasty. At surgery, the strictured segment appeared abnormal with a mass invading the corpora cavernosa. Biopsy was taken and tissue histopathology showed squamous cell carcinoma of the urethra. Total penectomy with perineal urethrostomy was then done after consent was reluctantly given.

Conclusion: Malignant strictures of the anterior urethra are uncommon. An early index of suspicion is important in the management of suspected patients, considering the low acceptability of penectomy.

Laparoscopy Guided Liver Abscess Drainage: An Additional use of Veress Needle

CN Ekwunife, EC Amadi, FN Amaechi

Federal Medical Centre Owerri, Nigeria

Background: The mainstay of the management of liver abscesses has been antibiotics and image guided percutaneous drainage. However not all abscesses are amenable to or will resolve with percutaneous drainage. Laparoscopic surgery may be an alternative to open surgical drainage of these abscesses.

Case Report: A 34 year old man presented to our hospital with an expanding huge hepatic abscess that could not be aspirated percutaneously. He subsequently had a laparoscopic drainage of the abscess, with the aid of veress needle. He had a dramatic improvement and was discharged home 3 days after surgery. Three weeks post operatively no abscess cavity was noticeable on ultrasound scan.

Conclusion: This is the first reported case of laparoscopic liver abscess drainage in Eastern Nigeria to the best of our knowledge, and we suggest that veress needle can be a useful tool in the percutaneous aspiration of liver abscesses.

Pioneering Upper Gastrointestinal Endoscopy in Owerri, Nigeria: Outcomes and Challenges

CN Ekwunife

Federal Medical Centre Owerri, Nigeria

Background: The benefits of upper gastrointestinal endoscopy are not in question. However the issue is how to make this service readily available for patient care. Our institution only recently started to offer this service.

Objectives: This study evaluates the teething problems, the indications, endoscopic findings and complications of flexile endoscopy in out centre.

Method: Aretrospective study of the first thirty seven patients who had upper gastrointestinal endoscopy at the Federal Medical Centre Owerri, between January 2008 and June 2009.The patients' biodata, indications, findings and complications during endoscopy were analysed. The peculiar problems of our endoscopy practice were also studied.

Results: The age of the patients ranged from23to84years with a peak in the 5 th decade. There were 22(59%) males and 15(41%) females. The commonest indication for endoscopy was upper gastrointestinal bleeding (37%) followed by dyspepsia, gastric cancer, gastric outlet obstruction and oesophageal cancer. The commonest findings were gastroduodenitis, peptic ulcer disease and gastro esophageal reflux disease. The fee for endoscopy is not significantly higher than that of bariummeal.

Conclusion: Upper gastrointestinal endoscopy improves diagnosis. Efforts should be made to expand this service nationwide to include therapeutic capacities, despite the financial difficulties in our environment.

Squamous Cell Carcinomain Port Harcourt

RS Jamabo SN Elenwo

Department of Surgery University of Port Harcourt Teaching Hospital Port Harcourt

Background: Cutaneous squamous cell carcinoma is commoner than other skin malignancies in our environment. Aetiology varies from solar to nonsolar factors.

Aim: To highlight the importance of aggressive management of chronic cutaneous ulcers and evaluate the treatment outcome.

Patients and Methods: All patients with proven histological diagnosis of squamous cell carcinoma seen at the University of Port Harcourt Teaching Hospital, Port Harcourt from January 2006 to July 2009 were studied.

Results: There were 28 patients with preponderance of males 18males and 10 females. The male: female ratio is 1.8:1. The age range was 18 to 65years with a mean of 43.1 years. 8 (28.5%) patients were albinos with their lesions on the scalp & face . 6(21.5%) patients had Marjolin's ulcer on the face and lower extremities. 14(50%) patients had their lesions on the lower extremities known aetiologies were post burns scars, trauma including old bullet injury. Granulomatous lesion in the groin. Effects of solar radiation on the albinos. Wide excision was feasible in 16(57.1%) patients 7(25%) only had oral chemotherapy (capecitabine) 12(42.9%) were inoperable because of late presentation. Adjuvant chemotherapy/radiotherapy were not done for these.

Conclusion: Ignorance, traditional beliefs (eg stepping on a poison been responsible for chronic ulceration) and poverty were responsible for delayed presentation. Vigorous public enlightenment is required.




 

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