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Year : 2013  |  Volume : 19  |  Issue : 2  |  Page : 88-100  

Abstracts of Joint NSRS/ASON Meeting of July 2013

Date of Web Publication3-Oct-2013

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. Abstracts of Joint NSRS/ASON Meeting of July 2013. Niger J Surg 2013;19:88-100

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. Abstracts of Joint NSRS/ASON Meeting of July 2013. Niger J Surg [serial online] 2013 [cited 2020 Feb 28];19:88-100. Available from: http://www.nigerianjsurg.com/text.asp?2013/19/2/88/119238

A Technique of Making Available Low Cost Mesh for Inguinal Hernia Repair

Udo IA, Umeh KU, Akpanudo E

General Surgery Unit, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria

Background: Current best practice for inguinal hernia repair recommends the use of prosthetic biomaterials for reconstructing the posterior wall of the inguinal canal to reduce the recurrence. Cost and availability of mesh and perhaps reluctance to adopt a new technique are factors, which prevent widespread adoption of hernioplasty in low resource settings. Use of sterilized mesh significantly reduces the cost of hernioplasty and is safe. Aim: To describe a technique of making available mesh at low cost for repair of inguinal hernia in a tertiary facility. Methods: Sheets of 30 cm × 30 cm polypropylene mesh (Premilene mesh, BBRAUN Aesculap, 82 g/m 2 ) were cut into 8 cm × 6 cm to produce 15-18 strips, which are re-package into self-seal (Medical Action Industries Inc.) sterilizing pouches measuring 90 mm × 230 mm and autoclaved. At repair, the strips are taken out of the pouch, shaped to fit the anatomy of the posterior wall of the inguinal canal, a slit created at one end and applied in Lichtenstein repair of inguinal hernias. Results: A total of 60 inguinal hernia repairs were done in 58 patients using the prepared mesh. No recorded cases of wound infection. The unit cost of each mesh was N = 850.00-1,000.00. Conclusion: The use of sterilized polypropylene mesh for the repair of inguinal hernias is safe and does not significantly add to the cost of hernia repair. This technique is recommended in low resource settings.

Abdominal Injuries in University of Port Harcourt Teaching Hospital

Dodiyi-Manuel A, Ray-Offor E, Jebbin NJ, Igwe PO, Enebeli VC

Department of Surgery, University of Port Harcourt Teaching Hospital, East-West Road, Port Harcourt Rivers State Nigeria

Background: Abdominal injuries are relatively common in this environment. The mechanism may be penetrating or blunt injury. Some of them require operative intervention while others are managed non-operatively. Objectives: The aim of this study was to determine the pattern and outcome of management of abdominal injuries in University of Port Harcourt Teaching Hospital (UPTH). Materials and Methods: This is a prospective study of all patients with abdominal injuries seen and managed in UPTH over a 4 year period (from 1 st January 2009 to 31 st December 2012). Relevant data were analyzed. Results: 45 patients were seen within the study period. There were 40 males (88.9%) and 5 females (11.1%) making a male to female ratio of 8:1. Their ages ranged from 15 to 45 years with a mean of 27.8 ± 1.6 years and 21-30 years as the most commonly affected age group. The mechanism of injury was penetrating in 33 patients (73.3%) and blunt in 12 patients (26.7%). Gunshot to the abdomen was the most common etiology, seen in 21 patients (46.7%). The small bowel was the most commonly injured organ, seen in 14 patients (31.1%). 34 patients (75.6%) had exploratory laparotomy while 11 patients (24.4%) were managed conservatively. The most common complication was surgical site infection, seen in four patients (8.9%). Two patients died giving a mortality rate of 4.4%. Conclusion: Gunshot to the abdomen is the most common cause of abdominal injury in UPTH. Early intervention is advocated to further reduce the mortality.

Recommending the Use of Trauma Patients Presenting to an Accident and Emergency, for the Nigeria National Seroprevalence Survey

Nottidge TE, Utam AU 1

Department of Orthopaedics and Traumatology, University of Uyo Teaching Hospital, Uyo, 1 Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria

Objectives: To consider the relevance of using human immunodeficiency virus (HIV) prevalence data obtained from the trauma patients as an alternative to the routine use of antenatal patients, for Nigerian National HIV prevalence estimates. Methods: Trauma patients who are presenting to the Accident and Emergency unit of the University of Uyo Teaching Hospital, who met the inclusion criteria, were enrolled into the study. The process of obtaining the data was contrasted with the National HIV Antenatal care survey. Ethical approval was obtained from the Institutional Ethical Review Board. Results: There were 100 patients tested from October to December 2008 and the HIV prevalence was 5%. The details of the process were contrasted with that of the National HIV sentinel survey. Conclusions: Trauma patients are a suitable supplementary population for the determination of the Nigeria National HIV prevalence.

Pattern of Mammographic Findings in Females Presenting with Breast Symptoms in a Tertiary Health Center in South East Nigeria

Ebubedike UR, Umeh EO, Anyanwu SNC 1 , Ukah CO 2 , Ikegwuonu NC, Eze PC, Morah CN

Departments of Radiology, 1 Surgery, and 2 Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Introduction: Mammography is valuable in the investigation of symptomatic breast disorders. The imaging modality serves as an adjunct in establishing the diagnosis of palpable and non-palpable breast lesions. Objective: The objective of this study is to document the pattern of mammographic findings in females presenting with palpable breast lumps, breast pain and nipple discharge. Results: Mean age of participants, 47 ± 9.7 years. Presenting symptoms were palpable breast lump, 20 (38.4%), breast pain, 30 (57.7%) and nipple discharge, 9 (17.3%). Mammographic findings were Negative (Final-Breast Imaging-Reporting and Data System 1) in 9 cases (17.3%) and positive in 43 cases (82.7%). Mammographic opacities suggestive of breast mass in 30 cases (57.7%). Asymmetric density in 24 cases (46.2%) while calcification was seen in 22 cases (42.3%). Nearly, 57.1% of mammographic opacities were on the right side and 53% at upper, outer quadrant. Five mammographic opacities (16.7%) had spiculated margins while 25 (83.3%) were well-circumscribed. Nearly, 58.3% of asymmetric densities and 86.3% of calcification were also on the right side. Conclusion: Cases with mammographic opacities suggestive of the breast mass exceed presenters with breast lumps. This suggests that some presenters with nipple discharge and breast pain may additionally have non-palpable breast mass.

Pre-internship Nigerian Medical Graduates Lack Basic Musculoskeletal Competency

Nottidge TE, Ekrikpo U, Ifesanya AO 1 , Nnabuko RE 2 , Dim EM, Udoinyang CI

Department of Orthopaedics and Traumatology, University of Uyo Teaching Hospital, Uyo, 1 Department of Orthopaedics and Trauma, University College Hospital, Ibadan, 2 Department of Plastic and Reconstructive Surgery, National Orthopaedic Hospital, Enugu, Nigeria

Assess the basic musculoskeletal competency of pre-internship graduates from Nigerian medical schools. Methods: The authors administered the Freedman and Bernstein basic musculoskeletal competency examination on 113 pre-internship graduates from seven Nigerian medical schools, over a 3-year period from 2008 to 2010, at the University of Uyo Teaching Hospital. Five specialist residents took the examination to test criterion relevance. Results: These graduates failed this test of basic musculoskeletal competency, obtaining scores ranging from 7% to 67%. The duration of the orthopedic posting and observing operative fracture fixation were not significant determinants of the score. The two final year specialist residents each had a marginal pass in the examination. Conclusion: Basic musculoskeletal competency among Nigerian medical graduates is inadequate.

Pilot Study on Laparoscopic Surgery in Port-Harcourt, Nigeria

Ray-Offor E, Okoro PE, Gbobo I, Allison AB

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

Video-laparoscopic surgery has long been practiced in western countries, however documented practice of this minimal access surgical technique are recently emanating from Nigeria. Our study is the first from the Niger Delta region. Aim: The aim of this study is to evaluate laparoscopy as a useful tool for management of common surgical abdominal conditions in a developing country. Materials and Methods: This was a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution from August 2011 to December 2012. Data on patients' age, gender, indication for surgery, duration of hospital stay and outcome of surgery were collated and analyzed. Results: During this study period, 15 laparoscopic procedures were performed with age range of 2-65 years, mean age 31.5 years. There were 11 male and four female. Six laparoscopic appendicectomies. Six diagnostic laparoscopy ± biopsy, one laparoscopic trans abdominal pre-peritoneal herniorrhaphy for bilateral indirect inguinal hernia and two laparoscopic adhesiolysis for small bowel obstruction. All were successfully completed except one conversion (6.7%) for uncontrollable bleeding in an intra-abdominal tumor. Conclusion: The practice of laparoscopic surgery in our environment is feasible and safe despite the numerous, but surmountable challenges. There is the need for adequate training of the support staff and a dedicated theatre suite.

Incidence and Risk Factors for Retinal Vein Occlusion at The University of Port-Harcourt Teaching Hospital, Port-Harcourt, Nigeria

Fiebai B, Ejimadu SC, Komolafe R

Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Portharcourt, Rivers State, Nigeria

Background: Retinal vein occlusion is a common vascular disease of the retina that causes significant loss of vision. Certain systemic and ocular risk factors have been associated with this disorder and knowledge of them is key in managing recurrences and complications. Aim: The aim of this study is to determine the prevalence of retinal vein occlusion and identify the risk factors in retinal vein occlusion in patients presenting to a tertiary hospital in Rivers State. Methods: A 5-year retrospective study carried out between January 2008 and December 2012. The medical records of 27 consecutive patients who presented to the retina clinic of the Eye Department of University of Port Harcourt Teaching Hospital. Information culled from the data included the demographic data of patients, presenting visual acuity, history of systemic and ocular disease, blood pressure and intraocular pressure. The data was analyzed using the Statistical Package for Social Sciences (SPSS version 20.0, IBM, USA). Results: Out of the 364 patients seen at the retina clinic during this period, 27 cases were diagnosed as retinal vein occlusion. The mean age of the patients was 58.8 ± 10.1 years. The male: female ratio was 1:2.8. The prevalence of retinal vein occlusion in the retinal clinic was 7.4%. Central retinal vein occlusion (74.1%) was more common than branch retinal vein occlusion (25.9%).The four major risk factors in this series were systemic hypertension, diabetes mellitus, glaucoma and hyperlipidemia in descending order. Vitreous hemorrhage was the most common ocular complication. Conclusion: With a good knowledge of the prevalent risk factors, visual morbidity and blindness can be prevented particularly in the fellow eye.

Prevalence of Circumcision in an Urban Population

Ikechukwu NM

Department of Surgery, University of Jos, Nigeria

Background: Circumcision is one of the most commonly carried out surgical procedures. It is commonly done for religious and cultural reasons. However, it is reported that the practice of circumcision has health benefits including reduced transmission of human immunodeficiency virus infection. Aim: To determine the prevalence of circumcision in Jos and to demonstrate the reasons for this practice. Methods: In this ongoing community based study, questionnaires were administered to males to ascertain whether they had been circumcised, at what age this was done, the method and the reason for circumcision. Results: Responses of 54 males have been received. The majority 33 (61%) were aged between 31 and 40 years. All respondents were circumcised. 40 (74%) were circumcised under one year of age, 10 (19%) were circumcised between 1 and 12 years of age, 2 (3.5%) between 13 and 40 years of age and 2 (3.5%) at above 40 years old. In 30 (56%) respondents, circumcision was surgically done with sutures placed, whereas in 13 (24%), traditional methods were used. In 50 (93%) of the respondents, circumcision was for cultural/religious reasons. Conclusion: Prevalence of male circumcision is a 100% in this study. A significant proportion is done outside the hospital in a traditional setting. The main reason for circumcision is culture/religion.

Management of Posterior Urethral Valves in Uyo: A 10 Year Experience

Akaiso OE, Ukpong A, Essiet IU, Ibiok IA, Ekwere PD

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

Posterior urethral valves (PUV) are the most common cause of male pediatric obstructive uropathy. Objective: The objective of this study was to evaluate the clinical presentation, treatment and outcome of 21 PUV patients managed over a period of 10 years. Methodology: A prospective study of charts of 21 PUV patients managed between 2002 and 2012 at the University of Uyo Teaching Hospital and KSH Hospital Ltd., Uyo. Patient data retrieved included age, clinical features, laboratory and radiological findings, methods of drainage, initial and definitive management; complications and outcome. Patients were treated with Mohan's valvotomy, Endoscopic resection, balloon avulsion and open resection. Results: The age range was between 2 weeks and 15 years (mean = 4.3 ± 4.4 SD years). All patients had lower urinary tract symptoms and abdominal distension. 7 patients (33.3%) had vomiting; 2 patients (9.5%) had fever; while 2 patients (9.5%) had hematuria. The electrolytes, urea and creatinine were abnormal in 15 patients (11%). Micturating cystourethrogram was diagnostic in all patients. 15 patients (71%) had back-pressure effects with vesico-ureteric reflux and hydroureteronephrosis. Mohan's valvotomy was done in 10 patients (47.6%). Endoscopic valve ablation was done in 7 patients (33.3%). Balloon avulsion was done in 1 patient (4.7%) and open valve resection in 2 patients (9.5%). 50% of patients were lost to follow-up. Conclusion: Early diagnosis and ablation of PUVs improved outcome in our patients. Prenatal ultrasound would have detected the patients in utero. Preliminary vesical drainage by urethral catheterization or suprapubic cystostomy improved renal function and prevented chronic renal failure. The provision of endoscopic facilities for direct vision valve ablation is strongly advocated.

The Uyo Trauma Registry: Developed for Sustainable Audit of Trauma Care and Cause in Nigeria

Nottidge TE, Dim EM, Udoinyang CI, Udoh IA 1

Department of Orthopaedics and Traumatology, University of Uyo Teaching Hospital, Uyo, 1 Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria

Introduction: The Cape Town trauma registry (CTTR) was developed as a minimum data set for low resource settings and was applied in a Southern Nigeria tertiary hospital. Based on the outcome of the study, the CTTR was modified to produce the Uyo Trauma Registry. Purpose: The purpose of this study was to develop the Uyo Trauma Registry, using the CTTR as a template and thus provide Nigeria with a locally developed minimum data set Trauma Registry. Methods: Data was obtained prospectively from injured patients who presented to the Accident and Emergency Department of the University of Uyo Teaching Hospital over a 7 week period in June/July 2012, using the CTTR. The final data set was determined based on ease of capture of each item and its relative importance to injury surveillance. The goal for satisfactory data capture was chosen as ≥ 80%. Results: The Uyo Trauma Registry has 20 items and may be the first locally relevant hospital based on injury surveillance tool in Nigeria. Conclusion: The Uyo Trauma Registry has provided the resource constrained setting in Nigeria with a simplified tool to sustainably obtain Trauma data and thus engage in objective locally relevant efforts at injury prevention and improved care of the injured patient.

Emergency Open Prostatectomy for Bleeding Benign Prostate Hyperplasia: A 6-Year Experience

Ukpong AE, Akaiso OE, Essiet IU, Ibiok IA, Okonkwo CO

Urology Unit, Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria

Introduction: Massive persistent hemorrhage in benign prostatic hyperplasia (BPH) is a fairly common and life-threatening complication at presentation. Aim: The aim of this study was to determine the cause of bleeding and safety of an emergency open prostatectomy in patients with bleeding BPH. Patients and Methods: A 6-year prospective study of 40 patients who underwent an emergency open prostatectomy for persistent bleeding BPH was undertaken between June 2007 and June 2013 at the University of Uyo Teaching Hospital. Each patient's data consisting of personal bio-data, clinical, laboratory, radiological, operative findings and post-operative complications as well as histological diagnosis were entered into a protocol and analyzed to determine the cause of bleeding and outcome. Outcome was measured in terms of survival, bleeding (number of times the catheter had to be flushed) and wound complications. Prostatic adenoma after removal was weighed and recorded. Results: The age distribution of the patients ranged from 55 to 90 years, 37.5% (15) of them being in the 71-80 age brackets. 97.5% (39) and 2.5% (1) had emergency transvesical and retropubic prostatectomies respectively. Large adenomas (70-400 g weight) and prominent median lobes were found to be the cause of bleeding in all cases. 65% (25) of adenomas were 150 g and above. All patients had multiple blood transfusions both pre-, intra- and post-operatively. 40% (16) of patients had post-operative complications ranging from wound infection (15%), minimal bleeding (27%) to vesicocutaneous fistula (5%). In spite of the associated co-morbid conditions in these patients (55%), no death was recorded. Conclusion: Emergency open prostatectomy is a safe and effective treatment for bleeding BPH. Recovery following this procedure is usually dramatic with little or no bleeding complications.

Posterior Urethral Valve in a 16-year-old Nigerian boy: Rare Complications of Late Presentation: Case Report and Review of Literature

Ukpong AE, Akaiso OE, Essiet IU, Ibiok IA, Akpan FX

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

Posterior urethral valve (PUV) is the commonest cause of a lower urinary tract obstruction in the male children's. It is usually detected during the neonatal and infancy period. Rarely it may be diagnosed during later childhood, adolescence or even adulthood. We report rare complications of PUV in a 16-year-old boy with clinical presentation of urinary incontinence, difficulty with micturition, a fistulous scrotal wound all dating back to early childhood. Clinical diagnosis of urethral stricture with urethra-cutaneous fistula was made. Retrograde urethrocystogram however, showed a lamellated, figure-of-eight vesico-prostatic calculi with urethrocutaneous fistula and a normal anterior urethra. Vesicolithotomy was carried out and patient recovered without complications.

One-Stage Anastomotic Urethroplasty for Traumatic Urethral Strictures

Odoemene CA, Okere PCN 1

Urology unit, Department of Surgery, Federal Teaching Hospital, Abakaliki, 1 Department of Radiology, University of Nigeria Teaching Hospital, Enugu, Nigeria

Purpose: One-stage anastomotic urethroplasty is an attractive procedure for reconstructing the urethra following trauma. This prospective study highlights the advantages of the procedure and outcome of the treatment. Methods: A total of 87 patients, age range between 11 and 62 years with a median of 37 years were included in the study. These patients were seen at two tertiary institutions namely: Niger Foundation Hospital and Diagnostic Center, Enugu and Federal Teaching Hospital Abakaliki. The stricture lengths varied between 1.3 and 3.2 cm. All had suprapubic cystostomy initially followed by the end to end perennial anastomosis after thorough work-up. Pre-operatively 9 (10.3%) patients had impotence from the trauma. Post-operatively the patients were assessed with pericatheter retrograde urethrogram, micturating cysto-urethrogram and uroflometry. Results: All the patients were male. At 6 months, 70 (80.5%) patients had satisfactory micturition with urine flow rate greater than 20 ml/sec: 13 patients (15%) had urine flow rate of between 15 and 20 ml/sec −4 (5%) patient had urine flow rate of less 15 ml/sec. At 1 year, there was no impotence, re-stricture, urinary incontinence resulting from the surgery. Conclusion: Delayed one-stage anastomotic urethroplasty provides a decreased incidence of post-operative morbidity, re-structure, impotence and urinary incontinence for most short segment post traumatic urethral strictures.

Prostate Cancer in University of Uyo Teaching Hospital, Uyo

Akaiso OE, Ukpong AE, Umanah I, Ekpo M, Essiet IU, Ibiok IA, Okonkwo CO, Ekwere PD, Attah Ed B

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

To establish the hospital incidence, clinical presentation and management outcome of Carcinoma of the Prostrate in University of Uyo Teaching Hospital, Uyo. Design: Retrospective. Materials and Methods: Men, 40 years or older presenting with lower urinary tract symptoms between 2002 and 2012 were evaluated. Patients with histological diagnosis of Carcinoma of the prostate were analyzed for risk factors, clinical features, tumor characteristics and management. The Hospital incidence was calculated from Hospital admission records. Results: 210 patients with Prostate Cancer Histology were identified from the Hospital records. (1) Hospital incidence = 151/100,000/year; (2) Age range, 45-90 years (mean = 64 ± 9.3 SD); (3) Major risk factors were sex, age, Genetic influences and sexually transmitted diseases; (4) 96.2% of the patients had AdenoCarcinomas; (5) 2.4% had transitional cell carcinomas; (6) 1.5% had squamous cell carcinomas; (6) 85.2% of the patients had advanced diseases stage C and D while the remaining 14.8% had stage A and B; (7) 90% of the patients had Androgen Deprivation Therapy (8) 10% had definitive therapy for early state prostate cancer; (9) Approximately 70% of patients died within 5 years of diagnosis. Conclusions: Prostate cancer incidence in Uyo compares favorably with the reports from other centers in Nigeria and African Americans. Transrectal ultrasound guidance Biopsy will improve cancer yield. Screening and early detection is strongly advocated so that curative treatment with Radical prostatectomy and radical therapy could be instituted.

Management of Anterior Urethral Strictures in Uyo

Akaiso OE, Ukpong AE, Essiet IU, Ibiok IA, Okonkwo CO, Ekwere PD

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

Purpose: We report on our experience with the management of Urethral strictures in the University of Uyo. Materials and Methods: Between January 2002 and December 2012, 49 patients with Urethral strictures were admitted into University of Uyo Teaching Hospital. Patients data entered into a pro forma were age, sex, occupation, etiology of the stricture, clinical features, investigation and treatment were included. Results: The age range was 3-75 years (mean: 35.7), the sex ratio M: F = (47:2). 22 patients (44.9%) had post traumatic strictures; 19 (38.8%) had post inflammatory strictures while 6 patients (12.2%) had latrogenic strictures, 2 women (4.1%). 41 of the patients (83.6%) presented in an acute or chronic Urinary retention. 18 (36.7%) with lower Urinary tract symptoms. 11 patients (22.4%) presented with complex strictures complicated by multiple Urethrocutaneous fistula, abscesses penoscrotal edema, Fournier's gangrene and scrotal fibrosis. The stricture length varied from 2 cm to 10 cm and were located in the Bulbar region in 24 (49.0%), penobulbar 10 (20.4%), penile 7 (14.3%), glansmetal 3 (6.1%) and multiple strictures 5 (10.2%). Treatment modalities included dilatation 16 (32.6%), anastomotic urethroplasty 23 (47.0%) and substitution urethroplasty 10 (20.4%). Conclusion: Simple short segment annular strictures < 2 cm were readily treated by urethral dilatation or excision and end to end anastomosis. Extended primary anastomosis was successful in most of the patients with stricture length 2.5-5 cm. Patients with long segment stricture (>5-10 cm) complicated with fistula and Perineural fibrosis were treated with Dorsal penile island skin flaps (either as a patch or a tube) urethroplasty or modification of Quartey's urethroplasty.

Management and Outcome of Posterior Urethral Valves in Uyo: A 10 Year Experience

Akaiso OE, Ukpong A, Essiet IU, Ibiok IA, Okonkwo CO, Ekwere PD

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

Posterior Urethral Valves (PUV) is the most common cause of male pediatric obstructive uropathy. Objective: To evaluate the clinical presentation, treatment and outcome of 21 PUV patients managed over a period of 10 years in UUTH, Uyo. Methodology: A prospective study of charts of 21 PUV patients managed between 2002 and 2012 at the University of Uyo Teaching Hospital. Patients data retrieved included age, clinical features, laboratory and radiological findings, methods of drainage, initial and definitive management, complications and outcome. The patients were treated with Mohan's valvotomy; Endoscopic resection, Catheter balloon avulsion and open resection. Results: The age range was 2 weeks to 15 years (mean = 4.3 years) All of the patients had lower urinary tract symptoms and abdominal distension. 7 patients (33.3%) had vomiting, 2 patients (9.5%) had fever, while 2 patients (9.5%) had hematuria. The electrolytes, urea and creatinine were abnormal in 15 patients (71.4%). Micturating cysto-urethrogram was diagnostic in all patients. 71.4% had back pressure effects with vesicoureteric reflux and hydroureteronephrosis. Mohan's valvotomy was done in 10 patients (47.6%). Endoscopic valve ablation in 7 patients (33.3%) Balloon avulsion in 1 patient (4.7%) and open valve resection in 2 patients (9.5%). Conclusion: Early diagnosis and ablation of PUV improved outcome in our patient's prenatal ultrasound. Preliminary vesical drainage by urethral catheterization or suprapubic cystostomy improved renal function. The provision of endoscopic facilities for direct vision valve ablation is strongly advocated.

Etiology and Presentation of Acute Intestinal Obstruction in Uyo

Udo IA, Umeh KU

General Surgery Unit, University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Obstructed inguinal hernia is still considered to be a common cause of intestinal obstruction in many rural and sub-urban communities in Nigeria; however, recent reports would suggest the trend is evolving toward adhesions and large bowel tumors. This evolution will likely alter aspects of the clinical features and presentation of the disease. Aim: The aim of this study is to audit the etiology and clinical features of acute intestinal obstruction in the University of Uyo Teaching Hospital. Methods: A prospective hospital based study involving consecutive adults presenting with acute intestinal obstruction at the University of Uyo Teaching Hospital. Patient bio-data, presenting features, clinical and intraoperative diagnoses were entered into a designed format on first assessment in the emergency room, wards and operating room. Data analysis was performed using SPSS 17 (IBM, USA) and results presented as simple percentages and tables. Results: A total of 31 cases of acute intestinal obstruction were recorded made of 12 (38.7%) males and 19 (61.3%) females. The mean age was 46.5 years (±15.8). The 46-55 year age group had the highest incidence of 8 cases (25.8%). Traders had the highest incidence of 11 (35.5%). Colonic tumors 6 (19.4%), adhesions 5 (16.1%) and obstructed inguinal hernia 5 (16.1%) were the most common causes of intestinal obstruction. Conclusion: Colonic tumors and adhesions are fast replacing obstructed inguinal hernia as a cause of intestinal obstruction in Nigeria.

Age at Presentation of Breast Cancer in Uyo

Umeh KU, Udo IA

General Surgery Unit, University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Carcinoma of the breast is the most common malignancy and cause of death from malignancy in females. The true burden of the disease in Nigeria is unknown due to lack of population studies; but there is increased awareness of the disease in the general population with heightened anxiety, which has increased consultations. Breast cancer in blacks has aggressive cellular features, behavior and worse stage-specific survival, occurring on average 10 years earlier than in Caucasians. This implies that the disease in blacks require aggressive therapy to improve outcome, apply less aggressive surgery and prolong survival. Screening and early diagnosis are key to achieving these ideals and provision of the needed tool is important. Aim: The aim of this study is to audit the age at first presentation of patients with carcinoma of the breast at the surgery clinic. Methods: A unit based study from December 2007 to January 2010 involving all females who were diagnosed with breast cancer in the surgical clinics. The patient bio-data were recorded in a prepared format. Results: A total of 62 patients with breast cancer were enrolled in the study with an average age of 40.2 years. The highest incidence of the disease was in the second to fourth decades of life. Conclusion: Breast cancer in Nigerians would appear to occur at an early age. Aggressive measures are required to contain the mounting morbidity and mortality associated with this disease.

Pattern of Pathologies in a New Cardiothoracic Surgery Unit

Ekpe EE

Department of Surgery, Cardiothoracic Surgery Unit, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria

Background: Cardiothoracic surgery service was not available in Akwa Ibom State up until the year 2007, which saw the inauguration of a cardiothoracic surgery unit domiciled in the Department of Surgery of the University of Uyo Teaching Hospital Uyo on February 21, 2007. Objective: The objective of this study is to analyze the pattern of pathologies seen in the new cardiothoracic surgery unit in its first 5 years with a view to redirecting the available resources to important areas. Methods: A retrospective analysis of the case files of patients seen in the unit during the period under review in terms of age, sex and pathology. Results: During the study period, 714 patients presented in a near-increasing pattern except for year 2010 which witnessed a slight reduction over that of the previous year in the following proportions; 14% in 2007, 17% in 2008, 21% in 2009, 20% in 2010 and 26% in 2011. Gender analysis showed male preponderance with a Male-Female ratio of 2.3:1. There were patients in all age groups from neonatal to geriatric, with highest frequency in 41-50 years group (18.76%) and lowest in > 70 years group (4.48%). Pathology analysis showed cardiovascular pathology to be the most common (22.3%), followed by surgical complications of pleuropulmonary tuberculosis (21.4%) and thoracic trauma (21.0%), while mediastinal pathology was least (0.98%). Conclusion: Further development in the unit in terms of manpower and facilities should be concentrated to the treatment of cardiovascular, surgical complications of pleuropulmonary tuberculosis and thoracic traumas as a matter of priority.

Clinical Significance of Adverse Outcome of Blood Transfusion in Surgery

Usoro NI

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

Infectious and non-infectious hazards of blood transfusion have been documented over the years. Adverse outcome of blood transfusion is however, a recent concern arising from the advent of evidence-based medicine. Blood transfusion is independently associated with greater morbidity and mortality and a generally worse outcome in a broad spectrum of patients, surgical and non-surgical. This is thought to be due to storage lesions, immunomodulation and other factors not fully elucidated yet. Transfusion avoidance on the other hand is associated with improved patient outcomes. This paper reviews the recent evidence of harm due to blood transfusion and discusses the clinical significance of this in the modern practice of surgery.

Bilateral Lower Limb Gangrene in a Nigerian Child Following High-voltage Electrical Burns Injury: A Case Report

Dim EM, Amanari OC 1 , Inyang UC, Nottidge TE

Department of Orthopaedics and Traumatology, Faculty of Clinical Sciences, University of Uyo, Akwa Ibom, Nigeria

Background: The human body conducts electricity very well. Direct contact with electrical current can be lethal. The passage of electric current through the body is capable of producing a wide spectrum of injuries, including serious damage to the heart, brain, skin and muscles. Naked high-voltage electric cables negligently abandoned in residential, commercial and industrial areas are a recipe for disaster. This paper illustrates the consequence of such abandonment in a developing country and draws attention to the need for adequate statutory regulations towards the control of electric cables in municipalities, especially in developing countries. Methods: A case report of a child who had bilateral lower limb gangrene following electrical burns injury is presented. Result: A 5-year-old girl presented with a 4 day history of electrical burns injuries of both lower limbs including both gluteal regions, associated with 3 day history of fever. Extensive full thickness burns, deep wound sepsis and gangrene of both lower limbs were noted at presentation. The estimated surface area of the burns wound was 42%. She had bilateral above knee guillotine amputations through the proximal third of both femora. The amputation stumps and residual burns wounds were resurfaced using split-thickness skin graft. The patient was given physiotherapy to both hips. Conclusion: High-voltage electrical injuries may result in far reaching soft-tissue damage, leading to a loss of the injured body part in survivors.

The Role of Achilles Tendon Elongation in Distal Tibial Malunion with Post Traumatic Anterior Angulation of the Tibia: A Case Report

Dim EM, Inyang UC, Ndafia NM 1

Department of Orthopaedics and Traumatology, University of Uyo Teaching Hospital, Uyo, 1 Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Fractures of the tibia and fibula are common. Unorthodox treatment sometimes leads to unacceptable complications. The aim of this paper is to illustrate the management of one of such complications following unorthodox treatment of an open fracture of the distal tibia and fibula. Methodology: A case report of a 42-year-old woman who had post traumatic anterior angulation of the distal right tibia following traditional bonesetter's treatment is presented. Results: A 42-year-old woman presented with a 4 years history of deformity of the right leg following an open fracture of the tibia and fibula, which was treated by a traditional bonesetter. She was found to have malunion of the distal tibia and fibula with an anterior angulation of the tibia measuring 45°. There was an extensive unstable scarring of the skin of the distal leg covering the antero-medial and antero-lateral surfaces of the leg. She had a limb length discrepancy of 7 cm, a severe equinus deformity of the right foot and walked with a limp. She was offered a two-staged surgery. The first stage comprised right fibula osteotomy, osteoclasis of the tibial malunion, elongation of the Achilles tendon and distal tibia skeletal traction with a weight of 7.5 kg for 2 weeks. There was a breakdown of the unstable anterior soft-tissue envelop around the fracture site following the first stage operation. The second stage comprised removal of the transtibial Steinmann pin and fracture stabilization using an external fixator. Soft-tissue wound healed and check X-ray at 7 weeks showed callus bridging of the fracture site. Patient was discharged on above knee cast after removal of the external fixator. Conclusion: Achilles tendon elongation is an important component of the surgery to correct malunion of the distal tibia with severe anterior angulation and equinus deformity of the foot.

Discharge Against Medical Advice Among Patients in the Accident and Emergency Room of the University of Uyo Teaching Hospital, Uyo, Southern Nigeria

Dim EM, Nwashindi A 1 , Inyang UC,

Uduma FE 2

Department of Orthopaedics and Traumatology, University of Uyo Teaching Hospital, Uyo, 1 Maxillofacial Unit, Department of Dental Surgery, University of Uyo Teaching Hospital, Uyo, 2 Department of Radiology, University of Uyo Teaching Hospital, Uyo, Nigeria

Background: The accident and emergency room is usually the first point of call for patients having a life or limb threatening disorders, or disorders that cause severe and agonizing pain. Such patients often present voluntarily in the emergency room of a hospital for some form of acute care. Sometimes, some of these patients might seek to be discharged contrary to the opinion of the attending medical personnel or managing team. The aim of this study was to evaluate the characteristics of patients going on discharge against medical advice from the accident and emergency room of the University of Uyo Teaching Hospital and the reasons for such discharges. Methodology: A prospective study of discharge against medical advice among patients at the accident and emergency room of the University of Uyo Teaching Hospital, Uyo, over a period of 14 months, from September 2011 to October 2012, is presented. Results: A total of 141 patients took discharge against medical advice within the period under review, at the average frequency of 10 voluntary discharges/month. This represents 3.45% of 4088, being the total number of patients registered in the accident and emergency department within the same period. The age of patients varied between 10 and 89 years, with a mean of 37.7 ± 7.07 years. Nearly 72.34% of the patients were in the age group of 20-49 years. There was a slight preponderance of males over the females in a ratio of 1.3:1. About 26.95% of patients took voluntary discharge to seek native or traditional treatment. Nearly 50.35% of the patients had trauma related conditions, while 15.60% had infective or inflammatory conditions. Conclusion: Trauma and young age appear to be risk factors for discharge against medical advice following admission for acute care.

Congenital Lung Cyst: A Case Report

Bassey OO, Etiuma AU, Ogbudu SO, Nwogboso CI, Echieh CP

Department of Surgery, Cardiothoracic/Vascular Unit, University of Calabar Teaching Hospital, Calabar, CRS, Nigeria

Introduction: Congenital lung cysts are rare congenital malformation of the lung. It was first reported by Bartholin in 1687. The term was introduced into American literature in 1925 after Koontz reviewed the previously described cases, adding an autopsy report. Congenital bronchogenic cysts, although relatively rare, represent the most common cystic lesion of the mediastinum. Shanti and Klein (2008) studied a series of 236 patients undergoing pulmonary resection for cystic lung lesions. Bronchogenic cysts constituted 20% of this group. Of these 47 cases, 20 involved a lobar location, which required lobectomy and 27 cases were extralobar and were treated with resection of the cyst. In infants and small children, these cysts can be life-threatening when they compress vital structures. In particular, subcarinal cysts can pose life-threatening airway compromise. In infants, the initial presentation may be respiratory distress. More than one-half of patients are asymptomatic. No such reports have been described in South/South Nigeria. Objective: Report of our experience and outcome of a case of congenital lung cyst with pressure symptom causing collapse and hypoplasia of the left lung. Method: The only case encountered in our center in 10 years is reviewed and indicating the age, sex, clinical presentation, investigations intra-operative findings, surgical procedure and outcome. Case Report: A 16-year-old miss CHN who presented to us with a history of recurrent cough productive of copious foul smelling sputum for 14 years, with associated recurrent difficulty in breathing on exertion and at rest, but no history of orthopnoea. There is a history of recurrent high grade fever with chills and rigors at the onset of each episode, which usually settled down as low grade and continuous. She was not a known asthmatic, but had occasional episodes of bronchospasm, which were relieved with bronchodilators. Physical Examination: She was not acutely ill-looking. Chest findings included; trachea shift to the left, reduced left chest expansion, increased tactile fremitus, dull percussion notes, reduced air entry with bronchial breath sounds with basal crepitation on the left. Right lung field was normal. She was admitted, investigated for a congenital lung cyst and to exclude pulmonary tuberculosis. Results of Investigations: Acid fast bacillus X3 was negative, sputum culture sterile (repeated use of antibiotics) chest X-rays shows mediastinal shift to the left, reduced lung volume on ipsilateral side, homogenous opacity on the left lower lung zone and a compensatory hyperinflation of the right lung, computed tomography-scan showed a huge emphysematous bullae in the left upper lung zone with the rest of the lung fields showing extensive dilated cyst occupying almost the entire lower lung zone with multiple cystic bronchiectasis on the left lung zone, lung function test done at presentation showed combined (obstructive and restrictive) type and a high risk of post-operative morbidity with a forced expiratory volume in 1 second (FEV 1 ) of 27.1% of predicted for pneumonectomy. Following weeks of chest physiotherapy were climbing up to five flights of staircase frequently. Her functional capacity and predicted post-pneumomectomy lung function improved showed by FEV 1 of 31%. Both confirm that she will withstand pneumonectomy. A post-operation lung function further improved to 35% and 37%. She had pneumonectomy with en bloc excision of the lung cyst. Operative findings of left lung cyst occupying the upper part of the lower lobe extending upward and downward compressing the left lung with hypoplasia of same, which was not inflatable even with continuous positive airway pressure ventilation and adhesion of the lung to the parieties, pericardium and mediastinum. She was discharged home on the 15 th post-operative day and function optimally histology showed lung tissue displaying interstitial pneumonia, composed of lymphocytic exudates involving the interalveolar tissue, interalveolar fibrin exudates, involvement of the pleurae involved with areas of progressive fibrosis and desquamative changes are seen in the smaller airway. Conclusions: Congenital lung cyst should be considered in young people presenting with recurrent chest infection for which common chest infection in our environment have been excluded.

The Roll of Immediate Tracheostomy in Gaint Cystic Hygroma in Port Harcourt

Nwogbo AC, Gbobo I 1

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

Background: Sequestration of a portion of a jugular lymph sac, from the lymphatic system during embryonic life, results in cystic swelling of the neck. This frequently gives rise to cystic hygroma. Sometimes the cystic swelling can be very large that excision becomes difficult without providing alternative airway in the form of tracheostomy. Aim: The aim of this study was to demonstrate and highlight the importance of immediate tracheostomy in giant cystic hygroma. Method: This is a prospective study of 35 cases of cystic hygroma seen in Department of Pediatric Surgery and Otolaryngology Departments of University of Port Harcourt Teaching Hospital. 15 cases qualified the criteria for the study. The case notes of each were analyzed, looking at the age, gender, size of cyst and operative technique used. Results: A total of 15 cases had giant cystic hygroma. Of these, 10 were male and 5 were female with male/female ratio of 2:1. 12 cases had tracheostomy Intraoperatively while 3 cases did not have tracheostomy. One patient out of the 12 died post-operatively while the 3 without tracheostomy all died in the post-operative period. Conclusion: There is a need to have trachestomy as part of the surgical excision in the treatment of giant cystic hygroma. Post-operative complication and mortality occur more in the absence of tracheostomy.

Delayed Repair of Congenital Oesophageal Atresia with Tracheoesophageal Fistula: A Case Report

Etiuma AU, Bassey OO, Nwagboso CI, Echieh CP, Ogbudu SO

Cardiothoracic Surgery Unit, University of Calabar Teaching Hospital, Calabar, Nigeria

Congenital esophageal atresia (OA) with tracheoesophageal fistula (TOF) is an uncommon condition with an average rate of 2.4/10,000 live births. Isolated OA was first reported by Durston in 1670. Associated TOF was reported 27 years later by Gibson. Initially, a condition associated with high mortality due to its pulmonary complications of aspiration and pneumonitis, survival rates have increased markedly with improved neonatal intensive care, surgical technique of repair and nutritional support. We present a neonate who was referred to us at 21 days of age following an inability to pass a nasogastric tube, with excessive drooling of saliva, choking on feeds, fever and weight loss. Patient was diagnosed with oesophageal atresia, distal tracheoesophageal and pneumonitis following a confirmatory chest radiograph. Other anomalies were ruled out by computed tomography scan and echocardiography and the baby had gastrostomy and right posterolateral thoracotomy, complete disconnection of the fistula, closure of trachea ostium and primary end-to-end anastomosis of the esophagus 5 weeks later. Patient was discharged 5 weeks after the operation on account of an anastomotic leak, which was managed conservatively. Early diagnosis remains invaluable in the management of this condition. This is because aspiration of feeds and pneumonitis is avoided. However as with this patient, with adequate support and treatment, even those diagnosed late have a good chance at survival.

Experience of Surgical Patients' Relatives in a Nigerian Hospital

Etuk EB, Umeh KU, Uko AS, Ekrikpo UE 1

Departments of Surgery, and 1 Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria

Introduction: Patients and their attendants experience is a recognized component of high quality cares. Hospital should understand how relatives feel about the care of their patients as their experiences reflect the quality of health-care and ancillary services available. Objectives: The objective of this study was to highlight surgical patients' relatives' experience and assessment of our services. Methodology: This prospective audit was carried out at University of Uyo Teaching Hospital, using a structured questionnaire. Relatives of 100 consecutive admitted patients in surgery were questioned by an interviewer. Information requested were demographic variables, perception of clinical and ancillary services and their involvement in patient care. Results: Age range of attendants was 11-60 years, averaging 28.8 and 29.7 years for males and females respectively. Male, female ratio was 1:1.86. First degree relatives (82%) and spouses (15%), students (34%) and traders (24%) admission points were accident and emergency unit (A and E) (75%) and clinics (25%). Waiting time was < 30 min at A and E (50%) and at clinic within 1 h in 44% of cases. Nearly, 86% had courteous approach by nurses. Proper direction was to laboratory (93%). Satisfactory blood bank services (80%). Communication by doctors: Good (88%). Food source: Restaurants (38%), home (29%). Drinking water: Sachet (75%). Sleeping site: Ward floor (70%). Nearly 90% used ward toilets (stool/urine/bath). Regular mosquito bites (87%) and 25% encountered other animals. About, 29% missed school or work. Participation in care: Bed dressing (70%), carrying bed pan (75%), changing wound dressings (6%), turning patient (67%), emptying urine bag (61%), measuring urine quantity (26%), emptying nasogastric tube bag (27%), measuring abdominal drain output (20%) and changing drip (10%). Common complaints: Very poor power supply, poor lighting wards, lack of sleeping space, expensive services, staff's bad attitude (pay point) and dirty hospital environment. Conclusion: There is urgent need to improve the conditions of our hospitals. The health-care system needs revamping, staff retraining and provision of healthy environment for efficient health-care delivery. However, national systems alone will not be the answer; a big cultural shift in our hospital is needed.

Gap Non-union of the Patellar: Outcome of One Stage Surgical Treatment with V-Y Quadricepsplasty and Tension Band Wiring: Report of 2 Cases

Inyang UC, Dim EM, Nottidge TE, Essien IAJ, Usendiah I, Ekpene U

Department of Orthopedics and Traumatology, University of Uyo, Uyo, Nigeria

Background: Patellar fractures are common, but gap non-union of the patellar may be rare. There are commonly found in environments where there is paucity of orthopedic practice. It is a management challenge to the surgeon in terms of approximation of the gapped fragments and post-operative complications of knee stiffness. Aim of this work is to assess the outcome of a one-stage surgical treatment (open reduction and tension band wiring with V-Y quadricepsplasty and segmentation) of gap non-union of the patellar. Methods: Report of two cases; (i) A 57-year-old man who had repair of gap non-union of the left patellar, 2 months after injury. (ii) A 34-year-old lady who had repair of gap non-union of the left patellar, 5 years after injury. Conclusion: Satisfactory clinical outcome can be obtained including improved quality-of-life of the patient with this procedure. Good surgical technique and aggressive rehabilitation must be applied and this may be irrespective of the age of the nonunion.

Human Immunodeficiency Virus-Related Salivary Gland Disease: Report of Two Cases and Review of Literature

Alex-Okoro JI, Udo IA, Umeh KU, Ben IM

Department of Surgery, General Surgery Unit I, University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Human immunodeficiency virus (HIV)-related salivary gland diseases is a very recent presentation in our practice. Parotid gland swelling is a common feature of the condition and a high index of suspicion for HIV/acquired immunodeficiency syndrome (AIDS) and malignancy in these patients is required from clinicians who manage them. Aim: The aim of this work is to highlight an emerging trend of HIV/AIDS presenting for the 1 st time with a salivary gland neoplasm. Methods: Reports of two adult males, previously undiagnosed with HIV, presenting with salivary gland enlargement. Results: Two males aged 30 and 40 years presenting to the surgical out-patient clinic with bilateral parotid gland swelling, dryness of the mouth, weight loss, cough and difficulty in breathing. The lesions were tender and firm. One had multiple swellings on his trunk and lower limbs and generalized lymphadenopathy. HIV serology was positive and chest radiogram showed extensive reticular pattern in both. Immunohistochemistry on biopsied specimen showed non-Hodgkin's lymphoma in one patient. Conclusion: Parotid neoplasm is an AIDS defining condition, which can suggest undiagnosed HIV infection or disease progression and development of AIDS in the diagnosed. Diffuse infiltrative lymphocytosis syndrome is an important histological feature of this disease and lymphocytic pulmonary infiltration is common. The salivary gland swelling is often benign but the possibility of malignancy must always be considered.

Late Presentation of Undescended Testis in Port-Harcourt

Gbobo I, Igwe P, Okoro P

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

Introduction: Undescended testis is the most common congenital anomaly of the urogenital system. Sexual differentiation begins at fertilization with the determination of the chromosome sex. The resulting karyotype depends upon the contribution of the X or Y chromosome contributed by the male partner. Before the 12 th week, both gonads are indistinguishable. Chromosomal sex directs gonadal sex. Testicular descent occur form the second trimester and the external genitalia undergo differential growth. Aims and Objectives: (1) To study the prevalence of undescended testis among surgical patients. (2) Age of presentation in Port-Harcourt. (3) Pattern of presentation. (4) Post-operative complications. Materials and Methods: (a) Undescended testis that had orchidopexy from 2008 to 2012. (b) Undescended testis under watchful waiting below 1 year of age was excluded. (c) Follow-up of patients varied from 5 months to 4 years. Result: (a) Total no. of patients 998. Undescended testis 50 (0.05%). (b) Left (LT) was 13 (26%) while the right (RT) was 29 (58%) and bilateral cases 8 (16%). (c) None palpable testis was 9 (18%). (d) Palpable testis most common at superficial inguinal pouch 28 52%). (e) Age at orchidopexy varied from 1 year 2 months to 16 years of age. (f) The commonest complication was scrotal wounded infection. Conclusion: (a) Most of the patients presented late in this series. (b) The right side was the most common site of undescended testis. (c) The most common associated anomaly was umbilical hernia followed by hypospadias.

Management of Urethral Strictures in Port Harcourt

Ekeke ON, Sapira MK, Raphael J,

Obidinnu OC, Amusan EO 1 , Eke N

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

Introduction: Urethral stricture disease (USD) is a common urological problem. Inflammatory condition was the most common cause in developing countries with trauma highly rising. Simple urethral dilatation, endoscopy could quickly treat patients. Urethroplasty is the mainstay of treatment as recurrence rate of other modalities is high. Objectives: The objective of this study is to highlight the pattern and management of USD in Port Harcourt. Patients and Methods: This is a review of all cases of USD in Port Harcourt teaching hospital between January 2005 and June 2012. Case notes of the patients were retrieved. Social demographic, etiology, site, treatment and outcome of USD were assessed. Data was analyzed using SPSS 20.0. Results: There were 141 patients with urethral stricture, out of that 135 (95.7%) were male and 6 (4.26%) were female. Their ages ranged from 15 to 82 years (mean 38 ± 6.1 standard deviation years). In 78 (55.32%) e patients stricture was post-traumatic while 35 (24.82%), 26 (18.44%) and 2 (1.4%) was due to post-inflammatory, iatrogenic and malignancy respectively. In 52 patients, the strictures were anterior urethral; 4 (2.83%) at fossa navicularis and 48 (34.04%) at bulbar urethra. Posterior urethral stricture was 78, 9 (6.38%) and 69 (48.93%) were in prostatic and membranous urethra respectively. 5 (3.54%) patients had long segment stricture involving both anterior and posterior segments. 34 and 59 had substitution and anastomotic urethroplasty respectively. One patient had penectomy for malignant stricture while 31 had endoscopic surgery. Nearly 12% had complications with a recurrence rate of 7.81%. Conclusion: Trauma is the leading cause of USD in Port Harcourt due to activities of militant groups, road mishaps. Iatrogenic USD is also high. We advocate proper training of interns, general practitioners in urethral catheterization.

Neglected Patellar Tendon Tear Repair with Fascia Lata Graft: A Case Report

Inyang UC, Dim EM, Nottidge TE, Essien IAJ, Ekot E, Ita IO

Department of Orthopedics and Traumatology, University of Uyo, Uyo, Nigeria

'Patellar tendon injuries are rare. However, when it occurs, it may possess a management problem to the orthopedist particularly in environments where there is paucity of orthopedic practice and instruments. It can be easily missed in a group of patients. In multiply injured patients, late diagnosis may be the rule. Aim of this work is to assess the effectiveness of fascia Lata graft in the treatment of neglected patellar tendon tear in a 20-year-old man and the outcome of treatment. Methods: A case report of a 20-year-old man who had repair of a 9 month old right patellar tendon tear using fascia Lata graft is presented. Conclusion: Fascia Lata graft is an option for neglected patellar tendon tear repair particularly when there are contraindications to Hamstrings tendon harvest or unavailability of tendon striper.

Outcome of Bloodless Surgery in a Resource-limited Setting

Usoro NI, Ekanem EI, Ngim N, Ilori IU, Anwan EE, Ibanga IA

University of Calabar Teaching Hospital, Calabar, Nigeria

Purpose: Allogeneic blood transfusion is particularly hazardous in a resource-limited setting with high malaria, human immunodeficiency virus (HIV) and hepatitis B prevalence. Efficacy of blood transfusion in the surgery remains unproven. Bloodless surgery is however rarely reported in a resource-limited setting. We aimed to demonstrate the practicality and good outcome of bloodless surgery in a resource-limited setting. Methods: We reviewed bloodless surgery cases involving the Bloodless Medicine and Surgery Group in University of Calabar Teaching Hospital, Nigeria, over a period of 3 years using a protocol in which oral iron was given to all patients, while specific perioperative blood conservation techniques were used in combinations tailored to the individual patient. At the end-of-surgery vital signs, recovery from anesthesia, post-operative hematocrit, length of hospital stay, wound complications, morbidity and mortality were assessed. Results: There were 22 patients, out of which 17 females and 5 males, ranging in age from 2 to 72 years. Procedures included head and neck, gynecologic, obstetric, urologic, maxillofacial, gastrointestinal and orthopedic surgeries. Mean pre-operative hematocrit was 35.4%. Positioning, normothermia and crystalloids were employed in all 22 patients, diathermy in 12, acute normovolemic hemodilution in 11, colloids in 10 and topical glue in 5 patients. All the 22 patients had safe surgery, normal end-of-surgery vital signs (lowest SaO 2 98%) and all recovered from anesthesia without incident. Mean post-operative hematocrit was 31.8% on the 3 rd day. Mean hospital stay was 5.2 days with a range of 3-8 days. None of the patients had wound complications and there was no mortality on follow-up over 6 months. Conclusion: Bloodless surgery is practical and safe in a resource-limited setting. Significance: Practice and teaching of bloodless surgery in resource-limited environments has the potential of improving outcome while drastically reducing the cost and transfusion transmissible infections such as malaria, HIV, hepatitis and others.

Ovarian Cyst: An Unsual Cause of Intestinal Obstruction

Dodiyi-Manuel A, Jebbin NJ, Igwe PO

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

Background: An ovarian cysts is common, frequently asymptomatic and often resolves spontaneously. These cysts commonly occur during the child bearing years. They are usually found either during the course of investigation for abdominal pain or as a result of performing abdominal ultrasound scan for other reasons. We present a case of large bowel obstruction resulting from an ovarian cyst. Case Report: A 38-year-old lady presented to our hospital with a 2 weeks history of colicky abdominal pain, constipation, vomiting and abdominal distension. She had a cesarean section 1 year prior to presentation. On examination, she was in painful distress with distended abdomen and marked tenderness in the pelvis and right iliac fossa. She was resuscitated and managed conservatively for 3 days, but no improvement was noticed. Exploratory laparotomy was subsequently done and findings were adhesions involving the small bowel and an ovarian cyst adherent to and compressing the rectum causing obstruction. The cyst was mobilized out and excised. She had an uneventful post-operative recovery. Conclusion: Although intestinal obstruction due to ovarian cyst is uncommon, prompt surgical intervention is important for favorable outcome.

Pattern of Endourology Practice in Port Harcourt, Nigeria

Ekeke ON, Eke N, Raphael JE, Sapira MK, Amusan OE, Ofuru VO

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

Endourology is a modern and important aspect of urology practice. This practice is routine in developed countries and is getting increasingly available in Nigeria, but not affordable to many patients. Training, cost and maintenance of equipment are some unique challenges. Objectives: The objective of this study is to review the management of patients who had endourological procedures. Patients and Methods: Data was obtained from the case notes of all patients who had endourological procedures and analyzed using SPSS 20 (IBM, USA). Results: A total of 179 patients were seen, with a male to female ratio 5.8:1. The mean age was 43.5 years (4 months-82 years). 59 (32.9%) of the procedures were diagnostic and 120 (67.1%) therapeutic. Direct vision internal urethrotomy (DVIU) was the most common procedure. 4 patients (2.2%) had associated open surgery. 126 (70.4%) had spinal anesthesia. 168 (93.9%) of the procedures were carried out successfully. The complication rate was 13.9%. They included: Re-stricture (5.0%) following DVIU, urinary tract infection (3.3%), epididymo-orchitis (3.9%), poor stream following transurethral resection of the prostate/DVIU (1.1%) and urinary retention (0.5%). Conclusion: Endourology is an integral aspect of urology. Attention to newer equipment for lower and upper urinary tracts evaluation and treatment along with training of personnel is important to bridge the gap with the developed countries.

Snodgrass Tubularized Incised Plate Urethroplasty for Anterior Hypospadias Repair

Akaiso OE, Ukpong AE, Essiet IU, Ibiok IA, Akpan FX, Okonkwo CO, Ekwere PD

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

Background: Hypospadias is the most common penile congenital anomaly. Snodgrass tubularized incised plate (TIP) urethroplasty preserves the urethral plate and results in a functional and cosmetically acceptable penis. Objective: This is a review of our experience with the Snodgrass technique for hypospadias repair in our institution. Materials and Methods: We reviewed the medical records of boys who had TIP urethroplasty in University of Uyo Teaching Hospital over a 5 year period (2007-2012). The location of the meatus, age at surgery, technique, complications, voiding function and cosmesis were recorded. Results: In this study, 10 children with age range from six (6) months to three (3) years were included. The hypospadias was coronal in 3 (30%), subcoronal in 4 (40%), distal penile in 2 (20%) and mid-penile in 1 (10%). All had healthy urethral plates and were suitable for TIP urethroplasty. The urine stream was straight in 50% and 90% reported satisfactory cosmetic appearance post operatively. Three patients (30%) developed urethrocutaneous fistula while one patient (10%) had meatal stenosis; one patient (10%) urethral stricture; one patient (10%) had partial dehiscence. The fistulae were repaired by rotation of local dartos flaps while the meatal stenosis and urethral stricture were easily dilated. Patient with partial dehiscence had a repeat urethroplasty. Conclusion: The Snodgrass urethroplasty produced a functional and cosmetically acceptable reconstruction in our series.

Helicobacter Pylori Associated Appendicitis is a Rare Event

Etuk EB, Ita IO, Nwagbara UO, Umanah IN 1

Departments of Surgery, and 1 Histopathology, University of Uyo Teaching Hospital, Uyo, Nigeria

pylori caused appendicitis is a rare event. We present a case of histologically diagnosed acute appendicitis associated with H. pylori in a 31-year-old man. This article reminds us that H. pylori is a rare cause of acute appendicitis. The 31-year-old man was admitted with clinical features suggestive of acute appendicitis. He was resuscitated and worked up for appendicectomy under general anesthesia and this revealed an inflamed turgid retrocaecal appendix. The post-operative period was uneventful. Histology showed inflamed appendix with infiltration of H. pylori. We conclude that H. pylori infection of the gastrointestinal tract may involve the appendix, though the cause is considered pyogenic bacteria, can present as acute appendicitis.

Inguino-labial Neurofbroma Presenting as Ingiunolabial Hernia: A Case Report

Etuk EB, Uko AS, Umanah IN 1

Departments of Surgery, and 1 Histopathology, University of Uyo Teaching Hospital, Uyo, Nigeria

Inguinal hernias are a very common cause of groin swellings and the most common abdominal wall abnormality. Some conditions do resemble inguinal hernia, but rarely does neurofibroma. After clinical assessment has differentiated hernia from other inguinal swellings, tissue diagnosis can confirm the type of solid inguinal swelling. This article shows that neurofibroma can present as ingiuno-labial hernia and adding to the existing scanty literature. We present a case of inguinolabial neurofibroma presenting as an inguinolabial hernia in a 54-year-old farmer. She had a 2-year history of gradually increasing right groin swelling that became painful 1 year prior to presentation. There were no symptoms of intestinal obstruction. It was irreducible from the onset. Examination showed right inguino-labial swelling, tender, firm, irreducible and not attached to the skin. Intra-operative findings revealed wellcircumscribed soft-tissue tumor extending from the inguinal canal into the labia majora; its proximal end was 2 cm from the deep inguinal ring. The tumor was excised. Histology revealed neurofibroma. We conclude that neurofibroma can occur in the inguinal canal and extend into the perineum mimicking inguino-labial hernia.

Small Bowel Volvulus at University of Uyo Teaching Hospital: A Six Year Review

EtuK EB, Uko AS, Edubio MN 1

Departments of Surgery, and 1 Anesthesia, University of Uyo Teaching Hospital, Uyo, Nigeria

Introduction: Volvulus causes acute intestinal obstruction of both large and small intestine with sigmoid volvulus being the most common. Small intestinal volvulus is rare and occurs more frequently in Asia and Africa than the Western world. We review 12 cases of adult small bowel volvulus that presented in our hospital in the past 6 years. Objective: The objective of this study is analyzes the presentation, diagnosis and management of acute small intestinal obstruction caused by small bowel volvulus in our hospital. Methodology: The folders of patients with small bowel volvulus from January, 2007 to April, 2013 at Department of Surgery of University of Uyo Teaching Hospital were reviewed and analyzed. Results: A total of 12 patients were admitted with acute small bowel volvulus. The diagnoses were confirmed intra-operatively. All patients had general anesthesia using volatile anesthetic agents and muscle relaxation. Male, female ratio was 2:1. Age range was from 17 years to 61 years. The ratio of primary small bowel volvulus to secondary volvulus was 3:1. Nearly, 33% had gangrene of the affected loops of small intestine. Mobile caecum occurred in 75% of patients. Appendix was inflamed in 25%. The procedures that were carried out include the right hemicolectomy in 25%, 17% had small intestinal resection and anastomosis, the combination of detorsion/release of bands/appendicectomy was performed in 25%. Another 25% had release of bands and detorsion only. In addition to those that had right hemicolectomy, all the others with mobile caecum had cecopexy. Nearly, 33.3% had superficial surgical infection, post-operative bowel gangrene occurred in one patient (8.5%) and a repeat resection and anastomosis of affected small bowel loop was performed. Mortality rate was 8.5%. Conclusion: Small bowel volvulus is an unusual cause of acute small intestinal obstruction associated with considerable morbidity and mortality. The incidence of strangulation and subsequent gangrene is high, thus the need for early operative intervention.

Small Intestinal Obstruction from Malignant Carcinoid Tumor of the Ileum: A Case Report

Etuk EB, Okonkwo CO, Anyanwu PC, Abudu EK 1

Departments of Surgery, and 1 Histopathology, University of Uyo Teaching Hospital, Uyo, Nigeria

Carcinoid tumors are well-differentiated neuroendocrine tumors with secretory properties. Carcinoids rare, but they are the most common primary tumors of the distal small intestines including the appendix. The presentation of small intestinal carcinoid is usually non-specific and symptoms mimic obstruction from other causes. We present a rare case of malignant carcinoid tumor of the ileum causing acute small intestinal obstruction. A 65-year-old man, diabetic and hypertensive, presented with generalized, colicky abdominal pains of 1 week duration, aggravated postprandially; associated with nausea and vomiting and constipation 3 days prior to presentation. Weight loss started 6 months prior to presentation. Examination showed distended abdomen with visible peristaltic movement, soft, mild tenderness in the central part of the abdomen. No guarding, rebound tenderness or palpable mass. Laboratory investigations showed anemia, electrolyte and urea levels were normal, blood glucose was normal. Abdominal X-ray showed features of small bowel obstruction. He had laparotomy and excision of the involved loop of small intestine. Histopathology confirmed the diagnosis of malignant carcinoid tumor. This case highlights the late presentation of carcinoid tumor of the small intestine. Malignant carcinoid tumors generally are slow growing, but the prognosis is poor in late presentation.

Ultroid Haemorrhoids Treatment in Uyo: The Experience

Etuk EB, Akpan EC, Edubio MN 1 , Effiong GA 1

Department of Surgery, and 1 Anaesthesia, University of Uyo Teaching Hospital, Uyo, Nigeria

Introduction: The desire for minimally invasive method of treating hemorrhoids is increasing. Ultroid procedure is a relatively new technology that is gradually being accepted because it is painless, safe, has fewer complications and requires no special preparation. Ultroid procedure can be carried out for internal hemorrhoids and interno-external hemorrhoids. Thrombosed hemorrhoids are not treated. Objectives: The objective of this study is to review our early experience of Ultroid use and challenges in Uyo. Methodology: A prospective clinical study that includes all 20 patients that had Ultroid procedure in Uyo from July, 2010 until date. All degrees of hemorrhoids were treated. The diagnosis was based on clinical findings. All patients had pre-operative sitz baths, fasted overnight and passed stool in the morning of the day of the procedure. The findings and post-procedure complications were collected. Coexisting fissures or fistulae were treated. All procedures were carried out in theatre with or without sedation or anesthesia. Results: Age range was 17-80 years. Male to female ratio was 3:2. About 60% were day cases while 40% were admitted cases. Nearly, 20% surgical operation for other co-existing anal conditions at the same sitting: 15% had lateral internal anal sphincterotomy for fissure-in-ano, while 5% had fistulectomy for subcutaneous fistula-in-ano. 40% had the procedure without anesthesia, 20% were sedated, 20% had spinal anesthesia while 20% had general anesthesia. Intra-procedure blood loss was a nil or minimal, 50% had no bleeding. Nearly, 40% had pain-free post-operative period, another 40% had mild to moderate pain that was controlled by oral analgesics. 20% that had operative procedure under anesthesia for other anal conditions had severe pains controlled by a combination of opioid analgesics and non-steroidal anti-inflammatory agents. 50% had complete shrinkage of the hemorrhoids within 2-3 weeks, 30% had complete shrinkage within 4-6 weeks. 15% had partial shrinkage: 10% needed a second Ultroid procedure, while 5% needed a third procedure for complete shrinkage. One patient with interno-external hemorrhoid had excision hemorrhoidectomy 3 months after. 10% had moderate post-procedure hematochezia that resolved after repeat procedure. Conclusion: Ultroid is a potent means of treating all degrees of uncomplicated internal hemorrhoids. It could be used at the same sitting with other operative surgical procedures. More data and experience will be acquired by surgeons with time.

Retrospective Study of the Clinicopathologic Profile and Treatment of Phyllodes Tumor in Enugu, Nigeria

Enemuo VC, Okafor O 1 , Ezeome ER

Departments of Surgery, and 1 Pathology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria

Background: Phyllodes tumor is one of the rare breast pathologies. It accounts for about 1% of all breast tumors. It has a spectrum of behaviors that range from a frankly malignant tumor to a completely benign one. The rarity of this tumor ensures that most published works on it are retrospective small series with limited follow-up. There is paucity of studies of this tumor in the Nigerian and African environment and yet clinical experience and the few publications on it suggest that this tumor may not be as rare as mentioned in the literature and that it may be presenting at a much earlier age than in western world. It is based on this information that we decided to study the characteristics and treatment options of this tumor in our center. Aims: The aim of this study is to determine the clinicopathologic profile and treatment of phyllodes tumor in Enugu, Nigeria. Methodology: This is a retrospective study cases of histologically proven phyllodes tumor was collated from the histopathology database of the University of Nigeria Teaching Hospital, Enugu spanning a period of 7 years (2005-2011). Patients medical records were also retrieved from the hospital medical records department. Patient's data including age, sex, symptom, duration of symptom(s), clinical diagnosis, surgical procedure, histological diagnosis, time of tumor recurrence, number of years of follow-up and evidence of metastases were obtained from their folders. The statistical analysis was carried out using the SPSS 17 version (IBM, USA). Results: Out of 2999 patients with breast tumors diagnosed in the hospital during the study period (2005-2011), 268 (8.9%) were histologically confirmed to be phyllodes tumor. 244 of these (91%) were benign phyllodes tumor while 9 (3.4%) were reported as malignant tumor and 15 (5.6%) were borderline. All patients were females. Nearly, 90% of patients were clinically diagnosed as fibroadenoma, 5.97% as phyllodes tumor and the rest were non-specific. The ages of patients ranged from 12 years to 52 years with a median age of 32 years and a peak age range of 21-25 years. Of all patients 95.3 were treated with wide local excision and 4.7% had simple mastectomy. Recurrence rate was less than 4%. Conclusion: From our study, we noted that phyllodes tumor occurred at a younger age group in our environment (about 15-20 years younger).This tumor is also not as rare as quoted in western literature. Therefore, clinicians should have a high index of suspicion when reviewing young female adults presenting with breast lumps.

Indications and Complications of Tube Thoracostomy with Improvised Underwater Seal Bottles

Edaigbini SA, Delia IZ, Aminu MB, Anumenechi N, Ibrahim A 1

Departments of Surgery, Cardiothoracic Surgery Unit, Ahmadu Bello University, 1 Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background: Tube thoracostomy is a lifesaving and frequently performed procedure in hospitals where the expertise and necessary tools are available. Like any surgical procedure it is associated with numerous complications some of which can be fatal. Where the ideal drainage receptacle is unavailable, the underwater seal device can be improvised with bottled water plastic can especially in emergency situations. Aims and Objectives: The objective of this study is to determine the frequencies of the various indications and complications of tube thoracostomy with improvised underwater seal. Materials and Methods: A cross-sectional study with a structured proforma was used for assessment over a 3-year period (May 2010-April 2013). The proforma was filled at the time of the procedure by the performing surgeon and patients were followed-up with serial chest X-rays until certified cured. A 1.5 L bottled water container was used as the underwater seal receptacle. The data was analyzed with SPSS 15 (IBM, USA) software program. Results: A total of 167 patients were managed. There were 106 (63.5%) males and 61 (36.5%) females. The mean age was 34.85 ± 16.72 with a range of 1-80 years. The most frequent indication was for malignant/paramalignant effusion, 46 (27.5%). Others were trauma, 44 (26.3%), parapneumonic effusion, 20 (12%), post-thoracotomy 14 (8.4%), empyema thoracis 12 (7.2%), heart disease and tuberculosis effusion 11 (6.6%) each, pneumothorax 8 (4.8%) and misdiagnosis 1 (0.6%). A 101 (60.5%) of the procedures were performed by registrars, 41 (24.6%) by consultants, house officers 15 (9%) and senior registrars 10 (6%). The overall complication rate was 16.8% with the more frequent complications been empyema (5.6%) and pneumothorax (3.6%). The average duration of tube placement was 13.02 ± 12.362 days and range of 1-110 days. Conclusion: Tube thoracostomy can be a relatively safe procedure with acceptable complication rate even with improvised underwater seal drainage bottles.


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