|Year : 2015 | Volume
| Issue : 1 | Page : 78-82
10TH Scientific Meeting of the Association Surgeons of Nigeria
|Date of Web Publication||13-Mar-2015|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. 10TH Scientific Meeting of the Association Surgeons of Nigeria. Niger J Surg 2015;21:78-82
Achalasia cardia management outcome: A 10 years review
Okugbo SU, Efobi CA
Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
Background: Achalasia is a motility disorder of the oesophagus which presents with functional obstruction. It is largely idiopathic in origin though its pathophysiology and presentation are well elucidated in the literature. Its onset is largely insidious and in climes with poor attention to healthcare, presentation may be late with the consequent sequelae. Dysphagia to liquids which is progressively worsening is the rule. There may be features of pulmonary infection from aspiration of regurgitated oesophageal contents. Treatment is either medical with muscle relaxants, or by use of botulinum toxin injections at the gastro-oesophageal junction. Forceful pneumatic dilatation is another means of treatment, but the gold standard appears to be modified Heller's myotomy which may be achieved by either the more traditional open surgery through the thorax or abdomen. Modified Heller's myotomy may be done by laparoscopic or video assisted thoracoscopic means. The choice of surgical options is dependent on the state of health of the patient, and the presence of other co-morbidities. Oesophagectomy and oesophageal replacement is indicated in the presence of malignancy or in mega oesophagus. Aim of the Study: To audit our management of patients with achalasia in the University of Benin Teaching Hospital, Benin. Patients and Methods: This is a retrospective study comprising all cases of achalasia cAQardia seen from January2004 to December 2013. Results: There were a total of 23 cases seen with a mean age of 44 years, male:female ratio was 1:1.6. The mean female age was 38 years and the male was 57 years. There was no early stage case. Four patients presented with stage 3, whilst only one presented in stage 2, and 17 presented in stage 4. Cachexia was evident in 17 (44%) while weight loss was reported in all the patients. Only one patient had feeding gastrostomy as part of nutritional rehabilitation. Modified Heller's Procedure was the surgical definitive treatment offered. 11 cases had surgery via the abdominal approach. While 12 had trans-thoracic approach. Mucosal perforation occurred in two patients and it was closed primarily with omental patch. There was no attempt at anti-reflux surgery as adjunct. Follow-up continued for over 6 months in all cases. There was evident epigastric/retro-sternal pain in six patients while only two patients needed antacids and proton pump inhibitors. Mortality was one who was too ill for any surgical intervention, whilst morbidity by malignant transformation was not observed in any patient though follow-up did not continue beyond 1-year for most patients. Conclusion: Patients with achalasia present late and modified Heller's procedure is the most readily available in our setting with good outcome.
Neurosurgical operative interventions in Benin City, Nigeria
Udoh DO, Osazuwa U, Akpede G, Akpodoado D 1
Department of Surgery, Division of Neurological Surgery, University of Benin, 1 Department of Anaesthesiology, University of Benin Teaching Hospital, Benin City,
Edo State, Nigeria
Background: Neurosurgical operations commenced in this institution (established in 1973) 8 years ago. Serving a populations of 10-12 million, it is the sole neurosurgical facility serving the Midwest of the country where the demand for neurosurgical care is very high, especially neurotrauma, congenital anomalies, intracranial tumour and degenerative diseases. Aims / Objective: A study of neurosurgical operative interventions highlighting limitations to effective care and factors influencing outcome. Study Design / Setting: We studied retrospectively the demographic data, the indications for and nature of (elective/emergency) neurosurgical operations in 1253 patients at our teaching hospital, a major referral centre for neurosurgical patients, between September 2006 and 2014 May. Results: A total of 1253 operations (53% of all admissions) were carried out during the 8-year period. Male to female ratio was 2.5-1. Moat patients were in their third decade of life where tumours and trauma were the commonest indications. Overall, the indication was traumatic brain injury. The others were: Spinal cord injury, hydrocephalus, chronic subdural haematoma, intracranial abscess, compressive myelopathies, intracranial tumour, spina bifida, cranioplasties and encephalocoeles. Conclusion: The profile of central nervous system surgery in Benin over 8 years especially in the past 2 years underscores the need for improvement in the available neurosurgical services, personnel training and facility to meet the escalating society demands.
An unusual presentation of carcinoma of the prostate as a huge retroperitoneal tumor: A case report
Kolawole OA, Eziyi AK, Olajide AO, Ojewuyi O
Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
Background: Carcinoma of the prostate is known to present in various forms, at different stages and in this environment a great number of patients usually present with the disease in advanced stages, and in fact, metastatic. However, its presentation in the form of a retroperitoneal mass as it was in this patient is uncommon. Methods: A case report of a 75-year-old man who presented with a huge retroperitoneal tumor in addition to features of bladder outlet obstruction. Result: We report the case of a 75-year-old male Nigerian with progressive painless, suprapubic swelling of 6 years duration, with both storage and voiding urinary symptoms, in addition to history of tenesmus and reduction in stool caliber. On examination, he was chronically ill-looking, though not pale. Abdominal findings revealed a hard suprapubic mass arising from the pelvis, corresponding to 24 weeks size. The mass was demonstrated clinically to be intra-abdominal and retroperitoneal. The prostate was enlarged, asymmetrical, median groove obliterated, hard and nodular. Serum prostate-specific antigen was 29.8 ng/ml. Abdominal computed tomography scan showed a retroperitoneal mass not separable from the prostate, and had displaced the bladder antero-superiorly, with possible diagnosis of (1) Colorectal cancer with huge mesenteric adenopathy, (2) prostatic carcinoma with rectal and mesenteric infiltration. At Laparotomy a huge retroperitoneal lobulated mass was found, which was unresectable, and an incisional biopsy taken revealed an infiltrating prostatic adenocarcinoma. Conclusion : Advanced prostate cancer can present in very bizarre forms, including mimicking a retroperitoneal tumor, thus one should keep an open mind in evaluating such patients.
Intracranial tumours in children
Udoh DO, Usiholo EA, Udoh MO
Division of Neurological Surgery, Department of Surgery, University of Benin Teaching Hospital, Benin City
Background: Intracranial tumours refer to a mixed group of neoplasms originating from intracranial tissues and meninges with varying degrees of malignancy. They cause considerable concern, more so when they occur in children where they are mostly solid tumours and second only to hematological malignancies in the pediatric age group. Up to two thirds of childhood intracranial tumours are infratentorial as opposed to what is seen in adults, with gliomas and medulloblastomas making up the bulk of these lesions. Study objective / Aims/Institution: A study of the epidemiology of intracranial tumours in children based on demographic, clinical, radiological and histological data obtained from the neurosurgical unit of our teaching hospital. Patients and Methods: The records of all the patients under 18 years with intracranial tumors seeking treatment in the neurosurgical division between June 2006 and June 2013 were inspected. These patients presented via referrals from the general practice clinic, children emergency unit or from private health facilities. Demographic, clinical, radiological and histological data. All these patients had cranial computer tomography done and some also had cranial magnetic resonance imaging. The data were collected and statistically analyzed using SPSS 16, IBM, Chicago USA. Results: Childhood intracranial tumours represented approximately 11% of paediatric neurosurgical admissions. Of the 29 patients, 15 were male (51.7%) and 14 (48.3%) were female. The male:female ratio was 1:0.93. The age range was 3-17 years with a peak at 10-14 years (34.5%). Two thirds presented after 6 months of onset of symptom (65.5%). Duration of symptoms before presentation ranged from 2 weeks to 4 years. Headaches and vomiting were the most common symptoms, affecting more than half of the patients. A third of the patients presented with altered sensorium or coma. Tumor location was infratentorial in 16 cases (55.2%) and supratentorial in 13 cases (44.8%). Craniopharyngioma was the most common tumour encountered (17.2%). There was one case of tumour metastasis to the posterior cranial fossa, a neuroblastoma. Conclusion: Intracranial tumours in children, though less common than congenital anomalies of the central nervous system, are an important contributor to mortality in paediatric neurosurgical patients. Outcomes depend mostly on duration of symptoms as well as location and type of the tumour.
Carcinoma of the oesophagus in Benin City
Okugbo SU, Ugiagbe RA, Efobi CA
Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
Background: Carcinoma of the oesophagus is amongst the top ten commonest cancers worldwide. It shows marked variation in incidence, types and outcome in the various regions of the world. Whereas in some areas the incidence appear to be rising, it has plateaued in others. Adenocarcinoma is the commonest variant worldwide with increasing association with gastric and cardial tumours, whereas squamous cell carcinoma appears commoner in developing countries. Aim of Our Study : This is to ascertain the hospital incidence and epidemiology of patients presenting with oesophageal cancers. Patients and Methods: This is a retrospective study spanning from January 2008 to December 2012. It is an evaluation and audit of our management of confirmed cases of carcinoma of the oesophagus. All histologically confirmed cases of carcinoma of the oesophagus was enrolled in the study. Cases whose records were incomplete, or histology not done were excluded from the study. Results: A total of 35 cases were seen in the period with increasing incidence in the last 2 years. The male:female ratio was 3:1.The mean age was 60 years, with the mean male age being 61.5 years and female 55 years. All patients presented with dysphagia and some weight loss. Severe malnutrition (cachexia) was observed at presentation in over 30% of patients. The commonest histological type was squamous cell carcinoma occurring in 91.4% and 8.6% being adenocarcinoma. All had oesophagoscopy and biopsy done either in the endoscopy suite (awake or conscious sedation) or in the theater. A greater percentage (67%) of cases, the tumour was located in the distal third of the thoracic oesophagus and cardial area. Palliative procedure using the Mouseau Barbin tube as oesophageal stent was the mainstay of treatment in 54%. Oesophagectomy was only feasible in two cases. All cases came in with stage 3 or 4 disease. Late presentation and inoperability was the norm. None of the patients were followed-up beyond 9 months following presentation. Conclusion: Oesophageal Carcinoma is commonly squamous and in the distal third of the thoracic oesophagus. Most patients present late with palliation being the only treatment feasible for most patients.
One year mortality review at the accident and emergency unit of the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South-West Nigeria
Kolawole OA, Olaitan PB, Adedeji OO, Idris OL
Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria
Background: The accident and emergency unit is the first point of call for all critically ill or injured patients in any hospital and varying degrees of severity of various illnesses and injuries are seen and managed here, some leading to death within the period of admission at the accident and emergency unit. This study was carried out to determine the pattern of patient deaths at the accident and emergency unit of the Ladoke Akintola University of Technology Teaching Hospital, Osogbo. Methods: A review of the cases presenting to the A and E unit and mortality over a 1-year period is presented. Results: During the period of the study, a total of 2376 patients were seen at the A and E unit and the number of deaths was 70 (3%). Regarding the mortality, the age ranged from 16 to 85 years, with a mean age of 47 years. The male to female ratio was 1.5:1. The leading causes of death were infective (25.79%), trauma (21.43%), cerebrovascular events (15.71%), diabetic complications (14.29%) amongst others. 71.22% of the deaths from trauma were between the 21 and 50 years range, and 65.58% of trauma deaths occurred in victims of road traffic injuries. Most of the trauma deaths (35.54%) occurred in patients with multiple injuries. 65.22% of deaths from infective causes ranged between 21 and 50 years, and 34.50% of these were respiratory - related. Most deaths (43.6%) occurred within 24 h of admission. Conclusion: Infections and trauma were the leading causes of deaths in our study, with most deaths occurring within 24 h of A and E admission. Multiply injured patients took the lead amongst trauma patients while respiratory - related infections were the most amongst infective causes.
Recurrent inguinal hernia in Ile-Ife Nigeria: Patients' characteristics and outcome of management
Agbakwuru EA 1],[2 , Etonyeaku AC 1],[2 , Olasehinde O 1],[2 , Kolawole AO 3 ,
Talabi AO 1],[2 , Akinkuolie AA 1],[2 , Wuraola FO 2
1 Departments of Surgery, Obafemi Awolowo University Teaching Hospital, Ile Ife, 2 Wesley Guild Hospital, Ilesa, Nigeria, 3 Department of Surgery, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria
Background: Recurrent inguinal hernia constitutes a challenge to both patients and their surgeons. Methods: A retrospective review of all patients who had recurrent inguinal hernia repair between January 1, 2004 and December 31, 2013 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife. Clinical notes were reviewed for sociodemographic and hernia characteristics, operative techniques and postoperative complications. Result: Forty-one recurrent hernia repairs were done constituting 4.6% of all hernia repaired. The male:female ratio was 40:1 with a mean age of 57 years. 36 (87.8%) were first time recurrences while 5 (12.2%) had recurred previously. 85% (n = 35) were reducible and had elective repair while 6 patients (15%) had complications requiring emergency repair. 24 patients (58.5%) had their primary surgery at a nonspecialized facility (P < 0.05). The recurrences were within 1-year of earlier repair in 37.1% of cases; while 14.3% and 48.6% of cases recurred within 1-5 years and >5 years respectively. Technique (P < 0.05) and place (P = 0.0001) of previous repair were associated with higher recurrence rates. Lichtenstein and Nylon Darn techniques were the most common methods of repair for recurrent hernias (20 and 17 cases respectively). Overall complication rate was 36.6% (n = 15) with wound hematoma being the most predominant (11 patients = 25.6%). There was no early recurrence at 6 months follow-up period. Conclusion: Type and place of previous repair were associated with hernia recurrence. Tension free repair is pivotal to its management.
Urological complications of obstetrics and gynaecology surgeries in a Nigerian tertiary hospital
Ekeke ON, Amusan OE
Division of Urology, University of Port Harcourt Teaching Hospital, Port Harcourt, Choba, Rivers State, Nigeria
Introduction: Urological complications of obstetrics and gynaecology surgeries are fairly common. Due to associated morbidity and occasional mortality, they remain a source of concern to surgeons. Aims and Objectives: To present the risk factors and outcome of treatment of urological complications from obstetrics and gynaecology surgeries in our centre. Patients and Methods: This is a retrospective study of patients who had Obstetrics and Gynaecology Surgeries in University of Port Harcourt Teaching Hospital between 2009 and 2014. Patients with urological complications were identified. Data on age, clinical presentations, investigations, treatments and outcome of treatment were extracted and analysed using SPSS 20.0 IBM, Chicago, USA. Results: During this period, 8,270 obstetrics and gynaecology surgeries were performed; 25 patients (0.31%) had urological complications. The mean age was 38.4 years (range 24-62). The commonest initial diagnosis was uterine fibroids in 9 patients followed by uterine rupture in 8 patients. Total abdominal hysterectomy (12 patients) was the commonest surgery. 21 patients had ureteral injury. Of these, 7 patients had bilateral injuries while 11 and 15 patients had injury to their right and left ureters respectively. 8 patients had bladder injury, 1 patient had bladder and both ureteral injuries. Seven injuries were identified intra-operatively. Ureteric re-implantation was the commonest repair. Eighteen patients had satisfactory outcome, I patient died due to chronic renal failure while 2 patients had sepsis. Conclusion: Conditions that distort pelvic anatomy and emergencies were the major risk factors. Early operative repairs achieved good results. Early detection of urological complications of obstetrics and gynaecology surgeries is important. Good knowledge of anatomy of urogenital system and meticulous surgical technique by the surgeon will reduce the incidence.
Bacteriology of urine specimens of men with benign prostatic hyperplasia
Agbugui JO, Obarisiagbon EO,
Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
Background: Urinary tract infection is a common complication of benign prostatic hyperplasia (BPH). The knowledge of the bacteriology of urine specimens of affected patients in our environment will play a complimentary role in management. Objectives: To determine the incidence of bacteriuria and the antibiotic sensitivity pattern of bacterial isolates in cultured urine samples of patients with BPH. Methods: This prospective study was done over a period of 10 months. All patients who presented with lower urinary symptoms due to BPH and met the inclusion criteria were studied. Urine samples were obtained from the patients for microscopy, culture and sensitivity following standard protocol. Results: Ninety-four patients were studied. The age range was between 53 and 80 years with a mean of 64.8 ± 6.8 years. Mid stream urine specimen was obtained in 60 patients while catheter specimen urine was obtained at the point of relief of acute urinary retention in 34 patients. 42 (44.7%) patients had positive urine cultures. Six patients had two different bacterial organisms cultured in their samples. Escherichia More Details coli noted in 20 (47.6%) patients was the most common organism isolated while the least common, Providencia specie was noted in 1 (2.3%). The bacterial isolates were mostly sensitive to imipenem (90.5%), meropenem (88.9%) and nitrofurantoin (85.7%). Antibiotics to which the isolates were mostly resistant included cefuroxime (70%), genticin (73.7%) and ofloxacin (69.7%). Conclusion: Bacteriuria is a common finding in patients with BPH in our setting. Bacterial isolates were mostly sensitive to newer and more expensive carbepenems but show greater resistance to oral cephalosporins and flouroquinolones. There may be a greater role for nitrofurantoin in the treatment of uncomplicated UTI in patients with BPH.
Pattern of mechanical intestinal obstruction in Delta State University Teaching Hospital from May 2012 To May 2014
Campbell C, Akpo E, Akhator A, Akporaiye L, Momoh M, Odigie VI
Department of Surgery, a Delta State University Teaching Hospital, Oghara, Nigeria
Introduction: Mechanical intestinal obstruction is a surgical challenge to most practicing surgeons. Contemporary literature review suggests a change in the pattern and that bands and adhesions are on the increase as a cause, in some reports it has taken a pride of place. Delta State University Teaching Hospital (DELSUTH) is a state owned tertiary health facility for delta state (south-south geopolitical region). We wish to highlight our experience over a24 month's prospective study. Aim of Study: To highlight the causes of mechanical intestinal obstruction and its associated morbidity and mortality in DELSUTH. . Patients and Methods: All patients with mechanical intestinal obstruction presenting between May 2012 and May 2014 were prospectively studied via a profoma, data collected was statistically analysed using Microsoft version 12 Microsoft, Redmond, Washington, USA. Result: Total numbers of patients studied are 50 which constituted 26% of admitted surgical emergencies seen in our services over the study period. Male to female ratio was 2:1; age range is between 6/12 and 100 years and mean age is 44 years. Bands and adhesions were the commonest cause of mechanical intestinal obstructions (42%), intestinal tumour was next most common (28%) while external hernias constituted only (18%). The clinical features at presentation were commonly abdominal pain (90%) abdominal distension (64%) vomiting (58%) constipation (54%). Obstetric and gynaecological operations were the most common postoperative cause of bands and adhesions. Conservative management was successful in 24% (1:4). Gangrenous rate was 4%; the low gangrenous rate was due to the high index of suspicion of strangulation obstruction. Mortality rate was 14%, this was related to fluid and electrolyte derangements and malignant obstructions. Conclusion: Band and adhesion is the commonest causes of mechanical intestinal obstruction in DELSUTH. It is related to obstetric and gynaecological operations. Physicians may need to be more careful and less invasive during surgeries to reduce this observation. Intestinal tumours are on the increase as a cause of obstruction. Elective repair of external hernia may be the cause of reduced intestinal obstruction in DELSUTH.
Pattern of presentation of nasopharyngeal carcinoma as seen in the University of Benin Teaching Hospital, Bnein City
Okhakhu AL, Eche VC, Oseghale EE
Department of Otorhinolaryngology, University if Benin a Teaching Hospital, Benin City
Background: Nasopharyngeal carcinoma (NPC) is a tumor arising from the epithelial lining of the nasopharynx. It is generally an uncommon tumour in Nigeria albeit presents with high morbidity and mortality. Aim: To document the demographic and present lying pattern of NPC in Benin, south-southern Nigeria. Materials and Methods: Retrospective review of all patients seen in ENT Department, University of Benin Teaching Hospital with histologic diagnosis of NPC between January 1 st , 2009 and December 31 st , 2013. Medical records and case notes were used. Results: A total of 83 patients were seen in the period under review, which was 24.1% of the total head and neck cancers. Males 48, females 35, M; F is 1.4:1. Patients were between 3 and 75 years 0-10 years: 2 (2.40%), 11-20 years: 8 (9.6%), 21-30 years: 10 (12. %), 31-40 years: 20 (24.1%) 41-50 years: 8 (9.6%), 51-60 years: 20 (241%) 61-70 years: 10 (12.0%), and 71-80: 5 (6.0%) Mean age of presentation as 38.6 years. There was bimodal age presentation in the 4 th and 6 th decades. Presenting symptoms included 65 (78%) with neck masses, 67 (81%) with epistaxis, 60 (72%) with nasal obstruction, 44 (53%) with aural fullness/tinnitus, 35 (42% with impaired hearing and 32 (39%) with neuro-ophthalmic symptoms. 34 (45%) of patients reside in Edo State, 39 (47%) in Delta State while 10 (12%) outside these two status of the 39 from Delta State 32 (82.1%) love in the riverine areas of Delta State. Conclusion: Highest number of cases were in the 4 th and 6 th decades. A significant number of the patients reside at the riverine areas of Delta State, a region plagued with the deleterious effects of crude oil exploration and exploitation. Commonest presentations were epistasis neck masses, and nasal obstruction.
Pattern of hoarseness in Benin City
Emma-Nzekwue NH, Okhakhu AL 1
Stella Obasanjo Women and Children Hospital, 1 Department of Otorhinolaryngology, University of Benin Teaching Hospital, Benin City
Background: Hoarseness is a change in the voice which is usually subject to misdiagnosis and sometimes a pointer to a more sinister pathology. This study seeks to describe the pattern of hoarseness as seen in the University of Benin Teaching hospital and Stella Obasanjo Women and Children's Hospital Benin City. Materials and Methods: A prospective review of all patients who presented with hoarseness to the University Of Benin Teaching Hospital and Stella Obasanjo Women and Children's Hospital Benin City between January 2012 and September 2013. Information extracted included age, sex, duration of hoarseness, previous treatment, findings at direct laryngoscopy and histology of masses where present. Results: A total of 75 patients were seen, 24 (32%) females and 51 (68%) males presented with hoarseness during the period under review. The age ranged from 7 to 78 years and the mean age was 47 years. Most of the patients presented after 24 months, 65 (86.7%) patients had been previously seen by doctors most whom were misdiagnosed as asthma. The most common causes 53.3% were benign, 13.3% were due to infective causes while 25 patients (33.3%) had malignant pathologies. Conclusion: Hoarseness is a pointer to various pathologies and as such when present for more than 3 weeks an otorhinolaryngological consult is necessary.
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