|Year : 2015 | Volume
| Issue : 2 | Page : 159-163
Nigeria Journal of Surgery Enugu Abstracts
|Date of Web Publication||17-Aug-2015|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Nigeria Journal of Surgery Enugu Abstracts. Niger J Surg 2015;21:159-63
Virilized external genitalia in young girls: Clinical characteristics and management challenges in a low-resource setting
Ekenze SO, Adiri CO1, Igwilo IO1, Onumaegbu OO2
Sub-Department of Paediatric Surgery, 1Departments of Obstetrics and Gynaecology, 2Surgery, Plastic Surgery Unit, University of Nigeria Teaching Hospital Enugu, Nigeria
Objective: Virilization of the external genitalia in young girls (VEG) manifests mostly as ambiguity of the genitalia and elicits concern and uncertainties, especially in settings with poor awareness. This study evaluates the profile and challenges of VEG in South-East Nigeria. Methods: We prospectively evaluated 23 children with VEG managed in South-East Nigeria from June 2005 to January 2013. Results: They presented at the median age of 13.3 months (IQR 3 months–3 years). The cases included 3 (13.05%) of prader type 1, 6 (26.1%) of type 2, 11 (47.8%) of type 3, and 3 (13.5%) of type 4. Five of the prader type 3 and all three cases of prader type 4 were reared as male prior to presentation. Following the evaluation, all the cases were assigned female gender at a mean age of 2.7 years (range 2 months–10.5 years). Appropriate feminizing genitoplasty was undertaken in all cases and after a follow-up period of 3-month to 5-year (mean 2 years) two patients developed vaginal stenosis, and three cases had a surgical wound infection. Poor awareness, delayed presentation, inadequate facilities, and lack of trained manpower were the challenges in the management of the cases. Conclusion: VEG in our setting is associated with delayed management. Focused health education and public awareness programs and improved healthcare funding may improve outcome and minimize the need for gender reassignment.
Transperineal versus transrectal prostate biopsy: Our findings in a Tertiary Health Institution
Udeh EI, Amu OC, Nnabugwu I1, Ozoemena OFN1
Department of Surgery, Enugu State University Teaching Hospital, Parklane, 1Department of Surgery, University of Nigeria, Enugu, Nigeria
Background: Prostate cancer is a major public health issue. Its incidence is rising, especially in Nigeria. Prompt diagnosis is necessary by histology. Transperineal and transrectal approaches to prostate biopsy are well documented. Both methods are fraught with complications, though, most times minor. Studies carried out to compare both methods were carried out mainly on Caucasians, generating conflicting results. Purpose: This study aims to compare the complications rates and tissue yield of these two methods in Nigerian men. Methods: Seventy-five patients completed the study. Forty-five patients had a transperineal prostate biopsy (TPbx), while 30 patients had a transrectal prostate biopsy. Pain perception for all patients was determined by visual analog scale; whereas the complications were ascertained by a validated purpose-designed questionnaire administered on the 7th and 30th day postoperatively. Results: The risk of rectal bleeding was higher for transrectal prostate biopsy compared to transperineal (Odds ratio: 0.03; 95% confidence interval (CI): 0.001–0.450; P = 0.012). TPbx was more painful than transrectal (P < 0.0001; df: 75; t: 4.98; 95%CI of difference in mean: −2.98−[−1.28]). There was no statistical difference between transperineal and transrectal prostate biopsy in hemospermia, fever, prostatic abscess, urethral bleeding, acute retention, and tissue yield. Conclusions: TPbx is more painful than transrectal prostate biopsy though with a significantly reduced risk of rectal bleeding. There appears to be no significant difference with respect to the risk of fever, urethral bleeding, hematospermia, prostatic abscess, and acute retention. Both routes provided sufficient prostate tissue for histology.
Penetrating gunshot injury to the neurocranium in Enugu
Onyia AA, Mezue WC, Chikani MC1, Uche E1, Ohaegbulam SC, Ndubuisi CA, Erechukwu U, Iloabachie I1, Ozor II1, Okorie E1, Ikpegbu I1, Amuta D, Aniaku
Memfys Hospital for Neurosurgery, Enugu, 1Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
Introduction: Penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria due to increase in firearm – related violence, armed conflicts, militancy, and terrorism. Head injuries from penetrating gunshot injuries are poorly reported in developing countries such as Nigeria. They are associated with poor outcome; and at close range are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those who are not mortally wounded. Materials and Methods: Fifty-two patients with penetrating gunshots wounds seen over a 10-year period (2004–2014), at Memfys Hospital for Neurosurgery and the University of Nigeria Teaching Hospital Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impact on outcome. Only patients with clinical and imaging evidence of cranial gunshots injuries who reached hospital alive were included. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty-two patients with isolated cranial gunshot wounds were identified (M:F = 6.7:1 mean (standard deviation) age was 32.77 (11.9) years. There was a high correlation (0.983) between the sex of the patient and the outcome of the treatment while significant association (X2 = 20.475, P = 0.009) was observed between the type of ballistics and patient treatment outcome. The overall mortality was 30.8%, whereas the mortality for patients with post resuscitation Glasgow coma scale (GCS) ≤8 was 57%, as against 12.9% in those whom post resuscitation GCS was >8; meaning that 87.1% of patients in whom post resuscitation GCS was >8 survived. Thirty-one (59.6%) patients had papillary abnormalities. Bihemispheric injuries (17 patients), posterior fossa involvement (3 patients), intra-ventricular hemorrhage (21 patients), multiple intracranial pellets (24 patients), and severe brain swelling appeared to correlate with adverse outcome. Conclusions: Admitting GCS, bihemispheric/transventricular trajectory and posterior fossa involvement, appear to among other variables, be predictive of outcome.
Nontraumatic surgical emergencies in adults: Spectrum, challenges, and outcome of care in a tertiary center in a developing country
Ibrahim NA, Oludara MA, Ajani A, Mustafa I, Balogun R, Idowu O, Osuoji R, Aderounmu AO1, Solagberu BA
Lagos University Teaching Hospital, Ikeja, Lagos, 1Ladoke Akintola University of Technology Teaching Hospital, Ogbomosho, Oyo State, Nigeria
Objective: Access to optimal emergency surgical care in the A and E of many developing countries is grossly inadequate/limited, this being responsible for between 21% and 38% mortality. Purpose: To highlight the pattern of nontrauma surgical emergencies at Ladoke Akintola University of Technology Teaching Hospital (LASUTH), identify the immediate challenges in management and evaluate the outcome of the intervention. Patients and Methods: It is a 1-year prospective study of all nontrauma emergencies seen at LASUTH A and E from October 1, 2011 to September 30, 2012. Study protocol was specifically designed to include patients' bio-data, duration of symptoms, and initial diagnosis at the emergency room. Outcome of management (operative or no operative) was noted. Data were analyzed using SPSS version 15.0 for analysis. Results: Out of 7536 patients presented at the A and E within the study period, 95% (7122) were adults and the remaining 5% were children under 13 years. Of the 7122 adult patients, 2065 (29%) were non trauma with a male to female ratio of 1.7:1. Majority of these 1109 (53.7%) were referred from another hospital. Acute abdomen and urological emergencies were the leading non trauma emergency conditions seen. Others were malignancies, bone/joint pains, soft tissue swellings and abscesses, acute/perforated appendicitis, complicated abdominal wall hernias, and peritonitis. Only 22.5% (464 patients) had emergency room admission because of bed shortage and 521 (25.2%) had to be referred to other tertiary institutions in Lagos. Of those managed by us, 11% were treated and discharged, 41.3% were referred to the clinics after the initial treatment in A and E for follow-up. Emergency surgical interventions were carried out in 222 patients-representing 10.8%. 12 (5.4%) deaths occurred in casualty before surgical intervention with causes of death been mainly acute abdomen. 6 (25%) and abdominal and breast malignancies 6 (25%). Discussion: Acute abdomen remains the most common nontrauma condition worldwide. Urological emergency from acute urinary retention is another frequent reason for nontrauma admissions, coming to the second acute abdomen in many reports. Global increase in urological emergencies has been observed. This is attributed to aging population and increase in benign prostatic hyperplasia; a common cause of acute urinary retention. Malignancies are becoming a more frequent cause of nontrauma surgical emergencies. Incidence of malignant conditions, especially breast cancer is increasing in many developing countries. It is, therefore, expected that more cancer patients presenting with complications requiring urgent attention will be presenting to the emergency room. The patterns of surgical diseases continue to change, especially in low and medium income countries due to increased aging of the population and urbanization. This has implications for planning services provisions and manpower development in such areas. More than half of our patients who needed hospital admission could not be admitted due to lack of bed space and most were referred to another University Teaching Hospital in the city. Conclusion: Nontrauma emergency problems are common in our Accident and Emergency Units. However, less than a third of those seen can be admitted because of shortage of admission beds and inadequate facilities to care for them. Some of those seen actually ought to have been taken care of at primary health care level to put less pressure on tertiary institutions. We, therefore, recommend strengthening the primary and secondary health facilities in Lagos to reduce this pressure.
Severity of male circumcisions and circumcision related complications in three tertiary health facilities in Southern Nigeria
Okoro PE, Ekeke ON1, Onoyona A2
Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, 1Department of Paediatric Surgery Unit, Federal Medical Centre, Owerri, 2Department of Surgery, Imo State University Teaching Hospital, Orlu, Imo State, Nigeria
Background: Complications following circumcision are well recognized in our environment, it is relatively common and frequently encountered in pediatrics surgical practice. While some may be easily corrected others may be more tasking and even life-threatening. There is need to identify the serious complications, and to proffer ways of preventing them or managing them when they occur. Purpose: To evaluate the spectrum of male circumcision and circumcision related complications in our region and to identify the major challenging ones. Patients and Methods: Data were prospectively obtained from all male children presenting with male circumcisions or circumcision related complications in three tertiary health facilities in Southern Nigeria between June 2006 and May 2013. Data included complication presented, age, circumcisionist, method of circumcision, treatment offered, and outcome. Results: A total of 126 male children with 143 male circumcision or complicated circumcisions were seen within the period. The spectrum ranged from minor glandular adhesions to penile amputation and life- threatening excessive bleeding. Procedures included: Manual removal of plastibell, suture ligation of bleeding vessel, adhesiolysis, periputial trimming, meatoplasty, urethroplasty, fistuloplasty, granuloplasty, and penile repair. Most tasking were urethral loss, fistula closure, and granular amputation. There were no deaths. Conclusion: Circumcision related complications are common in our region. Penile amputation, urethral loss, and fistulae are the most challenging complications. There is need to educate the health workers and general public on the hazards of untrained circumcisionists.
Management of cervical spondylosis – The technique of floating laminoplasty
Mezue W, Ohaegbulam SC, Ndubuisi CA, Chikani M
Memfys Hospital for Neurosurgery, Enugu
Background: Laminoplasty is an established procedure for posterior cervical decompression. The major advantages over laminectomy are membrane formation and lower incidence of spinal instability. However, standard laminoplasty still requires internal fixation, which is often not obtainable in developing countries. We present a technique of noninstrumented (floating) laminoplasty (FL) that avoids the need to anchor the laminoplasty to the anterior elements and discuss our experience with the technique over the last 5 years. Methods: Analysis of patients with cervical spondylosis who had posterior cervical decompression between 2007 and 2014. Patients who had classical laminectomy and hemilaminectomies were excluded. The operation involved a modification of classical laminoplasty aimed at avoiding instrumentation. The laminae were approached bilaterally through a midline incision with generous sparing of the supraspinous, interspinal, and interlaminar ligaments. During the closure, the laminoplasty was hitched to the ligamentum nuchae. Nurick grading was used for evaluation. Patients were followed for between 2 and 7 years. Results: We analyzed 36 patients. Mean age: 57.5 years. Male:female ratio of 3:1. Twenty-five patients had magnetic resonance imaging (MRI) alone, 8 had computed tomography (CT) alone, and 3 had both CT and MRI. Most (91.7%) patients presented with advanced disease, with 25.0%, 36.1%, and 30.6% at Nurick grade 3, 4, and 5, respectively. Postoperatively, all patients with grade 3 improved to grade 1 or 0, while 61.5% of the grade 4 improved to grade 2, 1, or 0. Only 27% operated at grade 5 improved to grade 2, 1, or 0. No postoperative instability was identified on follow-up. Conclusion: Floating laminoplasty is a safe and simple procedure and preserves spine stability and minimizes postoperative spinal deformity.
Endoscopic third ventriculostomy and ventriculoperitoneal shunt in noncommunicating hydrocephalus: Comparison of outcome profiles in children treated at a tertiary hospital in Nigeria
Uche EO, Okorie E, Ajuziego O1, Iloabachie I, Onyia EEI, Uche NJ
Departments of Anaesthesiology and 1Surgery and Anaethesiology, University of Nigeria Teaching Hospital, Enugu, Nigeria
Background: Endoscopic third ventriculostomy (ETV) as well as ventriculoperitoneal shunt (VPS) are options for treatment of noncommunicating hydrocephalus. We compared the outcome profile of pediatric patients with noncommunicating hydrocephalus treated with these surgical modalities. Methods: A 3-year single institution, prospective cohort study comparing the outcome profiles of the pediatric patient between the ages of 3 months and 5 years with noncommunicating hydrocephalus was treated with VPS or ETV. Occipitofrontal circumference (OFC) milestones and complication profiles of patients were analyzed using SPSS version 15. Tests of statistical significance were set at 95% level. Results: 55 patients were enrolled into our study, ETV was performed in 25 patients, and VPS in 30 patients. The mean age of the patients was 2.3 ± 0.7 years (95% CL). Aqueductal stenosis was the most common indication for surgery in both groups 17 cases in the ETV group, 20 cases for the VPS subgroup. OFC profile decline was significantly noticeable among the VPS group when compared with ETV group at 3 months follow-up (X2 = 0.59, df = 1, P < 0.05). However, for milestone improvement, there was no difference among the 2 treatment groups (X2 = 2.47, df = 1, P 0.05), sepsis was more experienced by the VPS group (13%, 4 patients) when compared with ETV (1 patient, 4%, X2 = 4.59, df = 1, P = 0.05). 24 patients in the ETV group remained shunt free in the follow-up period, one patient had VPS from failed ETV, 6 patients in the VPS group required reoperation during follow-up, and 3 had ETV. 3 deaths were recorded 1 for ETV (4%), 2 for VPS (6.3%) from sepsis (2 patients), and renal failure. Conclusion: ETV is associated with lower risk for postoperative sepsis in noncommunicating hydrocephalus. We recommend it as thefirst choice for surgical treatment of noncommunicating hydrocephalus in children within years of age.
Prostate cancer awareness and screening among males in Nigeria; South-South and South-East Nigeria, Nigerian experience
Ozoemena OFN, Ayogu BO, Ugwumba FO, Udeh EI, Nnabugwu II, Amu OC, Mbadiwe MO, Okoh DA, Echetabu KI
Department of Surgery, Urology Unit, Enugu Campus, University of Nigeria, Nsukka, 1Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
Background: Early detection of cancer of prostate (CAP) leads to a reduction in cancer-related mortality and morbidity if appropriately treated. Institution of such treatment is, however, dependent on informed consent, hence, the need to ascertain the awareness of cancer of the prostate and screening tests in Nigeria. Aims and Objective: To determine the awareness of the use of prostate specific antigen (PSA) as a screening test for CAP, and acceptance of treatment in the event of detection of this potentially curable disease when asymptomatic. Subjects and Methods: Male Christians in Southern Nigeria were invited to complete a self-administered questionnaire structured to test their knowledge of CAP and PSA as a screening test. They were also to decide whether to be treated or not, if lesions are detected. Results were analyzed using Microsoft Excel® 2007. Results: A total of 44,564 men completed the questionnaires. Their mean age was 45.1 years. Overall, 30,660 (68.8%) of the respondents were aware of the existence of CAP. Only 1429 (3.2%) accepted to be treated if asymptomatic; an overwhelming percentage of 39,162 (87.7%) preferred watchful waiting; while the rest 4153 (9.3%) had no opinion. Conclusion: Despite a high degree of awareness of CAP among males in Nigeria, a small proportion of them would accept treatment when detected but asymptomatic. The benefit of early detection of CAP among the people of Nigeria is doubtful, judging by the poor acceptance of being treated. Serious public enlightenment campaign is necessary in order that men in Nigeria may benefit from treatment of early detected of CAP. Patients Summary: We looked at the awareness of Nigerian males to the use of PSA as a screening test and acceptance of treatment if detected but asymptomatic. The people are aware but reluctant to be treated if asymptomatic.
Scalp reconstruction after excision of malignant scalp tumors
Okwesili OR, Achebe JU, Onumaegbu OO, Mezue WC, Uche EO, Chikani MC, Onyia EE
University of Nigeria Teaching Hospital, Enugu, Nigeria
Background: Management of malignant scalp tumors is usually a challenge in our environment because many patients present late with large tumors. Aims and objective: To present the results of various methods of scalp reconstruction following excision of primary scalp tumors at the UNTH Enugu. Materials and Methods: This is a retrospective review of patients who had scalp reconstruction after excision of malignant scalp tumors from June 2010 to May 2014 (4 years) at the University of Nigeria Teaching Hospital, Enugu. Information was obtained from the theater and medical records. Results: Their ages ranged from 19 years to 85 years. Reconstruction was with pedicled radial forearm (Chinese flap) in two, crane principles I in three, split thickness skin graft in four, and direct closure in five. In five cases, the craniofacial team comprising plastic surgeons and neurosurgeons were required because of cranial bone involvement and intracranial extension of the tumor. Conclusion: In the developing countries like Nigeria where facilities are limited, older but well-tried methods of scalp reconstruction such as crane principle, local, and distant flaps should be considered when confronted with complex scalp defects following oncological resection of malignant tumors.
Canal stenosis index of the subaxial cervical spine adult Nigerians in Enugu
Ndubuisi CA, Mezue WC, Ohaegbulam SC, Chikani MC
Memfys Hospital for Neurosurgery, Enugu
Background: The burden of posttraumatic cervical cord injury and degenerative diseases is high in Nigeria. The space available for the cord (SAC) is a measure of functional reserve and a major determinant of prognosis. An understanding of these values is necessary in the asymptomatic individual for the timing of intervention and prevention of severe morbidity. Aim: To determine SAC at each subaxial cervical spine level of young adults in Enugu; relationship between age and SAC; and compare the SAC of asymptomatic young adults who are not involved in contact sports with controls involved in contact sports as leisure. Methods: Prospective, cross-sectional study conducted at Memfy's Hospital Enugu, between years 2012 and 2013. Magnetic resonance imaging-based measurement of 204 randomly selected consenting asymptomatic adults aged 21–50 years, stratified into two groups of participation in contact sports. Analysis was done using inferential and descriptive statistics. Results: The SAC was lowest at the C4/5 level, (4.43 ± 1.0 mm). SAC correlated negatively with age in the cervical spine (P = 0.0001), especially at the C3/4 level (−0.296) while SAC at each subaxial level had a positive correlation with other levels (P = 0.0001). SAC for individuals in the contact sports (4.5 ± 1.1 mm) group was significantly smaller than the non-contact sports group (4.9 ± 1.3 mm) at C3/4 level (P = 0.027). Conclusion: The C4/5 level is the narrowest subaxial cervical spine level. There is a negative correlation between age and SAC. Participation in contact sports activity reduces the SAC, especially at C3/4 level.
Challenges of pediatrics abdominal trauma care in Port Harcourt
Okoro PE, Gbobo I, Igwe WP, Ekere AU
Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Background: Trauma is recognized as a leading cause of morbidity and mortality in children worldwide. In our region, its contribution to the burden of childhood diseases is being increasingly felt. Trauma to the abdomen in children is particularly important because of the visceral injuries that may be attending but whose prompt diagnosis and monitoring may be difficult without sophisticated tools. Purpose: This study was aimed at identifying the common causes of pediatrics abdominal trauma in our practice and to highlight the challenges in management. Methods: All children, 0–18 years of age who presented with abdominal injury at the Accident and Emergency Department of our institution between August 2008 and July 2014 were included. Injured children without abdominal involvement were excluded. Data were prospectively collected by a dedicated staff using a proforma. Dada included age, sex, type of injury, region of the body involved, mechanism of injury, interval between injury and presentation, initial care, investigations, treatment offered, outcome, and follow-up. Data were subjected to simple statistical analysis. Results: Eighty-three children, 56 males and 27 females were seen in the period with an abdominal injury. The age range was 2–18 years with a mean age of 8 years. Injury was blunt in 64 cases and sharp in 19 cases. Of the sharp injuries, 16 penetrated the abdominal cavity while 3 were within the wall. Causes of injury were RTA – 46, physical assault – 8, falls – 14, sports – 3, stab – 7, and gunshots – 5. 28 patients required laparotomy and of these, 16 actually required splenectomy. Diagnosis and monitoring depended only on physical, ultrasound, and X-ray findings. There were 3 deaths related to injuries to other parts of the body. Conclusion: Abdominal injuries are common in our practice. Road traffic accidents are by far the commoner causes. Close monitoring of physical signs in the absence of sophisticated tools can achieve impressive results in the care of these patients.
Low back pain in adults: Pattern of abnormal findings on magnetic resonance imaging lumbosacral spine images
Umeh EO, Ebubedike UR, Ndubuisi CA1, Mezue WC1, Ohaegbulam SC1
Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, 1Memfy's Neurosurgery Hospital, Enugu, Nigeria
Background: Low back pain is a leading cause of musculoskeletal disability resulting in loss of productivity. Magnetic resonance imaging (MRI) allows detailed evaluation of the lumbosacral spine and assesses abnormalities that may be associated with low back pain. Objective: To document the frequency and most prevalent lumbosacral spine MRI findings in low back pain. Methodology: Three hundred archived MRI images of patients aged 18 years and above investigated for low back pain at Memfy's Hospital for Neurosurgery were enrolled into the study. They underwent lumbosacral spine MRI examination. Results: Study population had a mean age of 53.9 years with a range of 18–91 years. Positive findings were noted in 299 of 300 subjects. Subjects aged 40–49 years (22.67%) were of the highest frequency followed by 50–59 years (22.33%), positive findings were neural foramina narrowing (96.33%), disc herniation (93.67%), disc dehydration (79%), canal stenosis (46.67%), vertebral degenerative changes (43%), scoliosis (19.67%), cord compression (11%), discitis (9%), vertebral fracture (7%), spinal mass (5.67%), vertebral mass (5%), and kyphosis (4%). Most prevalent findings were in the 60–69 age group and male gender. Conclusion: A significant proportion of the study population shows positive findings on lumbosacral spine MRI images. The most prevalent findings were neural foramina narrowing, disc herniation, and disc dehydration.
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