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ABSTRACTS
Year : 2019  |  Volume : 25  |  Issue : 1  |  Page : 107-130  

Abstracts of papers presented at the joint association of surgeons of Nigeria and Nigeriansurgical Research Society Meeting, Umuahia, Nigeria, July 2018


Date of Web Publication11-Mar-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1117-6806.253792

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How to cite this article:
. Abstracts of papers presented at the joint association of surgeons of Nigeria and Nigeriansurgical Research Society Meeting, Umuahia, Nigeria, July 2018. Niger J Surg 2019;25:107-30

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. Abstracts of papers presented at the joint association of surgeons of Nigeria and Nigeriansurgical Research Society Meeting, Umuahia, Nigeria, July 2018. Niger J Surg [serial online] 2019 [cited 2019 Mar 21];25:107-30. Available from: http://www.nigerianjsurg.com/text.asp?2019/25/1/107/253792




  The Pattern of Day Case Surgeries in A Tertiary Institution in Enugu Top


Edeh AJ, Okenwa WO, Udeh UI, Odo AJ, Ene WS, Uchendu TU, Nwangwu IC

Department of Surgery, Enugu State University Teaching Hospital, Enugu, Nigeria

Background: Day case surgery is one of the most rapidly growing trends in health care. The benefits are many, and despite the reluctance of many surgeons to fully embrace it, it is considered one of the components of surgical best practices. Aim: To find out the volume, complexity, and challenges of day case surgery in our tertiary institution in Enugu, Nigeria. Methods: A retrospective study of all day case surgeries was carried out in our hospital from January 1, 2017, to December 31, 2017. The data were collected from theater and surgical ward records. Results: There were 229 day case surgeries out of 856 elective surgeries, which is 26.75%. The age range is 10 months to 89 years. The distribution by units is: GS 74 (32.3%); pediatrics 57 (24.9%), urology 51 (22.3%); Burns and plastic 41 (17.9%); ENT 4 (0.02%); and orthopedics 2 (0.01%). Males are 132 and females are 97. In terms of complexity of cases, according to units: (1) cases in general surgery are mostly breast lump and lipomas, with few abdominal wall hernias; (2) pediatric surgery did mostly herniotomies and excision of cutaneous lumps, but there were two appendectomies; (3) urology was mostly prostatic biopsy and SPC; (4) B&P – excision of cutaneous, lump, wound debridement, and release of flaps; (5) ENT did foreign body removal, tonsillectomy, and nasal polypectomy; (6) orthopedic surgery did one implant removal; (7) and MUA anesthesia for children are general and locoregional for adults. Day cases were listed with other elective cases and operated in the surgery inpatient theaters, and there were many canceled cases. Conclusion: There volume and complexity of day case surgeries in Enugu remain unimpressive. Dedicated DSU wards, theaters, and staff should be established to improve on our day case surgeries.


  Complications of Femoral Access for Hemodialysis: A Surgical Perspective Top


Ngwu DC, Amadi CE, Onwuta CN

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Vascular access is of critical importance for patients who require extracorporeal renal replacement therapy, and arteriovenous fistula (AVF) is the gold standard. However, owing to delayed diagnosis, late referral, poverty, and limited availability of competent access surgeons, many of these patients commence dialysis without an AVF and hence the frequent use of central venous catheters. In these instances, the transjugular route is preferred, but percutaneous femoral cannulation remains the most frequently used vascular access for hemodialysis in Nigeria. We aim to analyze the spectrum of vascular complications associated with these repeated femoral punctures. Methodology: This is a multicenter study with prospective data collection from January 2017 at the Cardiovascular Units of FMC, Umuahia, and UPTH, Port Harcourt. The data being considered are patients’ demographics, complications of femoral access, surgical approach, and outcome. Results: Of the 18 patients treated during this period for complications of femoral access for hemodialysis, 7 (38.9%) had pseudoaneurysm of the femoral artery, 2 (11.1%) had iatrogenic femoro-femoral AVF, 3 (16.7%) had groin abscess, 3 (16.7%) had groin hematoma, and another 3 (16.7%) had a combination of femoral artery pseudoaneurysm and iatrogenic femoro-femoral AVF. All patients with abscess and hematoma were successfully managed with incision and drainage, antibiotics, and repair of injured vessel wall as indicated. In the pseudoaneurysm group, 6 patients had open catheter thrombectomy and repair (5 made satisfactory recovery and 1 died postoperatively from exsanguinating hemorrhage), while 1 patient suffered a spontaneous rupture resulting in exsanguination. Two patients with AVF had successful takedown of the fistulae. One of the three patients with combined AVF and pseudoaneurysm had successful takedown of the AVF and repair of the pseudoaneurysm while the other two declined surgery and died of clinically diagnosed pulmonary embolism within 2 months. Conclusion: Femoral vein cannulation, though apparently simple and easy to perform, should not be used as the vascular access of choice for chronic hemodialysis because of its complication profile. Optimal training and retraining of operators and employment of ultrasonographic guidance should reduce the risk of complications from femoral puncture. Patients with end-stage renal disease should have AVF fashioned in the predialysis stage, as this will reduce the use of catheters in general.


  Emergency Neurosurgical Consultations in A Tertiary Hospital in Southeast Nigeria: A Pilot Study Top


Okorie EC1, Onyia E1,2, Uche EO2, Guga DA2, Ibebuike KE3, Uzoanya M1, Nwachukwu C1, Ukoha O1

1Federal Medical Centre, Umuahia, Abia, 2Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 3Division of Neurosurgery, Imo State University Teaching Hospital, Orlu, Imo, Nigeria

Introduction: This pilot survey evaluates emergency neurosurgical consultations in a tertiary hospital in southeast Nigeria. It presents an analytical scope of the consultations, as well as a salient purview of the determinants of outcome. Methods: Relevant data of all emergency room admissions were collected prospectively for 90 consecutive days (January–March 2018) and were analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics Inc.,) version 20.0. Associations between variables were measured by Pearson’s Chi-square test, with P < 0.05 being considered statistically significant. Results: Of the 1810 patients admitted into the emergency department, 114 (6.3%) were neurosurgical consultations. Most of them were male (n = 91) with a M:F ratio of 4:1. Most consultations were for head injury (75.4%), spinal cord injury (10.5%), and stroke (6.1%). Road traffic accident in 67.4% of cases was the most common cause of craniospinal trauma. Falls (14.3%) and assault (12.2%) were also common. Only 7.1% of trauma cases presented within an hour of injury. Neurosurgical operations were performed in 10 (8.8%) of 114 patients. The overall 30-day mortality was 12.3%. Postresuscitation Glasgow Coma Scale <9 on admission was associated with increased mortality in head injured patients (2 = 15.582, P < 0.05). Anisocoria (2 = 0.662, P = 0.416) and multiorgan injuries (2 = 0.238, P = 0.625) were not predictive of mortality. Conclusion: Craniospinal injuries are the leading indications for emergency neurosurgical consultation and mostly occur from road traffic accidents. Head injury is associated with poorer outcome when severe. We recommend an audit of current road safety measures as well as emergency medical care.


  Removal of Foreign Body in The Ear, Nose, and Throat Under General Anesthesia: Our Experience at The Federal Teaching Hospital Gombe, Nigeria Top


Yahya AI, Ali A1, Quadri OR1, Muhammad SI, Njidda AG2, Kabilis L, Adigun AW, Aminu HG2

Departments of Ear, Nose and Throat and 2Anaesthesia, Federal Teaching Hospital Gombe, 1Department of Ear, Nose and Throat, College of Medical Sciences, Gombe State University/Federal Teaching Hospital Gombe, Gombe State, Nigeria

Background: The removal of foreign bodies in the ear, nose, and throat (ENT) constitutes some of the emergency procedures in otorhinolaryngological practice. They can be removed with or without anesthesia (local or general), depending on the location of the foreign body (FB), age of the patient, failed attempt at removal, and presence or absence of associated complications. Objective: To determine the spectrum of ENT foreign bodies removed under general anesthesia based on the location, type of FB, outcome of removal, and complications from FB impaction. Methods: A 15-year retrospective review of all cases of ENT foreign bodies removed under general anesthesia at the Federal Teaching Hospital Gombe, from January 2003 to December 2017, was carried out. The data were obtained from theater records and patient’s case notes and were analyzed using SPSS Version 20.0. Results: A total of 863 ENT procedures were done within the study period, of which 93 were cases of foreign bodies removed under general anesthesia, constituting a prevalence of 10.8%. There were 65 (69.9%) males with a male-to-female ratio of 2.3:1. Majority of the patients (47; 50.5%) were in the 0–5-year age group. The most common foreign bodies were earrings in 11 (11.8%) cases. Hypopharynx (23; 24.7%) constituted the most common site of FB removal under general anesthesia. Eighty-seven (93.5%) patients had successful removal, 5 (8.6%) patients had emergency tracheostomy due to airway obstruction by FB, and mortality was recorded in 1 (1.1%) case. Conclusion: In this study, the removal of foreign bodies in the ENT under general anesthesia was mostly done among under-fives, with the hypopharynx being the most common location. Early presentation and removal by an expert is crucial for successful outcome.


  Foreign Body Inhalation in A Ten-Month-Old Child Top


Ilo IS, Okeke IH

Department of Anaesthesiology, FMC, Umuahia, Nigeria

Summary: A case presentation of removal of infraglottic foreign body (groundnut bark) in a child of 10 months age. Case Presentation: A 10-month-old infant presented to A and E of FMC Umuahia with a history of inhalation of foreign body 2 h before presentation. There was a history of attempted removal and a change in voice. Initial saturation was 96–99 on 100% oxygen. The patient was billed for urgent bronchoscopy. Few hours later, the saturation became poor, with increasing dyspnea, and the patient was taken to theater for emergency tracheostomy. Because of worsen condition, attempt to secure airway revealed infraglottic mass, external laryngeal maneuver done, and the object removed. The patient was discharged 4 h later. Conclusion: Groundnut aspiration is a known cause of mortality because of mechanical and obstructive airway obstruction. Prompt intervention improves morbidity and prevents mortality.


  Anthropometric Analysis of Lip–Nose Complex Among The Igbo Population in Umuahia, Abia State Top


Ogbonna U, Nnabuko RE, Chukwu I

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Introduction: The need to establish local anthropometric standards cannot be overemphasized. Reconstructive and esthetic surgeons require these standards to enhance precision and better results in their procedures. This study aims to measure and document some of these standard measurements. Methods: This is a prospective study. Participants were chosen by computer-generated random sampling from those attending the outpatient clinics of the three major hospitals in our town. Measurements were taken using landmarks identified by Farkas with a digital electronic Venire’s calipers. Results: Four hundred and eight adults were enlisted; 177 (43.4%) were male and 231 (56.6%) were female. The overall average measurement of upper lip height was 19.2 mm. The mean Cupid’s bow width was 14.4 mm, while the average width of mouth (intercommissural distance) was 58.7 mm. The mean columellar height was 11.9 mm and the mean columellar width was 8.4 mm. Nasal dome height average was 24.8 mm while nasal tip protrusion was 18.7 mm. Nasal width had a population average of 44.9 mm. The naso-oral proportion index had an average value of 75.8%, while for upper lip height/width of mouth index, the average was 32.8%. Sexual dimorphism was observed in all parameters investigated with males generally having higher figures (P < 0.05). Conclusion: Most values obtained were similar to those obtained elsewhere for the black race.


  Laparoscopic Cholecystectomy: Gombe Experience Top


Mba EL, Mshelia NM

Department of Surgery, Federal Teaching Hospital, Gombe, Nigeria

Study Background: Laparoscopic cholecystectomy (LC) is the gold standard for the surgical removal of a diseased gallbladder. This is still at its nascent stage in Nigeria and faces a lot of challenges such as the cost, inadequate equipment, unstable power supply, unawareness, and inadequate expertise. This study evaluates the outcome of LC in our center. Methodology: This is a retrospective study. All patients who had both LC and open cholecystectomy (OC) in Federal Teaching Hospital, Gombe, between January 2012 to December 2016 were studied. Their relevant data were obtained from the records and were analyzed. Results: A total of 26 patients had cholecystectomy during these periods, of them 4 were excluded because 3 had extra procedures at the same seating and 1 had no record of the duration of surgery. Of 22 patients, 12 (54.5%) were female and 10 (45.5%) were male with female-to-male ratio of 1.2:1. The age range was 18–70 years, and the mean age was 39 years. The indications were for symptomatic gallstones in all patients, except 1 in which was for an acalculous cholecystitis. Fifteen (68%) patients had LC while 7 (32%) had OC. Seven of the LC were male and 8 were female. Three of the OC were male and four were female. The age range for LC was between 18 and 53 years (mean = 38 years) and for OC was 30–70 years (mean = 41 years). The mean duration of procedure was 75 min for LC and 97.5 min for OC. The duration of hospital stay for LC was 3.3 days and 11 days for OC. All patients had paracetamol and pentazocine injections postoperatively. Hence, postoperative pain could not be assessed. One patient who had LC developed paralytic ileus while one who had OC developed postoperative adhesion. There was no surgical site infection nor mortality recorded. Conclusion: LC is very safe and has a good outcome in our environment despite our challenges.


  Situs Inversus Totalis With Congenital Duodenal Obstruction and Preduodenal Portal Vein: A Case Report Top


Emehute JDC, Ezomike UO1, Chukwu IS

Department of Surgery, Federal Medical Centre, Umuahia, Abia State, 1Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Background: Situs inversus is a rare condition commonly associated with cardiac and splenic anomalies. Its association with congenital duodenal obstruction and preduodenal portal vein is very rare. Aim: To report the rare finding of situs inversus in association with duodenal atresia, preduodenal portal vein, annular head of pancreas, and polysplenia in a male neonate. Case Report: An exploratory laparotomy in a 5-day-old male child, who had a reverse double-bubble sign on plain abdominal radiography, showed a right-sided stomach, left-sided liver and gall bladder, polysplenia, type 1 duodenal atresia with preduodenal portal vein, and annular head of pancreas. A duodenoduodenostomy was done. Conclusion: A case of situs inversus with congenital duodenal obstruction and preduodenal portal vein is presented. This “variation” should be borne in mind during laparotomy in neonates.


  The Use of Resterilized Polypropylene Mesh for Inguinal Hernioplasty in Aba, Nigeria Top


Eleweke N, Iweha UU, Ekpemo SC, Mbanaso AU

Department of Surgery, Abia State University Teaching Hospital, Aba, Nigeria

Background: The gold standard for repair of inguinal hernias is the use of mesh. The cost of mesh in a low-resource setting like ours is one of the factors preventing the use of mesh for hernioplasty. We used resterilized mesh for elective inguinal hernioplasty in Abia state University Teaching Hospital, ABSUTH, Aba, Nigeria. Patients and Methods: After ethical clearance from the ABSUTH Ethical Review Board, polypropylene mesh of 30 cm × 30 cm were cut into 16 cm × 8 cm strips. These were wrapped with three layers of gauze and resterilized. During elective repair of uncomplicated inguinal hernias, the resterilized strips of mesh were used to repair the posterior wall of the inguinal canal in patients who have given their consent for the procedure. All the patients had prophylactic antibiotics with ceftriaxone and metronidazole. Results: Ninety inguinal hernioplasties were carried out with the resterilized mesh in 86 patients. There were 75 males and 11 females (M:F, 6.8:1). The age range was 20–68 years with a mean age of 45 ± 9 years. Three patients had bilateral inguinal hernias. Two patients who were diabetics had wound infection and three had seroma which resolved on conservative treatment. No incident of recurrence has been recorded. Conclusion: Large sheets of polypropylene mesh can be cut into smaller sizes, resterilized, and used for inguinal hernioplasty. This reduces the cost of hernioplasty with little postoperative morbidity.


  Cardiopulmonary Resuscitation: Knowledge, Attitude, and Experience of House Officers and Junior Residents in A Tertiary Health Institution in Nigeria Top


Ekpemiro UC

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: From time to time, doctors would be faced with situations requiring them to perform cardiopulmonary resuscitation (CPR) on patients. Besides this, they would also play a leading role in the training of lay responders. It is, therefore, important that doctors have the right attitude, sufficient knowledge, and experience for satisfactory performance. To gain insight into this and act appropriately, the knowledge, attitude, and experience of house officers and junior residents in a tertiary health institution – Federal Medical Centre in Umuahia – are assessed. Methods: This is a cross-sectional study of House Officers and Junior Residents in the Federal Medical Centre, Umuahia. The data were collected, using a questionnaire that was based on the 2005 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care. The data were fed into a password-protected computer and analyzed using a statistical software. Results: The mean test score for the 69 respondents was 10.43. Only 13 (18.84%) of the respondents had a score of ≥50%. Of the 68 respondents, 50 (73.53%) stated that training in CPR was extremely important to them and 18 (26.47%) stated that it was very important to them. Of the 68 respondents, 5 (7.35%) were extremely confident that they had basic life support skills, 13 (19.12%) were very confident, 39 (57.35%) were confident, and 11 (18.97%) were not confident. Of 69 respondents, 42 (60.87%) had not been faced with a situation requiring making contact with and ventilating a patient with their mouth, but 27/69 (39.13%) had. Of 69 respondents, 60 (86.96%) had been faced with a situation requiring chest compression on a patient whereas 9/60 (13.04%) had not. Of 47 respondents, 27 (57.45%) had not been faced with a situation requiring cardiac defibrillation on a patient whereas 20/47 (42.55%) had been faced with such. Of 69 respondents, 54 (78.26%) had never ventilated someone with their mouth whereas 15/69 (21.74%) had done so. Those who had done so were all junior residents; none was a house officer. Of 69 respondents, 48 (69.57%) were willing to make contact with and ventilate a neonate or a child whereas 21/69 (30.43%) were unwilling. Of 66 respondents, 42 (63.64%) were unwilling to make contact with and ventilate an adult with their mouth, but 24/66 (36.36%) were willing. Of 69 respondents, 39 (56.52%) were not confident that they had advanced life support skills; 24/69 (34.78%) were confident; 4 (5.80%) were very confident; and 2 (2.90%) were extremely confident. The mean survival rate expected by the respondents (n = 55) was 55.10% (standard deviation 21.01). Conclusion: The knowledge and experience of junior residents and house officers is low and their expectations concerning survival following CPR are too high and unrealistic. Training in CPR is important to them, but most of them would not make contact and ventilate an adult with their mouth and some would not do so for a neonate or a child. Periodic training of the doctors in all aspects of CPR is proposed to enhance their knowledge and modify their attitude.


  Changes in The Temporal Profile of C-Reactive Protein in Children Undergoing Elective Major Surgery Top


Emehute JDC, Adejuyigbe O, Sowande OA, Usang EU, Talabi A

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Introduction: This research work evaluated the changes in the level of C-reactive protein (CRP) in children undergoing elective major surgery from the baseline level until 120 h postsurgery. CRP is a marker of acute-phase reaction in humans. Objectives: The aim of the study was to evaluate the changes in the temporal profile of CRP in pediatric elective major surgery in Ile Ife, Nigeria, from the baseline level until 120 h postsurgery. Patients and Methods: Consecutive patients were recruited for the study after informed consent was obtained. Three millimeters of venous blood were collected for CRP estimation, 8 times, from before surgery till 120 h after surgery. The samples were allowed to clot and were centrifuged to obtain the serum, which was then analyzed. CRP estimation was done using the ELISA method. Data were expressed as median values. Results: Forty-four patients were recruited for the study with a median age of 2.75 years and an age range of 2 months to 15 years between June 2015 and May 2016. There were 33 males and 11 females with a M:F ratio of 3:1. The median serum CRP levels from the patients demonstrated that the levels at baseline and induction of anesthesia were unchanged. The levels started rising from 6 h postsurgery, rose steadily to a peak at 24 h postsurgery, and steadily declined till 120 h postsurgery. It did not return to the baseline by 120 h. The baseline level was 2.00 mg/L. Conclusion: Serum CRP levels have been shown to be a useful marker of acute-phase response in children undergoing elective major surgery. There was no difference in the level of serum CRP of children of different age groups who had surgery. There also was no difference in the level of serum CRP of the male and female children who had surgery.


  Prostate-Specific Antigen Pattern Among Patients With Benign and Malignant Prostate Diseases in Umuahia Top


Ngwu PE, Eziefule V, Achor GO, Mgbeojedo C

Department of Surgery, Division of Urology, Federal Medical Centre, Umuahia, Nigeria

Background: Prostate-specific antigen (PSA) can be elevated in both benign and malignant diseases of the prostate, but remains a very useful marker in prostate cancer management. In our African population where the morbidity and mortality from prostate cancer is high, a clear knowledge of the pattern of PSA will be helpful in the management of patients in the region. Objectives: To determine the PSA pattern in benign prostatic hyperplasia and prostate cancer. Methods: A cross-sectional prospective study was done using 234 consecutive consenting patients between April 2015 and March 2016. Serum PSA was done, and patients with values above 4 ng/ml and/or abnormal digital rectal examination (DRE) were selected to have prostate biopsy. Patients’ demographics was recorded, and the sample was histologically analyzed. Results: Of 234 patients involved in the study, 138 (59%) had prostate cancer. The mean PSA for BPH was 29.46 ng/ml (confidence interval [CI]: 22.9–35.9) and that for carcinoma of the prostate (CaP) was 52.35 ng/ml (CI: 46.1–58.6) with P < 0.001. The mean age for BPH and CaP was 71.39 years and 71.73 years, respectively, which was not statistically significant. The mean PSA level increased progressively from patients with nodular hyperplasia to patients with poorly differentiated CaP. On univariate analysis, factors associated with the presence of cancer on biopsy were DRE and PSA level with P = 0.01 and <0.001, respectively. Multivariate logistic regression analysis showed that patients with abnormal DRE are 2.02 times more likely to have prostate cancer than patients with normal DRE (odds ratio = 2.02, 95% CI: 1.07–3.82, P = 0.03). Conclusion: This study has shown a rise in PSA in both patients with BPH and CaP. Sending patients for prostate biopsy should therefore be based on a continuum of risks, rather than solely relying on PSA levels more especially in men of black African ancestry where the burden of prostate cancer is high.


  Suppurative Prostatitis With Benign Prostatic Hyperplasia: A Case Report and Review of Literature Top


Ngwu PE, Chukwuegbo CC1, Achor GO

Department of Surgery, Federal Medical Center, 1Department of Histopathology, Federal Medical Center, Umuahia, Nigeria

Background: The diagnosis of suppurative prostatitis is rare. We report a case of suppurative prostatitis in a man who had open prostatectomy for benign prostatic hyperplasia. Case Summary: The patient is a 75-year-old male who initially presented in 2014 with storage and voiding lower urinary tract symptoms (LUTSs). PSA was 16 ng/ml for which he had digitally guided prostate needle biopsy with histological diagnosis of benign prostatic hyperplasia. He was commenced on tamsulosin, an alpha adrenergic blocker, but was lost to follow-up. He, however, re-presented in March 2018 in acute urinary retention and after a failed urethral catheterization was offered suprapubic cystostomy. He was still having LUTS, but no suprapubic or perineal pain. Digital rectal examination revealed an enlarged prostate with benign features. Abdominopelvic ultrasound scan revealed an enlarged prostate with a volume of 106.2 cm3 with a heterogeneous echotexture and smooth outline, no mass, cyst, or calcification noted. Urine culture yielded mixed growth of Pseudomonas species and Enterococcus species sensitive to augmentin, gentamicin, and erythromycin, and PSA was 26 ng/ml. He was treated with augmentin and gentamicin, and a repeat culture showed a resolution of infection. He had transvesical prostatectomy, and the postoperative period was uneventful. He was discharged on the 5th postoperative day. On pathological examination, the prostate weighed 100 g with a nodular grayish white appearance and bosselated surface. Cut sections revealed multiple cysts giving a spongy appearance. On microscopy, prostatic tissue showed a biphasic lesion consisting of acinar and fibromuscular proliferation. Within the stroma are foci of abscess composed of abundant neutrophils and necrotic debris. There was no typia. A histologic diagnosis of nodular hyperplasia with suppurative prostatitis was made. Conclusion: Suppurative prostatitis is rare and presentation can be nonspecific as seen in the index case. A high index of suspicion is required to make the diagnosis.


  Management of Chronic Empyema Thoracis With Unexpandable Lung Using Combination Approach Top


Onwuta CN, Ngwu DC, Ezeanwu E1

Department of Surgery, Cardiothoracic and Vascular Unit, Federal Medical Centre, Umuahia, 1Department of Surgery, Cardiothoracic and Vascular Unit, Federal Teaching Hospital, Abakaliki, Nigeria

Background: Chronic empyema thoracis with unexapandable lung is uncommon and sometimes it is associated with empyema necessitans and scoliosis. The management of this late chronic stage of empyema poses a significant challenge to thoracic surgeons. The various types of minimal invasive methods still take long period, and associated scoliosis is not corrected. Objective: The objective of this work is to determine whether the combination of parietal pleural decortication and 2 weeks of postoperative pleural space irrigation can correct the associated scoliosis and reduce the long period of management of the disease. Patients and Methods: This was a 1 year prospective study involving two referral hospitals in Southeast Nigeria: Federal Teaching Hospital Abakaliki and Federal Medical Center, Umuahia, from April 2016 to March 2017. Results: Within this period, 18 patients who presented with empyema thoracis with unexpandable lung were selected for the study. These patients were randomly selected based on informed consent and patients were allocated to the groups of A or B. Group A consisted of patients who accepted decortication and irrigation while Group B consisted of those who accepted minimal invasive approach. All the patients were followed up for 9 months. Our results showed that 8 (44.8%) of the patients underwent decortication and irrigation while 10 (56%) accepted minimal invasive procedure. Male:female ratio was 9:1. Right-sided/left-sided ratio was 2:1. The age range was 22–62 years. The average duration of disease with minimal invasive approach was 28 weeks, and the average duration of the disease after decortication and irrigation was 4 weeks. The number of patients with scoliosis was 12 (67%). 7 (58%) accepted minimal invasive and 5 (42%) accepted invasive method. Conclusion: The use of combination method in the management of chronic empyema thoracis with unexpandable lung reduced long period of patients management and corrected scoliosis in the affected patients.


  Typhoid Intestinal Perforation in Children in Aba, Nigeria Top


Ekpemo SC, Eleweke N, Abali I

Department of Surgery, Abia State University Teaching Hospital, Aba, Nigeria

Background: Typhoid intestinal perforation is still prevalent in many low- and middle-income countries. This may be due to the lack of potable water, poor refuse disposal, and health education. This study is to evaluate the outcome of management of typhoid intestinal perforation in children at the Abia State University Teaching Hospital, Aba, Nigeria. Methods: This is a prospective study of children who were managed for typhoid intestinal perforation at the Paediatric Surgery unit, Department of Surgery of the Abia State University Teaching Hospital, Aba, Nigeria, from November 2016 to April 2018. Pro forma was opened for demography, clinical features, investigations, site of perforation, type of surgery, complications, and outcome. The data collected were analyzed using SPSS computer software version 17 for proportions and percentages. Results: Ten patients were seen over the 16-month study period. Eight males and two females with a male-to-female ratio of 4:1. Their ages ranged from 7 to 15 years with a mean age of 8.9 years. Fever, vomiting, and abdominal distension were the most common clinical features in 50% of patients. Double-layer closure and resection and anastomosis of ileal segment were done in equal number of patients (five patients each). Surgical site infection was the most common complications in 8 (80%) of patients. One patient died giving a mortality rate of 10%. Conclusion: Typhoid intestinal perforation is still a persistent scourge in low-income countries. Morbidity is still high despite low mortality in our series. Early presentation, good nutrition, and public health education will improve outcome.


  Zone 1 Neck Synovial Sarcoma: A Case Report Top


Ngwu DC, Camazine M1

Department of Surgery, Cardiovasular and Thoracic Surgery Unit, Federal Medical Centre, Umuahia, 1Department of Surgery, Nigerian Christian Hospital, Nlagu, Abia State, Nigeria

Background: Synovial sarcomas (SSs) are distinct soft-tissue sarcomas that predominantly occur in the lower extremities and rarely in the head and neck region, where they constitute 2.5%–3.5 % of all sarcomas. Head and neck synovial sarcomas were first reported in 1954 by Jernstorm, are more common in men, and more often present in the middle age group. The most common presentation is as a painless mass that is occasionally associated with hoarseness, dysphagia/odynophagia, and/or bleeding. An optimal treatment strategy is yet to be established; however, a widely employed therapeutic approach is total surgical excision with a wide margin, and when the risk of locoregional recurrence is high, adjuvant radiotherapy is usually recommended. SSs are very aggressive tumors with a 5-year overall survival rate in the range of 40%–60%. In this article, we report a case of this rare tumor situated in the zone 1 of the neck, at the carotid-subclavian crotch, with emphasis on a bone-sparing, strictly cervical approach to proximal vascular control and tumor resection. Case Report: We reported a 58-year old male, with a 1-year history of a slow-growing, asymptomatic swelling in the right supraclavicular fossa. Computed tomography revealed an irregular mass at the subclavian-carotid crotch. Surgical approach was via a hockey-stick right supraclavicular incision, curved downward over the sternum, should the need for urgent claviculectomy or sternotomy arise. The distal innominate artery was reached for proximal vascular control by incision and retraction of the clavicular head of the sternocleidomastoid muscle. The right common carotid artery was also exposed and controlled. Using a combination of blunt and sharp dissection, the tumor (solid, 5 cm × 4 cm) was excised while sparing the important neurovascular structures in the region, including the brachial plexus, musculocutaneous nerve, and the contents of the carotid sheath. The incised sternocleidomastoid muscle was repaired and the wound closed in layers, leaving an active drain behind. Postoperative recovery was uneventful and he was discharged to outpatient follow-up on the fourth postoperative day. Histopathological examination of the specimen revealed that it was a synovial sarcoma. He has been referred for adjuvant radiotherapy. Conclusion: Synovial sarcoma is a very aggressive tumor with yet no universally accepted optimal treatment strategy. Like most other sarcomas, surgery plays a dominant role in the management of these tumors and should be done with a wide margin of excision to reduce the chances of locoregional recurrence. When this risk is particularly high, adjuvant radiation therapy may be beneficial. Proximal vascular control for surgical excision of tumors in the zone I of the neck can be safely achieved via a strictly cervical approach, thereby sparing the patient the extra postoperative burden of a claviculectomy or a sternal splitting.


  Benign Solitary Fibrous Tumor of the Pleura: A Rare Cause of Intrathoracic Space-Occupying Lesion Top


Ngwu DC, Chukwuegbo C, Onwuta CN

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Solitary fibrous tumor (SFT) of the pleura is a rare neoplasm accounting for <5% of primary pleural tumors, with an incidence of approximately 2.8 cases per 100,000 per year. Benign and malignant variants of these tumors have been reported. The benign tumors are often small pedunculated tumors, usually asymptomatic and diagnosed incidentally on routine chest radiographs. Giant benign SFTs are those rare tumors with a diameter of >15 cm or tumor occupying more than 40% of the hemithorax.

Here is the case of an elderly female who presented with a right intrathoracic space-occupying lesion on account of a giant benign SFT. Case Report: We report the case of a 75-year-old woman who was referred to the cardiothoracic unit of our hospital with complaints of a vague chest discomfort and progressive shortness of breath spanning an 18-month period. She had been managed by several health-care providers for various conditions including asthma, pleural effusion, hydatid disease, and heart failure until chest imaging (chest radiograph and computed tomography scan) revealed a large mass in the right hemithorax, necessitating a referral for expert thoracic surgical care. The imaging investigations were reviewed and the above findings were noted. She had a formal right posterolateral thoracotomy for resection of the tumor. Surgery lasted for about 2 h, followed by an uneventful postoperative recovery. She was discharged home after 1 week, is currently asymptomatic, and being followed up on outpatient basis. The gross appearance of the resected tumor, the histopathologic features, and the result of immunohistochemistry, all agree with the diagnosis of benign SFT of the pleura. Conclusion: Benign SFTs are rare. When they do occur, they are usually small and asymptomatic. The larger, symptomatic tumor may present a diagnostic dilemma by mimicking other more common chest conditions. A CT scan of the chest would usually show that the culprit is a circumscribed intrathoracic mass. Surgical resection is curative and provides specimen for definitive pathological diagnosis.


  Localized Gastric Gastrointestinal Stromal Tumor: A Case Report Top


Ekpemiro UC, Jegede OO, Chukwuegbo CC, Chukwu IS

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Gastrointestinal stromal tumor (GIST) is a rare entity. The diagnosis, treatment, and follow-up pose a challenge in our environment. We describe the presentation, diagnosis, treatment, and follow-up of a patient with a localized, large gastric GIST. Methods: The case notes of a 51-year-old female who presented with a 1-year history of upper abdominal swelling with no associated symptom were reviewed. Result: On examination, an oval intraperitoneal mass at the epigastrium measuring 16 cm × 14 cm which was freely mobile, smooth, firm, nontender with dull percussion notes was found. She subsequently had resection of a large exogastric mass with a histologic diagnosis of GIST. Following tumor resection with a wide margin of gastric wall, she has done well so far for more than 4 years. Conclusion: Wide margin gastric resection may suffice in the treatment of a large localized gastric GIST when it is exogastric.


  Malignant Peripheral Nerve Sheath Tumor of the Neck Complicating Neurofibromatosis: A Case Report Top


Amadi CE, Okonta KE, Ocheli EO

Department of Surgery, Cardiothoracic/Vascular Surgery Unit, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are very rare sarcomas occurring in 0.001% of the general population. Adequate modality of management has not been reported and they have been a group of tumors difficult to treat. We present the first case of this rare tumor managed in our center and the surgical challenges. Case Presentation: A 34-year-old male, known neurofibromatosis (NF) patient, presented to our unit through the surgical outpatient clinic with complaints of swelling at the root of the left side of the neck; tingling sensation, pain and progressive weakness of the left upper limb; all of 1-year duration that became worse in the preceding 2 months before presentation. Examination revealed left infraclavicular tender mass with slight supraclavicular extension and zero power in the left upper limb. Computed tomography scan of the chest revealed a fairly well-circumscribed left infraclavicular mass without any intrathoracic extension. Abdominal ultrasound scan showed no intra-abdominal involvement. Through a transverse skin incision, the left clavicle was resected (reimplanted at the end of surgery with wires), the mass excised with a breach in the posteromedial surface that was firmly attached to the root of the brachial plexus. Findings included a seemingly well-circumscribed oval-shaped mass, firmly attached in the posteromedial aspect, measuring 6 cm × 7 cm in its widest diameters. Postoperatively, physiotherapy was commenced, power improved to 3, no more pains, and the histology showed high-grade MPNST. He was referred to the clinical oncologist for chemotherapy and still being followed up. Conclusion: MPNST complicating NF is rare and can be a challenge during surgery, especially those located at the root of the neck. However, with proper patient evaluation and planning, some feared complications such as bleeding and paralysis can be avoided.


  Colonoscopy in Patients With Hematochezia in Ubth: A 9-Year Prospective Study Top


Irowa Oo, Agbonrofo PI, Odigie VI

Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria

Background: Colonoscopy is increasingly assuming an important role in the diagnosis of colorectal lesion in Nigeria in many tertiary medical centers. Hematochezia is a common indication for colonoscopy. Aims/Objectives: To highlight the colonoscopic findings of patients presenting with hematochezia over a 9-year period in the premier tertiary health center in the South-South zone of Nigeria. Patients and Methods: Consecutive patients who were seen in our surgical services (May 2009 – May 2018) requiring colonoscopy for hematochezia were entered into a pro forma. The demographics, the indication for colonoscopy, and outcome were analyzed. A total of 365 colonoscopies were done during the study period. There were 160 (44%) patients with hematochezia. Singly as a symptom, hematochezia constituted 67% (107 patients). The mean age was 51.2 years. The age range was 16–86 years. Cluster age group was 5th–7th decade, 100 patients (62.5 %). Male-to-Female ratio was 2:1. Children were rare. Hemorrhoid constituted 84 (52.5%) patients; large bowel cancer constituted 32 (20%) patients. The most common site for cancer was sigmoid/rectum in 10 (62.5%) patients. Polyps in 15 (9.4%) patients. Inflammatory disease of the bowel in 10 (6.3%) patients. Others constituted 19 (11.9%). Repeat colonoscopy occurred in 3 (1.9%) patients due to abandonment of procedure. Procedural bleeding was the most common complication in 3 (1.9%) patients. Two (1.3%) patients had colonic perforation. Of clinical note is the finding that 19 (11.9%) patients had more than one pathology causing hematochezia. Conclusion: Colonoscopy is an important armamentarium to the colonoscopist for the diagnosis of hematochezia. We advocate routine more regular colonoscopy for patients with hematochezia, particularly in the 5th–7th decade of age group. Proficiency is advocated for the colonoscopist to achieve better results.


  Acetabular Reconstruction Using A Cage in Complex Primary Total Hip Replacement in A Developing Country Top


Katchy AU, Ezeobi I, Katchy S

Department of Orthopaedics, Davidson and Judith Consultants clinics, Enugu, Nigeria

Introduction: Acetabular reconstruction following bone loss is the major challenge facing the arthroplasty surgeon. Conventionally, the armamentarium for the treatment of large bone defects (Paprosky Type IIC or III) included antiprotrusio cages (APC) 3. Objective: The aim of this study is to determine the pattern of presentation and assess the early functional outcome of patients who had undergone acetabular reconstruction using antiprotrusio cages in complex primary total hip replacement (THR). Patients and Method: Between November 2008 and November 2013, 38 THRs were carried out in 35 patients who required acetabular reconstruction by the authors at Davidson & Judith Consultants Clinics Enugu, Nigeria. Results: There were 25 males and 10 females, with a ratio of 2.5:1. The average age of the patients was 61.33 ± 6.92 years with a range of 56–72. The mean preoperative Harris score was 49.02 ± 2.3. The mean postoperative hip score was 88.75 ± 10 (P < 0.001) at 1 year and 92.25 ± 13 (P < 0.001) at 5 years. The etiology showed that most (52.63%) of our patients had primary osteoarthritis with Type 3. Two (5.26%) patients had the following complications: dislocation, 1 (2.63%) and screw breakage, 1 (2.63%). The minimum follow-up period was 5 years. Discussion: After follow-up at 1 year and 5 years, the hips showed significant improvement concerning pain, gait, and mobility based on Harris hip score and were able to return to their various professions. Conclusion: APC provides a satisfactory solution for patients who present with acetabular deficiency in complex primary THR.


  Effect of Dilute Povidone-Iodine Lavage on Infection Rate in Orthopedic Surgery Top


Ikeanyi UOE, Udemezue CO, Chioma CJ, Amaraegbulam PI

Federal Medical Centre, Umuahia, Nigeria

Background: Postoperative wound infection in orthopedic surgery poses serious challenges to both the surgeon and the patient. One major cause of postoperative wound infection is intraoperative bacterial contamination. Apart from normal saline, this study explores the extent of dilute povidone-iodine irrigation in reducing intraoperative bacterial contamination as reflected by the postoperative infection rate. Materials and Methods: The study observed the same protocol that involved a single surgeon, 104 patients managed consecutively between November 2014 and April 2018, admitted for only 1 day, and the same type of perioperative regimen. The patients were divided into two groups. In the first group of patients, just before wound closure, the wound was irrigated with 2 l of normal saline and then closed over a suction drain; in the second group of patients, each wound was soaked with 0.35% povidone-iodine solution for 3 min, followed by irrigation with 2 l of normal saline to remove the povidone-iodine before closure. All patients were followed up for at least 4 weeks. Data were analyzed with an SPSS statistical program (Version 11.0.1, SPSS Inc., IL, USA). Results: There were no statistical differences between both groups with regard to age, gender, DM, smoking, body mass index, the duration of follow-up, preoperative diagnosis, type of operation, operation time, postoperative drainage, or usage of NSAIDs after surgery (P > 0.05). There was no wound infection in the second group during the follow-up period, but two early onset wound infections occurred in the first group. Conclusions: This study clearly showed that povidone-iodine lavage significantly reduced the infection rate. It did not necessarily mean that the diluted povidone-iodine irrigation alone would prevent postoperative infection, but rather such irrigation did aid in combination with the preventive measures employed herein, such as intraoperative aseptic techniques, diligent surgical procedures, and parenteral antibiotics. This effectiveness might be more meaningful in a relatively poorer perioperative environment.


  Epidural Steroid for Low Back Pain: Experience in FMC Umuahia Top


Ilo IS, Aguocha UB1, Ilo DI, Chukwu JC

Departments of Anaesthesiology and 1Surgery, FMC, Umuahia, Nigeria

Aims and Objective: To determine the effectiveness of methylprednisolone combination with bupivacaine and pethidine in the management of low back pain. Material and Methods: Twenty patients with chronic low back pain were referred by orthopedic surgeon for epidural steroid injection. 80 mg of methyl prednisolone with 3 ml of 0.5% plain bupivacaine and 20 mg pethidine made up to 10 ml were administered into the epidural space. Results: Eighteen patients have VAS of 0–20 mm after 4 h of administration. Of 20 patients, 12 were lost to follow-up and 8 were assessed up to 12 weeks. The mean presteroid VAS was 75 mm, 4 h after injection 13.5 mm, but it increased to 34.29 mm by the 12 weeks. One out of eight patients has pain score of 60 mm at 1-week review. Four out of seven patients had good pain control and would like to have another dose if pain worsens again. Conclusion: Epidural steroid with local anesthetics has shown to be beneficial in low back pain management. It improves quality of life and reduce requirement for surgical correction.


  Indications for Limb Amputations at Federal Medical Center, Umuahia: A 6-Year Experience Top


Ogbonna U, Nnabuko RE

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. It is among the earliest recorded surgical procedures dating back to prehistoric times. Babylonian code of Hammurabi (1700 BC) and Plato’s symposium (385 BC) both had described amputations. Hippocrates in De Articularis described therapeutic amputation for vascular gangrene. Most common indications for amputations include peripheral vascular disease, trauma, tumors, infections, and congenital limb deficiency. Diabetes mellitus constitutes the most common disease entity leading to amputation worldwide. In our setting, trauma takes an important place due to high rate of RTA and gun violence, TBS intervention a serious menace. Typical infective cause includes gas gangrene. Severe limb deficiencies may be better served by amputation and prosthesis, Constriction band syndrome-autoamputation. Methods: This is a retrospective study covering a 6 year-period (2010–2015). All patients treated at FMC Umuahia who had amputation from any cause were included. The records were reviewed and relevant data were extracted. The data were analyzed. Results: Of the 136 patients treated, 94 (69.1%) were male and 42 (30.9%) were female. Patient’s ages range from 12 to 103 years with a median age of 54 years. Lower limb amputations constituted 123 (90.4%) while there were 13 cases (9.6%) of upper limb amputations. Diabetes mellitus had the lion share of indications for these amputations constituting 70 (51.4%). Trauma (16.2%), malignant conditions (6.6%), ischemia (19.8%), and infection/sepsis (2.9%) were other indications. Below knee (64.7%) was the most common level of amputation, followed by ray (13.2%) and above knee (9.6%). Conclusion/Recommendation: Complications of diabetes mellitus are still the most common indication for limb amputation as it is worldwide. Early diagnosis and control of diabetes will undoubtedly reduce the incidence of limb amputations. Population screening should be encouraged especially for individuals above the age of 40 years.


  Total Knee Replacement in Nigeria: An Assessment of Early Functional Outcome of 68 Consecutive Knees Top


Katchy AU, Ekwedigwe H, Katchy S, Ifeanyi E

Department of Orthopaedics, National Orthopaedics Hospital, Enugu, Nigeria

Background: Although there are many methods of treatment for knee OA, total knee replacement (TKR) is a very effective way of managing this condition as it improves function and alleviates pain with a consequential improvement on quality of life of patients. To the best of our knowledge, no comprehensive study of the outcome of TKR has been published in our environment hence the need for a study of our TKR outcomes. Objectives: The aim of this study was to describe the pattern of presentations of our patients with knee OA who have undergone TKR, assess the outcome, and identify any variables that affect the outcome. Methods: Between November 2008 and November 2013, 52 patients, 68 TKR for treatment of end-stage arthritis were carried out. All the patients were implanted with the same prosthesis design (Depuy and Biomet) and had posterior cruciate substituting knee. The average follow-up was 5 years. The preoperative and postoperative Oxford Knee Score (OKS) was used for outcome measurement at 1 and 5 years. Results: There were 20 males and 32 females (M:F 5:8). The mean age was 63.54 ± 0.62 with a range of 55–77. There were 18 (26.47%) valgus knees with a mean angle 22.07° ± 5.73°, 12 (17.65%) varus knees with a mean angle 14.69° ± 2.84°, and 8 (11.77%) knees with flexion deformity with a mean angle of 10.2° ± 1.32°. 30 (44.11%) knees had no deformities at all. The variables such as deformities, comorbidities, gender, side affected, and occupation did not affect the outcome (P > 0.05). At 1 year and 5 years, there was no radiological evidence of osteolysis, loosening, or component subsidence. Conclusion: Despite the deformities and comorbidities our patients presented with, quality of life of our patients improved based on the improved OKS of the patient. We recommend a well-planned meticulously executed TKR for patients with debilitating OA in our environment.


  Limb Salvage in Orthopedic Trauma With Vascular Injury Top


Amadi CE, Okonta KE, Ocheli EO

Department of Surgery, University of Port Harcourt, Port Harcourt, Rivers Stat, Nigeria

Background: Management of orthopedic trauma with vascular injury (OTWVI) can be quite challenging as there could be threat to life in addition to limb loss. Timely recognition of vascular injury in orthopedic trauma is critical to limb salvage. Physical examination could be misleading as 5%–15% of vascular injured patients may present with normal pulse examination. The greatest risk of limb loss in any peripheral vascular injury is associated with popliteal artery injury. We set out to look at the success rate of limb salvage following OTWVI after limb stabilization and vascular repair. Methodology: This is a descriptive study with prospective data collection from April 2017 looking at the success rate of limb salvage in patients with OTWVI that had limb stabilization and vascular repair. The parameters being considered are patients’ demography, mechanism of injury, the vessel(s) involved, time of presentation, surgical approach, and outcome. Results: In this 1st year of the study, 14 patients have been managed, 12 males (85.7%) and 2 females (14.3%). The age range was 15–48 years with a mean (standard deviation) of 33.5 ± 9.9 years. Mechanisms of injury were gunshots 7 patients (50%), machete cuts 4 patients (28.6%), and motor vehicle accidents (MVAs) 3 patients (21.4%). Seven patients presented within 6 h, 5 within 12 h, and 2 after 48 h. Vessels involved were popliteal artery 5 patients, brachial artery 3, superficial femoral 2, axillary artery 1, anterior tibial 1, radial artery alone 1, and radial with ulnar artery 1. All the patients had external fixation and thrombectomy, 13 had direct vascular repair, while one patient had a patch repair with vein graft. Repairs were successful in 11 patients who presented early while two patients with popliteal artery injury that presented late had failed repair and ended up with limb amputations. One patient died immediately after axillary artery repair from multiple injuries and massive blood loss. Conclusion: OTWVI could be quite challenging and may be associated with limb loss. However, timely presentation, recognition, and intervention by a multidisciplinary team, including the orthopedic and vascular surgeons, are pivotal to limb salvage.


  Thoracotomy for Trauma: An Analysis of the Indications and Outcome in Umuahia, South-East Nigeria Top


Ngwu DC, Okpa NN, Onwuta CN

Department of Surgery, Federal Medical Centre, Umuahia, Abia State, Nigeria

Background: Thoracic trauma directly accounts for 25% of trauma-related mortality and is a contributing factor in another 25% of cases. The progress made in thoracic surgical principles, particularly in endotracheal intubation, mechanical ventilation, and thoracic pain control, over the last two centuries have been rewarded by a corresponding reduction in mortality from a value of 80%–90% during the American Civil war (1861-5) to 4%–7% in recent civilian experience. Currently, over 80% of chest injuries can be managed nonoperatively utilizing tube thoracostomy, appropriate analgesia, and aggressive respiratory treatment. Before the establishment of the Division of Thoracic and Cardiovascular Surgery Unit in our institution, 8 years ago, patients who required open thoracic surgical intervention either succumbed to the problem or were referred out. Methodology: The medical records of all patients who had an open thoracic operation following trauma in the first 7 years of the establishment of our Cardiovascular and Thoracic Unit (2010–2017) were retrieved and retrospectively analyzed. The data collected included patients’ demographics, mechanism of injury, indications for surgery, surgical approach, and outcome. Results: Of the 168 patients admitted for chest trauma, 16 (9.52%) patients underwent thoracotomy. The male:female ratio was 3:1, and their ages ranged from 19 to 65 years (average = 37.5 years). 3 (18.75) of the thoracotomies were emergent, urgent in 5 (31.25%), and delayed in 8 (50%). The mechanism of injury was blunt in 5 (31.25%), gunshot wound (GSW) in another 5 (31.25%), and stab wound in 6 (37.50%). Of the three patients who had emergency thoracotomy, 2 (66.67%) were on account of tamponade following stab injury to the heart and 1 (33.33%) was for refractory shock resulting from GSW with major pulmonary vascular injury. In the urgent thoracotomy group, all 5 (100%) had penetrating pulmonary injury from high-velocity GSW. Delayed thoracotomy was for retained hemothorax in 4 (50%), empyema thoracis in 3 (37.50%), and diaphragmatic hernia in 1 (12.50). Interestingly, all the patients who had delayed thoracotomy were initially treated elsewhere and subsequently referred to us on account of worsening symptoms. Conclusion: Most cases of chest trauma today can be managed successfully without the need for open surgery. Careful evaluation of these patients and optimal utilization of closed tube thoracostomy in the early stages of trauma care would further reduce the requirement for delayed thoracotomy for retained hemothorax and empyema thoracis.


  Anatomical Sites of Foot Lesions Resulting in Amputation among Diabetics and Nondiabetics in A Referral Hospital in South-Eastern Nigeria Top


Aguocha UB, Ezeani U, Okorie EI, Imahigbe F, Chioma CJ

Departments of Surgery and 1Medicine, Federal Medical Centre, Umuahia, Nigeria

Background: The study aimed to determine the most common anatomical site of foot lesions among diabetics and nondiabetics that resulted in amputation. Methods: Patients presenting to Federal Medical Center, Umuahia, from December 1, 2017, to May 31, 2018, with gangrenous foot lesions and who subsequently had amputation were recruited prospectively. Structured questionnaires were used for the study. The SPSS version 23 was used for data analysis. Results: 63 patients with gangrenous foot lesions (mean age 63.5 ± 13 years) were studied. There was a female preponderance with a male-to-female ratio was 1:1.1. These lesions were seen more among urban dwellers (57.1%) and in patients who have not received diabetic foot education (68.3%). The left lower limb was the most affected (55.6%). The digits were the most common anatomical site (54%) while the midfoot was the second most common (27%), under the metatarsal head 7.9%, heel 4.8%, and dorsum of the foot 3.2% and around the ankle 3.2%. The digits were seen more among urban dwellers while the midfoot was frequent among rural dwellers. 96.8% of patients had diabetes mellitus while peripheral vascular disease accounts for the rest. Conclusion: The digits are the most common anatomical site of gangrenous foot lesions that resulted in lower extremity amputation. However, there is a relationship between this high-risk lesions and the patient’s place of residence and work environment. We recommend more research to properly delineate these relationships.


  Evaluation of Impact of Perinatal Factors on Time to First Meconium Passage in Nigerian Neonates Top


Ezomike UO, Ugwu EO1, Ezomike NE2, Eke CB2, Ekenze SO

Sub-Departments of Pediatric Surgery and 1Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, 2Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State, Nigeria

Background: Delayed meconium passage usually is a signal to congenital distal bowel dysfunction. Timing may vary depending on race, sex, and several perinatal factors. Understanding the timing and associated perinatal factors in any given population will help in prompt diagnosis and adequate management of cases in that population. Objectives: To determine the timing of first meconium passage among Nigerian neonates and evaluate the impact of various associated perinatal factors. Materials and Methods: This was a cross-sectional study using interviewer-administered questionnaires to obtain data from mothers of apparently normal infants attending the postnatal clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Data acquisition and analysis were done using SPSS version 20. P < 0.05 was considered statistically significant. Results: There were 276 males and 277 females. The mean birth weight was 3.4 kg and mean gestational age at delivery was 38.8 weeks. The median age at presentation was 42 days. Preterm deliveries were in 6.3% (32/510) and 3.7% (20/536) weighed <2.5 kg at birth. Sixty-five percent (339/519) had spontaneous vertex delivery and 35% (180/519) had caesarean delivery. Passage of first meconium was within 24 h in 56.6% (307/543) and in 48 h 91.3% (496/543) had passed meconium. Fifty-four percent (54%, 288/537) commenced breastfeeding within 24 h and 85% (n = 456/537) within 48 h. Exclusive breastfeeding was done in 61.5% (326/533) of subjects. Timing of first meconium passage was significantly affected by gestational age at delivery (P < 0.001), mode of delivery (P < 0.01), birth weight (P = 0.02), 1st min APGAR score (P < 0.001), timing of commencement of breastfeeding (P < 0.001), and feeding before breastfeeding is commenced (P = 0.02). Conclusion: Compared to other studies, we found smaller proportion of neonates passing meconium in the first 24 h. Term neonates, birth weight ≥2.5 kg, spontaneous vertex delivery, high Apgar score, commencement of breastfeeding within 24 h of birth, and feeding before breastfeeding is commenced are perinatal factors associated with earlier first meconium passage.


  Gastric Outlet Obstruction in Ubth: A 3-Year Study Top


Agbonrofo PI, Irowa OO, Odigie VI

Department of Surgery, University of Benin/UBTH, Benin City, Nigeria

Study Background/Introduction: Gastric outlet obstruction (GOO) is a clinical condition which arises from a mechanical impairment of gastric emptying at the pyloroduodenal area. It is a contemporary surgical challenge that may arise from several pathologic entities. In Africa, it is commonly secondary to cicatrizing duodenal ulcer and antral tumors. Chronic cases present with severe fluid, electrolyte, and nutritional abnormalities, which could be life-threatening. Definitive intervention depends on the etiology of the GOO. Aim: To highlight the clinical features and management of GOO in UBTH. Methodology: A 3-year prospective study of patients with GOO who presented in UBTH, from January 2015 to December 2017, was conducted using a pro forma. Diagnosis was confirmed by contrast studies, upper GI endoscopy and biopsy, and intraoperative findings. Data were analyzed using SPSS version 21. Results: Fourteen cases of GOO were seen during the study with average incidence of 5 cases/year. This constituted 5.6% of 248 gastrointestinal conditions requiring surgery, during the study. Male:Female ratio was 1.8:1. The age range was 32–89 years with mean age of 63.5 ± 15.3 years. Most patients were in the 7th decade (35.7%). Common clinical features were nonbilous vomiting (92.9%), epigastric pain (92.9%), weight loss (92.9%), and dehydration (28.6%). Common causes were antral cancer (50%), chronic duodenal ulcer (21.4%), and carcinoma of the head of pancreas (21.4%). Surgical interventions were truncal vagotomy and gastrojejunostomy (21.4%), partial gastrectomy and gastrojejunostomy (14.3%), gastrojejunostomy for nonresectable tumors (42.9%), and vagotomy and pyloroplasty (0%). Nutritional support and electrolyte derangement (71.4%) were the most common preoperative challenges. SSI was the most common complication (14.3%). Hospital stay ranged between 16 and 23 days. Prolonged because of preoperative state of most patients. Mortality was 7.1%. Conclusion: In UBTH, GOO is a disease of the elderly. Malignant obstruction is the most common cause and presentation is often late. Routine endoscopy for patients with epigastric pains may reduce late presentation and is advocated by the author.


  Management of Type 1 Jejunal Atresia in A Preterm Low Birth Weight Neonate Top


Emehute JDC, Ezomike UO1, Nwokeforo N2, Chuwudi NK2, Chukwu IS

Department of Surgery and 2Pediatrics, Federal Medical Centre, Umuahia, Abia State, 1Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Introduction: Jejunal atresia is a common cause of neonatal intestinal obstruction. It occurs due to intrauterine vascular accidents. Management is still challenging in our environment, particularly when the neonates are preterm. Aims: To report the management of type 1 jejunal atresia in a preterm low birth weight female neonate. Case Description: We present the case of a type 1 jejunal atresia in a preterm low birth weight female neonate. She was referred from another medical facility at 11 days of life. Estimated gestational age was 32 weeks + 5 days. Birth weight was 1.9 kg. Weight at presentation was 1.4 kg. At laparotomy, there was a dilated bulbous proximal jejunum with an atretic section. There was a mucosal diaphragm obstructing the jejunum with bowel continuity. She had resection and jejunojejunal anastomosis. She did well and was discharged 27 days after the surgery. Conclusion: A case of type 1 jejunal atresia in a preterm low birth weight female neonate. Excellent multidisciplinary care is essential for a good outcome.


  An Unusual Cause of Acute Abdomen in the Adult: Enteroenteric Intussusceptions Top


Ngwu DC, Camazine M1

Department of Surgery, Federal Medical Centre, Umuahia, 1Department of Surgery, Nigerian Christian Hospital, Nlagu, Abia State, Nigeria

Background: An intussusception occurs when a segment of bowel invaginates into its adjacent segment. This condition rarely occurs in adults in whom it accounts for <0.1% of all hospital admissions and about 2–3 cases per million per annum. They occur more commonly in children, particularly younger children, in whom they are the most common cause of bowel obstruction. There is a case of adult intussusception for every 20 childhood cases. In children, the pathological process is more likely to be idiopathic (>95%), while an identifiable etiology is usually present in adult cases (80%–90%). When a cause is unraveled, it is more likely to be benign when the small gut is involved, but large bowel disease is commonly of malignant etiology. Here is the case of an elderly male who presented with acute abdominal pain that turned out to be due to intussusceptions with bowel gangrene. Case Presentation: A 65-year-old male was brought to our facility with a 10-day history of intermittent abdominal pain, which became constant, progressively worsened in intensity, and localized to the right lower abdominal quadrant, about 2 days before presentation. He had a fever and 2 bouts of vomiting, a day prior to presentation. He was not constipated, had no significant comorbidity, and had not had surgical operations in the past. Important physical findings included painful distress, a raised axillary temperature (37.5°C), tachycardia (105 bpm), and right lower quadrant abdominal tenderness. Preoperative ultrasonography suggested intussusception and ruled out acute appendicitis. Biochemical and hematologic investigations yielded results that were within normal limits. He had an urgent laparotomy which showed pus in the peritoneal cavity and a mass in the right iliac fossa which was shown to be an enteroenteric intussusception involving the distal ileum up to 25 cm from the ileocecal valve. The involved gut was resected and ileoileal anastomosis was performed with a G.I.A stapler, hence sparing the ileocecal valve. Postoperative recovery was quick and uneventful and he was discharged home on the 8th day after surgery. Conclusion: Intussusception is an unusual cause of acute abdomen in the adult population. A high index of suspicion on the part of the primary care physician and the surgeon is needed, if the desirable rapid preoperative diagnosis followed by expeditious surgical intervention is to be achieved.


  Buccal Mucosal Graft Urethroplasty: Comparison of Single- Versus Two-Team Approach Top


Ugwumba Fred O, Orji Foster T1, Nnabugwu Ikenna I, Echetabu Kevin N, Okoh Agharighom D, Mbadiwe Okezie M

Departments of Surgery and 1Otorhinolaryngology, University of Nigeria Teaching Hospital, Enugu, Nigeria

Background: There are increasing numbers of long-segment urethral strictures that arise due to catheter-induced urethritis, trauma, or infective urethritis seen in Enugu, Nigeria. Often, these patients require urethral substitution with buccal mucosal graft (BMG). We hypothesized that using a team approach to this procedure should reduce operating time and may improve outcome. Previously this team did not exist in our institution and it became necessary to create and nurture one. We aimed to assess the impact of a single- versus two-team approach on BMG urethroplasty using measurable outcomes as well as highlight challenges in formation and maintenance of a BMG team. Methods: Audit of patients who had BMG urethroplasty at the University of Nigeria Teaching Hospital, Saint Mary’s Hospital, Royal Hospital, and Mother of Christ Specialist Hospital all in Enugu, Nigeria between January 2008 to December 2015 using the single-team (Group A) and two-team approach (Group B). Prospective assessment of length of surgery, donor site morbidity, complications of repair and patency/flow rate/international prostate symptom score. Challenges encountered in forming a team and problem-solving methods were also assessed and presented. Results: Forty-three patients were evaluated: 27 in Group A and 16 in Group B. Operating time was significantly longer in the single-team method (mean; 171 min). Donor site morbidity and complications of repair were greater in Group A (P < 0.05). Urethral patency, flow rate, and mean IPSS scores were all better in Group B (P < 0.05). Conclusion: The use of a two-team approach to BMG urethroplasty reduces operating time and reduces donor site morbidity and complications of repair. Functional outcome as assessed by patency/flow rate and international prostate symptom score is also improved.


  Early Years of Neurological Surgery in A Tertiary Hospital from A Developing Sub-Saharan African Country: Salient Perspectives from Audit of Operative Procedures Top


Okorie EC1, Uche EO2, Onyia EE1,2, Ibebuike KE3, Mathew Mesi2, Uzoanya M1

1Department of Surgery, Federal Medical Center, Umuahia, Abia State, 2Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 3Division of Neurosurgery, Imo State University Teaching Hospital, Orlu, Imo, Nigeria

Introduction: The continued effort to tackle the dearth of neurosurgeons in Nigeria has seen proliferation of new centers offering basic neurosurgical services. In the face of manpower and logistical constraints, an audit of the procedures done is necessary for future planning. Methods: An 8-year retrospective review of cases treated surgically in an emerging neurosurgical unit of a tertiary referral center was done. Patients’ data from admission and operation registers were analyzed using SPSS for Windows, version 21 (SPSS, Inc., Chicago, Illinois, USA). P < 0.05 was considered significant for associations. Results: A total of 200 cases were operated over the study period. 149 (74.5%) were male and 51 (25.5%) were female with a M:F ratio of 2.9:1. Patients’ age varied from 14 days to 88 years. Pediatric patients were 55 (27.5%) while adults were 145 (72.5%). Subgroup age analysis showed that 5% were of neonatal age group, while 14.5% were aged 65 years and above. Trauma and congenital malformations were the most commonly operated conditions accounting for 48.0% and 24.0%, respectively. Other conditions include degenerative spinal lesions (7.5%), tumors (7.5%), and infectious lesions (5.5%). Among adults treated, 118 (59.0%) had cranial, while 21 (10.5%) had spinal procedures. Other procedures accounted for 6 (3.0%) cases. There were 10 (5%) postoperative deaths. Tumor surgery (P = 0.0006), female sex (P = 0.01), and cranial procedures (P = 0.04) were associated with higher risk of mortality. Conclusion: Trauma is the most common indication for neurosurgical intervention. Based on our study, we recommend the establishment of a regional neurotrauma center to cater for the high trauma case load.


  Management of Posterior Urethral Valve at The Abia State University Teaching Hospital, Aba, Nigeria Top


Ekpemo SC, Chapp-Jumbo AU1, Eleweke N

Departments of Surgery and 1Paediatrics, Abia State University Teaching Hospital, Aba, Nigeria

Introduction: Posterior urethral valves are the most common cause of bladder outlet obstruction in boys. The incidence varies from 1 in 5000 to 25,000 live birth worldwide. The incidence in low- and middle-income countries is unknown due to the paucity of data. The consequential pathology due to backpressure from untreated obstruction from posterior urethral valve leads to thickened bladder wall, trabeculation, sacculation, diverticulum, and hydronephrosis. The pop-off mechanisms such as vesicoureteral reflux syndrome, large bladder diverticulum, patent urachus, and perinealurinoma may help in reducing the backpressure, abating renal failure, and subsequent death. Endoscopic ablation of the posterior urethral valve under direct vision using resectoscope remains the gold standard. These facilities are not readily available in some centers in low-income countries such as Nigeria. The aim of this study was to review the presentation, management, and outcome of posterior urethral valve at the Abia State University Teaching Hospital, Aba, Nigeria. Patients and Methods: Fifteen boys with posterior urethral valve seen at the Abia State University Teaching Hospital, Aba, from January 2016 to June 2018 were included in the study. Data collected include demographic data, clinical features, duration of symptoms, serum biochemistry, radiological diagnosis, surgical management, and outcome. Results: The patient age ranged from 2 weeks to 2 years, with the median age of 12 months. 7 (46.6%) of the patients were neonates. The most common symptoms were straining at micturition, recurrent fever, and abdominal swelling in 10 (62.5%) patients. Duration of symptoms was 2 weeks in 6 (40%) patients, 4 weeks in 4 (27) patients, and 8 weeks in 5 (33%) patients. 6 (40%) patients had grade 2 vesicoureteric reflux on expressive cystourethrogram. All the patients had Foley catheter avulsion of posterior urethral valve. There was no case of frank hemorrhage, but hematuria was noticed which resolved spontaneously. Fourteen (93.3%) of 15 patients reported consistent good urinary stream without evidence of renal deterioration. A patient (6.6%) had persistent straining at micturition requiring a repeat Foley catheter balloon avulsion. All mothers were satisfied with the outcome of treatment due to good postoperative urinary stream. There was complete resolution of the vesicoureteric reflux at 6 months postvalve ablation expressive cystourethrogram. The postoperative urinary stream, serum electrolyte, urea, and creatinine status remained normal during follow-up period of 6 months. Conclusion: Posterior urethral valve is common, high index of suspicion will lead to early diagnosis, and late presentation still persists due to poor knowledge of health-care workers in our environment. Public health education and health insurance will ameliorate the morbidity resulting from the disease.


  Pattern of Diseases Seen at Accident and Emergency Department of A Tertiary Health Facility in South East Nigeria: A Retrospective Review Top


Uche B Aguocha, Ugochukwu U Onyeonoro1, Chinweotuto J Chioma, Grace U Aguocha2, Patrick Njoku3

Departments of Orthopaedics, 1Community Medicine, 2Mental Health and 3Family Medicine, Federal Medical Center, Umuahia, Nigeria

Introduction: Health service data are vital for assessing health-care interventions and quality of care and are also useful for health managers in making informed decisions. The accident and emergency department is a section of the hospital that provides emergency care to the acutely and critically ill patients. This is a cross-sectional descriptive study aimed at assessing pattern of diseases seen in Accident and Emergency Department of Federal Medical Centre, Umuahia, in 2008 and 2012. Methodology: Data collected were age, gender, disease condition, specialty, and subspecialty using a pro forma and were analyzed descriptively. Results: Key findings were that there was a difference in disease pattern by age, gender, and subspecialty. There was increase in the presentation of older patients, women, and patients with cardiologic and endocrine-related conditions, and there was a decline in proportions of patients presenting with communicable diseases and trauma-related conditions. Conclusion: The change in disease pattern underlies the need for health-care managers to adapt health-care resources to cope with the change.


  Presentation of Large Hernias in Enugu: A Retrospective Study Top


Eneh WU, Uchendu UT, Ivenso J, Umeji EI, Edeh AJ

Department of Surgery, Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria

Background: Large inguinal hernias refer to hernias that have descended beyond the groin, and presents peculiar problems both in symptomatology and treatment. Aim: To portray the presentation of large hernias in Enugu. Methods: The data were collected on patients with large inguinal hernias using clinic, Emergency, and theater records over a 3-year period. The data were analyzed using Excel. Results: All of the large inguinal hernias observed in this study occurred in males, with elective presentations and all went on to have surgery. A total 18 cases were collected, 2 recurrent and the rest primary, mostly unilateral with 12 being left-sided, 5 being right sided, and 1 bilateral. The lowest age at presentation was 27 years, the highest 75 years, with a mean age of presentation of 52.44 years, and median of 53 years. Discussion: Delay in seeking treatment allows inguinal hernias grow to huge sizes, and when this happens, they are associated with problems such as increased risk of complications, and interference with intimacy prior to presentation, as well as problems of repair such as loss of domain, with possible increased intra-abdominal pressure, and respiratory embarrassment, and increased risk of damage to contents of the cord and scrotum upon presentation and treatment. Surgery remains the only acceptable treatment option for inguinal hernias and patients should be encouraged to treat their hernias early, using standard tension-free technique. Conclusion: Inguinal hernia if untreated results in large hernias, with associated problematic symptoms and problems of treatment.


  Psychometric Analysis, Patients Characteristics, and Duration of Indwelling Urethral Catheters: The Relationship Top


Udeh EI, Ndukuba AC1, Nnabugwu II, UgwumbaFO, Echetabu KN

Departments of Surgery and 1Psychiatry, UNTH, Enugu, Nigeria

Aims: We determined the relationship among psychometric analysis, duration of indwelling urethral catheters, and patients characteristics. Methods: A total of 130 patients were selected as subjects. The psychometric analysis involved administering the hospital anxiety and depression scale to the subjects and the Beck’s anxiety inventory and the Beck’s depression inventory, respectively. The result was analyzed using SPSS 22. The test for significance was set at P ≤ 0.05. Results: The mean values of their ages, body mass index, ECOG performance status, and duration of indwelling catheters were 63.85 ± 14.67, 23.8 ± 4.4, 0.69 ± 0.86, and 12.98 ± 21.25, respectively. The Pearson’s correlation between age and hospital anxiety score and age and hospital depression score was r = 0.023, P = 0.8 and r = −0.07, P = 0.93, respectively. The correlation between BMI and hospital anxiety score and BMI and hospital depression score was r = −0.181, P = 0.53 and r = −0.084, P = 0.366, respectively. The correlation between ECOG and hospital anxiety score and ECOG and hospital depression score was r = −0.084, P = 0.366 and r = 0.283, P = 0.001, respectively. The correlation between duration of catheter and hospital anxiety score and duration of catheter and hospital depression score was r = 0.16, P = 0.09 and r = 0.13, P = 0.12, respectively. Conclusion: There was a statistical significant positive correlation between psychometric vales and patients performance status. No relationship was established between duration of catheter and the psychometric values.


  Quality of Life of Patients with Urinary Symptoms: The Effect of Erectile Dysfunction – A Preliminary Report Top


Udeh EI, Ndukuba AC1, Nnabugwu II, Ugwumba FO, Ohayi Robsam

Departments of Surgery and 1Psychiatry, UNTH, Enugu, Nigeria

Aims: We determined the effect of erectile dysfunction on quality of life of patients with urinary symptoms. Methods: Patients with urinary symptoms were grouped into subjects and controls based on their erectile function. The subjects had erectile dysfunction while the controls had good erectile function. The quality of life of both groups was assessed with quality of life enjoyment and satisfaction questionnaire. Results: The mean values of the ages, IPSS, IIEF, and years of marriage for controls and subjects were 54.5 ± 15, 65.73 ± 12.68, P = 0.002; 11.16 ± 10.09, 16.84 ± 11.02, P = 0.053; 22.8 ± 1.88, 12.08 ± 4.85, P = 0.0001; and 18.28 ± 14.49, 32.51 ± 11.49, P = 0.0001, respectively. The mean quality of life enjoyment and satisfaction score for subjects and controls were 54.25 ± 8.9 and 64.0 ± 12.55, respectively, P = 0.00001. Subjecting these IIEF-5 scores to paired Student’s t-test for a significant difference in mean between controls and subjects revealed a statistical significant difference between the two groups (P < 0.0001; df: 77; t: 10.0; 95% confidence interval of difference in mean: −12.84−[−8.58]). The Pearson’s correlation between quality of life enjoyment and satisfaction score and the international index of erectile function was r = 0.46, P = 0.00001. Conclusion: Erectile dysfunction worsens the quality of life of patients with urinary symptoms. There appears to be a positive correlation between quality of life and erectile function.


  Experience with A Policy of Repair of All Abdominal Wall Hernias With Prolene Mesh Top


Edeh AJ, Anieze IS, Nwachukwu B, Eze IS, Ene WS, Nwangwu IC, Ivenso JC

Department of Surgery, ESUT Hospital, Enugu, Nigeria

Background: over the last 30–50 years, the gold standard for repair of adult abdominal wall hernias is tension-free mesh repair. In resource-poor countries, various challenges militate against the universal adoption of this standard. Objective: To relate our experience with a policy of repair of all abdominal wall hernias in adults, presenting to our teaching hospital, with sutured prolene mesh. Materials and Methods: The surgery department agreed in January 2016 on a policy to repair all adult abdominal wall hernias presenting to the teaching hospital with prolene mesh for a period of 1 year. Enough mesh was provided form of re-packaged and resterilized strips of prolene mesh. A workshop was organized with consultants as resource staff. Anesthesia was mostly locoregional for groin and local or general for ventral hernias prophylactic antibiotics was used in all repairs. Results: A total of 67 abdominal wall hernias, 46 groin and 21 ventral hernias, were repaired within the period. There were males and females with age range from 17 to 99 years. Operation time average was 45 min to 1 h for groin hernias and 60–90 min for big ventral hernias. Surgical site occurrences were mostly in intraoperative blood loss with hematoma/seroma formations in the large ventral hernias. Follow-up was good specialty with the use of ICT. There was no reported recurrence so far and patients seem satisfied with their repairs. Conclusion: Meeting the standard surgical needs for hernia repair in our environment is possible. We need to articulate the right policies; trains staff well and be a little ingenious in sourcing required materials.


  Emergency Total Abdominal Colectomy and Ileorectal Anastomosis for Bleeding Diverticular Disease of The Colon in Umuahia, Nigeria: A Case Report Top


Ekpemiro UC, Okoye CI

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Diverticular disease of the colon is a common condition in developed countries. It had been considered rare in Asia and Africa, but recent reports suggest otherwise. When bleeding occurs, it presents as bright red blood (which may be darker when it is from the right side of the colon) per rectum and resolves without any specific treatment but rebleeding can occur in 25% of patients. Treatment includes resuscitation and control of bleeding by endoscopic measures, interventional radiology, and/or colectomy. Colectomy may be segmental, subtotal, or total. Total colectomy appears to be rare in Nigeria. A case of total colectomy and ileosigmoid anastomosis for bleeding diverticular disease of the colon is reported. Methods: The information in the patient’s case notes were reviewed and presented. Results: A 60-year-old male presented at the accident and emergency department with a 5-day history of bleeding per rectum that was copious and with clots, frank red, and associated with dizziness and easy fatigability. He became hypotensive when he first bled (blood pressure was 90/40 mmHg) and was resuscitated with normal saline and referred to us following a second episode of bleeding. The patient received 6 units of blood. Colonoscopy revealed few diverticula in the sigmoid colon and progressively more in the descending colon, splenic flexure, and transverse colon toward the hepatic flexure with some fresh blood seen. Ascending colon, cecum, and terminal ileum were not intubated. On finding diverticula throughout the entire colon and blood within its whole length intraoperatively, a total colectomy and ileorectal anastomosis was performed. The patient continued to pass loose stools, but stool consistency became normal before he was discharged home on the 21st postoperative day. Postoperative complications including suspected sepsis necessitated readmission into the intensive care unit (ICU) and prolonged stay in ICU. The patient has not bled after the operation and has continued to pass normal stool 2–3 times in a day.


  Baseline C-Reactive Protein in Children Undergoing Elective Major Surgery Top


Emehute JDC, Adejuyigbe O, Sowande OA, Usang EU, Talabi A

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Introduction: This research work evaluated the baseline level of C-reactive protein (CRP) in children undergoing elective major surgery. CRP is a marker of acute-phase reaction in humans. Objectives: The aim of the study was to evaluate the baseline level of CRP in pediatric elective major surgery in Ile Ife, Nigeria. Patients and Methods: Consecutive patients were recruited for the study after informed consent was obtained. Three milliliters of venous blood were collected for CRP estimation before surgery. The samples were allowed to clot and were centrifuged to obtain the serum, which was then analyzed. CRP estimation was done using the ELISA method. Data were expressed as median values. Results: Forty-four patients were recruited for the study with a median age of 2.75 years and an age range of 2 months to 15 years between June 2015 and May 2016. There were 33 males and 11 females with a M:F ratio of 3:1. The results of the median serum CRP levels from the patients demonstrated that the levels at baseline were within normal limits. The baseline level was 2.00 mg/L. This represented the baseline value of serum CRP in this patient population. Conclusion: There was a significant difference in serum CRP levels across the four different age groups. There was no difference in the serum CRP levels between the two sexes. There was no difference between the group that had early postoperative complications and the group that no complications.


  Management of Neonatal Necrotizing Fasciitis Top


Emehute JDC, Ogbonna U, Ezomike UO1, Chukwu IS

Department of Surgery, Federal Medical Centre, Umuahia, Abia State, 1Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Introduction: The occurrence of necrotizing fasciitis in a neonate is not so common. It is a serious infection which can be life-threatening. It may involve the skin, subcutaneous tissue, deep fascia, and muscles. Aims: To report the rare finding of necrotizing fasciitis in a female neonate. Case Description: We present the case of a female Nigerian neonate with necrotizing fasciitis. The illness started as a small papule on the chest and slowly increased in size and became necrotic and extensively involved the anterior and posterior parts of the chest. She was quite ill and we managed her successfully using intravenous antibiotics and intravenous fluids. Local wound care was done using serial debridement and wound dressing with honey-soaked gauze. The wound healed satisfactorily. There was no need for skin grafting. Conclusion: A case of necrotizing fasciitis involves the anterior and posterior parts of the chest in a female Nigerian neonate. This condition should be managed aggressively for an optimal outcome.


  The Challenges of Managing Cancer in Nigeria and The Journey So Far at Federal Teaching Hospital, Gombe, Nigeria Top


Yahya AI, Ali A1, Ali-Gombe M2, Adamu DB2, Abdullahi YM3, Lawan AI3, Girei AI4, Yuguda S4, Kabilis L, Adigun AW, Quadri OR1

Department of Ear, Nose and Throat, Federal Teaching Hospital, Departments of 1Ear, Nose and Throat, 2Radiology, 3Histopathology and 4Haematology, College of Medical Sciences, Gombe State University/Federal Teaching Hospital, Gombe, Gombe State, Nigeria

Background: Cancer is the second most common noncommunicable disease and the second leading cause of mortality globally. It is of significant public health concern in low- and middle-income countries like Nigeria where the challenges involved in the management of cancer patients are enormous. Purpose: The objective of this review is to highlight some of the challenges in managing cancer in Nigeria with more emphasis on our experience at Federal Teaching Hospital (FTH), Gombe. Methods: The available records from the Cancer Registry, Haematology Unit, Radio-oncology Department, as well as Activities/Policies of Tumour Board of FTH Gombe were reviewed in addition to Google Scholar and PubMed search, relating to the most relevant articles on challenges of cancer management in Nigeria. Findings: The challenges facing cancer management in Nigeria include lack of awareness and knowledge of the burden of cancer as a disease; late presentation; delay and/or misdiagnosis; stigma and psycho-social problems; lack of family or community support; limited comprehensive cancer care centers; cost and adverse effects of treatment; lack of survivorship care and rehabilitation; limited cancer registries, research, and policies; and lack of political will. The resolution of the tumor board of FTH Gombe is to treat all cancer cases as emergency. Formulated policies were built on multidisciplinary approach to care and aimed at providing optimal cancer care in our facility. Conclusion: The challenges facing cancer management can be overwhelming. Effective policies and efficient cancer care centers are essential in combating some of these challenges.


  Management of Malignant Pleural Effusion: 5-Year Experience at Federal Medical Center, Umuahia, Abia State Top


Onwuta C

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Malignant pleural effusion occurs as a result of disseminated and advanced cancer disease. There is no documented work on this subject in our local experience. MPE constitutes about 25% of pleural effusion. Lung cancer is adjudged the most common cause of malignant pleural effusion worldwide while breast cancer is the most common cause of MPE in women.[1] Dyspnea and chest pain are the common clinical presentations. Thoracocentesis with positive cytology report confirms the diagnosis. The goal of treatment is palliation. Tube thoracostomy followed by pleurodesis are the methods of palliative care in MPE. Recurrence, chest pain, and fever are common complications. Median life expectance of patient with MPE is 3–12 months depending on the stage and the type of underlying malignancy. Objective: The aim of the study is to examine the outcome of the management of malignant pleural at Federal Medical Umuahia, Abia State. Methods: This is a 5-year retrospective study. Data were collected from patients’ folder. 280 patients were managed of plural effusion within the period under study (2011–2016). Eighty patients (29%) had malignant pleural effusion while 19 (7%) patients had paramalignant pleural effusion. Results: MPE occurs in 35 (41%) patients with breast cancer while lung cancer constitutes about 18 (26%) patients of MPE. Other causes make up 27 (33%). The complications of pleurodesis are chest pain 58 (87%). Fever within 48 h was 6 (8%). Recurrence before 1 month was 17 (21%).


  Pattern and Etiological Agents of Superficial Soft Tissue Abscesses in Children Top


Ezomike UO, Ituen MA1, Ekpemo SC2, Chukwu IU2, Emehute CJ2

Sub-Department of Pediatric Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu, 1Department of Surgery, Pediatric Surgery Unit, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, 2Department of Surgery, Pediatric Surgery Unit, Abia State University Teaching Hospital, Aba, 4Department of Surgery, Pediatric Surgery Unit, Federal Medical Centre, Umuahia, Abia State, Nigeria

Background: Superficial soft tissue abscesses are no uncommon in our environment. Publications identifying the etiological agents and patterns of presentation in our environment are uncommon. Aims: To determine the microbial agents involved in the causation of superficial soft tissue abscesses and assess the pattern of presentation in our environment. Materials and Methods: This was a prospective, observational study of patients presenting with superficial soft tissue abscesses involving various regions of the body at the Federal Medical Centre, Umuahia, Abia State, over a 15-month period. All the patients had incision and drainage and packing with gauze drain and a sample of the pus sent for aerobic culture and sensitivity. Data entry and analysis were done using SPSS version 20. The results presented as means, ratios, percentages, and tables. Results: There were 40 patients with 45 abscess sites (three patients had two abscesses sites and one patient had three abscess sites). They were 22 males and 18 females aged 7 days to 14 years (median of 21 months). The symptom duration before presentation ranged from 2–90 days (mean 10.54 ± 14.57 days). The estimated volume of drained abscess ranged from 3 ml to 600 ml (mean 53.47 ± 113.57 ml). The most common anatomical site of abscess was the lower limb (12/45), followed by upper limb (7/45) and head/neck region (7/45). Staphylococcus aureus was the most common organism grown in all positive cultures (23/40). Thirteen patients took antibiotics before presentation (18/40). Trauma was the most common predisposing factor to abscess formation (17/45) and gentamycin was the most common antibiotic to which the cultured organisms were sensitive to (14/25). Conclusion: Most superficial abscesses occur in the lower limbs of children. Staphylococcus aureus are the most common cultured organisms and trauma the most prevalent predisposing factor. Gentamycin is the most common antibiotic to which the organisms are sensitive to.


  Stage At Presentation of Breast Cancer in Enugu, Nigeria: A Retrospective Study Top


Uchendu UT, Edeh AJ, Ivenso J, Eneh WU, Umeji E

Department of Surgery, Enugu State University of Science and Technology Teaching Hospital, Enugu, Enugu State, Nigeria

Background: Breast cancer is a growing problem in poor-resource environments. Poor treatment outcomes may be largely accounted for the clinical stage at presentation. Aim: The aim of this study was to characterize breast cancer clinically at presentation in Enugu, Nigeria. Methods: Data on breast cancer patients being managed at Enugu State University of Science and Technology Teaching Hospital, Parklane, were collected over a 12-month period. Data collected included demographic and clinical information at presentation, namely gender, age at diagnosis, parity, duration of symptom before presentation, and clinical stage of breast cancer based on the Modified American Joint Committee on Cancer (AJCC). Descriptive statistics were performed. Results: 51 patients with breast cancer seen over the period were studied. 98% were female and 2% were male. The age range of patients was 21 years to 90 years, median age was 47 years, and mean age was 49.4 years. The highest frequency (31.4%) of breast cancer occurred within the 40–49 years age group. 49% of patients presented 1–3 years after onset of breast symptoms. 80.4% of patients presented with stage III breast cancer, 15.7% with stage IV, 3.9% with stage II, and none presented with stage 0 or stage I. Discussion: The study showed advanced stage at presentation of breast cancer patients, which is similar with previous studies done in Nigeria. These findings are indicative of the urgent need for health programs and policies targeted at improving early diagnosis of breast cancer. We recommend a realistic framework that would allow for the implementation of a breast cancer screening program, built under a strong network based on cooperation, teaching, audit, international best practices, and the organization of health services in Enugu, Nigeria. Conclusion: Enugu needs a program for early diagnosis of breast cancer.


  Correlation Between Prostate-Specific Antigen and Prostate Biopsy Gleason Score in Umuahia, Nigeria Top


Ngwu PE, Eziefule V, Achor GO, Mgbeojedo C

Department of Surgery, Division of Urology, Federal Medical Centre, Umuahia, Nigeria

Background: Prostate-specific antigen (PSA) is a commonly used marker in prostate cancer management. Gleason grading is one of the most powerful predictors of biological behavior and influential factors used to determine treatment. PSA, when combined with Gleason score and clinical stage, improves the prediction of pathological stage for prostate cancer. Objectives: To assess the degree of correlation between PSA and Gleason score in Umuahia and to determine the likelihood of aggressiveness of prostate cancer in Umuahia using Gleason score as a parameter. Methods: A cross-sectional, prospective study was done using 234 consecutive consenting patients presenting to the urology outpatient clinic between April 2015 and March 2017. Serum PSA was done and patients with values above 4 ng/ml and/or abnormal digital rectal examination were selected to have prostate biopsy. The sample was histologically analyzed with Gleason score recorded for those with prostate cancer. Gleason score was then correlated with PSA levels. Data were analyzed using SPSS 21. Results: The mean age for prostate cancer from the study was 71.3 ± 8.7 years. The mean PSA for patients with prostate cancer was 52.35 ± 37.5 ng/ml (confidence interval: 46.1–58.6) with P < 0.001. 18.2% of the patients with histologically confirmed prostate cancer had Gleason score 8–10 which implies a high level of tumor aggressiveness. There is a positive correlation between PSA and Gleason score with R value 0.590 which indicates a good degree of correlation. Conclusion: There is a good degree of positive correlation between PSA level and Gleason score, as well as a high level of aggressiveness of prostate cancer in Umuahia based on the Gleason score.


  Assessment of The Different Variants of Abnormal Digital Rectal Examination Finding as Indication for Prostate Biopsy in Nigeria: A Preliminary Report of A Two-Center Study Top


George Achor, Eshiobo Irekpita1, Ugochukwu Alili2

Department of Surgery, Federal Medical Center, Umuahia, 1Department of Surgery, Ambrose Alli University, Ekpoma, 2Department of Surgery, Irrua Teaching Hospital, Irrua, Nigeria

Background: Abnormal digital rectal examination (DRE) findings have been used over the decades to predict prostatic adenocarcinoma. The validity of the different variables that constitute abnormal DRE findings is yet to be studied sufficiently in our environment. Objective: To assess the value of the different variables which constitute abnormal DRE findings. Materials and Method: This is a hospital-based, cross-sectional, prospective, two-center study in Irrua Specialist Teaching Hospital and Federal Medical Center, Umuahia. The study was conducted between April 2016 and June 2017. All men who met the inclusion criteria of an abnormal DRE finding had sextant and targeted biopsies. Variables sought for during DRE were suspicious nodules, hard and nodular feel, lobar asymmetry, indurations, and obliteration of the median groove. Targeted biopsies were directed at the suspicious areas while blood specimen was obtained for prostate-specific antigen (PSA) estimation before the biopsy. The prostate size was obtained at ultrasonography. The histology was classified as nodular hyperplasia, prostate intraepithelial neoplasia (PIN), and adenocarcinoma. The later was further categorized using the Gleason scoring system. The outcome variables assessed were the positive predictive value (PPV) of DRE and its different variants and various tests of correlation. Data were analyzed using simple statistical methods and SPSS version 21. Results: Following ethical approval, 131 men met the inclusion criteria and were enrolled in the study. The peak incidence of abnormal DRE finding was in the 8th decade of life while the PPV was 66.5%. Of the total, 44 (33.5%) were nodular hyperplasia, 12 (9.2%) were prostate intra-epithelia neoplasia (PIN), and 75 (57.3%) were adenocarcinoma. With a PPV of 73.3%, a hard nodular feel was the only abnormal DRE finding that independently and significantly predicted the risk of prostatic adenocarcinoma. A suspicious nodule and obliterated median groove had PPV of 23.1% and lobar asymmetry of 0%. There was a statistically significant correlation (P = 0.005) between DRE findings and histology, between PSA and histology (P = 0.000) and between the size of the prostate and PSA value (P = 0.021). The mean size of the prostate was 101.2 g, standard deviation 92.11783, maximum 648 g, and minimum 13.6 g. Conclusion: Most of the variants of abnormal DRE findings do not sufficiently predict the risk of adenocarcinoma on their own to be indication for prostate biopsy. They need to be in combination with other DRE findings or a raised PSA to significantly predict adenocarcinoma.


  Increasing Awareness of Prostate Cancer Screening in A Tertiary Medical Centre in Umuahia, South East Nigeria Top


Mbanaso AU, Achor GO, Ibe IU, Eleweke N

Department of Surgery, Abia State University Teaching Hospital, Aba, Nigeria

Background: Prostate cancer is one of the leading causes of cancer-related death in Nigerian men. There is, therefore, the need to screen men at risk of prostate cancer to detect it early and reduce prostate cancer-related morbidity and mortality. Objective: To screen patients at risk of prostate cancer who are attending the outpatient surgery clinics of Abia State Specialist Hospital and Diagnostic Centre. Methodology: This was a prospective study spanning from January 2011 to December 2015. Patients who met the inclusion criteria were counseled about prostate cancer screening and their consents obtained for prostate-specific antigen measurement. Those who had abnormal PSA were evaluated further. Results: The number of patients screened continued to increase with each passing year, with 572 men screened in 2011, 668 in 2012, 768 in 2013, 844 in 2014, and 866 in 2015. Of the 866 men screened in 2015, 396 (45.7%) had normal PSA, 150 (17.3%) had PSA values in the 4.1 to 10 ng/ml range, 120 (13.9%) had values of 10.1–20 ng/ml, 64 (7.4%) between 20.1 and 50 ng/ml, 54 (6.2%) between 50.1 and 100 ng/ml, and 82 (9.5%) had values above 100 ng/ml. A total of 3718 men were screened over the 5-year period. Conclusion: There was increasing awareness of prostate cancer screening using prostate-specific antigen measurement among men attending surgery outpatient clinics between 2011 and 2015.


  Acute Limb Ischemia: An Uncommon Complication of Long-Bone Fracture Top


Ngwu DC, Orji EI1, NNezianya IC1

Department of Surgery, Cardiovascular Surgery Unit, Federal Medical Centre, 1Department of Orthopaedics, Federal Medical Centre, Umuahia, Nigeria

Background: Vascular injuries associated with long-bone fractures are surprisingly uncommon, with a reported incidence of <3%. An injuring force severe enough to fracture the long bones of the limb may seriously damage adjacent arteries either directly or indirectly, hence jeopardizing the viability of such an extremity. Reperfusion of the affected limb must be expeditious if amputation is to be avoided. Here is the case of a middle-aged male who presented to our facility with left supracondylar femoral fracture complicated by acute lower limb ischemia, following a pedestrian-motor vehicle accident. Case Report: A 52-year-old victim of a motor vehicle crash was brought to our emergency room about an hour afterward. Initial assessment revealed that he had open left femoral and right tibia/fibular fractures. Distally, the left lower limb was pale, cold, and pulseless, with an unrecordable oxygen saturation (SpO2) on pulse oximetry. The contralateral limb was well perfused. The initial radiograph revealed a posteriorly displaced supracondylar left femoral fracture. Following a rapid initial resuscitation, a joint operative intervention was carried out by the orthopedic and cardiovascular units. The distal segment of the fractured femur was observed to be impinging on the proximal popliteal artery leading to total occlusion. Open reduction and internal fixation was achieved using an angle blade plate, followed by Fogarty catheter thromboembolectomy. This procedure was commenced about 4 h after the injury and lasted about 80 min. SpO2 in the early postoperative period was about 70%, but increased to 98% over the next 48 h. He is currently being followed up on outpatient basis. Conclusion: Acute limb ischemia is an uncommon but potentially devastating complication of long-bone fractures. Precise and prompt diagnosis of arterial injury and a well-organized multidisciplinary approach is paramount to ensure life and functional limb salvage.


  Injuries from Road Traffic Accidents in Abia State University Teaching Hospital, Aba, Nigeria Top


Eleweke N, Abali I, Ekpemo SC, Eweputanna L1

Departments of Surgery and 1Radiology, Abia State University Teaching Hospital, Aba, Nigeria

Background: Road Traffic accidents result in injuries that lead to morbidity and mortality globally. More than 1.2 million deaths result from road traffic crashes annually worldwide. The active productive age group is mostly affected. This study aims at identifying the epidemiological features of injuries sustained following RTAs in Abia State University Teaching Hospital, ABSUTH, Aba, Nigeria. Methodology: All patients who presented with injuries following RTAs at ABSUTH from January 1, 2015, to December 31, 2017, were included in the study. A pro forma was designed which contained information on victims biodata, type of vehicle involved, time of accident, whether patient was the driver/rider or passenger, mode of transportation to hospital, and type of injury sustained. Results: Ninety-seven patients of RTA were seen during this period. There were 73 males and 24 females (M:F = 3:1). The age ranged from 1 year to 75 years with a mean age of 50.6 ± 9 years. The age groups of 20–49 years were mostly affected, accounting for 62.9% of the patients. In 60% of the cases, commercial vehicles were involved. The injuries sustained involved the lower limbs in 60%, abdomen in 55%, chest in 43% either singly or in combination. All the patients were rescued and brought to our facility by passers by and uninjured passengers in the vehicle with various means of transportation including motor bike. The average duration of time from crash to presentation was 3 h. Conclusion: Males in the active productive age group are mostly affected in RTAs seen at ABSUTH. There is no organized rescue and prehospital care in our environment.


  Morphometric Analysis of Calcaneal Angles in Igbos of South East of Nigeria and its Clinical Implication Top


Amechi U Katchy, Ngozi R Njeze, David Okorofor

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

Introduction: The calcaneum is repeatedly subjected to static and dynamic stresses, and this is reflected in the trabecular pattern within the calcaneus. There are six radiological angles associated with this bone, notably the Böhler (tuber joint) angle (BA/TJA) and Gissane’s angle (GA) and they vary in different ethnic population. Aim: This is to determine the calcaneal angles among the ethnic Igbos of the South Eastern Nigeria, to determine the relationships between these angles, to determine any correlation with gender and age, to compare the values of the Bohler’s and Gissane’s angles to that of other populations, and to discuss the clinical implications of the determined values. A 5-year review of all lateral views of X-rays of the ankle done at Federal Teaching Hospitals Abakiliki, Nigeria, from January 1, 2012, to December 31, 2016, was done. Materials and Methods: We used drawing and mathematical sets to measure the six radiological angles on the lateral views of plain X-ray films of the ankle and subjected them to descriptive and inferential statistics. Results: There were 120 patients: 65 males and 55 females. The calcaneal angles among the ethnic Igbos of the South Eastern Nigeria showed the following values: 32.58 ± 4.98, 121.22 ± 6.11, 30 ± 3.01, 22.58 ± 5.28, 17.35 ± 3.79, and 67.24 ± 7.22 for Bohler, Gissane, calcaneal compression, talcalcaneal, calcaenael pitch, and apical angles, respectively. There were no relationships between these angles. The TCA and AA showed a correlation with gender and age and other angles did not. There was a statistically significant difference between our Bohler’s angle values and that of Ugandan and American populations (P < 0.05). Our Gissane’s angle values showed a statistically significant difference between our values and that of Turkish, New Zealand, and Indian populations. Conclusion: These determined values would be a useful tool in the management of patients of Igbo extraction with of the ankle pathology.


  Patients’ Acceptability of Limb Amputation at Federal Medical Centre, Umuahia Top


Ikeanyi UOE, Udemezue CO, Chioma CJ, Amaraegbulam PI

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Limb amputation is a common procedure in our environment. It may be necessary to save life. The indications for limb amputation include trauma, vascular diseases, tumor, and severe infections (as may occur in diabetes mellitus). The reasons why patients may accept or refuse this option of the management are varied. This study explored the reasons why patients accepted or refused limb amputation at Federal Medical Centre Umuahia. Materials and Methods: It was a questionnaire-based study of all patients who were counseled for limb amputation at the Federal Medical Centre, Umuahia, within an 18-month period of January 2017 and June 2018. The questionnaires were administered by residents and house officers. The data entry and analysis were done using SPSS version 20. Results: 71 patients participated in the study: 39 males and 32 females with a male:female ratio of 1.2:1. The indications for limb amputation included diabetic foot gangrene (71.83%), trauma (12.68%), tumor (7.04%), assault (5.63%), and vascular disease (2.82%). Lower limb amputation accounted for 92.96% and upper limb 7.04%. 47 (66.20%) patients accepted amputation in order to prolong life (67.73%), stop pain (23.91%), remove the source of bad odor (19.57%), refashion an already amputated limb (5.43%), and stop bleeding (4.35%). 24 (33.80%) patients refused because of poor body image (31.11%), fear of surgery (24.44%), belief that it would heal (17.78%), social discrimination (13.33%), superstition (13.33%), and morbidity (4.44%). Discussion/Conclusion: In the study, diabetic foot gangrene was the most common indication for amputation as collaborated by other studies. A greater percentage of patients accepted amputation. Major reason for accepting limb amputation was to prolong life, others included to stop pain, remove the source of bad odor, stop bleeding, etc. Patients who refused amputation did so mostly because of body image. Other reasons included fear of surgery and superstition.


  Upper Limb Salvage using Thoracoepigastric Flap to Cover Exposed Humerus Top


Ogbonna U, Amaraegbulam PI, Nnezianya CI

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria

Background: Managing large arm/elbow defects could be quite challenging, especially when there is exposure of a long segment of bone. In such circumstances, skin grafting will not be an option for obvious reasons. Free flap reconstruction would be ideal, especially because it would afford opportunity for single-stage surgery. However, in the third world, where the skill and equipment may be lacking, the need to explore other possibilities becomes apparent. Webster in 1937 described a thoracoepigastric flap extending from the axilla to the groin. The flap is based on a perforator system derived from the internal mammary in the thorax and the deep inferior epigastric artery inferiorly; these vessels are in continuity from the subclavian system. There is also a communication between the epigastric system and the intercostals. The flap can be applied either as a free flap or pedicled. We present a case of pedicled thoracoepigastric flap used to reconstruct a large defect of right arm with exposed humerus. Case Summary: We present a 40-year-old male who was involved in road traffic accident and sustained extensive soft tissue loss on the right arm with exposure of about 10 cm length of humerus. There was associated ipsilateral radioulnar fracture. He sustained a fracture of the same humerus when an X-ray machine component fell on him during investigation. He was treated with serial debridement, fixation of the bones while a pedicled thoracoepigastric flap was raised to cover the defect. The flap has been successfully divided on the 26th day and the patient is doing well. Conclusion: Thoracoepigastric flap can be useful in covering extensive upper arm and elbow defects when free flaps are not feasible.


  Cementless Total Hip Replacement For Management of Severe Osteoarthritis in A Developing Country: A 5-Year Assessment of Functional Outcome in 72 Consecutive Hips Top


Amechi U Katchy, Henry Ekwedigwe, Somtochukwu Katchy, Ezeobi Ifeanyi

Department of Orthopaedics, Davidson and Judith Consultants Clinics, Enugu, Nigeria

Background: Outcome assessment of joint replacement procedures allows providers and patients to evaluate the quality of services delivered, thereby adding value to the services provided. Objective: The study is to describe the pattern of presentations of our patients with hip OA who have undergone cementless total hip replacement (THR), to assess the outcome using the Harris Hip Score (HHS), and to identify any variables that affect the outcome. Patients and Methods: Between November 2008 and November 2013, 72 THRs in 62 patients were carried out by the authors at Davidson & Judith Consultants Clinics Enugu, Nigeria. These patients were assessed using preoperative and postoperative Harris Hip Score (HHS) administered at 1 year and 5 years. Results: There were 62 patients and 72 Hips. 10 (16.13%) patients had bilateral conditions; 25 (40.32%) patients had theirs on the right while 27 (43.55%) patients had it on the left. 20 (32.26%) patients were male and 42 (67.74%) were female, with M:F ratio of 1:2.1. Etiology of the osteoarthritis shows: Avascular necrosis (AVN) secondary to Sickle cell disease (SCD) 14 (22.58%) patients were due to postavascular necrosis of the head of femur, 16 (25.81%) traumatic due to Osteoarthritis (OA) like fracture head of femur with dislocation, fractured acetabulum and old dislocations.32 (51.6129%) patients had primary OA. The comparison of means of HHS showed that preoperative HHS and postoperative HHS at 1 year had P = 000 (P < 0.05). Preoperative HHS and postoperative HHS at 5 years had P = 0.000 (P < 0.05). The comparison of HHS means for gender showed that male preoperative HHS and female preoperative HHS at 1 year had P = 0.341 (P > 0.05). The comparison of HHS means for morbidity showed that comorbidity postoperative HHS and no comorbidity postoperative HHS at 1 year had P = 0.320 (P > 0.05). Conclusion: Our patients presented at a younger age with secondary osteoarthritis secondary to hip joint affectations and they benefited from our intervention with very low complication rate.


  Prehospital Care of Cervical Injuries: Trends With Evolving Neurosurgical Care Top


Onyia EE1,2, Okorie EC², Mesi M¹, Mezue WC¹, Okoli C², Chikani MC¹, Uche EO¹, Iloabachie II¹

¹Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, ²Department of Surgery, Neurosurgery Unit, Federal Medical Centre, Umuahia, Nigeria

Introduction: The cervical spine is the most common region injured in spinal cord injuries. It constitutes a significant cause of morbidity the burden of which is worse as the severity of the injury increases hence the need to institute prehospital measures that will prevent further deterioration. How well has this fared in our setting? Methods: This is a prospective analysis of 95 consecutive acute cervical spine injured cases managed at two neurosurgical centers in South East, Nigeria. Using preformed questionnaire, demographic and clinical information were retrieved. All patients had cervical radiographs and magnetic resonance imaging. Patients who had no cervical spine protection on admission had a philadelphia cervical collar applied. Data obtained were analyzed using SPSS version 21, and P < 0.05 was considered statistically significant. Results: There were 82 males (86.3%) and 13 females (13.7%). Their ages ranged between 15 and 78 years (mean 40.3, standard deviation ± 15.6) with two-third (66.3%) between 21 and 50 years. Majority were rural dwellers (65.3%), who received initial care at a nontrauma center (73.7%). MVA, motorcycle accident, and falls account for 37.9%, 23.2%, and 18.9% of etiology, respectively. Time to care was ≥48 h in 61.1%. First responders were mainly untrained passer-by (64.2%) and Federal Road Safety Corps (30.5%). Majority (65.3%) of patients were transported in sitting position. Most victims (94.7%) had no cervical protection at point of resuscitation despite 73.7% having paralysis noticed immediately or at point of extraction from scene. Complete injury (ASIA A) was seen in 29.5%, while the most common AIS at admission was ASIA B (44.2%). Mortality rate was 21.2% and was associated with delay in initiation of treatment ≥48 h (P = 0.001). Conclusions: Prehospital care of cervical spine injured patients is still crude and poorly organized as reflected by the poor quality of first responders. Rapid and safe transportation of patients remains dismal and falls short of international best practices and negatively influences fatality.



 
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