|Year : 2020 | Volume
| Issue : 2 | Page : 170-182
Nigerian Surgical Research Society 76th Scientific Conference Asaba, 2019
|Date of Web Publication||27-Jul-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Nigerian Surgical Research Society 76th Scientific Conference Asaba, 2019. Niger J Surg 2020;26:170-82
| The Effect of Tranexamic Acid Infusion on Blood Loss in Open Intramedullary Nailing of Diaphyseal Femoral Fractures|| |
Chukwuemeka Iheanacho Chibuzo
Department of Surgery, Orthopaedic/Trauma Unit, Federal Medical Centre, Asaba, Nigeria
Background: Blood loss is a concern for patients undergoing femoral shaft fracture surgeries. The objective of this study was to determine the effect of tranexamic acid (TA) in reducing the postoperative blood loss and its effect on thrombosis in patients undergoing open intramedullary nailing of femoral diaphyseal fractures. Methods: A total of 80 patients with isolated femoral diaphyseal fractures were randomized into two equal groups with patients receiving either 100 ml of 1 g TA or 100 ml of normal saline (NS) intravenously at two intervals during surgery. Hematocrit levels were measured preoperatively and postoperatively (day 1 and 5). Calculated blood loss volume was measured to determine the perioperative total blood loss. Three venous samples taken at timed intervals (preoperatively, day 5 and day 14) were evaluated for thrombotic risk using quantitative D-dimer monitoring. Results: The calculated perioperative blood loss volume was lower in the TA group (TA 0.44 ± 0.16 l; NS 0.57 ± 0.21; P = 0.004) compared to the NS group. Significantly higher differences in mean hematocrit level on day 5, lower differential hematocrit, and shorter hospital stay favored the TA group. Transfusion rate was not significantly different between TA and NS treatment groups (TA 0.95 ± 0.78; NS 1.22 ± 0.80; P = 0.124). No significant difference in the serum D-dimer value was noticed after TA administration compared to the control. However, the rate of decline to baseline was significantly faster in the NS group compared to TA group after week 1 (3.125 ± 2.15; P = 0.04). Conclusion: Tranexamate (TA) significantly reduces the perioperative calculated blood loss and the hospital stay but has an extended prothrombotic effect postoperatively in patients who undergo open intramedullary nailing for femoral shaft fractures.
| Incidence and Pattern of Extremity Fractures Seen in Accident and Emergency Department of a Nigerian Teaching Hospital|| |
Omoke NI, Ekumankama FO, Omoke Njoku Isaac
Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
Background: Extremity fracture is an important component of musculoskeletal injury worldwide. The distributions of etiological factors and types of extremity fractures vary from and within subregions and have implications in preventive and treatment strategies. Aim: To determine the incidence and pattern of extremity fractures seen in the emergency department of a Nigerian Teaching Hospital. Methods: This was a prospective study of all patients with extremity fractures seen in the Accident and Emergency Department (A&ED) of Federal Teaching Hospital, Abakaliki, over 12 months between February 1, 2016, and January 31, 2017. Results: Extremity fractures necessitated visits in 251 patients with 306 fractures giving an incidence of 22.6 per 1000 per year of A&ED attendances (39.2 per 1000 males and 9.2 per 1000 females) with an age range of 2–90 years and mean of 35.6 ± 16.7 years. Road traffic accident (184, 73.3%), fall from height (23, 9.2%), and gunshot (13, 5.2%) were the three top causes of fractures whereas tibia, femur, and humerus were the three top bones involved. Of the 306 fractures, 270 (88%) involved the long bones, while 193 (63.1%) were close and 113 (36.9%) were open fractures. Forty-four (17.5%) of them were multiply injured patient, and head injury in 32 (12.8%) was the topmost associated injury. One hundred and ninety-four (77.3%) were admitted into the surgical ward and 28 (11.2%) were self-discharged against medical advice. Conclusion: Appropriate preventive mechanisms based on observed pattern are needed. Treatment strategies entail appropriate facilities and skilled workforce to deal with fractures of varying degrees of severity and complexity observed.
| Indications for Skin Grafting in Two Tertiary Hospitals in Southern Nigeria|| |
Peace C Isamah, Cletus I Otene
Department of Surgery, Delta State University of Teaching Hospital, Oghara, Delta State, Nigeria
Background: Skin grafting is one of the most common surgical procedures performed by a plastic surgeon. It is done to close skin defects in settings where healing by the second intention or direct apposition is either not feasible or would produce suboptimal result. Skin grafting could be split thickness skin graft (STSG) or full thickness skin graft (FTSG) with the choice of thickness determined by a number of factors-desired cosmesis, size of defect to be closed, and availability of donor sites, among others. The relatively cheap nature of the procedure makes it an easy option for the patients in developing countries, while its simplicity in technique makes it one of the most commonly performed reconstructive procedures. It is indicated in wound excision for cutaneous malignancies, burns, and chronic cutaneous ulcers. The purpose of this study is to identify the most common indication for skin grafting in a tertiary hospital in Southern Nigeria. Methodology: This is a prospective study carried out at Delta State University Teaching Hospital, Oghara, and Federal Medical Centre, Asaba, Nigeria, over a period of 1 year. All patients with skin defects requiring skin grafting, who consented, were included in the study. An observer-administered questionnaire was utilized, and indication for skin grafting was documented. Data generated were analyzed using IBM SPSS version 20, and the results were presented in frequency distribution, tables, and charts. Results: A total of 68 patients participated in the study. Age range of the patients was 1–89 years. 57.4% (39) were males, while 42.6% (29) were females. More than half of the patients (57.4%) had grafting because of chronic leg ulcers, while 23.5% and 11.8% were for wound excisions/contracture release and burns reconstruction, respectively, crush injury accounted for the remaining 7.4%. Among patients with chronic cutaneous ulcers, traumatic ulcers accounted for 64.1%, pyogenic ulcers accounted for 28.2%, sickle cell and venous ulcers accounted for 5.1% and 2.6%, respectively. STSG (86.8%) was the most commonly performed compared with FTSG (13.2%). Conclusion: The most common indication for skin grafting from our study is chronic leg ulcer – trauma being the leading cause, and it is a reflection of the burden of chronic leg ulcers in this subregion. It is not surprising then that STSG is the most commonly performed skin grafting due to the large size of defect to be covered. The significantly low rate of graft following burns could be due to delayed presentation with postburn contracture – with subsequent high rate of contracture release.
| Profile of Congenital Digital Anomalies in Children Seen in Two Tertiary Health Facilities in Southern Nigeria|| |
Okoro Philemon E1, Otene Cletus I2, Gbobo Isesoma1, Okoh Nelson U3
1Department of Surgery, Paediatric Surgery Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, 2Department of Surgery, Delta State University, Abraka, Delta State, Nigeria, 3Department of Surgery, Federal Medical Centre, Asaba, Delta State, Nigeria
Introduction: Anomalies of the digits are among the common congenital limb anomalies seen worldwide. While the majority of these digital malformations are relatively minor and require simple treatment, some of them are complex and often associated with other anomalies and systemic disorders. Reports on the occurrence of these anomalies and their treatment are scanty in our region. Aims and Objectives: We sought to evaluate the burden of these digital anomalies among pediatric patients seen in our centers and outcome of treatment. Patients and Methods: The study was carried out as a prospective study in two tertiary health facilities in Southern Nigeria between June 2014 and May 2019. Data obtained and analyzed were the patients' gender, age, family history, type of digital anomaly, the limb/s involved, other limb anomalies, systemic disorders, treatment given, outcome, and duration of follow-up. Results: A total of 113 children with anomalies of the fingers and/or toes were seen during the study period, but 104 were analyzed. They comprised 63 (60.6%) males and 41 (39.4%) females, giving a male-to-female ratio of 1.5:1. Polydactyly was by far the most common digital anomaly, and the upper limbs were mostly affected. Associated anomalies contributed significantly to morbidity and mortality in those cases. Conclusion: Digital anomalies are fairly common surgical problems in our region. Although majority of cases are mild and are easily treated, the more complex ones still pose a challenge to treatment in our practice. There is need for more interest and training among surgeons in our region to improve the surgical care and outcome of treatment of these digital anomalies in our region.
| Prehospital, Crash Site Care, Perception, and Practices of Selected Doctors and Nurses in Three Tertiary Hospitals in Southwestern Nigeria|| |
Etonyeaku Amarachukwu C1, Ogundipe KO2, Akinkuolie AA1, Olaogun J2, Abiyere H3, Isola O4, Olugbami A1
1Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun State, Nigeria, 2Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria, 3Department of Surgery, Federal Teaching Hospital, Ido Ekiti, Ekiti State, Nigeria, 4Mishmael Hospitals and Clinic Hospital, Akure, Ondo State, Nigeria
Background: Vehicular crashes are common events in Southwestern Nigeria. Crash site deaths are common, and prehospital care of crash victims can reduce crash-related morbidity and mortality. The first responder care can be provided by doctors and nurses. Aims: To ascertain the proportion of doctors and nurses who are having first aid boxes and who provided some form of first responder services at crash sites and factors mitigating such services. Materials and Methods: A self-administered questionnaires was completed by doctors and nurses working in units catering for crash victims in three tertiary hospitals in Southwestern Nigeria. Focus was on demography, possession of first aid boxes in vehicles, provision, and willingness to provide, crash site care for crash victims and factors mitigating such services. Results were analyzed with IBM SPSS version 21 for frequencies and percentages. Results: Two hundred and forty-three completed the questionnaires and the data were analyzed. There were more males than females (60.9% vs 39.1%) and more doctors than nurses (55.1% vs. 44.9%). Mean age was 36.05 (range: 20–60) years, while median driving experience was 5 (0–38) years. One hundred and forty-three respondents (58.9%) had witnessed a vehicular crash, 97 (39.9%) had experienced a crash, but only 98 had ever provided crash sites care. Major perceived mitigating factors were lack of equipment (200; 82.3%) and poor emergency medical services and transport systems (205; 84.4%). Conclusion: Most doctors and nurses do not provide crash site care as they feel ill equipped to do so.
| Early Experience with Laparoscopic Surgical Practice in Ondo State Southwestern Nigeria|| |
George Chilaka Ogbonna1, Etonyeaku AC1, Katung IB2, Bamigbola KT2, Okereke CE2
1Department of Surgery, University of Medical Sciences Teaching Hospital, Ondo State, Nigeria, 2Department of Surgery, Federal Medical centre Owo, Ondo State, Nigeria
Background: Laparoscopic surgery is a relatively new and expanding field of surgical therapy in Ondo State. This is a multicenter study from Ondo State, Nigeria. Aim: To determine the indications, operative findings, and interventions at laparoscopy in study centers. Patients and Methods: This was a 9-year retrospective review of laparoscopy at the Federal Medical Centre, Owo; Ondo State Specialist Hospital, Okitipupa; University of Medical Sciences Teaching Hospital, Ondo; George and Martins Medical Centre, Ore; and Mishmael Hospitals and Clinics, Akure. Data on patient's age, gender, indications for surgery, duration of hospital stay, and outcome of surgery were analyzed. Challenges and adaptations were also noted. Results: One hundred and eighty-one laparoscopies were done; only 152 had completed records for review. The median age was 35.5 years (range 8 month to 72 years). There were more males 88 (57.9%) than females, 64 (42.1%). Laparoscopy was purely diagnostic (n = 28, 18.4%), therapeutic (n = 118, 77.6%), or both (n = 6, 3.9%). Cholecystectomy (n = 76, 50%) and appendicectomy (n = 37, 24.3%) were the two most common procedures done. In the pediatric patients, patent processus vaginalis (hernia), cryptorchidism, and indeterminate sex (gender) were the common indications. Challenges encountered were power failure (n = 3, 2%), equipment failure (n = 4, 2.6%), and difficult dissection (n = 4, 2.6%). The mean duration of surgery was 96.96 (±25) min for diagnostic and 150 (±57.6) min for therapeutic interventions; while the mean duration of hospital stay was 1 day for diagnostic and 2.3 (±1.7) days for therapeutic interventions. Conclusion: Laparoscopic service is achievable with adequate motivation, males appear to benefit more in our setting, and the service transcends all aged groups.
| Surgical Outcomes after Major Abdominal Surgery in Children: Can Postoperative Morbidity Survey Determine Relevant Morbidity Dormains?|| |
Nwabuoku SE, Sholadoye TT, Audu JA, Yusufu LMD
Department of Surgery, ABU Teaching Hospital, Zaria, Nigeria
Background: Surgery is associated with considerable potential morbidity and mortality. Any tool assessing these potentials would simultaneously assess processes involved in the patient's management as well as the outcome of such care. The study objective was to establish if the postoperative morbidity survey could determine morbidity domains that adversely affect surgical outcomes (in terms of length of hospital stay [LOHS] and mortality) in children after major abdominal surgery in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Materials and Methods: This was a prospective cross-sectional study conducted at ABUTH from December 2018 to November 2019. Data were collected using a structured pro forma; the postoperative morbidity survey (POMS) data were taken on the 1st to the 5th day after surgery. Data were analyzed using IBM SPSS version 24.0.0 software, and the statistical relationship between the 5th day POMS findings, LOHS, and mortality was determined. Categorical data were analyzed using the Chi-square test, with P < 0.05 being regarded as statistically significant. Results: A total of 84 patients with 60 males and 24 females (male:female ratio = 2.5:1) were studied. Forty-two (50.0%) patients were in the 4–12 years (school-age) age group. Thirty-eight patients (42.9%) had no formal education while six of them (7.1%) were in secondary school. Perforated typhoid ileitis was the most common preoperative diagnosis (19.0%). All had a derangement in at least one of the POMS domains on the 1st postoperative day, with 78 patients (92.9%) having derangements in the gastrointestinal tract domain. Seventy-two patients (85.7%) had derangements in the 5th day POMS, with the most common in the infectious domain (48 patients, 51.7%) and the least in the hematological domain (2 patients, 2.4%). Twelve patients (14.3%) had no derangements in any POMS domains on the 5th postoperative day. Patients who had derangements in the hematological and wound domains on the 5th postoperative day had statistically significant longer LOHS (P = 0.001 and 0.003, respectively) than those with derangements in other domains. Eighty patients (95.2%) survived and four patients (4.8%) died. These mortalities had 5th-day POMS derangement in the infectious, gastrointestinal, and wound domains. The relationship between derangement in the 5th-day POMS in the infectious, gastrointestinal, and wound domains and mortality was statistically significant (P = 0.033, 0.038, and 0.010, respectively). Conclusion: Derangements in the hematological and wound domains of the POMS at 5th day after surgery significantly prolonged the LOHS than when there were derangements in other domains. Furthermore, patients with derangements in the infectious, gastrointestinal, and wound domains are at higher risk of mortality. POMS can determine relevant morbidity domains after major abdominal surgery in children that may adversely affect surgical outcomes.
| Side-to-Side Penoscrotal Anastomosis: A Reliable Technique for Repair of Recalcitrant Urethrocutaneous Fistula in Male Children|| |
Okoro Philemon E1, Ekeke Onyeanunam N1, Okoi Nnyonno1
1Department of Surgery, Paediatric Surgery Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, 2Division of Urology, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Introduction: Urethrocutaneous fistula (UCF) is an abnormal communication between the male urethra and the skin. Surgical repair of these fistulae is relatively simple, and the results are often satisfactory. However, in some cases of UCF repair, recurrence can occur following several attempts at repair. Reports are scanty on the management of such recalcitrant UCF. Aims and Objectives: To present our experience with recalcitrant UCF and to describe our technique of side-to-side penoscrotal anastomosis (PSA) for repair of such fistulae. Patients and Methods: This is a 10-year analytical comparative study of the outcome of repair of recalcitrant UCF in pediatric patients using the simple double-layer repair technique and our technique of anastomosing the penis to the scrotum. Children who had repeated repair of UCF were studied partly retrospectively and partly prospectively between 2008 and 2018 in our center. Data obtained included the number of previous attempts at repair, number, site and size of UCF, technique of repair, and the incidence of recurrence of UCF. Data were analyzed with the IBM SPSS version 21. Results: Nineteen patients were studied. Nine had conventional double-layer repair of UCF with recurrence in 5 (55.6%). Two of the recurrent cases were added to the remaining 10 patients to make a total of 12 cases who had the staged repair by PSA, and there was no recurrence during the average follow-up period of 1 year, P < 0.05. Conclusion: Findings in this study point to a superior outcome when the PSA is used for repair of recalcitrant UCF. We think that it is better to apply this technique in cases of UCF which the surgeon considers potentially difficult than to wait to have a failed attempt before deploying it.
| The Histological Patterns of Breast Lumps at Delta State University Teaching Hospital, Oghara|| |
Ejeheri OD, Imoudu GO
Department of Surgery, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
Background: Breast lumps are a common presentation in surgical outpatient clinics, with potential malignancy. Various symptoms and etiological factors are clinical pointers to the possibility of cancer, and early or late presentation may affect prognosis. They therefore pose a management challenge as they require urgent clinical, radiological, and histological evaluations to make the distinction, for which the patient may be unable to pay at the time. Moreso, the required intervention following evaluation in the case of malignancy can be daunting to patients both financially and psychologically. The fear of this is a further cause of delay. The aim of the study is to assess the clinical presentation, radiological and histological evaluations, and diagnosis of breast lumps in Delta State University Teaching Hospital so that we can bring awareness to the community and healthcare providers on this pathology. In addition, this will help in developing guidelines for the management of breast lumps in our setting. Methods: This is an observational prospective study from November 1, 2018, to November 1, 2019, of 51 female patients who had histological studies of breast lumps. Results: Breast lumps were noticed to occur in the female population from 17 to 68 years, with a mean age of 41 years. The average duration of disease before presentation was 22 months. The percentage of lumps that were malignant was 66% with the highest occurring histological diagnosis of invasive ductal carcinoma in 28% of the patients in the survey. The patients with malignant breast lumps mostly presented in Stage III disease (57%), and 50% of them had a BIRADS score of 5 though 53% of benign cases had a BIRADS score of 4. Of the patients surveyed, 78% resided in 13 petroleum producing local government areas (LGAs) of the 25 LGAs in Delta State, and of this percentage, lumps were more likely to be malignant (40%) unlike the equal distribution between benign and malignant in the other 12 LGAs. This was found to be statistically significant (P = 0.006) Conclusion: Breast lumps are becoming more common among women, and early presentation and evaluation are helpful in prompting timely and potentially lifesaving intervention. There is however the need to look into the effect of petroleum exploration on the health of the population, especially in relation to tumorigenesis and cancer.
| A 4-Year Retrospectives Evaluation of Nontrauma-Related Pediatric Abdominal Surgical Emergencies in Federal Medical Centre, Asaba|| |
Department of Surgery, Federal Medical Centre, Asaba, Delta State, Nigeria
Background: Pediatric surgery is age-related general surgery in a broad sense; children are not regarded as small adult but rather as special patients. Pediatric surgical emergencies are associated with higher morbidity and mortality. The aim of this study is to compare the epidemiology of nontrauma-related pediatric abdominal surgical emergencies in our center and to determine the indicators for survival in a cohort of patients. This research was done in Lagos University Teaching Hospital (LUTH) in 2012 and published in Nigerian Medical Journal April–June 2012. Patients and Methods: This was a retrospective sturdy of children aged 1 day to 18 years who presented with nontrauma-related abdominal emergencies at Federal Medical Centre (FMC), Asaba, Delta State. Results: There were 92 children. The mean age at presentation was 7.4 years (range 1 day to 18 years). There were 55 males (59.78%) and 37 females (40.22%). Female/male ratio was 1:1.5 Seventy-seven (83.7%) presented within 48 h of the onset of symptoms, while 15 (16.3%) presented after 48 h. Acute appendicitis (42, 45.6%) was the most common indication for pediatric emergency in FMC, Asaba, followed by intussusceptions (18, 19.56%) and obstructed inguinal hernia (12, 13.04%). There were four deaths in all (4.3%) mortality rate. Three out of 12 (25%) neonates died compared with 1 (1.25%) patient in the other age groups. There were two mortalities (9.09%) among patients with postoperative complications, compared with two without any postoperative complication. Conclusion: Acute appendicitis (42, 45.6%) is the most common cause of nontrauma abdominal surgery done in the pediatric unit, compared to the study done in LUTH where intestinal obstruction is the most common. Neonates who are delivered outside the center and also presented late greater than 48 h in severe postoperative complications, are associated with high mortality.
| The Use of Pentazocine, Promethazine, and Midazolam in Proctocolonoscopy in Adults in University of Benin Teaching Hospital|| |
Irowa OO, Agbonrofo PI
Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
Background: Colonoscopy is a useful armamentarium for the diagnosis of lesions in the colon. In Africans on high-fiber diet, bowel preparation is required. Sedation/anesthesia makes the procedure easier and tolerable. Poor tolerability is one of the reasons for incomplete colonoscopy, and the later may be secondary to anxiety and pain. Complete colonoscopy involved visualization of the cecum. Aims/Objectives: To share our experience on the use of pentazocine, promethazine, and midazolam during colonoscopy, highlighting the tolerability of procedure, success rate, and lesional findings. Patients and Methods: This is a 2-year prospective study in the surgical services of the University of Benin Teaching Hospital. All patients entered a pro forma. The patients had low-residue diet consisting of Pap 3 days before. Twenty-four-hour before proctocolonoscopy, all patients were given oral magnesium sulfate and castor oil in two divided doses. All patients had intravenous single-dose pentazocine, promethazine, and midazolam. Blood pressure, pulse rate, respiratory rate, and oxygen saturation were monitored during the procedure. Patients who required additional doses of midazolam were adjudged to have poorly tolerated the procedure. Specimens were subjected to histopathologic analysis. The patient's demographics, indication for colonoscopy, and tolerability of the procedure were analyzed. Results: A total of 129 colonoscopies were done over the study period. The male-to-female ratio was 3:2. The peak age was 65 years, and the cluster age group was 5th–8th decade of life. Bleeding per rectum was the main indication for colonoscopy (37.2%). Others were altered bowel habits, abdominal pains, suspected colon cancer, anal protrusion, surveillance, and screening. The colon was normal in 28.7% of the patients. Hemorrhoids were most common in 24.8%, colon cancer constituted 15.5%, and others were diverticular disease – 10.1%, inflammatory disease – 6.2%, and polyps – 2.3%. In 12.4%, there was more than one lesional finding. One hundred and twenty-five patients (97%) tolerated the procedure, while 3% (4) poorly tolerated the procedure. Poor tolerability was three times more common in males than females. The complication rate was nil. Conclusion: The most common indication for colonoscopy was bleeding per rectum. The two most common lesions were hemorrhoids and colon cancer in our environment. Colonoscopy is well tolerated with the use of pentazocine, promethazine, and midazolam. It is the authors' opinion that single-dose promethazine, pentazocine, and midazolam are adequate for elective colonoscopy and are so advocated after bowel preparation using magnesium sulfate and castor oil.
| Breast Diseases: Another Look at Clinical Findings and Histopathological Diagnosis|| |
Chimezie Innocent Madubogwu
Department of Surgery, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra State, Nigeria
Background: Physical characteristics associated with breast lumps are very vital in making clinical diagnosis of breast conditions. Combined evaluation of these physical characteristics of the breast tumor is the main ingredient in making clinical diagnosis of breast diseases. Objective: To evaluate the physical findings of the breast tumor in relation to the histopathological diagnosis of the various breast diseases. Materials and Methods: This was a 1-year prospective study of all the consecutive patients with palpable breast lesion presenting at the general surgery outpatient clinics. Patients were evaluated clinically and then followed up until the histology report was obtained following open surgical biopsy. The data were entered into a database, and statistical analyses carried out using the IBM SPSS version 17.0. Results: Of 110 patients evaluated, 47.3% were malignant and 52.7% benign. Fifty-four patients had masses greater than 5 cm in its widest diameter; 13 of them were benign and 41 malignant (P = 0.00). Thirty-five patients had axillary lymphadenopathy; 30 of them were malignant while five had benign disease (P = 0.00). Forty-seven masses were hard; 3 (6.4%) benign and 44 (93.6%) malignant (P = 0.00). Of the 37 patients with attached masses, 3 (8.1%) had benign diagnosis while 34 (91.9%) were malignant (P = 0.00). Of 52 patients with malignancy, 23 (44.2%) had no skin change while 29 (55.8%) had at least one skin change (P = 0.00). Only 4 (6.9%) patients out of 58 with benign diagnosis had skin changes. Conclusion: The physical features of breast masses still shows known relationship with the histopathological diagnosis.
| Childhood Bone Infections in a Southern Nigerian Tertiary Hospital|| |
Emeagui NK, Obu GO, Hyginus Hio, Emeagui DO, Ajaegbu CO, Esievoadje SO, Urhi A
Department of Surgery, Federal Medical Centre Asaba, Asaba, Nigeria
Background: The burden of pediatric bone infections varies in different subregions of the world and poses a significant threat to optimal childhood growth and development. The aim of this study is to determine the prevalence, sites, microbiological causes, clinical presentations, and outcome of childhood osteomyelitis. Methods: This was a 4-year single-center retrospective study of all pediatric osteomyelitis managed from January 2014 to December 2018. Important information such as the type (acute or chronic) of osteomyelitis, bone, bone sites (diaphyseal, metaphyseal, or epiphyseal) affected, culture results, genotype, drugs used for treatment, and outcome. Results: Of 3657 children, 40 had osteomyelitis; 16 (40%) and 19 (47.5%) diagnosed with acute and chronic osteomyelitis, respectively. The prevalence of osteomyelitis was 1% with a male-to-female ratio of 1:1.2 and a mean age of 8.2 ± 4.23 years. The average duration of admission was 19 ± 14 days. Tibia (47.5%) and femur (25%) were the most common bones. Staphylococcus aureus accounted for 45% of cases, and the metaphysis was the most common site involved. A total of three patients had septic arthritis complicating acute osteomyelitis. The SCD to normal genotype is 1:3. An antibiotic combination of ampiclox and gentamicin or ceftriaxone and clindamycin were used empirically in most of the cases. Incision and drainage and sequestrectomy were also treatment modalities in chronic osteomyelitis. Conclusion: Childhood osteomyelitis remains a debilitating disease responsible for prolong hospital stay.
| Demographic Characteristics of Breast Cancer Patients at the Federal Medical Centre, Asaba|| |
Ezeokenwa MO, Osarenkhoe MO, Amaefule KD, Maduemezie B, Ossai CO
Department of Surgery, General Surgery Unit, Federal Medical Centre, Asaba, Delta State, Nigeria
Introduction: Breast cancer constitutes a majority of patients (56%) seen at the Oncology Clinic at the Federal Medical Centre (FMC), Asaba. Cases of breast cancer in Nigeria are characterized by younger age at onset (40–49 years), premenopausal status, and the most common histopathological status being that of invasive ductal carcinoma. The aim of this study was to determine the age of presentation, sex, menopausal status, and the most common histopathological pattern at the FMC, Asaba. Methodology: It was a prospective study of biopsy-proven cases of breast cancer that presented at FMC, Asaba, between June 2019 and November 2019. Age at diagnosis, sex distribution, menopausal status, and histopathological pattern were assessed. Results: There were 24 biopsy-proven cases of breast cancer over a 6-month period. The average age was 48.13 years with an age range of 28–76 years and peak age of 36–45 years. 23 (95.8%) were in females. Majority of the patients 13 (54.17%) were in the postmenopausal age group. All of the patients presented at advanced stages (III and IV), while the most common histological types was invasive ductal carcinoma (83.3%). Conclusion: This study indicates that patients presenting with breast cancer at the FMC, Asaba, are predominantly women, with most in the postmenopausal age group, with the most common histopathological type being invasive ductal carcinoma.
| Modified Alvarado Score as a Useful Tool in the Diagnosis of Acute Appendicitis|| |
Department of Surgery, Federal Medical Centre Asaba, Asaba, Nigeria
Introduction: A diagnosis of acute appendicitis in patients presenting with right iliac fossa is a surgical challenge, especially to young surgeons. The clinical presentation of acute appendicitis may mimic other abdominal conditions. This may result in increased negative appendicectomy rate following surgical intervention which may expose the patients to unnecessary risk of anesthesia and surgical complications. With the gold standard of confirmation being histology, modified Alvarado score was designed to assist in the diagnosis of acute appendicitis, thereby reducing the risk of anesthesia and surgery. It is a ten scoring system incorporating both clinical features and laboratory investigations. A score of 1–4 excludes appendicitis, 5–7 is equivocal, and 8–10 strongly suggest acute appendicitis. This study was to assess the usefulness of the scoring system in our environment. Methods: It was a prospective study of patients presenting with right iliac fossa at the University of Benin Teaching Hospital between 2015 and 2019. Sixty-two patients were included in the study and were divided into Groups A1, A2, and A3. A1 had patients with scores of 1–4, A2 with scores of 5–7, and A3 with a score of 8–10. All the patients had appendicectomy following clinical evaluation, and specimen was sent for pathologic examination which was then compared to the scores. Data were extracted from a pro forma into a data collection sheet and analyzed using IBM SPSS version 21. Results: Sixty-two patients were in Group A1–A3. The age range was 21–30 years with a mean of 25.4 ± 9.1 years and the male-to-female ratio was 1:1.9. Right iliac fossa and nausea/vomiting were the most common presenting features (100% and 96.8%), respectively, while leukocytosis was the least parameter (24.2%). Half of the patients (50%) were in Group A2, 33.9% in Group A3, and 16.1% in Group A1. 80.6% of the patients had histologically confirmed acute appendicitis. Of the ten patients in Group A1, only two had histologically confirmed appendicitis, 27 of the 31 patients in A2 had histologically confirmed appendicitis, while all patients in A3 had confirmed acute appendicitis. P < 0.001 was considered statistically significant. At a cutoff of 4, sensitivity and specificity were 96.0% and 66.7%, respectively. Positive predictive value and negative predictive value were 92.3% and 80.0%. At a score of 8, sensitivity and positive predictive value were 100% and negative predictive value was 29.3%. Negative appendicectomy rate was 19.4%. Conclusion: This study shows that modified Alvarado score is useful in making a diagnosis of acute appendicitis. It also decreases the rate of negative appendicectomy.
| Nonsteroidal Anti-Inflammatory Drugs-Induced Gastric Perforation in Uyo|| |
Udo I, Ubochi D, Ita I
Department of Surgery, General Surgery Unit, University of Uyo Teaching Hospital, Uyo, Nigeria
Background: Acute gastric perforation (AGP) is a sudden and severe condition with heightened morbidity and mortality from associated systemic derangements. Abuse of nonsteroidal anti-inflammatory drugs (NSAIDs) is a known cause of the disease. Most patients with AGP present late and usually require correction of metabolic derangement, surgical closure of the perforation, and treatment of associated peritonitis. Aim: To audit and characterize patients with an operative diagnosis of NSAID-induced AGP. Methods: This was a retrospective/prospective observational study of patients presenting in the emergency room with acute abdomen and a final diagnosis of NSAID-induced gastric perforation. Records were abstracted and analyzed with IBM SPSS version 17 and presented as percentages and tables. Results: Seventeen cases of NSAIDs-induced gastric perforation were recorded over 2 years (January 2018–December 2019), with four cases in 2018 and 10 in 2019. Three records were not traced. There were 11 males (78.6%) and 3 females (21.4%). All the perforations were located anteriorly in the gastric antrum. Seven (50%) cases occurred in the 41–60 years of age group, 4 (28%) in 18–40 years of age group, 2 (14%) in persons older than 81 years of age group, and 1 (7%) in the 61–80 years of age group. All patients had deranged urea and electrolytes, two of whom underwent sessions of hemodialysis before and after surgery. One patient was reoperation for failed closure. Three deaths (21% mortality) were recorded. Summary/Conclusion: Gastric perforation from NSAID is a strong differential in acute abdominal pain and affects predominantly males in Uyo. The anterior gastric antrum was commonly the location of injury. Young and middle-aged individuals were more at risk. Renal impairment is a common accompaniment in all patients, and the 21% of mortality we experienced though considered high is within normal for this condition.
| Open versus Laparoscopic Appendectomy: Comparing Apples to Apples|| |
Ekwunife CN, Anele AA, Oparaocha D, Duru O, Enendu SE
Department of Surgery, Federal Medical Centre, Owerri, Nigeria
Background: Open appendectomy has been a safe and efficacious treatment for acute appendicitis. However, the advent of minimal access surgery has modified the treatment options for this disease condition, especially in the developed countries. Objective: To compare the early experience with laparoscopic appendectomy to the standard open appendectomy in a resource-poor environment. Methodology: Patients records of cases of appendectomies at Federal Medical Centre, Owerri, in the 5-year period January 2014 to December 2018 were reviewed. Information on patient demographics, type of operation done, cadre of the surgeon, duration of hospital stay, and outcomes was retrieved. Results: The total number of operations for acute appendicitis done within the period was 189 (open 161 and laparoscopic 28). In the open group, there were 79 males and 82 females, whereas in the laparoscopic group, there were 21 females and 7 males. Laparoscopic appendectomy was done by only one consultant surgeon, whereas open appendectomies were done predominantly by residents in 96.9% (n = 156). One mortality was recorded, which occurred in a patient who had overwhelming sepsis from ruptured appendicitis. Conclusion: Open appendectomy is the default treatment for acute appendicitis in our center. Laparoscopic appendectomy will become more widespread when residents become competent to carry out the procedure.
| Pattern of Presentation of Breast Cancer in Asaba|| |
Osarenkhoe MO, Ezeokenwa O, Uwuigbe O, Emejulu I, Amaefuna KD, Maduemeziae B
Department of Surgery, Federal Medical Centre Asaba, Asaba, Nigeria
Background: Breast cancer (BC) is the most common cancer worldwide, and local studies have demonstrated this. It is also one of the leading causes of death from cancer in our environment. It affects women in their prime, and so, it is a major burden on the family and society at large in terms of psychosocial, economic, and the health infrastructure. Aim: In Asaba, no previous study has been done on breast cancer. The aim of this study was to determine the pattern of presentation of BC as seen in Federal Medical Centre, Asaba. It is to find the sociodemographics, major presenting complaints and duration, stage of presentation, histopathology, and survival. Methods: We collected data from the cancer registration records and matched case files over a 2-year period starting from January 2016 to December 2017. We collected information on age at presentation, sex, occupation, presenting complaint, age at menarche, parity, menopausal status, use of oral contraceptives or hormone replacement therapy, side involved, stage at presentation, histopathological type, and status on follow-up at 2 years. These were analyzed using simple percentages. Results: A total of 38 histopathologically confirmed cases of BC were seen over the period. The peak age of presentation was fourth and fifth decades, i.e., 31–50 years (52.6%). All our patients were females (100%). Majority (61%) of our patients were multiparous. 97.4% presented with breast lump. 40% of them presented more than 1 year after onset of symptoms. Majority (40%) of them attained menarche at 12–14 years. 73.7% of them never used oral contraceptives or hormone replacement therapy. 50% occurred on the right, 44.8% on the left, while 2.6% was bilateral. 63.1% presented in Stages 3 and 4. 95.8% were invasive ductal carcinoma. At follow-up, about 30% of our patients were alive, 21% died, and 36.8% defaulted at 2 years. Conclusion: Our study highlighted the pattern of BC in Asaba and this is similar with results from other studies in Nigeria and other developing countries. Delayed presentation and at an advanced stage remain the hallmarks of the pattern of presentation of BC in Nigeria.
| Spectrum of Adult Anorectal Diseases in Delta State University Teaching Hospital, Oghara|| |
Akpo EE, Omatighene EU, Enuma NJ, Emanerame TP
Department of Surgery, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
Introduction: Anorectal disorders could be discomforting and debilitating. Presentations are usually insidious and often times chronic, with or without complications. We document the spectrum of anorectal diseases in our environment and highlight the significance of early intervention. Methods: This is a 5-year prospective hospital-based study carried out between November 1, 2014, and October 31, 2019, at the Delta State University Teaching Hospital, Oghara. All patients older than 18 years of age who presented in the surgical outpatient clinics or via the emergency room with anorectal conditions compliant were included in the study, and their data were entered into a pro forma. Analysis was done using the IBM SPSS version 23. The parameters evaluated include the age distribution, and symptoms, including duration of symptoms and their diagnosis. Results: Our findings show that of 206 patients studied, 117 (56.8%) were males, while 89 (43.2%) were females giving a male:female ratio of 1.3:1. The mean age was 48.1 ± 13.7 years. Majority of the patients (142, 68.9%) were 30–59 years old. The major presenting complaint was bleeding per rectum seen in 148 patients (71.8%), followed by anal pain in 125 patients (60.7%) and constipation in 95 patients (46.1%). The least presenting complain was fecal incontinence seen in 8 patients (3.9%). The most common anorectal condition diagnosed was hemorrhoids in 88 patients (42.7%) among whom third-degree hemorrhoid was the most common (38, 18.4%), followed by first-degree hemorrhoids in 21 patients (10.2%). The least was fourth-degree hemorrhoids (12, 5.8%). The next most common anorectal disease was rectal carcinoma which was seen in 62 patients (30.1%) followed by anal cancers (24, 11.7%) and fistula-in-ano (29, 14.1%). Among patients with rectal and anal carcinoma, hemorrhoids occurred in 40.3% (P = 0.289) and 29.2% (P = 0.527) of patients, respectively, while rectal bleeding occurred in 79.0% of patients with rectal carcinoma (P = 0.132) and 87.5% of patients with anal carcinoma (P = 0.07). Conclusion: Hemorrhoid is the most common anorectal condition in our environment presenting with rectal bleeding. Patients older than 30 years in our environment should be further evaluated to rule out anal or rectal carcinoma.
| Management of Symptomatic Gall Stones in a Tertiary Care Health Institution in Southern Nigeria|| |
Promise Nnamdi Wichendu, Amabra Dodiyi-Manuel, Kelechi Ikonwa
Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Background: Gall stone disease is one of the most common problems affecting the digestive tract. The disease spectrum ranges from silent stones to symptomatic stones, with its various complications. The disease is relatively uncommon among people of the black race being unknown among the Masai tribes of East Africa. Treatment modalities range from stone dissolution, contact dissolution, lithotripsy, and surgery. Surgery is the most effective means of treating gall stones and it complications. Open surgery was once the only option surgically; however, with the advent of minimally invasive techniques, laparoscopic cholecystectomy has now become the gold standard of surgical care. The main advantage of this surgical novelty is improved cosmesis and reduction in the morbidities associated with open surgery. Aim: Although not common in this environment, there is a need to evaluate the age and sex prevalence, types of stone prevalent here, varying modes of clinical presentation, and spectrum of the disease as well as treatment modalities adopted in this institution. Methods: This is a retrospective review of all cases done in this institution within a 16-year period. The case files of these patients were retrieved and relevant information extracted using a pro forma. The results were analyzed using IBM SPSS version 22. Results: The collated information showed that gall stone disease is commoner in females with a male-to-female ratio of 1:5.6; the most preponderant age group was 41–50 years; the most common mode of presentation was recurrent right hypochondrial/epigastric pain. The most common stone type was mixed contrary to what obtains in Europe and North America. Treatment offered for symptomatic, but uncomplicated stones were open cholecystectomy and open common bile duct exploration for common duct stones. Conclusion: This study established that gall stone disease is overwhelmingly preponderant in females in this locality and continues to be treated by open surgery, which has been found to be cheaper, safe, and effective.
| The Predictive Value of Preoperative Serum Bilirubin in Simple and Complicated Acute Appendicitis|| |
Olaogun JG1, Atiba AS2, Ige JT3, Omotayo JA4, Omonisi EA4
1Department of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria, 2Department of Chemical Pathology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria, 3Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria, 4Department of Anatomic Pathology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
Background: Early diagnosis and prompt surgical intervention can reduce the rate of complications in acute appendicitis. However, accurate diagnosis still remains a common surgical problem. Aim: To determine the value of preoperative serum bilirubin level in patients with simple and perforated appendicitis. Methods: The preoperative serum total bilirubin (STB) and total white blood counts (WBC) were done for all patients diagnosed of appendicitis between January 2017 and December 2018. Hyperbilirubinemia was defined as a total bilirubin >1.0 mg/dl, and histopathology of the appendix specimen was considered the final diagnosis. Data were analyzed using IBM SPSS version 21. A P < 0.05 was considered statistically significant. Results: Eighty-two patients were seen during the study period. Their ages ranged between 8 and 77 (mean 28.4 ± 13.6) years. There were 48 (58.5%) males and 34 (41.5%) females (male:female = 3:2). Sixty-two (75.6%) patients had simple appendicitis, 19 (23.2%) had perforated appendicitis, while a patient (1.2%) had uninflamed appendix. The mean STB in nonperforated and perforated appendicitis was 0.8 ± 0.5 and 1.4 ± 0.4 mg/dl (P = 0.01), respectively, while the mean WBC was 9.7 ± 4.3 for nonperforated and 11.4 ± 3.0 for perforated (P = 0.12). STB had sensitivity of 81%, specificity of 84%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 57%. Total WBC had sensitivity of 60%, specificity of 68%, PPV of 86%, and NPV of 34%. Conclusion: High STB is a useful adjunct to improve the diagnostic yield in perforated appendicitis. Hyperbilirubinemia and clinical features consistent with complicated appendicitis should warrant early surgery.
| Social Issues in Medicine: An Evaluation of Determinants of Medical Brain Drain in Nigeria|| |
Department of Surgery, College of Medicine, Enugu State University of Science and Technology, Enugu State, Nigeria
Background: The national health care system of Nigeria continues to suffer from scarcity of medical workforce resource available to them. Brain drain has been blamed as a major contributor to this state of affairs. Objective: To evaluate some of the major causes of medical brain drain in Nigeria using clinical medical students of a Nigerian University as study population. Materials and Methods: A questionnaire titled “Survey of Nigerian Medical Doctors Country of Practice Preference” was developed and administered to 120 clinical medical students of Enugu State University College of Medicine. The questionnaire was ascertained to have psychometric reliability and construct validity. Results were analysis using SPSS software and presented in tables and graphs. Results: Age range was 20–40 years with majority in the age range 20–25 years. There were 56 males and 64 females. We found that 87.5% were single, 54% said the primary motive to study medicine was personal interest, followed by 34.2% who said bright job prospects were the main reason and only 8.3% are studying medicine because of humanitarian considerations. Everything considered, only 15.8% will like to practice in Nigeria while 64% will practice anywhere that pays better. None of age, sex, marital status, or specialization was an important determinant of preferred place of practice. Conclusion: Social indices such as riches, better social life, and better working conditions were strong incentives before entering to study medicine and were equally important in deciding where to practice medicine. In the context of Nigeria, there is need to look at improvements in remuneration of medical practitioners, updating health infrastructure, and improving social services to stem the present state of medical brain drain.
| Achalasia Cardia as Seen in a Tertiary Center in Midwestern Nigeria|| |
Okugbo SU, Efobi CA, Osemobor KO, Olufemi SP
Department of Surgery, Federal Medical Centre Asaba, Asaba, Nigeria
Introduction: Achalasia cardia is a functional dysphagia affecting predominantly the third to fifth decade of life across both sexes. It has pathological features of neurodegeneration affecting the auerbach plexus of the esophagus manifesting as failure of propulsive peristalsis and relaxation of the lower esophageal high-pressure zone to incoming bolus. Its prevalence in Nigeria has not been established due to lack of population-based studies; however, hospital-based studies have shown it to be relatively rare, though its incidence appears to be rising from recent hospital-based studies. Aim of the Study: This study aims at reviewing the hospital-based incidence, mode of presentation, management, and outcome of patient's diagnosed in our tertiary center. Patients and Methods: This is a cross-sectional survey of all patients who presented with features and confirmed cases of achalasia cardia presenting to the Cardiothoracic Unit of the University of Benin Teaching Hospital, Benin City, from October 2011 to November 2019. Results: A total of 20 patients were seen in the period under review, 98 months, with a male:female ratio of 1:1.5. Age range was 20–67 years. Mean age of 41.2 ± 3 years. Modal age at presentation was 31–40 years with 75% of patients <50 years. 75% were Stage II and 20% were Stage III while only 5% were in Stage I. 85% had modified Heller's procedure through the abdominal route with only 15% having colon replacement. One patient had colon replacement post modified Heller's due to persistence of complains and the diagnosis of squamous cell carcinoma postmodified Heller's. All cases of modified Heller's were done through the abdominal route. Conclusion: Achalasia cardia is a rare disease in our locality. Most patients presents with advanced stage of the disease. Modified Heller's esophagocardiomyotomy through the abdominal route provides satisfactorily relief in our study.
| Pattern of Presentation of Congenital Diaphragmatic Hernia at the Federal Medical Centre, Asaba|| |
Orakue OI, Iyamu CO, Agbomah AA, Okolie E
Department of Surgery, Cardiothoracic Surgery Unit, Federal Medical Centre, Asaba, Nigeria
Background: Congenital diaphragmatic hernia (CDH) occurs through embryologic defects in the diaphragm. Majority of the patients presents early in life; however, a subset of adults may present with a smaller congenital hernia that was undetected during childhood. They are of two main types; the posterolateral hernia otherwise called Bochdalek hernia and the anterior hernia also called the Mogagni hernia. The presence of this defect promotes the herniation of the abdominal visceral into the chest. It is usually commoner on the left than on the right. The pathology was first described by Bochdalek in 1848, but it was not until 1946 when Gross did the first successful repair of the defect. The pathophysiology of CDH involves pulmonary hypoplasia, pulmonary hypertension, pulmonary immaturity, and potential deficiencies in the surfactant and antioxidant enzyme system. The compressive effect of bowel herniation into the chest during crucial stages of lung development leads to limited airway divisions on the ipsilateral side compared to the contralateral side. Because airspace development follows airway development, alveolarization is simply reduced. Development of the pulmonary arterial system parallels the development of the bronchial tree, and hence, fewer arterial branches are also observed in CDH. Most patients with CDH present with respiratory distress and cyanosis. The respiratory distress can be severe and may be associated with circulatory insufficiency that would necessitate aggressive resuscitate measure. The diagnosis of CDH may be made prenatally as early as second trimester or postnatally in the neonatal period and beyond. Suggestive findings include in the prenatal period include polyhydramnios, absent or intrathoracic gastric bubble, and a mediastinal and cardiac shift. Management remains a major challenge to surgeons as mortality and morbidity are still high and are usually related to degree of lung hypoplasia. Aim: To review the spectrum of clinical presentations and outcome of surgical management of patient presenting with CDH. Methods: This is an on-going research work which commenced in October 2016 at the Federal Medical Centre, Asaba. As of November 2019, five patients with CDH have been recorded. There were four males and one female. The Ages at presentation were 4 weeks, 10 weeks, 4 years, 10 years, and 40 years, respectively. All five patients presented with shortness of breath, two had severe chest pains, while three patients had cough, and one presented with asthma-like symptoms. Three of these patients were been managed in the pediatric unit for respiratory distress for quite some time before we were invited; two patients were involved in roads traffic accident but were incidentally found to have congenital diaphragmatic hernia at surgery. The diagnosis was made with chest X-ray in 4 of the patients and by a chest computed tomographic scan in one. They all had posterolateral defects and the sizes of the defect range from 5 cm × 6 cm to 7 cm × 8 cm. The herniating viscera included stomach, spleen, omentum, and transverse colon. There were no additional congenital malformations seen in any of the patient. All the defects were closed primarily; no prosthetics material was used. Three had thoracotomy while two had laparotomy to close the diaphragmatic defects. Results: All patients did well postoperatively and were discharged between the 5th and 8th postoperative day. The postoperative chest X-ray showed satisfactory repair. There were no complications recorded.
| Management of Traumatic Cerebrospinal Fluid Fistula: Our Experience in a Newly Established Unit of a State-Owned Hospital, Southeast Nigeria|| |
Ozor II, Okoro PE, Basil-Nwachukwu CC
Department of Surgery, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
Introduction: Traumatic cerebrospinal fluid (CSF) fistula occurs when there is fracture of the base of the skull with dural tear. It can follow surgical or nonsurgical trauma with over 80% of the cases of traumatic CSF fistula occurring as a result of nonsurgical trauma. Road traffic accident (RTA) is the leading cause of traumatic CSF fistula via the nostrils or the ears. Majority manifests within 48 h and stop spontaneously within 7 days. Few may require surgical intervention. Our aim was to showcase our experience in the management of patients with traumatic CSF fistula. Methods: A retrospective study on 50 patients with traumatic CFS fistula over a 2½ period. Information was retrieved and analyzed using statistics and IBM SPSS version 16. Results: 40 (80%) were males and 10 (20%) females (M:F = 4:1). Ages range from 3 to 70 years; the peak age group was 18–35 years with the mean age 27. The etiologies varied 60% following RTA, 20% fall from height and 20% from assault. 28 patients presented with CSF otorrhea, 16 with rhinorrhea, and 6 with both otorrhea and rhinorrhea. Conservation treatment with empirical antibiotics was adopted in all and the fistulae closed within 5–10 days. There was no complication of meningitis in any of the patients. Conclusion: Traumatic CSF fistula is relatively common. A number of them present within few days of injury. Conservative treatment remains the first line of action.
| Closed Tube Thoracostomy Drainage: Experience of Junior Resident in Federal Medical Center, Asaba, from May to October 2019|| |
Orakwe OI, Iyamu CO, Agbomah AA, Okolie EK
Department of Surgery, Cardiothoracic Surgery Unit, Federal Medical Center, Asaba, Nigeria
Background: Closed tube thoracostomy is a common surgical procedure done in the accident and emergency and the hospital wards. It is indicated for drainage of pleural collections such as blood, air, chyle pleural fluids, and prophylactically following open thoracic surgeries and Video Assisted Thoracoscopy (VATS). The indications for closed tube thoracostomy in Federal Medical Center (FMC), Asaba, are similar are similar to indications obtained in the literature, ranging from trauma, malignancies, postsurgical and other medical indications, including empyema thoracis, pneumothorax, and Pulmonary TB (PTB). Closed tube thoracostomy was first described by Hippocrates in about 460–370AD. Many physicians and surgeons of old such as Galen, Guy, and Giovanni de Vigo have described closed tube thoracostomy in their work. Playfair was the first to describe water seal drainage in 1873, for the treatment of empyema. Over the years, the indications for closed tube thoracostomy have remain the same with little or no modifications. Aim: To review the indications and outcome of closed tube thoracostomy passed by the Registrar at the FMC, Asaba. Methods: This study was done within a 6-month period of rotation in cardiothoracic unit by two registrars. A total of 44 patients had closed tube thoracostomy drainage. Indications for the procedure included trauma and nontrauma causes such as malignancies, infections, postthoracostomy, and prophylactic indications. Data were obtained from accident and emergency and remaining 25% diagnosis was clinical, especially in subsets of trauma patients, in which chest tube was passed without chest X-ray (CXR) due to overwhelming respiratory distress and the urgent need for intervention without further delay. Prophylactic antibiotics and analgesics were administered, and the wound was dress daily with povidone iodine. Chest physiotherapy was done by uses of incentive spirometry and improvised balloon. Results: A total of 44 of out 74 patients admitted within this period under review satisfied the inclusion criteria and had closed tube thoracostomy drainage for various indications (53.5% of total admission). Thirty-two (73%) were males and 12 (27%) were females. The age range was between 6 months to 95 years for both sexes. Nineteen patients representing 43% of the study population had trauma. They were all males. Among the trauma patients, 10 (52.6%) had stab injury, 4 (21.1%) were gunshot wound, while 5 patients representing 26.3% had RTA. For the nontraumatic pleural effusions, 12 patients (27.3%) had malignancies. Majority of the patients with malignant pleural effusions were females with metastatic breast disease. There were two childhood tumors (nephroblastoma and peripheral nerve tumor). Infective indications accounted for 11 (25%) of the patients who had chest tube drainage. These were patients who had pulmonary tuberculosis, HIV, and empyema thoracis. Nine were males (82%), and two were females (18%). Postthoracotomy chest tube drainage accounted for 4.5% of cases. Uses of incentive spirometer improved clinical outcome, and surgical site infection was prevented by daily dressing of tube site with povidone iodine. Removal of chest tube following adequate lung expansion was done between 5th and 7th day in traumatic cases and 7th and 14th day in the other etiologies. Complications encountered include hemorrhage, subcutaneous emphysema, pneumothorax, and tube dislodgement. Two mortalities were recorded in patients with advanced malignancies from progression of the disease and not from the procedure. Conclusion: Closed tube thoracostomy is a life-saving procedure. This indication in FMC, Asaba, is similar to what obtains in literature. The outcome is usually good especially when instituted at the appropriate time. A delay in getting CXR should not delay our intervention in patients whose survival depends on the procedure. Few complications are usually encountered. These are however manageable. The experience within this period of rotation in the cardiothoracic unit was worthwhile, and I wish to recommend that all surgeons should be conversant with this life saving procedure.
| Posterior Lumbar Interbody Fusion for Degenerative Lumbar Spine Spondylolisthesis|| |
Ndubuisi CA, Chikani MC, Okwunodulu O, Mezue MC, Ohaegbulam SC
This is a Specialist Neurosurgical Centre, Memfys Hospital for Neurosurgery, Enugu, Nigeria
Introduction: Posterior lumbar interbody fusion (PLIF) is one of the options for managements of lumbar spine instability and is increasingly used in Enugu. The aim of the study is to access the outcome of cases managed with PLIF in Enugu. Methods: This was a retrospective analysis of 36 consecutive patients that had PLIF for degenerative lumbar spine spondylolisthesis over 2-year period (2016–2018) at Memfys Hospital, Enugu, Nigeria. The most common interbody fusion device was polyetheretherketone cage loaded with autologous bone graft in 92%. All patients had severe low back pain. Patients operated for traumatic spondylolisthesis and those managed with pedicle screw fixation were educated. Patients were followed up for at least 6 months. Outcome was assessed using the Japanese Orthopaedic Association (JOA) Scoring System, 5-point scale patient satisfaction, and fusion rate. Results: Mean age was 56.3 ± 7.4 years. The median duration of back pain was 3 years (range 1–15 years). The mean preoperative visual analog score (VAS) was 7.9 ± 1.1 while the postoperative VAS score was 3.3 ± 1.6. The mean JOA score before surgery and at least after surgery were 12.9 ± 2.8 and 23.1 ± 4.8, respectively. The patient recovery rate was 63.3%. Satisfactory outcome was noted in 86% of the patients managed. Average fusion rate postsurgery was 88%. The common postoperative complication was cerebrospinal fluid leak (13.8), superficial surgical infection (11%), and new-onset weakness observed in one patient. Four obese patients had implant-related complication that that require revision surgery in three cases. Conclusion: PLIF for degenerative spine disease is associated with significant improvement in preoperative back pain, neurological outcome, and patient (self)-reported satisfaction in quality of life. It is associated with good fusion rate and recovery late.