Gallstone disease is a worldwide medical problem, but the incidence rates show substantial geographical variation, with the lowest rates reported in African populations. Publications in English language on gallstones which were obtained from reprint requests and PubMed database formed the basis for this paper. Data extracted from these sources included authors, country, year of publication, age and sex of patients, pathogenesis, risk factors for development of gallstones, racial distribution, presenting symptoms, complications and treatment. Gallstones occur worldwide, however it is commonest among North American Indians and Hispanics but low in Asian and African populations. High biliary protein and lipid concentrations are risk factors for the formation of gallstones, while gallbladder sludge is thought to be the usual precursor of gallstones. Biliary calcium concentration plays a part in bilirubin precipitation and gallstone calcification. Treatment of gallstones should be reserved for those with symptomatic disease, while prophylactic cholecystectomy is recommended for specific groups like children, those with sickle cell disease and those undergoing weight-loss surgical treatments. Treatment should be undertaken for a little percentage of patients with gallstones, as majority of those who harbor them never develop symptoms. The group that should undergo cholecystectomy include those with symptomatic gallstones, sickle cell disease patients with gall stones, and patients with morbid obesity who are undergoing laparotomy for other reasons.

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Background: Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Methods of Study: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. Results: A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. Conclusion: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.

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The duodenum is a rare site for gastrointestinal lipoma with less than 230 cases reported in the literature. Although, peptic ulcer disease remains the most common benign cause of gastric outlet obstruction (GOO), duodenal lipomas remain a rare, but possible cause of GOO and could pose a diagnostic challenge, especially in countries where access to endoscopy and modern imaging techniques poses a challenge. The authors present a case of GOO in a 40-year-old male, secondary to a duodenal lipoma. It was successfully treated by a transduodenal resection through a midline laparotomy. The histology report confirmed it was a submucosal lipoma.

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Background: The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater education of our trainees. Materials and Methods: Residents in the department of surgery anonymously evaluated teaching in the operating room using the operating theater education environment measure. The residents evaluated 33 variables that might have an impact on their surgical skills within the operating theater. The variables were grouped into four subscales; teaching and training, learning opportunities, operating theater atmosphere and workload/supervision/support. Differences between male and female residents and junior and senior registrars were assessed using Mann-Whitney test. Statistical analysis was completed with the statistics package for the social sciences version 17. Results: A total of 33 residents were participated in this study. Twenty nine (88%) males and 4 (12%) females. 30 (90%) were junior registrars. The mean total score was 67.5%. Operating theater atmosphere subscale had the highest score of 79.2% while workload/supervision/support subscale had the least score of 48.3%. There were significant differences between male and female resident's perception of workload/supervision/support P < 0.05; however, there was no significant differences in junior registrar versus senior registrar's perception of the education environment in all the subscales P > 0.05. Conclusion: This study has shown a satisfactory teaching environment based on the existing local realities of means, resources and tools and highlighted the need for improvement in workload/supervision/support in our institution. An acceptable learning environment in the operating theatre will produce surgeons that are technically competent to bridge the gap in the enormous unmet need for surgical care in Nigeria.

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Rupture of hepatocellular carcinoma (HCC) is not uncommon and most ruptured HCC present with hemoperitoneum and hemorrhagic shock. Management of ruptured HCC is different than non-ruptured one. Short- and long-term mortality increases following rupture of HCC with increasing chances of tumor dissemination. We describe a case with non-bleeding spontaneous rupture of HCC. A 62-year-old male patient was admitted to our institute hospital with mild to moderate pain in the right upper part of the abdomen. He lost appetite and weight. Ultrasonography of the abdomen was performed and it suggested HCC and ascites. Triple phase computer tomography revealed HCC in segments 6 and 7 of liver with typical radiological characteristics. Portal vein was thrombosed. No extravasation of dye was seen. Ruptured of tumor through liver capsule was seen with necrosis and hemorrhage in the center of the tumor. Non-bleeding ruptured HCC has not been reported in the literature to the best of our knowledge. We herein describe this rare case.

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Background: Various investigative modalities are used to detect intra-abdominal injury requiring surgical intervention. Ultrasonography (US) is a cheap, readily available, safe and non-invasive investigation used in the evaluation of patients with blunt abdominal trauma. Patients are subjected to no added risk of radiation. Aims: The aim of this study was to evaluate the diagnostic value of US in patients with blunt abdominal trauma. Materials and Methods: Patients who had US for blunt abdominal trauma were prospectively evaluated from 1 January 2006 to 31 December 2007. A total of 57 patients were included is this study. US results in each patient were classified as true positive (TP), false positive (FP), false negative (FN) or true negative (TN) by comparing with findings at either diagnostic peritoneal lavage or surgery. Sensitivity, specificity, positive and negative predictive values (NPV) and diagnostic accuracy of US in detecting free fluid and in detecting the visceral parenchymal injury were calculated using two by two tables. The Epi Info statistical software version 3.4.1 was used for data analysis. Results: By scanning to detect free fluid, TPs were 46, FPs three, FNs two and TNs six. Sensitivity, specificity, positive and NPV and the diagnostic accuracy were 96%, 67%, 94%, 75% and 91% respectively. By scanning to detect the parenchymal injury, TPs were 24, FPs 15, FNs 10 and TNs 8. Sensitivity, specificity, positive and NPV and diagnostic accuracy were 71%, 35%, 62%, 44% and 56% respectively. Conclusion: US has a high diagnostic value in the screening of patients with blunt abdominal trauma. Scanning for the presence of free fluid yields better results than scanning for the visceral parenchymal injury.

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Fusion of teeth is the union of two or more tooth germs, which are usually separated. Depending upon the stage of odontogenesis, it can be complete or incomplete. The present case describes fusion between the maxillary primary right central and lateral incisor with a supernumerary tooth. Clinical and radiographic examination revealed the presence of fused triple teeth. The fused teeth were extracted, sectioned and were visualized under stereomicroscope at three levels and the diagnosis of fusion of three teeth was confirmed histologically.

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Background: In the changing world of clinicopathologic practice where surgeons and pathologists are faced with increasing therapeutic demands, precise demands of each group from the other have often been reduced to blames and counter-blames. This study is thus aimed at auditing the current practice of specimen handling as a means of highlighting areas where mutual best practice is required. Materials and Methods: A total of 200 specimens and 100 separate request cards received over the 3 months were audited for: Use of fixative, adequacy of fixative used, types of specimen containers and appropriate labeling of containers. The request cards were audited for: Documentation of patients' hospital numbers, ages, histories of disease, sites of biopsy, examination findings, investigations done, provisional diagnosis and concordance of clinical diagnosis with histopathological diagnosis. Results: About 20% of specimens were unfixed, 23.5% had inadequate fixative, 16.5% were in inappropriate containers and 32.5% were incompletely labeled respectively. In 25%, 50% and 53% of forms the age, clinical history and examination findings respectively were not documented. Provisional diagnosis was in concordance with eventual histological diagnosis in 69% of cases. Conclusion: To ensure the quality of histopathological diagnosis with minimal turnaround time, the surgeon plays a vital role by ensuring adequate and prompt fixation of tissue biopsies, put in the right container and accompanied by well labeled request cards.

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