Chronic foot ulcer complicating a traumatic arteriovenous fistula

Background: Chronic foot ulcers could be a complication of traumatic arteriovenous (A-V) fistulation. We report a rare case of chronic foot ulcer and deformity resulting from arteriovenous fistula of the anterior tibial artery. Method: The clinical presentation and the outcome of treatment in a patient treated at the University of Calabar Teaching Hospital (UCTH) Calabar are reported. The relevant literature on this subject matter is briefly reviewed. Result: A case of chronic foot ulcer and oedema secondary to traumatic arteriovenous fistula of the anterior tibial artery was managed by the authors at the University of Calabar Teaching Hospital. The diagnosis was mainly clinical as sophisticated equipment was not readily available and satisfactory healing was achieved by exploration; quadruple ligation; skin grafting and cast application. Conclusion: Prompt diagnosis and treatment of difficult cases should warrant sophisticated equipment to make diagnosis

Anaesthetic challenges in surgical excision of phaeochromocytoma

Background: Phaeochromocytoma is a rare tumour; which is benign but metabolically active; with a potential for malignancy. This tumour of adrenal or extra adrenal origin usually presents as hypertension; which can be sustained or paroxysmal and with lethal complications. Aim: To present an anaesthetic experience during the surgical resection of a phaeochromocytoma. Method: A 26-year old woman with phaeochromocytoma of the right adrenal gland is presented. The tumour was excised under general anaesthesia. The anaesthesia involved the use of continuous infusion of esmolol (an ultra short-acting intravenous cardioselective beta-antagonist) and propofol. The resected tumour was sent for histopathological examination. Results: The tumour was completely excised under general anaesthesia. The haemodynamic changes that occurred during tumour handling were controlled with fentany1;propofol/esmolol infusion. Histopathological findings confirmed phaeochromocytoma. Conclusion: Although; the anaesthetic and surgical management of a phaeochromocytoma could be an uphill task; it is possible in an environment with limit laboratory and intensive care facilities

Tropical Surgical abdominal emergencies blunt splenic rupture in Calabar

A detailed study of splenic rupture in 34 consecutive patients living in souttheastern equatorial rainforest Nigeria was conducted during a 5-years period. The results clearly show that blunt abdominal injury from road traffic accident (RTA) was the cause of rupture in the vast majority of cases. Road traffic accident was due in many cases to collision with a motor bike which is a popular means of transportation in this region. Although the external injury to the abdomen was slight; and in some cases nil; the ensuing trauma to the spleen was extensive. In contrast RTA due to the motor car; seen in 5 of the 34 patients studied; caused much associated injury to the patient. The pattern of splenic rupture seen in this tropical African community is out-standingly in contrast with that of the developed countries of the West where spontaneous rupture of diseased spleen seems to be common