Outcomes of surgical treatment of malrotation in children

Background: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. Materials and Methods: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. Results: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The main presentation was vaginal bleeding (five cases). Physical examination revealed a soft; non-tender mass that bleeds on touch (six cases); with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery; one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. Conclusion: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical

Acute Sigmoid Volvulus in a West African Population

BACKGROUND: Acute sigmoid volvulus is one of the commonest causes of benign large bowel obstruction. Its incidence varies considerably from one geographic area to another. OBJECTIVE: To review the management of acute sigmoid volvulus in a relatively high prevalence area. METHODS: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH) Banjul; between September 2000 and January 2005 were studied. Information obtained for analysis from the records included age; sex; clinical features; test results; and outcomes. RESULTS: A total of 48 patients; 45 (93.8) males and three (6.3) females; with a male: female ratio of 14.3:1; age range of 19 to 78 years and mean age of 45.8 +17.6 years; underwent treatment for acute sigmoid volvulus. Twenty-one (43.8) of the patients were aged 40 to 59 years. Two (4.2) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission; while 24 (50) had emergency laparotomy at which bowel decompression; onestage resection and primary anastomosis without on-table lavage was done. The rest of the patients; 22 (45.8) had gangrenous sigmoid colons at laparotomy and consequently had Hartmann's procedure done. Fourteen patients (29.1) developed wound infection and five (10.4) had prolonged ileus that was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were five deaths giving a mortality rate of 10.4. CONCLUSION: Acute sigmoid volvulus in the Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage

Management of sigmoid volvulus in Polokwane-Mankweng Hospital

Objective. To evaluate the outcome of treatment ofpatients with sigmoid volvulus in the Polokwane-Mankweng Hospital and to identify the best managementoptions for these patients. Methods. A retrospective study was undertaken of 85patients with sigmoid volvulus treated in Polokwane-Mankweng Hospital during the period July 1997 - May2004. Results.In total, 85 patients were evaluated (77 malesand 8 females, male/female ratio 9:1). The age range was7 - 80 years (mean 42 years). Sigmoidoscopic derotationwas attempted in 17 patients, and was successful in 10patients. Laparotomy was done in 84 patients, viz. 75emergencies and 9 electives. During laparotomy, gan-grenous sigmoid colon was found in 30 patients and viablesigmoid in 54 patients. Resection with primary anastomo-sis was done in 44 patients. Hartmann's procedure wasperformed in 33 patients. Sigmoidopexy was done in 7patients. Total hospital mortality was 6% (5 deaths).Mortality in the 84 operated cases was 5% (4 deaths). Conclusions.There was no mortality in patients undergo-ing elective resection and primary anastomosis aftersuccessful preoperative deflation and in patients withviable sigmoid volvulus who underwent an emergencyHartmann's procedure. There was low mortality in thosepatients with resection and primary anastomosis on viablesigmoid (3%, 1:39). The highest mortality (1:5) occurredin cases of resection and primary anastomosis of gan-grenous sigmoid colon

Volvulus du caecum

Le volvulus du coecum se definit comme etant une plicature ou torsion; aigue ou chronique et recidivante du coecum; entrainant parfois une portion variable de l'ileon et limitee a la zone anormalement mobile du coeco-colon ascendant. Sans defaut d'accolement; le volvulus est impossible. Il s'agit d'une affection rare; de diagnostic difficile. Pourtant; il faut y penser dans le cadre d'une occlusion intestinale en urgence devant le faisceau d'arguments que nous avons developpe. L'interet de ce travail; est d'attirer l'attention sur le diagnostic precoce de cette pathologie et d'instituer un traitement chirurgical adequat afin de guerir le malade. Dans notre cas; le premier patient age de 62 ans; avec antecedent de constipation chronique; diabetique; tabagique admis dans nos services pour douleurs abdominales; vomissements et arret des matieres et des gaz. L'ASP amis en evidence une volumineuse image hydroaerique plus large que haute occupant la totalite de l'hypochondre droit. Une laparotomie exploratrice a ete pratiquee ce qui a permis: *d'identifier un volvulus du coecum necrose avec 20cm d'ileon; presence d'environ 150cc de liquide verdatre; nombreuses fausses membranes. *La seconde patiente avait presente a j 5 post operatoire d'une hysterectomie; une occlusion franche. Son ASP a mis en evidence des niveaux hydroaeriques dissemines et etages. La laparotomie exploratrice a permis. *D'identifier un volvulus d'un coecum mobile autour d'une bride reliant le fond caecal au ligament lombo-ovarien droit associes aux zones necrotiques verdatres perforees. Dans les deux cas; il a ete pratique unS resection large des lesions (amputation colo-coecale; associee aux dernieres anses ileales) suivie d'une anastomose immediate ileocolique termino- terminale. L'evolution a ete fatale pour le premier patient. Les suites operatoires ont ete favorables dans le deuxieme cas et la patiente a ete guerie. Devant toute occlusion intestinale mecanique basse; il faut evoquer en dehors des etiologies frequentes (volvulus du sigmoide; cancers coliques; etc...) le volvulus du coecum. Surtout que l'image caracteristique de I'ASP une image hydroaerique volumineuse qui occupe le coecum et deborde la region mesocoeliaque. Ce faisant; le diagnostic est pose precocement et le traitement entrepris rapidement empeche l'evolution des lesions vers un stade irreversible