Surgical Management of Common Bile Duct Stones at Saint Paul's Hospital; Addis Ababa; Ethiopia

Background: This study was aimed at evaluating the trend and outcome of surgical management of choledocholithiasis in St. Paul Teaching Hospital Addis Ababa; Ethiopia. Methods: This was a clinical based retrospective analysis. The operation register was used to identify the cases that were operated for biliary lithiasis. Their clinical records were obtained from the record office of the hospital and data collected and recorded on a predesigned format. Data was analyzed by SPSS statistical software. Pearson's chi-square test was used for statistical analysis. P-value 0.05 was considered significant. Results: A total of 1230 underwent open cholecystectomy over 5 year period of which 98 patients where found to have choledocholithiasis constituting 7. Of the 98 patients who underwent common bile duct (CBD) exploration; the records of 78 patients were found and made the basis of this analysis. Fifty-nine (75.6) patients were females and 19(24.4) were males; with a male to female ratio 1: 3. The mean age was 49.15 years. The most common symptoms were right upper quadrant pain and jaundice. The most frequent physical findings was right upper quadrant tenderness. Choledocholithotomy with T-tube insertion was done in 39 patients; side to side choledochoduodenostomy in 34 patients; and hepaticojejunostomy in 5 patients. Twenty-four (71.6) choledochoduodenostomy patients were discharged in less than ten days after operation while 36(87.1) of those with T-tube were discharged after 10 days (p0.019). The re-operation rate was 12.8for the T-tube insertion group and 2.9for choledochoduodenostomy patients. There were 3(8.8) deaths in the former and 1(2.9) in the group of choledochoduodenostomy. The overall complication rate was 11 (30.6) for the T-tube insertion and 3 (8.8) for the choledochoduodenostomies. Conclusion: Choledochoduodenostomy is a better option than Choledocholithotomy with T-tube insertion in the treatment of choledocholithiasis in African setting. We recommend choledochoduodenostomy (CD) for multiple CBD calculi; big calculi in the CBD; much dilated CBD (2cm); primary CBD stones; hepatic stones; recurrent stones; and elderly patients where the size of the CBD is 15mm and above

Aspergilloma of the Lungs: Operative Experience from Tikur Anbessa Hospital; Ethiopia

Background: Pulmonary aspergilloma represents a potentially life-threatening disease caused by saprophytic growth of Aspergillus fumigates in pulmonary cavities. This is the first report of its operative treatment from Ethiopia.The aim of this study was to determine the clinical presentations; operative treatments and post operative outcome of patients with pulmonary aspergilloma. Methods: This was a retrospective review of patients' record with post operative diagnosis of pulmonary aspergilloma treated over a period of three years between April 2005-March 2008 at The Tikur Anbessa hospital which is a teaching and referral hospital in Addis Ababa. Results: Eleven patients were included; 81.8of whom were males. Cough and hemoptysis were the two most common presenting symptoms; occurring in 11(100) and 10(90.9). The chest x-ray features typical for aspergilloma was seen in only 4(36.4). The left lung was involved in 8(72.75) and the upper lobes were the most commonly affected lobes occurring in 10 (90.9). The most frequent clinical indication for surgery was severe hemoptysis in 8 (72.75). Left upper lobectomy was the most frequently performed surgery in 4(36.4) and left pneumonectomy in 3(27.3). Four significant complications occurred in the postoperative period and one patient died; making the postoperative mortality 9.1. Histopathologic confirmation of the fungal ball was possible in 10 patients and the most common underlying cavitary disease was tuberculosis in 9(90). Conclusion: Aspergilloma is not an uncommon disease in Ethiopia and the diagnosis should be considered in patients who present with hemoptysis or chronic non-resolving cough. Surgery for pulmonary aspergilloma accounted for 5.8of all thoracotomies done at the hospital and we have adopted the policy of early surgical treatment for all cases. In our series; the commonest lung pathology behind the aspergillus lesions was cavitary pulmonary tuberculosis; similar to many reports. Since the typical x/ray finding is not present in all patients; we believe that a supportive x/ray finding is sufficient enough an investigation to decide on early surgery in patients who present with suggestive symptoms