Unusual blast colonic injury due to a fall.

Civilian colonic injuries are usually due to penetrating injuries like gun shots, stab wounds and blunt trauma especially following road traffic accidents. Blast injuries are caused by bomb blasts, intracolonic explosion of gases after diathermy, over-enthusiastic bowel insufflation at sigmoidoscopy or by pressure hose applied to the anus. We report the case of a 28-year old man with an unusual blast injury of the colon following a fall from a colanut tree. The transverse colon was sheared off at its two ends while the descending colon was split open along its entire length. There was a delay of 14 hours before the man was discovered in the remote bush and brought to hospital. The mode of injury, its severity and the ultimate favourable outcome are quite unique considering the gross faecal soilage of the peritoneal cavity and the inevitable time lapse before the institution of medical care.

Prognostic factors in intestinal gangrene.

103 patients with intestinal gangrene were treated over a ten-year period in Ile-Ife, Nigeria. The various causes of the intestinal gangrene were herniae (63%), intussusception (20%), adhesions (12%), volvulus (3%) and mesenteric vascular occlusion (2%). The presence of pre-operative shock, purulent and faeculent peritonitis, intra-peritoneal perforation of bowel and involvement of long bowel segments in the gangrene process; constitutes the important prognostic factors. The presence of a pre-operative febrile response also influences the course of the disease while the age and sex of the patient, the duration of symptoms and the portion of bowel involved showed no relationship with the ultimate outcome. It is recommended that the patients with the ominous prognostic factors constitute a high risk group and should be given intensive care to ensure survival.

Acute intestinal obstruction in Nigerian children.

Over a 7 year period, intestinal obstruction accounted for 41.7 per cent of abdominal emergencies and 1.03 per cent of all paediatric admissions at the Obafemi Awolowo University Teaching Hospital in Ile-Ife, Nigeria. Of the total 76 cases of acute intestinal obstruction, intussuception was seen in 34 (44.7%), peritoneal adhesions in 17 (22.4%), obstructed hernia in 14 (18.4%), roundworm impaction in 4 (5.3%), volvulus in 3 (4.0%) while faecal impaction and mesenteric cysts were encountered in 2 children each (2.6%). Generally the patients presented late to the hospital and this accounted for the high post-operative morbidity and prolonged hospital stay. Wound infection occurred in 21.1 per cent of patients and formed the commonest post-operative complication. The overall mortality was 21.1 per cent.