Surgical Glove Perforations During Surgical Operations: an Ever Existing Risk in the Theatre

Background:The use of surgical gloves as a protective barrier between the surgeon and the patient has been the accepted standard. The prevalence of intraoperative glove perforations is high and often not recognized. Perforations may increase the potential for wound sepsis and for accidental exposure of the surgeon and the patient to human immunodeficiency virus (HIV) and hepatitis B virus.Aim: To investigate the incidence of glove perforations during surgery and to evaluate the extent to which glove perforations remain undetected during surgery. Methods: A prospective study in which a total of 2541 gloves used to perform surgical operations on 210 patients within a period of 12 months (January - December; 2009) were analyzed for perforations. These gloves were worn by the surgeons and scrub nurse and were double gloves. Twenty five unused gloves were used as control. The operations were all for general surgical cases. All gloves were tested for perforations by a simple water inflation technique at the end of each procedure. Results: By this water inflation technique; 225 gloves (8.9) were observed to have had perforations. Twenty one gloves (9.3) were noticed to have perforated in course of the surgery while 204 (90.7) were unnoticed. None of the unused gloves showed any perforation. There was an obvious difference in the perforate rate between the inner and outer gloves. It was 13.7for inner gloves as against 88.3for outer gloves.Conclusion: The incidence of surgical glove perforations is unacceptably high. The risk of transmission of diseases between surgeon/patient remains present. Protective measures like double gloving; the use of blunt needles; needle puncture resistance surgical gloves; glove liners and finger guards should be introduced in hospitals

Primary Carcinoma of the Gall Bladder in University of Port Harcourt Teaching Hospital

Background: Carcinoma of the gall bladder [CaGB] is an uncommon but deadly cancer of the biliary tract Aim: To report experience in the management and the treatment outcome of patients managed for an uncommon tumour. Methods: Case notes of 215 patients who had gallbladder surgery between 1989 and 2009 in the Department of Surgery were retrieved. Demographic data; treatment and treatment outcome were retrieved from these case notes. Results: There were 18 cases of proven primary carcinoma of the gallbladder. There were 14 (77.8) females and 4 (22.2) males with a female/male ratio of 3.5:1. The patients aged between 52 and 70 years. The mean age at diagnosis was 61.3 years. The presenting symptoms were related to the associated gall stones and they are dyspepsia; anorexia; right hypochondrial pain; palpable gall bladder mass; weight loss; jaundice; pruritus; palpable liver and ascites. Five (27.8) cases were diagnosed correctly pre- operatively while 2 (11.1) cases with distended gall bladder were misdiagnosed as gastric outlet obstruction. Eleven (61.1) cases were diagnosed during surgery and were confirmed post operatively from the histopathological reports. Attempt at curative treatment was possible for only 8 (44.4) patients with early disease (stages I and II) .Fourteen cases (77.8) were well or moderately differentiated adenocarcinoma while 4 cases were undifferentiated adenocarcinoma and squamous cell carcinoma. Conclusion: From this report; we deduced that the treatment outcome of patients with gall bladder carcinoma is highly dependent on the stage of the tumour and the feasibility of a curative treatment

Phyllodes Tumour in Young Female Adults in Port Harcourt; Nigeria

Background: Phyllodes tumour of the breast is a rare and potentially aggressive tumour. Little information is available regarding the optimal management of this tumour and rarer still; are data regarding survival. We report our experience in the diagnosis; management and outcome of phyllodes tumour. Patients and Methods: The hospital case notes of adolescent female patients found to have phyllodes tumour from 1997 to 2007 were identified from the medical records department of the hospital. Data extracted included sex; age; presenting symptoms; anatomical site of lesion and clinical evaluation including approximate size of the breast masses. Results of investigations including haemogram; urea and electrolytes; chest xray; ultrasonography; tru-cut and excision biopsy; surgical treatment and outcome of treatment were obtained. The follow up visits to the outpatient clinic were also noted. Results: There were 17 females aged between 25 and 30 years. Five patients had previous excision biopsy of fibrodenoma from the ipsilateral breasts when they were teenagers. The median tumour size was 17.5 cm in diameter. There were no clinical features suggestive of malignancy. The chest radiographs were within normal limits. Histopathological findings showed that ten (58.82) patients had the benign variety while seven (41.18) had the borderline variety. All had a wide excision of the tumour but were not offered any adjuvant therapy. Conclusion: Early diagnosis and treatment with adequate surgical margins are essential in the successful management of phyllodes tumour

Spontaneous Rupture of an Umbilical Hernia with Evisceration of Small Intestines in a 16-year-old girl

Background : Umbilical hernia is relatively common in African children. Most of these hernias close spontaneously as the children grow older and they are often remarkably free from complications. Aim: To report a case of spontaneous rupture of an umbilical hernia with evisceration of small bowel. Setting : Seaside Specialist Surgery; Port Harcourt. Case report : A 16-year-old girl; who had had an untreated umbilical hernia from birth; developed a severe pain at the site of the swelling. The swelling had quickly enlarged as a result of an obstructed loop of bowel within it. Traditional medicaments applied to it did not relieve the pain. Severe retching and vomiting ensued resulting in a spontaneous rupture of the umbilical skin. Subsequently; there was evisceration of loops of bowel through the defect. At operation; the eviscerated bowel loops were found to be viable and were returned into the peritoneal cavity. The abdomen was closed in layers with repair of the umbilical defect. Post operatively; her condition was satisfactory. Conclusion : Complications associated with umbilical hernia are not common but justify prevention by early repair of umbilical hernias with large defects

Abdominal actinomycosis; an unusual cause of intestinal obstruction

Background: Actinomycosis is a rare inflammatory disease caused by an anaerobic bacterium; Actinomyces israelii. Aim: To report a case of abdominal actinomycosis presenting as intestinal obstruction. Setting: University of Port Harcourt Teaching Hospital; Port Harcourt. Case report: A 54-year-old gentleman was involved in a road traffic accident in which he sustained fractures of the right humerus and pubic rami. A month later; he developed signs and symptoms of intestinal obstruction. At operation; a retroperitoneal mass obstructing the transverse colon and the proximal ileum was found and resected. Histological examination confirmed the mass to be due to actinomycosis infection. The patient was therefore placed on a parenteral therapy of 20 mega units of crystalline penicillin daily for three weeks and then a maintenance therapy of oral Amoxycillin for another six months. He recovered fully from the infection. Conclusion: Abdominal actinomycosis infection is an uncommon disease entity. Careful and expert histopathological analysis is essential in post operative diagnosis

Spontaneous rupture of an umbilical hernia with evisceration of small intestines in a 16-year-old girl

Background: Umbilical hernia is relatively common in African children. Most of these hernias close spontaneously as the children grow older and they are often remarkably free from complications. Aim: To report a case of spontaneous rupture of an umbilical hernia with evisceration of small bowel. Setting: Seaside Specialist Surgery; Port Harcourt. Case report: A 16-year-old girl; who had had an untreated umbilical hernia from birth; developed a severe pain at the site of the swelling. The swelling had quickly enlarged as a result of an obstructed loop of bowel within it. Traditional medicaments applied to it did not relieve the pain. Severe retching and vomiting ensued resulting in a spontaneous rupture of the umbilical skin. Subsequently; there was evisceration of loops of bowel through the defect.At operation; the eviscerated bowel loops were found to be viable and were returned into the peritoneal cavity. The abdomen was closed in layers with repair of the umbilical defect. Post operatively; her condition was satisfactory. Conclusion: Complications associated with umbilical hernia are not common but justify prevention by early repair of umbilical hernias with large defects