Colostomy in children: indications and common problems in Benin City, Nigeria

To evaluate the indications for colostomy and highlight associated problems as well as its contribution to the successful treatment of children. This is a retrospective study of the indications, complications, parents/caregivers acceptance and outcome of colostomy in children over a ten-year period at the University of Benin Teaching Hospital, Benin City, Nigeria. There were 46 children aged two days and 15 years [mean 3 months +/- 2.1] with male/female ratio 2.8:1. Congenital anomaly was the major indication and accounted for 40 [87%] with associated higher morbidity and mortality and an observed significant statistical difference compared with the acquired indications [P < 0.0001]. Anorectal anomaly accounting for 22 [48%] and Hirschsprung's disease 18 [39%] were the congenital indications. Morbidity and mortality were mostly associated with children that had anorectal anomaly [P = 0.0021]. Acquired indications were mainly rectovaginal fistulae, perineal and left colonic injury which accounted for 6 [13%]. Skin excoriation 39 [85%], colostomy prolapse 15 [33%] and persistent odour 21 [46%] resulted in poor acceptance by 10 [22%] parents/caregivers. Adequate preoperative counselling, skin protective paste and regular washing of colostomy site alleviated the complications. Wound infection and overwhelming sepsis were difficult to control in 14 [31%] with resultant six [13%] mortalities. Colostomy still has much to offer in emerging paediatric surgery units. Adequate preoperative counselling of parents/caregivers, good stoma care and early stoma closure gave good results in our setting

Congenital adrenal hyperplasia: the challenges of management in a developing country

The management of congenital adrenal hyperplasia [CAH] is challenging, particularly in developing countries. The objective of this study is to report the challenges and outcome of management of this pathology at an institution in Nigeria. All the children that were diagnosed with CAH at the University of Benin Teaching Hospital, Benin City, Nigeria, between January 2002 and December 2007 were included in this retrospective study. The parameters studied were: age, sex, mode of presentation, family history of similar lesions, findings on examinations and investigations, treatment given, challenges and outcome. The available parents/caregivers were interviewed in order to document their socioeconomic status, place of residence, level of education and level of awareness about CAH. The data obtained were analyzed using SPSS and presented as count, frequency and percentage, while continuous data were expressed as mean +/- standard deviation. In total, 27 children aged between 2 and 15 [mean 8 +/- 2.4] years were treated. Twenty-four of them were females and 3 males with a male-to-female ratio of 1:8. Delayed presentation, which was influenced by cultural beliefs and lack of awareness, was very common and none of the cases was diagnosed under 2 years 01 age. Oemtal manifestation was me reason ror seeking medical consultation in 23 [85%] patients, while the 3 males [11%] and one female [4%] presented due to precocious puberty. All the females were mistakenly raised as males despite obvious deformity of the phallus. Establishing an accurate diagnosis was a major challenge due to the lack of facilities and manpower required, and a combination of clinical, radiological and biochemical laboratory investigations plus/minus mini-laparotomy was used. Although surgical and steroid replacement therapy was satisfactory, gender re-assignment was very challenging and required a multidisciplinary approach, counseling and relocation of the affected families. Management was difficult mainly due to late presentation, and there is ah obvious need for a public information campaign in our country in order to increase the awareness of CAH in order to avoid wrong gender assignment in neonates

Management of chilhood abdominal masses by nigerian traditional doctors: a worrisome cause of delay in presentation

Abdominal masses are very common in Nigeria. These have been managed by traditional doctors even before the advent of orthodox medications. Traditional doctors are however, not able to distinguish between the various causes of abdominal swellings, hence all are diagnosed and managed as splenomegaly [ude]. Their modes of treatment are scarification, tattooing and concoction application in different combinations. We retrospectively studied twenty two patients who were mismanaged by traditional doctors before presenting to us at the University of Benin Teaching Hospital, Benin City-Nigeria. They all presented very late with life threatening complications and advanced diseases. Treatment offered on presentation included wound dressing, resuscitation, blood transfusion, antibiotics and laparotomy with resection of the masses, depending on diagnoses. These could only salvage 13[59.1%] of the patients while a high mortality of 9[40.9%] was recorded. The need to improve on our health care delivery system is stressed