Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?

BACKGROUND: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. PATIENTS AND METHODS:This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. RESULTS: Adhesive intestinal obstruction accounted for 21 (8.8%) of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 +/- 6.4 years), comprising 13 males and eight females (ratio 1.6:1). Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%), perforated appendix (five, 23.8%), perforated volvulus (three, 14.3%), penetrating abdominal trauma (two, 9.5%) and perforated typhoid (two, 9.5%) were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6%) children due to poor response to nonoperative management, 11-13 days in 12 (57.1%) who responded minimally and 2-5 weeks in three (14.3%) who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%), multiple bands/adhesions (13, 61.9%) and encasement, including one bowel gangrene (six, 28.6%). Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. CONCLUSION: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and mortalities in settings with limited resources

Adult Patients Presenting with Undescended Testis in Awareness-Poor Region

Objectives The majority of patients with undescended testis present during childhood with minimal complications owing to straightforward treatment with excellent postoperative outcome. This paper reports the mode of presentation; challenges and outcome of management of adult patients with undescended testis. Methods. This prospective study included consecutive cases of adult patients managed with undescended testis from January 2004 to December 2008 in Evbuomore; Nigeria. Results Eighteen adults with a mean age of 38.3 years (range 19-61) were managed during the period. Ten (55.5) had bilateral; 5 (27.8) right and 3 (16.7) left lesions. Awareness was poor as they presented due to infertility in 8 (44.4); associated hernia 5 (27.8); wife/self discovery 4 (22.2) and accidental discovery by a health worker 1 (5.6); with 9 men (50) presenting between 30 and 40 years of age. On inguinal exploration; only 3 (10.7) patients had viable but significantly reduced testicular volume; 17 (60.7) were atrophic/fibrotic while in 8 (28.6) the vas deferens ended blindly in the inguinal canal with no viable testicular tissue. Apart from three patients who had children before presentation; infertility persisted even after treatment despite adequate hormone profiles and satisfactory sexual performance. Counseling of spouses was a major challenge; with 8 couples adopting children and three marriages ending in separation. conclusion: Management of adults with undescended testis was challenging due to irreversible complications; psychological effects and poor outcome of treatment which shows the importance of awareness programs that will result in childhood presentation

Causes; Spectrum and Effects of Surgical and Neglect in a Nigerian City

BACKGROUND: Children are dependent on parents/care givers for the quality of health care services received and in developing countries; where they are not protected treatment. OBJECTIVE: The objective of this study was to determine the causes; spectrum and effects of abuse/neglect on surgical children. METHODS: Analysis of cases of surgical child abuse/neglect between January; 1998 and December; 2007 at the University of Benin Teaching Hospital; Benin City; Nigeria; was done. RESULTS: A total of 281 children aged two days and 12 years comprising 113 males and 168 females with male/female ratio 1:1.4; mainly with congenital malformation; suffered surgical child abuse/ neglect ranging from delayed presentation; to child abandonment which was perpetuated by ignorance; poverty; superstitious beliefs; customs as well as non availability offree medical services for children. Counselling and home visits in addition to surgeries were done and 198 (70.5) children were successfully treated with those abandoned happily reunited with their families; while 56 (19.9) mortality was recorded due to complications of the primary surgical pathology; and this was statistically significant compared with other children with similar lesions but without abuse or neglect during the period (P=0.0102). Whereas 27 (9.6) among those discharged against medical advice were lost to follow-up; of the 198 children that survived; 22 suffered psychological trauma and were co-managed with psychologists while seven were transferred to orphanage homes.CONCLUSION: Surgical child abuse/neglect is rampant; hence; it is hoped that these findings will influence policy makers in this sub-region to formulate policies that will protectchildren against this form of child abuse

Pattern and Outcome of Childhood Teratoma: a 10-Year Review

Background: Teratomas are neoplasms which originate from pluripotent stem cells. They are composed of a wide variety of tissues foreign to the organ or anatomic site in which they arose. This study sought to determine the clinical manifestations and outcome of treatment of childhood teratomas. Method: A retrospective analysis of the case files of children treated for teratoma at the University of Benin Teaching Hospital Benin City; Nigeria between January 1999 and December 2008 was done. Results: Fifty-three children aged between 5 days and 16 years; comprising 15 males and 38 females with male:female ratio of 2:5 were treated for teratoma; gonadal 27(50.9) and extragonadal 26 (49.1). Ovarian; 23 (43.4) and sacrococcygeal; 17 (32.1) sites were frequently involved. Other sites included testicular; 4 (7.5); retroperitoneal; 4 (7.5) and renal; 2 (3.8); while posterior mediastinal; cervical and breast involvement were 1 (1.9) each. Despite late presentation; no frankly malignant primary teratoma was diagnosed. Benign cystic teratomas with malignant elements comprising yolk sac tumour and immature neuroepithelial elements (mixed germ cells tumour) were the major histological types. Complete tumour resection that included total coccygectomy; oophorectomy and orchidectomy; plus combination chemotherapy using vincristine; actinomycin; and cyclophosphamide was curative in 25 (47.2) children. Eighteen (34) cases of recurrence were all malignant. They presented very late with rapid disease progression that resulted in 10 (18.8) deaths during the five years of follow-up. Conclusion: Although all primary teratoma were benign; recurrent malignant tumours with rapid progression to carcinomatosis; multiple organs failure and deaths were common in childhood teratoma. We advocate close follow-up of all children with teratoma to detect and commence early treatment

Male infertility secondary to varicocele : a study of the management of 45 patients

Varicocele is a common condition worldwide. The aim of this five-year prospective study is to examine the effect of varicocelectomy on the fertility profile of affected men in a male infertility clinic in Benin City, Edo State. A total of 45 men aged 16-65 years were diagnosed with varicocele during the period. Forty one (91.1%) had infertility while 4 (8.9%) were unmarried boys with third degree varicocele. Thirty seven (82.2%) consented to varicocelectomy; thirty three had infertility. Varicocelectomy was done through an open subinguinal approach. Restored testicular volume and semen quality were achieved within the first 12 months in all but one. Among the 33 men who had infertility, the spouses of 23 (69.7%) achieved pregnancy during the period of follow-up after varicocelectomy while the spouses of 10 (30.3%) had not. No major complication was recorded after operation. It is recommended that in subtropical Africa where there are no facilities for microscopic varicocelectomy and embolization, open varicocelectomy should be used. It is safe, effective and has much to offer. (Afr Reprod Health 2008; 12[1]:54-59)

Spontaneous Neonatal Gastrointestinal Perforation : Surgical or Conservatisme Management

B a c k g r o u n d : S p o n t a n e o u s n e o n a t a l gastrointestinal perforation occurs without any primary lesion of the gastrointestinal tract. It is a rare surgical emergency that may be caused by shunting of blood from renal; peripheral and mesenteric vascular bed to vital organs such as heart and brain during periods of perinatal stress.Aim: To report three neonates with spontaneous gastrointestinal perforation. Results: Between 2001 and 2005; we managed three cases of spontaneous gastrointestinal perforation in neonates at the University of Benin Teaching Hospital; Benin City. The perinatal stress factors were caesarian delivery; prematurity and fetal distress due to prolonged obstructed labour. Two had exploratory laparotomy and their perforations were closed in 2 layers while one was managed conservatively. They survived and were discharged after ten; thirty-six and eight days on admission and remained well during one year of follow up.Conclusion: Early diagnosis; adequate resuscitation and timed surgical intervention resulted to encouraging outcome

Paediatric intussusception in Benin city, Nigeria

Intussusception is one of the leading causes of intestinal obstruction in children. This study reports our experience in the management of intussusception in Benin City; Nigeria. This was a 10-year retrospective review of intussusception in children at the University of Benin Teaching Hospital from January; 1997 to December; 2006. Twenty four children were admitted with intussusception (M: F = 1:1.4) within the period. Only three patients (12.5) presented within 24 hours of onset of illness. Ten (41.6) presented between one and four days; seven (29.2) between five and 10 days; while four (16.6) presented between 11and14 days. Abdominal pain; irritability; blood in stools; vomiting; abdominal distension and palpablemass in various combinations were the clinical features. All the patients; except one (4); were below the age of one year. There was much delay before presentation of infantswith intussusception; with high attendant mortality