message from the past: splenectomy and devascularisation with salvage sclerotherapy in the treatment of bleeding schistosomal oesophageal varices

To study the short and long term results of splenectomy and esophagogastric devascularisation in the prevention of bleeding from esophageal varices secondary to schistosomal portal hypertension. This is a retrospective prospective study of patients, who underwent splenectomy and devascularisation for schistosomal bleeding varices during the period 1980 to 1990 at Soba university hospital. They had clinical, laboratory, and endoscopic evaluation. They were followed up for a period of 10 years [mean 4.5 years]. At follow up special emphasis was laid on recurrence of variceal hemorrhage and, or mortality. Patients with recurrent variceal bleeding received emergency treatment in the form of resuscitation, balloon tamponade when necessary, and flexible endoscopic sclerotherapy. Splenectomy and oesophagogastric devascularisation was performed in 185 patients, and devascularisation only in 5 patients. Early postoperative mortality occurred in 8 patients [4.2%]. Early recurrence of variceal bleeding occurred in 4 patients who responded to emergency treatment. Transient of treatable ascitis developed in 21% of patients, transient jaundice in 12.6%, and liver failure in 1.6%. Major postoperative septic complications occurred in 6.4%. The rate of recurrence of variceal bleeding was 18.1% within the first 5 years, and 23.6% by 10 years follow-up. Late mortality occurred in 8 patients [4.4%]. The overall mortality of the procedure was 8.4%. Splenectomy and oesophagogastric devascularisation for the treatment of schistosomal portal hypertension can be associated with a high rate of variceal rebleeding. However, when coupled with sclerotherapy for recurrence, it carries an acceptable mortality rate

Indications and findings of colonoscopy in patients presenting to the endoscopy unit at Soba University Hospital in Khartoum, Sudan

The new endoscopy unit at Soba University Hospital in Khartoum, Sudan is an emerging unit, established in June 2003. In 2004 less than 200 colonoscopies were performed, the number rising to over 700 colonoscopies in 2009. The objectives of this study were to identify the common indications and findings in patients attending for colonoscopy and to study the correlation between patients' symptoms and significant endoscopic findings, mainly colonic polyps and colorectal cancer. All patients referred for colonoscopy were assessed prospectively by the study investigators and a questionnaire was filled with all relevant data including age, gender, indications for the procedure, clinical examination and endoscopic findings. A total of 123 patients were included in the study with a mean age of 46.7 years. Indications for colonoscopy included abdominal pain, altered bowel motions, rectal bleeding and iron deficiency anaemia. Polyps were found in 15% of cases and colorectal cancer in 11%. Male gender, iron deficiency anaemia and a rectal mass on digital examination were all significant risk factors in predicting a positive diagnostic yield on colonoscopy. Patients presenting with iron deficiency anaemia and a rectal mass on digital examination should have a priority over others in undergoing a colonoscopy. Despite the fact that flexible sigmoidoscopy is a useful initial investigation when a delay is anticipated in doing a colonoscopy, cases with proximal colonic polyps and cancers can be missed. Performing a full colonoscopy should be the investigation of choice in symptomatic patients