Familial Adenomatous Polyposis Coli in East Africa: A Case Report and Review of the Literature

Introduction: Familial adenomatous polyposis (FAP) is a rare diagnosis in East Africa. The author reports a case of a 21 year old gentleman presenting with occasional passage of blood stained stool, and found to have familial adenomatous polyposis coli. This is followed by a literature review on the pathogenesis, clinical features and treatment options of FAP in East Africa.Presentation of Case: This patient presented with a strong family history of familial adenomatous polyposis, blood stained stool and a rectal mass. A total proctocolectomy and ileoanal anastomosis was carried out. The postoperative course of this patient was uneventful.Discussion: The typical gross pathological and histological features of familial adenomatous polyposis and rectal adenocarcinoma were seen on the resected colorectal specimen. In addition this study reviews the literature regarding the clinical presentation, pathological characteristics and treatment options of familial adenomatous polyposis coli.Conclusion: FAP should always be considered in a young patient presenting with a strong family history of CRC. Colonoscopy should be performed on these patients with early symptoms and those patients with a strong family history of FAP. In East Africa, the creation of a permanent stoma is unacceptable and therefore a proctocolectomy and Brooke ileostomy will not be a desirable option in a young patient in this part of the world

Mucinous Adenocarcinoma of the Colon in Uganda: A Case Report and Literature Review

Introduction:In Uganda, the Kampala Cancer Registry has reported a steady increase in the incidence of colorectal carcinoma(CRC) over the last few decades. The author reports a case of a 25 year old gentlemanpresenting with bowel obstruction and found to have mucinous adenocarcinoma of the colon. This is followed by a literature review of the clinical and pathological characteristics of young age sporadic colorectal carcinoma (YSCC) and hereditary nonpolyposis colorectal carcinoma (HNPCC).Presentation of Case:This patient presented with a family history of colorectal carcinoma (CRC) and with bowel obstruction. An emergency laparotomy involving a right hemicolectomy was carried out. The postoperative course of this patient was uneventful. Discussion:The typical histological features of mucinous adenocarcinoma of the colon were seen on the resected colon specimen. In addition this study reviews the literature regarding the clinical presentation, pathological characteristics, histology and prognosis of mucinous and medullary carcinoma of the colon.Conclusions:Mucinous adenocarcinoma happens to be the most common histological type of colorectal carcinoma in young adults. In Uganda, low risk young patients withsymptoms should be screened for colorectal lesions. A high index of suspicion should therefore be taken in the diagnosis of colorectal malignancy in these patients

Colorectal Adenocarcinoma in East Africa: A Narrative Literature Review

This paper is a review of work done on colorectal adenocarcinomain East Africa showing geographic spread, age and sex ratios, clinical presentation, management and predominant histopathology. A steady increased incidence of CRC in East African countries is currently being documented however this is associated with a higher CRC-associated morbidity and mortality. Whilst the male: Female ratio varies between 1.2:1 to 1.88:1, up to 38% of CRC diagnosis are in patients younger than 40 years, in contrast to only 1.9% of CRC patients in Western developed countries such as the USA. Generally rectal carcinoma is more common than colon carcinoma and abdomino-perineal resections are commonly performed in up to between 54% -71% due to the advanced stage of presentation of rectal tumours in East Africa. The late stage presentationand delayed effective treatment in East Africa may result in a higher morbidity in CRC patients. Interestingly there is a significant incidence of mucinous adenocarcinoma sub-groups compared to Western developed countries which carry a poor prognosis. A significant proportion of CRC patients have been found to have histological and demographic features which suggest that MSI-tumours and these tumours are more common in younger patients. However only a few authors have looked at the possibility of mismatch repair mutations in the genetic aetiopathogenesis of colorectal adenocarcinoma in East Africa.

Incidence of Sigmoid Volvulus in Northern Uganda: A Cross-Sectional Study Design.

Aims: To determine the incidence of sigmoid volvulus in Northern Uganda. Study Design: A cross-sectional (2 years retrospective and one year prospective) study design was conducted on patients’ medical records and those admitted, surgically managed or referred from the 19 hospitals in Northern Uganda. Place and Duration of the Study: This study was conducted in 19 hospitals in Northern Uganda from January 2010 to December 2012. Methodology: A cross sectional study design with a two year retrospective and one year prospective studies were conducted to determine the incidence of sigmoid volvulus in Northern Uganda. All patients’ records with a diagnosis of sigmoid volvulus in 19 hospitals were included in the study. Ethical approval was obtained from the IRB of Gulu University Medical School and Uganda National Council for Science and Technology (UNCS&T). Data analysis was conducted using STATA/IC version 12.1. Results: The incidence of sigmoid volvulus in Northern Uganda was 251.8 per 100,000 surgical populations in 2 years. Most cases occurred in the dry season particularly from December to April and least observed from May to November. Middle aged and elderly male were the most commonly affected. Conclusion: The incidence of sigmoid volvulus in Northern Uganda was 251.8 per 100,000 surgical populations in 2 years. The proportion of bowel obstructions due to sigmoid volvulus in Northern Uganda was 23.4% and similarly comparable with the proportion found in other African countries and higher than those in developed countries.

Factors influencing Outcome of Management of Sigmoid Volvulus in Northern Uganda: A Prospective Observational Study.

Aims: To determine the factors that influence outcome of management of sigmoid volvulus in Northern Uganda Study Design: A prospective observational study was conducted on 103 sigmoid volvulus patients admitted and surgically managed in 19 hospitals in northern Uganda and followed-up postoperatively for 30 days. Place and Duration of the Study: This study was conducted in 19 hospitals in Northern Uganda from January 2012 to December 2012. Methodology: One hundred and three patients with sigmoid volvulus were consecutively recruited and admitted in 19 of the 20 hospitals in Northern Uganda and were surgically managed by resection and primary anastomosis or Hartmann’s procedure or double barrel colostomy. Patients 13 years and above with sigmoid volvulus and who had consented/Assented were included in the study and followed up to the 30th postoperative day. Ethical approval for the study was obtained from the Institutional Review Committee of Gulu University Medical School. Data analysis was carried out using STATA/IC version 12.1. The outcome events observed were uneventful recovery morbidity and mortality. Results: Eighteen patients (17.48%) developed complications including wound sepsis 10(9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, thus giving a mortality rate of 7.7%. The factors associated with a high risk of morbidity and mortality were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileosigmoid knotting (RR=4.94; 95% CI: 1.30- 18.78). Resection and primary anastomosis had a better outcome compared to the Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099). Conclusion: The risk factors associated with morbidity and mortality of sigmoid volvulus management were preoperative hypernatraemia and ilio-sigmoid knotting. Hartmann’s procedure was associated with a higher risk of morbidity and mortality than resection and primary anastomosis.