Challenges and Outcome of Management of Gastroschisis at a Tertiary Institution in North-Eastern Nigeria.

Introduction: Gastroschisis is a congenital anterior abdominal wall defect characterized by herniation of abdominal contents through a defect usually located to the right side of the umbilical cord. It occurs in about 1 in 2,000-4,000 live births and is slightly commoner in males. Management has remained challenging in the low and middle-income countries (LMICS), with high mortality rates. This study highlights the clinical presentation, treatment, outcomes, and challenges in the management of gastroschisis at a tertiary healthcare center in a resource-limited setting. Methods: This was a retrospective review of the records of all patients with gastroschisis managed over a period of 30 months (January 2016-June 2018). Data on patients' demographics, age, birth weight, clinical presentation, method of gastroschisis reduction and closure, complications, and outcomes were collated. Statistical analysis was performed using SPSS version 20. A p-value of >0.05 was considered significant. Results: Twenty-four patients with gastroschisis were managed. Of these, 18 patients had data available for analysis. There were 14 males, with a male-female ratio of 3.5:1. The median age at presentation was 11.0 h (range 1-36 h). Ten patients (55.6%) were delivered in a medical facility. One patient had type II jejunal atresia and transverse colonic atresia as associated anomalies. Improvised silos were applied by the bedside in 15 (83.3%) patients, while two patients (11.1%) had primary closure under general anesthesia. One patient died before definitive treatment could be done. Sterile urobags and female condoms were used for constructing improvised silos in 9 (60%) and 6 (40%) patients, respectively. Eight patients who had initial silo application had complete bowel reduction over a median time of 8.0 days (mean 10.0 ± 6.5 days, range 2-23 days). Total parenteral nutrition (TPN) was not available. The average time to commencement of feeding was 8.0 days ± 6.6 (median 6.0 days, range 2-22 days). Full feeding was achieved in five patients (two patients in the primary closure group and three from the silo group) over a mean time of 16.8 days ± 10.4 (median 14.0 days). Sepsis was the commonest complication. Four patients (22.2%) survived. Conclusion: Management of gastroschisis remains challenging in resource-limited regions.

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting.

BACKGROUND: Despite the advances in management, congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. METHODS: All confirmed cases of CDH were prospectively documented from 2003 till date. RESULTS: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8%) and on the right side in one (17.7%). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. CONCLUSION: With inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.

The epigastric heteropagus conjoined twins.

Conjoined twins are rare and are classified as symmetrical or asymmetrical, in which a member, the host (autosite), is near normal and bears the parasite, which is incomplete, smaller, and fully dependent for growth on it. This form of conjoined twins is referred to as heteropagus and when attached to the epigastrium of the autosite is called epigastric heteropagus. Only 44 cases of epigastric heteropagus twins have been previously reported in the world literature. We hereby report the successful separation of a pair of heteropagus twins.

Primary cutaneous aspergillosis in an immunocompetent patient.

We present a 32-year-old woman with primary cutaneous aspergillosis and an apparently normal immune status. She is a dietitian who carried out research on Aspergillus contamination of palm oil over a six-month period, during which she apparently shaved her axillae and perineum using a safety razor blade. She presented with nodular lesions, which became extensive ulcers after an attempt at incision and drainage. Diagnosis was based on culture and histology. The patient was treated with itraconazole 200 mg twice a day, with surgical excision and a rhomboid flap cover of the axillae. She has remained disease-free five years after discharge. This highlights the likely benefits of a combination of surgical excision and drug therapy, in achieving a cure in this patient.

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting

Background: Despite the advances in management; congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. Methods: All confirmed cases of CDH were prospectively documented from 2003 till date. Results: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8) and on the right side in one (17.7). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. Conclusion: With inadequate neonatal intensive care facilities; the severe early presenting CDH has a dismal prognosis. In contrast; the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted; it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive