A case report of tracheal tenting to the skin: An option to tracheostomy for post-thyroidectomy tracheomalacia.

Operating on a huge and long-standing goiter is challenging to the surgeon and anesthetist because of the possibility of tracheomalacia and collapse of the tracheal rings after extubation. We report our innovation of tenting the trachea to the skin using sutures (passed through the strap and sternocleidomastoid muscles) to prevent post-thyroidectomy tracheomalacia.

A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria.

BACKGROUND: Peptic ulcer perforation is a common cause of emergency admission and surgery. This is the first study that documents the presentation and outcome of management in Irrua, Nigeria. PATIENTS AND METHOD: This is a prospective study of all patients operated on for perforated peptic ulcer between April 1, 2010, and March 31, 2015. A structured questionnaire containing patients' demographics, operation findings, and outcome was filled upon discharge or death. RESULTS: There were 104 patients. 81 males and 23 females (M : F = 3.5 : 1). The age range was between 17 years and 95 years. The mean age was 48.99 years ± SD 16.1 years. The ratio of gastric to duodenal perforation was 1.88 : 1. Perforation was the first sign of peptic ulcer disease in 62 (59.6%). Pneumoperitoneum was detectable with plain radiographs in 95 (91%) patients. 72 (69.2%) had Graham's Omentopexy. Death rate was 17.3%. CONCLUSION: We note that gastric perforation is a far commoner disease in our environment. Perforation is often the first sign of peptic ulcer disease. We identify fasting amongst Christians as a risk factor for perforation.

Volvulus complicating jejunal diverticulosis: A case report.

INTRODUCTION: Diverticular disease is uncommon among Africans though increasing number of cases is now being reported, mainly of colonic diverticulosis. This condition afflicts all parts of the gastrointestinal tract but commonly the colon. Jejunal diverticula are rare, usually asymptomatic but may lead to an acute abdomen. CASE PRESENTATION: A 68 year old female trader, who was referred from a peripheral center with insidious onset of severe colicky, generalized abdominal pain, repeated vomiting of recently ingested meal, no hematemesis. There was constipation and abdominal distension. The working diagnosis was dynamic intestinal obstruction of small bowel origin. She had emergency exploratory laparotomy following resuscitation. The findings were: volvulus of the jejunum and multiple jejunal diverticula. A resection of 80cm of the jejunum with most of the diverticula involved in the torsion was done with an end-to-end anastomosis of the jejunum. Her out-patient follow-up has been uneventful. DISCUSSION: Jejunal diverticular disease is rare in Africa. Our patient presented with small bowel obstruction due to volvulus. Other complications are discussed. CONCLUSION: Intestinal obstruction from diverticular disease is not always of colonic origin. It can occur in the jejunum.

Motorcycle Related Injuries among Rural Dwellers in Irrua, Nigeria: Characteristics and Correlates.

Background. The escalating use of motorcycle for commercial transportation of commuters and goods has resulted in an increase in morbidity and mortality from road traffic injuries. Objectives. To study the characteristics of motorcycle injuries seen in Irrua, Nigeria. Materials and Methods. This is a one-year prospective study of all patients seen from January 1, 2009, to December 31, 2009. A structured proforma was filled for all consecutive crash victims involving a motorcycle. Results. Motorcycle injuries accounted for 11.6% of attendance in surgical emergency room (142 out of 1,214); 76.8% were males. Amongst victims 47.1% were riders, 42.9%, passengers, and 7.8% pedestrians. Extremity injury accounted for 42.2% while head injury occurred in 21.8%. There were 9 deaths (6.3%). In this study no victim used crash helmet. Conclusion. Banning of motorcycle for commercial use and the introduction of tricycles into rural/suburban comminutes may be an important preventive strategy.

Colonic cancer in adolescents. A report of three cases.

Colorectal cancer is a common malignant neoplasm in adults, with a peak incidence of 60-79 years. About 1 million cases of the disease and half a million deaths associated with it are reported world-wide each year. Colorectal cancer, however, is very uncommon in children and adolescents. This is a presentation of 3 cases of colon cancer in Nigerians aged 17 and 19 years. Two of them were adenocarcinoma and the other leiomyosarcoma. The pathogenesis and aspects of management are discussed.

Splenectomy in a rural surgical practice.

We reviewed the clinical presentation and indications for splenectomy in a rural community in Southern Nigeria from January 1988 - December, 2000, a period of 12 years. A total of 17 cases were seen. Twelve (70.6%) were for big spleens due to sickle-cell anaemia, tropical splenomegaly syndrome, malignancy and 5 (29.4%) were due to trauma from road traffic injuries. Anaemia was a common feature in all the cases. Patients were followed up for 18 months but all those suspected to have malignancies died within eight months of surgery. Diseased spleen is commonly seen in rural community, its management in the face of limited facilities could be tasking, but some modicum of treatment has to be offered those who may not be able to honour a referral. It is the surgical treatment thus offered that is being shared in this review.

Microorganisms associated with wound infection in Ekpoma, Nigeria.

Bacteria associated with wound infection in Ekpoma, Nigeria, and their antimicrobial susceptibility profile was investigated by standard microbiological methods, using hospital as well as non-hospital patients. Of 40 patients seen, 25 (62.5%) were males, while the rest were females. Those aged 30 years and above accounted for 63% of the patients, and post-operative sepsis was the most frequently encountered wound infection. Of the organisms encountered, Staphylococcus aureus was the most frequently occurring organism (39%), followed by coliform bacilli (24%), which was the most prevalent organism (44%) in post-operative sepsis. Twenty-one percent of the isolates were Pseudomonas aeruginosa. The majority of the bacterial isolates from the infected wounds were susceptible to Gentamicin, as follows: 92% of the Staph. aureus, 100% of Streptococcus faecalis, Escherichia coli and Pseud. aeruginosa, and 75% of the coliform bacilli. It is suggested that gentamicin, in combination with metronidazole, be used not only for empirical treatment of wound infections in Ekpoma locality but also for prophylactic coverage of surgical operations.