Post-myomectomy intussusception: report of two cases.

BACKGROUND: Post-myomectomy intussusception is a very rare cause of post-operative intestinal obstruction in adult surgical practice. Preoperative diagnosis is usually missed or delayed because the symptoms are usually subacute and nonspecific. METHOD: The case notes of the patients were retrieved and relevant data extracted and summarized. An extensive literature search was done and results reviewed and compared with the present case. RESULTS: The two patients reported developed features of post operative intestinal obstructions which were thought to be due to adhesive bands and initial conservative managements instituted. Exploratory laparotomies later revealed ileo-ileal and jejuno-ileal intussusceptions which were reduced without resection with good outcome. CONCLUSION: Intussusception is a rare but serious complication of myomectomy. High index of suspicion with prompt intervention and early team management optimize outcomes.

Outcome of urethroplasty for urethral stricture at Jos Universitry Teaching Hospital.

BACKGROUND: The treatment of urethral stricture disease has remained a challenge over the years. The outcome has also been varied, with recurrent stricture being a major concern. We determined the outcome of urethroplasty with particular reference to the complications. METHODOLOGY: This was a retrospective study over 10 years (1995 to 2005) done at the Jos University Teaching Hospital, a tertiary health institution in the middle belt region of Nigeria. RESULTS: There were a total of 32 patients whose ages ranged from 0.06 to 75 years (mean 25 yrs, SD 18.8 yrs,). Eleven patients had had one form of stricture treatment or the other. Stricture aetiology was traumatic in 21 (66%) and inflammatory in 6 (19%) patients. Of the 24 patients in whom the stricture length at operation was specified, six, 11 and seven were <2 cm, 2-4 cm and >4 cm respectively. The stricture was located in the anterior urethra in 18 (58.1%), posterior urethra in 2 (6.4%) and bulbomembranous in 11 (35.5%) of patients (unspecified in one). The bulbar urethra was the single most involved region, occurring in 12 (38.7%) patients. Resection and end to end anastomosis was done in 16 patients and replacement urethroplasty in 16 others (Quarteys in 12, Swinney in 3 and Orandi in 1). Complications observed were urinary tract infection in 12 (37.5%) patients, recurrent stricture 11 (34.4%) wound infection 10 (31.3%), oedema of genitalia 7 (21.9%), urethrocutaneous fistula 4 (12.5%), impotence 3 (9.4%), wound haematoma 2 (6.3%) and urinary incontinence in 1 (3.1%) patient(s). CONCLUSION: Urinary tract infection, recurrence of the stricture and wound infection remain our major challenges. We recommend that in order to improve outcome, surgeons should regularly audit their practice and make necessary adjustments. In addition, urethroplasty should preferably be carried out by those with the cognate experience, while not compromising the need to teach younger colleagues.