Isolated gallbladder rupture following blunt abdominal trauma.

The gallbladder is a relatively well-protected organ; consequently its rupture following blunt abdominal injury is rare and usually associated with other visceral injuries. Isolated gallbladder rupture is extremely rare. We report a healthy Nigerian adult male who sustained isolated gallbladder rupture following blunt abdominal injury from riding a motor cycle (Okada). A high index of suspicion with positive bile aspirate might lead to early diagnosis. Open cholecystectomy is a safe option of treatment in a resource poor centre especially in delayed presentation and has a good outcome.

Epidemiology of armed robbery-related gunshot injuries in Maiduguri, Nigeria.

BACKGROUND AND OBJECTIVES: Gunshot Injuries used to be rare in Nigeria until the civil war of 1967-1970. Unfortunately, it has become very rampant recently. The objective of this paper is to look at the epidemiology of armed robbery-related gunshot injuries as seen in the University of Maiduguri Teaching Hospital over a five-year period. MATERIALS AND METHODS: Data on patients that presented with gunshot injuries within the study period (January 2002 to December 2006) were collected and analyzed retrospectively. RESULTS: We studied 129 patients with gunshot injuries that were managed during the study period. This comprises of 117 males and 12 females (M:F=9.8:1). Eighty four (65.1%) were young males between 20 and 40 years. One hundred and fifteen (89.2%) of the 129 victims were shot by armed robbers, the remaining 14 (10.8%) were shot under other circumstances not related to armed robbery. Analysis of the time of attack revealed 72% of victims were attacked at night. Over 80% of victims were shot along the highway. The anatomical sites of gunshot entry wound show the extremities having the highest of 46.1%. Ninety one (79.1%) victims were treated operatively while 16 (13.9%) were treated nonoperatively. CONCLUSION: Armed robbery is the motive behind most gunshot injuries in Nigeria. Most of these attacks are preventable if the government would support and motivate the security apparatus responsible. There is also need for the government to support the victims by shouldering their treatment and subsequent rehabilitation.

Congenital aganglionic megacolon in Nigerian adults: two case reports and review of the literature.

Congenital aganglionic mega colon (Hirschsprung's disease) is a motor disorder in the gut, due to a defect in the craniocaudal migration of the neuroblast originating from the neural crest that occurs during the first twelve weeks of gestation, causing a functional intestinal obstruction, with its attendant complications, in infants. Despite modern pediatric practice, with emphasis on early diagnosis, Hirschsprung's disease is seen in adults in regions where perinatal care is limited. We report two cases of Nigerian adults with longstanding, recurrent constipation, getting relieved by laxatives and herbal enemata, and then presented to our Emergency Department with a history of progressive abdominal distention, colicky pain, occasional vomiting, and weight loss. Per rectal examination revealed a gripping sensation in the rectum, 10 cm from the anal verge, with rectal fecal load. Barium enema showed a grossly distended proximal large colon, with high fecal retention, with the transition zone at the middle one-third of the rectum. Due to difficulty in bowel preparation of these patients, emergency laparotomy was done. The first case had a diverting sigmoid colostomy and later had a low anterior resection. The second case had a one-stage procedure. Histology of both the cases showed aganglionosis of the stenotic segment and a normal distal rectum. Both patients had complete resolution of the symptoms, without complications, in a three-year follow-up. The related literatures were reviewed. Hirschsprung's disease should be considered in adults patient presenting with chronic constipation. Low anterior resection of the rectum would be a surgical option for the treatment of short and zonal segment of adult Hirschsprung's disease.

Breast-axillary complex in HIV/AIDS patients.

BACKGROUND: HIV/AIDS have not only increased the health care burden especially in developing countries, it equally complicates the presentation of many diseases. Some well known disease entities now occur in fulminant complexities not previously described or known as such. The objective of this article is to report an unusual presentation of HIV/AIDS patients to the surgeon with Axillary and ipsilateral breast swelling. METHOD: This is a report of three cases seen and managed by the authors. RESULTS: Three adult female patients presented with progressively increasing axillary and ipsilateral breast swellings. They also had associated fevers and weight loss. Their main concern had been development of breast cancer. One of the patients was a known retroviral positive on Highly Active Anti-Retroviral Therapy (HAART). Examination revealed axillary abscess and ipsilateral breast oedema in two cases. The patient on HAART had a hard breast-axillary mass complex. Biopsy (FNAB) revealed inflammatory cells and no malignancy in all three cases. HIV screening was positive in all cases. One of the patients had excision of breast-axillary mass complex, and the histology showed features of chronic inflammation, with no malignant cells. The other two had incision and drainage of their axillary abscess. CONCLUSION: This shows the ubiquitous presentation of HIV/AIDS in our environment and surgeons should be aware of the breast axillary complex in HIV/AIDS. Medical practitioners should be careful to obtain accurate diagnosis before embarking on treatment especially mutilating surgical procedures.

Tuberculous ileal perforation in a HIV positive patient: a case report and review of literature.

BACKGROUND: Tuberculosis is prevalent worldwide. Even in developed countries there is a resurgence of tuberculosis mainly due to increasing HIV infection. Tuberculous ileal perforation is uncommon. It is, however, a potentially fatal complication of intestinal tuberculosis especially in HIV/AIDS patient. AIM: To highlight tuberculous ileal perforation as an underestimated complication of intestinal tuberculosis in an HIV patient presenting with acute abdomen. METHOD: A 42-year-old HIV positive long distance truck driver with tuberculous ileal perforation is presented and related literatures reviewed. CONCLUSION: Intestinal perforation due to abdominal tuberculosis is an aetiological factor in acute HIV abdomen. High index of suspicion remains the key to diagnosis.

Recurrent respiratory papillomatosis in Ibadan, Nigeria.

BACKGROUND: Recurrent respiratory papilomatosis (RRP), the most common benign neoplasm of the larynx, usually results in upper airway obstruction that is most often misdiagnosed as lower airway disease in children. The prevalence of RRP and various aspects of its clinical course are still unknown with a dearth of literature on this in Nigeria. This study aims at presenting the clinical profile of RRP as seen in the University College Hospital, Ibadan, Nigeria. METHODOLOGY: A retrospective study of 43 cases of histologically confirmed RRP over a fifteen-year period in the Otorhinolaryngology Department of the University College Hospital Ibadan. RESULTS: There were 28 (65.1%) males and 15 (34.9%) females with mean age of 8.7 years (range 2-23 years). Thirty-two patients (74.4%) were between 110 years with the highest incidence occurring at the 6-10 year age group (39.5%). Forty-one patients (95.3%) belonged to low social classes V and IV. Thirty-one patients (72%) presented within 1 year of onset of symptoms. All the patients were hoarse with 70% of those dyspnoeic at presentation having emergency tracheostomy. The lesions involved the vocal cords and anterior commissure mostly. There were no recurrences in 23 patients (53.5%) while twenty patients (46.5%) had 2 to 5 recurrences. CONCLUSION: Sequelae of RRP in Children may be grave, thus a high index of suspicion is needed in a patient with progressive voice change exceeding six weeks and unresponsive to standard medical therapy.