Spring active drain using bladder (50-60ml) syringe (De Adotey's drain).

INTRODUCTION: Closed active drainage system with a syringe is an accepted way to let out fluid in a surgical wound. We present a simple spring active (negative suction) drainage (SAD) system using locally improvised metallic spring and 60ml (bladder syringe); SAD of Adotey, a newly designed compression-expansion spring mechanism which serves especially in situations where an active drainage system is of utmost importance. CONCLUSION: De Adotey's drain is a 60ml bladder syringe with spring mechanism which is used to provide a negative pressure as an active drain.

Abdominal injuries in university of port harcourt teaching hospital.

BACKGROUND: Abdominal injury is relatively common in both civilian and military casualties and remains a major source of morbidity and mortality. The mechanism of injury may be blunt or penetrating. Some would require operative intervention, whereas others may be managed conservatively. OBJECTIVE: The aim was to determine the pattern and outcome of management of abdominal injuries in the University of Port Harcourt Teaching Hospital (UPTH). PATIENTS AND METHODS: This was a prospective study of all patients with abdominal injuries seen and managed in UPTH over a 4-year period (from January 1, 2009 to December 31, 2012). Relevant data were recorded and analyzed using Statistical Package for Social Sciences version 16. RESULTS: Forty-five patients were seen during the study period. There were 40 males (88.9%) and five females (11.1%) making a male to female ratio of 8:1. Their ages ranged from 15 to 45 years with a mean of 27.8 ± 1.6 years and 21 to 30 years was the most commonly affected age group. The mechanism of injury was penetrating in 33 patients (73.3%) and blunt in 12 patients (26.7%). Thirty-four patients (75.6%) had an exploratory laparotomy after resuscitation, while 11 (24.4%) were managed conservatively. Small bowel was the most commonly injured organ following penetrating injury, seen in 14 patients (42.4%) while spleen was the most common in blunt injuries, seen in five patients (41.7%). The most common postoperative complication was surgical site infection, seen in four patients (8.9%). Two patients died giving a mortality rate of 4.4%. CONCLUSION: Gunshot to the abdomen is the most common cause of abdominal injury in UPTH. Serious campaign and legislation against militant and criminal activities would help to reduce the incidence.

Ileosigmoid knotting in patients under 25 years of age: A report of two cases.

INTRODUCTION: Ileosigmoid knotting is a rare cause of acute abdomen with high morbidity and mortality. Its diagnosis is infrequently made before surgery because of its varying ways of presentation and rarity. PRESENTATION OF CASE: The first was a 21-year-old male who presented with a history of sudden generalized abdominal pain and progressive abdominal distension. He was pale and severely dehydrated. His extremities were cold and clammy. His pulse rate was 110 per minute and blood pressure was 90/50mmHg. The second case was 20-year-old male who presented with similar symptoms as above. He was not pale but mildly dehydrated. His pulse rate was 92 per minute and blood pressure 110/70mmHg. Both patients were resuscitated and had exploratory laparotomy a few hours after presentation. The first patient was found to have ileosigmoid knotting with gangrenous sigmoid colon and terminal ileum. He had Hartmann's procedure and right hemicolectomy with ileo-transverse anastomosis. The second patient was found to have ileosigmoid knotting with viable loops of bowel. He had careful detorsion, sigmoidectomy with primary anastomosis. Both patients' have good outcome. DISCUSSION: This is to report two cases of ileosigmoid knotting in two male patients aged 21 and 20 years, respectively, with the hope of increasing awareness. CONCLUSION: Ileosigmoid knotting though more common in fourth or fifth decade of life, can also occur in the 2nd decade. Early diagnosis, careful resuscitation and skilful surgical intervention will improve outcome.

Gastric outlet obstruction from duodenal lipoma in an adult.

The duodenum is a rare site for gastrointestinal lipoma with less than 230 cases reported in the literature. Although, peptic ulcer disease remains the most common benign cause of gastric outlet obstruction (GOO), duodenal lipomas remain a rare, but possible cause of GOO and could pose a diagnostic challenge, especially in countries where access to endoscopy and modern imaging techniques poses a challenge. The authors present a case of GOO in a 40-year-old male, secondary to a duodenal lipoma. It was successfully treated by a transduodenal resection through a midline laparotomy. The histology report confirmed it was a submucosal lipoma.