Spectrum of causes of intestinal obstruction in adult Nigerian patients : general surgery

Objective. To present changes in the cause of intestinal obstruction in an African setting. Design. Consecutive cases of acute intestinal obstruction from 1985 to 1994. Setting. Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria. Subjects. Adult patients with clinical and radiological evidence of intestinal obstruction. Results. There were 99 patients (60 males) aged 15 - 101 years (mean age 45 years). The majority of patients were young and middle-aged adults. Main causes of obstruction included adhesion (N = 44); volvulus (N =15); external hernias (N = 11); colorectal carcinoma (N = 10) and intussusception (N = 8). Approximately twothirds of patients (28/44) with adhesion had had previous abdominal operations. The overall mortality was 14; mainly owing to strangulation obstruction and colonic malignancy. Conclusions. The increasing role of adhesions as a cause of acute intestinal obstruction demands greater need for routine preventive measures against adhesion formation

Experience with anorectal malformations in Ile-Ife, Nigeria.

The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.

A review of typhoid perforation in a rural African hospital.

In Wesley Guild Hospital Ilesa in the South-West region of Nigeria a retrospective study of 105 consecutive cases operated upon for typhoid perforation between January 1988 and November 2001 was carried out. The ages of the patients were between 4 to 70 years with a mean age of 19.2 +/- 8.81. There were 84 males (80%) and 21 females (20%) giving a ratio of 4:1. Diagnoses were based on clinical and radiological findings. All the patients had laparotomy after resuscitations with intravenous fluids, electrolytes replacement, broad spectrum antibiotics, Nasogastric intubation/suctioning and urethral catherterisation. There were five negative laparotomies (4.8%). Eighty patients (76.2%) had a single perforation, while the rest 20 had multiple perforations. The perforations were located between 7 cm and 100cm from the ileo-Caecal junction. Apart from the patients who had resection and primary anastomosis, 95 (90.5%) had 2 layered closure of the perforation. The most common complications were wound infections (26.7%). Intra-abdominal abscesses (9.5%) and would dehiscence (7.6%). The mortality rate was 16.2% showing a remarkable improvement in the West African Subregions.

Gastrointestinal duplications in Ile-Ife, Nigeria.

BACKGROUND: Gastrointestinal duplications are rare congenital malformations that commonly present within the first year of life. When they present in older age groups, diagnosis is often difficult. This difficulty derives from the lack of specific clinical features attributable to these lesions OBJECTIVES: To document the challenges posed to surgeons by gastrointestinal duplications in different parts of the world and to report our experience in its management in Ile-Ife, Nigeria. DESIGN: A retrospective study. It involved a study of the clinical records of all patients diagnosed to have gastrointestinal duplication in our hospital. SETTING: A Paediatric and General Surgical unit, University of Ile-Ife Teaching Hospital, Ile-Ife, Nigeria.. RESULTS: Five patients were diagnosed to have gastrointestinal duplications over the of the study. The ate, ranged from 28 days to 52 years. There were four males and one female. One patient presented within the first month of life. The others presented after the age of one year. There were two gastric, two ileal and one rectal duplication. All had the cystic variety of duplication. Three of the patients had excision, one had mucosal stripping and one had internal drainage of the duplication. The outcome was satisfactory in all of them. CONCLUSION: Duplications tend to present at a much older-age group in our environment. Early diagnosis therefore depends on a high index of suspicion and every surgeon operating in the abdomen must be familiar with the management of this condition.

Rectovestibular fistula with absent distal vagina in an adolescent Nigerian girl.

Rectovestibular fistula is the most common variant of anorectal malformations reported in girls. Rarely does the whole of the anorectum occupy an ectopic position in the vestibule of the vulva. The authors report a case of a 15-year-old girl with rectovestibular fistula associated with occult distal vaginal atresia that was managed successfully by posterior sagittal anorecto-vaginoplasty (PSARVP).

Aspirin-induced duodenal perforation in a Nigerian with sickle cell disease: a case report.

A case of duodenal perforation associated with aspirin ingestion in a 21-year old male Nigerian with sickle cell anaemia is reported. He presented with a sudden onset of epigastric pain which later spread to involve other parts of the abdomen. He had previously used aspirin at a dose of 1800 mg daily for two weeks to treat bone pain. Abdominal ultrasonography and X-ray showed fluid collection in the pelvis and elevation of the diaphragm. At exploratory laparotomy, the perforation found in the first part of the duodenum anteriorly was repaired. He was discharged 11 days post-surgery. In view of the frequent usage of salicylates and non-steroidal anti-inflammatory drugs to treat painful crises in sickle cell disease, we suggest careful monitoring of patients on such drugs and those with dyspeptic symptoms must be fully investigated including the use of endoscopy, to prevent fatal outcome.

Thyroid malignancy in endemic nodular goitres: prevalence, pattern and treatment.

AIMS: The epidemiology of thyroid cancers in goitre endemic zones has not been recently reviewed, and changes being currently reported have been from studies in non-endemic areas. The aims of this study were to present the clinical pattern of thyroid malignancy in a goitre endemic area and identify recent changes, if any. METHODS: The study was conducted at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between January 1983 and December 1993. Records of patients with nodular goitres treated with thyroidectomy were reviewed, and the clinical features, laboratory parameters, treatment, outcome and follow-up of histologically-proven malignant cases were studied. RESULTS: Thirty-six of 279 (12.9%) patients, aged 13-85 years (mean)=43.7+/-14.7 years), carried malignant goitres, and most (80%) were young or middle-aged women. Of the well-differentiated cancers, follicular type was the most prevalent, being six- and 12-fold as frequent as papillary and medullary cancers (69%vs 11% and 5.6%), respectively. Lymphoma accounted for 5.6%, fibrosarcoma, 5.6% and anaplastic, 2.8%. No relationship was demonstrable between cancer type, duration of goitre and age at diagnosis (r=0.06 and 0.17, respectively). CONCLUSIONS: Thyroid cancers afflict comparatively young women in our environment, and follicular cancer remains the predominant type, partly as a result of persisting dietary iodine deficiency.