Circumcision mishaps in Nigerian children.

BACKGROUND/OBJECTIVE: Circumcision may be associated with complications which are usually minor but could be life threatening on certain occasions. This study determined contributory factors, pattern of presentation, challenges of management and outcome of circumcision mishaps in Benin City, Nigeria. METHODS: A retrospective analysis of all male children managed for circumcision mishaps between January 1998 and December 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: There were 346 male children aged between 6 days and 12 years. Period of presentation to the unit ranged between 1 hour and 12 years. Redundant prepuce, 51 (14.7%); glandulopenile adhesions, 30 (8.7%); implantation cyst, 10 (2.9%); penile chordee, 11 (3.2%); local wound infection, 17 (4.9%); and proximal migration of plastibell ring, 11 (3.2%), were common mishaps treated with good outcome. On the other hand, urethrocutaneous fistula, 73 (21.1%); hemorrhage, 46 (13.3%); glandular amputation, 9 (2.6%); penile tissue avulsion, 24 (7.0%); and transmission of infections, 4 (1.2%), were challenging mishaps to manage. These resulted in 18 children with residual penile deformity and 4 deaths. Challenging mishaps and late referrals were common among children circumcised by traditional circumcisionists (P < 0.0001). Inadequate training of circumcisionists; circumcision in unhygienic environment; circumcision with unsterilized instruments; circumcision without the use of anesthesia, analgesia and antibiotics - which were compounded by late referrals - influenced the development and final outcome of circumcision mishaps. CONCLUSION: Circumcision mishaps presenting very late with resultant poor outcome are still common in our setting. Hospital circumcision by experts, health awareness campaigns, adequate training of circumcisionists and early referrals of affected children should be encouraged.

Factors affecting the management and outcome of neonatal surgery in Benin City, Nigeria.

INTRODUCTION: Neonatal surgery poses a major challenge, particularly in developing countries. The objective of this study was to determine the pattern and various factors that may affect the outcome of surgical management of neonates in a developing country like Nigeria. METHODS: A retrospective study was carried out of all neonates who underwent surgery over an 8-year period at the University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: There were 83 males and 35 females with a male/female ratio of 3.4:1. The age of the patients was from 12 hours to 28 days (mean 8+/-5.1 days) and they weighed from 1.8 to 3.9 kg (mean 2.7+/-0.5 kg) on presentation. A large proportion of the babies, 103 (87.3%), were delivered by poor women living in rural areas without supervised antenatal care and delivery. Mortality did not differ significantly between those babies delivered in hospital and those delivered at home (p=0.2127). However, unhygienic care of neonates, which allowed overwhelming resistant sepsis to set in, the delay in presentation and hazardous transportation without stabilisation led to high morbidity and mortality rates. The difference in mortality was significant when the mortality of patients operated on an emergency basis was compared with those operated electively (p=0.0483). Nine (75%) patients with tracheo-oesophageal pathologies, 24 (35%) patients with gastrointestinal anomalies, 1 (17%) with a cranio-spinal defect, 1 (13%) with a head/neck defect and 1 (5%) with a genitourinary anomaly died, with no death in the musculoskeletal group. Overall, a total of 56 (47.4%) morbidities and 36 (30.5%) mortalities were recorded. CONCLUSION: The morbidity and mortality following surgical management of neonates is still very high in this hospital. Financial constraints, emergency surgery, delivery outside the hospital and tracheo-oesophageal/gastrointestinal anomalies were significant and contributory factors.