Abdominal Masses in Children: A 10-Year Review

Background: Some childhood diseases present with abdominal masses alone or with other constitutional symptoms. The knowledge of the common causes of abdominal masses in children can assist in developing a protocol of management by clinicians.Objective: To describe the aetiology and presentation of abdominal masses in children.Methods: The hospital records of all cases of intra-abdominal masses in children managed between May 1998 and April 2008 were retrieved for analysis. Socio-demographic and clinical data were obtained and analysed using simple descriptive statistics.Results: A total of 93 children were included while those without clinical, radiological and intra-operative evidence of intra-abdominal masses were excluded from the study. There were 49 males (52.7%) and 44 (47.3%) females with male-to-female ratio of 1.1:1. The children were aged 1 day to 14 years; 15 (16.1%) were aged <3 years while 23 (24.7%), 27 (29%) and 14 (15.1%) each were aged 3-6 years, >6-9 years, >9-12 years and >12-14 years. The most common cause of abdominal masses was appendiceal mass/abscess in 29%, followed by hydronephrosis in 22.6% and nephroblastoma in 16.11%. The most common symptoms included abdominal pain (86.0%), fever (46.2%), vomiting (40.9%) and abdominal distension (32.2%). The mortality rate was 13%.Conclusion: Non-malignant conditions were mostly responsible for abdominal masses in children while abdominal pain, fever and vomiting were the leading presentations of abdominal masses in children

Surgical complications from local herbal practitioners: report of five cases.

Over a 12-month period, five patients (out of a total of 72) with serious complications resulting from use of herbs by traditional healers were seen at the surgical unit of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The age range was one and a half to five years with a mean age of 23.4 +/- SD years and a male to female ratio of 3:2. All the cases were misdiagnosed and mismanaged and ended up with various complications. Such as penile amputations, digital necrosis, upper and lower limb gangrene as well a severe sepsis among others. Ignorance, cultural beliefs and attitudes, delusion, poverty and inaccessibility to orthodox medical practice were some of the factors responsible for the patronage of traditional healers.

Rectal carcinoma in a nine-year-old Nigerian male child: case report.

Carcinoma of the colon and rectum are rare in children and under the age of 40 years. A case of coro-rectal carcinoma in a nine-year-old Nigerian male child is reported. Family history was significant in the patient, it revealed that his father died three years earlier because of chronic diarrhoea and mucoid stool with associated on and off constipation and one of his elder brothers died eight years ago of colonic cancer at the age of twenty years. Exploratory laparotomy was done for the patient which revealed fixed rectosigmoid tumour with metastases to the liver, omentum and small intestine and ascites was also found. Hartmann's procedure with sigmoid colostomy was performed and the tumour was resected. Histological report of the biopsy specimen was consistent with poorly differentiated adeno-carcinoma. To the best of our knowledge, the youngest patient recorded in the literature is seven years old, which is younger than our patient, but this is still the youngest in our records.

Ruptured false iliac artery aneurysm--a case report from Nigeria.

A 23 year old male Nigerian presented to the Nephrology unit of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with features of chronic renal failure secondary to chronic glomerulonephritis. He was referred to the surgical department of the hospital on account of severe torrential uncontrollable bleeding from an infected cannulation site. He was maintained on regular hemodialysis but developed femoral triangle sepsis at the cannulation site and aneurysm of the external iliac artery. The aneurysm later ruptured with severe jet exsanguinations bleeding. Exploration revealed a-4 cm rent in the external iliac artery that was sutured with 6/0 prolene, interrupted, using clamp and suture technique. Perfusion was satisfactory in the immediate post-operative period. The patient was transfused with 11 pints of blood within 12 hours and had an uneventful post-operative period.

Thermal injuries in under-4-year-old children: the Lesotho experience.

The Queen Elizabeth II Hospital is the apex of the health care services in the Kingdom of Lesotho but has no designated burns unit. A review of patients managed during a 5-year period was done to document our experience so as to show what can be achieved even without a standard burns unit. We reviewed the clinical course of children who were admitted for care of acute thermal injuries during a 5-year period, May 1997 to April, 2002 inclusive. All were treated in the children surgical ward in accordance with a protocol of care emphasizing urgent care of shock, accurate fluid therapy, open wound care and early enteral feeding. Ninety-eight children (51 males and 47 females) aged 4 months to 43 months (mean 21.66 +/- 11.30 months) were admitted on account of acute thermal injuries during the study period. The injuries included scalding (46%) involving predominantly the upper part of the body and full thickness burns (87%). Skin grafting was needed in 82% of the patients. The common complications were infection, fluid imbalance, respiratory problems, and contracture deformities. The mean duration of hospital stay was 40 +/- 4.43 days and the case fatality rate was 9%. The case fatality rate in this series is considered high and could be improved if there were a well staffed specialized burns unit.

A retrospective audit of paediatric surgical admission in a sub-urban tertiary hospital.

BACKGROUND: Data on utilization of paediatric surgical services and the burden of paediatric surgical diseases in the West African subregion is scarce. METHODOLOGY: This retrospective study describes paediatric surgical admissions in a Nigerian teaching hospital between January 1998 and December 2002. RESULTS: Two hundred and eighty three children up to 15 years of age with surgical disorders were studied. Their mean age (+/- SD) was 5.8 +/- 4 years for males and 6.9 +/- 4 years for females. Length of stay (LOS) ranged from 1 to 127 days (mean 17 days). Turnover interval declined from 22.1 to 6.4 days while percentage bed occupancy and patients per bed per year averaged 70% and 17.4 respectively between January 2000 and December 2002. The highest mean LOS was due to malignant neoplasm (38 +/- 12 days), trauma (22 +/- 25) and surgical infection (21 +/- 22 days) while the shortest mean LOS was due to foreign body (6 +/- 4 days). The most common admitting diagnoses were trauma (36.7%), congenital anomalies (27.9%) and surgical infections (22.6%). Foreign body (2.1 %), benign tumours (0.7%) and malignant neoplasms (0.7%) were uncommon. Overall mortality was 0.4%. CONCLUSIONS: Childhood injuries, congenital anomalies and infections are important paediatric health problems.

Basic trauma life support: knowledge of medical students.

BACKGROUND: The first hour of management (golden hour) of any trauma patient might be the determining factor if he/she will survive. The first contact most patients have in an emergency room is with a young medical graduate. The knowledge of basic trauma life support (BTLS) by all doctors therefore becomes important. AIMS AND OBJECTIVES: This study set out to assess how much knowledge medical students had about BTLS in their final year compared with their knowledge at the beginning of clinical postings. METHOD: A cross-sectional study of fourth and sixth (final) year medical students to evaluate their knowledge of BTLS using a test of 30 questions under examination conditions. One hundred and twenty-three fourth year students were given a test after a lecture on the care of injured patients. The same test was administered on 41 sixth year students without prior lecture on day of test, having had a similar lecture 2 years before. Data analysis was performed using the SPSS 11.0 for Windows statistical software and EPI INFO version 6.04. RESULT: Mean scores were 25.8 +/- SD1.91 for the 4th year students and 21.0 +/- SD2.93 for the 6th year students. There was a statistically significant difference between scores of the 4th year and the 6th year (P < 0.000001). CONCLUSION: Knowledge was imparted in the 4th year but was forgotten by the 6th year. It is essential that courses in BTLS be given periodically to all medical graduates and all personnel involved in care of the traumatised patient.

Major limb amputations: an audit of indications in a suburban surgical practice.

BACKGROUND: Advancements in vascular and microsurgery in developed countries have led to fewer major limb amputations. AIM: This audit of major limb amputations performed at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, between June 1998 and May 2003, was conducted to find out the indications for amputation and highlight those cases that could be salvageable. PATIENTS AND METHODS: This was a retrospective study. Case notes of all patients who had major limb amputations were examined for patients' age, sex, time of presentation, limb affected, indications for amputation, the severity of crush injury to limb, stage of musculoskeletal tumors and Wagner's grade of diabetic foot. RESULTS: A total of 71 limbs were amputated in 69 patients; 56 limbs (78.1%) were unsalvageable, while 15 limbs (21.1%) were salvageable. Trauma accounted for 76% followed by 22% performed due to gangrene secondary to diabetes mellitus. Out of the 56 unsalvageable limbs, 31 patients presented with severely crushed limbs. Out of the 15 salvageable limbs, there were 11 cases of clean-cut traumatic amputations, two of soft-tissue sarcoma and one each of ruptured popliteal aneurysm and stenosed popliteal artery. CONCLUSION: Trauma and diabetes mellitus were leading indications for amputation. Expertise in limb salvage procedures and availability of appropriate equipment may reduce the numbers of amputations performed.

A preliminary report of fine-needle aspiration biopsy in superficially accessible lesions in children.

BACKGROUND: Fine-Needle Aspiration Biopsy (FNAB) is a diagnostic technique which has achieved widespread use and acceptance. Its clinical use has continued to widen with the availability of more sophisticated methods of imaging. Its minimal invasiveness, cheap cost and easy application make it a technique of choice in investigating swellings even in children. AIMS AND OBJECTIVES: To investigate the reliability, safety and diagnostic value of FNAB in superficial masses including lymph nodes in children. PATIENTS AND METHODS: Superficial masses and lymph nodes of twenty consecutive children aged 2-13years were subjected to FNAB. Open biopsies were also performed on them to validate the FNAB. All specimens were subjected to examination by a cytopathologist and a histopathologist. RESULTS: Nine of the patients (45 %) had malignant diseases (lymphoma and osteosarcoma); seven had tuberculous lymphadenopathy while four had reactive lymphadenitis. Open biopsies corroborated these findings. There were no false-negative or false-positive cytology results from aspirates. There were no complications related to the procedures. CONCLUSION: Fine-needle aspiration biopsy is a reliable, safe, less invasive and relatively cheaper alternative method of establishing a pathologic diagnosis, compared to open biopsy, in children.

Mature sacrococcygeal teratoma: a case report and literature review.

BACKGROUND: Sacrococcygeal teratomas are derived from embryonic germ cell layers. They present mostly in infancy and are extremely rare in adults; with an associated risk of malignancy. Modern imaging technique may be helpful to delineate the extent of the mass but surgical excision is generally indicated at the time of detection. PATIENTS AND METHODS: A case report is presented with a review of literature utilising MEDLINE, Microsoft Net and Yahoo search engines. RESULTS: A three day old female baby presented with a mature sacrococcygeal teratoma containing well-developed limb buds. She had surgical excision and primary repair with good results. A two-year follow up utilising serial serum alpha-fetoprotein assay and CT Scan revealed no evidence of tumour recurrence. CONCLUSION: Sacrococcygeal teratoma is a rare tumour that may be benign or malignant. Complete excision is the primary therapy and is adequate if the tumour is benign. Chemotherapy and radiotherapy are however indicated in malignant cases and in recurrence after previous excision.

Femoral hernias in children at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.

OBJECTIVE: To ascertain the diagnostic accuracy and outcome of surgical treatment in Nigerian children referred for paediatric surgical opinion at the Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west Nigeria. DESIGN: A retrospective review of our practice experience over a 15-year period; between January, 1989 and December, 2003. SETTING: The Olabisi Onabanjo University Teaching Hospital (OOUTH), serves as a referral centre for other government and private hospitals in and around the Ogun State, South-west Nigeria. The OOUTH, though a tertiary medical centre also receives patients who present directly at the General Out-Patient Clinics and the Emergency Units of the hospital. The catchment population is estimated at 7.5 million. SUBJECTS: The medical records of all patients under 14 years of age with a final diagnosis of femoral hernia who presented between January, 1989 and December, 2003 were reviewed. METHODS: The age, sex, mode of presentation, findings at surgery, procedure performed, immediate post-operative and 12 months follow-up details were recorded. RESULTS: Seven of 1,213 (0.58%) patients with groin hernias within the study period had femoral hernias; four (57%) were girls and three (43%) were boys. Age range was 3 to 9 years. The mode of presentation in all the children was recurrent lump in the groin. Five patients (71%) had right sided lump while the lump was on the left side in two of the patients. The duration of symptoms ranged from two years to eight years. The provisional diagnosis by the referring general practitioners and paediatricians were incorrect in all seven patients. Five patients (71 %) were correctly diagnosed preoperatively by the attending surgeon while two were thought to be inguinal hernias. CONCLUSION: The diagnosis of femoral hernia remains a challenging problem in childhood because of its rarity and similar clinical presentation as inguinal hernia.

Congenital syphilis in an immunocompromised neonate: case report.

Syphilis is a notifiable and preventable disease, congenital syphilis more so. Consequently, attention has been recently focused on prenatal diagnosis of foetal syphilis by the use of ultrasonography apart from the conventional serologic screening. Congenital syphilis has not been reported from the Kingdom of Lesotho. We report the case of a 3.0 kg male neonate with florid joint and bone lesions of congenital syphilis associated with HIV infection seen at the Queen Elizabeth II Hospital, Maseru, Kingdom of Lesotho. Co-existing HIV infection influences the clinical manifestation of syphilis, the progression of neurosyphilis and the response to standard therapy. The baby had the recommended standard treatment with good response and he was followed-up for a period of twelve months with serologic screening and radiographic evaluation.

Sirenomelia in one of Nigerian monochorionic twins.

A 1,600 gm baby with sirenomelia (caudal regression syndrome) associated with extensive anomalies in the internal organs occurring in one of a set of monochromic twins delivered at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Shagamu, Nigeria is being reported. The baby lived for approximately twenty hours. The co-twin had no obvious malformation.

Pattern of congenital alimentary tract malformation in Ibadan, Nigeria.

Nineteen children with congenital upper alimentary tract malformation were studied prospectively at the Department of Paediatrics, University College Hospital (UCH), Ibadan, over a period of 12 months. There were 20 cases, grouped into six types comprising congenital hypertrophic pyloric stenosis, seven; cleft lip and/or cleft palate, five; oesophagal atresia with or without tracheo-oesophageal fistula, four; jejunal atresia two and a case each of achalasia and annular pancreas. One patient had oesophageal atresia and congenital hypertrophic pyloric stenosis. The mortality rate was 31.51% (six out of nineteen). Low mortality was recorded in cases of cleft lip and/or palate, while mortalities of over 70% were recorded among cases of jejunal atresia, and oesophageal atresia with or without tracheo-oesophageal fistul. The common causes of death were milk feed aspiration (28.6%-two cases), purulent peritonitis (14.3%-one case), and probable septicaemia (14.3%-one case). The cause of death in two cases could not be determined.