Fistula-in-Ano Complicated by Fournier's Gangrene Our Experience in North-Eastern Region of Nigeria.

BACKGROUND: Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. METHODS OF STUDY: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. RESULTS: A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. CONCLUSION: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.

Epidemiology and management of head injury in paediatric age group in North-Eastern Nigeria.

BACKGROUND: Paediatric head injury (HI) is the single most common cause of death and permanent disability in children world over, and this is increasingly becoming worrisome in our society because of increased risks and proneness to road traffic accidents on our highways and streets. The study set to determine causes and management of HI among children in our society. PATIENTS AND METHODS: A retrospective review of all children aged 0-15 years with traumatic head injury (THIs) who were managed at the University of Maiduguri Teaching Hospital between July, 2006 and August, 2008. RESULTS: A total of 45 children with THIs presented to the casualty unit of the hospital; 30 (66.7%) were boys and 15 (33.3%) were girls. Three (6.7%) children were less than 1 year of age, 21 (46.7%) were between 1 years and 6 years while 16 (35.6%) and 5 (11.0%) were aged 7-11 years and 12-15 years respectively. Thirty six (80.0%) of the children were pedestrians, 6 (13.4%) fell from a height, while 2 (4.4%) and 1 (2.2% were as a result of home accident and assault, respectively. Twenty one patients (46.7%) had mild HI, while 53.3% had moderate to severe category. Forty one (91.1%) of children were managed as in-patients, mostly (95.1%) by conservative non-operative management, while 4 (8.9%) were treated on the out-patient basis. The mortality rate was 17.8%. CONCLUSION: H1 among children is of a great concern, because of its incremental magnitude, due to increasing child labour and interstate religious discipleship among children, with attendant high mortality and permanent disabilities. Necessary laws and legislations should be formulated and implemented with organized campaigns and public enlightenment to prevent and mitigate this menace.

Photoletter to the editor: Scarring alopecia resulting from pyoderma gangrenosum of the scalp.

Pyoderma gangrenosum is an uncommon ulcerative cutaneous condition of uncertain aetiology. It is a disease that causes tissue to become necrotic, leading to deep ulcers. We report a case of pyoderma gangrenosum localized at the scalp, which is an unusual location. After 16 months of treatment with prednisolone 40 mg daily, methotrexate 15 mg weekly, ciprofloxacin 500 mg and honey dressing the indurated elevated ulcer margins flattened and the ulcer healed with scarring of the entire scalp.

The epigastric heteropagus conjoined twins.

Conjoined twins are rare and are classified as symmetrical or asymmetrical, in which a member, the host (autosite), is near normal and bears the parasite, which is incomplete, smaller, and fully dependent for growth on it. This form of conjoined twins is referred to as heteropagus and when attached to the epigastrium of the autosite is called epigastric heteropagus. Only 44 cases of epigastric heteropagus twins have been previously reported in the world literature. We hereby report the successful separation of a pair of heteropagus twins.

Primary cutaneous aspergillosis in an immunocompetent patient.

We present a 32-year-old woman with primary cutaneous aspergillosis and an apparently normal immune status. She is a dietitian who carried out research on Aspergillus contamination of palm oil over a six-month period, during which she apparently shaved her axillae and perineum using a safety razor blade. She presented with nodular lesions, which became extensive ulcers after an attempt at incision and drainage. Diagnosis was based on culture and histology. The patient was treated with itraconazole 200 mg twice a day, with surgical excision and a rhomboid flap cover of the axillae. She has remained disease-free five years after discharge. This highlights the likely benefits of a combination of surgical excision and drug therapy, in achieving a cure in this patient.