Severe Chest Injury Revisited - An Analysis of The Jos University Teaching Hospital Trauma Registry.

BACKGROUND: Chest injury remains a major source of morbidity and mortality in trauma as approximately two-thirds of all severe traumas involve the chest. OBJECTIVE: To determine the changes in the profile management and outcome of severe chest injury in Jos University Teaching Hospital, Jos, Nigeria. MATERIALS AND METHODS: This is an analysis of the Trauma Registry of Jos University Teaching Hospital-a prospectively gathered database. Patients' entries with severe chest injuries for 7 years, from January 2012 to December 2018, were entered into a database and analyzed using the Epi Info Statistical Software, using simple statistics. RESULTS: In all, 162 patients presented with severe chest injury over a 7-year period, of whom 78 (48.1%) had polytrauma, while 84 (51.9%) had isolated chest injury. There were 139 males and 23 females, giving male: female ratio of 6:1. Over 95 (58.6%) of them were between 20 and 39 years. Blunt injury was predominant, constituting 66.7%. Motor vehicular crash was the most common mechanism of injury constituting 87 (53.7%), while gunshot injuries were responsible for 34 (21%). In managing these severe chest injuries, 146 (90%) of the patients had closed-chest tube thoracostomy as the definitive treatment, while 16 (9.9%) had thoracotomy. The mean and median duration of hospital stay was 13.3 and 10 days, respectively. The commonest complication was wound infection in 8 (4.9%) patients and a mortality of 5.9%. CONCLUSION: Blunt chest injury remains the commonest mechanism of chest injury but with an increasing proportion of penetrating injuries affecting predominantly young males. Most severe chest injury patients survive with simple interventions of resuscitation, and closed-chest tube thoracostomy for definitive treatment.

DISTAL ILEAL STENOSING SUBSEROSAL LIPOMA: A CASE REPORT.

Lipoma is the commonest soft tissue tumour and ubiquitous in distribution. The gastrointestinal tract is a rare site for this neoplasm. This 38 years old patient presented to the surgical emergency unit of the Jos University Teaching Hospital with features of intestinal obstruction which was confirmed by plain abdominal X-ray. Patient was resuscitated and had exploratory laparotomy. At surgery, a dilated, oedematous, and pale segment of ileum was seen measuring 56 cm in length and 10 cm short of the ileo-caecal junction, where an obstruction had occurred.The distal segment was collapsed. A limited right hemi-colectomy was done with ileocolic anastomosis. Specimen received atthe Histopathology Laboratory consisted of 45 cm of the ileum, the caecum, appendix, and proximal 25 cm of the colon in continuity. There was stenosis affecting the distal 30 cm of the ileum. The wall of the stenosed part of ileum had intramural fat at the sub-serosal locale. Histology confirmed the presence of sheets of matured adipocytes between the muscularispropria and serosa. Patient condition improved and was discharged seven days after surgery. This case is reported five months after surgery. We recommend that lipoma be at all times considered in the differential diagnosis of intestinal obstruction.

Management of the mass casualty from the 2001 Jos crisis.

BACKGROUND: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. MATERIALS AND METHODS: A retrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care. RESULTS: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients. Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside. CONCLUSION: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.

Experience with rubber band ligation of hemorrhoids in northern Nigeria.

BACKGROUND: Treatment of hemorrhoids in Nigeria is usually done by the traditional open method that requires hospital admission; anesthesia and is associated with high morbidity. Rubber band ligation is a suitable alternative to open hemorrhoidectomy and has the potential to reduce the need for hospital admission. PATIENTS AND METHODS: This was a prospective analysis of consecutive patients presenting with hemorrhoids that were suitable for surgical treatment to the Jos University Teaching Hospital and the Federal Medical Centre Gombe from January 2008 to December 2010 (24 months). RESULTS: A total of 232 rubber band ligations were performed on 40 patients whose ages ranged from 20 to 54 years with a mean age of 37.1 ± 12.2 years. There were 24 males and 16 females (M:F::2:3). Thirty-nine patients (97.5%) were cured of their symptoms following the procedure, and 1 patient (2.5%) had severe pain as complication of the treatment. Another patient had recurrence that was treated by repeat rubber band ligation. CONCLUSION: We conclude that rubber band ligation is a safe and reliable way for outpatient treatment of hemorrhoids in Nigeria.

Laparoscopic paediatric surgery: a potential for paradigm shift in developing countries.

BACKGROUND: Until recently, surgical conditions in children requiring operation were managed by the traditional open method. The introduction of the laparoscopic surgical technique seems to be reversing this trend in many centres. We are pioneering some laparoscopic surgery procedures in our environment and the aim of this study was to document our experience with laparoscopic paediatric surgical procedures in a developing country. MATERIALS AND METHODS: This was a prospective analysis of all consecutive children that had laparoscopic surgery at 5 hospitals in Northern Nigeria from June 2008 to February 2011. RESULTS: Twenty-one patients had laparoscopic surgeries during the study period with a mean age of 12.5 ± 2.6 years and age range of 10-16 years. There were 14 females and 7 males with a M:F ratio of 1:2. Seven patients (33.3%) had cholecystectomies and 13 (61.9%) had appendicectomies and the remaining one patient (4.8%) had adhesiolysis for partial adhesive intestinal obstruction following previous open appendicectomy. The mean operating time was 89 min with a range of 45-110 min for appendicectomies, 55-150 min for cholecystectomies and the adhesiolysis took 50 min. The mean hospital stay was 2 days except for the conversions that stayed up to 7 days. There were 2 (9.5%) conversions with no mortality. CONCLUSION: We solicit a paradigm shift in our approach to surgical management and implore other centres to embrace laparoscopic surgery in the management of surgical conditions in children since it confers obvious advantages over open surgery.

Pattern of urological malignancies seen at Federal Medical Centre Gombe North Eastern Nigeria.

BACKGROUND: The incidence of urological malignancies is on the increase globally like most other malignant tumours. There is generally poor documentation of urological malignancies in Nigeria attested to by the paucity of literature on this subject matter. This study was carried out to document the pattern and distribution of urological malignancies seen at Federal Medical Centre, Gombe, North Eastern Nigeria. MATERIALS AND METHODS: This was a retrospective analysis of all pathologically proven urological malignancies seen at this centre from January 2000 to December 2007. All records of patients with the diagnosis of urological malignancies were retrieved from the histopathology registers, operation registers and patients' case notes. The patients' biodata including their ages, sex and tumour site were extracted and analysed. RESULTS: A total of 118 cases of urological malignancies were recorded during the 8 years under review. Ninety-nine (83.9%) ocurred in males while the remaining 19 (16.1%) were in females giving a male: female ratio of 5:1. Children comprised of nine 9 (7.6%) and adults 109 (92.4%) of the population. The organ specific frequency of occurrence of the tumour in descending order comprised of prostate 63 (53.4%) bladder 33 (28.0%), kidney 17 (14.4%), testes 3 (2.5.%) penis 2 (1.7%) ureter and urethra (0%). CONCLUSION: We concluded that prostate, urinary bladder and renal carcinomas are the three most common urological malignancies in North Eastern Nigeria.

Histopathological types of breast cancer in Gombe, North Eastern Nigeria: a seven-year review.

This was a retrospective analysis of all consecutive breast cancer specimens submitted to the Pathology Department Of Federal Medical Centre, Gombe which renders histopathology services to four states in the North Eastern region of Nigeria. A total of 172 cases of malignant breast tumours were recorded during the 7 years under review. Out of the 172 cases of breast cancers analysed, 7 (4%) were in males while the remaining 165 (96%) were in females giving a male: female ratio of 1:24. The most common histopathological type of breast cancer found in this study was Invasive Ductal Carcinoma no special type (NST) accounting for 78.8% of cases.

Histopathological types of breast cancer in Gombe, North Eastern Nigeria: a seven-year review

This was a retrospective analysis of all consecutive breast cancer specimens submitted to the Pathology Department Of Federal Medical Centre, Gombe which renders histopathology services to four states in the North Eastern region of Nigeria. A total of 172 cases of malignant breast tumours were recorded during the 7 years under review. Out of the 172 cases of breast cancers analysed, 7(4%) were in males while the remaining 165(96%) were in females giving a male: female ratio of 1:24. The most common histopathological type of breast cancer found in this study was Invasive Ductal Carcinoma no special type (NST) accounting for 78.8% of cases (Afr J Reprod Health 2011; 15[1]: 107-109)

Laparoscopic general surgery--the journey so far.

BACKGROUND: Laparoscopic surgery has evolved in a relatively short time to become a popular and integral part of the surgical armamentarium. An overview of developments which have taken place since its inception is presented. METHODS: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: Laparoscopic surgery has developed rapidly, initially from a basically diagnostic procedure to a therapeutic one which is currently challenging time-honoured traditional methods of surgery. Technological advancements and enthusiasm as well as the desire for scar less surgery appear to be poised to push even further the frontiers of this discipline.

Inguinal hernia: the quest for the best repair.

BACKGROUND: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current mesh-based techniques is presented. METHODS: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: The history of inguinal hernia is a rich one, from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure.

Histopathological Pattern of Breast Carcinoma in Different Age Groups

Background: Breast cancers tend to be more aggressive in younger patients and some histopathological types like medullary; mucinous and tubular variants have a better prognosis. This study describes the histopathologic pattern and tumour grade of breast carcinoma in younger patients. Methods: This was a retrospective analysis of all consecutive breast cancer specimens submitted to the histopathology department of Federal Medical Centre Gombe during the study period. The data was analyzed with EPI Info 2002 using simple means and percentages. Results: A total of 167 cases of breast carcinoma in 164 females were reviewed with three patients having bilateral disease. The age range of the study population was 22-75 years with a mean age of 44 +/-11.7 years. One hundred and twenty seven patients (76) were aged less than 50 years while the rest were above 50 years. A total of 133 tumours were invasive ductal carcinomas; 107(80.45) of which were in the premenopausal age group and 26(19.55) in post menopausal age. One hundred and six patients (63.5) had low grade tumours (grades 1 and 2) while 61(36.5) had high grade tumours (Grades III and IV tumours). Forty three (70.5) of these high grade tumours were seen in premenopausal age group. Eleven patients had invasive lobular carcinoma of which 4(36.4) were premenopausal while 7(63.6) were post menopausal. Conclusion: It is concluded that younger patients tended to frequently have aggressive and high grade disease

Laparoscopic General Surgery - The Journey So Far

Background: Laparoscopic surgery has evolved in a relatively short time to become a popular and integral part of the surgical armamentarium. An overview of developments which have taken place since its inception is presented. Methods: The PubMed database was searched for all eng language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Conclusion: Laparoscopic surgery has developed rapidly; initially from a basically diagnostic procedure to a therapeutic one which is currently challenging time-honoured traditional methods of surgery. Technological advancements and enthusiasm as well as the desire for scar less surgery appear to be poised to push even further the frontiers of this discipline

Inguinal Hernia:The Quest for the Best Repair

Background: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current meshbased techniques is presented. Methods: The PubMed database was searched for all eng language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Conclusion: The history of inguinal hernia is a rich one; from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure

Pattern of duplex doppler ultrasound scans in Jos University Teaching Hospital.

INTRODUCTION: Doppler ultrasound scan is a non invasive diagnostic tool used in the evaluation of vascular and perivascular lesions. It is gaining a wider acceptance over other methods of vascular evaluation which are expensive and invasive. We aimed at evaluating the indications and findings of duplex doppler ultrasound scans performed in this centre. METHODOLOGY: This was a retrospective study of all consecutive patients that had doppler ultrasound scans from January 2000 to December 2004. RESULTS: One Hundred and sixty five (165) Doppler ultra sound scans were performed on 115 patients. Thirty nine patients had a double scan while 19 had repeated scans. The study population was aged between 2-90 years with a mean age of 44.5 +/- 17.5 years. There were 86 (52.1%) males and 79 (47.9%) females giving a male to female ratio of 1:1.67 (41%) of the doppler scans were for deep vein thrombosis while peripheral vascular disease and vascular aneurysm accounted for 24 (14.5%) and 23 (13.9%) respectively, see Table 1. Reduction in vascular blood flow was the most common doppler finding seen in 34 (20.6%) patients followed by visible thrombi in 14 (8.5%) patients. CONCLUSION: Deep vein thrombosis is the most common indication for doppler ultrasound scan in our practice.

Unsedated flexible upper gastrointestinal endoscopy: need for routine oxygen monitoring?

BACKGROUND: To determine the incidence of oxygen desaturation and whether routine oxygen monitoring is necessary during unsedated diagnostic flexible upper gastrointestinalendoscopy. METHODS: A prospective study involving 54 consecutive in and out patients who had diagnostic upper gastrointestinal endoscopy at the endoscopy suit of the Jos University Teaching Hospital, Jos, Nigeria between March 2007 and October 2007. The patients were reviewed before the procedure and classified according to the American Society of Anesthesiologists' (ASA) classification into classes I, II, III and IV Endoscopy was carried out after topical pharyngeal anaesthesia using 10% lidocaine spray and oxygen saturation was monitored throughout the procedure. RESULTS: There were 30 males and 24 females, with a male, female ratio of 1.25:1. The mean age was 46.7 with a range of 17 to 81 years. Mild to moderate desaturation occurred in 10 (18.5%) of the patients while severe desaturation occurred in 7 (12.9%) of the patients. All cases of severe desaturation lasted less than 30 seconds and no supplementary oxygen was needed. There were no significant statistical correlations between desaturation and gender, age, duration of procedure or ASA status of the patients. CONCLUSION: Routine oxygen monitoring may not be necessary in patients undergoing unsedated diagnostic upper gastrointestinal endoscopy and who do not have respiratory disease.

Thyroidectomy under local anaesthesia: how safe?

BACKGROUND: In order to compliment the inadequate health facilities in the rural areas in Nigeria, nongovernmental organisations provide adhoc outreach health camps that offer treatment in various medical specialties including surgery. SETTING: Rural outreach health camps. OBJECTIVE: To evaluate the safety of thyroidectomy under local anaesthesia at rural outreach setting with inadequate facilities for general anaesthesia. PATIENTS AND METHODS: This was a prospective descriptive study of 33 consecutive cases of thyroidectomy performed using field block with 1% lignocaine and adrenaline 1: 200,000 dilution during two free medical outreaches that held at Jos, Nigeria in March and October 2005 respectively, lasting two weeks each. RESULTS: A total of 33 primary thyroid operations were performed consisting of 30 subtotal thyroidectomies (91%), 2 lobectomies (6%) and one total thyroidectomy (3%), The patients were aged between 23 and 62 years with a mean age of 45.8 years. There were 3 males and 30 females with a male: female ratio of 1:10. There was no mortality but morbidity was 2/33 (6%) Two complications were recorded in 2 patients and were superficial surgical site infection (3%) and reactionary haemorrhage (3%). CONCLUSION: We conclude that thyroidectomy under local anaesthesia is a safe procedure in experienced hands at rural settings with inadequate facilities for general anaesthesia.

One-stage treatment of left-sided large bowel emergencies.

OBJECTIVE: To evaluate the safety and benefits of left-sided colectomy and primary anastomosis without intraoperative colonic irrigation in the management of patients with colorectal emergencies. DESIGN: Prospective descriptive analysis of patients with emergency left-sided colonic and rectal lesions requiring resection and primary anastomosis. Setting A hospital based cohort over a five and a half year period at Jos University Teaching Hospital, Jos, Nigeria. SUBJECTS: A total of 42 patients with left sided and rectal emergency lesions. Their ages ranged from 9-65 years with a mean of 43.1 years. INTERVENTION: Twenty patients had sigmoid colectomy and primary colorectal anastomosis for sigmoid volvulus. Two patients with compound sigmoid volvulus had sigmoid colectomy as well as ileal resection and primary colorectal and ileoileal anastomosis. Transverse colectomy and primary colocolic anastomosis was carried out in six patients who had transverse colon tumour from gastric neoplasia. These six patients had in addition distal partial gastrectomy and gastrojejunal anastomosis to remove the primary gastric neoplasia. One patient had transverse colectomy and another four left hemicolectomy and primary colocolic anastomosis for trauma. Left colectomy and colocolic anastomosis was performed in three patients with left colon tumour while anterior resection and colorectal anastomosis for rectosigmoid cancer was carried out in six patients. MAIN OUTCOME MEASURES: Manual decompression of the colon is as good as antegrade colonic irrigation in the management of left-sided large bowel emergency conditions in selected patients when undertaken by dedicated experienced surgeons. RESULTS: There was one clinical anastomostic leak presenting as enteric fistula on the sixth postoperative day. The discharge was bilious and occurred in a patient with gastric mesenchymal stromal tumour who had distal partial gastrectomy and gastrojejunal anastomosis. He had no features of generalised peritonitis nor residual intra-abdominal abscesses. The fistula was managed non-operatively. A 12% wound infection rate was recorded. All infections were superficial and healed with conservative measures. We had no mortality in our series. The hospital stay ranged from 6 to 21 days with a mean of 7.5 days. CONCLUSION: Manual decompression of the colon alone is as good as colonic irrigation in the management of left-sided large bowel emergencies. However, on-table antegrade colonic irrigation should be reserved for the loaded colon that may interfere with the use of a stapling instrument, when the resection margins are limited as in low anterior resections and when left-side colonic emergencies are undertaken by non-dedicated, less experienced surgeons.

Endoscopic Dilatation of Severe Oesophageal Stricture in Pregnancy: Case Report

In this paper; we present a case report of a severe oesophageal stricture in a pregnant woman that was successfully dilated endoscopically with improved maternal and foetal outcomes

Gastrointestinal perforation following blunt abdominal trauma.

OBJECTIVE: To highlight the pertinent management problems of bowel perforation following blunt abdominal trauma. DESIGN: A prospective descriptive study. SETTING: Hospital-based cohort over a nine year period in Jos University Teaching Hospital, Jos, Nigeria. SUBJECTS: A total of 23 patients with bowel perforation out of 8,970 trauma victims with a mean age of 28.5 years. INTERVENTION: Exploratory laparotomy, drainage of septic peritoneal fluid and wound saline lavage and closure of perforations were performed in all the 23 patients with clinical features and imaging signs suggestive of bowel perforation following blunt abdominal trauma. Femoral fractures were splinted and tube thoracostomy were carried out in four and two patients respectively. MAIN OUTCOME MEASURES: There is an apparent delay in presentation and diagnosis of traumatic bowel perforation following blunt abdominal trauma. Signs of peritoneal sepsis remain the most consistent findings in our environment. The morbidity and mortality following blunt abdominal trauma and bowel perforation are high because of established peritonitis. Delayed presentation or large leakage of bowel content into the peritoneal cavity and the attendant ease with which peritonitis develops in the latter are factors responsible. RESULTS: Delayed presentation (mean 3.05 days) was observed in seven of 23 patients. Eight patients had concomitant injuries; two to the head, four had right femoral fracture and two blunt chest injury. Features of peritonitis were present at initial evaluation in 19 patients. Seventeen patients were victims of motor vehicle accident. Radiological evidence of perforation (pneumoperitoneum) was present in only two of four patients with difficult diagnosis. Free peritoneal fluid without solid organ injury was detected in two patients with ultrasound. Diagnostic peritoneal lavage was, therefore, not used in any of our patients. The mean time from admission to laparotomy was six hours. Sites of perforations were: stomach (2), jejunum (9), ileum (8), jejunum/ileum (2) and colon (2). Sepsis originating from the perforated bowel was responsible for mortality in our patients who died in the perioperative period with concomitant injury playing significant role in three of 11 patients with such injuries. CONCLUSION: Peritonitis following a bowel perforation after blunt abdominal trauma is often present at the time of presentation and diagnosis is usually made. In the few doubtful cases, often in patients presenting soon after trauma, X-ray and trans-abdominal ultrasonography will assist in making a diagnosis. Delayed presentation still accounts for a high mortality in bowel perforation following blunt abdominal trauma.