Surgical management of patients with severe anaemia due to acute blood loss: a case for withholding perioperative blood transfusion.

Twenty one consecutive patients who had an average packed cell volume (PCV) of 16.2% (range 13-25) due to acute blood loss were treated surgically without perioperative blood transfusion. All the surgical procedures were carried out under intravenous ketamine hydrochloride. The surgical wound in each patient healed by primary intention. The packed cell volume rose to 35% and above in an average of six weeks by use of oral haematinics. The only morbidity observed was dizziness which lasted for an average of six days in ten patients. There were no deaths and all the patients remained well at an average follow-up period of 42 weeks. The study shows that perioperative blood transfusion can be avoided in surgical care of most patients who have severe anaemia due to acute blood loss without mortality and without significant morbidity.

Chest complications of amoebic liver abscess: a report of six cases from Nigeria.

During a seven year period, six patients with intra-thoracic rupture of amoebic liver abscesses required surgical intervention. Of the six cases, three ruptured into the right pleural space, two into the right lower lobe and one into the pericardium. Definitive surgical procedures performed were decortication and repair of the diaphragm in three, segmental lung resection and repair of the diaphragm in two cases and continuous subxyphoid catheter drainage of the pericardium in the remaining case. There were no death and the morbidity was insignificant.

Anaemia and wound healing. A clinical observation in 38 patients.

In a six year period, 38 patients who had an average packed cell volume of 17.9% (range 14-25%) were treated surgically and their anaemia was corrected with oral haematinics post-operatively. Twenty one of the patients had emergency while 17 had elective surgical procedures under spinal (N = 30), ketamine hydrochloride (N = 6) and local infiltrating (N = 2) anaesthesia. All the wounds healed by primary intention and no wound complication was observed after a mean follow-up period of three years. Headache following spinal anaesthesia occurred in 6 patients and was the only significant post-operative complication detected. We conclude that severe anaemia alone does not retard wound healing in man.

Intussusception: is floating caecum a causative factor? Analysis of 10 cases.

Ten consecutive cases of intussusceptions treated by the authors at the University of Port Harcourt Teaching Hospital (UPTH) in a five year period are analysed. The median age of occurrence was nine months; average 5.2 years; range: one month to 25 years. The male to female ratio was 2:3. Five patients had ileocaecal, two ileoileal, two colocolic and one ileocolic intussusceptions. Of the two patients with ileoileal intussusceptions one had antegrade with Meckel's diverticulum and the other retrograde with lipoma as lead-points. The two patients with colocolic intussusceptions had mesenteric and mesocolic lymph nodes hypertrophy. The remaining six patients had freely mobile caecum anchored to the posterior peritoneum by a long mesocaecum and such arrangement was believed to be the cause of the intussusceptions. In addition to intraoperative reduction in five cases and resection with end to end ileoileal anastomosis in one, each of these six patients had the caecum fixed to the posterior abdominal wall to prevent recurrence of the intussusception.

Pilot study of injured patients seen in the University of Port Harcourt Teaching Hospital, Nigeria.

A 12-month pilot study of injured patients seen in the Emergency Department of the University of Port Harcourt Teaching Hospital was carried out. Trauma (28.8 per cent) was the main reason for emergency visits; 82.1 per cent of the patients were under 31 years of age. Domestic accidents were the commonest cause of trauma (42.5 per cent), followed by criminally motivated injuries (30.4 per cent), road traffic accidents (26.0 per cent), industrial (0.5 per cent) and other accidents (0.6 per cent). The overall mortality rate due to trauma was 5.4 per cent and within the period of study, trauma was the most common cause of deaths in hospital (10.1 per cent). Road traffic accidents were responsible for 67.9 per cent of these deaths, followed by criminally motivated injuries (16.1 per cent). Domestic, industrial and boat accidents caused 7.6 per cent, 5.4 per cent and 3.1 per cent deaths, respectively. Injury Severity Scores (ISS) among 419 patients showed a 100 per cent mortality for those with scores above 35. There were 48 prehospital, 19 emergency room and 14 in-hospital deaths among patients with an ISS below 35. The deaths resulted largely from delayed transportation of victims to the hospital and partly from inadequate emergency medical services. To reduce the current high rate of preventable deaths from injury, we recommend (i) ambulance services for early transportation of victims to the hospital and (ii) improved emergency medical care.

Acute appendicitis: a clinical pattern in Port Harcourt Nigeria.

A retrospective study of 201 patients, 152 with simple and 49 with complicated, appendicitis is presented. Diagnosis of simple acute appendicitis was made on symptoms of abdominal pain, anorexia, nausea and vomiting, together with rebound abdominal tenderness and not on white blood cell count. Normal white blood cell count was found in 80.3% cases of simple acute appendicitis while elevated white cell count was associated with 85.7% of complicated appendicitis. There was no mortality in 152 patients who had appendectomies for uncomplicated acute appendicitis, but the mortality rate in the 49 patients with complications was 12.2%. This was responsible for the overall mortality rate of 3% for all appendectomies in this report. Complicated appendicitis in this review was largely due to pre-admission delays and the ingestion of strong cathartics, both of which could not be influenced by surgeons.

Strangulated external abdominal wall hernia: experience with 53 cases in Port Harcourt, Nigeria.

External abdominal wall hernias located in the groin commonly affect the male population, and are the most frequent cause of mechanical small-and large-bowel obstructions seen in Port Harcourt, Nigeria. The mortality associated with gangrenous strangulations of these hernias is quite high (29.4 percent), as revealed by this report. Early surgical intervention for strangulated hernias reduced this mortality to 0 percent for 34 patients who had ischemic, but viable, bowels at surgery.

Spontaneous neonatal gastric perforation.

Sixteen cases of spontaneous neonatal gastric perforation seen between January 1969 and March 1979 are reported. There were 13 surgically treated patients and three autopsy cases. This study provides information relative to the incidence among black populations, an incidence 1 per 2,900 live births. The entity is at least four times more common in males than females. All perforations occurred within the first week of life (average 72 hr). All perforations were on the greater curvature of the fundus. The operative mortality of this series is 7.5% (1 of 13) with an overall mortality of 25% (4 of 16). A gastrostomy was routinely done. No peritoneal cavity drainage or segmental gastric resection was necessary.

Pancreatic abscess: a major complication of cystogastrostomy.

Twelve cases of pancreatic abscess, managed at two hospitals in the District of Columbia, are analyzed. Forty-two percent of cases followed acute pancreatitis and infected pancreatic pseudocysts without previous surgical intervention. In 58 percent of the patients, pancreatic abscess was a complication of internal drainage of pancreatic pseudocysts. A discussion of management problems is presented.

Traumatic diaphragmatic hernias: analysis of six cases.

During three years, from January 1975 through December 1977, the authors saw six cases of traumatic left diaphragmatic hernias, all of whom survived. All were males aged 17 to 56 years, with an average age of 30 years. Four (67 percent) of the cases resulted from blunt abdominal trauma while two (33 percent) were due to stab wounds of the left lower chest. Admitting chest x-ray findings were diagnostic for all acute hernias due to blunt trauma and for all hernias presenting with a delayed interval. Digital exploration of all penetrating lower chest wounds is recommended by some authors if exploratory laparotomy is not contemplated. Our preferred approach for the repair of the hernias includes (1) laparotomy for all acute cases, (2) thoracotomy for delayed cases, and (3) separate abdominal thoracic incisions whenever a combined approach is considered necessary. The repair should be carried out in two layers with nonabsorbable sutures.