Paediatric Acute Appendicitis: A Comparison of Diagnostic Accuracy of Three Pre-operative Diagnostic Modalities.

Introduction: The diagnosis of acute appendicitis (AA) is usually clear cut but sometimes there is atypical presentation of this condition in children. There is a need to determine and compare the diagnostic accuracy of these three pre-operative diagnostic modalities: Paediatric Appendicitis Score (PAS), abdominal ultrasonographic scan (USS) findings, and serum C-reactive proteins (CRPs). The objective of this study was to determine the diagnostic accuracy of the three diagnostic modalities and to compare each diagnostic test result with the histopathological results of the appendix specimens. Materials and Methods: This was a prospective cross-sectional study that involved children aged 4-15 years with suspected AA who presented at the emergency paediatric unit of a tertiary health care hospital in North Central, Nigeria. The PAS, quantitative serum CRP, and abdominal USS were performed for all eligible patients. Results: A total of 43 patients were included in this study. Forty appendicectomy specimens (93%) were histologically confirmed to be AA and three appendicectomy specimens (7%) were normal appendix. The diagnostic accuracy values of PAS, abdominal USS, and CRP were 95.3%, 93.0%, and 90.7%, respectively. Conclusion: This study demonstrated that PAS, abdominal USS, and serum CRP provided useful diagnostic accuracy for AA in children.

Pediatric Groin Surgeries: A Comparison of Analgesic Effects of Caudal Block and Inguinal Field Block Using Plain Bupivacaine.

Introduction: There is a paucity of studies in the West African sub-region which have compared both the intraoperative and postoperative analgesic effects of caudal block and inguinal field block using plain bupivacaine in groin surgeries in children. The study aimed to compare the duration of analgesia and complications of caudal block and inguinal field block in pediatric groin surgeries. Patients and Methods: This was a prospective, double-blind randomized study conducted at a tertiary health institution in North Central, Nigeria, over a period of 6 months. A total of 74 children scheduled for day case groin surgeries for inguinal hernia, hydrocoele and palpable undescended testis were recruited into the study. The effectiveness of the analgesic effect was assessed by measuring serum cortisol levels before surgery (i.e. baseline at 8am), 5minutes after caudal block or inguinal field block, and 1-hour after surgery. Post-operative pain was determined using FLACC score (Face, Legs, Activity, Crying and Consolability) every 15 minutes till 6 hours after surgery when the patients were discharged home and the caregivers measured the patients' pain scores using the FLACC score every 1 hour to a maximum duration of 10 hours after surgery. Data obtained from the study was entered into the study proforma and analysed using IBM SPSS version 21.0. The P value was considered statistically significant at <0.05. Results: A total of 74 patients were recruited for this study, with 68 males (91.9%) and 6 females (8.1%). The children's age range was 6 months to 7 years, with a mean age of 3.35 ± 1.90 years. The mean basal serum cortisol levels of the caudal block group and inguinal block group were 11.15 ± 5.38 µg/dL and 10.79 ± 4.92µg/d respectively (p-value = 0.767). Five minutes after caudal block, the mean serum cortisol level was 10.50 ± 5.39µg/dL while inguinal field block was 10.63 ± 4.68µg/dL (p-value = 0.288). The mean serum cortisol level obtained one hour after each procedure was 9.34 ± 4.05 µg/dL for the caudal block group and 10.00 ± 3.56 µg/dL in the inguinal field block group with p-value = 0.275.Using the FLACC score, the mean duration of analgesia in caudal block group was 372.00 ± 71.55 minutes and was inguinal field block group was 387.43 ± 62.65 minutes with a p-value = 0.116. There was no anaesthetic technique related complications that was recorded in both caudal block group and inguinal group during the study period. Conclusion: This study demonstrated that caudal block and inguinal field block using plain bupivacaine provided comparable duration of analgesia in paediatric groin surgeries. Therefore, caudal block or inguinal field block using plain bupivacaine should be recommended for both intraoperative and postoperative analgesia in elective paediatric groin surgeries.

Persistent Mullerian duct syndrome: a case report and review of the literature.

Persistent Mullerian duct syndrome is a rare form of internal male pseudohermaphroditism, in which Mullerian duct derivatives (uterus and fallopian tubes) are present in a genotypic (46XY) and phenotypic male. Over 150 cases have been reported, mainly from outside the African setting. This article presents an unexpected case encountered in an African setting. Handicaps in the management were unavailability of necessary diagnostic tools as well as lack of finance to assess those available. Although a diagnosis was eventually arrived at and the parents thoroughly counseled, the patient has not represented for definitive surgery.

Epidemiology of non-trauma surgical deaths.

BACKGROUND AND OBJECTIVES: It is established that 70 % of morbidity and 75 % of mortality in the surgical accident and emergency (A and E) are due to trauma. However, non-trauma deaths still are an important entity requiring a specific study to highlight their pattern, and institute improvement strategies to lower death rates. METHODOLOGY: A retrospective analysis among non-trauma surgical deaths that occurred in the A and E Department of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over 24 months was done. Data collected included age, sex, interval between onset of illness and presentation, clinical features, occurrence of prior hospital visit, investigations done, cadre of surgeons that reviewed the patients and the interventions done as part of treatment before death. RESULTS: 4164 patients visited the A and E, 2916 (70%) were trauma, 1251 (30%) were non-trauma conditions. There were 171 deaths, 129 (75.4%) were trauma deaths while 42 (24.6%) were non-trauma deaths. Thirty (71.4%) of the 42 had complete information for analysis. Age range was 2-95 years (mean 42.7 +/- 21.8 years) comprising 18 males and 12 females. Patients with generalized peritonitis were in the majority 8 (26.7 %) comprising typhoid perforation 4, ruptured appendix 2 and perforated peptic ulcer 2. Terminal malignancies followed closely with 6 deaths (20.0%), 3 from urological causes (2 prostatic and 1 bladder cancer), acute gastrointestinal bleeding 3 (10%), intestinal obstruction 1 (3.3 %) and others. Nineteen patients (63.3%) had visited a previous hospital where they had spent <48 hrs (4 patients), 48hrs -1 week (4 patients) and >1 week (2 patients), undocumented (9 patients). Less than 40% of the patients were able to do the requested investigations (electrolytes, X-rays and ultrasound) or got the desired interventions (blood and antibiotics) CONCLUSION: Non-trauma deaths account for a quarter of the deaths in the A and E, generalised peritonitis and advanced malignancies were the main conditions responsible and characterized by late presentation, having spent a considerable time in a previous private hospitals.