Routine use of intravenous fluids in appendicectomy is unnecessary.

Fifty-three patients aged 13 to 48 years (mean 27.5 years) underwent appendicectomy for acute non-perforated appendicitis in Benin city or Asaba, Nigeria, between November 1990 and December 1992 and did not receive intravenous fluids at any stage. Postoperatively, they were started on oral hydration as soon as they recovered fully from anaesthesia. Two (3.8%) patients vomited postoperatively but this did not significantly interfere with their oral hydration. Six (11.4%) patients developed wound infection. All the patients were discharged within 48 hours. Routine use of intravenous fluids in appendicectomy for non-perforated appendicitis is unnecessary and wasteful. It should be used only in selected cases.

Incidence of hypo-parathyroidism following thyroidectomy in a prospective study of 108 consecutive African patients.

In a prospective study of 108 consecutive African patients in the University of Benin Teaching Hospital undergoing thyroidectomy over the period 1986-1990, one patient had overt hypoparathyroidism while six others presented with the latent form, giving an overall incidence of 6.5 pc. Hypoparathyroidism was associated with large adherent goitres involving extensive dissection. Routine post-operative serum calcium is advocated so as not to miss latent hypoparathyroidism. Identification of the parathyroids with preservation of the blood supply should be carefully observed so as to minimise the incidence of hypoparathyroidism.

Obstructed duodenal ulcer syndrome. Observations from Kano, Northern Nigeria.

23 patients with obstructed duodenal ulcer syndrome presented in a government hospital in Kano, Northern Nigeria within a 14 months period. One presented in acute obstruction while the remaining twenty two were chronic cases. Only one patient sought medical attention before the onset of symptoms of obstruction. These figures suggest that obstructed duodenal ulcer syndrome is fairly common in Kano and that most patients with uncomplicated duodenal ulcer there do not seek proper medical attention. Duodenal ulcer is therefore probably not as uncommon there as current literature suggests.

Simultaneous appendectomy and inguinal herniorrhaphy could be beneficial.

Two patients seen in Murtala Muhammed Hospital in Kano, Nigeria in 1989, who developed acute appendicitis after inguinal hernia repair during which the appendices were present in the hernia sacs but not removed, are described. Eleven patients who had an appendectomy during inguinal hernia repair are also described. None had a wound infection or recurrence of their hernia. Because of the possibility that postoperative adhesions in the vicinity of the appendix might subsequently provoke inflammation, it is suggested that an adequately exposed appendix in an inguinal hernia sac be routinely removed.

A comparison of wound complications after inguinal hernia repair under local and general anaesthesia.

Ninety-one male patients with unilateral reducible inguinal hernia were randomly allocated to receive either general or local anaesthesia in order to compare the incidence of postoperative wound complications following both methods of anaesthesia. Forty-seven patients received local anaesthesia while 44 received general anaesthesia. Two patients (4.3%) who received local anaesthesia and three patients (6.8%) who received general anaesthesia developed various types of postoperative wound complications. Chi-squared test however showed no significant difference in the incidence of wound complications between the two groups of patients.

Surgical abdominal tuberculosis in Nigerians: a series of 17

Seventeen cases of abdominal tuberculosis were seen over a period of thirteen years in the surgical units of the University of Benin Teaching Hospital. There were 9 males and 8 females and their ages ranged from 15 to 60 years with a median age of 38.9 years. There were 7 cases of tuberculous mesentric lymphadenitis; 3 of gastric tuberculosis; 2 each of tuberculous peritonitis and ileo-ccaecal tuberculosis fistula-in-ano. The common presenting clinical faetures were abdominal pain; fever; vomiting; weight loss; abdominal distension and abdominal mass which were not always diagnostic. Laparotomy was mostly used to obtain tissues for diagnosis in which there was histological confirmation of tuberculosis in all 17 cases and positive bacterial examination in only 5 patients. [abstract terminated]

Possibilities of the strong posterior wall of inguinal canal in women.

Three hundred and twenty-nine females aged 15-81 years (mean 51.5 years) and 1,928 males aged 17-76 years (mean 42.9 years) who presented with inguinal hernia over a ten-year period were reviewed. Combined ipsilateral direct = indirect (pantaloon) hernia appeared only from the fourth decade in both sexes with 7 (1.8 pc) and 111 (5.6 pc) cases occurring in females and males respectively. 3.5 pc of the total herniae in females and 18.6 pc in males were of primary direct type. 40 (12.2 pc) females and 270 (14 pc) males had bilateral hernia. There was a marked rise in the incidence of primary direct and bilateral hernia in males from the fourth and fifth decades. It is postulated that this is because defective collagen synthesis in the tissues of the inguinal region occurs more in males than in females.

Early post-appendicectomy discharge in Nigerians.

Thirty-one Nigerians with uncomplicated acute appendicitis were discharged within forty-eight hours of operation. Before discharge, 3 patients experienced abdominal colics but this did not prolong their hospital stay. 3 patients developed wound infection which, in all cases, manifested more than twenty-four hours after removal of stitches. No patient returned to hospital with any complaints before removal of stitches and there were no re-admissions. 26 patients liked this early discharge while the remaining 5 patients preferred the conventional hospital stay. Early discharge after appendicectomy is safe, has socio-economic benefits and should be more readily practised in the developing countries.