Observations on early and delayed colostomy closure.

BACKGROUND: Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. AIMS AND OBJECTIVES: The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. PATIENTS AND METHODS: Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. RESULTS: Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). CONCLUSION: Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

A study of the pattern, management and outcome of penetrating colon injuries in Sagamu.

BACKGROUND: Colon injuries are increasingly being treated safely by primary repair in spite of the high risk of septic complications. OBJECTIVE: This is a retrospective study of the pattern, management and outcome in patients treated for penetrating colon injuries at Olabisi Onabanjo University Teaching Hospital, Sagamu over a 7 year period (January 1995-December 2001). PATIENTS AND METHODS: Records of thirty-two patients were studied. RESULTS: Gunshots (75 percent) and knife stabs (18.75 percent) accounted for ninety-four percent of penetrating colon injuries. Associated intra-abdominal injuries were present in 22 patients (68.8 percent). Eight (twenty-five percent) patients presented in shock. Moderate to major faecal contamination was present in 30 (93.8%) patients. Severe colon injury occurred in nine patients. The eighteen patients with right colon wounds were managed by primary repair. All the fourteen patients with left colon wounds had a diverting colostomy alongside repair or resection. Complications included wound infection (56.7 percent) and septicaemia (31.7 percent). Eleven patients died, giving an overall mortality rate of 34.4 percent. Mortality was significantly associated with shock on admission (p<0.02), degree of faecal contamination (p<0.05) and severity of colon injury (p<0.01). Colostomy did not affect mortality. (P<0.1). CONCLUSION: In this study primary repair was employed in 56% of patients with penetrating colon injuries. The routine use of diverting colostomy for all left colon injuries can no longer be justified in current surgical practice as colostomy did not affect mortality.

Pattern of presentation and management of typhoid intestinal perforation in Sagamu, South-West Nigeria: a 15 year study.

BACKGROUND: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern, mode of therapy and outcome of cases diagnosed and treated as typhoid intestinal perforation at Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1990 and December 2004. METHODS: Complete records of 105 adult patients were studied. RESULTS: The male to female ratio was 2:1. The mean age was 27 years. Prior to arrival in our hospital, all the patients were on various combinations of antibiotics. Twenty-seven (26%) patients had been hospitalized elsewhere during the current illness. Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4%) patients. Resistance to chloramphenicol was found in three (60%) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations, mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure, multiple perforations by primary resection and anastomosis. Fifty-five (52.4%) patients developed complications. Fourteen (13.3%) patients died. There was a slight drop in mortality (8.8 %) in phase 2. Deaths were due to septicaemia in 8 (57%) patients. CONCLUSION: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation.

Pattern of Presentation and Management of Typhoid Intestinal Perforation in Sagamu; South-West Nigeria: a 15 year Study

Background: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern; mode of therapy and outcome of cases diagnosed and treated as typhoid intestina perforation at Olabisi Onabanjo University Teaching Hospital; Sagamu; between January 1990 and December 2004. Methods: Complete records of 105 adult patients were studied. Results: The male to female ratio was 2:1. The mean age was 27years. Prior to arrival in our hospital; all the patients were on various combinations of antibiotics. Twenty-seven (26) patients had been hospitalized elsewhere during the current illness Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4) patients. Resistance to chloramphenicol was found in three (60) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations; mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure; multiple perforations by primary resection and anastomosis. Fifty-five (52.4) patients developed complications. Fourteen (13.3) patients died. There was a slight drop in mortality (8.8) in phase 2. Deaths were due to septicaemia in 8(57) patients. Conclusion: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation

Extremity amputation in Nigeria--a review of indications and mortality.

Amputation is a common surgical procedure in Nigeria but there are no national data on the subject. The objective was to determine the common indications for amputation in Nigeria, mortality rate, and regional differences in indications. Results of studies on amputation in Nigeria over a 15-year period were collated and analysed. The most frequent indications for amputation were trauma (34%); complication of traditional bonesetting (TBS) (23%); malignant tumours (14.5%); diabetic gangrene (12.3%); infections (5.1%); peripheral artery disease (2.1%); and burns (2.1%). In the southern regions, trauma is the most common indication while complications of traditional bonesetting are the most common in the northern and eastern regions. The average age of the Nigerian amputee is 33 years. Hospital mortality after amputation is 10.9%. The estimated prevalence of extremity amputation in Nigeria is 1.6 per 100,000. Peripheral artery disease is an uncommon indication for amputation in Nigeria while trauma, complication of traditional bonesetting, malignant tumours and diabetic gangrene are relatively much more common. The young male is frequently affected.

Evaluation of Alvarado score as an admission criterion in patients with suspected diagnosis of acute appendicitis.

BACKGROUND: Patients with right iliac fossa pain present a diagnostic challenge to emergency room doctors when equivocal signs are present. OBJECTIVE: To evaluate Alvarado score as an admission criterion in patients with suspected diagnosis of acute appendicitis. METHODS: This was a prospective study of 100 consecutive patients who presented to the an emergency department with right iliac fossa pain and suspected diagnosis of acute appendicitis between January 2004 and December 2004. They were assessed usingAlvarado score. Main outcome measures in relation to these scores were, patient's admission, patient's discharge, and whether patient had appendicitis or not. RESULTS: The range of scores was 1-10. Seventy-four patients were admitted while 26 were discharged. Thirty-four patients with confirmed diagnosis of acute appendicitis had scores ranging from 5-10. No patient with score less than 5 had appendicitis. The sensitivity and negative predictive value reached 100% at scores below five, while specificity and positive predictive value reached 100% at the score of 10. CONCLUSION: The Alvarado score can be used as an objective criterion in selecting for admission patients with suspected diagnosis of acute appendicitis. Patients with scores of 4 and below do not require admission since they turn out not to have acute appendicitis.

Chronic intestinal obstruction due to rectosigmoid endometriosis: a case report.

BACKGROUND: Intestinal endometriosis is not commonly reported in Nigeria and Africa. This paper presents a case of chronic intestinal endometriosis in a young Nigerian woman presenting with features of chronic intestinal obstruction. METHOD: The case records of a 29-year old Nigerian female, who presented with chronic intestinal obstruction secondary to endometriosis at the Olabisi Onabanjo University Teaching Hospital (OOUTH) Sagamu, Nigeria and literature review on the subject using medline and manual library search is presented. RESULT: A young woman presented with a three- month history of progressive abdominal distension and worsening constipation. Examination revealed a grossly distended abdomen, slightly tense but no area of tenderness. Bowel sounds were slightly exaggerated. A plain radiograph of the abdomen showed features of small and large bowel obstruction. A diagnosis of chronic large bowel obstruction was made. She was found to have a stricture in the rectosigmoid at laparotomy. Hartmann's resection was done. Histologically, the stricture was due to endometriosis. Subsequent closure of colostomy and re-establishment of intestinal continuity gave excellent results. CONCLUSION: A young Nigerian female diagnosed with chronic intestinal obstruction due to rectosigmoid endometriosis was successfully treated. Though this condition is believed to be relatively uncommon in Nigeria, there is a need for a high index of suspicion, to ensure early diagnosis.

Abdominal injuries in olabisi onabanjo university teaching Hospital Sagamu, Nigeria: Pattern and outcome

Objective: The aim was to study the pattern and outcome of abdominal trauma managed by Laparotomy in Olabisi Onabanjo University teaching Hospital Sagamu (OOUTH), South Western Nigeria.Method: This is a retrospective study. The records of the patients were retrieved and relevant data extracted such as age, sex, occupation, address, cause of injury, vital signs on admission, abdominal signs, other injuries, number of units of blood transfused, investigations, indications for surgery, operative findings, procedure carried out, complications and outcome.Results: Seventy seven subjects were reviewed. There were 23 females (29.9%), and 54 males (70.1%). The age range was 3years to 68years, 32 patients (41.6%) were in 20-30 years age group. The mechanism of injury was blunt trauma in 61 (79.2%) and penetrating injury in 16 patients (20.8%). Road traffic accident was the commonest cause of injury, in 53 patients (68.8%). 42 patients (54.5%) had extra abdominal injuries. Positive paracentesis abdominis was the commonest indication for surgery, in 53 patients (68.8%). The spleen was the most commonly injured organ, in 31 patients (40.2%) while the organs were normal in 4 patients (5.2%). The complication observed includes acute renal failure, in 5 patients (6.5%), multiple organ failure in 5 patients, and wound infection in 8 patients (10.4%). Ten patients died. (13%)Conclusion: Splenic rupture is the most common abdominal injury treated by Laparotomy in OOUTH Sagamu and the commonest cause is road traffic accident. Mortality was due mainly to acute renal failure and multiple organ failure

Anal complaints in Nigerians attending Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu.

The objective of this study was to determine prospectively the prevalence of anal complaints amongst Nigerians attending the General Out-patient Department (GOPD) of the hospital and review the records of those admitted to the surgical service with related complications. All the 272 patients attending the GOPD of OOUTH in November, 1999 were interviewed using a structured questionnaire. Information concerning age, sex, educational status, present or past history of at least one of the following symptoms viz recurrent bleeding per rectum, anal prolapse, anal/perianal pain, pruritus ani and anal discharge were obtained. Also obtained were reason(s) for current hospital attendance and any previous medical consultation. Those with at least one of the symptoms were classified as symptomatic. The symptomatic group had rectal examination including proctoscopy. The results showed that 82/272 (30.15% ) were symptomatic. Rectal examination on these 82 patients showed that 10(3.7% of 272) had haemorrhoids, 2(0.7% ) had rectal prolapse, 0.7% had peri-anal warts; 15(5.5% ) anal tags, 10(3.7% ) chronic anal fissure, 2 (0.7% ) perianal fistulae. In 29(10.4% ), the examination was normal and in 12 the rectum was too loaded with feaces to permit proctoscopy. However, only 5/272 (1.84% ) attended the clinic for the anal complaint, while 12(4.4% ) had previously consulted a physician for same. Fear of impotence following surgery in 24 males and belief in herbal remedies in 32 patients were the main reasons for not consulting a physician. During the year 1999, out of a total of 558 admissions into our surgical service, only 4(0.6% ) were for complications related to anal complaints. This study indicated the prevalence of anal complaints in the study population of Nigerians as 30.15% , haemorrhoids constitute 3.7% and anal fissure 3.7% , contrary to low rates reported for developing countries. While this result cannot be extended to represent prevalence amongst Nigerians, it may be a pointer to what is to be expected.

Purulent pericarditis complicating septicaemia: report of two cases.

Intrapericardial (Pericardial) abscess is quite rare as a complication of sepsis and as a cardiac complication of typhoid septicaemia. It is rapidly fatal if untreated. We report two cases of a schoolboy eight years old with septicaemia from pyomyositis of the right thigh and another of nine and a half years with typhoid perforation and typhoid septicaemia that developed pericardial abscesses. In well-developed centres, computerised tomography, ultrasonography and other radiological investigations are employed for both diagnosis and therapy. We emphasise that these can be accomplished by good clinical examination, radiography of chest and the use of 18-G intra-venous cannula for percutaneous pericardiocentesis without aggressive surgical intervention.