A 10-year audit of gynaecological surgeries performed in the paediatric age group at the Jos University Teaching Hospital.

BACKGROUND: Surgeries performed for gynaecological conditions in children and adolescents are not common in our environment. Adequate facilities and the skill to perform the required procedures may also be lacking. We were interested in reviewing the practice of paediatric gynaecological surgery in our facility. PATIENTS AND METHODS: A retrospective study of case files and theatre records of children below the age of 16 years who had surgeries at the Jos University Teaching Hospital over a 10 year period was undertaken. RESULTS: A total of 89 surgeries were performed in this age group during the period under review. Twenty-eight (33.4%) of the patients were below the age of 11. The most common surgical procedure was for the management of septic abortion (21.3%). Correction of congenital malformations of the genital tract accounted for 21.4% (19) of the surgeries performed. Fourteen (15.7%) laparotomies were performed for ovarian cysts. CONCLUSION: Though the number of surgeries performed on children for gynaecologic reasons may appear small, the skills required to manage them should be enhanced and the requisite facilities provided.

Marfan's syndrome presenting with abdominal aortic aneurysm: a case for vigilance.

We present the case of a 16-year old student with Marfan's syndrome and abdominal aortic aneurysm who presented with a diagnostic conundrum. He presented with a three months history of progressive painful left upper abdominal mass and back pain. It became severe in the last two weeks before presentation and was associated with constipation. This mass was thought to be of splenic origin but the initial ultrasound suggested a pancreatic pseudocyst. Review of his previous hospital record revealed that he had been treated for severe myopia which started at infancy. Another opthalmic review at our centre revealed bilateral ectopia lentis. He had no cardiac signs and no family history of cardiovascular diseases. He is the 6th of 8 siblings, all the family members are alive and healthy except one sibling who died at 7 months. The diagnosis of abdominal aortic aneurysm was only made at laparotomy and confirmed by on-table aortogram. He had excision of the aneurysmal sac and replacement with on-lay dacron tube graft. He died on the 4th post-operative day. A diagnosis of abdominal aortic aneurysm was not made at initial presentation because of the rarity of this condition in our environment and incompetence of the ultrasonographer. Aortic aneurysm in Marfan's syndrome is commonly found in the thoracic part of the aorta, however in this case, it is abdominal. A high index of suspicion is necessary to avoid missing this pathology, therefore the need for vigilance.

Childhood intussusception: a 9-year review.

Sixty-four consecutive cases of intussusception in 48 infants and 16 older children managed at Jos University Teaching Hospital between January 1990 and December 1998 are reviewed. The age range was between 3 months and 15 years (mean 2.2 years) and the male to female ratio was 3.6:1. The quartet of abdominal pain, bloody mucoid stools, abdominal mass and palpable rectal mass was present in 70% compared with the classical triad (abdominal pain, bloody mucoid stools and abdominal mass) which occurred in only 32%. All the children had surgery. In 26 (41%) of the children, no associated cause was found, in three polyps formed the lead point and in five children a buried appendicectomy stump formed the lead point. In 30 (47%) other children, mesenteric lymphadenopathy and inflamed Peyer's patches were noted. Ileo-colic intussusception occurred in 32 (50%) children. Manual reduction was successful in 67%. Bowel resection for gangrene, irreducibility and an iatrogenic colonic tear was done in 30% of patients. Two (3%) had spontaneous reductions. There were four deaths. The commonest complications were wound infection and adhesive intestinal obstruction.