Primary Small Intestinal Non-Hodgkin's Lymphoma: A Case Report.

BACKGROUND: Primary intestinal lymphoma has not been previously reported in our unit, and we consider it to be a very rare cause of acute small bowel obstruction. METHODS: We present an adult male with features of recurrent small intestinal obstruction who previously underwent umbilical hernia repair for the same pain. A plain x-ray and ultrasound scan showed features of intestinal obstruction but did not suggest an aetiology of his symptoms. RESULTS: He was resuscitated and underwent an exploratory laparotomy and resection of an obstructing ileal mass with mesenteric nodes. Primary anastomosis of healthy ileum was done and the post-operative period was uneventful. The tissue was reported as low-grade B-cell non-Hodgkin's lymphoma (NHL). He was placed on CHOP with a satisfactory response. CONCLUSION: Small intestinal lymphoma is a rare cause of intestinal obstruction.

CONTEXTE: Le lymphome intestinal primaire n'a pas été rapporté précédemment dans notre unité, et nous le considérons comme une cause très rare d'obstruction aiguë de l'intestin grêle. MÉTHODES: Nous présentons un homme adulte présentant les caractéristiques d'une obstruction récurrente de l'intestin grêle et ayant déjà subi une réparation de hernie ombilicale pour la même douleur. La radiographie et l'échographie ont montré des caractéristiques d'obstruction intestinale mais n'ont pas suggéré l'étiologie de ses symptômes. RÉSULTATS: Il a été réanimé et a subi une laparotomie exploratoire et la résection d'une masse iléale obstructive avec des ganglions mésentériques. Une anastomose primaire de l'iléon sain a été réalisée et la période postopératoire s'est déroulée sans incident. Le tissu a été déclaré comme étant un lymphome non hodgkinien (LNH) à cellules B de bas grade. Il a été placé sous CHOP et avec une réponse satisfaisante. CONCLUSION: Le lymphome de l'intestin grêle est une cause rare d'obstruction intestinale. Mots clés: Lymphome intestinal primaire, Obstruction intestinale récurrente, Laparotomie.

Clinical presentation of inguinal hernia among adults in Uyo, Nigeria.

BACKGROUND: Inguinal hernia is a common pathology seen by the general surgeon in the outpatient clinic. Its spectrum of clinical features on presentation significantly varies from the asymptomatic to the complicated. OBJECTIVE: To identify and audit the common clinical presentation and presence of known risk factors for inguinal hernia among adult patients with inguinal hernias presenting to an outpatient clinic. METHODS: The study involved adults presenting over 1 year at a surgical clinic with a clinical diagnosis of inguinal hernia. Data on age, sex, family history, abdominal pain, constipation, chronic cough, previous hernia surgery as well as features of bladder outlet obstruction and intra-abdominal mass were recorded into a format. Analysis into a simple percentage, mean, and standard deviation was done with SPSS version 17 (SPSS Inc. Chicago, IL, USA). RESULTS: Sixty-five patients were enrolled in the study, comprising 49 males (75.4%) and 16 females (24.6%), M:F = 3:1. The mean age was 45.6 years (SD ± 16.9). The 16-40-year age group had the highest incidence of 29 cases (44.6%) of inguinal hernia. A family history of inguinal hernia (31 cases [47.7%]) and history of previous inguinal hernia surgery (15 cases [23.1%])) was observed. Ten patients with previous surgery presented with a contralateral hernia and 5 with a recurrence. Other factors were chronic constipation 10 cases, smoking 9 cases, chronic cough 8 cases, dysuria 7 cases, enlarged prostate 6 cases, abdominal mass 4 cases, and urethral stricture 1 case. CONCLUSION: Inguinal hernia is common among young and middle-aged adults in our series. Many patients have features suggestive of complications at presentation. Family history and past inguinal hernia surgery were important risk factors.

Impalement injury to the abdomen: Report of a case.

Impalement presents a combination of injuries severe enough to cause the homeostatic mechanisms to malfunction or fail. It challenges the abilities of the managing team as well as the available medical resources. Its management is even more demanding in environments where health-care personnel, facilities for emergency care, and communications infrastructure are absent or poorly funded and equipped. The primary objective of managing impalement injuries is to prevent further injuries and preserve or restore homeostasis. Leaving the impaling object in situ until in the operating room is a time proven approach as it allows for managing life-threatening hemorrhage in the operating room. Adequate volume replacement, good visualization, debridement of injuries, and anti-infective measures are complementary. We present a case of type I abdominal impalement in a young man who sustained minimal visceral or neurovascular injuries and underwent exploratory laparotomy for his injuries; he developed a traumatic incisional hernia. He defaulted on the scheduled hernia repair.

Day surgery: are we transferring the burden of care?

CONTEXT: Day procedures are preferred by many surgeons for minor and intermediate procedures in fit patients. It is however considered to transfer the burden of care to care-givers and other healthcare providers. AIM: The aim of the following study is to assess the tendency of day care patients seeking attention from health care providers and their ability to ambulate in the first week. SETTINGS AND DESIGN: Prospective study in a tertiary health facility in South-South Nigeria. MATERIALS AND METHODS: Patients in American Society of Anesthesiologists class I and II undergoing day-care procedures in a surgery unit were assessed at one week for the effects of the procedure on ambulation and their likelihood to seek medical attention. Data on the sex, type of procedure, pain, bleeding and ambulation was analyzed. A visual analog pain score of 0- 3 (mild); 4-6 (moderate) and 7-10 (severe) was used. Bleeding was defined as complete soaking of the two-layered gauze dressing with blood. STATISTICAL ANALYSIS: Analysis was performed with SPSS 17 for Windows (SPSS Inc. Chicago, Illinois) and presented as percentages, mean and tables. RESULTS: A total of 99 patients comprised of 47 males and 52 females registered in the study; with a mean age of 38 years (range 16-70); 76 patients (77%) complained of pain at the operation site while 23 (23%) had no complaints. Pain was mild in 59 (78%) and moderate 17 (22%). None had severe pain or bleeding from the operation site; 85 patients (86%) could ambulate easily, 14 (14%) partially and none completely unable to ambulate. CONCLUSION: Day procedures in selected patients has minimal affects on their ambulation and no increased risk of seeking medical attention in the first week and would appear not to transfer the burden of care to the community.