Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria.

BACKGROUND: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion. PATIENTS AND METHODS: The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16. RESULTS: Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123). CONCLUSION: DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.

Syndromic anorectal malformation associated with Holt-Oram syndrome, microcephaly, and bilateral corneal opacity: a case report.

BACKGROUND: The occurrence of an anorectal malformation with Holt-Oram syndrome, microcephaly, and bilateral corneal opacity is rare and to the best of our knowledge has not previously been reported in the literature. Hence, there is a need to document our experience in this case and learn as much as possible from it. CASE PRESENTATION: We present the case of a Nigerian female neonate with a postnatal diagnosis of syndromic anorectal malformation associated with Holt-Oram syndrome, microcephaly, and bilateral corneal opacity. The infant had successful staged correction of her anorectal malformation but developed a metastatic Wilms' tumor and died before other corrective procedures could be instituted. CONCLUSIONS: An anorectal malformation is here reported to occur with Holt-Oram syndrome, an association that has not been reported previously. To enhance the prognosis and quality of life of children with syndromic anorectal malformation, prenatal ultrasound monitoring of high-risk pregnancies and expertise in prenatal detection of congenital anomalies are invaluable in antenatal care.

Intussusception in children: Comparison between ultrasound diagnosis and operation findings in a tropical developing country.

BACKGROUND: Intussusception is one of the more common causes of intestinal obstruction in children. The diagnosis may be based mainly on clinical features; however, there are no classic signs and symptoms that are common to all cases. This study reports our experience at US diagnosis and operation findings of children with intussusceptions in a tropical developing economy. MATERIALS AND METHODS: This was an 8 years retrospective review of intussusceptions in children in a tertiary health facility in a tropical developing country from January 2004 to December 2011. RESULTS: Twenty-five out of 41 children (M:F = 2.2:1) admitted with intussusceptions within the period were studied. The median age was 6.0 ± 5.57 months (range 3 months- 7 years). US positively diagnosed intussusceptions in 20 (80%) cases. CONCLUSION: US can increase diagnostic confidence in intussusceptions.

Utilization of banked blood in pediatric surgical procedures in Calabar, Nigeria.

BACKGROUND: Performing major surgery in a child demands that blood is cross-matched and saved to be transfused as indicated. Because the cost of cross-matching and donation of blood can be enormous and may equal or surpass the cost of surgery in our setting, it is pertinent to evaluate its utilization. The aim of this study was to determine how banked blood meant for pediatric surgical procedures was utilized with the hope of streamlining our blood requisition policy. This may be useful to pediatric and other surgeons involved in the operative care of children in similar settings. MATERIALS AND METHODS: This was a prospective study of all children who had ELECTIVE or EMERGENCY surgical procedures between January 2009 and June 2010. The age, sex, nature of surgery, blood loss, banked units of blood and amount transfused were collected and analyzed. RESULTS: Eighty two patients had 81 units of blood banked for them. Forty - eight and half units (59.9%) of the banked blood were for the emergency group but only 18 units (22.2%) were actually transfused at the end (P = 0.044) leading to inadequate use of the product. CONCLUSION: Banking large quantities of blood but utilizing only little is tantamount to inadequate use and delays surgical intervention. Indirectly, it increases cost of surgery. There is need to rationalize our blood ordering habits without causing harm to patients.

Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge.

All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many low-and middle-income countries, the death rates from trauma in the pediatric age group exceed those found in developed countries. Much of this mortality is preventable by developing suitable preventive measures, implementing an effective trauma system and adapting interventions that have been implemented in developed countries that have led to significant reduction in both morbidity and mortality. This review of literature on the subject by pediatric and orthopedic surgeons from different centers in Africa aims to highlight the challenges faced in the care of these patients and proffer solutions to the scourge.

Dicephalus parapagus conjoined twins discordant for anencephaly: a case report.

INTRODUCTION: Cases of conjoined twins occur so rarely that it is important to learn as much as possible from each case. CASE PRESENTATION: We present a case of 9-hour-old, female, Nigerian dicephalus parapagus conjoined twins discordant for anencephaly diagnosed only after the birth of the twins. The anencephalic twin was stillborn while the normal one died within 9 hours of birth from cardiopulmonary failure. CONCLUSION: Many congenital defects of interest can now be detected before birth. A severe lesion such as that found in our index case, which is incompatible with postnatal life, requires counselling. If detected early enough during a properly monitored antenatal care, it may indicate termination of pregnancy.