RESUMO
BACKGROUND: Appendiceal agenesis is a rare intraoperative diagnosis which occurs in 0.001% of laparotomies done for presumed acute appendicitis. To our knowledge, this is the first report of appendiceal agenesis in our country and the second in Africa. CASE PRESENTATION: A 19 year old Ethiopian female student came with clinical and imaging findings of acute appendicitis. No history of previous abdominal surgery and similar illness. The vermiform appendix could not be identified following laparotomy performed for the assumption of acute appendicitis. The surgical exploration also revealed no cause for the abdominal pain. Then appendiceal agenesis was declared with an additional diagnosis of nonspecific abdominal pain (NSAD). The postoperative follow-up was uneventful. CONCLUSION: Appendiceal agenesis is a rare malformation which demands a careful examination and meticulous laparotomic/laparoscopic exploration for diagnosis.
RESUMO
BACKGROUND: The prevalence of urolithiasis is on a rising trend in tropical and sub-Saharan African countries. The treatment options and data on the surgical outcome are limited in our country. This study was designed to assess the clinical presentation, surgical management and outcome of patients operated on for urolithiasis. PATIENTS AND MATERIALS: A retrospective study of all patients admitted and operated for urolithiasis at St. Paul's hospital millennium medical college (SPHMMC) from July, 2016 to December, 2017 was conducted. Factors associated with surgical outcome were identified with binary logistic regression. RESULTS: Urolithiasis constituted 247 (30.0%) of 824 urologic admissions. Of these, 202 (Male:Female = 2:1) patients were investigated. The mean age was 37.1 ± 14.4 years (range, 10-85 years). The mean duration of illness was 16.7 ± 18.7 months and the commonest presenting symptom was isolated flank pain (97, 48.0%). A majority of the patients (186, 92.1%) had upper tract stones of which 96 (51.6%) were renal stones. More than two-thirds (164, 81.2%) of the patients had complications at presentation, and hydronephrosis (148, 73.3%) was the major one. Half of the patients (104, 51.5%) were treated with endoscopic procedures, 88 (43.6%) with open stone surgery and in 10 (4.9%) patients both were performed. Nephrectomy was done to 15 (7.4%) patients. Intraoperative and postoperative complications were noted in 16 (7.9%) and 26 (12.9%) patients, respectively. These complications were higher in patients with comorbid illness (AOR = 2.44; 95% CI 1.12-5.31; p = 0.024). Complete stone clearance was achieved in more than half of the clients (114, 61.0%). Multiple stones (AOR = 8.33; 95% CI 2.53-27.43; p < 0.0001) and endoscopic procedures (AOR = 4.17; 95% CI 1.57-10.71; p = 0.003) had significant association with incomplete stone clearance. CONCLUSION: Patients' presentation in this review was not different from studies elsewhere. Endoscopic procedures are emerging in our set up; however, it was significantly associated with incomplete stone clearance. Strategies to improve outcome (stone clearance) need to be implemented accordingly.
