Background: The most common treatment for displaced femoral neck fractures in the elderly patient is hemiarthroplasty. Postoperative wound infection is considered early when it occurs within 30 days of orthopedic operations. Infection rates vary in the literature. Availability of descriptive data is limited. Patients and Methods: Medical records of 40 out of 52 patients who had hemiarthroplasties in Irrua Specialist Teaching Hospital, Irrua, Edo State and Delta State University Teaching Hospital Oghara, 2007–2016 were reviewed retrospectively. All patients had prophylactic as well as presumptive antibiotic treatment. All had ceftriaxone and metronidazole at one point or the other. Results: Of the 40 patients, age range was 17–91 years; median age was 65 years with a slight female to male preponderance. Twenty-two (55%) patients were 60–90 years of age. Trivial/domestic falls accounted for the majority, 26 (65%) patients. Only 3 (7.5%) patients presented within 24 h. Hypertension (HT) was the most common comorbid medical condition, 67.5%. Wound infection was the most common complication noted 7 (17.5%). Polymicrobial (mixed) infection agents ranked the highest among the microbes' cultures. Five out of the seven patients with wound infection had superficial wound infection. Two had deep wound infections. Ceftriaxone and metronidazole were the most commonly used antibiotics and the most effective against infections. Genticin was uncommon. Conclusion: Sixty-seven percent of patients studied had wound infection. Superficial wound infections were the most predominant type of early postoperative wound infection, and polymicrobial mixed infection agents were the most implicated. HT was the most common comorbid medical condition identified.
Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. Survival after the age of 12 years without corrective surgery is rare. We present a case of 42-year-old Indian male with uncorrected tetralogy of Fallot. Possible reasons for the longevity in this patient are left ventricular hypertrophy and systemic to pulmonary shunting through mediastinal collaterals.
Background: Catheter-associated urinary tract infection (CAUTI) is a source of morbidity in patients on indwelling urinary catheters. Patients in both outpatient and inpatient general wards can be on indwelling urinary catheters at one time or the other due to various underlying pathologies. These indwelling urinary catheters can attract microorganisms into the urinary tract causing CAUTI. The aim is to determine the offending pathogens, antimicrobial sensitivity, and complications in CAUTI. Patients and Methods: This was a prospective interventional study involving catheterized patients without prior urinary tract infection. The catheters were inserted due to various underlying pathologies either on an outpatient basis or on admission in the general ward. On suspicion of infection by the presence of any of these, cloudy urine, pericatheter pain, suprapubic pain, fever, chills or hematuria, and urine samples were aseptically collected by the laboratory scientist for culture and sensitivity. Any significant bacteriuria either asymptomatic or symptomatic was documented, and the offending pathogens also identified. Antimicrobial sensitivity patterns were recorded, and any complications noted in the patients were recorded. Results: A total of 460 patients, 376 (81.7%) males and 84 (18.3%) females were recruited into the study. The prostatic disease was the most common pathology necessitating urinary catheterization, accounting for 59.5% of all the cases. There were 100% recorded cases of CAUTI in the study. Escherichia coli was the most common organism isolated 45.2%. There was asymptomatic bacteriuria in 81% of the patients, while in 19%, it was symptomatic. There was multidrug resistance to the commonly used antimicrobials. Conclusions: CAUTI still poses enormous challenges to both the outpatients and general inpatients. To minimize CAUTI, indiscriminate use of urinary catheters should be discouraged and urinary catheters should be removed immediately; they serve the purpose for which they were inserted.
Long loop vas, encountered during orchidopexy for undescended testis, is a rare entity and deserves a note. We report the case of an 8-year-old child who presented with pain in the left groin and was clinically diagnosed to have undescended testis and palpable in the left groin. Ultrasonography confirmed the presence of testis in the left inguinal region. The incidental finding of long loop vas intraoperatively mandates careful dissection during surgery to preserve the viability of the testis. Examination for a looping vas by inspecting structures caudal to the testis should be done during orchidopexy to avoid inadvertent transection. In view of paucity of literature of long loop vas, our aim is to enhance the already existing scanty literature and suggest the effective single-stage management of this rare condition.
Introduction: Available data in congenital musculoskeletal anomalies (MSAs) in Africa are sparse; hence, we decided to evaluate the pattern of congenital MSA as seen in Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo state of Nigeria. Materials and Methods: The clinical records of patients who presented to ISTH with congenital MSA over 10 years (January 2005–December 2014) were extracted and reviewed. Demographic data, diagnosis, description of abnormalities, associated congenital deformities, side of the body involved, and bilaterality were noted. Results: Seventy-five patients met the criteria. Fifty patients were male and 25 were female. Male: female ratio was 2:1. Congenital talipes equinovarus (CTEV) deformity was the most common MSA in 46 (61.33%) patients. Others were syndactyly in 20 (26.7%) patients and congenital constriction band syndrome in 4 (5.3%) patients. Among patients with clubfoot were a predominance of bilaterality involved with 44.7% in the idiopathic group and 62.5% of those in the nonidiopathic group. The idiopathic variety constituted 82.5% of clubfoot deformity. Spina bifida cystica was the most common associated deformity among patients with nonidiopathic clubfoot. Conclusion: CTEV was the most common congenital MSA seen in ISTH, Irrua, with a high incidence of bilaterality. Spina bifida cystica was the most associated anomaly in the nonidiopathic clubfoot in this center.
This article provides surgeons with a simplistic method to convert an injection needle into a suture needle in the operating theater itself. In the following procedure, we take an injection needle and a suture material (polypropylene number 1) and create a curved suturing needle ready to be used with minimal fuss and with the help of simple instruments. This method will definitely save time and the cost of an extra suture.
Background: Delay in presentation and treatment of abdominal wall hernias is phenomenal in Africa. The three-pronged problem of delayed presentation, multiple comorbidities, and advancing age makes management of complicated abdominal wall hernias more tasking and hazardous. The purpose of this study was to determine the causes of delayed presentation and treatment outcomes of complicated abdominal wall hernias in our environment. Patients and Methods: This was a 3-year multicenter prospective study of the causes of delayed presentation and treatment outcomes of complicated abdominal wall hernias in rural Southeast Nigeria. Results: A total of 138 patients with complicated abdominal wall hernias were enrolled and comprised of 117 males and 21 females. Of the entire patients, those with inguinal hernia represented 76.1% followed by umbilical hernia (8.0%). Only 18.1% presented within 24 h after the onset of complications, 24.6% between 24 and 48 h, 29.0% between 49 and 72 h, and 28.3% after 72 h. In the preoperative period, theater waiting time was 0–12 h in 10.9%, 13–24 h in 23.2%, 25–48 h in 39.1%, and >48 h in 18.1%. The major barriers against early presentation were financial constraint (23.9%) and treatment at alternative homes (15.9%). The overall morbidity rate was 58.0%, whereas the mortality rate was 13.8%. The bowel resection rate was 26.1%, and majority of the resection (77.8%) and deaths (73.7%) occurred in those who had overall delay beyond 72 h before surgical repair. Conclusion: The rates of morbidity and mortality were proportionally related to the length of delay in the presentation and duration of waiting time before operative repair.
Background: Acute appendicitis is the most common surgical abdominal emergency worldwide. The diagnosis is mainly clinical and the treatment of choice is appendicectomy. Aim: The aim of the study was to examine the clinical features, diagnoses, treatments, and outcomes in patients with acute appendicitis. Patients and Methods: This was a prospective descriptive study carried out over a year period from September 2009 to August 2010 at the University of Benin Teaching Hospital, Benin City. All consenting and consecutive adult patients from the age of 18 years and above with a diagnosis of acute appendicitis were recruited. Demographic, clinical features, treatments, and outcomes were noted and entered into a pro forma and later analyzed using SPSS 16 version. Results: Acute appendicitis was preoperatively diagnosed in 86 patients but confirmed in 71 patients on histology. Twenty-nine were male, while 57 were female with a mean age of 28.36 ± 10.40 years. The most common age range affected was 21–30 years. All the patients had appendicectomy. Fifteen patients had a negative histology, of which two were male, while 13 were female, with an overall negative appendicectomy rate of 17%. All the patients were well and discharged. Conclusion: Acute appendicitis occurred most commonly in the age range of 21–30 years. Females accounted for a higher number of acute appendicitis, although negative appendicectomy rate was higher in them. The overall outcome was good.
Background: Distal femoral intra-articular fractures present a serious surgical challenge to an orthopedic surgeon. These fractures are usually complex and are difficult to treat, and the operative treatment is usually recommended. Problems encountered in the fixation of these fractures include poor exposure of the articular surface, loss of fixation, and joint incongruence. Materials and Methods: This was a prospective review of all patients treated with distal femoral locking plates (including patients presenting with nonunion) between January 2017 and January 2018 using the Swashbuckler's approach. Fractures were categorized using the AO/OTA classification. Patients with AO type A fractures were excluded from this study. Results: Six patients (5 females and 1 male) were recruited into this study. The mean age of the patients was 43.2 years (age range of 31–63 years). Mechanism of injury was road traffic accident in 83.3% of cases. The mean time for radiological union was 12 weeks, and all (100%) patients achieved union without any further intervention. Conclusion: The use of the Swashbuckler's approach for distal intra-articular fractures improves exposure of the articular surface and aids reduction and proper application of the locking distal femoral plate. High union rates can usually be achieved with these implants.
Parapharyngeal space (PPS) tumors constitute only 0.5%–0.8% of all tumors of which lipoma is the rarest. In general, lipoma is found just beneath the subcutaneous tissues. Here, we present a case of a 2-year-old female child with lipoma of the right PPS extending into the neck mimicking cystic hygroma on presentation.
This study reports a rare case of parosteal osteosarcoma, a low-grade malignant lesion diagnosed in a 67-year-old female who presented with a slow growing oval-shaped, well circumscribed, bony hard, left maxillary swelling of 4 months' duration; extending from the region of the left upper lateral incisor tooth (22) to the left upper first molar tooth (26) and fixed to the overlying gingival. Oblique lateral radiograph showed the left maxillary alveolar ridge with lobulated ossified mass. The clinical differential diagnoses of the lesion were osteoma, and fibrous dysplasia histopathological diagnosis of parosteal osteosarcoma was made after incisional biopsy of the lesion. Surgical resection (with a wide margin) of the affected maxillary segment and the associated teeth was performed, and postsurgical biopsy confirmed the diagnosis of parosteal osteosarcoma. Parosteal osteosarcoma shares similar clinicopathological characteristics with some periosteal lesions. However, special imaging techniques and histopathological evaluation remain the most reliable tools for definitive diagnosis of these lesions.
Introduction: Enterostomies are one of the common surgical procedures performed in a general surgery unit. Enterostomies are fixed to the peritoneum/abdominal wall, before being sutured to the skin. This results in prolongation of operative time and dense adhesions between the bowel wall and the abdomen at the site of stoma. This is a comparative study between the commonly followed methods of maturation with our method of direct suturing of the stoma to the skin. Materials and Methods: A prospective randomized study to compare the traditional method of maturation of stoma with direct suturing of the stoma edges to the skin without a peritoneal fixation was carried out in a tertiary health-care hospital. Results: Skin complications and stomal prolapse were the most common type of complication seen. Most of the stoma-related complications were managed conservatively. There was no difference in stoma-related complications between the two methods of stoma construction in our study. However, during stoma closure, dense adhesions were seen in 90% of cases in Group A (peritoneal hitch) as compared to 7% in Group B (direct skin fixation). There was a significantly high 16.7% incidence of iatrogenic perforation of bowel in Group A during stoma closure. Conclusions: Thus, additional rectus and/or peritoneum fixation does not add any benefit in preventing stoma-related complications over intestinal stomas, which are constructed with fixation only to skin. In the group, where the stoma was fixed to abdominal wall, the higher incidence of dense adhesions between the stoma and the abdominal wall resulted in longer operative time during stoma closure and increased risk of iatrogenic bowel trauma.
Background: Intestinal obstruction is a common surgical emergency. Its pattern and causes vary between communities. Previous reports, including a study from Nnewi, showed obstructed external hernias to be the most common cause. Objective: The objective of the study is to determine the current pattern of intestinal obstruction at Nnewi. Materials and Methods: All case notes of intestinal obstruction managed at Nnewi between January 1, 2000, and December 31, 2009, were retrieved and analyzed. Results: It was found that adhesions caused 62.1% of cases of intestinal obstruction, while obstructed external hernias caused 21.4%. The rest were from other causes. Furthermore, 62.5% of intestinal obstruction from adhesions were managed nonoperatively. Conclusion: Adhesion has emerged as the most common cause of intestinal obstruction at Nnewi.
Background: Infertility is a major concern among couples in our environment. Hysterosalpingography (HSG) is a radiological procedure used to investigate women with infertility. It can be used to assess the cervical canal, the uterine cavity, and the fallopian tubes in these women. So far, the pattern of HSG findings in Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Amaku, Awka, has not been documented despite a lot of these investigations already carried out here. Objective: The objective of the study was to review the HSG findings among women with infertility in Awka. Materials and Methods: A retrospective study of HSG of women with infertility was carried out simultaneously at COOUTH and Amen Specialist Diagnostic Clinic, both in Awka, Anambra State, South-East Nigeria, from April 2013 to May 2017. The Statistical Package for the Social Sciences (SPSS) version 21 was used for the analysis. Tests for central tendencies and dispersions as well as paired sample correlation tests were carried out.P ≤ 0.05 was considered statistically significant. Results: A total of 446 cases were analyzed. The age ranged from 19 to 53 years. The mean ± standard deviation was 32.33 ± 6.02 years. The most common age group that presented was 26–30 years (33.9%), while the least were those aged ≥51 years (0.2%). Majority (56.1%) of cases presented with primary infertility while 43.9% had secondary infertility. The HSG was normal in 120 (26.9%) cases and abnormal in 326 (73.1%). Intrauterine filling defects were seen in 120 (26.9%) cases. Tubal occlusion occurred in 178 patients (40%): 106 (23.8%) bilateral, 31 (7%) left unilateral, and 41 (9.2%) right unilateral. Hydrosalpinx occurred in 49 (11%) patients: bilateral in 19 (4.26%), left unilateral in 19 (4.26%), and right unilateral in 11 (2.47%). Loculated peritoneal spillage was seen in 58 (13%) cases. Conclusion: HSG plays a vital role in the diagnostic workup of females with infertility in our environment and is therefore encouraged as a frontline investigation in women with infertility.
Context: cancer remains the most common reason for death from gynaecological malignancy in Nigeria while screening remains opportunistic. Pregnancy provides a veritable ample opportunity for screening for this malignancy. Aim: to evaluate the risk factors for cervical cancer among antenatal clinic attendees at a tertiary centre and assess their uptake of cervical screening. Methods: This was a cross sectional descriptive study using questionnaires. Result: Three hundred and eighty five out of the 400 questionnaires distributed were analysed. The mean age of respondents was 31.3+6.8 years. Majority 73.2% had tertiary level of education. Only 54% have ever heard of cervical cancer screening. Knowledge was gained mainly via health workers and the media. Of these, only 32 (8.3%) have ever been screened. Many of them (48.3% to 62.5%) knew of some of the risk factors but most of them had no established risk factors. Conclusion: While knowledge of cervical cancer screening is average amongst antenatal clinic attendees at the Federal Teaching Hospital Abakailki is average, the uptake is quite abysmal. Antenatal clinic visits provide an opportunity to increase awareness and uptake of cervical cancer screening among women of reproductive age.
Introduction: Inflammation has been shown to play a major role in the pathogenesis of most malignancies including breast cancer. The inflammatory basis of breast cancer has not been evaluated in our environment. Objective: The purpose of this study is to determine the level of some biomarkers of systemic inflammation in patients with breast cancer compared to those of apparently healthy subjects without the disease in Benin City, Nigeria. Methodology: This is a case control study conducted in Benin City, Edo State, Nigeria. Breast cancer patients from Central hospital, Benin City and controls from the general population had their venous blood sampled and analyzed for Erythrocyte Sedimentation Rate (ESR) and C-Reactive Proteins (CRP) levels using standardized laboratory methods. Data were analyzed using SPSS (version 17). Results: Results showed a statistical significant increase (P < 0.05) in both ESR and CRP levels of patients with breast cancer compared to the control. There is also a significant positive correlation (P < 0.001) between ESR and CRP in the study population. Conclusion: These findings support the fact that inflammation is a risk factor for the development of breast cancer and this association might be of clinical significance as these inflammation markers might be of prognostic value.
Endobronchial lipomas are rare benign tumors of the respiratory tract. We describe a 61-year-old male with a history of recurrent pneumonia and hemoptysis whose computed tomography scan revealed a destroyed left lower lobe of lung caused by an endobronchial tumor. A bronchoscopic biopsy was suggestive of a lipoma. He underwent a left lower lobectomy since there was irreversible damage to the lower lobe beyond the obstruction. With this report, we stress the importance of early diagnosis of such tumors which could have made an endobronchial resection possible without resorting to a lung resection, thus preserving lung function.
Desmoid tumors are slow-growing tumors derived from musculoaponeurotic tissue. They can occur sporadically or as part of inherited familial adenomatous polyposis (FAP). They are usually seen in women of reproductive age. Desmoid tumors grow and invade surrounding tissues with negligible potential for metastasis. The tumors have higher recurrence rate especially if excision is incomplete. We report a case of extraperitoneal desmoid tumor in a 24-year-old female who had complete excision of the tumor for over 6 months without tumor recurrence. The aim of the case report was to highlight the rarity of such tumor and the role of complete surgical excision in preventing early recurrence.
Background: Surgical acute abdomen is one of the most common causes of admission into the surgical emergency room. It is a sudden onset of abdominal disease condition which requires immediate surgical evaluation and intervention. Aim: This study aims to determine the pattern and outcome in surgical acute abdomen. Patients and Methods: This was a prospective descriptive study carried out at University of Benin Teaching Hospital, Benin City over 1 year between September 2009 and August 2010. Consecutive patients aged 18 years and above with a diagnosis of surgical acute abdomen formed the study sample. Surgical acute abdomen caused by gynecological and urological problems were excluded from the study. A data form was opened for all patients on admission. Patients who met the inclusion criteria were recruited. Data collated from the patients were analyzed using SPSS version 16. Results: One hundred and eighty-six patients who met the inclusion criteria were recruited. There were 99 males and 87 females with male to female ratio of 1.1:1. The mean age of the patients was 36.60 ± 16.74 years with the age range of 18–92 years. Acute appendicitis confirmed on histopathology in 71 patients was the most common cause of surgical acute abdomen in the study. One hundred and seventy-four patients were treated and discharged while 12 patients died. The overall mortality rate was 6.5%. Conclusion: This study has shown that acute appendicitis is the most common cause of surgical acute abdomen at the University of Benin Teaching hospital, Benin City, and the 21–30 years of age group was most commonly affected.
