An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. They are notorious for their diagnostic difficulty and present a challenge to the surgeon. Preoperative diagnosis is often a rarity. They commonly present in elderly emaciated women, typically associated with chronic diseases. The most common symptom is strangulation combined with mechanical intestinal obstruction. Early surgical intervention is often delayed due to the absence of clinical and radiological clues. The following case report highlights these difficulties and reviews current literature on the management of such cases.
Lower gastrointestinal bleeding (LGIB) is defined as bleeding from a source located at any point in the lumen of the small bowel from ligament of Treitz and the large bowel down to the anal opening. The ligament of Treitz has been considered to be the fibrous band of tissues that plastered the duodenojejunal junction to the posterior peritoneum. It is often referred as the reference point of LGIB. As it is a well-known fact, LGIB has been a significant cause of morbidity and mortality worldwide.[1] There are numerous causes which are often classified as common causes because they occur quite common in virtually every community and rare causes which rarely occur or cause a threat to life. However, in the recent times, these so-called rare causes are becoming significant causes, particularly in the presence of certain conditions[2] couple with new causes that were not known before. These, together constitute an emerging rare cause of LGIB which this editorial intends to highlight.
Background: The perennial scarcity of surgical equipment in Nigeria has given room for improvisation of such items using locally available materials. Aim: This publication aims to appraise the ingenious methods employed by surgeons to overcome their challenges in clinical practice. Methods: An in-depth research into relevant literature about the functionality of various surgical devices was carried out using selected texts and relevant articles. Results: Many surgeons have come up with various techniques to make do with local resources in overcoming the limitations imposed by scarcity of certain equipment/device. Conclusion: Surgical practitioners in resource-limited regions have been able to surmount the challenges of scarcity of required items using different methods and materials from the local environment.
Utero-cutaneous fistula is an extremely rare entity, and only a few case reports have been published. Most Utero-cutaneous fistulas are secondary to postpartum or postoperative complications. A 23-year-old woman, para 1 +0 , not alive, noticed bleeding through her abdominal incision scar, following a cesarean section for retained second twin 5 years before presentation. A fistulous tract was demonstrated at examination under anesthesia with a probe, between the uterus and wound. The patient had laparotomy with excision of the fistulous tract and uterine repair; she did well postoperatively. Although our patient had a successful surgical treatment, prevention of utero-cutaneous fistula by meticulous technique during the primary surgical procedure and measures to prevent postoperative sepsis would have spared this patient the distress, cost, and risk of a second operation.
Background: The use of cotton bud for self-ear cleaning is a common practice among many people despite its attendant ill-effects. This study examined the prevalence, attitude toward the use of cotton buds, and reasons for the use of cotton buds and problems or ill-effects associated with its use among medical doctors working at Aminu Kano Teaching Hospital. Materials and Methods: A descriptive cross-sectional study was carried out among a randomly selected sample of 130 medical doctors working in Aminu Kano Teaching Hospital spread across several departments in the hospital using a self-administered semi-structured questionnaire. Data were analyzed using MINITAB statistical software and the results summarized using measures of central tendency while Chi-square test was used to assess for associations between categorical variables. Results: The respondents' age ranged from 25 to 55 years with a mean age of 33.6 ± 5.4 years. Most of the respondents were males (68.0%) The prevalence of cotton bud use was found to be 76.3% and for many, the frequency of use of cotton buds was once daily, and both ears were frequently cleaned. A common problem encountered with cotton bud use was retention of the bud as a foreign body. There was an association between owning a cotton bud and using it (χ2 = 38.317, P= 0.001). There was also a significant association between the use of cotton buds and the department where the respondent works (χ2 = 19.28, P= 0.0001). Conclusion: The use of cotton buds for self-ear cleaning is surprisingly prevalent among medical doctors working at Aminu Kano Teaching Hospital. There is a need for health education and promotion strategies for health workers in the hospital community that ear cleaning is best done by trained personnel.
Fibrous dysplasia is a bone disease that manifests usually before the end of the third decade. Fracture occurring after a minor impact is usually on a background of diseased bone. This case illustrates an asymptomatic bone disease that was diagnosed incidentally when there was failure of union of a humeral fracture after 10 weeks of adequate conservative treatment.
Caudal regression syndrome (CRS) is a rare, congenital anomaly that is often complicated by a neurogenic bladder. Congenital anomalies of the kidney and urinary tract in aforesaid patient present an added challenge in the management. The aim and objective of this study is to report a rare case of CRS with neurogenic bladder and right solitary hydronephrotic kidney. The patient was a 3-year-old female infant with burdensome lower urinary tract symptoms and congenital back and lower limbs deformities. Her examination unveiled vertebra and lower limbs anomalies. The computed tomography scan showed lumbosacrococcygeal agenesis with a right solitary hydronephrotic kidney. She was treated for urinary tract infection at presentation, after which cystometry confirmed high-pressure neurogenic bladder. She did well to the initial continuous bladder drainage and the ensuing oxybutynin with clean intermittent catheterization. Instantaneous management of the bladder dysfunction prevents potentially permanent solitary renal dysfunction and the secondary bladder malfunction in a patient with CRS and neurogenic bladder.
Epithelioid hemangioma (EH) is an uncommon cutaneous vascular lesion often localized to the superficial dermis. We report a 55-year-old female with multilobular anterolateral neck mass which was clinically diagnosed as multinodular goiter. However, tissue histology revealed EH.
Objectives: To study the pattern of presentation and outcome of conservative treatment of traumatic spinal cord injury (TSCI) in our institution. Setting: Benue State University Teaching Hospital, Makurdi, Benue State. Materials and Methods: A 3-year retrospective review (June 2012 to May 2015) of TSCI was done. Demographic data, cause, associated injuries, time interval to presentation, level of injury, American Spinal Injury Association (ASIA) classification at presentation and at 6 weeks were obtained from case notes. The patients were all managed conservatively and had bed rest on air or water mattress. Results: There were 45 patients mean age 33.26 ± 1.55 (range 8–77 years) with TSCI comprising 37 males and 8 females giving a male: female ratio of 4.6:1. Students were mostly affected ( n = 11, 24%) while motor vehicular accident was the cause of injury ( n = 18, 40%). Cervical spine was the most injured ( n = 24 53.3%). Majority had the ASIA Class A ( n = 22 48.9%) at presentation. Thirteen (48.1%) of them improved, two were referred, six remained the same, eight deteriorated, and 16 were discharged against medical advice. Period of hospitalization was 1–65 days. Conclusion: TSCI affects mainly young males involved in motor vehicular accident. Conservative treatment can be used in resource-constrained centers.
Fracture neck of femur occurs commonly among elderly people with osteoporosis being the risk factor favoring its occurrence. Its occurrence among young adults, though uncommon, follows high-energy trauma with multisystem affectation. Fracture neck of femur poses a management challenge to the surgeon in deciding on the best option of treatment, in achieving accurate reduction and fixation, and in dealing with complications which may be inevitable. Fracture neck of femur following electroconvulsive therapy is rare. Simultaneous bilateral femoral neck fractures following electroconvulsive therapy are even rarer. Simultaneous bilateral femoral neck fractures management is technically demanding, requiring considerable experience, appropriate instrumentation, and equipment. It is also associated with high morbidity which includes nonunion and avascular necrosis. These fractures can be prevented by the use of modified electroconvulsive therapy. This case seeks to reemphasize the rarity of simultaneous bilateral femoral neck fractures following electroconvulsive therapy, highlight the challenges of managing this condition and proffer ways of avoiding its occurrence.
Background and Aim: The challenge of the “shared airway” is a recurring predicament in maxillofacial surgeries. The need to have unfettered access to the nasal pyramid and oral cavity without jeopardizing the integrity of the airway during maxillofacial surgeries is vital. The use of submental intubation has been reported as an excellent adjunct in maxillofacial trauma surgery; however, few, if any, report exists on its use for massive facial tumors. This is a report of its use in varied scenarios including traumatic and neoplastic conditions. The aim of this study was to review the indications, complications, and outcomes of airway management using submental intubation in maxillofacial surgery at a tertiary hospital in Nigeria. Patients and Methods: Records were retrieved retrospectively over a period of 28 months (June 2013–October 2015). Data recorded included demographics, indications, and intraoperative and postoperative complications. Results: A total of eight patients were evaluated, all of whom had surgery under general anesthesia. All of them had conventional orotracheal intubation initially, which was then converted into the submental route. Two of them had intraoperative complications of raised airway pressure, however no postoperative complication was observed. Conclusions: Although it requires some surgical skill, submental intubation provides a reasonable substitute to other airway management techniques in certain patients. Its importance in patients with massive maxillofacial tumors was also highlighted along with other indications.
Peyronie's disease (PD) is characterized by fibrous plaque deposit in the tunica albuginea of corpus cavernosum, which may be associated with penile pain, deformities, and erectile dysfunction (ED). Its prevalence in Nigeria is not known, but limited numbers of cases were reported in literature. However, improvement in the management of ED has led to an increase in the presentation of patients with ED to physicians; in which during evaluation of such patients, PD has been occasionally diagnosed. This case report highlights the clinical findings and management of a Nigerian adult male who presented with erectile failure with clinical findings of PD and literature review of PD associated with ED.
Prayer houses that profess miracles and healing through prayers and vigils abound in our clime, but this case report of irreparable limb damage due to an unprofessional medical intervention by a prayer warrior is new and worrisome. This case is an advanced acute compartment syndrome of both legs which was caused by a prayer warrior who, supposedly, had the inspiration to apply tight splints on the legs of a girl with cerebral palsy so that she could walk.
Background: Cataract surgery is the most commonly performed surgery in most ophthalmic units. Endophthalmitis is still a dreaded complication and knowledge of the normal bacterial flora on the ocular surface and adnexae is paramount in the management of these cases. Aims and Objectives: To investigate the most frequently found ocular bacteria flora in patients scheduled for routine cataract surgery at the Ahmadu Bello University Teaching Hospital Shika Zaria, Northern Nigeria and to determine their antimicrobial susceptibility pattern. Materials and Methods: This was a cross-sectional descriptive study carried out between December 2010 and February 2012 in subjects scheduled to undergo routine cataract surgery. The lower conjunctival fornix was swabbed with a sterile swab. The samples were inoculated onto enriched and selective culture media. Antimicrobial susceptibility testing was done using the modified Kirby Bauer standardized disc-diffusion method. Data were entered and analyzed using SPSS version 20.0. Results: One hundred and fifty-seven eyes of 157 patients were sampled. The patients were between the ages of 16–96 years with a mean age of 58.8 ± 14.5 years. Positive bacterial culture was found in 35% ( n = 55) of the patients. The predominant bacteria cultured was Staphylococcus epidermidis 49.1%. There was resistance to tetracycline (32.7%) and gentamycin (1.8%). All the isolates were sensitive to tobramycin and ciprofloxacin. A statistically significant relationship was found between age and culture status ( P = 0.008). Conclusion: Coagulase negative Staphylococcus ( S. epidermidis ) was the most common commensal found in the conjunctival sacs of patients undergoing cataract surgery, and most of the isolates were susceptible to commonly used antibiotics.
Background: Chronic low back pain (CLBP) is a common orthopedic condition that co-exists with depression. The combination of these two contrast ailments is often associated with poorer treatment response and increase health care cost. Objectives: To determine the prevalence of depression in patients with CLBP and study the effects of sociodemographic factors. Materials and Methods: This is a cross-sectional study of adult patients with CLBP seen at BSUTH Makurdi from April 2014 to September 2014. Patients were assessed for depression using hospital anxiety depression scale (HADS). Data obtained were analyzed using SPSS version 16. Results: One hundred and fourteen patients were recruited for the study, consisting of 48 males and 66 females. Age ranged from 23 to 75 years, with mean age of 44.7 years. Of 114 patients, 45 patients were found positive for depression using HADS. The rate of depression in these patients was 39.5%. The highest rate of depression was seen in 30–39 years age group. Conclusion: The prevalence of depression in patients with CLBP was observed to be 39.5% which is comparable to the reports of previous studies in the developed countries.
Background: Thrombelastography (TEG) assesses the viscoelastic properties of the whole blood and it is more comprehensive and capable to detect any coagulation abnormalities in comparison to classical coagulation tests (CCTs). On this ground, TEG can be more efficient in acute settings. Therefore, the primary aim was to compare TEG parameters of traumatic brain injury (TBI) versus non-TBI (NTBI) patients. The secondary aim was to identify TEG versus CCT parameters associated with outcome. Methods: A cross-sectional retrospective observational study of 142 patients admitted to a university-based, Level 1 trauma center. TEG and CCT were collected on admission. Institutional Review Board approval was obtained for this study. SAS was used for categorical data were analyzed using Chi-square or Fisher's exact test. A comparison of continuous variables between TBI and NTBI patients was performed using the independent-sample t-test. Results: In a total of 142 patients, 48 patients had TBI and 94 patients did not. Overall, mortality was 20.4% (45.8% TBI vs. 7.4% NTBI). There were no significant associations between TEG or CCT parameters and studied variables some of which are injury severity score, abbreviated injury scale, craniotomy/ectomy, type of brain injury, discharge status, and blood pressure. There was no difference between the TBI and NTBI groups regarding TEG or CCT parameters. Maximum amplitude (MA) was the only parameter (TEG or CCT) associated with need for transfusion of packed red blood cell (PRBC) (P = 0.0377). PRBC transfusion was given in 94% of patients with an MA <57.4. Platelet transfusion was given in 89% of patients who have MA < 58.1. Fresh-frozen plasma (FFP) transfusion was given in 80% of patients who have R ≥5.8. PRBC transfusion was given in 77% of 18 patients with α <62.9. Conclusions: TEG parameters are potentially useful as means to rapidly diagnose coagulopathy and predict transfusion in trauma patients. Independently, the presence of TBI does not cause a detectable coagulopathy. TEG analysis is more efficient than the classical parameters in detecting patients who will need PRBC and FFP transfusion.
Objective: To report our experience with the management and outcome of treatment of adults with pelvi-ureteric junction(PUJ) obstruction Subjects and Methods: This was a retrospective study of adults with PUJ obstruction from January 2009 to December 2013. The study was conducted at a Tertiary Teaching Hospital in Ibadan in Nigeria. All adults with clinical features and radiological evidence of PUJ obstruction were included. Some patients had non operative treatment while others had open surgical treatment. The main outcome of treatment was measured by the relief of symptoms. We are not aware of previous report of the management of PUJ obstruction in adults in Nigeria. Results: Eighteen adult patients were treated. The mean age was 39 ± 11.2 standard deviation years (range 20-65 years). Seventy-two percent presented with loin pain. Thirteen of these patients were treated surgically, and 5 were treated nonoperatively. The operation findings were narrow but patent PUJ that barely admit a probe due to intrinsic muscle fibrosis in six patients, aberrant crossing vessels in 3, severely hydronephrotic kidneys in 3 and one impacted PUJ calculus. Fifty percent of patients had open dismembered pyeloplasty, simple nephrectomy (16.7%) while combined pyelolithotomy and Foley Y-V plasty (5%). All surgically treated patients were pain-free as at last time of review. Conclusion: Intrinsic muscle fibrosis and aberrant crossing vessels are the most common causes of PUJ obstruction in adults. Open pyeloplasty is still the main stay of treatment in our environment with satisfactory symptomatic relief.
Mesenteric lymphangiomas are rare in occurrence. The dumb-bell shaped ones are even rarer. We report a case of a 7-year-old girl with a huge dumb-bell shaped mesenteric tumor weighing 3 kg, located in the jejunal mesentery and causing failure to thrive. En mass excision of the tumor along with the involved bowel segment was done with a successful outcome. Histopathology diagnosed the tumor to be mesenteric lymphangioma of the jejunal mesentery. At a follow-up of 2 years, the child is symptom-free and has a good catch up growth.
Introduction: Soft tissue sarcomas (STSs) are solid malignancies mostly of mesodermal origin whose rarity and variety present formidable challenges in characterization and treatment. According to Pisters and Brennan, STS make up Patients and Methods: Medical records of patients with histopathologically diagnosed malignant oral and maxillofacial tumors between January 2003 and December 2013 were retrospectively reviewed at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Results: There were more male than female in a ratio of 1.28:1.The age range from 7 months to 70 years with a mean of 29.3 years and 37.8% being Conclusion: STS remains a challenge in our center due to late presentation and affordability of treatment by our patients. Another contributing factor is the believe that cancer cannot be treated with orthodox medicine.
