Trauma surgeons and emergency care physicians in Nigeria would often be required to manage solid organ transplant patients with injuries; this is because of increased transplant activity both locally and from other countries for the citizens.Knowledge of various transplanted organs physiology and anatomy is essential to ensure adequate allograft protection and good outcome. The reported patient had split deceased-donor liver transplantation at infancy 25 years ago for biliary atresia. He presented with blunt abdominal injury following road traffic accident and was evaluated and managed according to the guidelines for managing native solid organ injuries. The injury to the pathologic spleen was managed non-operatively, successfully. Familiarization with transplant process, physiology, and management is recommended for acute care and trauma specialist to enable adequate participation in transplant services establishment, optimal management of transplant patients with emergency conditions for better allograft protection and overall patient outcome.
Background: Transurethral resection of the prostate (TURP), is the gold standard treatment for prostatic obstruction. TURP is associated with less morbidity. Despite this obvious edge, limited availability, access, and affordability are major drawbacks to the utility of this treatment modality in our setting. The purpose of this study is to examine our initial experience with TURP. Patients and Methods: Patients undergoing TURP in our institution over a period of 20 months (April 2013–November 2014) were prospectively followed. Consecutive patients who hadprostatic obstruction and indication for TURP were included in this study. Patients with contra-indications to TURP were excluded from this study. Informed consent was routinely obtained preoperatively. Patients' demographics, pre-, intra- and post-operative clinical records, and outcome details were entered into pro formas. The results were analyzed using descriptive statistics. Results: Fourteen men with a median age of 66.5 years (50–102) were included in this study. The mean prostate size was 56 g (32–91). They all had bothersome lower urinary tract symptoms (LUTS). Nine (64.3%) were in the middle socioeconomic class, whereas five (35.7%) were in the lower class. The mean duration of hospital stay was 4.3 days. Thirteen of the patients (92.9%) stayed for ≤7 days. One of the patients (7.1%) had a duration of hospital stay of nine days. Three patients (21.3%) had postoperative complications. The mean follow-up was 10 months. All had a satisfactory patient-reported subjective outcome at follow-up. Conclusion: TURP was found to be effective, and associated with few peri-operative morbidities. These findings, however, remain to be verified with long-term studies involving a larger number of patients.
Gastrointestinal duplication cyst is a rare congenital anomaly. When it involves the pylorus or the first part of the duodenum, it may present with features of gastric outlet obstruction. We present a 4-month-old baby girl, second of a set of twins who presented with features of gastric outlet obstruction. A diagnosis of gastric outlet obstruction querying hypertrophic pyloric stenosis was made and she was resuscitated. The intraoperative finding was that of a huge non-communicating duplication cyst involving the pylorus and the first part of the duodenum. Excision and mucosal stripping of the cyst was done. Histology showed ectopic gastric mucosa. Pyloroduodenal duplication cyst is a rare congenital anomaly of the gastrointestinal tract and a close differential for patients who present too early or too late with features of Hypertrophic pyloric stenosis.
Background: Prostatic obstruction is a common problem of elderly men. This will often times require surgical removal of the prostate. Geriatric surgeries are froth with risks and complications, partly due to depleted functional reserves and comorbities. This study is designed to compare the efficacy and outcomes of three methods of prostatic ablation amongst elderly men. Patients and Methods: This study was retrospective. The study population consisted of men who had surgery for relief of prostatic obstruction. Three surgeries were considered viz: Open prostatectomy/channelization, TURP, and transurethral diode laser vaporization of the prostate (DiLVP). Inclusion criteria were men aged ≥65 years, who had any of the above procedures. Exclusion criteria were synchronous urethral stricture, and prior history of prostatic, bladder or urethral surgery. Patients' demographic, pre-operative, intra-operative and post-operative details were extracted and filled into a proforma. The primary and secondary outcome measures were documented. Data analysis was done using SPSS version 20. Statistical significance was set at a P value of <0.05. Results: Records of 70 patients were reviewed. Thirty-seven of the patients (52.9%) had open prostatectomy/channelization, 21 (30%) had TURP/channelization, while the remaining 12 (17.1%) had DiLVP. The mean ages were 69.5, 73, and 67 years for groups 1, 2, and 3, respectively. The mean duration of procedure in minutes was 87.5, 75, and 70.5 for groups 1, 2, and 3, respectively (p = 0.12). The groups did not differ in terms of need for blood transfusion (p = 0.81). The groups differed significantly in terms of time to catheter removal and hospital stay. The differences in rates of post-operative complications were statistically significant (p = 0.00). The procedures had comparable long-term rates for satisfactory voiding. Conclusion: Elderly men have significant peri-operative risks. As such, the choice of surgical options for management of prostatic obstruction in them should be carefully considered. Endoscopic methods, especially DiLVP, are associated with fewer peri-operative complications in the elderly.
Ovarian cysts in pregnancy are usually managed conservatively but surgical treatment is done for complicated cases. The diagnosis of complicated ovarian cyst in pregnancy is challenging, management often poses a dilemma to the obstetrician and is a source of anxiety to the patient because it can be associated with adverse pregnancy outcome. Complicated ovarian cysts in pregnancy accounted for 16.7% of all surgically managed ovarian cyst accidents (3/18) in our institution. It was also the most common indication for non-pregnancy-related laparotomy in pregnancy (3/6). The mean age of the patients was 31 ± 5.6 years, 66.7% (2/3) were primigravidae and all had cyst complication in the second trimester. All women presented with abdominal pain but accurate initial preoperative diagnosis was made in only 33.3%. Mean presentation to surgery interval was 46.7 h. All patients received tocolytic argents. The mean size of the cyst was 10.9 cm, commonest complication was torsion, and all cysts were benign. The commonest surgery performed was salpingo-oophorectomy. Surgical intervention was associated with favorable perinatal outcome in most cases with fetal loss seen when cyst was rapidly increasing in size or ≥15 cm in size. Prompt diagnosis and intervention enables preservation of affected adnexa.
Background: Vocal cord paralysis refers to absent or reduced function of vagus nerve or its distal branch, the recurrent laryngeal nerve. Several surgical procedures have been proposed for the management of respiratory distress secondary to bilateral vocal cord paralysis that are aimed at restoring glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable voice quality. We aimed to present our experience in surgical management of bilateral abductor paralysis using endoscopic suture lateralization of vocal cord with eyelet needle. Patients and Method: A prospective study of all consenting patients presenting with bilateral abductor paralysis managed from November, 2010 to December, 2018 in National Ear Care Centre Kaduna, Nigeria. Ethical approval was obtained from the institution's Health Research Ethics Committee (HREC). All patients were evaluated by taking detailed history, thorough clinical examination including flexible endoscopy and investigations. Eleven patients underwent endoscopic suture lateralization using proline 0 suture. Results: Thyroid surgery was the main etiology, 8 out of a total of 11 that underwent lateralization procedure had tracheostomy elsewhere for duration of 1 to 2 years prior to presentation. All tracheostomized patients were successfully decannulated within 2 weeks after the procedure and final voice quality was subjectively good. None had any complications after surgery. Conclusion: Endoscopic suture lateralization with eyelet needle is reversible; less invasive cost-effective technique that ensures stable airway and preservation of laryngeal sphincter with acceptable quality of voice especially in a resource constrained setting where laser is not available.
Background: Tumors originating from bone and cartilage are mostly benign with distinct feature of non-metastasis. Such tumors may occur in any bone of the skeleton, and are more frequent in the younger age group. Complete excision and curettage as the main modality of treatment is in most of the cases adequate with satisfactory outcomes. This study reviewed the histological types of primary benign bone tumors and results of various surgical options of treatment offered. Patients and Methods: Thirty-nine patients with histologically confirmed benign bone tumors arising from upper and lower limbs were retrospectively selected over 13-year period from August 2007 to August 2020 and analyzed. Results: Twenty-two patients were males while 17 were females. Age range is between 3 and 53 years, mean of 24.8 years with highest frequency in the third decade. Histological types were 18 giant cell tumors, 14 osteochondromas, 3 Ecchondromas, 2 Enchondromas and 2 Ossifying fibromas. Twenty five patients had excisional biopsy alone, 6 had excisional biopsy and bone grafting, 3 had limb amputation/dis articulation, 2 had excision with limb reconstruction using dynamic external devices, a patient underwent excision with bone cementing, one had excision and joint replacement (hip hemiarthroplasty), and another one had excision and joint arthrodesis. Conclusion: Benign bone tumors remain largely asymptomatic accounting for the late presentation. Excisional biopsy alone remains the commonest modality of treatment with good result. Giant cell tumor remained the commonest benign tumor in our center. Population based study is needed to assess its true epidemiology.
Glomus tumors are perivascular hamartomas originating from glomus apparatus which are rare in occurrence and have a higher predilection for the subungual region of the hand. We retrospectively analyzed the management and outcome of patients with subungual glomus tumor treated over a period of 5 years from January 2013 to December 2018. Clinical evaluation included Love's test, Hildreth's test, and cold sensitivity tests. X-ray and MRI were done for all patients. Transungual approach was used in the treatment of all the patients. Total of seven cases were included in the study (6 females and 1 male). Mean age was 30.4 years with a range from 21 to 42 years. Average duration of complaints was 1.6 years ranging 1-3 years. Bone involvement was detected only in one case. Average size of the lesion was 2.7 mm ranging from 1.8 to 4 mm. Post operatively there was no nail deformity except in one patient.
Foreign bodies in the lower urinary tract are rare with self-infliction for sexual gratification as the commonest reason. Presenting complaints are lower urinary tract symptoms, abdominal pain, and haematuria. We report two cases of self-inflicted foreign bodies in the lower urinary tract of adult male patients; one by an electrical wire and another by Bengal grams. Bengal gram as the foreign body has never been reported previously. X-ray, ultrasound, and computed tomography of the KUB region help to confirm the diagnosis. The primary goals of treatment are safe removal of foreign bodies, avoiding iatrogenic injuries to the lower urinary tract, and preservation of the sexual function. Endoscopic management is the commonest procedure performed and described in such cases. We were able to manage both cases endoscopically. Psychiatric consultation and appropriate counselling should be given to prevent further repetitions of such acts in the future.
Background: The use of ureteral stents is an integral part of daily urological practice. These need to be removed after a specified time limit. Unfortunately, some of the DJ stents are forgotten and hence retained. This is where the usefulness of smartphone-based Ureteral Stent Tracker (UST) application comes into play. In this study, we have aimed to evaluate the efficacy and usefulness of smartphone-based UST application and compare the results with basic appointment card system to prevent forgotten ureteral stents (FUS).Patients and Methods: It is a prospective observational study including a total of 118 patients. They were divided into two groups. Those in group A, were recorded to UST application and those in group B, were provided with only the printed advice to remove their ureteral stent. The two groups were compared in terms of overdue days and lost to follow-up rates.Results: Groups A and B were comparable with no statistically significant differences among the groups regarding age, educational level and laterality of the ureteral stent. The mean overdue days were 4.25 ± 3.627 and 11.49 ± 6.273 in group A and B respectively.Conclusions: In our study, we checked the dashboard of the ST application every day to look for overdue days. Patients followed up with the stent tracker application had significantly less overdue days compared to those who were not. So, UST can be an important addition to daily urological practice to minimise the incidence of retained ureteral stents.
Johann Friedrich Meckel was the first to feature the anatomy and embryology of a diverticulum in 1809, as an incomplete obliteration of the omphalomesenteric duct, and named this as Meckel's diverticulum. Since then, lots of facts have been gained about its presentations and treatments. When a surgeon encounters a Meckel's diverticulitis with a normal base instead of an inflamed appendix in a patient with acute pain in the right iliac fossa, diverticulectomy should suffice. We present a patient with clinical features of acute appendicitis but was found to have torsion and gangrene of a Meckels diverticulum. This was successfully managed by laparoscopic diverticulectomy with a hand-sewn technique. Laparoscopy has utility in the treatment of complicated Meckel's diverticulitis.
Squamous cell carcinoma is an aggressive but rarely diagnosed cancer of the kidney. Most cases occur in association with renal calculi and thus require a high index of suspicion for their diagnosis. Though aggressive, it usually presents at a late stage and has an average 5-year survival rate of less than 10%. This is a case report of a 61-year-old male who presented with right flank pain and swelling of 4 years duration and fever and weight loss for 4 months. There was no hematuria and urinalysis and serum chemistry were within normal limits. A tumor in the right kidney was identified clinically and by computerized urography (CTU). At nephrectomy, multiple stones, hydronephrosis and pyonephrosis were found in addition to the tumor in the right kidney. Histological examination revealed squamous cell carcinoma of the kidney.
Background: Urinary incontinence is an under-diagnosed and underreported problem especially among women living in developing countries. Pregnancy is one of the most consistent risk factors in the development of urinary incontinence in women with prevalence increasing with gestational age; being more marked in the late second and third trimester resulting in detrimental effects on the quality of life women live. The objective of this study was to determine the prevalence of urinary incontinence in late pregnancy and help identify women at risk who would benefit from interventions during and after pregnancy.Patients and Method: This was a cross-sectional study that was conducted to determine the prevalence of urinary incontinence in late pregnancy using a structured interviewer administered questionnaire. Respondents were recruited from the antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. The result was analyzed using SPSS version 20.Results: The prevalence of urinary incontinence was found to be 26.20% with the majority of the respondents having symptoms in keeping with stress urinary incontinence (57.2%) while 34.1% had urgency urinary incontinence and 8.6% had mixed urinary incontinence.Conclusion: There is a high prevalence of urinary incontinence in pregnancy in our environment with every 1 in 5 women being affected. The antenatal period is an opportunity to identify such patients so as to ensure continuity of care and effective referral in order to improve outcome in women at risk.
Background: Hirschsprung's disease (HD) was initially treated as a multistage procedure. Subsequently, it has been recognized that surgery can be done as a single-stage at an early age as this approach is safe, cost-effective, and avoids the morbidity associated with stomas. We study the effectiveness and safety of single-stage management of HD using Langer's or Georgeson's techniques, to analyze the outcome of surgery, and its comparison with other similar studies.Patients and Method: The study was retrospectively carried out in our institution from October 2016 to September 2019. They were operated in a single-stage either by Langer's procedure or by laparoscopy-assisted Georgeson's procedure. Inclusion criteria were clinically diagnosed cases of HD with an obvious transition zone. Patients without a funnel (on barium enema films) were excluded. Results were analyzed using IBM SPSS statistics 20.00 software.Result: The present series included 28 patients. The mean age of the patients was 16.24 months. Mean intra operative blood loss for Langer's series was 30 ml and Georgeson's series was 20 ml. The mean operative time for Georgeson's procedure was 150 min and for Langer's, it was 90 min. Postoperative enterocolitis 3 (10.7%), persistent constipation 2 (7.5%), and perianal excoriation 9 (32.14%) were some of the important complications noted.Conclusion: Single-stage surgery for HD is safe and avoids the need for multiple operations including stoma and its related complications.
Goiters with mediastinal extension are very rare. Occasionally they necessitate thoracic exploration for complete surgical excision which may be associated with serious complications. A 50-year-old man presented with a simple multinodular goiter and huge thoracic extension. After adequate investigative workup and optimal preoperative preparation, he underwent successful total thyroidectomy via combined cervicotomy and complete sternotomy. The excised goiter was 1.85 kg in weight and 20 × 25 × 18 cm in dimensions occupying entire anterosuperior mediastinum and 60% of left pleural cavity. Postoperative recovery was uneventful with no major morbidity. Rarely, giant thoracic extensions such as this case can be encountered. We are arguably reporting one of the largest thoracic goiters ever reported.
Cholecystoenteric fistula is a rare entity, which is seen in cholecystitis complicated with cholangitis. The incidence of such fistula in pediatric patients with the choledochal cyst is extremely rare. Here, we report one such case of choledochal cyst in which cholecystoenteric fistula was detected intraoperatively.
Background: Globally, the demand for proper surgical services is on the increase, and subsequently, the need to universally adopt mesh implants for tensionless prosthetic repairs has become expedient. The hallmark of tension-free repair is the lower short- and long-term recurrence rates compared to suture-based techniques. The aim of this study was to document our early experience with the use of mesh in abdominal wall hernia repair.Patients and Method: This was a prospective study of all adult patients with abdominal wall hernias treated with mesh implants from January 2009 to December 2015. Recurrence, bilaterality, inguinoscrotal or inguinolabial status and voluminous sizes were the main factors considered.Results: A total of 110 patients with abdominal wall hernias had mesh implants repair. There were 66 (60.0%) males and 44 (40.0%) females. Majority (56.4%) were inguinal hernias followed by incisional hernias (20.9%). Of those with inguinal hernias, eight (12.9%) had bilateral hernias, 30 (48.4%) had primary inguinoscrotal hernias while 14 (22.6%) had recurrent inguinoscrotal hernias. Nearly a third (31.8%) of the entire patients had recurrent hernias. Nearly a third (31.8%) of the entire patients harbored recurrent hernias. Majority (82.7%) of the patients presented after 1 year of onset of the hernias. The overall complication rate was 12.7% and over 81% were discharged home by the 4th post-operative day. No recurrence or mortality was recorded.Conclusion: The use of mesh implants to repair abdominal wall hernias in our environment is safe and effective. Most of the challenges relating to the acceptance of mesh, comorbid conditions and post-operative complications can be minimized through discussions and facilitated consultations.
Background: Pre-eclampsia is a pregnancy-specific disorder characterized by the onset of hypertension and proteinuria after the 20th week of gestation. It is characterized by an exaggerated maternal inflammatory response with a preponderance of cell-mediated immune response. Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine that induces apoptosis and restrains differentiation. Defective trophoblastic invasion is now identified as the key etiology of pre-eclampsia. The objective of this study was to determine the serum levels TNF-α and interleukin 10 (IL-10) in women with pre-eclampsia/eclampsia and the relationship between these cytokines and the severity of the disease.Patients and Method: This was a case-control study carried out in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Forty-eight patients with a diagnosis of pre-eclampsia/eclampsia were recruited as cases. The diagnosis was according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. For each case, a healthy pregnant control was selected, after matching for age, gestational age, and parity. Blood samples were taken and assayed for TNF-α and IL 10 using enzyme-linked immunosorbent assay. Data were analyzed using SPSS v 20. A P value <0.05 was considered statistically significant.Results: The prevalence of pre-eclampsia/eclampsia in ABUTH Zaria is 5.1%. Nulliparous women constituted 65.9% of the patients. Thirty-five percent of the women were between 20 and 24 years of age. The mean serum levels of TNF-α in women with pre-eclampsia/ eclampsia and controls were 294.8 ± 146 pg/mL and 176 ± 35.5 pg/mL, respectively. The mean serum levels of IL-10 in patients and controls with pre-eclampsia were 13.9 ± 5.7 pg/mL and 33.0 ± 11.0 pg/mL, respectively. The levels of TNF-α correlated positively with the severity of the disease. The serum levels of IL-10 did not correlate with disease severity.Conclusion: The prevalence of pre-eclampsia/eclampsia is high in ABUTH. The disease is characterized by an exaggerated inflammatory response in women in Zaria. Use of anti- TNF-α drugs may possibly have a role in the prevention of pre-eclampsia.
Skin cancers are common worldwide though incidence is higher among Caucasians. While basal cell carcinoma (BCC) is more common among Caucasians, squamous cell carcinoma (SCC) is the most common non-melanoma skin cancer in Nigeria as well as in other African countries.The Standard of care remains surgical resection with preservation of function and cosmesis, followed by adjuvant radiotherapy. Occasionally, however, systemic chemotherapy may be indicated. When it is, Cisplatin-based regimen has been the standard of care. We hereby report two cases of high risk cutaneous SCC with a dramatic response to preoperative Cisplatin/Methotrexate combination chemotherapy and highlight the possibility of spontaneous regression of SCC.
