Background: The African continent is greatly underrepresented in research, specifically in surgical-related research. With the aim of encouraging research and publication of research from the African continent, the Annals of African Surgery was established in 2007. The aim of this study was to evaluate the trends and diversity of manuscript submissions to the journal. Materials and methods: This is a retrospective audit of all manuscripts submitted to the journal from January 2017 to December 2023. Summary reports were generated from the ScholarOne manuscript management system with the following variables: manuscript type, author names, number of authors, primary author affiliation, type of study, scope of manuscript, manuscript title, year of submission, and author country/region. Data were summarized using mean±SD and frequency. Results: A total of 493 manuscripts were submitted to the journal, 77% of these were from the African continent, with predominant content in General Surgery (32%). More than 90% of the manuscripts had observational study designs, a trend seen throughout the study period, with low (16%) female primary authorship. Conclusion: The Annals of African Surgery receives representative manuscript submissions predominantly from the African continent, with predominantly observational study designs.
Background: In low- and middle-income countries (LMICs), delayed diagnosis of Hirschsprung’s disease (HD) can lead to severe complications, including malnutrition and chronic constipation. This study examines patient experience and surgical outcomes for HD diagnosed beyond the neonatal period in an LMIC. Methods: A retrospective review of HD patients at a tertiary institution in sub-Saharan Africa was conducted to evaluate clinical characteristics, surgical interventions, and outcomes in patients with HD, including Wilcoxon rank-sum tests for non-parametric comparisons and univariate logistic regression to assess predictors of stoma placement. Results: Among the 61 patients (72.1% male), the average diagnosis age was 4.4 years. Short-segment HD was most common (68.9%), with the most frequent symptoms being constipation (70.5%) and abdominal distension (45.9%). Before referral, 48.6% had stomas, with older patients more likely to have them (p = 0.002). Pull-through surgery complications included strictures (17%) and requiring anal dilation (18.9%, N=53). Unfortunately, seven patients died, three before the pull-through surgery due to HD complications. Conclusion: Delayed pull through surgery was a common occurrence for patients with HD presenting after the neonatal period. Early detection with referral to surgeons with adequate resources is essential.
Background:Addressing the surgical burden of disease in low- and middle-income countries (LMICs) requires an increased number of medical researchers who understand local systems and resources. Advanced research training in medical programs in LMICs has been limited. To address this need, a hybrid, flipped-classroom research methods course was developed in a nurse anesthetist training program and expanded to surgery and anesthesiology training programs and an anesthesiology faculty development program in two countries. We assessed the effectiveness of the research methods course in strengthening research skills across anesthesiology and surgery specialties by evaluating participants' attitudes and perceptions of the course. Methods:Using an online course survey, we collected qualitative and quantitative data on trainees' perceptions of the course and their self-reported confidence to perform research competencies taught in the course. Quantitative data were analyzed through calculating descriptive statistics, and qualitative findings were reviewed through thematic coding. Results:Respondents were distributed across the three training programs as follows: surgical residency (n=17), registered nurse anesthetist (n=16), and anesthesiologist faculty development (n=3). Most (94%) agreed that they will use knowledge from this course. Using a scale of 1-5 with 5 corresponding to very confident, the respondents reported being confident in their abilities to engage in all phases of research consistent with the course competencies, with means ranging from 3.83 to 4.11. They were most confident in performing a scientific literature review and identifying a research topic. Conclusion:This course helped strengthen trainees' confidence in the seven phases of conducting and disseminating research. The course helped trainees from different specialties and training programs build skills in research methods. This novel, hybrid, flipped-classroom research methods course was effective in building self-confidence for healthcare professionals across the practice continuum to tackle, develop, and perform research.
This case report describes a rare instance of hypertrophic pyloric stenosis (HPS) presenting after gastric bypass surgery in an adult patient. The patient exhibited symptoms of gastric outlet obstruction, including persistent vomiting and weight loss. Diagnostic imaging revealed significant pyloric muscle hypertrophy consistent with HPS, confirmed by endoscopic and histopathological findings. This report highlights the diagnostic challenges in differentiating HPS from more common post-bypass complications such as anastomotic stenosis. The case underscores the importance of thorough evaluation using imaging and histology to establish the diagnosis. Early recognition and appropriate surgical intervention led to symptom resolution. This report aims to increase awareness of this uncommon presentation and guide clinicians in managing similar cases effectively.
Tuberculosis (TB) is a global health concern, primarily affecting the lungs. However, extrapulmonary manifestations of TB can occur, including abdominal TB, which is a rare but serious complication. We present a case series of three patients with abdominal TB, the diagnostic difficulties encountered, the varying nature of the presentation, and different approaches taken to arrive at a definite diagnosis and subsequent treatment. The first case is of a 17-year-old human immunodeficiency virus (HIV)-negative female patient on treatment for pulmonary TB who developed intestinal obstruction; the second case is of an HIV-positive male patient on treatment who presented with abdominal pain and distension for 3 months; and the third case is of an HIV-positive male patient on treatment presenting with acute abdominal pain whose initial evaluation was complicated by an imaging diagnosis of intussusception. These cases highlight the challenging nature of abdominal TB and emphasize the importance of considering it as a differential diagnosis in patients with obstructive symptoms, even in immunocompetent individuals on appropriate treatment.
Background: Colorectal cancer (CRC) is a prominent worldwide health issue, being recognized as the fourth most prevalent malignancy globally. Objective: Our research aims to investigate the demographics, characteristics, histological variants, and risk factors associated with CRC patients. Materials and methods: A retrospective study was conducted at the King Abdulaziz University Hospital (KAUH). Data were obtained from medical records of patients who underwent procedures and were diagnosed with CRC from 2015 to 2023. Results: A total of 204 patients were enrolled in the study, with 52.5% male and 47.5% female. Most (81.8%) of CRC patients were ≥45 years. Abdominal pain (72.1%) was the most common symptom. The most prevalent location for CRC was the sigmoid colon (33.8%). The most common complication was anemia (41.2%). The duration from symptom onset to diagnosis for patients with CRC in the cecum, descending colon, and transverse colon was significantly shorter compared to other sites of the colon. Post-operative complications were found to be more prevalent in patients who underwent an open surgical approach. Most patients (76%) who received palliative therapy were 45 years of age or older. Conclusion: The study examines CRC trends at KAUH, focusing on its prevalence in older adults, typical clinical presentations, and diagnostic timelines.
Adequate pain control for neonates undergoing thoracotomies can be challenging to accomplish without inducing respiratory depression from opioid administration. Premature neonates with cardiac and respiratory comorbidities are at increased risk of respiratory complications, and this risk further increases in resource-limited environments with shortages of skilled healthcare providers and equipment. Erector spinae plane (ESP) blocks have been shown to reduce opioid consumption post-operatively in neonates undergoing thoracic surgery in middle and high sociodemographic countries, but there are scant reports in the literature translating such advances to low-resource settings. In this case report, we describe the use of an ESP block in a limited critical care capacity setting to facilitate the early extubation of a 5-day-old infant undergoing thoracotomy for tracheoesophageal fistula repair. This case highlights that low-risk, low-cost, and easily teachable regional anesthetic techniques such as ESP blocks offer an excellent option in a multitude of surgical settings.
Background: Upper aerodigestive emergencies (UADEs) pose diagnostic and therapeutic challenges. We sought to define the socio-demographic and clinical characteristics of patients presenting with UADEs, describe the causes of emergencies, and report treatment and outcomes in our setting. Materials and methods: This study was a hospital-based retrospective study, conducted in two tertiary-level hospitals located in semi-urban settings in Cameroon. We included records of all patients admitted and treated for UADEs from January 2014 to December 2023. Results: Seventy-four files were included in the study. Males were predominant (46; 62.2%), and the most represented age group was 1–10 years (19; 25.7%). Infections (31; 41.9%), neoplasms (15; 20.3%), foreign bodies (12; 16.2%), trauma (11; 14.9%), and caustic injury (5; 6.7%) were the causes identified. The majority of patients (56; 75.7%) were treated surgically, among whom nine (16.1%) had tracheotomies. Endoscopy was used for 10 patients (13.5%), while 8 (10.8%) were managed conservatively. The outcome was good for the majority of patients (67; 90.5%). Causes that were significantly associated with poor outcomes were neoplasms (odd’s ratio [OR] 4.2, 95% confidence interval [CI] 1.2–6.8, p = 0.03) and caustic injury (OR 5.8, 95% CI 2.2–8.3, p = 0.02). Conclusion: The outcome of UADEs was generally good. Infectious causes that are mostly preventable by immunization and effective antibiotic therapy are predominant.
Background: Family caregivers providing support to surgical patients may bear substantial physical, emotional, and financial burdens. The objective of this study was to measure the burden on family caregivers caring for surgical patients and the factors that contribute to this burden. Materials and methods: The study population comprised patients that had surgery and their caregivers in two major hospitals in Delta State, Nigeria. A cross-sectional study design was used, and data were collected using an interviewer-administered questionnaire. Data obtained were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 26.0. All variables were summarized using descriptive statistics, while inferential statistics (analysis of covariates, Pearson’s correlation coefficient test, and analysis of variance) were used to ascertain the contributing factors to caregiver burden. Results: Less than one-tenth (18 [3.8%]) of the caregivers experienced a severe level of burden. Patients’ marital status, presence of comorbidity, type of surgery, severity of illness, and age were factors contributing to family caregiver burden. Conclusion: Findings from the study revealed that the family caregiver burden is notably low, and this could be attributed to the prevailing family-centric culture in many communities in Nigeria where family members share each other’s burden.
Enterolithiasis refers to the presence of stones inside the lumen of the intestine as a result of stasis. Formation of strictures in intestinal tuberculosis results in significant intestinal stasis and henceforth provides a favorable environment for stone formation. Even though abdominal tuberculosis is common in India, enterolithiasis associated with tuberculosis is a very rare entity. Enterolithiasis often remains undetected, either due to its asymptomatic nature or because of its small size enabling intermittent passage through the intestines. We are discussing a case of primary enterolithiasis secondary to tubercular stricture in the ileum, causing subacute intestinal obstruction in a fourth-decade female who presented to IMS & SUM Hospital, Odisha, India. She had a history of pulmonary tuberculosis 16 years back, for which she received anti-tubercular treatment. A plain radiograph of the abdomen revealed a single oval radio-opaque shadow inside the pelvis, likely within the bowel loops, suggestive of a stone. The patient underwent exploratory laparotomy, and stone removal with stricturoplasty.
Background: Despite the high incidence of pertrochanteric fractures in African countries, there are insufficient data on radiographic outcomes of fixation. Previous studies focused on cut-out as an outcome measure. Varus malunion may be a significant outcome measure as it results in biomechanical alterations at the hip. Objective: This study aimed to identify varus malunion as an outcome of pertrochanteric fracture fixation in our population. Study design: This was a cross-sectional, prospective, observational study. Patients and methods: Fifty-nine patients were operated on at three facilities over a 1-year period. Post-operative neck–shaft angle (NSA) and tip–apex distance (TAD) were measured. After 12 weeks, radiographs were assessed for varus malunion and cut-out. Results: The mean post-operative NSA was 3° of varus and the mean TAD was 36 mm. After 12 weeks, there was an average varus collapse of 6°. Predictors of varus collapse were increased TAD (p = 0.002) and decreased post-operative NSA (p < 0.001). The cut-out rate was 4.9%. Conclusion: Pertrochanteric fractures show varus collapse after fixation. Reduction in valgus may allow the fracture to collapse into a near-anatomical position, avoiding malunion. The position of the implant within the femoral head plays an active role in preventing varus malunion.
Familial adenomatous polyposis (FAP) is a rare disease syndrome characterized by mutations in the Adenomatous Polyposis Coli gene. Affected people have a markedly increased lifetime risk of colorectal cancer. The patient was a 17-year-old female with a 4-year history of intermittent abdominal pain, rectal bleeding, and anal masses. A proctocolectomy with perineal resection and a permanent ileostomy were performed. The histological findings were consistent with that of FAP. FAP can present in young patients with rectal bleeding and anal masses.
Background: Over half of infants with congenital heart disease (CHD) need surgery for non-cardiac abnormalities during the first year of life. Objective: This study looked at the variables and surgical outcomes related to non-cardiac surgery in this specific patient population. Methods: We looked at and analyzed 152 case records using SPSS software version 27 (SPSS Inc., Chicago, IL, USA) in order to identify factors associated with post-operative mortality on the 7th and 30th days using a binary and multivariable logistic regression model. Results: Infants with CHD who had non-cardiac surgery for non-heart-related abnormalities had mortality rates of 28.9% on the 7th, and 45.4% on the 30th post-operative day. Preterm neonates had a 2.16- fold higher mortality rate than mature neonates. The death rate was 1.2 times higher in patients who underwent surgery after 24 hours of diagnosis than those who had before 24 hours. Death is also associated with severe CHDs, comorbidities, genetic diseases, operating room mishaps, and age <1 year. Conclusion: The study found that among CHD cases undergoing non-cardiac surgery, the mortality rate was quite high on the 7th and 30th post-operative days.
Background: Eye health is an essential aspect of overall health, and visual impairment (VI) can significantly impact academic performance and quality of life. This study aimed to determine the prevalence of VI among undergraduates and the pattern of VI. We set out to give the situational analysis of the student’s eye health. Methods: A cross-sectional study was conducted among 1407 undergraduate students at the institution. Data obtained includes sociodemographic characteristics, vital signs, and visual acuity using a structured questionnaire. Visual acuity was classified using the International Statistical Classification of Diseases and Related Health Problems version 11 (ICD-11) of VI. Results: VI was found in either the right or left eyes of 797 (56.65%) participants. Of the 645 respondents with right-eye VI, 531 (82.3%) had mild VI while 104 (16.1%) had moderate VI. VI was found in the left eye of 657 (46.7%) respondents. The study also found that females had a significantly higher prevalence of VI than males (p < 0.05). Only 231 (28.98%) of the respondents had corrective lenses presently. Conclusions: The prevalence of VI among undergraduates is high, and the proportion currently using corrective spectacles among them is quite low. Eye health should be prioritized among undergraduates.
Oral cancer presenting in late stages requires extensive resection and mandibulectomy. Ideal reconstructive options for such defects are composite-free flaps so as to provide outer skin covering and bridge the mandibular defect. The availability of expertise and resources for such complex reconstructive surgeries is a setback. The predominant alternative in these cases is the use of the workhorse flap, the pectoralis major myocutaneous (PMMC) flap; there are several modifications proposed since the flap was first described. The most common modification, which is used, is bipaddle PMMC which carries an increased risk of complications. Here, we present a modification of PMMC flap for reconstruction of complex defects created after resection of buccal mucosa, mandible, and cheek skin with lesser complications and without the need for free flaps.
Idiopathic Scrotal Calcinosis (ISC) is a rare, benign dermatological condition that primarily affects the scrotal skin. It is characterized by the spontaneous deposition of calcium within the dermis, leading to the formation of multiple asymptomatic calcified nodules. ISC is diagnosed through clinical evaluation, with confirmation via histological examination. Surgical intervention is the most effective treatment for this condition. We present the case of a 37-year-old male who developed idiopathic scrotal calcinosis, a rare disorder marked by calcium deposition in the scrotal skin. The patient first noticed multiple mildly itchy nodular masses on his scrotum 6 months ago. These masses appeared suddenly, but progressively increased in size, causing discomfort and affecting his sexual function psychologically. On physical examination, multiple well-demarcated, high-density nodules, ranging from 70 to 10 mm, were observed diffusely across the scrotal skin. The patient underwent surgical resection of the lesions, with a single-step excision and primary closure. The post-operative recovery was uneventful. Histopathological examination confirmed the diagnosis of calcinosis cutis, consistent with skin calcium deposition in the scrotum. Scrotal calcinosis is a rare yet distinct dermatological condition that requires surgical excision for both diagnosis and treatment leading to favorable outcomes and patient satisfaction.
