INTRODUCTION:The urinary bladder undergoes morphological and functional changes in patients with symptomatic benign prostatic enlargement (BPE). These detrusor changes reflect chronically increased intravesical pressure as a result of outlet obstruction. This study aims to determine the relationship between the Pre- and Post-op detrusor wall thickness (DWT), international prostate symptom score (IPSS), and duration of lower urinary tract symptoms (LUTS) in patients who had open simple prostatectomy (OSP). METHOD:This was a prospective study of a cohort of patients who had OSP for symptomatic BPE. The IPSS and symptom duration for each patient were noted. Each patient also had an abdominal ultrasound scan with a measurement of their DWT. Retropubic OSP was done for each patient. The detrusor wall thickness was also measured 12 weeks after the prostatectomy. RESULTS:Fifty-two patients completed the study; the mean age was 66.37 ± 8.09 years. The median pre-operative IPSS was 28 (IQR = 13.75), and the median duration of symptoms was 24 months (IQR = 37 months). The mean pre-operative DWT was 4.41 ± 1.38mm, while the mean post-operative DWT was 2.16 ± 0.98mm. The preoperative IPSS (p = 0.833) and duration of symptoms (p = 0.375) did not significantly correlate with the pre-operative DWT. There was a significant reduction in the mean DWT (p < 0.001) and IPSS (p < 0.001) following prostatectomy. CONCLUSION:DWT appears not to be significantly influenced by the severity or duration of LUTS. However, it reduced significantly following OSP with corresponding improvement in urinary symptoms.

BACKGROUND:The role of prophylactic antibiotics in mesh repair of inguinal hernia is controversial and often based on institutional policies. Surgical site infection rate from earlier studies in Nigeria justifies the continued use of prophylactic antibiotics during hernia repair. With increased use of antibiotics comes the challenge of antibiotic resistance and toxicity. The use of antimicrobial coated suture may help avoid these challenges but its efficacy needs to be tested.OBJECTIVE:To compare Triclosan coated suture with intravenous antibiotics for the repair of inguinal hernia with mesh.METHODS:Patients with uncomplicated inguinal hernia undergoing mesh repair were randomized to either have intravenous antibiotics administered for prophylaxis or to have wound closure with Triclosan coated Vicryl 2/0 suture. Post operatively, wound infection rates were compared between the two groups. Follow up was for 1 year.RESULTS:We studied 49 patients with 59 hernias with a mean age of 53 years. Hernias were solitary in 75% of cases, the majority of which were right sided, while 25% were bilateral. There were 25 patients with 32 hernias in the Intravenous antibiotic group (Group A) and 24 patients with 27 hernias in the Triclosan suture group (Group B). Wound grades were similar between the two groups with one patient in the Triclosan group confirmed to have wound infection (4.2%) and none in the Intravenous antibiotics group (p=0.27). Wound infection was of the superficial type which resolved with wound care within 1 month.CONCLUSION:Triclosan coated suture may be safely used as an alternative to intravenous antibiotics for the mesh repair of inguinal hernia. Further studies are required to validate this finding.

The use of mesh has revolutionized the management of hernias in many parts of the world. There is, however, limited experience on its use in sub-Saharan Africa. This study describes a single hospital experience after 500 cases of mesh hernia repairs in a sub-Saharan African country. We reviewed the records of the first 500 cases of abdominal wall hernia operations performed using commercial mesh since year 2007. Socio-demographic characteristics, hernia type, method of repair and outcome data were analyzed and presented as descriptive statistics. The first 500 cases of mesh hernia repairs were performed between 2007 and 2017 during which a total of 1,175 hernia operations were carried out, mesh repair accounting for 42.5% of the total. There was a progressive rise in the uptake of mesh repairs over time, with mesh repairs overtaking tissue based repairs in the last few years of the review. Inguinal hernia was by far the commonest indication for mesh use (80.4%), followed by incisional hernia (9%). Polypropylene mesh was the most common type of mesh used in about 96.2% of cases. Overall, there were seven recurrences (1.4%) at a mean follow-up period of 15.3 months (1–108 months) In spite of resource limitations, the use of mesh for hernia repairs continues to rise and has overtaken tissue-based repairs in a sub-Saharan African setting. Results show good outcomes justifying continued use.

Colorectal cancer (CRC) is a major public health issue in Nigeria. The incidence is rising, and majority of the patients diagnosed with CRC, die of the disease burden. CRC is an ideal cancer for screening and early detection. It has been well documented that screening for CRC, by a variety of methods, leads to a sustained reduction in mortality from the disease in two ways: increased detection of early stage with more curable cancer and detection and removal of adenomas, which are known precursors to CRC. Screening has also been shown to be cost-effective in terms of quality-adjusted life-years gained compared to nonscreening. CRC screening can be approached as an organized program or on an opportunistic basis. Opportunistic screening is the only option in systems that lack the resources, infrastructure, and framework needed for an organized approach. A myriad of CRC screening tests exist, which can be divided into two main categories namely biological sample-based tests, which include fecal, blood, and urine tests, and colonic structure-based tests, which include flexible sigmoidoscopy, colonoscopy, and imaging studies such as computed tomography colonography, magnetic resonance imaging colonography, and double-contrast barium enema. The recommendation for CRC screening includes offering patients the opportunity to select test, based on their preference, affordability, and test availability. This decision-making process is personalized and requires an understanding between the patient and doctor. This guideline reviews the available evidence and makes recommendation on the screening method for CRC in Nigeria.

BACKGROUND Protein-energy malnutrition is a common problem in critically ill patient and it is a major cause of accelerated morbidity and mortality in this group of patients. Recent dramatic advances in both enteral and parenteral nutritional support have ensured that most of these critically ill patients are adequately nutritionally supported. Unfortunately, most of these advancements in nutritional supports are far from the reach of most patients in developing countries. In this report, we highlighted the indications, success, challenges of the use of percutaneous endoscopic gastrostomy (PEG) in Nigeria patients. PATIENTS AND METHODS All cases of PEG performed at the Endoscopy Unit of Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State from January 2011 and June 2012 were recruited into the study. The data obtained included the sociodemographic parameters, indication and duration of the procedure, complications, and follow up. RESULTS During the 18 months study period 645 upper gastrointestinal endoscopic procedures were performed. Majority [601(93.2%)] of the cases were for diagnostic purposes. Six (0.9%) cases of PEG were performed. Most (5 of 6) of the patients had central nervous system impairment while only one had severe chronic facial infection with naso-oral fistula. The median age of patients was 60.5 years. The entire procedure including endoscopy lasted an average of 25 minutes with a range of 12-35 minutes. Only one case had peristoma infection which resolved with antibiotics and repeated dressing with povidone iodine. There was no episode of aspiration pneumonitis or procedure related mortality. The average follow up was 6 months with variable weight gain during the follow up period. CONCLUSION PEG is a simple, cost effective and safe method to rehabilitate nutritionally all chronically ill patients in less developed countries such as Nigeria. The need to increase awareness and acceptability of PEG among physicians managing such patients and the society cannot be overemphasized.

Background: Surgical abdomen traverses all age groups. We sought to define the aetiology, patients’ characteristics, and outcome of management amongst children Methods: Two years prospective review of patients aged 5-15 years managed for surgical abdomen at the Wesley Guilds Hospital Ilesa and Mishmael Medical Centre Akure, Nigeria. Results: Fifty two patients were treated. The male: female ratio was 1:1. The age range was 5years to 15years (mean=11.25 ±2.24years). Mean duration of illness was 29.5hours (range 2-72hours). Gut perforation was the most common aetiology (n=39; 75%); with perforations due to infections most prevalent (n= 34; 87.2%). Ten cases (19.2%) were trauma related and showed male predominance. Obstructed gut accounted for 15.4% (n=8) of cases; and showed female predominance. Five out of the eight small bowel obstructions (62.5%) were due to post operation adhesions. Pre-operative and post-operative diagnoses were congruent in 90.4% (n=47) of cases. Major post-operative complications were surgical site infection (20; 38.5%), and pneumonia (5; 9.6%). The average hospital stay was 9days (range 4-21days). Mortality rate was 1.9% (n=1). Conclusion: Acute abdomen requiring surgical intervention is mainly infective origin. The male child is more at risk of abdominal trauma while gut obstruction was more common in females. Keywords : Surgical, Abdomen, Children, Emergency

Being a relatively new entrant into our practice, mesh repair has not been compared with previously existing tissue-based techniques in our setting. This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-operative complications, recovery and cost.

Riedel's thyroiditis is a rare cause of the enlargement of the thyroid gland. The etiology is not fully known. There has been no report of Riedel thyroiditis in our country. We report a case of a 61-year-old man with the disease as well as review the literature. We present the case of 61-year-old carpenter seen in our clinic with 2½ years history of painless anterior neck swelling associated with hoarseness of voice. He had multiple hard nodules on the left lobe of the thyroid gland with multiple cervical lymph nodes enlargement. No feature of hypothyroidism or thyroiditis. Clinical diagnosis of malignant goiter was made although Fine-needle aspiration for cytology did not suggest malignancy. He had surgery, findings included nonresectable hard multinodular left thyroid lobe from which a wedge biopsy was taken, Histology of the specimen revealed Riedel's thyroiditis. He was managed with oral Prednisolone and Tamoxifen with remarkable improvement in his clinical symptoms. Riedel's thyroiditis is a rare disease. It can easily mimic malignant goiter hence proper histological diagnosis will be necessary to differentiate. Review of medical literature showed that Riedel thyroiditis has not been reported in a black African patient inhabiting the sub-Sahara Africa. This was a report of Riedel thyroiditis in a black Nigerian patient that was successfully managed on oral glucocorticoid, tamoxifen and L-thyroxine.

Objectives: We sought to determine the current trends in groin hernia characteristics and surgical care in our hospital. Materials and Methods: A prospective descriptive study from Wesley Guild Hospital Ilesa Nigeria: A tertiary hospital unit in a semi-urban community. All adults who had groin hernia repair between September 2008 and August 2013 were reviewed for age, gender, occupation, hernia type, repair technique and anaesthesia, complications of surgery and duration of hospital stay were analyzed for descriptive and inferential statistics. The main outcome measures were post-operative complications and recurrence. Results: Totally, 270 patients with 296 hernias were treated. Majority were males (256; 94.8%). The modal age group was 51-60 years (20.4%). Hernias were unilateral in most patients (251; 93%) with the majority of them right-sided (162/270; 60%). There were 295 inguinal hernias and one femoral hernia. Indirect inguinal hernia was most common (205 patients; 73.3%); while 79 (27.7%) were direct and 11 (4%) pantaloon hernias. Repairs were for recurrent hernias in 17 cases (3.8%) while 64 patients (23.7%) presented with complications requiring emergency operation. Local anesthesia (LA) was most commonly used (80.7%), and day-case surgery was common (206, 76.3%). Nylon darn (155; 52.4%), mesh hernioplasty (94, 31.8%) and Bassini (43; 14.5%) techniques were commonly used. Morbidity (17, 6.3%) was mainly from the surgical site infection (6, 2.2%). Mortality rate was 0.7%. Follow-up ranged from 3 to 30 months (mean = 9.8 months); no recurrence was recorded. Conclusion: Most repairs are now done using LA as day-case procedures. Mesh hernioplasty is becoming popular.

AIMS AND OBJECTIVES:Trauma continues to assume a prominent role in the cause of disease in the developing world with increased westernization. This study highlights the pattern, management and outcome of gastrointestinal injuries following abdominal trauma in our hospital.PATIENTS AND METHODS:A descriptive retrospective study of all patients who had laparotomy following abdominal trauma at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and April 2013.RESULTS:A total of 120 patients had laparotomy following abdominal trauma. Forty- five patients comprising 41 males and 4 females whose ages ranged between 14 and 65 years had gastrointestinal injuries. Majority (68.9%) were in the third and fourth decades with penetrating injury occurring in 55.6% .Causes of injury included gunshots (44.4%), road traffic accidents (37.8%), stabs (8.9%), falls (6.7%) and impalement (2.2%). The small intestine was the commonest site of injury (57.8 %) irrespective of the mechanism. Gut perforations accounted for 71.1% of all injuries. Two-thirds of patients had other associated injuries with retroperitoneal trauma being the commonest associated intra-abdominal injury. Majority (44.4%) had bowel resection and anastomosis with surgical site infection recorded in 35.6%. Overall mortality was 6.7% and this was significantly associated with pre-operative blood transfusion (p<0.05).CONCLUSION:Gut perforations from gunshot especially of the small intestine are the commonest gastro-intestinal injury in our setting. Pre-operative blood transfusion, perhaps indicating severity of injury, implies poor prognosis.

BACKGROUND:The oral presentation of the clinical long case is commonly an implied knowledge. The challenge of the presentation is compounded by the examiners' preferences and sometimes inadequate understanding of what should be assessed.OBJECTIVES:To highlight the different opinions and misconceptions of trainers as the basis for improving our understanding and assessment of oral presentation of the clinical long case.METHODOLOGY:Questionnaire was administered during the West African College of Surgeons fellowship clinical examinations and at their workplaces. Eligibility criteria included being a surgeon, a trainer and responding to all questions.RESULTS:Of the 72 questionnaires that were returned, 36(50%) were eligible for the analysis. The 36 respondents were from 14 centers in Nigeria and Ghana. Fifty-two percent were examiners at the postgraduate medical colleges and 9(25%) were professors. Eight(22.2%) indicated they were unaware of the separate methods of oral presentation for different occasions while 21( 58.3%) respondents were aware that candidate used the "5Cs" method and the traditional compartmentalized method in long case oral presentation. Eleven(30.6%) wanted postgraduates to present differently on a much higher level than undergraduate despite not encountering same in literature and 21(58.3%) indicated it was an unwritten rule. Seventeen (47.2%) had not previously encountered the "5Cs" of history of presenting complaint in literature also 17(47.2%) teach it to medical students and their junior residents.CONCLUSION:This study has shown that examiners definitely have varying opinions on what form the oral presentation of the clinical long case at surgery fellowship/professional examination should be and it translates to their expectations of the residents or clinical students. This highlights the need for standardization and consensus of what is expected at a formal oral presentation during the clinical long case examination in order to avoid subjectivity and bias.

E.A. Agbakwuru1; A.C. Etonyeaku1, A.A. Akinkuolie1, A.O. Talabi1, O. Olasehinde1, A. Olekwu2, A. Ojo3, I.O. Akingbade4. 1Department of Surgery, Obafemi Awolowo Teaching Hospital Complex, Wesley Guilds Hospital Unit, Ilesa, Osun state, Nigeria. 2Department of Surgery Federal Medical Centre, Owo Ondo state, Nigeria. 3Department of Anaethesia, Obafemi Awolowo Teaching Hospital Complex, Wesley Guilds Hospital Unit, Ilesa, Osun state, Nigeria. 4Department of Anaethesia, Federal Medical Centre, Owo Ondo state, Nigeria. Correspondence to: Etonyeaku, Amarachukwu C, Email: dretonyeaku@gmail.com

BACKGROUND:Hand-sewn gastrointestinal anastomoses has been the traditional approach to gastrointestinal anastomosis in Nigeria while stapled anastomoses are infrequently performed in few centers.OBJECTIVES:To describe the outcome of our initial experience with stapled gastrointestinal anastomoses in a semi-urban patient population.PATIENTS AND METHODS:Consecutive patients who had stapled gastrointestinal anastomoses between January 2011 and June 2014 in a Nigerian tertiary hospital were prospectively evaluated. Indications for operation, procedures performed and anastomoses constructed and postoperative outcome of each patient were documented.RESULTS:Nineteen patients including seven males and 12 females had stapled anastomoses within the period. Their ages ranged between 41 and 68 (mean 52.5) years. Six (31.6%) Roux-en-Y gastrojejunostomies, 6 (31.6%) ileo-colic, 3 (15.8%) ileo-ileal, 2 (10.5%) colo-colic, and 2 (10.5%) colo-anal anastomoses were performed. Indications include antral gastric cancer in 4 (21.1%), right colon cancer 4 (21.1%), ileal perforations in 3 (15.8%) while 2 (10.5%) each had left colon cancer, common bile duct obstruction, rectal cancer and ruptured appendix. Mean duration of operation was 108 ± 46 min and mean duration of postoperative stay was 5 ± 2.6 days. No intraoperative complications were recorded and no anastomotic leakage occurred. At a median follow-up of 5 months no staple related stricture had occurred.CONCLUSIONS:Stapled gastrointestinal anastomoses are associated with a good outcome in our center. We propose a prospective, large-population randomized comparison of the technique with hand-sewn anastomoses.

Background: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR). Materials and Methods: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps. Results: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2-87 years with a median of 57 years. Forty-three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty-three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty-nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010). Conclusion: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.

Background: The pattern of abdominal surgical emergency may not be the same in different settings because of changes in demography, diet, socioeconomic or geographical factors. We present the pattern, management and outcome of such emergencies in Ile Ife, South Western Nigeria. Aim: To document the pattern of abdominal surgical emergency in our environment with a view to highlighting the management and outcome. Because, superstitiously our people mostly think toward poison as the cause of abdominal pain, it is justified to do this study. The societal meaning of poison refers to a situation whereby someone′s friend or relative introduces a deadly substance or material into his drink or food which will eventually lead to morbidity or mortality. It is thought that the introduction of deadly poison could be physically done or diabolically in form of spiritual attack. Materials and Methods: This was a retrospective review of data collected in Obafemi Awolowo University Teaching Hospital Ile Ife, Osun State, Nigeria between June 2006 and June 2012. Patients with abdominal surgical emergencies exclusive of gynecological cases were consecutively entered into the study at the time of presentation and followed-up. The frequencies of different diagnosis and age distribution were recorded. The indications for operative intervention, management and outcome were also highlighted. Results: Of the 8001 cases presenting with abdominal pain in our hospital, 2408 (28.8%) required surgery. Males were 1445 (60.1%), while 963 (39.9%) were female patients with a mean age of 35.9 years. Uncomplicated appendicitis was the most common indication for surgery (61.3%), obstructed hernias constituted the most common etiological factor in intestinal obstruction (51.2%), while postoperative bands and adhesions accounted for 14.6%. Ruptured appendix and typhoid perforation accounted for 32.4% and 18.9% of peritonitis, respectively. The spleen was the most affected intra-abdominal organ in cases of abdominal trauma. Three patients had repair of the spleen. 16 (0.7%) had emergency surgery for complicated duodenal ulcer, repair of burst abdomen accounted for 48 (2.1%) cases of emergency abdominal surgery. Postoperative death was 1.1%. Delayed presentation increased mortality. Conclusions: Surgery for appendicitis is the commonest emergency abdominal surgery. Others include operations for peritonitis, trauma and strangulated inguinal hernia. Delayed presentation contributed to delayed intervention in some cases which impact negatively on treatment outcome. No single case of abdominal pain secondary to ingestion of the so called poison was seen during the study period

Background. In the face of increasing HIV/AIDS prevalence in subSaharan Africa, we evaluate the effectiveness of ‘double-gloving’ during surgery as a means of protecting the surgeon operating on patients with a known or unknown HIV status.Methods. A prospective study was conducted to determine the rate of glove puncture and intraoperative injury in categories of patients with known positive, known negative or unknown HIV status.Results. The surgeon and the first assistant double-gloved in all the 1 050 procedures performed between 2009 and 2013, and a total of 8 400 surgical gloves were used. Sixty-nine patients (6.6%) were HIV-positive, 29 patients (2.8%) were HIV-negative, and the HIV status was unknown for the remaining 952 patients (90.7%). The overall glove puncture rate in the study was 14.5%. The glove puncture rate was 0%, 31% and 15% for HIV-positive, HIV-negative and HIV status unknown, respectively, and this difference was statistically significant. The mean operating time in the group with glove punctures was 148 min (95% confidence interval (CI) 135 - 161), while mean operating time in the group without glove puncture was 88 min (95% CI 84 - 92). Conclusion. Double-gloving offers protection against intraoperative injury. Knowing the HIV status of the patient offers additional protection to the operating surgeon. While we recommend routine double-gloving for surgeons working in HIV-prevalent patient populations, we also advocate for the routine screening for HIV in all surgical patients.

Background: Epigastric hernia (EH) is not uncommon in clinical practice. Repair is often achieved using general anaesthesia (GA). We explored the tolerability and acceptability of EH repair using local anaesthesia (LA) in our patients. Methods: Patients with EH, seen between April, 2007 and March, 2012; who were fit for ambulatory surgery and consented to use of LA for repair were recruited. Pentazocine or tramadol, diazepam and 0.5% xylocaine were used. Bio data, size of fascia defect, content of sac, and repair technique were entered into a spread sheet and was analyzed using the SPSS 17.0. Results: Thirty patients were treated. Eighty percent were females. Painful lump (90%) and dyspepsia (30%) were common complaints. The mean diameter of the fascia defect was 3.3cm. The hernia sacs contained: pre-peritoneal fat (46.7%), the omentum (46.7%) or gut (6.6%). Seventy percent, 16.7%, 10% and 3.3% had repair using simple closure, Mayo, Keel and mesh hernioplasty techniques respectively. Early post-operative complications were surgical site infection (3.3%), seroma (3.3%) and haematoma (6.7%). Tolerability was excellent or good in 86.7% and the acceptance rate was 90%. Tolerability did not depend on the duration of hernia, size of defect, or duration of surgery. No recurrence was noted after a mean follow up period of 29.94months. Conclusion: Ambulatory EH repair using LA is feasible and tolerable in well selected patients. Our patients preferred it to surgery using general anaesthesia. This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

Background: Gastro-duodenal perforations are common and may complicate peptic ulcer disease.Management is often by surgical closure.Objective: To determine the patterns of presentation and mode of management of duodenal ulcer perforations.Methods: Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011.Patients' records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications.Data obtained was analyzed using SPSS 15.0.Result: Forty-five patients were reviewed.There were 37 males (82.2%).Mean age was 39.7years (range 15-78years).There were 10 (22.6%) students and 8(17.8%)farmers.NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases.Seven (16%) patients presented less than 24 hours of onset of illness.Forty one perforations (91.1%) involved the first part of duodenum.Twenty two (49%) patients had Graham's omental patch.We had one (2.2%)failed repair and six (13.3%) mortalities.Conclusion: Late presentation of duodenal ulcer perforation is common with high mortality.Pragmatic surgical intervention with Graham's omentopexy with broad spectrum antibiotics is still commonly practiced.

BACKGROUND:Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized societies, which have recently been described among Africans. Presentations and distribution pattern of the disease among Africans appeared to be different from that described among the Western population. We embark on this study aimed at evaluating the presentation, distribution pattern, and the management of diverticulosis in our tertiary health facility.MATERIALS AND METHODS:A prospective descriptive study of the cases of diverticular disease seen between January 2007 and December 2011 at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.RESULTS:During the 5-year study period, 40 cases were seen. The patients were aged 41-85 years with a median age of 64 years. There were 29 (72.5%) male and 11 (27.5%) female with an average male to female ratio of 3:1. The most common presentation was bleeding per rectum in 28 (70%) patients, which mostly needed transfusion. Ten (25%) patients presented with recurring abdominal pain, whereas one (2.5%) patient presented with abdominal mass and features of intestinal obstruction. Thirty patients were diagnosed on colonoscopy, eight on barium enema, and two on computerized tomography scan. Thirty-four (85%) patients had a pancolonic disease. All the patients were placed on high fiber diet and antibiotics namely ciprofloxacin and metronidazole. Five patients had recurrence within 6 months of follow up, of which one had emergency colectomy.CONCLUSION:Diverticular disease is no longer a rare disease in Nigeria. It is a common cause of lower gastrointestinal bleeding in elderly patients. High index of suspicion for diverticular disease of the colon and its complications should increase in the country.