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ABSTRACT Table of Contents   
Year : 2010  |  Volume : 7  |  Issue : 1  |  Page : 45-54
Abstracts of papers presented at the (8th Annual and Scientific Conference of the Association of the Paediatric Surgeons of Nigeria) 23rd to 28th November, at the University of Maiduguri teaching Hospital, Maiduguri, Nigeria



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Date of Web Publication23-Jan-2010
 

How to cite this article:
. Abstracts of papers presented at the (8th Annual and Scientific Conference of the Association of the Paediatric Surgeons of Nigeria) 23rd to 28th November, at the University of Maiduguri teaching Hospital, Maiduguri, Nigeria. Afr J Paediatr Surg 2010;7:45-54

How to cite this URL:
. Abstracts of papers presented at the (8th Annual and Scientific Conference of the Association of the Paediatric Surgeons of Nigeria) 23rd to 28th November, at the University of Maiduguri teaching Hospital, Maiduguri, Nigeria. Afr J Paediatr Surg [serial online] 2010 [cited 2019 Nov 11];7:45-54. Available from: http://www.afrjpaedsurg.org/text.asp?2010/7/1/45/59364
1

Management of impalpable undescended testis without laparoscopy in ile ife nigeria

Sowande O A, Nyang I, Bakare T I

Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria

Background: Undescended testis is one of the commonest surgical conditions in the paediatric age group. The management of the impalpable undescended testes remains variable can be challenging. Aims: The aim of this study is to review the current practice and the outcome of management of the clinically impalpable testis without laparoscopy in a tertiary center from a developing country.

Materials and Methods: A retrospective review of all cases of clinically impalpable undescended testis managed at the Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria over a 10 year period January 1998 to December 2007 was done. Information on the age at presentation, side of UDT, type of investigation done, mode of management, operative findings, mode of management and outcome was recorded in a proforma.

Results: There were 32 patients with impalpable testis during the study period out of a total of 142 patients with UDT (22.5%). The right side was involved in 12, the left side in 8 and bilateral in 12 patients giving a total of 44 testicular units. The age range at presentation was 24-156 months (median 72 months).The age at exploration was 25-156 months (Median 72 months). 34(77.2%) testicular units were located in the inguinal canal, 19(55.9%) of them at or near the internal inguinal ring while 15 (44.1%) were in the canal proper. 6(13.6%) testicles were located following laparotomy while 4(9.1%) testicular units could not be located and were deemed absent. All the patients that had inguinal testis were offered orchidopexy and all the testicles were successfully placed in the scrotum. Eight of them however required multistage orchidopexy. Of the patients with abdominal testis, orchidectomy was done in 2 patients while 2 patients had a 2 stage FS. The remaining 2 patient had division of the testicular vessels but are yet to return for the second stage. During a follow up period ranging from 1 week to 6 years (median 2months), 2 patients had retraction of the testis necessitating re-orchidopexy while 2 patients the testis could not be palpated again one of who had the FS procedure.

Conclusion: Most patients with impalpable testis can still be managed without laparoscopy in our environment. Availability of laparoscopy however may help with localization and treatment planning if routinely available

2

Is day case orchidopexy attended by a higher wound infection rate?

Bode CO, and Njere I

Department of Surgery, College of Medicine of the University of Lagos

Background: Among many health care professionals in developing countries, there is a persisting reluctance by the surgical team to perform suitable cases such as orchidopexy as day cases for fear of wound infection.

Objective: To assess post-orchidopexy wound infection rates and cost of care between day cases (DC) and hospitalised children (HC) in an urban Nigerian setting.

Setting: 67 male children with undescended testes prospectively randomised into DC (32) and HC (35) at the Lagos University Teaching Hospital.

Result: Wound infection was observed in 1 DC and 2 and HC respectively. There was no statistically significant difference in the observed infection rates between the two groups. Day case orchidopexy cost less than admitted ones.

Conclusion: Day case orchidopexy is safe and not associated with higher wound infection rate when compared with admitted cases.

4

Challenges and surgical outcomes of pelvic ureteric junction obstruction in poor resources setting

Nasir AA, Abdur-Rahman LO, Adeniran JO

Division of Paediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background: Ureteropelvic junction obstruction typically refers to blockage at the junction of the renal pelvis and the beginning of the ureter. The introduction of perinatal sonographic screening dramatically changed the presentation and treatment of UPJ obstruction.

Objectives: To present the challenges and outcomes of managing Pelvi-Ureteric Junction (PUJ) obstruction in a poor resources setting.

Patients and Methods: Between October 2008 and October 2009, 4 children underwent surgery for PUJ obstruction. Median age at surgery was 8, range 4 to 8 years. The data prospectively collected included patients demographic informations, clinical presentation, imaging findings, i.e. ultrasonography (US) and intravenous urography (IVU) and outcomes of managements.

Results: There were three boys and a girl. The main presenting symptom was recurrent renal colic (pain, nausea, vomiting) in all the four patients, followed by urinary infection (UTI), abdominal mass and gross haematuria in one each. None was diagnosed prenatally. Ultrasound showed hydronephrosis in all the four patients. Intravenous urography showed dilated pelvis and calyxes in 2 and non excreting renal units in 2 patients. Diuretic renography was not done in any of the patient due to non availability. All patients had open Anderson-Hynes pyeloplasty with 5-0 or 6-0 vicryl sutures over a feeding tube stent. There was 100% relief of pain postoperatively. Nephrostogram showed good contrast flow in one of the two patients. Degree of hydrophrosis had improved in 3. None had an episode of renal colic or UTI during follow-up period of 2 weeks to1 year.

Conclusions: There is delay presentation and diagnosis of PUJO in our setting. Older children presenting with recurrent renal colic should be evaluated for PUJ obstruction. Lack of conventional imaging technique to determine differential renal function could be frustrating. Our radiologists should be encouraged to go beyond basic obstetric scanning to match global increase in prenatal diagnosis of congenital anomalies. Outcomes of surgical management of PUJO is good despite these our limitation.

5

Changing trends in paediatric urolithiasis in a developing country, nigeria

Chinda JY, Abubakar AM, Yawe T King-David,

Adamu S, Bwala KJ

Paediatric Surgical Unit, Oncology Unit, Department of Surgery, University of Maiduguri Teaching Hospital.

Background: Childhood urolithiasis has been reported to be rare in the country and predominantly endemic bladder stones. We have earlier reviewed our experience with the management of urolithiasis in children. The purpose of this study is to highlight recent changes observed in our practice in the occurrence of Paediatric urolithiasis.

Methods: In the period between January 2004 to October 2009, 53 children with urinary stones were retrospectively reviewed.

Results: Over the last 5.7 years, 53 children were managed for childhood urinary stones in this center. The youngest child was 9 months, while the oldest was 15 years with the mean age at presentation as 6.6 years. There were 44 boys and 9 girls with a sex ratio of 5:1. 18 children (34.0%) were below 5 years of age, 25 (47.2%) were between 5 - 10 years and 10 (18.8%) were 10 - 15 years of age. Majority of the stones, 37 (69.8%) were located in the upper urinary tracts (UUT), 15 (28.3%) were in lower urinary tract (LUT) and 1 (1.9%) were in both UUT and LUT (left renal and bladder). UUT stones were confirmed by ultrasonography and intravenous urography, while LUT stones were confirmed by either pelvic radiograph or ultrasonography. In 2 cases (3.8%) of bilateral ureteric stones were due to concomittant Schistosomal fibrosis of the distal ureters, otherwise, no other aetiological factor was identified. All the patients had open surgical removal of the stones with zero mortality recorded. Postoperative morbidity occurred in 5 patients (9.4%) which were mainly wound infection in 4 patients and vesicocutaneous fistula in one patient.

Conclusion: Paediatric Urolithiasis is now a common malady among children,it's on the rise and has become predorminantly an upper urinary tract disease in contrast to our earlier findings.

6

Outcome of treatment of nephroblastoma in nigerian children

Abubakar AM, Bwala JK, Abdur-Rahman LO, Chinda JY, Adeniran JO

Paediatric Surgery units, Departments of Sugery, 1 University of Maiduguri Teaching Hospital, Maiduguri, Borno State and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria

Background: Elsewhere the survival rate of nephroblastoma has been reported as high as 90% but the outcome in developing countries like ours are notably lower.

Objectives: The objective of this study was to review the treatment outcome of paediatric nephroblastoma in Nigerian children and to identify the factors associated with poor prognosis.

Materials and Methods: This was a retrospective study of all children 15years and below diagnosed and managed as case of Wilms' Tumour in University of Maiduguri Teaching Hospital, Maiduguri, Borno state and University of Ilorin Teaching Hospital, Ilorin, Kwara State over a 10 year period.

Results: There were 44 children comprising 18 boys and 26 girls. Median age at presentation was 3 years with a range of 7 months to 10 years. Only 3 patients presented within one month of the onset of the symptom. All the patients presented with abdominal mass but only 25 (56.8%) had abdominal pain. Gross haematuria was seen in 6 (16.2%) patients. Twenty of the patients had left sided tumours and 20 had right sided tumours. The remaining 4 patients had bilateral disease. Eight cases were managed as stage I disease while five had stage II. Eleven patients presented with stage IV diseae and 9 had stage III. Of the 4 patients who had bilateral disease, 2 had stage II disease on either side, while the other 2 had stage IV in both kidneys. Four (9.1%) patients had neoadjuvant chemotherapy before having surgery. Total nephrectomies were carried out in 34 patients. Nine patients had no form of surgery because they were unfit due to advanced nature of the disease. Post operative chemotherapy was given to 27 patients however only one patient had complete course the rest were lost to follow up. None of the patients had radiotherapy. Four patients had local recurrence and were treated with chemotherapy only. Nine (20.5%) died during the hospitalization.

Conclusion: Our analysis revealed poor outcome of treatment of patients with nephroblastoma. This could be attributed to late presentation and lack of adequate facilities for management.There was generally poor follow-up visits. It is recommended that all children presenting with abdominal masses should be promptly evaluated to rule out Wilms' tumour. Early diagnosis and multimodal treatment approach is advocated.

7

Genitourinary neurofibromatosis type 1 with pulmonary hypertension mimicking sacrococcygeal teratoma

Nasir AA, Abdur-Rahman LO, Adeniran JO

Division of Paediatric Surgery, University of Ilorin Teaching Hospital, Ilorin

Neurofibromatosis 1 is a common inherited autosomal-dominant disease. The unpredictable nature of neurofibromas has a serious impact on the quality of life of patients, and their management is challenging for clinicians. Genitourinary neurofibromas is rare. We present a case of plexiform neurofibromatosis of entire genitourinary system associated with pulmonary hypertension in a young girl, initially diagnosed as sacrococcygeal teratoma.

Case: A 9-year- old Yoruba girl was referred to our service on account of a progressive increasing sacrococcygeal mass since birth and lower abdominal swelling of 2 years duration. There was associated respiratory difficulty 3 days prior to presentation. Her mother had multiple café au lait spots and neurofibromas all over her skin. Physical examination showed a young girl in respiratory distress, pale and acyanotic. She had numerous cafe au lait pigmentations distributed over her trunk. There was a palpable suprapubic mass and a sacral mass extending to both vulva. Echocardiography revealed dilated cardiomyopathy with severe systolic dysfunction and pulmonary hypertension. Magnetic resonance imaging confirmed multiple abdominal visceral masses. She was resuscitated and stabilised. An incisional biopsy of the sacrococcygreal tumour suggested neurofibromatosis. Exploratory laparotomy showed an infiltrating tumor involving the entire wall of the bladder, uterus and both  Fallopian tube More Detailss. She had debulking of the sacrococcygeal and the perineal tumor. Histology of the resected tumor showed neurofibromatosis. Patient developed progressive respiratory distress and died of cardiac failure on the 4 th postoperative week. No autopsy was performed.

Conclusion: Patient with multiple café au lait spot and sacrococcygeal mass with genitalia enlargement should be evaluated for neurofibromatosis of genitourinary tract. Early identification may decrease patient morbidity and improve the chances of complete extirpation. Pulmonary hypertension is a poor prognostic factor.

9

Hypospadias: A review of 10 patients in sokoto

Lukong CS, Jabo BA, Mungadi IA

Paediatric Surgery Unit and Urology Unit, Department of Surgery, UDUTH, Sokoto

Background: Hypospadias is common urologic anomaly.The management of this condition is challenging.We present our experience with the management of this condition in Sokoto.

Patients and Methods:A prospective review of 10 patients operated upon for hypospadias in our centre, from January 2009 to August 2009. Data extracted from a structured proforma and analysed using SPSS version 11.0.

Results: There were 10 boys, age range 13months to 14 years (median 5 years).10 patients presented with abnormal urethral opening,5 patients with abnormal penis, 1patient with ambiquous genitalia. Evaluation was mainly clinical, except for the patient with ambiquous genitalia who imaging and karyotyping to exclude intersex.There were 2 glandular, 2distal penile, 2 midshaft, 2 penoscrotal, 2 perineal hypospadias.In terms of treatment 2 had MAGPI,5 had TIP, 2 had release of chordee and preputial skin graft in first stage procedure. One patient developed urethrocutaneous fistula at the corona which healed spontaneous.1 had short penis and is being planned for steroid therapy to enhance growth. No mortality and outcome has been good.

Conclusion: Hypospadias treatment can be staged where indicated with good outcome.Our results show few complications.

10

Management of bladder exstrophy in maiduguri: Preliminary report of 12 cases

Chinda JY, Abubakar AM, Dabkana TM, Adamu S, Bwala KJ

Department of Surgery, Paediatric Surgical Unit, Department Orthopeadic and Traumatology, University of Maiduguri Teaching Hospital

Background: Bladder exstrophy, although rare, poses tremendous challenge to both the surgeons and the parents. The management is intricate and experience with large numbers is restricted to few centers worldwide. This report is a review of 17 variants of Epispadias- Exstrophy complex managed in UMTH over 7 years, highlighting intricacies of management.

Patients and Methods: We reviewed the records of all the cases of Epispadias - Exstrophy complex that were managed from December, 2002 to September, 2009.

Results: There were 17 cases of Exstrophy- Anomalies seen and managed between December, 2002 and September, 2009. The youngest was a day old, neonate and the oldest was 12 years at repair with the median age, as 4 months. The patients comprised of 8 boys and 9 girls, with the sex ratio of 1:1. The anomalies comprised of 3 epispadias (17.6%),12 bladder-exstrophies (70.6%) and 2 cloacal-exstrophies (11.8).Associated anomalies noticed include undescended testes in 2 patients (25%,males), patent processus vaginalis in 1 patient (5.9), epispadias in all the cases and bifid clitoris in all female patients. 13 patients with exstrophies had posterior iliac osteotomy at bladder closure but the remaining one patient with bladder exstrophy did not have osteotomy at bladder closure. Out of the 13 patients that had osteotomy, 11 patients (84.6%) had satisfactory bladder closure and 2 (15.4) had incomplete bladder dehiscence. The only patient that did not have osteotomy, had complete bladder dehiscence. All the patients were immobilized on impoverished gallows traction for a period of 3 - 4 weeks following closure. There was no mortality. The longest follow- up was for a period of 2 years and the shortest was for a period of 2 weeks. Four patients did not turn-up for follow-up.

Conclusion: Bladder exstrophy is the commonest variant of Epispadias-exstrophy complex and concurrent iliac osteotomy remains a cornerstone for successful bladder closure.

11

Experience in the management of hypospadias in children at a tertiary health centre in nigeria

Abdur-Rahman LO, Nasir AA, Adeniran JO,

Adeyeye AA

Paediatric Surgery Unit, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin

Background: Urethral surgery in children is indicated mainly for correction of congenital malformations. These usually pose some challenges to the surgeon especially where facilities are lacking.

Objectives: To review the pattern and management hypospadias at our centre

Methodology: The records of children who had urethroplasty done between Jan 2002 and Oct. 2008 were retrospectively reviewed. The biodata, diagnosis, co-morbidity, repair techniques and outcome were recorded. Data was analysed using SPSS version 11.0 software.

Results: There were 61 children with hypospadias during the period of which 39 (63.9%) had urethroplasties and this comprised 9 proximal, 3 midshaft and 27 distal types. Their ages ranged between 2 months and 14 years, mean 2.43 years and SD of 1.62. Ten patients declined surgery and 12 are awaiting intervention because of age and size of penis. Co-morbidities were ambiguous genitalia 3, Down's syndrome 1, undescended testis 3 and 2 sickle cell disease patients. Four patients presented with circumcised hypospadias. Various techniques of urethroplasty were done with improvised equipments due to resource limitation. There was no mortality recorded though, there were 8 post- urethroplasty fistulas and 2 complete dehiscence that needed a secondary repair. Length of hospital stay was between 1 and 18 days (median 7.8 days).

Conclusion: Increase in cases of hypospadias reporting at earlier age is being witness at our centre over the years. There is need for public education about hypospadias presentations to prevent undue circumcision and delay referral. Provision of appropriate equipments will facilitate better outcome of paediatric urethroplasty.

12

Prenatally detected pelvi-ureteric junction obstruction: Impact on renal function and its recovery after pyeloplasty

Nasir AA, Abraham MK, Sudarsanan B,

Ramakrishnan P, Kedari PM, Unnithan GR

Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria, Department of Pediatric Surgery, Amrita Institute of Medical Sciences and Research Center, Kochi, India

Objective: To evaluate the impact of prenatal diagnosed congenital pelvi-ureteric junction obstruction (PUJO) on renal function at diagnosis and on Postoperative recovery of function.

Methods: We reviewed the records of consecutive children who underwent Anderson-Hynes dismembered pyeloplasty for pelvi-ureteric junction obstruction during a four year period (2004 to 2007). Patients were divided into group 1-24 who presented with prenatal hydronephrosis and group 2-17 with postnatally diagnosed hydronephrosis secondary to pelvi-ureteric junction obstruction. In each group we compared preoperative and postoperative differential renal function, as measured by diuretic renography.

Results: There were 41 children with sufficient pre- and postoperative data, of whom 24 (59%) and 17 (41%) presented with prenatal and postnatal hydronephrosis, respectively. There were no significant difference in preoperative average differential renal function in Kidneys in which hydronephrosis was diagnosed prenatally and those in which the condition was detected postnatally (39 versus 38%, p=0.553). Differential renal function (DRF) improved in 20 (83%) prenatal group and 16(94%) of postnatal group. The percentage of Renal units with differential function less than 40% were less in prenatal group than post natal group (46% versus 53%). There was a significant increase in postoperative differential renal function in both groups; the prenatal detected subgroup( from 39.4% to 43.8%, p=0.021) and the postnatal group(from 37.6% to 43.7% p= 0.002).

Conclusions: Prenatally detected hydronephrosis from PUJO is associated with less obstructive nephropathy and offer additional benefit of early diagnosis and affords opportunity to begin treatment plan early by the clinicians and the process of parent education on the need for long term follow up. Pyeloplasty resulted in significant improvement in differential renal function in both prenatal and postnatal detected PUJO.

13

Maternal preference in neonatal circumcision

Bode CO

Paediatric Surgery Unit, Department of Surgery, Lagos State University Teaching Hospital, Lagos

Background: Male circumcision in Africa is often been ascribed to cultural reasons, even in modern times where many operands are fast changing.

Objectives: We elucidate from mothers in Lagos their preferred methods for male circumcision, the cadre of personnel chosen by mothers to perform circumcisions, the age at circumcision and the mothers' reasons for circumcising their male children.

Setting: Lagos University Teaching Hospital, Nigeria.

Patients, Materials and Method: 1000 consecutive mothers of male children were interviewed through a questionnaire-based survey.

Results: A thousand mothers with 2975 children were interviewed. 1775 male children comprising 59.7% of the children and all of whom had been circumcised in Lagos were the subjects of this study. The Plastibell kit method was preferred by 49% of mothers while the open surgical dissection method was employed in 15% The Gomco method was only requested by 1.6% of mothers. Doctors performed 45.7% of all circumcisions while Nurses circumcised 42.3%. Traditional Birth Attendants, relations and mothers accounted for the remaining 12% of all circumcisions. 59.4% of mothers circumcised their children because it was considered an obligatory part of their traditions, 19.5 believed it fulfilled their religious obligations. The modal age at circumcision was 8 days on which 24.3% of all babies were circumcised. 85.2% of all male babies were circumcised in the neonatal period with 50% by the second week. Late circumcision beyond 5 weeks was ascribed to neonatal ill health. Others were babies born in climes where circumcision facilities were not readily available and Moslem babies of Northern Nigeria extraction.

Conclusion: The Plastibell kit remains the method of choice for male circumcision among mothers in Lagos. Doctors and nurses accounted for over 80% of circumcisions. The neonatal age is most preferred by mothers. Most male children in Lagos were circumcised for traditional and religious reasons.

14

Challenges and outcome of management of disorders of sexual differentiation in Ilorin, nigeria

Abdur-Rahman LO, Nasir AA, Adeniran JO,

AbdulKadir AY

Paediatric Surgery Unit, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin

Background: Genital malformations have important psychosocial impact on the patients and the family, and present great management challenges to the caregivers, worse so in the developing countries.

Objectives: To evaluate the social and professional challenges encountered in the management of children with ambiguous genitalia

Methodology: A prospective collection of data on children who presented with problems of gender identity including their clinical evaluation, laboratory and radiologic investigations, interventions and outcome

Results: There were 18 children seen over 5 years (Aug 2004-Sept 2009). The age at presentation ranged between 8 days and 60 months (median= 9.0 months). Six were reared as male while 12 were reared as female with social and religious rites as regard gender completed before presentation. There were 2 sets of twins. Clinical presentation included ambiguous genitalia (4, 22.2%), abnormal genitalia (14, 77.8%), microphallus (10, 55.6%), inguinal hernia (2, 11.1%), absent testes (7, 38.9%), progressive labial swelling (5, 27.6%), single perineal opening (17, 94.4%). Only 3 did hormonal assay which were inconclusive, karyotyping was not available but barr body test was 3-5% in 7 suspected male patients, urogenital sinogram was conclusive in 6 out of 8 patients. Laparoscopy and mini-laparotomy confirmed 2 (1 male, 1 female) and 3 (all female) internal genitalia respectively. Testosterone cream was used for phallic stimulation in 4 clinically confirmed male patients. Six had urethroplasty (and 3 orchidopexy), 3 had female genital reconstruction, 3 discharged against medical advice, 2 died prior to surgical intervention and 4 are awaiting definitive surgery.

Conclusion: Delayed presentation, inconclusive investigations from lack of facilities characterized management of disorders of sexual differentiation in this study. Adequate parental counseling, team approach and provision of facilities will assist in the management of this disorder in our environment.

15

Surgical repair of circumcised hypospadias

Uba A. Francis, Chirdan B. Lohfa

Paediatric Surgical Unit, Surgery Department, Jos University Teaching Hospital, Jos

Background: It is traditionally taught and instructed that circumcision should be avoided in patients with hypospadias because of the belief that prior circumcision does remove the prepuce that might be used for the reconstruction of the neourethra during hypospadias' repair. We evaluated outcomes in consecutive patients with circumcised anterior, distal penile hypospadias.

Patients and Methods: The results of repair of consecutive male children with circumcised hypospadias in our unit between 2000 and September 2009 were reviewed. In all cases the urethroplasty was accomplished with either urethral plate tubularization or by the use of flip-flaps procedure.

Results: A total of 12 patients with circumcised hypospadias (distal penile) underwent operative reconstruction by the same surgeon. All patients were followed for at least 8 months with satisfactory outcomes.

Conclusions: Prior circumcision did not negatively affect the results of subsequent urethroplasty in patients with distal penile hypospadias. The tubularized incised plate urethroplasty (TIP) and skin flip-flaps virtually produced equal results in the repair of circumcised anterior hypospadias.

17

Rectal schistomiasis complicating hirschsprung's disease in a child

Anyanwu LJC, Mohammed AM, Atanda AT, Ibrahim M

Paediatric Surgery Unit, Department of Surgery, and Department of Pathology Aminu Kano Teaching Hospital Kano, Nigeria. Paediatric Surgery Unit, Department of Surgery Murtala Mohammed Specialist Hospital Kano, Nigeria

Background: Schistosomiasis is a major public health concern in sub-Saharan Africa, being ranked as second most important parasitic disease after malaria.Mortality and morbidity from this disease remains high, varing with the organ affected.

Case: We report a case of a 10year old boy who was admitted on account of an inability to pass stool for one month, a past history of delayed passage of meconium in the neonatal period and subsequent recurrent constipation and progressive abdominal distention.An earlier Ba-enema showed a transition zone in the lower rectum with markedly dilated proximal bowel. Patient was resuscitated and had an initial loop transverse colostomy, with a subsequent Swenson's pull-through and colostomy closure later. Histopathology of the excised rectum showed calcified ova of Schistosoma haematobium in the mucosa,submucosa and muscularis, with hypertrophied nerve bundles. Granuloma and fibrosis were also noted. Following the histhopathology result, child admitted to playing in a stream in his neighbourhood. A urine microscopy showed no ova of schistosoma. Patient had a course of Praziquatel, and was discharged. He is currently doing well on follow up.

Conclusion: Schistosomiasis is endemic in sub-Saharan Africa. We recommend a routine screening for this disease in the older child suspected to have Hirschsprung's disease in the region.

18

Hirschsprung`s disease: Evolution of management technique and results in sokoto

Lukong CS, Jabo BA

Paediatric Surgery Unit, Department of Surgery, UDUTH, Sokoto

Background: The management of Hirschsprung`s disease has been evolving.This study highlights the evolution in management technique, and outcome of this disease in our centre.

Patients and Methods: A prospective review of 13 patients managed for hirschsprung`s disease in our centre from January 2009 to August 2009. Data extracted from a prospective proforma and analysed using SPSS version 11.0.

Results: There were 13 patients; 10 boys and 3 girls(ratio 3:1). Median age 21 months( range 12 days to 7 years).The youngest is a female with total colonic aganglionosis, while the oldest is a boy with short segment disease.At presentation 5 had delayed passage of meconium and were all less than 1 year of age, 8 had recurrent constipation and abdominal distension and were all older than 1 year of age, 3 had failure to thrieve. 10 patients had no colostomy,while 3 had loop transverse colostomy at presentation.1 patient developed hirschsprung`s desease related enterocolitis during course of evaluation. At evaluation 8 had rectosigmiod disease on barium enema, 5 never had barium enema.Rectal mucosal biopsy confirmed aganglionosis in 6 patients, 7 patients are still awaiting results and are doing well with colonic washout. 4 patients had transanal endorectal pullthrough.1 patient had postoperative intestinal obstruction that required re-exploration with findings of adhesions and sphincteric spasms. Rectal tube was left insitu for subsequent patients to prevent intestinal obstruction from sphincteric spasm.There no mortality.

Conclusion: Decompression is effective with colonic washout.Transanal rectal tube is useful in the early postoperative period.Transanal endorectal pullthrough is a novel technique with good outcome.

19

Ten year experience with the swenson procedure in nigerian children with hirschsprung's disease

Sowande OA

Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria

Background: Hirschsprung's disease is a common cause of intestinal obstruction in children. Definitive treatments consist of excision of the aganglionic segment and anastomosing the normal colon to the anal remnant. The outcome of this approach in children is not known

Aims: The aim of this study was to analyze the short to mid-term outcome of children who have undergone the Swenson Procedure (SPT) as a treatment of Hirschsprung's disease over a period of 10 years.

Patients and Methods: Data were collected on biopsy proven cases of HD who had SPT at the Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria between January 1998 and December 2007. Information collected includes age, sex and clinical presentation, type of colostomy done and complications if any, proximal level of aganglionosis, Age at SPT, levels of resection any complication of SPT. Other information recorded include days to oral intake, need for secondary surgery and bowel and sphincteric activities at follow up.

Results: There were 33 children managed with SPT during the period of which were 28 males and were 5 females (M 5.6: F = 1). The median age at presentation was 8 months ranging from 3 days to 11 years. Eighteen patients had primary pull through without colostomy while 15 patients had decompressive colostomy prior to the PT. The median age at formation of colostomy was 6mths (3days to 11years). Major complications of prolapse and wound breakdown occurred in 4 and 2 of the patients with colostomy respectively. The duration of the colostomy before definitive PT was 1 to 18 months with a median duration of 4months. The SPT was done at a median age of 14months with a range of 7weeks to 11years 4months. Twenty one (64%) of the patients were operated on after 1year. The level of aganglionosis as determined by histology was in the recto-sigmoid area in 30(91%)) patients. The commonest post SPT complication was intestinal obstruction from adhesions which was managed conservatively in 2 while the third patient required laparotomy. Two other patients required laparotomy, drainage of pelvic abscess and colostomy following anastomotic leak. One patient who had primary pull through required a redo because of residual aganglionosis. Bowel opening varies from once daily to 8 times daily median 3xce daily. There was only one case of incontinence in these series of patients.

Conclusion: The Swenson's Operation is an effective procedure in the treatment of Hirschsprungs disease in children in Ile Ife, Nigeria

22

Colostomy closure in maiduguri: An audit

Abubakar AM, Adamu S, Chinda JY, Usman UD, Obiano SK.

Paediatric Surgery unit, Department of Sugery, University of Maiduguri Teaching Hospital, Maiduguri, Borno State and Department of Sugery,Federal Medical Centre, Gombe, Gombe State, Nigeria

Background: Colostomy is still a common preliminary procedure for many gastrointestinal surgical problems in children. It is also associated with high mortality during its construction and closure.

Aims and Objectives: To determine the outcome of colostomy closure and to identify the factors contributing to the complications.

Materials and Methods: A retrospective study of all children that underwent colostomy closure over an 8 year period at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State.

Results: There were 33 (55%) males and 27 (45%) females. The major indications for colostomy were anorectal malformations 40(66.7%) and Hirschsprung's disease 11 (18.3%). The colostomy was sited at the transverse colon in 44 (73.3%) and the rest in the sigmoid colon. The types of colostomy performed were loop in 41 (68.3%) and divided in 19 (31.7%) patients. The median duration of colostomy before closure 9 months with a range between 1 and 48 months. Fifty four (90%) had intraperitoneal closure while 6 (10%) had extraperitoneal closure. There were 30 complications noted in 22 (36.7%) patients. The commonest was wound infection 11 (18.3%), anastomotic leak in 4 (6.7%) and adhesive intestinal obstruction in 3 (5%) patients. The median duration of hospital stay was 14 days with a range of 7 to 60 days. One of the patients died giving a mortality of 1.7%. The post operative complication rate was significantly affected by the status of the operating surgeon (p<0.005) and also when resection and anastomosis was carried out. It was not significant for the type of colostomy, duration of surgery or when blood was transfused (p>0.005).

Conclusion: The morbidity associated with colostomy closure is high. Therefore meticulous attention to operative techniques and early detection and treatment of complications by an experienced member of the surgical team would decrease the morbidity and even the mortality of colostomy closure.

23

One-stage without colostomy versus staged pull-through management of Hirschsprung's disease

Francis A. Uba, Lohfa B. Chirdan, Charles SOO, Olabisi Osagie, Shitta

Paediatric Surgery unit, Department of Surgery, JUTH, Jos

Background/Purpose: The authors evaluated the safety and benefits of l-stage pull-through in comparison with staged repair of Hirschsprung's disease under.

Patients and Methods: Sixty-eight patients were treated for Hirschsprung's disease during a 10-year period between October 2000 and September 2009 at our institution. Twelve patients were excluded from the study on account of incomplete data, and the medical records of the remaining 56 patients were reviewed.

Results: Thirty-four patients including 6 neonates underwent staged correction, and 22 patients underwent l-stage pull-through. There was no mortality for patients undergoing staged treatment, but there were 2 unexplained deaths after a 1-stage repair. There was obvious difference in the incidence of complications (45.2% vs 18.6%, p<0.002) and the need for additional surgical procedures (5 v 0) between the staged and 1-stage groups, respectively. Of the survivals, 98% after staged treatment and 100% after staged treatment had a satisfactory functional result, and the incidence of incontinence was 1% and 0%, respectively. Overall, the incidence of postoperative enterocolitis was low (4.2%), all in staged group.

Conclusions: One-stage correction of Hirschsprung's disease is a safe procedure in all age groups. Although it tends to be associated with occasional unexplained postoperative deaths, one-stage procedure offers economical and social advantages to families in developing countries. Benefits of l-stage over staged treatment include avoidance of multiple operations, elimination of complications associated with a colostomy, shorter duration of hospital stay, minimal incidence of enterocolitis and completion of treatment at an earlier age.

26

Infantile hypertrophic pyloric stenosis: Presentation and clinical outcome in Kano, Nigeria

Anyanwu LJC, Mohammed AM, Ibrahim M,

Ibrahim MU

Paediatric Surgery Unit, Department of Surgery Aminu Kano Teaching Hospital Kano, Nigeria. Paediatric Surgery Unit, Department of Surgery Murtala Mohammed Specialist Hospital Kano, Nigeria

Background: The aetiology of infantile hypertrophic pyloric stenosis (IHPS) still remains unclear. Various workers have reported its low prevalence among negroes. The purpose of our study is to review our experience with this condition in a predominantly negroid population.

Methods: Clinical records of all children who underwent surgical exploration for IHPS between January 2004 and October 2009 at the Aminu Kano Teaching Hospital Kano Nigeria (AKTH) were retrospectively reviewed. Demographic data, as well as clinical symptoms, examination findings and laboratory results were documented and analysed.

Results: Six patients had exploration for IHPS during the study period. All the patients were males. The mean age at presentation was 6.5 weeks (range 3-9 weeks). Mean age at onset of symptoms was 12.67 days (range 4-21 days). Duration of vomiting before presentation ranged between 14-56 days (median 28.9 days). Five (83.33%) of the patients had an ultrasound (US) confirmation of IHPS before exploration. 2 patients (33.3%) had hypokalemia (K + <3), and only one (16.67%) was alkalotic (HCO 3 - >28) on presentation.

Conclusion: The low number (6) of children with IHPS seen during the study period (mean of 1per year) could be a confirmation of the low prevalence of IHPS amongst blacks, as our hospital is the only referral centre in the region, and serves a population 0f over 14 million inhabitants.

28

Bubo masquerading as an incarcerated inguinal hernia in a child

Anyanwu LJC, Omatiga AG, Katung IA, Etonyeaku AC

Paediatric Surgery Unit, Department of Surgery Aminu Kano Teaching Hospital, Kano, Nigeria. Department of Radiology and Department of Surgery Federal Medical Center, Owo, Nigeria

Background: The pathogenesis of bubo is unclear. Various organisms have been implicated in its development. It could mimic a groin hernia and thus pose a diagnostic dilemma.

Case Report: We report a case of a 3year old boy presenting at our outpatient clinic with a 2 weeks history of a painful left inguinal swelling. Examination revealed a well preserved boy who was apprehensive. Temperature was 36.8 0 C. A tender left groin swelling (4cm by 2cm), firm, warm and irreducible was noted in the region of the external inguinal ring. A groin ultrasonography was suggestive of an incarcerated left inguinal hernia.Based on patient's stable clinical state, a diagnosis of bubo was made, and he was placed on per ora Erythromycin. He subsequently had an incision and drainage of the groin swelling 1 week later following suppuration. Staphylococcus aureus was isolated from the pus aspirate. Recovery was uneventful and patient is doing well.

Conclusion: Making a definitive diagnosis in acute inguinoscrotal conditions in children may pose a diagnostic dilemma especially in a setting of a delayed presentation, an inadequate clinical history and self medication.

29

Peri-operative localization of the processus vaginalis in hydrocele in children

O A Sowande

Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria

Background: The established approach to the management of hydroceles in children was ligation of the patent processus vaginalis through the inguinal approach. In a few instances the channel can not be easily identified at operation

Aims: The aims of this technique is to investigate whether the routine injection of Methylene blue helps in the identification of the patent processus vaginalis and decision making in paediatric hydrocele

Materials and Methods: Twenty boys aged between 1 and 9 years were enrolled in the study. The consents of the parents were obtained after excluding history of allergy. After induction of anaesthesia and draping the operative field, 0.2-0.5 ml of diluted methylene blue was injected into the hydrocele through the scrotum. The scrotum was elevated for 3-5 minutes to allow the dye to reflux back into the processus. Routine procedures for the ligation of the processus were then followed.

Results: The track of the processus vaginalis was clearly visualized in 17(85%) of the patients while in 3 (15%) patients there were no track and the hydrocele was localized to the tunica vaginalis.

Conclusion: The technique helps in the identification of the patent processus vaginalis where present.

30

Accessory scrotum- rare findings in paediatric urology. Two cases in our centres

Ibrahim Musa, Mohammad A.M., *Anyanwu L.J.C.

Murtala Mohammed Specialist Hospital and Aminu Kano Teaching Hospital, Kano, Nigeria

Introduction: Congenital scrotal deformity is restively rare and accessory scrotum is least frequent in clinical surgery. Congenital accessory of the scrotum was first reported by Kimura in 1930. Since the first report of the author, only about 40 cases were documented within the scientific community. This congenital anomaly is seen exclusively in boys; however, Sule et al. reported a case on a female with accessory scrotum.

Aim: The aim of our presentation is to highlight our experiences with two cases of accessory scrotum in our centres. We would also demonstrate mode of presentation and surgical approach of such congenital anomaly. The histological variants will also be presented with discussions of embryological explanations of its occurrences.

Conclusion: Accessory scrotum is relatively rare, mostly seen in boys. Complete surgical resection gives satisfactory results.

31

Ectopic pancreatic tissue in duplication cysts of the pyloroduodenal canal and body of the stomach in children

Anyanwu LJC, Mohammed AM, Atanda AT,

Ibrahim M, Tsauni IAJ

Paediatric Surgery Unit, Department of Surgery, and Department of Pathology Aminu Kano Teaching Hospital Kano, Nigeria. Paediatric Surgery Unit, Department of Surgery Murtala Mohammed Specialist Hospital Kano, Nigeria

Background: Gastrointestinal duplication cysts are rare congenital malformations. Pyloroduodenal duplications seem to appear more rarely with only 3 reported cases so far in literature.

Cases: We report herein 2 cases of gastric duplication cysts, in 2 children one arising from the greater curvature and the other from the pyloroduodenal canal. Both children were males. The patient with the pyloroduodenal cyst presented at 2months of age with a progressively increasing upper abdominal swelling and a gastric outlet obstruction since the second day of life. The other patient who had a cyst in the greater curvature presented at age 2 years with a history of a progressively increasing upper abdominal swelling since birth, recurrent obstructive jaundice associated with fever and abdominal pain. Both had surgical exploration and excision of the cysts. Histopathology of both cyst walls showed ectopic pancreatic tissue,and smooth muscle in the wall. Patients had an uneventful recovery and are doing well.

Conclusion: Though gastrointestinal duplications are rare conditions, the variability of their location could produce various clinical signs and symptoms which could make diagnosis difficult.

34

Necrotizing fasciitis in children: Experience with the management in northern Nigeria

Lohfa Chirdan, Jacob Legbo, Aba Uba

Paediatric Surgery Unit, Department of Surgery Jos University Teaching Hospital and Department of Surgery, Usmanu DanFodio University Teaching Hospital, Sokoto, Nigeria

Background: Necrotizing fasciitis (NF) is a rapidly spreading infection of the fascia and subcutaneous tissue cause by Streptococcus pyogenes. It is a life threatening condition if not diagnosed and treated promptly. This article describes the experience of two teaching hospitals in Northern Nigerian with the management of children with necrotizing fasciitis.

Methods: Records of children treated for NF at the Jos Uninversity Teaching Hospital and the Usman Dan Fodio University Teaching Hospital from January 2005 - December 2008 were reviewed retrospectively. Information recorded for each patient included medical history, clinical characteristics, diagnostic procedures, treatment methods and outcome.

Results: Thirty four children were treated for NF over the study period at two teaching hospitals in Northern Nigeria. Their ages ranged from 7 days - 5 years (median age 12 months). There were 21 boys and 13 girls. The predisposing factors were boils, intramuscular injections, omphalitis, and malnutrition. The commonest sites were the trunk (including chest wall), the gluteal region and the scalp. The initial presentation was skin induration progressing to skin discoloration and bullae formation associated with high grade pyrexia and tachycardia. The treatment consisted of extensive debridement, antibiotics and supportive therapy. Thirty one children survived while 3 died of overwhelming sepsis.

Conclusion: Necrotising fasciitis though rare in children could be lethal. Early diagnosis and institution of aggressive management offer the best chances of avoiding unnecessary mortality.

35

Three dimensional computer tomography and surgical approach to pectus excavatum repair

Ibrahim Musa, Arynov N.M., Mohammed A.M.

Murtala Moh'd Specialist Hospital, Kano Nigeria, A.N. Syzganov Scientific Centre of Surgery, Almaty, Republic of Kazahstan, Aminu Kano Teaching Hospital, Kano, Nigeria

Introduction: Since the advent of modern clinical diagnostic machines, the science of surgery and the surgeons use these machines to ease surgical intervention, which in turn has positive influence on the patient's recovery and satisfactions.

Aim: To highlight our experience with the usage of three dimensional computer tomography and way forward to surgical approach upon the image evaluation prior to surgery; To demonstrate easy surgical approach to such complex surgery; To compute surgical recovery time upon such approach versus traditional approach; To evaluate patients satisfactions upon minimal surgical intervention versus traditional approach.

Materials and Methods: We operated, analyzed and concluded the clinical observations of 34 patients with PE. The patients were divided into two groups. The first group 20 (58.82%) patients were operated without critical analysis of their three dimensional computer tomography, while the second group 14 (41.11%) was operated based on the results and tomographic images done prior to surgery.

Results: The results of our surgical approaches were calculated based on the patients' satisfaction, relapses of PE and cosmetic outlook. Satisfactory results increased by 23.1% while unsatisfactory result was reduced by 4.3% with p<0.005.

Conclusion: Three dimensional computer tomography provides good images of costo-sternal structures and the in case of helical rotation of the sternum, minimal incision provides good surgical results.

36

Skin grafting- use of laser rays in augmenting skin spread at the recipient side

Ibrahim Musa, Mohammad A.M., Anyanwu L.J.C.

Murtala Mohammed Specialist Hospital and Aminu Kano Teaching Hospital, Kano, Nigeria

Introduction: Skin grafting has its beginning in the ancient Indians between 3000-2500 BC and since than, different methods and techniques were employed in enhancing the effectiveness and cosmetic outcome of the both the donor and the recipient sides. It was in 1871 Pollock introduced the idea of using skin grafts to treat burn wounds and demonstrated the rapid wound healing of granulated wounds after grafting and with the advancements of quantum sciences, the effects of Laser Rays on wound healing are on daily scientific research.

Aim: To demonstrate our clinical observations and the effects of Laser Rays in augmenting skin spread at the recipient side of the graft.

Material and Methods: We are presenting sixty six (66) post-burns children who underwent split and full-thickness skin grafting in our centre. The patients were divided into two groups. Thirty eight (38) 57.57% had skin graft and had conventional wound dressing without application of Laser Rays, while twenty eight (28) 42.42% had conventional post grafting dressing with application of Laser Rays.

Results: The two groups were statistically analyzed and P=0.00035 in the second group in evaluating the skin spread in millimeters upon application of the Laser Rays and days of hospital stay were also statistically evaluated.

Conclusion: Low-Level Laser Rays are beneficial in post-burns skin grafting with rapid skin spread and good cosmetic out-come.



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