|Year : 2011 | Volume
| Issue : 3 | Page : 329-341
|Abstracts of papers presented at the 11 th Annual and Scientific Conference of the Association of Paediatric Surheons of Nigeria (APSON) in Portharcourt, Nigeria, between 22 nd - 24 th Sept. 2011
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|Date of Web Publication||11-Jan-2012|
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. Abstracts of papers presented at the 11 th Annual and Scientific Conference of the Association of Paediatric Surheons of Nigeria (APSON) in Portharcourt, Nigeria, between 22 nd - 24 th Sept. 2011. Afr J Paediatr Surg 2011;8:329-41
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. Abstracts of papers presented at the 11 th Annual and Scientific Conference of the Association of Paediatric Surheons of Nigeria (APSON) in Portharcourt, Nigeria, between 22 nd - 24 th Sept. 2011. Afr J Paediatr Surg [serial online] 2011 [cited 2019 Nov 14];8:329-41. Available from: http://www.afrjpaedsurg.org/text.asp?2011/8/3/329/91657
Epidemiology of paediatric burns in Kano, Nigeria
*Anyanwu LJC., Mohammad AM., Tsauni IAJ.
Paediatric Surgery Unit, Aminu Kano Teaching Hospital, Kano, Nigeria.
Objective: The objective of this study was to examine the risk factors associated with paediatric burns requiring hospitalization in our practice, with a view to proffering a public health intervention.
Materials and Methods: We undertook a retrospective review of all children aged 13 years or less admitted into our wards for burns injuries between January 2001 and December 2008, and also a prospective study of all those admitted between January 2009 and January 2011. Demographic and clinical data were extracted from patients' records for analysis. Data were analysed using SPSS 15.0 (SPSS Inc, Chicago, IL).
Results: Detailed data were available on 171 children. Their ages ranged from 2 months to 13 years (median 2.5 years). There were 95 boys (55.6%) and 76 girls (44.4%). Scalds accounted for 66.1% of the injuries, followed by flame burns (32.2%). Hot water was the injuring agent in 50.9% of the scalds, followed by hot oil (7%). Majority of the injuries occurred indoors (88.9%), with the kitchen being the location for 58.5% of scald injuries. The mean percentage TBSA of burns was 18.5%, and the mean duration of admission was 27 days. The average length of time between injury and admission was 11 days. There were 15 deaths (8.8%), with sepsis accounting for 11 (73.3%) of them.
Conclusion: The home environment can be potentially hazardous with regards to burns injury in children. There is a need for a public awareness campaign to educate parents and care givers in our environment on the need to limit children's access to the cooking area.
Keywords: Epidemiology, home environment, paediatric burns
Non accidental and intentional injuries in children
Kache SA, Mshelbwala PM, Ameh EA
Division of Paediatric Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika, Zaria
Background: Injuries are now an important cause of morbidity and mortality in children in Africa. However, little attention is given to non- accidental injuries (NAI) in Africa.
Materials and Methods: A retrospective review of hospital records at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria from January 1998 - December 2010 (13 years). All patients ≤ 17 years presenting with suspicion of NAI were included. All patients were evaluated by a paediatric surgeon. It is an update of our previous report.
Results: There were 23 children, 15 boys and 8 girls. Aged 11 days-16 years (Median 3 years). The mechanism of injury was sexual assault in 6(26.1%) patients, 6(26.1%) patients had burns injury, due to sharp objects in 4(17.4%) patients, 2(8.7% patients had gunshot injuries, 2(8.7%) patients had injuries from bites, while in 1(4.3%) patient the mechanism was unknown. The site of injury was in the perineum in 9 (39.1%) patients, Head and Neck in 6 (26.1%) patients, Abdomen in 5 (21.7%) patients, lower limb in 2 (8.7%) patients and chest in 1(4.3%) patient. The diagnosis was confirmed in 16 (69.6%) patients but was only suspected in 7 (30.4%) patients. Social evaluation was done for 4 (17.4%) patients, 3 children were removed from the environment where the abuse occurred, 2 of whom were socially evaluated. No culprit was prosecuted. Most families were unwilling to allow any action beyond clinical care of the child. Mortality occurred in 3 (13%) of the children, 1 due to head injury and the other 2 due to Abdominal injury. Long lasting physical disability occurred in 6 (26.1%) of patients, 2 from lower limb injury, 2 from head injury and 2 from perineal injury.
Conclusion: NAI in children is a largely overlooked aspect of childhood trauma. It is probably under - reported, because only severely injured come to hospital, some families want to keep it secret especially where sexual assault is involved. There is need to actively identify these cases, give more attention to these injuries and all efforts made to protect the child.
Falls from heights at the accident and emergency center of Ubth, Benin city
Osifo Osarumwense David, Iribhogbe Pius, Udefiagbon Ernest , Evbuomwan I, Akpanudoh Emem
Paediatrics Surgery and Traumatology Units, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
Background: Knowledge of epidemiology and pattern of injury sustained following falls from heights may be crucial in formulating policy aimed at prevention and improved outcome of victims. This study aimed to determine the epidemiology and spectrum of injury sustained following falls from heights at a referral trauma center in Benin City.
Materials and Methods: A retrospective analysis of cases of falls from heights between June 2010 and May 2011 at the Accident and Emergency Center of University of Benin Teaching Hospital.
Results: Eight-four patients aged between 1 and 60 years (median 24 years) comprising 54 males and 30 females with a male/female ratio 1.8:1 were managed. All the falls were accidental and occurred mainly among males aged between 18-30 years with a peak incidence between March-May which coincided with rainy and harvest seasons (P<0.0001). Consequently, falls from moving vehicles 13 (15.5%), off the top of buildings at construction sites 8 (9.5%), staircase 6 (7.1%) and tree tops 6 (7.1%) were common. Children fell mainly indoors from relatively lower heights. Eighty (95.2%) patients sustained injury that ranged from minor abrasions 12 (14.3%) to severe life threatening head injury 15 (17.9%) which resulted in one (1.2%) death. Sympathizers and passers-by were rescuers who gave first aid and brought patients to the center using hazardous public transport with a mean time lag of 12 hours (range 2-48 hours) between the falls and presentation.
Conclusion: Falls from heights were common in Benin. Health awareness programs and good government policy will reduce incidence and improve outcome.
Paediatric trauma deaths in a level 1 trauma centre in Benin city
Osarumwense David Osifo , Pius Iribhogbe, Osasumwen Osagie, Ezekiel Ugiagbe, Akpanudoh Emem
Paediatric Surgery, Traumatology Units, Departments of Surgery and Morbid Anatomy, University of Benin Teaching Hospital, Benin City, Nigeria.
Background: Trauma is a common cause of death among children/adolescents, and data on its epidemiology and pattern are crucial for policy formulation. The aim of this study was to determine the epidemiology and pattern of paediatric/adolescent trauma death in a Nigerian referral trauma centre.
Materials and Methods: The clinical and autopsy data of all paediatric/adolescent trauma death at the University of Benin Teaching Hospital between 1999 and 2010 were analyzed in a retrospective study.
Results: Of 905 trauma related deaths, 78 (9%) involved children/adolescents who comprised 49 males and 29 females with a male/female ratio 1.7:1 and a mean age of 9.2 ± 5 (range <1 to18 years). The Injury-Arrival time varied from one hour to 4 days (mean 18 hours). Thirteen (17%) cases were dead on arrival (DOA) and majority of the deaths occurred within the first week on admission. Road traffic accident (RTA), accounting for 61 (78%) cases, was the leading cause of trauma death. Other causes included burns, 8 (10%), gunshot injury, 5 (6%), and stab and sport injuries 2 (3%) cases each. Head injury which occurred in 44 (56%) cases was the commonest cause of death, followed by haemorrhagic shock in 25 (32%), hypovolaemic shock in 5 (6%), septic shock in 3 (4%) and spinal cord injury in 1 (1%).
Conclusion: Head injury following road traffic accident was the major cause of paediatric/adolescent trauma deaths. Increased road safety campaign, appropriate injury control policies, legislations, enforcement, development of high quality trauma system, and Emergency Medical Services are advocated.
Splenic rupture in Nigerian children; Experience with non operative management
Okoro PE, Nwagbara I 1 , Igwe WP
Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, 1 Department of Surgery, Imo State University Teaching Hospital, Orlu
Introduction: Whereas researchers in advanced countries have conclusively shown that non operative management (NOM) of children with splenic rupture is not only safe but desirous, the inclination of many surgeons in resource limited centres is towards surgical treatment. Ostensibly, absence of sophisticated imaging and diagnostic tools, makes any attempt of NOM unsafe and indefensible.
Aim and Objectives: To evaluate our experience with splenic rupture in children and to assess the outcome of non operative management of children with splenic rupture in the midst of scarce sophisticated imaging tools.
Materials and Methods: This is a prospective study of cases of splenic rupture managed in three tertiary health facilities in Southern Nigeria between September 2006 and August 2011. Diagnosis of splenic rupture was based on abdominal ultrasound, plain abdominal x ray and clinical findings. All patients were initially managed as though they were being worked up for surgery; their clinical progress determined whether they went for operative (OM) or non operative management (NOM).
Results: There were 37 consecutive cases of splenic rupture managed during the period of the study. Twenty two (59.5%) were males and 15(40.5%) females. Thirteen (35.1%) patients had immediate operative management (IOM), 3 (8.1%) had delayed operative management (DOM), and 21(56.8%) had non operative management (NOM). There were five deaths; 3 in the IOM, 1 in the DOM, and 1 in the NOM group; overall mortality rate of 13.5%.
Conclusion: The findings in this study indicate that with attention to fine details of clinical assessment and rigorous monitoring, the majority of children who had been diagnosed of splenic rupture can be managed non operatively even in the absence of sophisticated tools.
Key words: Children, management, non operative, splenic rupture
Paediatric road traffic accident deaths in a Nigerian referral centre
Osarumwense David Osifo, Theophilus Osasumwen Osagie, Pius Ehiawaguan Iribhogbe, Odion-Obhumhese Helen , Egwaikhide E
Paediatric Surgery and Traumatology Units, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.
Introduction: Road traffic accident (RTA) is a common cause of paediatric trauma death and disability, and constitutes a worldwide enormous loss of financial resources as well as a loss of potential manpower. This is a retrospective analysis of paediatric RTA in a Nigerian referral centre designed to determine the causes, prehospital care, presentation, and injuries which resulted to deaths so as to make suggestion to reduce the incidence and improve survival of victims. Materials and Methods: The records of all paediatric RTA between January 2006 and December 2010 at the University of Benin Teaching Hospital were retrospectively analysed for age, sex, causes, injury, rescue team/prehospital treatment, injury-arrival time, clinical condition on arrival, treatment, duration of hospitalization before death, challenges and postmortem findings.
Results: Twenty-six (18%) of 143 paediatric RTA comprising 18 males and 8 females with a male: female ratio of 2.3:1, aged between less than one and 18 (mean 9.3 ± 5.2) years died. There was no significant statistical difference observed when 15 (58%) deaths recorded among 67 (46.9%) children involved in motor vehicle accidents were compared with 11 (42%) following 76 (53.1%) motorcycle accidents (P = 0.31). More severe injuries which resulted in majority of the deaths were recorded following alcohol intoxication (P<0.0001). Fourteen (54%) dead children were pedestrians knocked down, eight of whom were hawking their wares by the roadside while the others were crossing roads which had no traffic signs and/or traffic control. Of the eight vehicle passengers who died, only two wore seat belt or used paediatric chair with no statistical significance compared to those who did not wear (P = 0.37). Four children each died among the 14 and 32 front and rear sitters, respectively (P = 0.222). Of the motorcycle passengers, none of those who wore protective crash helmet died while four died among those who did not wear. Passers-by and sympathizers served as rescue team, provided emergency treatment and presented the victims between one hour and 4 days after the accidents. Head injury in 14 (54%) cases was the commonest cause of death.
Conclusion: Paediatric RTA were due mainly to preventable causes which stressed the need to educate children, road users, general public and government policy formulators to adopt RTA preventive measures in this subregion.
A review of paediatric intussusception at the University of Abuja teaching hospital in Gwagwalada, Abuja
Osagie OO., Olori S., Osagie OE. 1
Paediatric Surgery Unit, Department of Surgery, University of Abuja Teaching Hospital, Gwagwalada, Abuja, 1 Department of Obstetrics and Gynaecology, Bwari General Hospital, Bwari, Abuja
Aim: To determine the pattern of paediatric intussusception in University of Abuja Teaching Hospital, Gwagwalada.
Materials and Methods: All cases of intussusception in children presenting at the University of Abuja Teaching hospital from January 2008 to June 2011 were reviewed for socio-demographic data, presentation, management and outcome.
Results: Within the study period, 43 children were managed for intussusception [M:F = 3:2]. Thirty six [83.73%] were infants. Eight [18.60%] had a history of a recent change in diet and 15[34.88%] had a recent history of upper respiratory tract infection and/or gastroenteritis. Twenty one [48.85%] caregivers had no form of formal education and 16[37.22%] caregivers sought help within 2 days of onset of symptoms. Pain and bloody mucoid stools were seen in 39[90.69%] of cases and 21[48.85%] of these also had a palpable abdominal mass. Thirty two[74.42%] were referred after spending an average of 3 days at the referral centre and 31[72.09%] were attended to by doctors at the referral centre. Five [11.62%] were referred as intussusception. Fourty two required surgery with 18[41.85%] having bowel resection. Nineteen [44.19%] had post operative complications. The average number of days spent on admission was 7. Mortality was 8[18.6%].
Conclusion: There is a considerable delay before presentation of children with intussusception in the paediatric surgery unit and this is largely due to a failure of medical personnel in referral centres to recognise the pathology early. This results in an increase in morbidity and mortality.
Time of passage of first stool in newborns in a tertiary health facility in southern Nigeria
Okoro PE, Enyindah CE 1
Paediatric Surgery Unit, Department of Surgery, and 1 Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State
Introduction: The first stool passed by the new born baby , the meconium, is different from the ordinary stool both in its nature and its implication. Delayed or non passage of the meconium may represent a number of clinical conditions. In this study, we sought to identify the normal time frame for passage of meconium in our babies and what should be considered as delayed passage of meconium.
Aims & Objectives: To investigate the timing of passage of first stool in Nigerian neonates and whether it is influenced by gender, birth weight, maternal age and parity.
Materials and Methods: A proforma was designed to obtain the following data: maternal age, parity, mode of delivery, Apgar score at 1 minute, birth weight, gender and interval between delivery and passage of first stool among normal newborn babies delivered at the obstetrics department of our centre in August and September 2011.
Results: One hundred babies out of 393 delivered during the period of the study were included in the study. There were 63 (63%) males and 37 (37%) females. The interval between delivery and passage of meconium ranged from 0.5 to 54 hours; mean 16.2 (SD=10.57. This was not influenced by gender, weight, maternal age and parity.
Conclusion: Non passage of meconium beyond 48 hours of life could be considered delayed among our study population. We therefore, recommend that clinicians should re-evaluate newborns, for hitherto unrecognized conditions, if after 48 hours they have not passed stool.
Key words: First stool, meconium, newborns, passage
Aetiological basis for peritonitis in childhood Salmonella More Details infection
Lukong CS, Jabo BA
Paediatric Surgery Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Background: Salmonella infection is still prevalent in our environment. The causes of peritonitis vary as a complication of this infection. The aim of this article is to review the causes of salmonella peritonitis and its management outcome.
Materials and Methods: This was a prospective study of children managed with salmonella peritonitis in our unit from January 2008 to December 2010. Data from these patients was recorded on a structured proforma. This data was collated and analysed using apt statistical parameters.
Results: There were 40 children managed over the study period, 28 boys and 12 girls. The age range was 3-16 years (median 10 years). All the patients presented with clinical features of peritonitis. The causes of peritonitis noted were; intestinal perforation 35 (87.5%), acute cholecystitis 4 (10.0%), perforated cholecystitis 1 (2.5%). The 5 (12.5%) patients with cholecystitis were offered tube cholecystectomy as an initial procedure, for cholecystectomy later. The 35 (87.5%) patients with intestinal perforations had the following modes of treatment; simple closure 4 (10.0%), wedge resection + closure 4 (10.0%), segmental resection + anastomosis 20 (50.0%), limited right hemicolectomy + anastomosis 4 (10.0%), exteriorization 2 (2.5%), divided ileostomy 1 (2.5%). The postoperative complications were; surgical site infection 20 (50.0%), anastomotic dehiscence/leak 4 (10.0%), pelvic abscess 1 (2.5%). There were 4 (10.0%) mortalities- 1 due to perforated cholecystitis and 3 from intestinal perforations.
Conclusion : Samonella peritonitis may be due to intestinal perforation or acute cholecystitis. The outcome from perforated cholecystitis could be poor.
Hirschsprung's disease: A survey of current practice in Nigeria
Nasir AA, Ameh EA
Division of Paediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin and 1 Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Background: Although there are several modalities of treatment, there is no clear guidelines on the way the conditions is treated by paediatric surgeons in Nigeria. This survey determines the current approach to treatmet and should help in establishing a concensus and guidelines for care in this setting.
Materials and Methods: An online questionnaire was designed on survey monkey to determine current clinical and operative management of patients with Hirschsprung's disease by consultant paediatric surgeons practicing in the Nigeria. The Survey questionnaire was sent to 55 paediatric surgeons in 18 paediatric surgical centers.
Results: Thirteen paediatric surgeons from 11 different tertiary paediatric surgery centers completed the online questionnaire giving a response rate of 24%. The questionnaire indicate that 46% (n=6) of surgeons managed average of 10-15 new cases of Hirschsprung's disease yearly. Fifty-four percentage (n=7) of the respondents see up to 20% of the cases in neonatal period. Eleven (85%) of the respondents do routine barium enema. Seventy-seven per cent (10) of the respondents do full thickness rectal biopsy under general anaesthesia for diagnosis, 2 (15.4%) of the respondents do modified suction and only 1 surgeon does a traditional suction biopsy. Five respondents will do colostomy for patient presenting with intestinal obstruction and 3 will do colostomy for Hirschsprung's associated enterocolities. About seventy per cent (9) do pull-through at any age, two respondent do pull-through at 6 months and two surgeons do pull-through at 1 year of age. Four respondents indicated that they do primary pull-through in 75% of cases, 3 respondents each do primary pull-through in 10-24% and 51-75% of the cases they managed.
Conclusion: Full thickness rectal biopsy under GA is still the vogue with wide variation in the surgical technique for management of Hirshsprung's disease in Nigeria. There's a need for the Association of Paediatric Surgeons of Nigeria to come up with a standard guideline on management of Hirschsprung's disease.
Avoidable stoma complications in children: Nursing perspective
Balogun AO, Ayeni AM 1 , Mshelbwala PM 1 , Ameh EA 1th
Department of Nursing Services, 1 Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Background: Although great advances have been made with regard to stoma formation and management, both early and late complications are common. This report evaluates avoidable complications of ostomies (intestinal and urinary) creation from the nursing perspective.
Materials and Methods: A retrospective study of 36 children who had stoma fashioned at a tertiary hospital between 2005 and 2010.
Results: There were 32(88.9%) boys and 4 (11.1%) girls, aged 1 day - 10 yrs (median 8.5 days). The primary indication for stoma creation was Anorectal malformation in 19(52.7%), intestinal obstruction in 7(19.4%), posterior urethral valves in 6(16.6%), while cloacal exstrophy, fecal fistula, Hirschsprung's disease and anastomotic leak accounted for 1(2.8%) respectively. Colostomy was fashioned in 24(66.7%) patients, ileostomy and vesicostomy was done in 6(16.7%) patients each respectively. Avoidable stoma complications occurred in 18 (50%) patients with 14(77.8%) of these patients having skin excoriation, stoma prolapse in 2(11.1%) and 1(5.6%) patient each had stoma wound breakdown and non-functioning stoma. skin excoriation occurred in all 6(100%) ileostomies, 8(33.3%) colostomies and none of the vesicostomies. All complications were managed by appropriate nursing and surgical intervention with no mortality directly related to these preventable complications; however duration of hospital stay varied from 5 days to 74 days (median 16.5 days). In the last 6 months, a dedicated stoma nurse became involved in the care of these patients, and this has helped in minimizing particularly the skin related complications.
Conclusion: Attention to surgical details at stoma formation and ensuring appropriate, well equipped and dedicated nursing care coupled with continuous patient and parental education will go a long way in preventing most stoma complications.
Duplications of the alimentary tract
Abubakar AM, Chinda JY, Adamu S, Bwala KJ
Paediatric Surgery Unit, Department of Surgery, College of Medical Sciences, University of Maiduguri/University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria.
Background: Duplications of the alimentary tract are rare anomalies of the gastrointestinal system. They present both diagnostic and therapeutic challenges because of their rarity. We share our experience with the management 9 duplications in 7 patients.
Materials and Methods: Between January 2003 and July 2011, 7 cases of alimentary duplications were managed.
Results: A total of 9 duplications in seven patients were encountered, comprising of 2 boys and 5 girls. Their ages ranged from 1 day to 3 years. Two of the 7 patients presented within the neonatal period. The others were seen between the ages of 1 to 3 years. There was one pyloric, 3 duodenal, one ileal, 2 colonic one rectal and 1 appendiceal duplications in 7 patients. Five of the duplications were spherical and 4 tubular. Four patients had excision of the duplication while in the 3 duodenal duplications a partial excision and mucosal stripping was done. The duration of follow up ranged from 1 month to 4 years with a median of 1 year. However, there was no post-operative complications observed.
Conclusion: The clinical features of gastrointestinal duplications are nonspecific; a high index of suspicion is required for prompt diagnosis in patients with unexplained gastrointestinal symptoms. They may also be unexpectedly encountered intraoperatively, and appropriate surgical management requires that the attending surgeon be familiar with the pathology and clinical characteristics.
Evaluating outcome of adenotosillectomy in children in Port Harcourt
Nwogbo AC, Da Lilly-Tariah OB
Department of Otolaryngology, University of Port Harcourt Teaching Hospital. E-mail: firstname.lastname@example.org
Background: Adenotonsillectomy is a common ENT surgical procedure with various indications. Despite obvious indications surrounding the procedure, some parents, clinicians and surgeons sometimes suggest a watch and see approach. Others will go for immediate surgery as soon as indication is observed. Thereby creating variability as when to perform procedure.
Aim: The study is therefore set to evaluate the outcome of adenotonsillectomy in children. Advantages/disadvantages of early and late surgery.
Materials and Methods: This is a prospective study of 120 children who had adenotonsillectomy between January 2009 to January 2011 in Otolaryngology Department of University of Port Harcourt Teaching Hospital and Braithwait Memorial Specialist Hospital, all in Port Harcourt. Age, Sex, Indication, presenting symptom and duration of symptoms as well as post operative complications were recorded and analyzed.
Results: Patients involved in the study were in the age range of 1 - 16 years. 50 (60%) males and 70(84%) female. Age group 1 - 4 years had greater number of patient that had surgery. Complications were observed more in the older children who had surgery, especially in age group greater than 5 years.
Conclusion: Children in the younger age group, below Age three (3) tolerated procedure better than those in the older age group. Few complications were also observed in the younger age group. It is obvious that surgery is better performed as early as symptoms become obvious.
Key words: Adenotonsillectomy, children, evaluation
Overview of adenotonsillectomy in Federal Medical Centre Owerri
Ajaero MI, Ibiam FA, Onyema CO.
Department of Surgery, Federal Medical Centre Owerri
Background: A 5-year retrospective study of all adenotonsillectomy surgeries done in Federal Medical Centre Owerribetween January 2006- December 2010.
Objectives: To determine the ratio of frequency of adenotonsillectomy to other major paediatric otorhinolaryngology surgeries. To ascertain common indications for surgery and safety of the procedure.
Materials and Methods: The case records of patients who had adenotonsillectomy were retrieved and analyzed. Information on age, sex, indications and complications of surgery were collated.
Results: There were 82 cases of major paediatric otorhinolaryngology surgeries done in the period under review, 34(41.5%) of patients had adenotonsillectomy with 24 males and 10 females a male/female ratio of 2.4:1. The age range 4 months-11 years. Age group of 1-5 years accounting for 22 cases (65%) with peak at 3-4years accounting for 8 cases. The common indications of surgery were obstructive sleep apnea in 20 cases (67%), recurrent upper respiratory tract infections 16 cases (47%) and recurrent acute otitis media in 2 cases (6%). Many patients had more than one indication. 2 patients had anaemia, 1 patient tethering of upper soft palate on posterior pharyngeal wall following surgery. There were no case fatalities recorded.
Conclusion: Adenotonsillectomy is the commonest paediatric otorhinolaryngology surgery in Owerri and treatment outcome appears safe in trained hands.
Diagnostic dilemma of sacrococcygeal tumour
Igwe P., Gbobo I., Okoro P., Numbere P.
Paediatric Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
Background: Sacococygealteratoma (SCT) is an uncommon tumour that presents on the caudal end of the spine, often protruding from the inferior end of the spinal column. These tumours though mainly benign may mimic other disease presentations, particularly in a malignant state.
Materials and Methods: Here we describe a case of a female child with clinical and investigative findings that enabled the diagnosis of sacrococcygealteratoma. She was managed accordingly, including surgical operation.
Result: The histopathological findings differ from earlier diagnosis.
Conclusion: The case shows the need to have wide differentials while considering sacrococcygeal mass.
Key words: Sacrococcygeal mass, Sacrococcygealteratoma
Multiple lymphomatous polyposis (mantle cell lymphoma) in a 6 year old child
Ekwunife OH, Ukah CO 1
Paediatric Surgery Unit, 1 Pathology Department, Nnamdi Azikiwe University Teaching Hospital, Nnewi
Multiple Lymphomatous Polyposis (Mantle Cell Lymphoma, MCL) is a rare and distinct form of B-Cell non-Hodgkin's Lymphoma characterized by the t(11; 14) (q13; q32) translocation, which results in over expression of Cyclin D1. It is type of primary gastrointestinal lymphoma characterized by the presence of multiple polyps or nodules along the gastro intestinal tract. It is extremely rare in children; almost all reported cases are adults usually above 60years. MCL is an aggressive disease with the poorest prognosis of the lymphoma subtypes. We report a 6 year old male child with Multiple Lymphomatous Polyposis (Mantle Cell Lymphoma) who presented with ileo ileal intussusception. Immuno-histochemistry was done and the response to chemotherapy documented.
Pattern of oesophageal foreign bodies in Federal Medical Centre Owerri
Ajaero MI, Ibiam FA, Onyema CO
Department of Surgery, Federal Medical Centre Owerri
Background: A 5-year retrospective study of cases of ingested oesophageal foreign bodies seen in Federal Medical Centre Owerri is hereby presented. Oesophageal foreign body impaction occurs in all age groups. Children explore their environment and inevitably put foreign bodies in their mouth and swallow them, most swallowed foreign bodies may pass harmlessly through the gastrointestinal tract, however quite a number may get impacted and require extraction.
Objectives: To determine the nature of commonly ingested foreign bodies as well as the age and sex distribution.
Materials and Methods: Case files were retrieved and analyzed with emphasis on above objectives, information on age, sex, nature of foreign bodies as well as treatment modalities were extracted.
Results: A total of 13 cases were seen, 9 males and 4 females with male/female ratio of 2.25:1. 7 patients (54%) were <
16 years, 5 males and 2 females, 5(38.5%) patients between 16-60 years and 1(7.5%) patient >60 years. 5(71%) of the paediatric cases were < 5 years, 4 swallowed radio-opaque objects viz 3 metallic sharp objects and 1 coin, the other 1 a radio-lucent material viz a piece of meat. 2 older children >5 years, 1 fishbone and 1 metallic belt head. 3 dentures and 2 fish bones seen in the young adult and middle aged and one fish bone in the elderly. 95% of the patients seen had successful oesophagoscopy and foreign body extraction.
Conclusion: Foreign body ingestion is still a common clinical presentation in our environment and may occasionally be life threatening. A high index of suspicion is therefore advocated especially in managing children presenting with acute upper gastrointestinal tract and airway symptoms. Oesophagoscopy remains a satisfactory treatment modality for foreign body removal in our environment.
Experience with the siop0 -9 protocol for Wilm's tumor in Kano: A preliminary report
Anyanwu LJC, Mohammad AM, Tsauni IAJth
Paediatric Surgery Unit, Department of Surgery, Aminu Kano Teaching Hospital, Kano.
Objective: To evaluate our experiences with the SIOP-9 protocol for Wilm's tumor in Kano.
Materials and Methods: The records of 11 patients which were admitted into our unit and managed for Wilm's tumor
between June 2008-October 2010 were retrospectively reviewed. The diagnosis and metastatic work-up was based on clinical examination, radiological work-up, intra-operative findings and histopathology. Chemotherapy was given to patients according to SIOP-9 protocol. No patient had radiotherapy.
Results: The ages of the patients range from 2-12 with a median age of 5, there were 6 boys and 5 girls (with M:F =1:1.2), 7 had left sided tumor while 4 were on the right. No patient had bilateral tumor, 2 patient had had only neoadjuvant chemotherapy according to SIOP-9 protocol, 2 patient had both pre-op & post-op chemotherapy, 5 patients had only post-op chemotherapy. Anemia and recurrent blood transfusion was the major complication followed by mucositis. 6 of the patient had stage 3 tumor, 3 had stage 4, 1 had stage 2N1 and 1 had stage 1 tumor. 6 patient completed the chemotherapy, 2 are receiving chemotherapy, 3 died during the course of treatment and 1 died after completion of chemotherapy. 2 out of the 6 patients that completed chemotherapy are still being seen on follow-up visits with no evidence of relapse, 1 who had relapse was referred for radiotherapy, while 3 have defaulted from follow-up visits. The longest duration of follow-up is 12 months.
Conclusion: Our preliminary results are encouraging with the greatest challenge being the affordability of chemotherapeutic agents. We recommend a policy of free cytotoxic drugs for children.
Key words: Chemotherapy, SIOP-9, Wilm's tumour
Juvenile polyp in children in Kano Nigeria: Clinical presentation and management challenges
LJC Anyanwu , AM Mohammad, MU Ibrahim, AT Atanda 1
Paediatric Surgery Unit, Department of Surgery, and 1 Department of Pathology, Aminu Kano Teaching Hospital Kano, Nigeria.
Purpose: The aim of this study was to describe the clinical characteristics of children presenting with colorectal polyp in Kano, Nigeria and to document the challenges faced in their management.
Materials and Methods: We undertook a retrospective review of the clinical records of all children aged 13 years or less who presented to our hospital with a colorectal polyp between January 2008 and December 2008, and also prospectively enrolled all those presenting between January 2009 and December 2010. Demographic data, as well as presenting symptoms and laboratory findings were noted. Operative findings and histopathology of the polyp were also recorded. Data were analysed using SPSS 15.0 (SPSS Inc, Chicago, IL).
Results: There were 16 patients in all, with their ages ranging between 2.5 years and 9 years (mean 6.03 years). There were 8 boys and 8 girls (M:F= 1:1). Haematochezia was the most common presenting symptom, followed by a prolapsing rectal mass, and rectal prolapse. In 13 of the patients, there was a solitary polyp, while 3 patients had 2 polyps each. All the polyps were located in the rectum within 7 cm of the anal verge. Only one patient had a sessile polyp, while all the others were pedunculated. Histopathology reported juvenile polyp without evidence of adenomatous change in all of them.
Conclusion: A careful digital rectal examination is recommended for all children presenting with a bloody stool to rule out juvenile polyp.
Key words: Challenges, haematochezia, juvenile polyp
Recurrent solid head and neck mass with different histologies
Gbobo I, Igwe P, Okoro P
Paediatric Surgery Unit, U P T H, Port Harcourt
Head and neck masses are common in children. Most are benign and a few are malignant. While benign lesion are common in the younger age group, most malignant lessions are commoner in the older age group. The records of patient were retrieved and reviewed critically regarding the presentation, investigations, treatment and course of disease. This is the case of an 11 year old girl who presented with a fast growing head and neck mass on the left side of the neck and involving the scalp. The mass was excised completely twice, and twice it recurred each time becoming even bigger. The histology reports obtained following two excisions were different leading to difficulty in management. This report is to highlight the difficulties in managing such massive head and neck tumours. It also brings to the fore the impediments constituted by unreliable support staff and financial constraints on the part of the patient. Conclusion: We present a recurrent week mass with initial histology as benign and later progressing to malignant. Outcome was poor.
University of Port Harcourt Teaching Hospital Cleft Week 2011: A report
Kejeh BM, Akadiri OA 1 , Akinbami B 1 , Okoro P, Briggs O 2 , Mato C 2
Departments of Surgery, 1 Maxillofacial Surgery, and 2 Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt
Background: The partnership between The Smile Train and the University of Port Harcourt Teaching Hospital started in 2008 on a slow note because cleft surgery was done only by the Burns and Plastic Unit of the Hospital. The scope has widened with the Maxillofacial and Paediatric Surgeons being involved. In order to increase our output, a week-long programme called Cleft week was organised.
Objectives: To increase awareness, sensitize the people and to improve capacity building.
Materials and Methods: Patient recruitment was through the mass media - local radio and television stations, NTA, fliers, banners and posters. Personal contacts were made through hospital staff. Surgeons, Anaesthetists and Nurses were also contacted. A week-long, surgical operations were done.
Results: Twenty nine procedures were done on 28 patients. Youngest was 2 months, oldest was 38 yrs, mean 13 yrs, under 5 yrs were 35.7%, > 16 yrs were 39.3%. Male to female ratio was 1:2.1, Right and left sides were equal.
Conclusion : Cleft week is a good method of increasing awareness of free surgery and patient recruitment.
Clinicopathologic implications of paediatric appendicectomy in Ilorin
Abdur-Rahman LO, Adeniran JO, Nasir AA
Paediatric Surgery Unit, University of Ilorin Teaching Hospital, Ilorin.
Introduction: Appendicectomies are done frequently in children for diagnosed and incidental reasons with various effects on the outcome of management.
Objectives: To determine the indications, and clinicopathologic correlations in appendectomies conducted among children in Ilorin.
Materials and Methods: Retrieval and analysis of the case files and histologic reports of appendectomy specimen between 2002 and 2010 of children less than 16 years.
Results: There were 167 children with mean age of 9.3±4.5 (range 4 mth-16 years) and Male female ratio of 1.42:1. The primary diagnoses were simple appendicitis (SA) 57 (34.1%), complicated appendicitis (CA) 51 (30.5%), and others (O) 59 (35.3%). Intraoperative (secondary) diagnoses were SA 75 (44.9%), CA 31 (18.6%) and O 61(36.5%). Negative appendectomy was 19.8% and unnecessary laparotomy for appendectomy was 61.3%. Histologic correlation accuracy with clinical diagnosis were 92.9% and 58.3% for Acute appendicitis and ruptured appendix respectively (P value= 0.000 and 0.008) and between 0 -33% for O (P value = 0.187-0.739).
Conclusion: There were many appendectomy done without primary indications and high negativeappendectomy rate in those initially thought to have appendicitis. Unnecessary laparotomy for suspected complicated appendicitis was also high increasing possible morbidity from increased surgery time and lenght of exposure to anaestheia risk and lenght of stay in the hospital. Diverse histology report terminology needs review. Clinical features in children might be exagerated and there is a need to take caution.
Role of damage control enterostomy in management of children with acute intestinal perforation and gangrene
Ayeni MA, Mshelbwala PM, Anumah MA, Ameh EA, Kache SA
Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Background: Diversion enterostomies are not as frequently performed as colostomies, however they can be useful in the management of children with acute intestinal conditions. This report evaluates the use of enterostomy as a damage control measure in a selected group of children with acute intestinal disease.
Materials and Methods: A retrospective study of forty-four (44) children with acute intestinal conditions who had diversion enterostomy as a damage control measure from 2000 to 2010.
Results: There were 28(63.6%) boys and 16 (36.4%) girls aged 3 days - 13 years (median 6 years). The primary indication for surgery was perforated typhoid ileitis 20 (45.4%), intestinal gangrene 24 (54.6%). Enterostomy was performed as the initial surgery in 30 (68.2%) patients and as salvage procedure following anastomotic leakage in 14 (31.8%) patients. Enterostomy-related complications occurred in 17 (42.5%) patients, including 10(25%) patients with skin excoriations and 7(17.5%) with hypokaleamia. There were 4(18.2%) deaths directly related to the enterostomy, from hypokaleamia 4, 12, 20 and 28 days (mean 16 days) after surgery.
Conclusion: Damage-control enterostomy is useful in management of severely ill children with intestinal perforation or gangrene. Careful and meticulous attention to fluid and electrolyte balance, and stoma care, especially in the first few days following surgery, are important in preventing morbidity and mortality.
Twelve hours bowel preparation for colostomy closure in children
Paediatric Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt
Introduction: Bowel preparation is usually required prior to colostomy closure. Bowel preparation among others reduces faecal load and soiling, reduces bacterial count, Restores the tone of the bowel. It also decreases the risk of infection and leakage of anatomosis. Traditionally a 3 day regime is now more popular than the previous 5 day regime. Other Materials and Methods include the Herculean and its modification.
Aims and Objectives: To study the effectiveness and complications of a 12 hours bowel preparation regime. Materials and Methods:
- Pt. is weighted on admission and after bowel preparation
- Hb is done on admission and
- chest is auscultated 30 min after the procedure to exclude pulmonary oedema.
- Patient is monitored - Bp, pulse after 1 hr.
- Then procedure is repaeated until the effluent is clear and then repeated in the morning by 8am.
- An N-G tube of size 18 or 20 is used
- Tube is well lubricated and inserted into the proximal loop as far as possible.
- Saline is poured through a funned attached to the tube.
- Forward and backward thrust is done to break down faeces.
- Tube is withdrawn and the process repeated until effluent is clear
- Same procedure is done for the distal segment
Results: There were 20 patients. Twelve were cases of anorectal malformation while 8 were cases of Hirschsprung's disease. There was no change in weight. The lungs were clinically clear after auscultation. No patient developed respiratory distress or peri-orbital oedema. Wound infection was 4:20 = 20%
The place of spermatic fascia closure during open hernia repair in children
Okoro PE, Gbobo I
Paediatric Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State.
Introduction: There is currently no consensus opinion about closing or otherwise of the spermatic fascia at hernia repair in children. This stems from lack of evidence to justify either stand, and most literatures are silent on this. This study is an effort to evaluate the place of closure of the spermatic fascia at hernia repair. Aim: To determine if it is justifiable to close the spermatic fascia following inguinoscrotal hernia repair in children.
Materials and Methods: Cases of inguinoscrotal hernia repaired by the same surgeon between July 2009 and June 2011 were randomly grouped into two; spermatic fascia closed (SC) and spermatic fascia open (SO) groups. They were assessed for operation duration, wound infection, scrotal haematoma, and scrotal oedema post repair. The Data obtained was collated and analysed using the SPSS 17.0.
Results: Seventy six male children with unilateral complete inguinoscrotal hernia were included in this study. There was haematoma formation in 7(17.9%) of the SC group and 9(24.3%) of the SO group (P=0.5). Scrotal oedema occurred in 24(64.8%) of the SO and 18(46.2%) of the SC group (P=0.3). No other complications were recorded during the period of study.
Conclusion: Closure of the spermatic fascia at herniotomy for children does not appear to reduce the incidence of haematoma and scrotal oedema, however, there is no increase in incidence of complications. We conclude that it is justifiable to close the spermatic fascia at herniotomy for children whenever possible.
Key words: Herniotomy, inguinal hernia, spermatic fascia
Central venous catheterization in children: An underutilised resource in this setting
Sholadoye TT, Okoh N, Mshelbwala PM, Ameh EA
Department of Surgery, Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Zaria.
Background: Central venous catheterisation provides for the administration of hypertonic fluid and critical medications as well as allowing sampling of blood and measurement of central venous pressure. This is a report recent experience with central venous catheterisation in children in this setting.
Materials and Methods: A retrospective study of 11 children who had subclavian venous catheterisation for varying indications, between June 2010 to June 2011. Data was obtain from patient case folder about the clinical diagnosis, indication for catheterisation, size used, duration of catheterisation and associated complications. Size catheters used depended on the availability and affordability.
Results: There were 4(36.4%) boys and 7(63.6%) girls aged 6month to 6years (median 4years). They were being managed for intussusception 4(36.4%), Wilm's tumour 3(27.3%), malignant sacrococcygeal teratoma 1(9.1%), complete wound dehiscence 1(9.1%), perforated typhoid ileitis 1 (9.1%), and vaso occlusive crises in sickle cell anaemia1 (9.1%). The indication for central venous catheterisation were resuscitation 7(63.6%), cytotoxic chemotherapy 3(23.3%) and exchange blood transfusion 1(9.1%). Eight (72.7%) of the children were catheterised using size 7fr catheter and 4 had size 5 catheter used. Catheter was insitu for 5 to 26 days (mean 12 days). Complications were encountered in 5(45.5%) patients including dislodged line 2(18.2%), arterial catheterisation 1(9.1%), septicaemia 1(9.1%) and pyrexia 1(9.1%). During the same period, a total of 61 patients were considered candidates for central venous catheterisation, but this could be achieved in only 11 (18%), due to lack of appropriate size, non-availability and cost limitations.
Conclusion : Central venous catheterisation is an underutilised resource in our setting. Efforts need to be made to make appropriate catheter sizes available. It is hoped that more utilisation should bring the cost down and make it more affordable and available.
Indications and management outcome of hyperalimentation in paediatric surgery at the Lagos University Teaching Hospital
Bode CO, Ademuyiwa OA, Elebute O, Thomas-Idodi H
Paediatric Surgery Unit, LUTH, Lagos
Background: In spite of it proven usefulness, hyperalimentation has not been employed in paediatric surgical and medical practice in Nigeria because of non-availability and lack of experience.
Objective: To document indications for and management outcome of the use of Intralipid and Astigmine for paediatric surgical patients in Lagos.
Materials and Methods: All children requiring total nutritional support as part of their surgical care were studied. They all received Intralipid 20 and Astigmine through peripheral routes. The indications, challenges, complications, morbidity and mortality were documented from November 2010-August 2011.
Results: Nineteen children comprising 7 neonates, 3 infants and 9 older children qualified for this study. Neonatal indications for hyperalimentation were non-availability of enteral feeding route following delayed surgery for congenital anomalies 4 (21%) and neonatal necrotizing enterocolitis 3 (15.8%). Profound sepsis, bowel fistulae from intussusception 2(10.5%) and perforated typhoid accounted for the infants and older children. One case of suspected fat embolism and a case of cholestatic jaundice were recorded in the neonates. Three children (all from the sepsis group) died in spite of the intervention. Thirteen (68.4%) children benefited from hyperalimentation as they would otherwise have died without the intervention.
Conclusion : Hyperalimentation is beneficial to surgical paediatric patients in our resource-poor setting. Specialist centres should be encouraged to explore this option to widen its scope in the care of the surgical child.
Key words: Hyperalimentation, Lagos, paediatric surgery
Laparoscopic Ladd procedure in children: Report of two cases from a developing country
Sholadoye TT, Kache SA, Ayeni AM, Abdullahi I, Suleiman AF, Bwala KJ, Hannu L, Mshelbwala PM,
Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. E-mail: email@example.com
Mid gut rotational anomalies encompass a broad spectrum of incomplete rotational events with malfixation of intestines during foetal development. In children, incomplete rotation is most common, predisposing to midgut volvulus, which can result in short-bowel syndrome or even death. Traditionally, Ladd's procedure through laparotomy is the treatment of choice. Laparoscopic ladd's procedure was performed in two selected patient with mid gut malrotation without volvulus. This is the first Laparoscopic ladd's procedure in our centre. The procedure was performed using three trocars. Under laparoscopic visualization, the Ladd's band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Result of the procedure was acceptable. This is a report of laparoscopic Ladd's procedures performed in our institution between January 2011 and March 2011.th
Keywords: Laparoscopic Ladd's procedure, mid gut Malrotation, volvulus
Paediatric laparoscopic surgery in Ilorin: The trend
Abdur-Rahman LO, Nasir AA, Bamigbola K
Paediatric Surgery Unit, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin
Introduction: Minimal access surgery has become a home language in many tertiary and private health facilities all over the world. Its extension to paediatric service has met with enthusiasm and broader scope of utilization.
Objective: To highlight the trend and challenges in provision of paediatric laparoscopic service at the UITH, Ilorin.
Materials and Methods: Prospective collection of data on patients' biodata, diagnosis and procedures, perioperative issues and outcome from September 2009 to August 2011.
Results: There were 36 patients recruited over ten months actual period. They aged 8 months to 16 years (median= ) and M:F ratio of 1.8:1. There were 7 urgent cases while others were elective. Fourteen cases were diagnostic while 22 cases were therapeutic. Disorder of sexual differentiation were 14, hernias 8, non-palpable undescended testes 6, appendicitis 6 and 1 case each of congenital diaphragmatic hernia and pelvic mass (appendiceal abscess). Procedure time ranged between 9-160 minutes, mean= 80.1 minute. Cost, technical set up and maintenance were the main challenges. Oral intakes were commenced between 4.5 and 18 hours, mean = 9. 6 hours post operation. There was a case of hernia recurrence and one conversion to open herniotomy. Lenght of stay was 6.5 hrs - 12 days, mean = 29.3 hrs.
Conclusion: Inspite of the challeges there is progressive increase in the therapeutic cases recruited for laparoscopic service. Cost of service and expert team are major constraints which are being addressed at different levels.
Does prior circumcision adversely affect the management and outcome of repair of anterior hypospadias?
Okoro PE, Ekeke NO, Onoyona AU 1
Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, 1 Department of Surgery, Federal Medical Centre, Owerri, Imo State.
Background: The role of preputial skin in hypospadias repair is well recognized. However, some authorities suggest it does not matter in anterior hypospadias repair. We seek, in this study, if prior circumcision adversely affected management and outcome of repair of anterior hypospadias in our practice.
Materials and Methods: This is a retrospective review of cases of hypospadias managed in three tertiary health facilities in southern region of Nigeria between December 2005 and November 2009. The case notes of patients were retrieved and the following data extracted: age, type of hypospadias, chordee, status of prepuce prior to repair, repair technique used, duration of catheterization, duration of hospitalization, outcome. Data was analyzed using the SPSS version 17.0.
Results: A total of 101 patients met the inclusion criteria. Thirty seven (36.6%) of these had prior circumcision before presentation. Repair techniques requiring flap movement and staged procedure were more common in the circumcised patients. The circumcised patients also had significantly longer periods of hospital stay and catheterization than their uncircumcised counterparts. More complications were seen among the circumcised patients.
Conclusion: We conclude that prior circumcision of patients with anterior hypospadias has adverse effect on our management and outcome of repair of anterior hypospadias.
Key words: Circumcision, hypospadias, outcome, surgery
Unilateral left multicystic dysplasia in a horseshoe kidney: Case report and review of literature
Amah CC, Ezomike UO, Obasi AA, Obianyo NEN
Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Ituku/Ozalla
Multicystic dysplastic changes in one half of a horse-shoe kidney (HSK) is a rare event. Massive and progressive abdominal distension due to unilateral multicystic kidney dysplasia (MCKD) in a HSK is even much rarer. Surgical resection is inevitable in such cases, as in the reported case. Accurate preoperative radiological evaluation ensures adequate planning, treatment and optimal outcome. We report the successful management of a 2 year old male child presenting with massive abdominal distension due to multicystic dysplasia in the left half of a HSK. Existing literature is reviewed and challenges of management in a resource-poor setting highlighted.
Evaluating the knowledge on aspects of nursing in paediatric surgical practice University of Abuja Teaching Hospital Gwagwalada, Abuja
Department of Surgery, Paediatric Surgery Unit, University of Abuja Teaching Hospital, Gwagwalada, FCT. Nigeria
Introduction: The art and science of surgical practice is largely the same for all fields of surgery, however paediatric surgical practice requires the understanding that the case of children is unique hence the need for a subspeciality to handle it.
Aim: The aim of this study was to evaluate among nurses the knowledge of the aspect of nursing that may be required for optimal care of the paediatric surgical patients.
Materials and Methods: It is a questionnaire cross sectional observational based study. The questionnaires were distributed to and filled by those who were willing to participate in all the wards in the hospital. Analysis was done using the EPI info 3.3.2 statistical software.
Results: A total of 61 nurses participated. Their age range between 30-51 years consisting of 44 females and 16 males. In response to a question; what age group constitutes the paediatric age, the response was non-uniform as showed in table II. Of 53 respondents who rated the paediatric surgical subspeciality. 44 (8.3%) rated it as highly specialized, 3 (5.7%) as not specialized, 6 (11.3) were not sure. On how to enhance nursing care, 53 (86.9%) listed more staff, training, equipment and accessories as necessary requirement for optimal care, whereas 1(1.6%) and 3 (4.9%) believe only more staff and training respectively would be needed. 58 respondents agreed that nutrition was vital tool and was rated by respondents as very important. In the care of the paediatric surgical patient 46 respondents believed that trained paediatric nurses have an edge over others while 4 (8.0) do not agree, but only 44 (95%) of the 46 gave reasons for edge over the non-trained nurse.
Conclusion: This study shows that the knowledge required for optimal care by nurses in this institution is above average. We hope to build on this to truly achieve excellent level of care for our patients.
Fate of abstracts presented at Association of Paediatric Surgeons of Nigeria Annual Meetings
Nasir AA, Ameh EA 1
Division of Paediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, and 1 Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Background: Presentation at conferences constitutes an invaluable method for rapid dissemination of research findings. Although Abstracts submitted to scientific meetings do not undergo the same critical peer review process as published manuscripts, it often influence clinical thinking and practice. Final publication of such research work in peer reviewed journals makes the findings of the research available to a much wider scientific community and would have more impact. Purpose: To examine the characteristics of abstracts presented at the annual scientific meetings of Association of Paediatric Surgeons of Nigeria and their final publication rate.
Materials and Methods: All abstracts accepted for presentation at the Association of Paediatric Surgeons of Nigeria meetings from 2004 to 2009 were identified from the conference proceedings and related published supplements in African Journal of Paediatric surgery. The presentations were searched for publication in Medline® indexed journals using the PubMed and through personal contacts at meetings and E-mail and phone contact with the authors.
Results: A total of 139 abstracts were examined, of which 48 (34.5%) resulted in publication in peer reviewed journals. Approximately three-quarters of the abstracts were case series (104, 74.8%). Case reports accounted for 20.8% of the abstracts. The largest number of the reports were published in the African Journal of Paediatric Surgery (16 of 48; 33%), the official Journal of the Association.
Conclusions: Only a third of presented abstracts were subsequently published in peer reviewed journals. Effort needs to be made to improve the publication rates of presented abstracts by improving quality of research work as well as encouraging pre-conference submission of full length articles for accepted abstracts, for publication in a conference supplement of the Association's journal.
Postmortem examinations on deceased neonates: A rarely utilized procedure in an African Referral Center
Osarumwense David Osifo, Ezekiel Enoghama Ugiagbe, Theophilus Osasumwen Osagie , Odion-Obhumhese Helen, Udefiagbon Ernest, Evbuomwan I
Paediatrics Surgery Unit, Department of Surgery and Morbid Anatomy, University of Benin Teaching Hospital, Benin City, Nigeria
Background: Postmortem examination remains the gold standard for the correct diagnosis of many diseases and for unraveling unexplained causes of death. This paper reports on the poor utilization of autopsy services and encourages parents/caregivers and practitioners to perform postmortem examinations on deceased neonates in this subregion.
Materials and Methods: In a retrospective study, the records of 1093 neonates who died at the University of Benin Teaching Hospital and who were brought to the mortuary between 2006 and 2010 were reviewed to determine the utilization of and factors influencing postmortem examination.
Results: A total of 1093 deceased neonates consisting of 653 males and 440 females (ratio 1.5:1) were included in the study. Sixty-two percent of the neonates died within the first week of life, and only nine (0.8%) underwent a postmortem examination. Findings in the nine postmortem studies performed on seven males and two females provided additional information on the causes of death. The religious beliefs that neonates should not be subjected to postmortem study and beliefs that deceased neonates are taboo and a punishment by the gods for past wrongdoings may have influenced 511 (46.8%) parents/caregivers to refuse postmortem analysis. The practitioners did not request postmortem study in 281 (25.7%) of the cases.
Conclusion: The utilization of postmortem examination was marginal in this setting. We advocate the need for public enlightenment campaigns to modify the attitudes of parents/caregivers toward the postmortem study of deceased neonates. Policies should be formulated to mandate postmortem examinations of deceased neonates to enhance insight into neonatal disease, unravel unexplained causes of death and improve the standard of neonatal care in this subregion.
The prevalence and challenges of abandoned dead neonates in an African Referral Centre
Osarumwense David Osifo, Akpanudoh Emem, Ezekiel Enoghama Ugiagbe, Theophilus Osasumwen Osagie, Odion-obhumhese Helen, Udefiagbon Ernest
Paediatric Surgery Unit, Department of Surgery and Morbid Anatomy, University of Benin Teaching Hospital, Benin City, Nigeria
Background: Dead neonates are often preserved in the mortuary pending parents/caregivers' collection for formal burial. This study reports on the prevalence and challenges of abandoned dead neonates in an African referral center.
Materials and Methods: The clinical and mortuary records of all dead neonates at the University of Benin Teaching Hospital between January 2006 and December 2010 were retrospectively reviewed to determine the prevalence, influencing factors, and challenges of abandoned dead neonates.
Results: A total of 1093 (22.9%) mortalities were recorded among 4781 neonates. The prevalence of abandoned dead neonates was 77.2% as 844 of the 1093 dead neonates were abandoned to the hospital and given mass burial by an assigned government agency after at least three months of abandonment. This was challenging as an average of 85 dead neonates were given mass burial every six months to decongest the mortuary. Of 618 illiterate parents/caregivers in low socioeconomic class, 520 (84.1%) abandoned their dead babies. This was extremely significant statistically when compared with 324 (68.2%) bodies abandoned by 475 literate parents/caregivers in upper/middle class (P<0.0001). Surgical neonates, neonates with obvious congenital anomalies, and babies from the third birth ranking onward were mostly abandoned.
Conclusion: We advocate the need for public enlightenment campaign to modify present parents/caregivers' attitudes toward dead neonates. Hospital-based post bereavement programs should be organized to help parents/caregivers adjust appropriately to neonatal deaths. Those with dead neonates should be exempted from paying hospital bills.
Doxycycline lavage reduces the recurrence rate of giant cervical cystic hygromas
Paediatric Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt
Introduction: Cystic hygromas are known to be commonest in the head and neck region. Varying rates of recurrence have been documented especially for the giant ones that cannot be completely excised. Mortality from such a benign tumour is unacceptable in an attempt to completely excise them. Some may be microscopic at the time of excision.
Aims and Objectives: 1 To study the affectivity of doxycyline lavage in reducing recurrence. 2. To study any complications that may arise from the substance.
Materials and Methods: Ig of Doxycyline capsule is mixed with 100 mls of physiologic saline solution:
- following excision of the cystic hygroma the doxycyline solution is instilled into the wound and left for 10mins
- The excess is mopped but not completely dry and the wound is closed over a closed drain.
- After 48 hrs the procedure is repaeated through the closed drain, clamped for 10 mins and then opened to drain.
- Close monitoring of the patient is done.
Results: There were 12 hygromas
Half of this number was treated with doxycycline. Two of the treated patients recurred while four of the untreated patients had recurred. Follow up period was two years.
Conclusion: Excision and lavage of the cystic hygroma with doxycycline solution reduced the recurrence rate. No dental stains were recorded.
Gastric tube for corrosive strictures: Initial experience from Maiduguri
Abubakar AM, Chinda JY, Adamu S, Bwala KJ
Paediatric Surgery Unit, Department of Surgery, College of Medical Sciences, University of Maiduguri/University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria.
Background: Severe Oesophageal strictures can only be treated by some form of oesophageal replacement. We favour the gastric tube as the replacement for the oesophagus in our children with corrosive strictures.
Materials and Methods: Between January 2005 and July 2011, 3 cases of corrosive oesophageal stricture were managed by the construction of antiperistaltic gastric tube.
Results: We have performed gastric tubes in 3 patients with oesophageal strictures. They are composed of 2 girls and 1 boy. The main complication observed was anastomotic leakage at the cervical anastomosis which occurred in all 3 patients but 2 of them closed spontaneously and only required reoperation 6 months later. They are all feeding well with absence of swallowing difficulties.
Conclusion: Despite our limited experience with gastric tube as replacement of the oesophagus, we have found it easy to learn and the overall outcome in the children satisfactory. We will recommend as a procedure of choice in patients with oesophageal strictures and in patients with oesophageal atresia requiring replacement.
Source of Support: None, Conflict of Interest: None
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