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   2010| May-August  | Volume 7 | Issue 2  
    Online since April 29, 2010

 
 
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ORIGINAL ARTICLES
Mechanical small bowel obstruction in children at a tertiary care centre in Kashmir
Khursheed A Shiekh, Aejaz A Baba, Syed Mudasir Ahmad, Altaf H Shera, Rekha Patnaik, Afak Y Sherwani
May-August 2010, 7(2):81-85
DOI:10.4103/0189-6725.62852  PMID:20431216
Background: Small bowel obstruction is the commonest surgical emergency encountered in childhood. We observed that intestinal obstruction caused by ascariasis is one of the leading causes of death in our children and consumes a major portion of our hospital resources. Other causes include intussusception, adhesions, volvulus, hernias, and worm obstruction. The aim of this study was to analyze the presentation, diagnosis, management of mechanical bowel and complication of obstruction in children. Patients and Methods : The study was conducted from Jan 2005 to Dec 2007 in the Department of Pediatric Surgery at Sheri- Kashmir Institute of Medical Sciences, Srinagar, Kashmir. All patients who presented in the emergency department with the diagnosis of intestinal obstruction were recruited. Patients with a dynamic obstruction were excluded from the study. Diagnosis was based on history and radiological findings. Data regarding the type of management, operative findings, operative procedure and post-operative complications were collected. Results: There were 207 patients admitted for intestinal obstruction. Males and females were equally affected. Most of the children (55%) were aged 3-5 years. The causes of obstruction included ascariasis 131 (63.2%), adhesion 23 (11.1%), intussusception 21 (10.1%), obstructed hernia 17 (8.2%), and volvulus 11 (5.3%). One hundred twenty-six patients needed an operative intervention and 81 were treated conservatively. The operative procedures performed included enterotomy in 37 (29.3%), milking of worms in 18 (14.2%), resection anastomosis in 31 (24.6%) and adhesiolysis in 13 (10.3%). Appendicular perforation was seen in 4 (1.9%) and worm in gall bladder in 1 (0.5%) patients. Surgical complications were wound infection in 18 (14.2%), burst abdomen in 5 (3.9%) and fecal fistula in 3 (2.3%) patients. Conclusion: Intestinal obstruction is associated with considerable morbidity and mortality in children. Obstruction by ascariasis constituted the majority of intestinal obstruction in this study. Efforts should be made to eradicate ascariasis in endemic areas through proper sanitation, hygiene and use of antihelminthics.
  7 5,844 276
LETTERS TO THE EDITOR
Primary Burkitt's lymphoma of the ovary
Sanju Cyriac, Lakshmi Srinivas, Vandana Mahajan, Shirley Sundersingh, TG Sagar
May-August 2010, 7(2):120-121
DOI:10.4103/0189-6725.62850  PMID:20431226
  6 3,926 253
ORIGINAL ARTICLES
Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?
Osarumwense David Osifo, Mike Efe Ovueni
May-August 2010, 7(2):66-70
DOI:10.4103/0189-6725.62843  PMID:20431212
Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. Patients and Methods: This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. Results: Adhesive intestinal obstruction accounted for 21 (8.8%) of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 ± 6.4 years), comprising 13 males and eight females (ratio 1.6:1). Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%), perforated appendix (five, 23.8%), perforated volvulus (three, 14.3%), penetrating abdominal trauma (two, 9.5%) and perforated typhoid (two, 9.5%) were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6%) children due to poor response to nonoperative management, 11-13 days in 12 (57.1%) who responded minimally and 2-5 weeks in three (14.3%) who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%), multiple bands/adhesions (13, 61.9%) and encasement, including one bowel gangrene (six, 28.6%). Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. Conclusion: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and mortalities in settings with limited resources.
  6 5,875 394
CASE REPORTS
Foreign body oesophagus in a neonate: A common occurrence at an uncommon age
Mohammed Zameer, Ravi Prakash Kanojia, BR Thapa, K. L. N Rao
May-August 2010, 7(2):114-116
DOI:10.4103/0189-6725.62853  PMID:20431224
Neonatal ingestion of foreign body is a very uncommon occurrence. We describe a 25-day-old neonate who had a large-sized stone impacted in the cervical oesophagus. The stone was accidently lodged by one of the elder siblings while playing. The stone, after failure to be retrieved endoscopically, was successfully removed by open esophagotomy. The case describes the unusual occurrence at a very uncommon age. It also re-affirms the successful role of open surgery in such situations, which are otherwise commonly treated endoscopically.
  5 2,999 144
ORIGINAL ARTICLES
A histopathological study of ovarian neoplasms in children in a tertiary hospital of northern Nigeria
Abdullahi Mohammed, SA Malami, B Calvin, K Abdullahi
May-August 2010, 7(2):75-77
DOI:10.4103/0189-6725.62848  PMID:20431214
Background: Information concerning the frequency and pattern of ovarian tumours in children is scant, more so in northern Nigeria. In view of this, we reviewed ovarian biopsies obtained from children in Zaria over a 25-year period. Materials and Methods: Ovarian tumours occurring in 48 patients of age 15 years and below were reviewed and classified using the current World Health Organization (WHO) histological classification of ovarian tumours. Results: Ovarian tumours in children accounted for 8.6% of all cases of tumours seen in all age groups over the period. Among all the malignant tumours seen in this period, 32% occurred in children, and Burkitt's lymphoma accounted for 31.2% of these. Germ cell tumours accounted for 58.0% while epithelial tumours had a frequency of 2.1%. Conclusion: Burkitt's lymphoma is the most common childhood ovarian tumour in Zaria, northern Nigeria.
  4 3,611 228
Undesended testis: How extensive should the work up be?
Altaf Hussain Shera, Aejaz Ahsan Baba, Shyam Kumar Gupta, Geetanjali Gupta, Afak Yusuf Sherwani
May-August 2010, 7(2):92-95
DOI:10.4103/0189-6725.62855  PMID:20431218
Aim: The aim of this study was to highlight various anomalies associated with undescended testis and to determine how much work up is necessary for this condition. Material and Methods: The study was conducted in the department of Pediatric Surgery SKIMS Srinagar, Kashmir. All patients between 0-14 years of age who attended out patient department (OPD) from January 2002 to December 2003 with maldescent of testes were included in the study. Detailed relevant history and physical examination findings were recorded in all the cases. Baseline investigations were performed along with ultrasonography of the abdomen. In relevant cases other investigations like intravenous urography, micturating cystourethrography, CT scan and laparoscopy were performed as and when indicated. Results: A total of 250 cases of undescended testis were registered during this period. Maximum number of cases were in the age group of 5-10 years. In 130 (52%) cases the right testis was undescended while 75 (30%) had left sided undescended testis and 45 (18%) had bilateral undescended testis. Maldescended testis comprised 11% of the admissions. The majority of cases were having gestational age of 37 weeks or more. The associated anomalies picked up on investigations included duplication of upper urinary tract (3.2%), hydronephrosis and polycystic kidney (0.8% each), horseshoe kidney, ectopic kidney, crossed renal ectopia (0.4% each) Posterior urethral valves, Prune belly syndrome (0.4%) and spina bifida (0.4%). On detailed clinical examination of genitalia several abnormalities were picked which included hydrocele, hypospadias, hernia, chordee, micropenis and ambiguous genitalia. Conclusion: We recommend ultrasonography to be done in all cases of undescended testis in addition to a thorough history and physical examination. Intravenous pyelography, micturating cystourethrogram, CT scan and other investigations should be performed selectively based on history, physical examination or ultrasound findings.
  4 4,653 325
Typhoid ileal perforation in children in Benin city
Osarumwense David Osifo, Scott O Ogiemwonyi
May-August 2010, 7(2):96-100
DOI:10.4103/0189-6725.62857  PMID:20431219
Background: Typhoid ileal perforation is a common complication of typhoid fever, a multi-systemic infection, which is endemic in many developing countries. Objective: This study reviews and compares the incidence, morbidity and mortality at the University of Benin Teaching Hospital with other referral centres located in areas with similar socioeconomic and population status. Materials and Methods: The incidence, morbidity and mortality of typhoid ileal perforation in children treated among Edo People at the University of Benin Teaching Hospital, Nigeria, in the period from 1993 to 2007 were retrospectively studied and compared with centres in localities of similar socioeconomic and population status. Results: Twelve children, all of middle class parents who resided in suburban community with poor water supply and substandard sewage disposal, accounted for 70.6% patients with typhoid ileal perforation managed over 15 years while 29.4% occurred in adults. The children comprised seven males and five females (M/F ratio 1.4:1), aged between five and 13 (average 9) years. This number seen over 15 years in this centre was extremely low when compared with other referral centres; as many as 191 patients were seen over 10 months in one of the centres. The few patients seen were traced to cultural beliefs in Benin City, which influenced proper sewage disposal by the about four million Edo people, especially those living in rural areas. Consequently, no child from the rural area with clean natural water supply or urban areas with pipe born water supply where sewages are disposed of properly had typhoid perforation. Unacceptably high morbidity (100%) and mortality (75%) due to late referrals were recorded in comparison with other centres. Conclusion: Proper sewage disposal may have influenced the low incidence in this centre but early referral is advocated so as to reduce the high associated morbidity and mortality.
  4 5,561 249
CASE REPORTS
Thyroid cervico-thoracic teratoma in a 14-month old child
Mohammad Aminu Mohammad
May-August 2010, 7(2):117-119
DOI:10.4103/0189-6725.62851  PMID:20431225
Cervical teratoma (CT) is a rare disease which accounts for approximately three to five per cent of all teratomas in children. Airway compromise is the most serious postnatal complication of cervical teratoma. Prenatal diagnosis is crucial for early recognition of neck masses that could obstruct the airway. We present our experience in the management of a huge cervico-thoracic teratoma in a 14-month old Nigerian child.
  3 2,731 148
ORIGINAL ARTICLES
Splenic artery embolisation for portal hypertention in children
Ila V Meisheri, Paras R Kothari, Anil Kumar, A Deshmukh
May-August 2010, 7(2):86-91
DOI:10.4103/0189-6725.62854  PMID:20431217
Background: Bleeding from esophageal varices is one of the most common causes of serious gastrointestinal haemorrhage in children. We analysed our experience with the use of splenic artery embolisation and variceal sclerotherapy for bleeding oesophageal varices. Patients and Methods: Records of all patients treated for bleeding oesophageal varices caused by portal hypertension from 1998 to 2004 were retrospectively analysed. Patients were followed up for five years. Results: Out of 25 patients treated, ten belonged to sclerotherapy (group A), eight to combined sclerotherapy and embolisation (group B), and seven to only embolisation (group C). The patients were selected randomly, only two patients who had active bleed recently were directly sclerosed. The splenic artery was embolised at the hilum using steel coils in 15 patients with portal hypertension and hypersplenism. Follow-up findings showed decrease in splenic mass, varices, and hyperdynamic flow. Conclusion: In spite of few patients and a short period of follow-up, our results pointed out that a serious consideration should be given to this procedure, as it slowed the sequel of portal hypertension and the complications associated with it. Patients who were embolised and followed up for five years had lesser rebleeds and complications than sclerotherapy patients.
  3 3,504 209
Breast tumours of adolescents in an African population
Ivy N Umanah, W Akhiwu, OS Ojo
May-August 2010, 7(2):78-80
DOI:10.4103/0189-6725.62849  PMID:20431215
Background: Tumours of the breast are uncommon in childhood and adolescence. Patients in this age group often require a different approach to diagnosis and treatment. The purpose of this study is to highlight the clinicopathologic features of breast tumours in adolescents in a Nigerian city. Materials and Methods: Eighty-four breast tumour materials from patients aged 10-19 years were analyzed over a 10-year period at the Department of Pathology, University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Benin City, Nigeria. Results: A majority of the breast tumours were benign. Fibroadenoma was the most common tumour with 46 cases (54.8%), followed by fibrocystic changes with 15 cases (17%). Malignancy was extremely rare in this group, with only one case (1.2%) of an invasive ductal carcinoma. Histologically, most tumours were indistinguishable from the adult types. Conclusion: Fibroadenoma is the most common breast tumour in adolescents in Benin City, Nigeria. Breast cancer and male breast tumours are rare in this age group. Routine complete physical examination of children and adolescents should include breast examination.
  2 3,665 302
Congenital diaphragmatic hernia: A 4-year experience in a single centre
Tutku Ozdogan, Cigdem Durakbasa, Murat Mutus, Mavisen Iscen
May-August 2010, 7(2):105-106
DOI:10.4103/0189-6725.62859  PMID:20431221
Background: This study aimed to evaluate congenital diaphragmatic hernia (CDH) patients in our department during a 4-year period. Patients and Methods: A retrospective study of 10 cases of CDH patients managed in the Neonatology and Pediatric Surgery Units of Goztepe Teaching Hospital from 2000 to 2004. Results: The mean birth weight of the patients was 2,600 g and the mean gestational age was 37.6 weeks. The mean admission time for the patients was 10.4 h. The mortality rate was 50%, comprising two deaths before operation and one during operation. The surviving infants followed for 1 year are free of any symptoms and complications. Conclusion: Conventional ventilation is an other treatment modality, especially in order to gain time before surgical operation for newborns with CDH.
  2 3,130 206
PRACTITIONERS SECTION
A simple procedure for management of urethrocutaneous fistulas; post-hypospadias repair
S Mohamed, N Mohamed, T Esmael, Sh Khaled
May-August 2010, 7(2):124-128
DOI:10.4103/0189-6725.62844  PMID:20431229
Objectives : The treatment of urethral fistulas is quite challenging. We try to evaluate the results of a simple procedure in post-hypospadias urethral fistula repair. Materials and Methods: In the period from 2003 to 2007, 35 patients with 35 fistulas, with an average age 3.5 years [range: 2-8], were classified into coronal 12, mid-penile 13 and proximal 10. Based on the size they were grouped into two - either less than 5 mm (20) or more than 5 mm (15). Midline relaxing incision was used for large fistulas and then covered with a vascularised flap dartos-based flap [flip flap] in 19 and tunica vaginalis in 16. If a patient had more than one small fistula adjacent to each other, they were joined into a large single fistula and then repaired. Results: We have successfully repaired all urethrocutaneous fistulas using our protocol, with success rate [97.3] 1/35. Conclusions: Dorsal midline urethral incision (DUMI), with dartos flip flap or tunica vaginalis coverage is an appropriate procedure to repair midline and proximal urethral fistulas.
  2 13,919 369
CASE REPORTS
Worms and war: A case report of trauma and tropical disease intersecting
Claude Kasereka Masumbuko, Michael Hawkes
May-August 2010, 7(2):107-109
DOI:10.4103/0189-6725.62858  PMID:20431222
Background: We report a case of heavy intestinal infestation with Ascaris lumbricoides complicating the surgical management of a gunshot injury to the abdomen. Co-existent traumatic and infectious pathologies in this case highlight the complex burden of illness among children living in areas of violent conflict, with clinical relevance to trauma surgeons in the tropics.
  1 3,928 170
Prenatal ultrasonic diagnosis of conjoint twins
Rachael A Akinola, Tawaqalit A Ottun, Adetokunbo O Tayo, Akinwunmi O Akanji, Oluwarotimi I Akinola
May-August 2010, 7(2):110-113
DOI:10.4103/0189-6725.62856  PMID:20431223
Background: A primipara with multiple pregnancy who booked for antenatal care at 21 weeks presented with vaginal bleeding and pedal oedema at the 27 th week. She had had five previous ultrasound scans that gave conflicting results. Materials and Methods: The patient was therefore sent for a confirmatory scan, which was performed using a linear 3.5 MHz transducer of a dynamic imaging dedicated, concept MC ultrasound scan machine. Results: A diagnosis of conjoint twins was made. The twin was joined from the mandible to the abdomen. Although they cried at birth, they died a few minutes after. The pregnancy was terminated by caesarian section at the patient's request. The patient did well postpartum and was discharged on the 5 th postoperative day. Records confirm that this is the first case seen in this hospital, which has been in existence for 18 years. Conclusion: To diagnose conjoint twins by ultrasound, one needs the expertise and careful scanning techniques, as the diagnosis may be easily missed, especially if the union is extensive.
  1 3,652 207
EDITORIAL
Childhood trauma: The neglected childhood killer disease
Devendra K Gupta
May-August 2010, 7(2):61-65
DOI:10.4103/0189-6725.62842  PMID:20431211
  - 4,107 411
LETTERS TO THE EDITOR
Transperineal migration of a portion of a writing pen into the urinary bladder
Sebastian O Ekenze, UO Ezomike, I Offor, IE Enyanwuma
May-August 2010, 7(2):121-123
DOI:10.4103/0189-6725.62847  PMID:20431227
  - 2,086 155
Splenic abscess in children: A concern of management
Viroj Wiwanitkit
May-August 2010, 7(2):123-123
DOI:10.4103/0189-6725.62845  PMID:20431228
  - 2,190 141
ORIGINAL ARTICLES
Primary swenson's pull-through in children with chronic constipation: A preliminary report
IB Bakare Tajudeen, TA Badmus, AO Lawal, AI Katung
May-August 2010, 7(2):71-74
DOI:10.4103/0189-6725.62846  PMID:20431213
Background: The discrepancy in diameters of the resected ends coupled with the heavy faecal loads in the colon of chronically constipated children with Hirschsprung's disease makes definitive primary pull-through procedure quite difficulty in this group. Patients and Methods: Four consecutive patients (aged 5 months to 11 years) who presented with chronic constipation were given warm saline enema along with Castor oil per oram twice daily for 1 week before and 2 weeks after full-thickness biopsies that confirmed Hirschsprung's disease. All patients had intravenous Cefuroxime or Ceftriaxone plus Metronidazole at induction of anaesthesia. Intra-operatively, the levels of resections were 6-8 cm proximal to the most contractile part of the colon adjacent to the transition zone observed after complete division of mesenteric vessels. Results: There were three males and one female, aged 5 months to 11 years. The levels of aganglionosis were in the rectosigmoid region, except one in the descending colon. There was one case each of anastomotic stenoses, mild enterocolitis and deep peri-anal excoriation. The bowel motions were two to four times daily within 1 month post-operatively. Conclusion: It can be concluded from this preliminary study that with pre-operative saline enema and oral Castor oil for about 3 weeks in chronically constipated children with Hirschsprung's disease primary pull-through procedures can be performed successfully. However, further prospective work is required with this method.
  - 4,788 340
Use of ropivacain and lidocaine for axillary plexus blockade
Michael Felfernig, Peter Marhofer, Marion Weintraud, Gudrun Huber, Andreas Duma, Aihie Nosa, Stephan Kapral
May-August 2010, 7(2):101-104
DOI:10.4103/0189-6725.62860  PMID:20431220
Objective: The use of certain peripheral nerve blocks in paediatric patients is gaining increasing popularity, although distinctive characteristics of the juvenile anatomy, psychological barriers, time constraints on block placement, and risks of neurotoxic and cardio toxic side effects are still mentioned. However, newer agents like Ropivacaine and Levobupivacaine seem to offer excellent alternatives to Bupivacaine and Lidocaine, especially for use in paediatric patients. Materials and Methods: We evaluated Ropivacaine 0.5% and Lidocaine 1.0% using axillary plexus blockade as a single-shot technique in 50 children in the age group of 2 to 10 years and undergoing short upper limb surgery. The primary objectives were to compare onset time, duration and quality of block and the incidence of breakthrough pain. Results: Onset time was longer in the Ropivacaine group (15.4 minutes) than in the Lidocaine group (8.2 minutes). The duration of the effect was greater in patients in the Ropivacaine group (337 minutes) than in the Lidocaine group (137 minutes). Duration appeared to vary with patient's age but this effect was not statistically significant. Conclusion: Axillary plexus anaesthesia provides satisfactory perioperative pain relief in infants undergoing short-trauma surgery. Apart from its safety, these results underline that Ropivacaine 0.5% can be recommended for axillary brachial plexus block in children.
  - 4,276 259
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