PEER-REVIEWED ABSTRACTS OF SCIENTIFIC PAPER PRESENTATION AT THE 54th ANNUAL CONFERENCE OF THE WEST AFRICAN COLLEGE OF SURGEONS AT KUMASI, GHANA 24TH – 28TH FEBRUARY, 2014.


*Olapade-Olaopa EO1,4, Owoaje ET2, Kola L3, Ladipo MM5, Adebusoye L5 and Adedeji TG4,6

Departments of Surgery and 2Community Medicine, University of Ibadan,
Ibadan, Nigeria.
E-mail:okeoffa@gmail.com

Formerly of the Department of Medical Social Welfare, University College Hospital, Ibadan, Nigeria

PIUTA Ibadan centre, Department of Surgery, University of Ibadan and University College Hospital, Ibadan

General Outpatient’s Department, University College Hospital, Ibadan, Nigeria.

Department of Physiology, University of Ibadan, Nigeria

Click for full text

STRENGTHENING TRAUMA CARE SYSTEMS GLOBALLY AND IN WEST AFRICA: THE ROLE OF INTERNATIONAL COLLABORATIONS
Charles Mock


ABSTRACT

Injuries are a major source of death and disability, causing over 5 million deaths per year globally. In addition to injury prevention, there is a need to strengthen trauma care. The World Health Organization defines a “trauma system” as all that a country or area has in place for care of the injured, across the spectrum of pre-hospital care, care in hospitals (both acute resuscitation and definitive care), and rehabilitation. Included in this spectrum are adequate data sources so that informed decisions can be made based on reliable information. There is considerable evidence that countries that improve the organization and planning of their trauma systems are able to decrease mortality rates significantly, in an affordable and sustainable fashion. This abstract will review that evidence and discuss examples of good practice in implementing trauma systems. It will also discuss ongoing initiatives to strengthen trauma systems globally through the World Health Organization and the International Association for Trauma Surgery and Intensive Care (IATSIC).

MERCY SHIP BASIC SURGICAL SKILLLS COURSES FOR WEST AFRICA

Michelle Bullington

Abstract

Mercy Ships operates the world’s largest non-governmental hospital ship, delivering high quality surgical interventions to local populations. Using this platform, Mercy Ships is also able to provide training opportunities for African medical professionals. This two-pronged approach that includes both direct medical services and training allows the organization to address immediate needs while improving the capacity of the local health care system. The Mercy Ships Education Program includes three categories: individual-based mentoring projects, curriculum-driven courses, and observation opportunities onboard the Africa Mercy. The objective of Mercy Ships Education Program is to improve knowledge, skills, and professional attitude amongst the participants.

Importantly, Mercy Ships aims to ensure that all training programmes are teaching techniques that are appropriate for the surgical needs in Africa. To help achieve this objective, the design and implementation of these programs is performed in collaboration with Ministries of Health, local medical professionals, non-governmental organizations, and corporate partners. One example of this collaboration is the partnership between the Medical and Surgical Skills Institute of Ghana, Johnson and Johnson, and Mercy Ships to implement the Basic Surgical Skills Course in the Republic of Congo for 13medical professionals. Other partnerships include the WHO Safe Surgeries, Save Lives initiative and Lifebox for training in the Safe Surgery Checklist, the Global Clubfoot Initiative for Ponseti casting training, and many others. Partnerships amongst various actors in the health care industry have helped Mercy Ships develop training opportunities that complement the local health systems while aligning with the capacity of the organization.

PUBLIC PRIVATE PARTNERSHIP (PPP) IN HEALTHCARE: A CASE-STUDY OF GARKI HOSPITAL, ABUJA, NIGERIA

I Wada
Address: Garki Hospital, Tafawa Balewa Way, Garki Area III, Abuja – Nigeria.
Abstract

Background: Garki Hospital Abuja (GHA) is owned by the Federal Capital Territory Administration (FCTA). In May 2007, the FCTA handed over GHA to Nisa Premier Hospital Ltd (NISA) to manage for 15 years under a renewable Concession Agreement. The objectives were:

i. To describe the level of new investments, scope of services, uptake of the services and assess GHA’s suitability for postgraduate training.
ii. To determine the financial sustainability of the PPP Concession Methods: The Concession Agreement and reports from GHA’s clinical and non-clinical performance from May 2007- December 2012

Results: NISA exceeded the level of new investments stipulated in the Concession Agreement by end of year 2. The full scope of clinical departments were up and running by end of year 1, particularly Obstetrics and gynaecology, Paediatrics, Surgery and Family Medicine. The total outpatient encounters were 18,000 and 70,000 for years 1 and 3 respectively.

The Departments of Family Medicine and Obstetrics & Gynaecology were accredited for postgraduate training by year 2. The hospital had reached a break-even financial point by year 3.

Conclusion: These results show a successful PPP model for GHA managed in conformity with the Concession Agreement. The PPP project is also financially sustainable.

THE ROLE OF ‘OPERATION HERNIA’ IN RELIEVING GLOBAL BURDEN OF SURGICAL DISEASE

Oppong F C, Boateng-Duah B, Ohene-Yeboah M, Irwin T, Fawole S, Abantanga F, Kingsnorth A N.
SURGERY AND GLOBAL HEALTH.
CORRESPONDENCE:
Oppong F C, Derriford Road, Plymouth, UK, PL6 8DH UK
E-mail: chrisoppong@gmail.com

Abstract

Background: The role of surgical conditions as an important component of the global burden of disease has been neglected until recently. 11% of the global disease burden is treatable by surgery. Hernias are common and cause significant disability. The objective of this paper is to highlight the pivotal work done by Operation Hernia to promote recognition of hernias as an essential component of the global burden of surgical disease and to improve access to treatment in low resourced countries. Methods: Operation Hernia is a surgical charity formed in 2005 by Prof Andrew Kingsnorth and Chris Oppong, consultant surgeons in Plymouth, UK. Its aims are: 1.Repair hernias in low resourced countries mesh, 2.Train local surgeons and 3. Spearhead research in affordable polypropylene mesh. A Hernia Centre was established at Takoradi, Ghana. It now has centres in 10 other countries in low resourced countries.

Results: The achievements of Operation Hernia:

  • Over 7000 hernias treated with low morbidity and low 12-month recurrence
  • Successful introduction of routine inguinal hernia Mesh repair into Ghana and other low resourced countries as a safe alternative to sutured repair
  • Proven: Inguinal Hernia repair with affordable mesh repair is cost effective
  • Mesh Repair training workshops successfully pioneered in Ghana to train local surgeons.
  • Scientific basis of safety of affordable mesh
  • Research proven quality of affordable mesh

Conclusion: Operation Hernia has successfully highlighted hernias as important cause of disability, and the need include in comprehensive health plans in low resourced countries.

REPAIR OF GROIN HERNIA WITH PROSTHETIC MESH IN OUAGADOUGOU

Abstract

Background: Groin hernia repair by using prosthetic mesh are increasingly used, mainly owing to the ease of the operation and because it provides a tension-free. The aim is to study the courses of groin hernia with prosthetic in Ouagadougou.

Methods: This was a retrospective, cross-sectional and descriptive study from 1 January 2008 to 31 December 2012.We included patients who received groin hernia repair in four health centers in the city of Ouagadougou. Results: 129 groin hernias were operated with 26.36 % of recurrences, 128 were inguinal, one femoral and 28 bilateral hernias. The right topography represented 59.69 %.

The mean age of the operated patients was 49.59 years. The sex ratio was 9.45. Strength workers represented 33.33 % of patients. The spinal anesthesia was performed in 78.26 % of patients, 98.26 % of operations were planned. The oblique inguinal incision was performed in 72.09 % of courses.

The Lichtenstein repair was more frequent 96.12 % and polypropylene prosthesis was used in 91.47 %. The mean duration of operation was 52.79 minutes. The mean hospital stay was 1.94 days. Nine patients had early local complications.

We received 11 complaints of feeling residual discomfort after a mean follow-up of 22.85 months. No recurrence has been reported.

Conclusion: The Lichtenstein repair is the most commonly used in Ouagadougou with satisfactory results despite inadequate patient monitoring. Keywords: Groin hernia, Prosthetic mesh, Lichtenstein repair, Ouagadougou

THE INCIDENCE OF STRANGULATED INGUINAL HERNIA IN ADULT MALES IN KUMASI M Ohene-Yeboah

Department of Surgery,Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Abstract

Background: The complications of untreated inguinal hernias are common surgical emergencies in adult Ghanaian men. The objective is to describe the epidemiology of strangulated inguinal hernia in adult males in Kumasi.

Method: From the hospital records the age and sex of all male adult patients treated for strangulated inguinal hernia were recorded at the Komfo Anokye Teaching Hospital, the University Hospital (UH), the Seventh Day Adventist Hospital (SDAH) and the Kumasi South Hospital (KSH) for the period January 2007 to December 2011 inclusive. The total number of inguinal hernia repairs from all four facilities was also recorded. The annual incidence of strangulated inguinal hernia and the hernia repair rates were estimated using the 2010 population data.

Results: In all 592 cases of strangulated inguinal hernia were treated over the five years. The incidence of strangulated inguinal hernia is 0.26%. A total of 2243 inguinal hernia repairs were performed and 26.4 % of these repairs were for strangulation. The total number of inguinal hernia repairs averaged 77.3 repairs per 100 000 adult males per year and the elective repair rate was low at 0.9%.

Conclusion: There is the need to increase the low levels of elective repair if inguinal hernia.

Keywords: Strangulated inguinal hernia, Incidence, Inguinal hernia repair rates, Adults, Kumasi, Ghana.

MESH REPAIR OF INGUINAL HERNIAS CAN BE PERFORMED SAFELY IN RWANDA TO REDUCE BURDEN OF DISEASE.

Oppong F C, Nutagengwa A.
SURGERY AND GLOBAL HEALTH.
ADDRESSS: Derriford Road, Plymouth, UK, PL6 8DH UK
E-mail: chrisoppong@gmail.com
Nyamata Hospital, Rwanda
E-mail: alfar777@gmail.com

CORRESPONDING AUTHOR: CHRISTIAN OPPONG, Derriford Hospital.

Abstract

Background: Eleven percent (11%) of the global disease burden is treatable by surgery. Hernias are common and cause significant disability. Estimated burden (prevalence) of hernias in Rwanda is 5.78% This compares with 5.36% in Tanzania, also in East Africa and 3.15% in Ghana in West Africa. Mesh repair of hernias averts significant number of disability adjusted life years (DALY). In low resourced countries high tension, sutured repair is standard because of cost of brand mesh and unavailability of skill. Resultant high recurrence rate increases total cost of treatment of hernias. The objective of study, therefore, is to successfully introduce mesh repair of hernias into Rwandan hospitals as a safe and effective alternative to sutured repair.

Methods: In 2012 and 2013, surgeons from Operation Hernia, a UK charity, affiliated to Ghana Hernia Society, performed 54 mesh repair of inguinal hernias at Nyamata and Remera hospitals in Rwanda. All cases were recorded on Operation Hernia database.

Results: Fifty-four (54) hernias were repaired in 45 patients. Median age was 56 years. 60% were RIH. Only 27.7% (15cases) were scrotal. 14.8% (8) were recurrent. There were neither deaths nor significant intra-operative complications. Two (2) patients had minor haematomas. At 6 months review, there were no reported septic complications. 12 month review of all 28 patients from 2012 showed no recurrences. Conclusion: For the first time in the history of the Rwandan hospitals, 54 inguinal hernias were repaired with mesh successfully with minimal morbidity and no deaths. Subsequent missions will include training of local surgeons in mesh repair.

THE ROLE OF TRAUMA REGISTRIES
Laura Cassidy
Address: Medical College, Wisconsin, Milwaukee WI, USA

Abstract

Globally, over the past four decades focus on injury prevention, research and treatment has been increasing. As with any disease the fundamental principles of research and prevention apply to traumatic injury and it cannot be controlled or prevented without a thorough understanding of the aetiology from cause to long term outcomes. Trauma registries are an integral part of a trauma system and can facilitate:

  1. Injury Prevention through descriptive epidemiology
  2. Development of population specific injury severity scales and stringent evaluation of these scales for reliability and validity.
  3. Data to promote research for disaster preparedness.
  4. Evaluation of quality of care and quality improvement activities at individual trauma centres and across centres, including trends in care.
While trauma registries have been operational in high income countries (HICs) for decades, they are basically nonexistent or rudimentary in low and middle income countries (LMICs), despite having the highest burden of injury. Even where some form of registry exists in some LMICS, they are often entirely paper-based, making data entry and retrieval cumbersome and time consuming. Such registries may be incomplete and the efforts face significant barriers including lack of funding and unfavourable government health policies. Efforts to implement trauma registries in LMICs will be discussed. Collaboration between the existing efforts and implementing lessons learned from HMICs can leverage existing resources and expertise to strive toward a minimum standardized data set in LMICs. These data are essential to convince policy makers about the increasing burden of trauma, mortality and associated long term disabilities. These data would provide a strong advocacy tool, and help in planning control measures, making provisions for unmet capacity needs as well as appropriate allocation of already limited health care funding and resources.

THE BURDEN OF ORTHOPAEDIC PRACTICE IN WEST AFRICAN SUB-REGION.
P I Amaraegbulam
Federal teaching Hospital, Abakaliki, Ebonyi State, Nigeria
E-mail: peacify12@gmail.com

Abstract

Background: The burden of musculo-skeletal disease in low- and middle- income countries, including Nigeria, is large, growing and neglected. The wide range of musculoskeletal diseases including trauma, infections, congenital anomalies and degenerative diseases are not adequately emphasized, and the knowledge not versatile, even among health workers. The aim of this study is to assess the burden of orthopaedic surgery in West Africa, with the view to making recommendations on adequate care.

Methods: Literature search on the topic, personal interviews to health workers and patients, direct observation of the hospitals involved in orthopaedic care. Results: Nigeria has about 500 orthopaedic surgeons, Burkina Faso, Sierra Leone 4 each, and Ghana about 20 and Liberia 2. These orthopods practice mainly in the cities leaving the rural areas inadequately covered. The rural dwellers use the traditional care givers more often, and most times present late to the orthopaedic surgeons with complications. There is a dearth of epidemiological studies on these conditions in the centres.

Conclusion: There is a high prevalence of musculoskeletal diseases in West Africa. The number of orthopaedic surgeons who should attend to these is few, with most of them practicing in the cities. Mid-level manpower, including traditional bone setters should be trained to bridge the gap, and health education provided by the orthopods to the populace in order to increase awareness and appropriate health seeking behaviour.

CAN ROCURONIUM REPLACE SUXAMETHONIUM FOR TRACHEAL INTUBATIONDURING THE EMERGENCY MANAGEMENT OF PENETRATING EYE INJURY?
Agbamu PO1, Menkiti ID1, Desalu I2, Kushimo OT2, Akinsola FB3
1Department of Anaesthesia, Lagos University Teaching Hospital,
2Department of Anaesthesia, Lagos University Teaching Hospital/College of Medicine University of Lagos,
3Department of Ophthalmology, Lagos University Teaching Hospital/College of Medicine University of Lagos, Lagos, Nigeria.

Abstract

Background: Suxamethonium causes a rise in intraocular pressure (IOP). Its use for intraocular surgical procedures especially management of the penetrating eye injury is controversial because of the risk of extrusion of vitreous contents. This risk can be avoided by substituting it with rocuronium. The aim of this study was to compare the IOP changes and intubating conditions following the use of both muscle relaxants.

Methods: This was a prospective, randomized study in which 70 patients received suxamethonium 1.5mg/kg or rocuronium 0.9mg/kg after induction with thiopentone 5mg/kg. Laryngoscopy was performed after 60 seconds. Measurements of IOP were taken before induction, 1 minute after administration of either muscle relaxant and at 1, 3 and 5 minutes after intubation. Intubating conditions were evaluated using a simple scoring system.

Results: Suxamethonium caused a significant rise in IOP throughout the study period (p < 0.005), maximal 1 minute after intubation (p < 0.001). Rocuronium caused a significant fall in IOP 1 minute after administration (p < 0.001) and this remained less than the baseline value in the post intubation period. Intubating conditions in both groups were similar.

Conclusion: Rocuronium can replace suxamethonium for tracheal intubation when a rise in IOP is undesirable.

Keywords: Suxamethonium, rocuronium, intraocular pressure, penetrating eye injury

THE EFFECT OF USE VERSUS NON-USE OF URETHRAL CATHETERIZATION DURING ELECTIVE CAESAREAN SECTION
Onwudiwe Elijah N* Ezegwui H U, Dim C C
Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria.
*Corresponding author: Dr Onwudiwe Elijah N
Telephone +2348036777789
E-mail belovedijah47@gmail.com

Abstract

Background: Peri-operative urinary catheterization during elective caesarean section is practised with the aim of proper visual of the lower uterine segment, minimizing the risk of accidental cystotomy and avoiding postoperative urinary retention. However this practice has been associated with some post operative morbidity like urinary tract infection. The impact of non-catheterization on the peri-operative urinary bladder morbidities during elective caesarean section was determined in Enugu, Nigeria.

Methods: A multicentre, randomized controlled trial using 264 term pregnant women who had elective Caesarean section in three centres in Enugu, Nigeria over a period of one year was done.Participants were randomized into catheter and non-catheter group. Result: The incidence of significant bacteriuria was lower in group A (6.8%, 9/132) when compared to the catheter group (12.9%, 17/132) (P=0.10).Urinary retention was observed in 14 participants of the non catheter group. Sixty three women (47.7%) in the catheter group were satisfied with use of catheter while 75% of the non catheter group expressed satisfaction with non catheterization (P<0.001).

Conclusion: There was no significant difference in the peri-operative bladder morbidities during elective caesarean section in Enugu, however more patients were satisfied with non catheterization.

SYSTEMS STRENGTHENEING FOR IMPROVED HEALTH SERVICES: EFFECTIVE AND EFFICIENT MANAGEMENT OF HEALTH CARE FACILITIES Anthony Nsiah-Asare, Former CEO, Komfo Anokye Teaching Hospital.
Correspondence: DR. ANTHONY NSIAH-ASARE, P.O. BOX KS 12378, KUMASI, GHANA
TELEPHONE: +233 202022159
EMAIL: ansiahasare@gmail.com

Abstract

Hospitals have been relatively neglected in the debate over Health System Development in developing countries, (Hanson et al (2001). It is clear that efficiency of health care facilities is important and vital to the overall efficiency of any health system. Health care facilities consume the high resources in the health sector of any nation and therefore, efficiency from such a system should generate high gains. Further functioning hospitals have become the hallmark of the overall state of the health system, noting that functional problems at the hospital level may create problems down the entire health system.

In the developing world, the state plays a major role in the provision of health services. However, over the years there has been a general collapse of centrally planned economic systems that underscored the poor performance of government services worldwide, (Kaul et al, 1997). Kaul suggests the restructuring of government system such that Policy formulation and Implementation are separated so that as governments “move from a concern to do towards a concern to ensure that things are done”, managerial focus will be directed towards results, distinguishing between political and managerial responsibilities. This approach ensures that “accountability is enhanced by tighter definitions of tasks, measurement of performance, devolution of resource control, strengthening monitoring and clarifying incentives” (Kaul et al, 1997).

The Ghana Health Sector Reforms which started in 1988 and also addressed the shortcomings in the Hospitals Administration Law, PNDC Law 209, enacted Act 525 of 1996. The Act established the Ghana Health Service and Teaching Hospital Boards which among other things provided for related matters including the functions and membership of the Council and Boards, and the management of institutions in the Health Service.

Traditionally, hospitals have been organized on functional groupings or clinical departments, with functional units supporting the clinical departments (e.g. laboratory, imaging, pharmacy), (Aas,1997). Aas further noted that the closer the decision-making is to the area of activity, the better the flow of information, distribution of workload, avoidance of duplication of work, efficient use of scarce resources and builds the confidence of the staff. Aas (1997 p 104) quotes extensively to show that decentralization leads to “productivity, quality and organizational adoption to need and demand”. This view is supported by Kaul, (1997), WHO (2000). The health sector reform has been described in various forms mainly because it falls within a continuum that starts from non-market bureaucratic system to a complete market system with a degree of self –management responsibility, or ‘autonomy’. There are organizational arrangements that characterize hospitals and Newbrander (1993; 1995) and Stover (1991) cited by Collins et al (1999) describe them as Governance, Operations and Management, and Finances.

The case of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana that adopted the divisionalised decentralised form of organizational design in 2002 is presented to show the benefits of effective and efficient management of a health facility. These reforms transformed KATH considerably to achieve the Hospital’s mandate as a Teaching Hospital.

Estimating the Prevalence of Fistulas in a Nationally Representative Survey in Sierra Leone
Hiten D Patel, Thaim B Kamara, , Adam L Kushner, Reinou S Groen,

a James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
b Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
c College of Medicine and Allied Health Science, Freetown, Sierra Leone
d Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
e University of Sierra Leone, Freetown, Sierra Leone
f Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
g Surgeons OverSeas (SOS), New York, NY
h Department of Surgery, Columbia University, New York, NY
i Department of Gynaecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD

Corresponding Author: Reinou S. Groen, Johns Hopkins Hospital, Department of Gynecology and Obstetrics, 600 North Wolfe Street, Phipps 264, 21287 Baltimore, Maryland, USA
E-mail: rsgroen@hotmail.com or rgroen1@jhmi.edu

Abstract

Objective: To report the prevalence of urinary and fecal incontinence with the barriers to care and associated disability for Women in Sierra Leone.

Methods: The study was a cross-sectional two-stage cluster based household survey in Sierra Leone. It included women >14 years of age, randomly accessed in 75 clusters. Surgeons OverSeas Assessment of Surgical need (SOSAS) was administered in Sierra Leone. Data from a verbal head-to-toe examination were analyzed to estimate the prevalence of fistulas based on reporting of urinary and/or fecal incontinence.Main Outcome Measures: The primary outcome measured was self-reported incontinence. Secondary outcomes included barriers to care and disability.

Results: Of 1320 women included in the study, 8 cases of incontinence were identified corresponding to a prevalence of 606 fistula’s per 100,000 women (95%CI 187-1025) and extrapolating to >10,000 women in Sierra Leone. All cases lived in a rural village (rural rate of 1030 per 100,000 women (95%CI 319-1743)) where transport time to health facilities was longer compared to urban areas (p<0.001), and most (75%) did not seek healthcare attention due to lack of money (67%). Feeling ashamed, difficulty with transportation, and difficulty working were the major disabilities reported.

Conclusions: The burden of unrepaired fistulas in Sierra Leone is significant and highlights the urban-rural divide likely affecting the majority of sub-Saharan Africa. Since the most common origin is delay in obstetrical interventions, increased surgical capacity will be necessary in order to prevent and repair these fistulas.

Keywords: Fistula, Sierra Leone, Access to care, Survey Abbreviations and Acronyms: LMICs - low and middle income countries; SOSAS - Surgeons OverSeas Assessment of Surgical Need.

POLYP PREVALENCE AT COLONOSCOPY AMONG NIGERIANS: A PROSPECTIVE OBSERVATIONAL STUDY Olusegun I. Alatise1, Anthony O. Arigbabu1, Augustine E. Agbakwuru1, Oladejo O. Lawal1, Oluwole Olaniyi Odujoko1, Omolade Adegoke2, Olusegun Ojo2

1. Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
2. Department of Morbid Anatomy, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

Corresponding Author: Dr OI Alatise, Department of Surgery, Obafemi Awolowo
University Teaching Hospital Complex, PMB 5538, Ile - Ife, Nigeria.
Mobile No: +234-803-385-9387.
E-mail:segunalatishe@yahoo.co.uk

Abstract

Background: Colorectal polyps, which are generally thought to be forerunners of colorectal malignancies, are believed to be rare among black Africans. This study was aimed at identifying the prevalence, distribution and clinic-pathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the polyp detection rate (PDR), Polyps per colonoscopy (PPC) and adenoma detection rate (ADR).

Methods: This study is a prospective observational study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2012. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, histo-pathological characteristics of the polyps. Polyp detection rate, adenoma detection rate and polyps per colonoscopy (PPC) were calculated. Data were analyzed using SPSS version 21.

Results: During the study period a total 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2 to 87 years with a median of 57 years. Forty-three (62.3%) patients were 50 years or above and there were 40 (59.7%) males. Thirty three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer and 13 (19.4%) for routine screening. Thirty nine (58.2%) patients had the polyps at the rectosigmoids region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segment. Adenomatous polyps was the most common [28 (47.5%)] histo-pathological finding of which 2 patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (p=0.010). No statistical significance was obtained when the histological diagnosis was compared with sex of the patient (p=0.381) and location of the polyps (p=0.483). Conclusion: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.

Key Words: Polyps, Adenoma, hyperplastic, Inflammatory, Prevalence, Nigeria

SELF-INFLICTED GUNSHOT INJURY

John Owoade Agboola, Joshua Taiye I Ige
Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
owoade14@gmail.com

Abstract Background: Gunshot abdominal injury is a common phenomenon in trauma, either as a lone injury or as part of injury in a poly trauma patient. However, accidental self-inflicted gunshot injury to the abdomen is not common. We hereby present a case report of a patient with accidental self-inflicted gunshot injury.

Case Presentation: A 17-year old male patient presented at our surgical emergency with peritonitis. He had accidentally dropped a loaded and corked locally made gun while pursuing game. The gun landed on a ridge in front of him and fired several rounds directly at him. He had sustained bullet wounds to the abdomen, right upper and lower limbs. Findings at surgery revealed multiple perforations of the jejunum and its mesentery. A week later he developed septic arthritis with pus collection in the right knee. X-ray revealed multiple pellets in the right knee. He subsequently had incision and drainage.

Conclusion: Many local hunters exist in our communities in Africa but handing over a gun to a teenager could more easily result in such accidental self-inflicted injuries. Documentation of such injuries is necessary to create awareness of the need for caution in the use of local firearms. Early presentation and prompt management saved the patient’s life.

Keywords: Gunshot injury, Self-inflicted.

DIVERTICULAR DISEASE OF THE COLON IN KORLE BU TEACHNG HOSPITAL - A 3-YEAR REVIEW Emmanuel Nachelleh and Rudolph Darko
Department of Surgery, University of Ghana Medical School, Korle Bu

Abstract Background: Colonic diverticulum: herniation of the mucosa, submucosa through a weak site of the colonic wall. It is symptomatic only in 20% of cases and may present as diverticulitis or bleeding per rectum. A few cases require elective resection to prevent some of the complications when the symptoms are repeated and frequent. It is rare in Africa and Asia but common in USA, Europe and Australia. In the Western countries, it is commoner at the sigmoid (left) while in Asia the right colon is most commonly involved. The aim of the study is to ascertain whether the prevalence of diverticular disease has changed in the same hospital. The study also sets to ascertain the pattern of the diverticuli and the age spread of the disease Methods: This is a cross-sectional study. It is a combined retrospective and prospective study performed at the endoscopy room identifying all patients who were noticed to have diverticuli of the colon during lower gastrointestinal endoscopy. The patients seen from October 2010 to September 2012 were recorded retrospectively while those seen from October 2012 to September 2013 were recorded prospectively. Inclusion criteria: only those who had complete or near complete colonoscopy were included in the study. Method of preparation: Patients had an overnight fast and were made to take 2 sachet of Polyethylene glycol mixed in 1 litre of warm water. The patients took the first dose between 3 and 5 pm the night before and the remaining was taken at about 3 AM on the morning of the procedure. This invariably purged them and made the colon clean for good viewing,

Results: A total of 1919 lower gastrointestinal endoscopies were performed. Out of this 145 were found to have diverticuli (7.6%) with a male female ratio of 1.6:1 This compares with 14 cases recorded over a similar period in 1974-76 and 1976 in 1987-2000 37 cases seen in 1997-2000. The commonest indication for the colonoscopy was bleeding per rectum (62%) and 15% of patients had the colonoscopy for change in bowel habits while 8% of patients had the colonoscopy for screening. Location of the diverticuli: Forty two percent had the diverticuli in the left colon.

CONCLUSION: Most patients required the colonoscopy for bleeding but it would be most helpful if patient would undergo screening for so that most cancers would be diagnosed early.

SURGICAL TREATMENT OF ENTEROCUTANEOUS FISTULA: OUTCOMES OF A NINE-YEAR EXPERIENCE. Adamu Ahmed, Ukwenya A Yahaya, Enesi Peter.
Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Correspondence: Dr Adamu Ahmed, Department of Surgery Ahmadu Bello University Teaching Hospital
Zaria, Nigeria
Email: mrahmed1010@yahoo.com

Abstract Background: The management of enterocutaneous fistula (ECF) is very challenging and is often associated with significant morbidity and mortality. In poor resource settings such as ours, while appropriate supportive facilities are limited the patients present in advanced stage of malnutrition and sepsis. The objective of this study was to present our experience on the postoperative outcomes, morbidity and mortality following surgical management of ECF.

Methods: This is a prospective study of patients who presented to our tertiary care referral centre from 2005 to 2013 and subsequently underwent definitive surgical treatment of ECF. Management strategy consisted of controlling sepsis, optimizing nutritional state, wound care, defining fistulas anatomy, timing of surgery and surgical strategy. Following diagnosis of ECF imaging studies, haematological, biochemical and microbiological investigations were carried out. Appropriate resuscitation and stoma care were also instituted. The primary outcome measures were postoperative fistula recurrence and mortality, assessed by multiple logistic regression analysis.

Results: A total of 106 patients with ECF were treated. In 41(38.7%) patients the fistulas closed spontaneously. Of the remaining 65 (61.3%) that required operative closure of their fistulas, 39 (60%) were males. Their age ranged from 18-77 years, mean of 31± 7.4 SD. 54(83%). The patients were referred from other institutions. Most (78.5%) fistulas occurred postoperatively. Restorative operations for fistula closure were performed after a median of 13weeks (range 1-38) and were successful in 57 (87.7%) patients. Mortality was 10.8%. Abdominal wall defect, preoperative serum albumin were significantly associated with fistula recurrence(p< 0.001) and mortality(p< 0.005)

Conclusion: A multi-disciplinary approach focusing on fluid and electrolytes replacement, nutritional rehabilitation, sepsis control and timed surgical intervention is necessary to reduce morbidity and mortality in patients with ECF. The high rate of ECF resulting from anastomotic break in patients referred from peripheral hospitals calls for surgical skills acquisition programmes in our sub-region.

SISTER MARY JOSEPH NODULE: MANAGEMENT IN A UNIVERSITY TEACHING HOSPITAL IN NORTHERN NIGERIA
Adamu Ahmed, Ukwenya A Yahaya.
Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

CORRESPONDENCE: Dr Adamu Ahmed, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Email: mrahmed1010@yahoo.com

Abstract Background: Sister Mary Joseph nodule (SMJN), a metastasis of visceral malignancy to the umbilicus is very rare and is encountered in 1-3% of intra-abdominal and pelvic malignancies. It often represents advanced malignancy with dismal prognosis. In this study we present the clinico-pathological features and treatment outcome of this condition in our environment and highlight challenges associated with the care of these patients.

Methods: This was a retrospective study of histologically confirmed cases of Sister Mary Joseph’s nodules seen at the Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria between January 2003 and December 2013. Following examination, imaging, biochemical, immunological and other appropriate investigations were carried out to establish the primary disease. Patients’ treatment was directed at achieving the best palliation. Data collected were analyzed using descriptive statistics.

Results: There were 25 patients with SMJN, 15 (60%) were males while 10 (40%) were females. Their ages range from 17-82 years; median 48years. The nodules sizes ranged from 2-8 cm, mean 3.2cm. In 14 (56%) patients there was an ulcerated umbilical nodule >5cm at presentation. The stomach was the most common site of origin (60%). 15 (60%) patients had previous diagnosis of malignancy before they presented with SMJN. The primary tumour could not be determined in 3(12%) patients. As the disease was advanced in all patients, only palliative treatment was offered. 16 (64%) patients had complete excision of their nodules which recurred in 4 after 3- 17 months. 4 (16%) patients died in the hospital. Overall median survival was 7 months (ranged 2-19months).

Conclusion: SMJN represents manifestation of a variety of advanced intra-abdominal malignancies. Although patient's survival is very short leading to a poor outcome, local treatment of the nodule is associated with improved quality of life. Detection of the primary cancer at an early stage may improve the prognosis.

ERYTHROCYTE SEDIMENTATION RATE (ESR) AND C-REACTIVE PROTEIN (CRP) LEVELS IN BREAST CANCER PATIENTS IN BENIN CITY, NIGERIA
Eboreime o1, Idemudia J.O2, Atoe K2.
1. DEPARTMENT OF SURGERY, CENTRAL HOSPITAL, BENIN CITY, NIGERIA.
2. DEPARTMENT OF CHEMICAL PATHOLOGY, UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY, NIGERIA.

Abstract

Background: Breast cancer is the most common type of cancer in women and the leading cause of cancer-related death worldwide. Inflammation has been shown to play a role in the pathogenesis of breast cancer. A high ESR has been found to correlate with prognosis of breast cancer and other types of cancer. Serum CRP has been shown to parallel carcinogenesis, possibly as an expression of the host defense reaction or as paraneoplastic syndrome.

Methods: This study was to determine the level of some systemic inflammation markers (ESR & CRP) in patients with breast cancer compared to those without the disease. Venous blood was obtained from participants. Erythrocyte Sedimentation Rate (ESR) and C-Reactive Proteins (CRP) levels were determined using standardized laboratory methods.

Results: Results showed a statistically significant increase (P <0.05) in both ESR and CRP levels of patients with breast cancer compared with the control. There was also a significant positive correlation (P<0.001) between ESR and CRP in the study population.

Conclusion: These findings suggest that inflammation may be a risk factor for the development of breast cancer. This association perhaps has clinical significance of prognostic value.

SERUM MAGNESIUM LEVELS IN WOMEN WITH BREAST CANCER IN BENIN CITY, NIGERIA Atoe K1, Idemudia J.O1, Eboreime O2.
1. DEPARTMENT OF CHEMICAL PATHOLOGY, UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY, NIGERIA.
2. DEPARTMENT OF SURGERY, CENTRAL HOSPITAL, BENIN CITY, NIGERIA.

Abstract

Background: The aim of this study was to compare the serum magnesium levels of patients with breast cancer and apparently healthy people without the disease. Methods: This is a cross-sectional prospective study carried out at the Department of Surgery, Central Hospital, Benin City and Department of Chemical Pathology, University of Benin Teaching Hospital Benin city, Nigeria, between July, 2011 and October 2012.

Methodology: A total of 60 female participants from Central Hospital, Benin City, Nigeria were recruited for this study. 30 of the women (50%) had breast cancer and 30 women (50%) without the disease served as control. Venous blood was obtained from participants and serum magnesium level was determined using standardized laboratory methods.

Results: The results showed a statistically significant reduction in serum magnesium level of patients with breast cancer compared with those without the disease.

Conclusion: We demonstrated from this present study that the participants with breast cancer have reduced serum magnesium level compared to those without the disease (control) and it is advisable to cautiously add magnesium as an adjuvant therapy in the management of breast cancer.

Key words: Serum magnesium, breast cancer, hypomagnesaemia, metabolism, adjuvant therapy.

TRIPLE PATHOLOGY IN A PATIENT WITH ACUTE ABDOMEN
John O Agboola, Joshua Taiye Itunuoluwa Ige.
Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria

Abstract

Background: Gastric perforation, acute pancreatitis and acute mesenteric ischaemia are surgical emergencies with grave consequences. Patients presenting with any of these pathology alone has a significant risk of death (12%, 30% & 60% mortality rates respectively). There are few reported cases of patients presenting with dual pathology. To our knowledge, triple pathology is a rare occurrence.

Case Presentation: A 76-year old known hypertensive female patient presented to our surgical emergency unit in hypovolemic shock. She had 5 days history of lower abdominal pain, gradual abdominal distension and 3 days of absolute constipation. With a diagnosis of sigmoid volvulus with possible gangrenous bowel, she was promptly resuscitated and subsequently had laparotomy. Findings at surgery revealed patchy gangrene of the small bowel, the ceacum and the corresponding mesentery, gross fatty necrosis involving the greater omentum and small bowel mesentery and 1cm perforation in the gastric antrum. Histology revealed ischemic necrosis of the resected bowel. The patient had an eventful postoperative period, gradually improved and was finally discharged.

Conclusion: Prompt surgical Intervention maximized the chances of survival in this elderly patient. The rare combination of these pathologies in the patient is quite difficult to explain. Possible hypothesis would be gastric perforation followed by acute pancreatitis from continued use of antihypertensives and subsequent ischaemic infarction of the small bowel from hypovolemic shock.

Keywords: Triple pathology, Acute abdomen.

PRIMARY ACTINOMYCOSIS OF THE BREAST IN A PRE-MENOPAUSAL WOMAN
Abdulrahman G O Jnr, Gateley C A.
Department of Surgery, Royal Gwent Hospital, Newport NP20 2UB, United Kingdom

Abstract Background: Actinomycosis of the breast is a rare disease which may mimic malignancy in presentation. Clinical presentation may make it difficult to distinguish primary actinomycosis from mastitis and inflammatory carcinoma.

Case report A 22-year-old lady presented with a 2-week history of right breast pain and greenish discharge through her nipple piercing. She was initially started on flucloxacillin by her GP 3 days prior to presenting to us with no improvement. Physical examination revealed an area of erythema in the upper inner quadrant of the right breast with an abscess at the edge of the areola. Histological examination of the aspirate isolated Actinomyces turicensis and Peptoniphilus harei.

Conclusion: Actinomycosis of the breast is rare and the species, Actinomyces turicensis, is even rarer. It is a difficult organism to treat due to its relative indolent course with potential scarring and disruption of local tissue. However, surgical intervention could be avoided with an intensive course of high-dose IV antibiotics and prolonged oral antibiotics afterwards.

MEATOPLASTY: NEW TECHNIQUE FOR ENLARGING THE EXTERNAL AUDITORY MEATUS.
Anthony O. Owa, R.M. Ogadako.
Broomfield Hospital U.K.
Lagos State UniversityTeaching Hospital and Queen’s Hospital, U.K.

Abstract

An adequately-sized external auditory is an essential step in canal wall mastoidectomy. The cavity needs to be easily examined in the clinic and adequately ventilated in order to prevent a recurrence of disease.

Having being familiar with the Korners. Fisch and Portmans techniques that had the disadvantages of either having a cosmetically unappealing meatus or meatal re-stenosis, the senior author has developed a different meatoplasty technique which he has been using over the last 18 months. He describes the technique and demonstrates a video of the procedure and gives the results of his technique since its inception.

Methods: The record of all records of patients that had the modified meatoplasty were collated. 15 patients were identified. Video Technique The technique is demonstrated in the video, however, the main parts of the technique incorporate endaural and conchal incisions. The resultant end-aural incision leaves the tragus exposed, which is closed with vicryl sutures. A large piece of conchal cartilage is the removed with the wound closed loosely leaving the anterior flap and adjoining skin free to be rotated into the cavity. Results: All external auditory canal were adequately sized, with no stenosis or unsightly scar formation. Conclusion: The technique is a simple and effective way to maintain an adequately sized and cosmetically acceptable external auditory meatus

Click for full text

<<< Back to Contents of Volume 4 Number 1 Jan – Mar 2014