Skip to main content
NCBI home page
Journal of the West African College of Surgeons logoLink to Journal of the West African College of Surgeons
. 2016 Jan-Mar;6(1):119–116.

Peer-Reviewed Abstracts of Scientific Paper Presentation at The 56th Annual Conference of The West African College of Surgeons at Yaounde, Cameroun 15th – 19th February 2016

PMCID: PMC5342616  PMID: 28344942
J West Afr Coll Surg. 2016 Jan-Mar;6(1):119–120.

outcome of feeding enterostomy for nutritional Rihabilitation in dysphagia

N Anumenechi 1, SA Edaigbini 1, MA Aminu 1, IZ Delia 1

Background

feeding enterostomy is used to build up patients with dysphagia by definitive surgery.

Objective

to evaluate the achievement of nutritional goals in dysphagia patients and to suggest management protocols.

methodology

retrospective study of feeding enterostomies for dysphagia over 4 years. The preoperative, postoperative weights and progression to definitive esophageal replacement were analyzed.

result

There were 34 patients, records were available for 29 patients, ages ranged from 1.5 to 90 years, mean age was 29.7years, and male to female ratio was 3:7 The causes of dysphagia were corrosive esophageal stricture-12, esophageal cancer-13, pharyngeal tumor-3 and mediastinal mass 1. The duration of symptoms ranged from 3 weeks to 106 weeks (mean 26.4 weeks). Preoperative weight ranged from 6.2 – 68 kg (mean 24.1kg), postoperative weight was between 7 – 65 kg (mean 25.7kg); follow up period ranged from 0.5 to 12 months (mean 3.2 months), weight gain was negative for those who had their last weight check by 6 weeks post op (p value 0.057). 15 patients (52%) proceeded to have definitive esophageal replacement surgery.

conclusion

Feeding enterostomy was successful in nutritional rehabilitation of dysphagia patients and 6 weeks may be required to appreciate positive weight gain. There is a need for standard protocols for better management and follow-up of these patients

J West Afr Coll Surg. 2016 Jan-Mar;6(1):120–121.

Extremity Ulcers secondary to Pentazocien Abuse

FO Abikoye 1,✉, OA Ayoade 1, AS Hassan 1, MA DrLawal 1, DC Egbeogu 1

Background

Pentazocine is a readily available opioid like analgesic. There has been an increase in the number of patients seen with pentazocine abuse with complications. A high index of suspicion is required. The skin is the tissue most evidently affected in drug addiction. When peripheral veins are sclerosed or inaccessible, the subcutaneous tissue and muscle are injected. Patient injects into thighs, forearms and buttocks under non sterile conditions.'Woody' cutaneous fibrosis with a background history of chronic pain is pathognomonic for pentazocine abuse.

Objective

To show our experience in the management of ulcers that develop following abuse and addiction of pentazocine, diagnostic clinical features, challenges in managing addicts and the way forward

Method

4 patients who had easy access to pentazocine are presented. They persistently abused parenteral pentazocine by indiscriminately injecting both thighs in unsterile circumstances until they developed extensive necrotizing fasciitis and muscle necrosis. They were co-managed with the psychiatrist. They were admitted for inpatient wound care and investigations. Some challenges were encountered in their management

Result

They were females between 31-42 years, 3 patients had HbSS while 2 were health workers. Dose administered range between 360mg and 700mg/day. Duration of ulceration ranged from 10 months to 2 years. NPWT significantly improved their wounds.

Conclusion

Pentazocine is a drug which is abused by patient with chronic pain. Obvious and extensive tissue loss is not a deterrent factor to further abuse. There is need for modification of the use of pentazocine and possibly should be a controlled prescription medication.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):121.

DRAINING PERICARDIAL EFFUSION IN PATIENTS WITH DRAINING PERICARDIAL EFFUSION IN PATIENTS WITH CONSTRICTIVE PERICARDITIS: A NEED FOR CAUTION

N Anumenechi 1, SA Edaigbini 1, M B Aminu 1, IZ Delia 1

Background

Constrictive pericarditis is usually associated with ascites, hepatomegaly and pleural effusion. The usual practice is to relieve the respiratory distress caused by the pleural effusion, before surgical management of the pericardial constriction. Renal failure can complicate this protocol

Objective

To report the occurrence of perioperative renal failure in patients with constrictive pericarditis, who got tube thoracostomy before pericardiectomy.

Mthodology

This is a retrospective report of constrictive pericarditis patients who had post tube thoracostomy renal failure.

Result

3 patients had renal failure post tube thoracostomy 1. S.D, a 28-year-old female who had a left tube thoracostomy that drained 3.7 liters of pus over 48 hours. She developed acute renal failure, and she died thon the 6 day post tube thoracostomy. 2. H.M, a 40-year-old female who had a right tube thoracostomy that drained 2.3 liters of effusion over 72 hrs. She went into acute renal failure, but she was successfully managed. 3. U.M, a 37-year-old male, who had subxyphoid tube pericardiostomy and right tube thoracostomy simultaneously. Tube thoracostomy was slowly drained; he however went into acute renal failure, which was successfully managed. He eventually had a successful pericardiectomy. Conclusion Drainage of pleural effusion in patients with constrictive pericarditis can be complicated by acute renal failure. Caution should be exercised in the management of such patients.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):122.

LAPAROSCOPY USING ROOM AIR INSUFFLATION IN A RURAL SETTING – THE BONGOLO HOSPITAL EXPERIENCE

MB Faniriko 1, A Niyukuri 1, J O'Connor 1, K Thelander 1, D Thompson 1, A Park 1, Z O'Connor 1

Background/Objective

Laparoscopy offers several advantages over open surgery. Carbon dioxide (CO2) is the standard insufflation gas used for laparoscopy. The cost and availability of CO2 in Low and Middle Income Countries limits its widespread utilization. We evaluated the use of atmospheric room air insufflation during laparoscopy at our institution to evaluate the safety profile as well as associated intraoperative and postoperative complications

Methodology

All laparoscopic cases performed at our hospital between January 2006 and December 2013 were identified. Demographic and perioperative information was collected. Insufflation was achieved with a standard air compressor using filtered air and an insufflation regulator. All cases were evaluated for intraoperative events as well as post-operative complications

Result

A total of 368 laparoscopic procedures were performed in the studied period; of which the majority were gynecologic (43%), others were diagnostic laparoscopy 23%, cholecystectomy 23%, appendectomie 6%, ventral hernia 3%. There was a 2% complication rate with one perioperative death. The complications related to insufflation were episodes of hypotension. No intracorporeal thermal events were observed despite the use of diathermy. The other complications and the death were not clearly tied to insufflation with air.

Conclusion

A wide array of laparoscopic procedures were safely performed using room air insufflation. The low cost and ready availability of room atmospheric air provides a viable and safe alternative for surgeons in low resource settings to perform laparoscopy. Prospective studies comparing this method to CO2 insufflation are warranted

Keywords

laparoscopy, room air insufflation, rural surgery

J West Afr Coll Surg. 2016 Jan-Mar;6(1):122–123.

SURGICAL WORKFORCE AND SURGICAL PROVIDER RODUCTIVITY IN SIERRA LEONE: A NATIONAL INVENTORY

Håkon A Bolkan 1,2,✉, Lars Hagander 3, Johan V Schreeb 4, Donald Bash-Taqi 5, Kamara Thaim B 6, Salvesen Øyvind 1, Arne Wide 1

Background

Limited data is available on providers of surgical pr ocedures and the impact of their interventions in low income countries.

Goals

The objective of this study was to evaluate the distribution and productivity of all providers of surgical procedures in low-income countries, and to assess the correlation between the availability of the surgical practice, productivity rates and the volume of surgical procedures in the districts and hospitals.

Methodology

Using the available log books and interviews with key persons between January and May 2013, data was collected on surgical procedures and their providers in 56 (93.3%) of the 60 health facilities which practiced surgery in Sierra Leone in 2012

Result

In Sierra Leone there were 164 full-time surgical posts, representing 2.7 providers of surgical procedures per 100,000 inhabitants. Non-specialists performed 52.8% of overall procedures. In rural areas, the density of specialists and medical doctors was respectively 26.8 and 6.3 times lower than in urban areas. Average individual productivity was 2.8 surgeries per week. A great variation was observed between the groups of surgical providers and locations. Excluding four centers where only ophthalmic surgery was proposed, there was a positive correlation between the surgical volume of a facility and the productivity of its providers (r = 0.642, p <0.001)

Conclusion

Less than half of surgical procedures in Sierra Leone are performed by specialists. Surgical providers are considerably more productive in health facilities with higher surgical volumes. If all suppliers had the productivity of specialists in the non-profit making private sector (5.1 procedures / week), the national surgical volume will increase by 85%.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):126.

NEGATIVE PRESSURE TREATMENT OF WOUNDS BY VACUUM ASSISTED CLOSED FORTUNE THERAPY AT THE OMAR BONGO ONDIMBA MILITARY HOSPITAL IN LIBREVILLE

R Tchoua 1,✉, C Igoho 1, G Edjo Nkili 1, JM Mandji Lawson 1, E MbongoKama 1, A Mikiéla 1

Introduction

serious infections on soft tissue wounds especially induce, apart from sepsis, problems of coverage and healing. They therefore require care and prolonged antibiotic therapy, as well as staff mobilization for bandage. That is why in this context, we proposed as alternative to conventional therapy to develop the technique of negative pressure treatment.

Patients and method

It was an observational and retrospective study on vacuum assisted closed (VAC) treatment of patients with severe soft tissue infection admitted to the emergency department for outpatient. VAC equipment included a phlegm aspiration and a bandage kit.

Result

Three cases were reported from 1 April to 30 June 2015: two women and one man. Their ages were respectively 28, 45 and 50 years old. They were hospitalized for myositis of the right thigh, lumbar region and right arm. They all had an initial antibiotic and local care followed by surgical drainage and installation of a VAC system at day 10, day 5 and day 6. The germs found were E. coli in two cases and roteus mirabilis in one case. The outcome was favorable after two months of hospitalization in the first case and a month in the two other cases.

Conclusion

VAC system saves procedures, personnel, bandage quantity and antibiotics. Its use has transformed the prognosis of some lesions and deserves wider dissemination. Using a Fortume system is an attractive alternative for economically weak settings.

Keywords

VAC, Wounds, Infections

J West Afr Coll Surg. 2016 Jan-Mar;6(1):127–128.

THE EFFECTS OF EBOLA ON THE NUMBER OF OPERATIONS IN SIERRA LEONE

Alex vanDuinen 1,2,✉, Bart Waalewijn 1,3, Bundu Ibrahim 4, Håkon Bolkan 1,2,5

Background

During the West-African Ebola Viral Disease (EVD) outbreak, over 25,000 people have been infected and over 10,000 people have died. Sierra Leone, with about 12,000 cases, is the most affected country. Health personal providing surgical care during the outbreak have an increased risk to attract EVD.

Objective

Aim of the study is to explore EVD´s effect on number of operations before and during the outbreak.

methodology

Between September 2014 and January 2015, 21 Community Health Officers, collected weekly retrospective data from hospital records. Data was retrieved from all facilities that were known to provide major surgeries. Data was collected from before EVD outbreak (2014 week 2 to 21) and during (2014 week 22 to 2015 week 20).

Result

From the 54 identified healthcare facilities, data from 42 was completely divided in three categories: governmental (21), private-non-profit (18) and private-for-profit (15). On average, 414 patients were operated weekly before the EVD onset and 241 after, an overall reduction of 42%. This decrease was higher after the peak (-46%) than before the peak (-39%). The reduction in admissions was more severe in the private-for-profit sector (-59%) compared to the privatenon-profit (-56%) and governmental (-22%) sector. The province most affected was Southern (-49%).

Conclusion

As a consequence of the current EVD epidemic, the number of weekly operations has decreased with 42%. The reduction is not equal among the different sectors and areas. Investment in human resources is essential to reestablish the Sierra Leonean healthcare system after the EVD epidemic.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):129.

TYMPANOMETRIC EVALUATION IN CEREBRAL PALSY PATIENTS IN BENIN CITY NIGERIA

IO Akpalaba 1,✉, FO Ogisi 1

Background

Cerebral palsy is a static neurologic condition from brain injury that occurred before cerebral development 1is complete. It is the most common childhood disability af fecting 2.5 to 10.3 children per 1,000 live births inNigeria. 1,2,3, 4, 5 23, 24 They are more vulnerable to hearing loss. This hearing loss can be due to middle ear pathology, which is preventable and correctable; justifying the study.

Objective

To determine the pattern of middle ear pathology and severity of Eustachian Tube Dysfunction (ETD) in children with Cerebral Palsy at UBTH, Nigeria.

Methodology

A prospective descriptive study carried out for fourteen months (May 2014 to June 2015). Total population sampling technique was used. Sample size determined using Cochran's formula. 112 subjects participated, each ear, as a separate entity. Pretest was done on 60 subjects at Project Chari-love. Structured interviewer questionnaire was administered, otoscopy and Tympanometry were done. Data analyzed using Statistical Package for Scientific Solution version 16. Similar procedures were carried out on 112 control subjects comprising children in Russell International Group of Schools, Ugbowo. Benin city.

Result

Otitis Media with Effusion predominated in 154 (68.8%) ears compared to 25.9% in the control. ETD, 129 (57.6%), mostly Type C1 tracing. Reduced middle ear compliance noted in 22 (9.9%) ears. (Statistically significant, p<0.001).

Conclusion

Middle ear pathology is predominant in cerebral palsy patients. Otitis Media with Effusion is the commonest middle ear pathology in cerebral palsy patients. Eustachian tube dysfunction was mostly Type C1 tracing.

Keywords

Middle ear pathology, Cerebral Palsy, Tympanometry

J West Afr Coll Surg. 2016 Jan-Mar;6(1):130–131.

ENDOSCOPIC ENDONASAL CLOSURE OF CEREBROSPINAL FLUID RHINORRHEA USING DIFFERENT TECHNIQUE

G M Mohammed, 1,✉, J Yohanna, 1, BM Ahmad 1, US Grema, 1, TS Abubakar 1

Introduction

Management of CSF rhinorrhea has been a challenging issue to ENT surgeons in Nigeria necessitating prolonged conservative management or intracranial approach by neurosurgeons with significant morbidity, including anosmia, intracerebral hemorrhage, frontal lobe deficits, need for extended hospital stay and higher recurrence rates.

Objective

To explore the less morbid approach of management of CSF rhinorrhea

Method

A Prospective study of all patients managed with CSF leak in National Ear Care Centre and dialogue Hospital Kaduna, from January 2012 to June 2014. Aetiology, site of leak, surgical approach were reviewed.

Result

During the period under study, 5 patients presented with CSF rhinorrhea. Three were as a result of head trauma while 2 were spontaneous CSF rhinorrhea. The site of CSF leak in three of the patients was from cribriform plate, one from the sphenoid while the site of leak cannot be located on computerized tomography in one patient that responded to conservative management. Four patients underwent endoscopic endonasal repair of CSF leak

Conclusion

Endoscopic endonasal approach for repair of CSF leaks is the mainstay of surgical therapy, with low morbidity, high success rates, and low complication and recurrence rates.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):131.

AUDIOMETRIC PATTERNS OF PRESBYCUSIS IN ILE-IFE, NIGERIA

Obasi Odefa 1,✉

Background

Presbycusis which occurs gradually over time is defined as the decline of hearing perception with advancing age. As the population of the elderly increases worldwide, the prevalence and incidence is expected to increase. There are various audiometric patterns of presbycusis as documented in literature. The patterns identifiable in a semi urban location like Ile-Ife, Osun State, Nigeria is important in correlating these findings with that published in literature in other parts of the world since there is a dearth of studies in Africa that determine the various audiometric patterns of presbycusis.

Objective

To determine the audiometric patterns of presbycusis in Ile – Ife.

Methodology

This is a community based study of elderly people with presbycusis in Ile – Ife. A questionnaire was administered followed by a clinical examination of the ear and a pure tone audiometry. Analysis of the data was done using the Statistical Package for Social Sciences (SPSS version 20). Results: Among the patients diagnosed with presbycusis, the bilateral flat audiometric pattern was the most common audiometric pattern seen among presbycusis patients. Conclusion: The most common audiometric pattern of bilateral flat was consistent with the findings in literature. Public enlightenment and prevalence of presbycusis was found to be high and intermittent screening of the patients 30 years and above is recommended.

Keywords

Pure tone audiometry; Audiometric Patterns; Presbycusis; Ile-Ife; Nigeria

J West Afr Coll Surg. 2016 Jan-Mar;6(1):132.

PREVALENCE OF PRESBYCUSIS IN ILE-IFE, NIGERIA

Obasi Odefa 1,✉

Background

Presbycusis refers to age-related hearing loss which is known to be common among elderly persons. As the population of the elderly increases worldwide, the prevalence and incidence is expected to increase. The prevalence of presbycusisis of keen interest at this time because there is a paucity of studies to determine the exact prevalence of presbycusis in Ile-Ife, South-western Nigeria

Objective

To determine the prevalence of presbycusis in Ile – Ife and its effect on quality of life.

Methodology

This is a community based study of elderly people in Ile – Ife. A structured proforma was administered followed by a clinical examination of the ear and a pure tone audiometry. Analysis of the data was done using the Statistical Package for Social Sciences (SPSS version 20) and the level of statistical significance was placed at p<0.05. Main Results: The prevalence of presbycusis in Ile-Ife was 34.8%. Conclusion: The prevalence of presbycusis was found to be high and periodic screening of the elderly is recommended to detect and rehabilitate those with presbycusis

Keywords

Presbycusis; Prevalence; Pure tone audiometry; Ile-Ife; Nigeria

J West Afr Coll Surg. 2016 Jan-Mar;6(1):132.

EYE SOCKET SURGERY: AN EXAMPLE OF COLLABORATION BETWEEN ORL/OPHTHALMOLOGISTS AT THE YAOUNDE UNIVERSITY TEACHING HOSPITAL

Antonie A BOLA SIAF 1,✉, Gilles KAGMENI 1, Francois DJOMOU 1, Sandrine OWONA NANGA Sandrine, 1, Alexis NDJOLO 1

Introduction

Surgery of the eye sockets is a collection of v arious indications. These can involve several separate specialties (ORL, ophthalmology, maxillofacial surgery, ...). Since July 2015, an orbital surgical unit composed of ORL and Eye Surgeons was established at the Yaounde University Teaching Hospital.

Objective

To report preliminary results of the Orbital Surgical Unit of the Yaounde University Teaching Hospital.

Methodology

Study on cases operated by surgeons at the Orbital Surgical Unit of the YUTH since the month of July 2015.

Result

Seven patients (one male and six females) have already been operated by the Orbital Surgical Unit of the Yaounde University Teaching Hospital. The average age of patients was 40.1 years, ranging from 8 to 70 years. The most frequent indications consist of mucoceles (43%) and fractures of the orbital floor (43%). All patients were operated externally and by a double team. No complications were recorded and the postoperative course was eventful.

Conclusion

The establishment of an orbital surgical unit is a new experience that we want to perpetuate. It is a collaboration that will benefit practitioners and patients with orbital surgery indications.

Keywords

surgery, eye sockets, Ophthalmologists/ ORL collaboration.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):133–134.

THE OUTCOME OF SURGICALLY TREATED CASES OF PERSISTENT POSTPARTUM HAEMORRHAGE: A COMP ARATIVE STUDY OF THE CONSERVATIVE AND THE RADICAL SURGICAL APPROACHES IN TWO MAJOR HOSPITALS IN YAOUNDE, CAMEROON.

JS Dohbit 1,✉, P Foumane 1, E Nkwabong 1, OD Kamouko 1, NOE Meka 1, NCC Noa 1, ET Mboudou 1

Introduction

Post-partum hemorrhage is the leading cause of maternal mortality in Cameroon. Surgery is sometimes used as the last resort in its management.

Objective

The aim of this study was to compare the fate of patients who had a conservative surgical treatment, to that of those who had a radical surgical treatment for post-partum hemorrhage.

Methodology

The study covered the period from January 1 st2004 to December 31 2014 and concerned women operated for post-partum hemorrhage in the Maternity services of The Yaounde University Teaching Hospital and of the Yaounde Gynaeco-Obstetric and Pediatric Hospital. The sampling was the consecutive and exhaustive type. The degree of association was measured using Odds ratio and relative risk with 95% confidence interval.

Result

During the study period, a total of 42,944 deliveries were recorded of which 144 were complicated with postpartum haemorrhage requiring surgery, giving an overall frequency of 0.3%. Of the 60 files retained for our final analysis, 36(60%) underwent a radical surgical treatment and 24 (40%) underwent conservative surgical management. The conservative surgical management was more frequently done in women aged 30 to 35 years (P=0.03) and whose parities were between one and two (OR=13.5; P=0.00). The predisposing factors for conservative surgical management were: parity greater than or equal to 5 (OR=0.2; P=0.00) and a number of living children greater than or equal to 4 (OR=0.2; P= 0.00). Conservative surgical management was more associated with per-operative and post-operative complications (RR=8.2; P= 0.00).

Conclusion

The conservative surgical management of postpartum haemorrhage exposes more to maternal death and to per-operative and postoperative complications when compared to the radical surgical approach.

Keywords

conservative surgical treatment, radical surgical treatment, postpartum haemorrhage.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):134.

OBSTRUCTED LABOUR AS A PRIMARY PRESENTATION OF A GIANT BLADDER CALCULUS: AN UNUSUAL OCCURRENCE

BM, Abubakar 1,✉, AA Atterwahmie 2, A Abdulkadir 3, MS Maina 4, AA Panti 5

Background

Prolonged obstructed labour is a known complication of labour. It is however, unusual as a primary presentation of a giant calculus.

Objective

We report a rare case of prolonged obstructed labour as a Primary Presentation of a giant bladder calculus. Case Report: The patient was a 25year old Para (6+1) 3 alive with lower urinary tract symptoms of 10 years ; suprapubic swelling and intermittent haematuria . She had a fresh still born delivered by Caesarean section (C/S) at her first presentation two weeks earlier following a prolonged obstructed labour that was secondary to a bladder mass. The pregnancy was booked but no antenatal ultrasound was done. All her previous deliveries were uneventful and the last child birth was 2 years to her presentation. She had low midline scar with bimanually palpable bladder mass that was hard, regular and mobile. Her Abdomino-pelvic ultrasound scan revealed giant bladder calculi with grade II-III obstructive uropathy. Pelvic X ray showed giant bladder calculus. Urine M/C/S yielded E. coli sensitive to Ciprofloxacin but other laboratory investigations were normal. She was treated for UTI then had opened Cystolithotomy with multiple bladder mucosal biopsies. The stone weigh 535g. Her Post-operative care was uneventful; no LUTS on removal of catheter. She was to be followed up in the appropriate clinics.

Conclusion

Prolonged obstructed labour is an unusual presentation of a giant bladder calculus. Therefore, the diagnosis requires a high index of suspicion. Clinical assessment and Radiologic investigations establish the diagnosis. Emergency C/S with subsequent cystolithotomy is an appropriate treatment

Keywords

prolong obstructed labour, giant calculus, primary presentation

J West Afr Coll Surg. 2016 Jan-Mar;6(1):135–136.

A CASE OF A 26 WEEKS AMPULLAR PREGNANCY MIMICKING INTRA-UTERINE FETAL DEATH

Elie NKWABONG 1, Eveline FOGUEM TINCHO 2

Abstract

The ampulla is the commonest localization of ectopic pregnancy. Almost all ampullar pregnancies rupture during the first trimester. The diagnosis of ectopic pregnancy with ultrasound is usually easy during the first trimester. However, ultra-sonographic diagnosis becomes difficult in the second and third trimesters and the diagnosis is usually made during laparotomy. The authors report a case of a right ampullar missed abortion at 26 weeks gestation, which was diagnosed during laparotomy only, after repeated failed attempts at induction of labor. The initial ultra-sonographic diagnosis was that of an intrauterine late missed abortion. The authors recommend that in cases of repeated failed attempts at induction for late missed abortions, the probability of an ectopic pregnancy should be thought of, even if ultrasound scans diagnosed an intra-uterine pregnancy, and an exploratory laparotomy performed.

Key words

Late missed abortion; Failed induction; Exploratory laparotomy; Advanced ampullar pregnancy; Total salpingectomy.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):136.

COMBINE UTERINE AND BLADDER RUPTURE – UNUSUAL COMPLICATION OF LABOUR IN A PRIMIGRAVIDA.

(MBBS, MHPM, FMCOG) I U Takai 1,✉, (MBBS,FWACS) A Abdulkadir 2

Background

Combined Uterine and Bladder rupture is a serious Uro-obsteteric emergency that results in stillbirth, maternal morbidity and occasional mortality. The bladder rupture is particularly very rare in absence of clinical factors that could predispose the bladder to be adherent to the lower uterine segment.

Aims and objective

We report a rare case of bladder rupture combined with the uterine rupture in a primigravida during a prolonged obstructed Labour.

Case Report:

A 17 year old married Unbooked Primigravida, who presented with 3 days history of spontaneous labour at term initially managed at home. The labour was complicated by combined uterine and bladder rupture with sepsis. Following resuscitations, she had exploratory Laparotomy. Findings at the Laparatomy included thick foul smelling liquor, fresh still born male baby weighing 3.85Kg, ragged lower uterine rupture that extended down to the uterine cervix. There was associated urinary bladder rupture measuring 10cm◊7cm. She had uterine and urinary bladder repairs with an uneventful recovery before discharged to see family planning and gynae clinics.

Conclusion

A high index of suspicion and appropriate prompt intervention will reduce the resulting morbidity and occasional mortality associated with the clinical condition. There should be increased community awareness on inherent risks associated unsupervised pregnancy, labour and delivery.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):137.

POST-PARTUM ECLAMPSIA COMPLICATED BY HEMORRHAGIC STROKE: CASE REPORT

JA Metogo Mbengono 1,✉, R Ndikontar 1, R Bengono Bengono 1, AL Amengle 1, J Metogo Ntsama 1, J Ze Minkande 1

Abstract

Peripartal strokes are not rare. We reported a case of post-partum eclampsia complicated by hemorrhagic stroke on a primigravida parturient of 20 years old. She was referred for tonico-clonic seizures and right motor deficit. The treatment consisted of hydration in saline 0.9%, administration of antihypertensive: nicardipine to the electric syringe pump, prevention of vasospasm by nimodipine 90mg /24h, magnesium sulfate, acetaminophen 1 g / 6 h, ranitidine 50mg / 8h, the prevention of venous thromboembolic disease (stockings, enoxaparin 40mg / 24h). Recovery from the motor deficit started on the second day of hospitalisation. The patient was discharged after 24 days of hospitalisation. The aim of this report was to reveal that eclampsia is a major cause of peripartal stroke.

Key words

Stroke, Eclampsia, Post-partum

J West Afr Coll Surg. 2016 Jan-Mar;6(1):138.

HOW SAFE IS TERM VAGINAL BREECH DELIVERY IN OUR SETTING, HGOPY, CAMEROON? A FIVE YEAR REVIEW

JS Dohbit 1,✉, P Foumane 1, NUE Meka 1, M Fadimatou 1, E Belinga 1, ET Mboudou 1

Background

Breech delivery is known to be a stressful situation for the mother, her unborn baby and health care providers.

Objective

The aim of this study was to evaluate the maternofetal prognosis in vaginal breech delivery at term in singleton gestations.

Methodology

An analytic and retrospective study was carried out, analyzing data from January 1st, 2010 to December 31st, 2014 in the Yaounde Gynaeco-Obstetric and Pediatric Hospital (HGOPY).

Results

A total of 13,695 deliveries were recorded, among which 364 singleton breech deliveries, giving a frequency of 2.66 %. During labor, vaginal breech delivery exposed: to referral from other hospitals [RR=5.83 ; IC (3,55-9,58)], to uterine (dynamic) dystocia [RR=01.74 ; IC (1.07-2.83)], to meconium stained amniotic fluid [RR=21.05 ; CI (2.83- 156.51)], to prolonged second stage of labour [RR=5.33; CI (1.23-23.11)], to fetal abnormalities in second stage of labour [RR=2.05 ; CI (1.15-3.67)], to Apgar scores less than 7 at the 5th minute [RR=7.20 ; CI(2.51-20.59)], to the need for neonatal resuscitation [RR=4.74; CI (3.09-7.26)], to transfer to the neonatology unit [RR=6.40; CI (2.18-18.77)], to fetal trauma [RR=12.00; CI (1.27-113.07)]. Vaginal breech deliveries were done by specialists [RR=9.85; CI (6.55-14.80)].

Conclusion

The fetal and neonatal outcome was jeopardized by several factors in the vaginal breech delivery group. The main maternal complication was dynamic dystocia.

Keywords

Breast tumor, Epidemiology, Histologic types.

J West Afr Coll Surg. 2016 Jan-Mar;6(1):140.

BREAST CONSERVING SURGERY IN BREAST CANCER PATIENTS: UNTH EXPERIENCE

ER EZEOME 1,✉, I ILOABACHIE 1, C ILO 1, KC UNAKA 1, VC Enemuo 1

Introduction

Breast conserving surgery (BCS) is a suitable treatment option for early and down staged breast cancer diseases. It compares favourably with modified radical mastectomy in outcome. Nevertheless, it is associated with higher local recurrence than mastectomy especially when clear resection margin is compromised. This treatment option is yet to take a firm footing in Nigeria and we are not aware of any report of its outcome in our local environment. In this communication, we report the results of breast conservation treatment as done in our centre

Objective:

To evaluate the outcome of breast conservation. To determine the rate of local recurrence in breast conserving surgery

Methods

This is a retrospective review of 16 cases of breast cancer done in our centre from 2002 to 2014. The case notes of the breast conservation surgeries were reviewed for patients demographic parameters, stage at diagnosis,presurgical treatments offered ,response to pre-surgical treatment, pre-op imaging investigations, type of breast conservation surgery done, care of the operating surgeon, early complications of the surgery, histo-pathological review of the resection margin, local recurrence, distant metastases, time to metastases. Cosmetic outcome as assessed by both surgeon and the patient and follow up events. Also included in the analysis was the reoperation and histological results of reoperation specimen was performed on.

Results

Eighty one per cent of the patients had clear resection margins whereas 19% had positive margins. This degree of clear margins was achieved despite lack of intraoperative cytological assessment in our centre, and invasive breast diseases in most of the cases. At a median follow up of 34 months, one patient had loco-regional recurrence in the treated breast and axilla. There were also 2 cases of disease progression with pulmonary and hepatic metastases respectively and one mortality.

Conclusion

In view of low recurrence and satisfactory cosmetic outcome of BCS in our centre, it is a reliable option to mastectomy in patients with early and down staged breast cancer disease .Early presentation and prompt referral of breast cancer patients to our centre will guarantee more patient selection for BCS. Low threshold for BCS and provision of intra-operative cytological assessment facility are recommended.

Articles from Journal of the West African College of Surgeons are provided here courtesy of Wolters Kluwer -- Medknow Publications

RESOURCES