Aa Nasir

Motorcycle Injuries in a Developing Country and the Vulnerability of Riders, Passengers, and Pedestrians

At a Nigerian university hospital, none of the motorcyclists who presented over a 12 month period had been wearing a helmet, and of the eight patients who died, seven had head injuries. Of the five collision types described, the rate of motorcycle-other vehicle collisions was highest at 40.6%, while the motorcycle-pedestrian rate was 23.4%. Measures to prevent these collisions might reduce overall crashes by 64%; in addition, helmet law should be enforced.

Hirschsprung's disease: 8 years experience in a Nigerian teaching hospital

Background: Hirschsprungs disease (HD) is a common cause of intestinal obstruction in children. Despite increased understanding of the disease and several techniques of treatment, significant complications continued to be associated with its management. Objective: To study the outcome of management of HD in the University Teaching Hospital, Ilorin, Nigeria. Materials and Methods: The clinical records of all children managed for HD between January 1998 and December 2005 were retrospectively reviewed. Demographic data, modes of presentation, methods of diagnosis, age at colostomy formation, age and type of definitive operations were noted from patients records. Complications associated with colostomy, pre- and postoperative complications, final outcome and duration of follow-up were also noted. Results: Twenty-one patients (20 males, one female) managed for HD were reviewed. Eight (38%) were diagnosed in the neonatal period, the mean age at diagnosis being 22 months. Fourteen patients had completed the three stages of the operation, one is awaiting colostomy closure and two patients are waiting for definitive operations. Out of the 15 patients who had definitive surgery, nine had Swensons pull-through operations while six had Duhamel operations. At presentation, six patients had enterocolitis, one of whom had spontaneous colonic perforation, two patients had sepsis. Colostomy-related complications recorded included sixteen patients with dermatitis, nine with colostomy prolapse, one patient with colostomy diarrhea and one with enterocolitis and sepsis. Following definitive surgery, three patients had wound infection, one partial intestinal obstruction, one postDuhamel hemorrhage and two enterocolitis. Complications after colostomy closure included two wound infections and one severe enterocolitis. There were five deaths (23.8%)-two from sepsis, two from enterocolitis and one from an adverse drug reaction. One of the children who had enterocotitis preoperatively died of enterocolitis after colostomy. Range of follow-up was six weeks- to eight years. Conclusions: Many complications from HD resulted from late presentation to our unit. Colostomy caused unacceptable morbidity. Most deaths were due to sepsis and enterocolitis. The Swensons and Duhamel operations gave satisfactory results. Early presentation and improved facilities in our pediatric surgical unit will reduce morbidity and mortality.

A rare form of domestic accidents: Penetrating abdominal injuries with evisceration of abdominal viscus

Penetrating abdominal injury resulting from home accidents is rare. Only one such case was found in the English literature after online searching on PubMed. We report two cases of penetrating abdominal injury. The first was a 2-year-old girl who was brought into the emergency room (ER) with evisceration of most of the stomach through the left hypochondrium. She had fallen on a broken soft drink bottle; she was holding, after missing her steps. On examination, she had a penetrating injury in the left hypochondrium and a 1.5 cm perforation on the proximal aspect of the anterior wall of the stomach. She was explored within 3 h of presentation, during which the gastric perforation was closed eviscerated bowel returned into the peritoneum and primary wound closure achieved. The patient did well postoperatively. The second was a 9-month-old boy who was brought to the ER by parents on account of gut evisceration following injury from a soft drink bottle at home. He sustained injury from exploded soft drink bottle while crawling. Examination revealed a penetrating injury in the left upper quadrant with evisceration of small intestinal loops. He also had exploratory laparotomy within 4 h of presentation, during which intact abdominal viscera was found. Bowel loops were returned and primary abdominal closure done. Postoperatively, the patient did well. These cases are eye openers to an unusual form of domestic injury, exemplifying the potential hazards of soft drink bottles in the home. Awareness about this is pertinent.

Congenital giant hydroureteric cistern in a duplex system of an infant.

Duplex collecting system is a congenital genitourinary anomaly commonly found incidentally. Our experience with a duplex system associated with giant hydroureter presenting as mobile abdominal swelling that was noticed from birth, constipation, and failure to thrive is described. Ultrasound and IVU did not assist in making the diagnosis, while a barium enema suggested a colonic duplication. Congenital giant hydroureter should be considered as a differential diagnosis in infants with cystic abdominal swelling. A preserved renal moiety attributed to a dilated ureteric cistern was a unique theory in this case.

Late presentation of congenital diaphragmatic hernia in Sub-Saharan Africa: A call for screening and prompt treatment

Background: Congenital diaphragmatic hernias (CDHs) are uncommonly seen anomalies of the diaphragm in our environment. They present late posing great difficulty in diagnosing and management. Objective: To review our experience in the management of CDH and to draw attention to misdiagnosis and mismanagement of cases. Methodology: A prospective study on all patients with CDH from August 2008 to June 2014. Protocols and questionnaire were designed for diagnosis, management, and follow-up of the cases. Results: Eight patients (five males and three females) with age between 15 days and 8 years (median = 5 months) were recruited. Seven (87.5%) cases had hernia of Bochdalek hernia (BH) (one on the right and six on the left) and one had Morgagni hernia (MH). All patients were underweight with a median of 10.7 kg (range = 3.0–17.6 kg). Five (62.5%) cases had recurrent cough, respiratory distress, and postprandrial vomiting; one patient (12.5%) presented with chronic constipation raising the suspicion of Hirschsprungs disease. Diagnosis was confirmed with plain chest X-ray in six patients; upper gastrointestinal contrast in three cases (37.5%) while the patient with chronic constipation and anterior CDH had barium enema, and two patients had chest ultrasound to confirm diagnosis. One patient underwent laparoscopic repair of an MH, and seven patients had open transabdominal repair of BH. The median age at surgery was 7 months (36 days – 96 months). The diaphragmatic defect dimension ranged from 3 cm to 11 cm. Only one patient had 24 h Intensive Care Unit care postsurgery, and median length of stay was 11.8 days (range = 5–27 days) in the open group and only 4 days in the laparoscopic case. Conclusions: CDHs were uncommon and presented late in our practice. Modalities of management require meticulous and structured professional care. We recommend that postmortem should be done in stillborn and infants deaths to determine true incidence of CDH and confirm possible high hidden mortality.

Restrictive feeding and airway obstruction from sub-glossopalatal synechiae with cleft palate: An african case report and review of literature

Glossopalatal and congenital alveolar synechiae are rare and often occur in association with orofacial anomalies. The occurrence of sub-glossopalatal membrane causing restrictive mouth opening associated with complete cleft of hard palate has not been reported from Africa. A report of a case of the subglossopalaal membrane and its management in a term male child delivered per vaginum by a 24-year-old primiparous woman in a rural setting in Nigeria. All available English literature was search using Medline, PubMed, and Google scholar. A 3-day-old boy was presented because of a restrictive mouth opening due to sub-glossopalatal membrane associated with a palatal cleft that made him to choke when feeding and snores all the time. He was admitted and nursed prone to allow the tongue to fall forward and prevent airway obstruction. He was also fed through nasogastric tube. He had a successful excision of membrane under local anesthesia on the 10 th day of life. He did well postexcision and was placed on cup and spoon feeding while awaiting a palatal cleft repair. He had an uneventful cleft palate repair at 10 months of age. This is the first African report of sub-glossopalatal membrane associated with a cleft palate. A careful management brings good outcome.

Outcome of management of complicated extragonadal teratoma in a resource poor setting.

Background: Extragonadal teratomas (EXGTs) are ubiquitous in the human body; hence, they have varied presentation. In underdeveloped areas presentation and management are affected by socio-economic, cultural and health facilities factors. The aim of this study was to review the outcome of management of complicated EXGT in a tertiary health centre. Materials and Methods: A review data of paediatric patients with EXGT was done between January 1999 and December 2012. Variables reviewed were bio-data, mode of presentation and site of tumour, comorbidity, treatments and outcome. The data was analysed with Statistical Package for Social Sciences (SPSS (R)) version 16.0. Results: There were 21 complicated EXGT (77.8%) among 27 children, age ranges from 4 days to 16 years (median = 2 years). Male:Female ratio of 1:2. The complications per region of the body at presentation were cervical 4 (66.7%), mediastinal 2 (100%), abdominal 3 (75%) and sacrococcygeal 12 (75%). The complications were respiratory distress 6, intestinal obstruction 5, faecal incontinence 2, bladder outlet obstruction 3, malignant transformation 5, ruptured sacrococcygeal teratoma 2, ulcerated tumour 2, anaemia 3 and malnutrition 3. There were 5 (23.8%) progressive disease post-excision outside our facility. Excision biopsy was successful in 19 (85%) patients two of which had neoadjuvant cytotoxic therapy. Overall mortality was 5 (23.8%) (septicaemia, anaemia, respiratory distress, renal failure) and post-excision mortality was 11.8% (endotracheal tube blockage and progressive disease). Conclusion: Delay presentation (due to local belief, ignorance and poverty) malnutrition, sepsis, malignant transformation characterised presentation of children in this study and the lack of paediatric intensive care unit facility and intensivists compromised survival of children with EXGT.