Am Abubakar

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting.

BACKGROUNDnDespite the advances in management, congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting.nnnMETHODSnAll confirmed cases of CDH were prospectively documented from 2003 till date.nnnRESULTSnSeven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8%) and on the right side in one (17.7%). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived.nnnCONCLUSIONnWith inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.

Sacrococcygeal teratoma in Northeastern Nigeria: 18-years experience

Although sacrococcygeal teratomas are rare, there have been several reports from various parts of Nigeria, outside the Northeast region. This report reviews the experience with this tumour from the northeastern part of Nigeria. A retrospective study of 21 children with histologically confirmed sacrococcygeal teratoma managed in 18xa0years. Over the 18-year-period, 21 histologically confirmed cases of sacrococcygeal teratoma were seen—80% were girls. Thirteen (60.9%) presented during the neonatal period. Eighteen patients presented with benign sacrococcygeal teratoma while three patients and a recurrence from an initial benign tumour had malignant sacrococcygeal teratoma. All malignant tumours had a significant presacral component. There were associated congenital malformations in 3 (14.3%) of the patients. All the benign tumours were resectable. Using the American Academy of Pediatrics (Altman’s) classification (Altman etxa0al., J Pediatr Surg, 9:389–398, 1974), 13 patients were type I, 5 patients type II, 3 patients type Ill and none was for type IV. The commonest post-operative complication was wound infection in six patients. Others were wound dehiscence in three and post-operative diarrhoea in two patients. Three deaths were recorded in this series. The size of mass greater than 5xa0cm did not correlate with the incidence of post-operative complications (P=0.367). The post-operative follow-up was very poor; but there was a recurrence in a girl, two-years after the initial surgery. Our study revealed that most of our patients with sacrococcygeal teratoma present early to hospital with benign lesions and the immediate post-operative results were excellent. However, the follow-up was poor as such long-term post-operative results are difficult to study. It is to be recommended that sacrococcygeal teratoma presenting early to hospital should have prompt surgical intervention.

The epigastric heteropagus conjoined twins

Conjoined twins are rare and are classified as symmetrical or asymmetrical, in which a member, the host (autosite), is near normal and bears the parasite, which is incomplete, smaller, and fully dependent for growth on it. This form of conjoined twins is referred to as heteropagus and when attached to the epigastrium of the autosite is called epigastric heteropagus. Only 44 cases of epigastric heteropagus twins have been previously reported in the world literature. We hereby report the successful separation of a pair of heteropagus twins.

Information-seeking behavior and computer literacy among resident doctors in Maiduguri, Nigeria.

BACKGROUND/OBJECTIVEnResident doctors are key actors in patient management in all the federal training institutions in nigeria. Knowing the information-seeking behavior of this group of doctors and their level of computer knowledge would facilitate informed decision in providing them with the relevant sources of information as well as encouraging the practice of evidence-based medicine. This is to examine information-seeking behavior among resident doctors and analyze its relationship to computer ownership and literacy.nnnMATERIALS AND METHODSnA pretested self-administered questionnaire was used to obtain information from the resident doctors in the University of Maiduguri Teaching Hospital (UMTH) and the Federal Neuro-Psychiatry Hospital (FNPH). The data fields requested included the biodata, major source of medical information, level of computer literacy, and computer ownership. Other questions included were their familiarity with basic computer operations as well as versatility on the use of the Internet and possession of an active e-mail address.nnnRESULTSnOut of 109 questionnaires distributed 100 were returned (91.7% response rate). Seventy three of the 100 respondents use printed material as their major source of medical information. Ninety three of the respondents own a laptop, a desktop or both, while 7 have no computers. Ninety-four respondents are computer literate while 6 are computer illiterates. Seventy-five respondents have an e-mail address while 25 do not have e-mail address. Seventy-five search the Internet for information while 25 do not know how to use the Internet.nnnCONCLUSIONnDespite the high computer ownership and literacy rate among resident doctors, the printed material remains their main source of medical information.

Giant omental lipoma in a 13-year-old adolescent girl

Although lipoma is a common benign mesenchymal tumor, its occurrence in the omentum is a rare finding. We report an unusual case of omental lipoma in a 13-year-old adolescent girl. The mass was completely excised and weighed 12.3 kg. The patient is alive and well with no evidence of recurrence at 4 months of follow-up.

Appendicovesical fistula associated with Hirschsprung’s disease

Appendicovesical fistulae are rare. Only 112 cases in all ages have been reported previously in the world literature. Our case is that of a 1-year-old boy who presented during the neonatal period with missed appendiceal perforation associated with a long segment Hirschsprung’s disease. The case is discussed.

Epidemiology and management of head injury in paediatric age group in North-Eastern Nigeria

Background: Paediatric head injury (HI) is the single most common cause of death and permanent disability in children world over, and this is increasingly becoming worrisome in our society because of increased risks and proneness to road traffic accidents on our highways and streets. The study set to determine causes and management of HI among children in our society. Patients and Methods: A retrospective review of all children aged 0-15 years with traumatic head injury (THIs) who were managed at the University of Maiduguri Teaching Hospital between July, 2006 and August, 2008. Results: A total of 45 children with THIs presented to the casualty unit of the hospital; 30 (66.7%) were boys and 15 (33.3%) were girls. Three (6.7%) children were less than 1 year of age, 21 (46.7%) were between 1 years and 6 years while 16 (35.6%) and 5 (11.0%) were aged 7-11 years and 12-15 years respectively. Thirty six (80.0%) of the children were pedestrians, 6 (13.4%) fell from a height, while 2 (4.4%) and 1 (2.2% were as a result of home accident and assault, respectively. Twenty one patients (46.7%) had mild HI, while 53.3% had moderate to severe category. Forty one (91.1%) of children were managed as in-patients, mostly (95.1%) by conservative non-operative management, while 4 (8.9%) were treated on the out-patient basis. The mortality rate was 17.8%. Conclusion: H1 among children is of a great concern, because of its incremental magnitude, due to increasing child labour and interstate religious discipleship among children, with attendant high mortality and permanent disabilities. Necessary laws and legislations should be formulated and implemented with organized campaigns and public enlightenment to prevent and mitigate this menace.

Primary cutaneous aspergillosis in an immunocompetent patient.

We present a 32-year-old woman with primary cutaneous aspergillosis and an apparently normal immune status. She is a dietitian who carried out research on Aspergillus contamination of palm oil over a six-month period, during which she apparently shaved her axillae and perineum using a safety razor blade. She presented with nodular lesions, which became extensive ulcers after an attempt at incision and drainage. Diagnosis was based on culture and histology. The patient was treated with itraconazole 200 mg twice a day, with surgical excision and a rhomboid flap cover of the axillae. She has remained disease-free five years after discharge. This highlights the likely benefits of a combination of surgical excision and drug therapy, in achieving a cure in this patient.

MECONIUM PERITONITIS IN NIGERIAN CHILDREN

BACKGROUNDnMeconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter.nnnMETHODSnThis is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria.nnnRESULTSnThere were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X-rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%).nnnCONCLUSIONnOur data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprungs disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.

Exstrophy anomalies: Preliminary review of 18 cases in Maiduguri, North-eastern Nigeria

BACKGROUNDnExstrophy anomalies, although rare, pose a tremendous challenge to both surgeons and surrogates. Management is intricate and experience with large members is restricted to a few centres worldwide. This report is a review of 18 cases of these anomalies managed in University of Maiduguri Teaching Hospital (UMTH) over 8 years, highlighting the intricacies of management, and contributes to the existing data bank on this subject matter in our environment.nnnMATERIALS AND METHODSnWe reviewed the records of all cases of anomalies that were managed in the index hospital from December 2002 to December 2010.nnnRESULTSnEighteen cases were studied. The youngest was a 2-day-old neonate and the oldest was 6 years at repair, with a median age of 4 months. There were 7 boys and 9 girls with bladder exstrophy, and the remaining two were girls with cloacal exstrophy, giving a male-female ratio of 7:11 for the exstrophy anomalies. Eight patients (33.5%) had associated congenital anomalies; 16.7% had undescended testes (UDT), anorectal malformation (ARM) and patent processus vaginalis (PPV); and duplicate bladder occurred in 5.6% of the patients. All but one patient had bilateral posterior iliac osteotomy at bladder closure. Out of the 17 patients that had osteotomy, 76.5% had satisfactory bladder closure (no complication), 5.9% had superficial wound dehiscence, 11.8% had bladder neck dehiscence and 5.9% had complete disruption. The lone patient that did not undergo osteotomy had complete bladder dehiscence. Postoperative immobilization was done for 3 weeks for 16 cases; one was discontinued after 1 week because of complication. The longest follow-up was for 2 years and the shortest for 2 weeks. Four patients (22.2%) did not turn up for follow-up.nnnCONCLUSIONnExstrophy anomalies although rare remain a major challenge in paediatric surgery. Iliac osteotomy, among other technical considerations, remains a cornerstone for successful bladder closure.