Amabra Dodiyi-Manuel

Abdominal injuries in university of port harcourt teaching hospital.

Background: Abdominal injury is relatively common in both civilian and military casualties and remains a major source of morbidity and mortality. The mechanism of injury may be blunt or penetrating. Some would require operative intervention, whereas others may be managed conservatively. Objective: The aim was to determine the pattern and outcome of management of abdominal injuries in the University of Port Harcourt Teaching Hospital (UPTH). Patients and Methods: This was a prospective study of all patients with abdominal injuries seen and managed in UPTH over a 4-year period (from January 1, 2009 to December 31, 2012). Relevant data were recorded and analyzed using Statistical Package for Social Sciences version 16. Results: Forty-five patients were seen during the study period. There were 40 males (88.9%) and five females (11.1%) making a male to female ratio of 8:1. Their ages ranged from 15 to 45 years with a mean of 27.8 ± 1.6 years and 21 to 30 years was the most commonly affected age group. The mechanism of injury was penetrating in 33 patients (73.3%) and blunt in 12 patients (26.7%). Thirty-four patients (75.6%) had an exploratory laparotomy after resuscitation, while 11 (24.4%) were managed conservatively. Small bowel was the most commonly injured organ following penetrating injury, seen in 14 patients (42.4%) while spleen was the most common in blunt injuries, seen in five patients (41.7%). The most common postoperative complication was surgical site infection, seen in four patients (8.9%). Two patients died giving a mortality rate of 4.4%. Conclusion: Gunshot to the abdomen is the most common cause of abdominal injury in UPTH. Serious campaign and legislation against militant and criminal activities would help to reduce the incidence.

Gastric outlet obstruction from duodenal lipoma in an adult

The duodenum is a rare site for gastrointestinal lipoma with less than 230 cases reported in the literature. Although, peptic ulcer disease remains the most common benign cause of gastric outlet obstruction (GOO), duodenal lipomas remain a rare, but possible cause of GOO and could pose a diagnostic challenge, especially in countries where access to endoscopy and modern imaging techniques poses a challenge. The authors present a case of GOO in a 40-year-old male, secondary to a duodenal lipoma. It was successfully treated by a transduodenal resection through a midline laparotomy. The histology report confirmed it was a submucosal lipoma.

Current concepts in the management of enterocutaneous fistula

Enterocutaneous fistula is an abnormal connection between the intra-abdominal gastrointestinal tract and skin.It is one of the most disheartening experiences to both the surgeon and the physician. In spite of the advances made in critical care, antibiotics and nutritional support, the management of enterocutaneous fistula remains a challenge to surgeons today with mortality remaining at 5-15%. The goals of management are restoration of gastrointestinal continuity and allowance of enteral nutrition with minimal morbidity and mortality. A multidisciplinary approach is essential in the successful management which is either by operative and nonoperative means. This involves optimal medical management, good and meticulous surgical technique where indicated with social and emotional support for ABSTRACT

Phaeochromocytoma: Is it that uncommon?

Background: Phaeochromocytoma has been described as a rare condition in the literature. Aim: This study aims to present cases of phaeochromocytoma seen at the University of Port Harcourt Teaching Hospital (UPTH) over a period of 6 years (2003–2008). Methods: All patients that presented with phaeochromocytoma within the study period were included in the study. Data were collected from hospital records and presented as case series. Results: Five cases of phaeochromocytoma seen at the UPTH between 2003 and 2008 form the subject of the retrospective report. There were three males and two females, and their ages were 40, 28, 23, 37 and 11, respectively. Four of the resected specimen were benign in histology while one was malignant. Mortality was recorded in only one patient. Conclusion: Having seen five cases of a condition that is reported as rare within a period of 5 years raises the question as to whether phaeochromocytoma is as rare as is generally recorded.

Spring active drain using bladder (50–60 ml) syringe (De Adotey’s drain)

Highlights • The use of a spring mechanism could be fashioned with a syringe.• De Adotey’s drain is a 60 ml bladder syringe with spring mechanism.• The spring mechanism is used to provide a negative pressure which serves as an active drain.• This is especially in a developing economy.

Ileosigmoid knotting in patients under 25 years of age: A report of two cases

INTRODUCTION Ileosigmoid knotting is a rare cause of acute abdomen with high morbidity and mortality. Its diagnosis is infrequently made before surgery because of its varying ways of presentation and rarity. PRESENTATION OF CASE The first was a 21-year-old male who presented with a history of sudden generalized abdominal pain and progressive abdominal distension. He was pale and severely dehydrated. His extremities were cold and clammy. His pulse rate was 110 per minute and blood pressure was 90/50 mmHg. The second case was 20-year-old male who presented with similar symptoms as above. He was not pale but mildly dehydrated. His pulse rate was 92 per minute and blood pressure 110/70 mmHg. Both patients were resuscitated and had exploratory laparotomy a few hours after presentation. The first patient was found to have ileosigmoid knotting with gangrenous sigmoid colon and terminal ileum. He had Hartmanns procedure and right hemicolectomy with ileo-transverse anastomosis. The second patient was found to have ileosigmoid knotting with viable loops of bowel. He had careful detorsion, sigmoidectomy with primary anastomosis. Both patients’ have good outcome. DISCUSSION This is to report two cases of ileosigmoid knotting in two male patients aged 21 and 20 years, respectively, with the hope of increasing awareness. CONCLUSION Ileosigmoid knotting though more common in fourth or fifth decade of life, can also occur in the 2nd decade. Early diagnosis, careful resuscitation and skilful surgical intervention will improve outcome.