Jm Adotey

Gossypiboma: a report of 2 cases.

BACKGROUND Retention of surgical sponges in body cavities (gossypiboma) is preventable. It is probably under reported, may be for medicolegal reasons. We report 2 cases we have managed, one at a tertiary medical centre, and the other, at a private clinic in Port Harcourt, in order to re-awaken the awareness of its occurrence and make a plea for caution during surgery. METHODS The case notes of patients treated surgically over the period between 1995 and 2004 were reviewed for cases of retained surgical sponges. RESULTS Two cases were identified over the period 1995 to 2004. One had presented acutely while the second case presented in a sub-acute manner. Both required re-exploration and retained sponges were retrieved. CONCLUSION It may not be possible to eradicate the occurrence of retained sponges in the body but it can definitely be minimized, thus saving many patients from the associated agony.

An audit of basic practical skills acquisition of final year medical students in a Nigerian medical school

BACKGROUND/OBJECTIVE Young medical graduates undertaking their housemanship are naturally expected to demonstrate reasonable competence in basic practical skills. Failure to do this may not only be a source of anxiety to the doctor but also potentially dangerous to the patient. The objective was to assess the level of exposure of final year medical students of a Nigerian medical school to basic practical skills. MATERIALS AND METHODS This is a descriptive cross-sectional study. Structured questionnaires were distributed to a set (all) of 86 final year medical students of the University of Port Harcourt immediately after their last lecture in their final posting in medicine and surgery. The questionnaires listed some selected basic practical skills (e.g. phlebotomy, male urethral catheter insertion, etc.) that house officers are expected to be competent in. The students were asked to anonymously fill them and return same before leaving the lecture hall. RESULTS Of the 86 students, 84 completed and returned the questionnaires, giving a 97.7% response rate. No student had performed an arterial puncture for an arterial blood sample. Seventy-six students (90.5%) had not inserted a naso-gastric tube. Only 14 (16.7%) students had successfully inserted more than 10 intravenous canulae. A significant number, 38 (45.2%), had never inserted a urinary catheter (for male patients) nor had any experience with bag/mask skills. Majority, 59 (70.2%) had had some experience with intravenous antibiotics administration. Forty-one (48.7%) students had had 6 or more successful attempts at venous blood sampling. CONCLUSION The exposure level of final year medical students to basic practical skills was low.

Acute abdominal conditions in people with sickle cell disease: A 10-year experience in Port Harcourt, Nigeria

BACKGROUND Abdominal crises (vaso-occlusive) are not infrequent in patients with sickle cell anemia. They usually present as acute abdomen. These patients none the less present with other causes of acute abdomen like others without hemoglobinopathy. Six cases of surgical acute abdomen in sickle cell disease patients treated in the University of Port Harcourt Teaching Hospital (UPTH) are presented. MATERIALS AND METHODS Six sickle cell anaemia patients presenting with acute abdominal conditions from 1999 to 2008 (inclusive) in the University of Port Harcourt Teaching Hospital were studied retrospectively (two patients) and prospectively (four patients). After initial resuscitation, appropriate surgical procedures, namely, appendicectomy (2), cholecystectomy (1), open drainage of splenic abscess (1), and release of adhesive band (1) were performed. RESULTS Six cases were treated (female/male ratio 2:1). Four patients were in the 11-20 year age group. Two patients had appendicectomy and two presented with acute cholecystitis/cholelithiasis, one of whom had open cholecystectomy. One young girl had drainage of splenic abscess and a 42-year-old male had division of obstructive adhesive band at laparotomy. There were two complications, namely, postoperative haemorrhage (in cholecystectomy patient) and acute chest syndrome (in one appendicectomy patient). These were successfully managed with blood transfusion and antibiotic/oxygen therapy, respectively. There was no mortality. CONCLUSION Sickle cell anaemia patients are not exempt from acute abdominal conditions requiring surgery. A high index of suspicion coupled with repeated clinical examination is needed for early diagnosis and appropriate treatment.

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.

Mucinous colonic adenocarcinoma in patients aged under 25 years.

Extracted from text ... SCIENTIFIC LETTERS 616 To the Editor: Mucinous adenocarcinoma of colorectal origin in patients under 25 years of age is rare in the Nigerian environment and there are few reports on it in the available literature.1 In this age group the tumour is aggressive.1 We report on 3 cases of mucinous colonic adenocarcinoma in patients aged under 25 years and highlight the aggressive course of this tumour. A previous study at University College Hospital (UCH), Ibadan, Nigeria, reported colorectal carcinoma in patients aged 30 years and below.1 However the study did not concentrate on mucinous adenocarcinoma. These tumours secrete large amounts ..