Aminu Mohammad

Rectosigmoid lithobezoar in a eight-year-old.

Bezoars are rare foreign bodies in the gastrointestinal tract. They may be composed of hair (trichobezoars), vegetable matter (phytobezoars), milk curds (lactobezoars) and, very rarely, stones (lithobezoars). Colonic lithobezoars are very rare findings in children. We report an eight-year-old boy with a giant rectosigmoid lithobezoar, who presented with history of recurrent constipation and pica for five years. Four hundred and seventy two (472) pieces of asphalt stones ware manually evacuated via the anus.

Thyroid cervico-thoracic teratoma in a 14-month old child

Cervical teratoma (CT) is a rare disease which accounts for approximately three to five per cent of all teratomas in children. Airway compromise is the most serious postnatal complication of cervical teratoma. Prenatal diagnosis is crucial for early recognition of neck masses that could obstruct the airway. We present our experience in the management of a huge cervico-thoracic teratoma in a 14-month old Nigerian child.

Open inguinal herniotomy: Analysis of variations.

Background: Repair of congenital groin hernia/hydrocele is the most common surgical procedure performed by paediatric surgeons. There is dearth of literature comparing the outcomes of open herniotomy in children using various surgical approaches. This study was aimed at evaluating the efficacy of open herniotomy by comparing external ring incision, hernial sac twisting and whether or not double ligation has benefit over a single suture application. Materials and Methods: A multi-centre prospective randomised clinical trial was conducted with a total of 428 patients having congenital inguinal hernia and/or hydrocele. Patients were randomly assigned into four groups: RO (had external ring opened, hernial sac twisted and doubly ligated), ST (had hernial sac twisted and doubly ligated without opening the ring), DL (had double ligation of hernial sac without ring opening nor twisted) while SL (had single ligation of hernial sac with neither ring opening nor sac twisting). Results: A total of 458 repairs were done. Patients′ age ranged from 0.25 years (3 months) to 21 years in group RO with mean of 4.87 × 4.07 (median, 4), 0.069 years (24 days) to 17 years in group ST with mean of 4.23 × 4.03 (median, 3), 0.5 years (6 months) to 16 years in group DL with mean of 4.59 × 3.87 (median, 4) and 1 year to 19 years in group SL with mean of 5.00 × 4.19 (median, 4). Operation time per repair was 26.50 × 5.46 min, range 16-40 min (median, 27 min) in group RO, 22.18 × 5.34 min, range 12-39 min (median, 21 min) in group ST while 17.98 × 3.40 min with range of 12-39 min (median, 17 min) in group DL and 15.27 × 4.18 min, range 7-40 min (median, 15 min) in group SL P < 0.0001. The mean paracetamol dose/patient was 3.96 × 1.43, 2.94 × 0.81, 2.18 × 0.69, 1.87 × 0.78 in group RO, ST, DL and SL, respectively, P < 0.0001. Conclusion: Congenital inguinal hernia repair with opening of the external ring, hernia sac twisting and double ligation of the processus vaginalis confers no advantage.

Herniotomy in resource-scarce environment: Comparison of incisions and techniques

Background: There are various methods for surgical treatment of hernia and hydrocele in children with variable cost-effectiveness, recovery and cosmetic outcomes. This study analyses our experience with mini-incision/invasive herniotomy in children in resource-limited centre. Materials and Methods: Seven hundred and eighty-four n = 784 patients underwent herniotomy via conventional and mini-invasive methods were assigned into Group A and Group B. Three hundred and seventy-six n = 376 (47.95%) in Group A while four hundred and eight n = 408 (52.04%) in Group B. Eight hundred and seventeen (817) herniotomy was performed. Demographic data, hernia/hydrocele sides, volume of surgical suture used, surgery duration, and complications analysed. Results: Right side hernia and/or hydrocele were 464 (59.18%). 287 (36.60%) had left sided while 33 (4.21%) had bilateral hernia and/or hydrocele. There were 14 bilateral hernia repair in Group A and 19 in Group B. The lengths of operation time for unilateral repair ranged from 14 to 54 min in Group A (median, 23 min) and 7-44 min in Group B (median, 15 min) with a mean surgical duration of 15.48 ± 4.16 min in Group B versus 23.41 ± 5.94 min in Group A (P < 0.001) while the range of the lengths of operation time for bilateral repair in Group A was 20-54 min (median, 36) and 12-30 min (median, 21) in Group B with a mean duration of 36.35 ± 9.89 min in Group A versus 20.42 ± 4.83 min in Group B P = 0.00563. 376 sachets of 45 cm suture material were used in Group A versus 137 in Group B. There were total of 87 (23.13%) complications in Group A versus 3 (1.47%) in Group B P = 0.000513. Superficial wound infection and abscess were 9 (2.36%) and 16 (4.25%) in Group A versus none (0) in Group B. Conclusion: Mini-incision/invasive herniotomy in children and adolescents is fast, cost-effective with satisfactory cosmetic outcome and limited complications

Burden of congenital inguinal hernia and hydrocele in northern and southern Nigeria: an opportunity for awareness creation.

Background: Nigeria, with a population of >150 million people in which half of the population are children encounters challenges in paediatric surgery practice in rural areas. There are paediatric surgeons in Nigeria, but majority practice in tertiary health facilities in cities. The poor rural dwellers have little or no access to such highly trained specialists. Hence, children with congenital and acquired paediatric surgical pathologies including anterior abdominal wall defects not only grow up with these diseases to adulthood, they are also exposed to various health hazards posed by unqualified personnel. Therefore, we are evaluating the burden of congenital inguinal hernia/hydrocele in northern and southern Nigeria for awareness creation and the way forward. Materials and Methods: Data obtained from organised free hernia missions to the rural populace from northern and southern Nigeria by the West African Collage of Surgeons in 2010 and Kano State Government in 2013 was analysed. Results: A total of 811 patients aged from 3 months (0.25 years) to 35 years was screened and found to have congenital hernia and/or hydrocele from the two centres. 171 (21.1%) were successfully operated, while the remaining 640 (78.9%) could not benefit from a surgical procedure during the missions. There were n = 46 (26.9%) patients with various forms of genital mutilations/and or surgical mismanagements among the operated patients. Conclusion: The burden of congenital anterior abdominal wall defects among Nigerian children is high. A little effort could bring succor and create awareness among this group of people.

Pentalogy of Cantrell; complete expression in a nine-month-old-boy

Pentalogy of Cantrell is a rare congenital malformation whose exact cause is not completely understood; it is characterized by defects in the anterior abdominal and thoracic walls consisting of omphalocoele, diaphragmatic defect, ectopia cordis, intracardiac defects and sternal clefts. The complex has variable clinical expression with complete and incomplete expressions reported. We, therefore, report a case of complete manifestation of the pentad in a 9-month-old boy.

Lymphoepithelial cyst of the pancreas in female children—report of two cases ☆,☆☆

Lymphoepithelial cyst (LEC) of the pancreas is almost always reported as a case report or in small series mostly in male adult patients with vague clinical manifestations and difficult pre-operative diagnosis. Between the years 2007 and 2012, two female children with LEC of the pancreas were operated on at the Childrens Surgical Unit of Murtala Mohammad Specialist Hospital, Kano in northern Nigeria. Satisfactory outcomes were achieved after distal pancreatectomy and splenectomy in one and a Whipple procedure in the other. This benign lesion of the pancreas should be considered in the differential diagnosis of cystic lesions of the pancreas in children.

Parasitic twins: Report of two cases

Parasitic twin is a rare malformation, which involves two fetuses attached to each other, whereby one of the pair is viable and develops into a mature embryo (the host twin) called the autosite, while the second twin (parasite) is usually nonviable, but survives on the host twin; the site and extend of their attachment are varied and may be associated with other congenital malformations. Its exact cause is not completely understood. Though, it has been reported in many countries, there is dearth of information on its occurrence in Nigeria. Therefore, we report two cases of parasitic twins seen in our institution. The first case had an extra-limb, scrotal mass projecting from the anterior abdominal wall, which also had an anterior abdominal wall defect below the extra-limb, while the second case had a sacroccoygeal mass which was a duplicate gluteal mass with malformed lower limb, digit with a toe nail projecting from it and an atrophic scrotal skin attached. Both cases had chest, spinal X-rays and abdominal ultrasounds, which excluded any other malformation. They had successful surgical excision of parasites and are being followed-up in the surgical clinic both having appropriate developmental milestones.

Menace of childhood non-accidental traumatic brain injuries: a single unit report

Background: Childhood traumatic brain injury (TBI) has high rate of mortality and morbidity worldwide. There are dearths of reports from developing countries with large paediatric population on trauma; neurosurgery trauma of nonaccidental origin is not an exemption. This study analysed menace of non-accidental TBI in the paediatric population from our center. Materials and Methods: This is a single unit, retrospective study of the epidemiology of non-accidental TBI in children starting from September, 2008 to March, 2014. The management outcomes of the epidemiology of the non-accidental TBI were analysed. Results: Total of 109 children age range from 0 (intra-natal) to 16 years with a mean of 5.8 ± 4.6 years (median, 5 years) were enrolled into the study. 34 (31.2%) were domestic violence, 26 (23.9%) street assaults, 16 (14.7%) were due to animal assaults and mishaps, 17 (15.6%) fall from heights. Seven (6.4%) cases of collapsed buildings were also seen during the period. Four (3.7%) industrial accidents and two (1.8%) were self-inflicted injuries. There were also three (2.8%) cases of iatrogenic TBI out of which two infants (1.8%) sustained TBI from cesarean section procedure while one patient (0.9%) under general anaesthesia felt from the operation bed resulting to severe TBI. Conclusion: Child abuse, unprotected child labour, parental/care-givers negligence are the main cause of nonaccidental TBI. Human right activists and government agents should be incorporated in curtailing the menace.

Intravesical migration of gossypiboma following vaginal hysterectomy: An unusual cause of acute urinary retention

A gossypiboma also known as textiloma or cottonoid are terms used to describe a foreign object, such as a mass of cotton matrix or a sponge that is left behind in a body cavity during an operation. It is an uncommon surgical complication. The manifestations and complications of gossypiboma are so variable that diagnosis may be difficult and patient morbidity is significant. The incidence of retained surgical instruments is estimated at 1 in 100-3,000 of all surgical interventions and 1 in 1,000-1,500 for all intra-abdominal operations. We report a case of extrusion of forgotten gauze following vaginal hysterectomy in a 49-year-old woman. The gauze migrated into the bladder presenting with acute urinary retention. She had vesicostomy retrieval of the gossypiboma and repair of the defect on posterior wall of the bladder. She did well postoperatively with no complication. Any woman that had pelvic surgery and is presenting with recurrent pelvic pain, urinary tract infection (UTI) and lower urinary tract irritative, or obstructive symptoms gossypiboma should be suspected and investigated.