Olusanya Adejuyigbe

Intrauterine intussusception causing intestinal atresia

The patient presented at the age of 2 days with persistent bilious vomiting, failure to pass meconium and urine, and progressive abdominal distension dating from birth, and a clinical diagnosis of intestinal obstruction was made. This was confirmed by plain abdominal radiographs. At laparotomy atresia of the terminal ileum was found. The proximal and distal segments of the bowel ended blindly and there was a V-shaped defect in the adjoining mesentery. The blind ends were resected and an end-to-back anastomosis was performed. The lumen of the resected distal segment contained an intussusceptum.

Pattern and factors affecting management outcome of neonatal emergency surgery in Ile-Ife, Nigeria

Objective:  To determine the pattern and various factors that can affect the outcome of emergency surgical management of the neonate in a developing country.

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria.

BACKGROUND Abdominal wounds following surgery for typhoid perforation are classified as dirty, with an infection rate of over 40%. To date, the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice, is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife, Nigeria, and advocates a multidisciplinary wound management protocol. PATIENTS AND METHODS This is a retrospective study of children aged < 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria, over a period of ten years. RESULTS Thirty-two patients, 18 males and 14 females, in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8%) patients, while 19 (59.4%) patients had surgical site infections. Wound dehiscence, intraabdominal abscess, and faecal fistulas were the other complications documented in the study. CONCLUSION Abdominal wounds of typhoid perforation, though classified as being dirty, can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs.

Determinants of mortality in neonatal intestinal obstruction in Ile Ife, Nigeria

BACKGROUND Neonatal intestinal obstruction (NIO) is a common cause of mortality. This study determined the causes of mortality in patients with NIO at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife. PATIENTS AND METHODS Records of all cases of NIO managed at OAUTHC between January 1996 and December 2005 were retrospectively reviewed and the possible factors that may result in mortality were analysed. RESULTS Sixty-three neonates with intestinal obstruction were managed, representing 24.3% of the neonatal admissions during the study period. Forty-two were males and 21 were females (M:F = 2:1). The majority (71.4%) of the patients presented within the first week of life. Anorectal malformation constituted 57.1% of the causes of NIO. Other causes included Hirschsprungs disease, duodenal atresia, intestinal malrotation with midgut volvulus and jejunal atresia. There were 18 deaths, with a mortality rate of 28.6%. Reoperation, postoperative bleeding and peroperative sepsis were significant determinants of mortality. CONCLUSION NIO is associated with significant mortality in our centre. Repeat surgery, postoperative bleeding and sepsis were the significant factors that contributed to mortality in NIO.

Management of ambiguous genitalia in ile ife, Nigeria: Challenges and outcome

BACKGROUND Ambiguous genitalia are a major cause of parental anxiety and can create social problems if not properly managed. Diagnosis and management can however be challenging. The aim of this study is to highlight some of the challenges in management of ambiguous genitalia in our environment. PATIENTS AND METHODS All cases of ambiguous genitalia managed at the Paediatric surgical unit of the Obafemi Awolowo University Teaching hospital, Ile Ife, Nigeria, between January 1993 and October 2007 were analysed for age, sex at presentation, investigation modality, and final sex of rearing and outcome of surgery. RESULT Nine patients had surgical reconstruction for ambiguous genitalia during the study period. Their age ranges from 5 weeks to 19 years at presentation. The causes of genital ambiguity in the patients was congenital adrenal hyperplasia (CAH) in 6, true hermaphroditism in 2 and male pseudo-hermaphroditism in 1. Seven patients were reconstructed as females while 2 were raised as males. Change of sex of raring was necessary in 2 patients. CONCLUSION The diagnosis and management of ambiguous genitalia is a challenging problem in our environment. Early presentation and treatment is necessary to avoid psychological and social embarrassment.

Day case inguinal hernia surgery in Nigerian children: Prospective study

BACKGROUND There has been an increase in day case surgery for children worldwide, but there have been few reports of the practice (most of them being retrospective) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. MATERIALS AND METHODS This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. RESULTS Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients, (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side, while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8%. In all, the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. CONCLUSION Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction.

Macrostomia: a report of three cases.

Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse properly to form the corners of the mouth. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the tragus. It is usually partial, but rarely complete. Transverse facial clefts are more common in males, and commoner on the left when unilateral. We report on 3 patients with macrostomia managed in our unit. There were 2 girls with a bilateral transverse facial cleft and a boy with a left unilateral transverse facial cleft. All had a 3 layered repair of their clefts with Z-plasty repair of the skin. The longest duration of follow-up was 2 weeks. Strict adherence to the principles of surgical reconstruction is advised in the repair of macrostomia to prevent a poor treatment outcome.

Pentalogy of cantrell: A report of three cases

Pentalogy of Cantrell is a rare upper midline syndrome that may present in association with anomalies outside the torso. The pentad - the supraumbilical body wall defect, sternal defect, deficiency of the anterior diaphragm, defect of the diaphragmatic pericardium, and the intracardiac anomalies - was first described by Cantrell et al., in 1958. The defect is said to be more common in males, and survival is dependent on the cardiac malformations and on the degree of completeness of the syndrome. We report three cases of Cantrell′s pentalogy managed in our unit. Two of the patients were females and one a male. All were seen at peripheral health centers before being referred to us. Age at presentation for the girls was 18 hours and 36 hours, respectively, the boy presented at the age of six weeks. All of their parents were unschooled manual workers. All patients presented with a defect in the supraumbilical body wall, bifid sternum, and a visible cardiac impulse. We were unable to do echocardiography to rule out intracardiac anomalies in the three patients. The thin membranous covering of the epigastrium in the female patients was managed conservatively. Both female patients were discharged against medical advice as requested by their parents, due to financial constraints. The male patient was lost to follow up after two clinic visits. A multidisciplinary approach to the management of this syndrome is recommended.

Experience with transverse preputial island flap for repair of hypospadias in Ile-Ife, Nigeria

OBJECTIVE To review our experience with the use of transverse preputial island flap in the repair of hypospadias in the paediatric surgical unit of our University Teaching Hospital, Nigeria. PATIENTS AND METHODS We reviewed the cases of hypospadias managed by transverse preputial island flap repair over a ten year period (1996 and 2006) in the paediatric surgical unit of our institution. Data was retrieved from the case notes and analysed. RESULTS Fifty-one patients had hypospadias repair during the period, 22 of whom were by transverse preputial island flap repair. Hypospadisas were in penile shaft in 16 (72.7%), penoscrotal in 5 (22.7%) and perineal in 1 (4.55%). All the patients had intact prepuce at presentation and chordee was present in 18 (81.8%). The commonest complication was urethrocutaneous fistula in five patients, which closed spontaneously in three leaving 2 patients (9.1%) with persistent urethrocutaneous fistular. CONCLUSION Transverse preputial island flap urethroplasty remains a viable option in the management of hypospadias especially when the meatal opening is proximal, with associated chordee limiting the options in the repair.

Spontaneous scrotal faecal fistula: A rare complication of incarcerated inguinal hernia in infancy

Spontaneous scrotal faecal fistula is a rare complication of incarcerated inguino-scrotal hernia in the neonate and infants. Only five previous cases have been reported in the English medical literature. We report another case of a 28-day-old neonate, who presented with fecal fistula following prolonged incarceration of a right inguino-scrotal hernia. The etiology and management of this rare complication is discussed.