Philemon E Okoro

Childhood burns in south eastern Nigeria

BACKGROUND Burns injuries are recognized as a major health problem worldwide. In children and, particularly, in our environment where poverty, ignorance and disease are still high, they constitute significant morbidity and mortality. Previous studies on this topic in parts of Nigeria either lumped adults and children together or were retrospective. We, therefore, prospectively studied the current trends in burns in children. PATIENTS AND METHODS This prospective study of burns spanned over a period of 18 months (June 2006-December 2007) at the Paediatric Surgery Units of the Imo State University Teaching Hospital, Orlu, and the Federal Medical Centre, Owerri, Imo State. Data were collected and analysed for age, sex, cause/type of burn, place of burn, presence or absence of adult/s, initial prehospital intervention, interval between injury and presentation, surface area and depth of burn and treatment and outcome. RESULTS Fifty-three patients were studied, 31 (58.4%) were male and 22 (41.6%) were female (M:F = 1.4:1). Patients mostly affected were aged 2 years and below. The most common cause of burns was hot water in 31 (58.5%) patients. The vast majority of these injuries happened in a domestic environment (92.5%) and in the presence of competent adult/s (88.7%). Outcome of treatment was good: there were two (3.8%) deaths and 46 (86%) patients had complete recovery. CONCLUSION Burns is still a major health problem among children in south eastern Nigeria. Fortunately, outcome of appropriate treatment is good. However, we think that poor safety consciousness among parents is a major predisposing factor. Public enlightenment on measures to ensure safe home environment may be necessary to avoid or limit childhood burns.

Pattern, outcome and challenges of neonatal surgical cases in a tertiary teaching hospital.

Background: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. Patients and Methods: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome. Results: Out of 7,401 neonates admitted within the study period, 460 (6.2%) had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8%) of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7%) of all the surgical cases. Intestinal obstruction 129 (31.6%), neural tube defects 101 (24.8%) and anterior abdominal wall defect 58 (14.2%) were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8%) and perforated NEC 14 (26.9%) were the commonest acquired conditions. Surgery was performed in 166 (36.1%) and 98 (59%) had postoperative complications. Significantly, more deaths occurred in preterms than in term babies (P = 0.003) and in those delivered outside the hospital than in in-born babies (P = 0.02). The major cause of death was infection in 92 (47%). Conclusion: Neonatal surgical conditions contributed significantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries.

Recurrent lymphangioma: what are the treatment options?

This is a report of a rerecurrence of extensive lymphangioma involving the neck, chest and both breasts of a female. The patient has had recurrence of the lesion twice following surgical excision. Surgery alone seemed to be insufficient in this case. Could adjunct of sclerotherapy have made a difference at the first surgery? Faced with a third recurrence, what other options are left? We report this case to highlight the difficulties and dilemma in managing extensive lymphangiomas.

Pilot study on laparoscopic surgery in port-harcourt, Nigeria.

Background: Video-laparoscopic surgery has long been practiced in western countries; however documented practice of this minimal access surgical technique are recently emanating from Nigeria. To the best of our knowledge, this is the first documented study on laparoscopic surgery from the Niger Delta region. Aim: To evaluate the feasibility of laparoscopy as a useful tool for management of common surgical abdominal conditions in our environment. Patients and Methods: This was a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution from August 2011 to December 2012. Data on patient′s age, gender, indication for surgery, duration of hospital stay and outcome of surgery were collected and analyzed. Results: A total of 15 laparoscopic procedures were performed during this study period with age range of 2-65 years; mean: 32.27 ± 17.86 years. There were 11 males and four females. Six laparoscopic appendicectomies, one laparoscopy-assisted orchidopexy, five diagnostic laparoscopy ± biopsy, one laparoscopic trans-abdominal pre-peritoneal herniorrhaphy for bilateral indirect inguinal hernia and two laparoscopic adhesiolysis for small bowel obstruction were performed. All were successfully completed except one conversion (6.7%) for uncontrollable bleeding in an intra-abdominal tumor. Conclusion: The practice of laparoscopic surgery in our environment is feasible and safe despite the numerous, but surmountable challenges. There is the need for adequate training of the support staff and a dedicated theatre suite.

Experience with neonatal hydrometrocolpos in the Niger Delta area of Nigeria: Upsurge or increased recognition?

Background: Hydrometrocolpos (HMC) is a clinical condition in which there is a cystic distension of the vagina (hydrocolpos), uterus and sometimes, fallopian tubes (hydrosalpinx) with fluid. This study described our experience with cases of HMC seen in our practice, and highlighted the flare in our practice. Patients and Methods: A retrospective study of cases of HMC managed at the University of Port Harcourt Teaching Hospital between September 2010 and August 2012. Results: There were seven cases; their ages ranged from 2 to 27 days (median 13 days). All the patients had abdominal distension but abdominal mass was obvious only in four. Other features varied depending on the presence of sepsis or other associated anomalies. The diagnosis of HMC was missed in all cases by the referring clinicians. One patient was referred with the diagnosis of tracheoesophageal fistula and esophageal atresia, 2 with bladder outlet obstruction, 1 with intestinal obstruction, 2 with anorectal malformation, and 1 with neonatal sepsis. Ultrasound identified bulky uterus in two cases and upper urinary tract dilatation in 3 patients. Six patients had laparotomy, 1 had hymenotomy only. Postoperative complications were basically wound sepsis and rectovaginal fistula resulted. Conclusion: Diagnosis of HMC should be considered as a differential in newborn girls presenting with lower abdominal mass. Attention to clinical detail is necessary to avoid a misdiagnosis.

Giant macroglossia with persistent nonocclusion in a neonate

Excessive enlargement of the tongue, macroglossia, is a well-recognised clinical condition which can pose significant social and health problems. We report a case of a neonate who was born with a tongue grossly enlarged to the point of inability to feed and deformation of the jaw. Despite surgical reduction of the tongue to normal size, there was a persistent nonocclusion of the mouth, making sucking impossible. Physiotherapy did not help and our experience with neonatal jaw osteotomy is limited. We wonder if a prenatal aspiration of the tongue cyst could have forestalled this jaw deformation.

The place of spermatic fascia closure during open herniotomy in male children

Introduction: There is currently no consensus about closing or otherwise of the spermatic fascia at herniotomy in children. This stems from lack of evidence to justify either stand, and most literatures are silent on this. This study is an effort to evaluate the place of closure of the spermatic fascia at hernia repair. Aim: To determine if there is advantage in closing the spermatic fascia over leaving it open during herniotomy in children. Materials and Methods: Cases of inguinoscrotal hernia repaired by the same surgeon between July 2009 and June 2011 were randomly grouped into two; spermatic fascia closed (SC) and spermatic fascia open (SO) groups. They were assessed for operation duration, wound infection, scrotal hematoma, and scrotal edema post repair. The Data obtained was collated and analyzed using the SPSS 17.0. Results: Seventy-six male children with unilateral complete inguinoscrotal hernia were included in this study. The overall mean duration of operation was 32.9 min (SD = 5.7); range 21-52 min. There was hematoma formation in 7 (17.9%) of the SC group and 9 (24.3%) of the SO group (P = 0.5). Scrotal edema occurred in 24 (64.8%) of the SO and 18 (46.2%) of the SC group (P = 0.3). No other complications were recorded during the period of study. Conclusion: There is no demonstrable advantage or disadvantage in closing the spermatic fascia at herniotomy for children. We conclude that the choice to close or not to close the spermatic fascia at herniotomy for children should be at the discretion of the individual surgeon.

Pattern and survival of biliary atresia patients; Experience in Southern Nigeria

Background: Biliary atresia (BA) has been a challenge to surgeons worldwide. Beyond the revolutionary surgical technique popularised by Kasai, liver transplantation has added renewed hope in the long-term outcome. In Nigeria, where late presentation is very common, there is need to assess the long-term results of the treatment options available to us. Aim: We aimed to evaluate the presentation and management outcome of BA and the long-term survival of BA patients seen in our practice. Materials and Methods: Cases of BA seen between January 2007 and December 2011 in three tertiary health facilities in South East Nigeria were included. Data obtained included age at presentation, clinical features, treatment offered and age at the time of death. Analysis was with the SPSS 17.0. Results: Twenty four patients comprising 10 (41.7%) males and 14 (58.3%) females were included in the study. The mean age of presentation was 4.02 (±214) months; range 1.75-11.0 months. Fifteen (62.5%) patients had surgery while 9 (37.5%) received medical treatment only. The mean age at death was 14.2 (±8.1) months; range 2.5-30 months. Conclusion: BA poses a daunting challenge in our practice. Outcome of treatment is still discouraging. We identified late presentation, lack of facilities to make early diagnosis, lack of adequately trained manpower to manage these children and lack of post-operative care and support for patients as the major challenges in the management of BA children in our region.

Collaboration between paediatric surgery and other medical specialties in Nigeria.

BACKGROUND The quality of service and success of patient care and research in most fields of medicine depend on effective collaboration between different specialties. Paediatric surgery is a relatively young specialty in Nigeria and such collaborations are desirable. This survey assesses the nature and extent of collaboration between paediatric surgery and other specialties in Nigeria. MATERIALS AND METHODS This is a questionnaire survey carried out in November 2008 among paediatric surgeons and their trainees practising in Nigeria. Questionnaires were distributed and retrieved either by hand or e-mailing. The responses were then collated and analysed using the SPSS 17.0. RESULTS Forty-seven respondents were included in the survey. Forty-five (95.7%) respondents thought that there was inadequate collaboration and that there was a need for an increased collaboration between paediatric surgery and other specialties. Anaesthesia, paediatrics and radiology are among the specialties where collaborations were most required but not adequately received. Collaboration had been required from these specialties in areas of patient care, training and research. Reasons for inadequate collaboration included the paucity of avenues for inter-specialty communication and exchange of ideas 33 (70.3%), lack of awareness of the need for collaboration 32 (68.1%), tendency to apportion blames for bad outcome 13 (27.7%), and mutual suspicion 8 (17%). CONCLUSION There is presently inadequate collaboration between paediatric surgery and other specialties in Nigeria. There is a need for more inter-specialty support, communication, and exchange of ideas in order to achieve desirable outcomes.

Clinicopathological report of children and young adults with nephrotic syndrome undergoing renal biopsy at workshops in Port Harcourt, Nigeria

Background: Kidney biopsy is a procedure that is not commonly performed in Nigeria. This study reports the clinical and pathological findings in children who underwent renal biopsies during nephrology workshops held in Port Harcourt in 2014 and 2015. Methods: The native kidney biopsies were processed and evaluated using light microscopy only. Results: Nineteen patients (10 females) were biopsied. The mean age was 11.0 ± 6.5 years and the range was 1.8 to 21 years. Eleven patients had steroid-dependent nephrotic syndrome (SDNS) whereas eight were steroidresistant (SRNS). Hypertension and haematuria were present more often in SDNS. There were 11 cases (58%) with non-proliferative lesions, including minimal change disease (4 cases), focal segmental glomerulosclerosis (4 cases) and collapsing glomerulopathy (3 cases). The proliferative lesions (8 cases) included membranoproliferative (mesangiocapillary) glomerulonephritis (MPGN, 5 cases), mesangial proliferative glomerulonephritis (2 cases) and MPGN with collapsing glomerulopathy (1 case). Overall, the most common pathological diagnosis was MPGN (26%). Hypertension was more common with proliferative than with non-proliferative lesions (63% versus 36%). Conclusions: Although MPGN was the most common morphological lesion among children with nephrotic syndrome, bigger studies are necessary to confirm this. Efforts should be intensified in acquiring the expertise and infrastructure for performing and interpreting renal biopsies in Port Harcourt in order to optimize patient management.