Abstracts – Association of Paediatric Surgeons of Nigeria

[vc_row][vc_column][vc_tta_tabs][vc_tta_section title=”2018″ tab_id=”2018″][vc_column_text]17TH ANNUAL GENERAL MEETING AND SCIENTIFIC CONFERENCE OF THE ASSOCIATION OF PAEDIATRIC SURGEONS OF NIGERIA.

KANO.  27TH – 28TH SEPTEMBER 2018.

THEME : PAEDIATRIC SURGICAL RESEARCH IN SUBSAHARAN AFRICA; CHALLENGES AND PROSPECTS.

SUBTHEME: ANTERIOR ABDOMINAL WALL DEFECTS

                       PAEDIATRIC SURGICAL INFECTIONS

                       NUTRITION IN PAEDIATRIC SURGERY

ABSTRACTS

  1. Hypospadias Repairs In Nnewi , Nigeria: Presentations, Techniques And Outcomes
  2. Experience With The Use Of Mohan’s Valvotome For Posterior Urethral Valve AblationA Preliminary Report.
  3. Nephroblastoma: 10 Year Experience In A Tertiary Institution In Sokoto, Northwestern Nigeria.
  4. Peritonitis Among Adolescents At Aminu Kano Teaching Hospital, Kano, Nigeria.
  5. Elective Mass Hernia Repair In Children: Prospects And Challenges.
  6. Epidemiological Aspect And Outcomes Of Patent Ductus Arteriosus Ligation From A New Cardiothoracic Programme
  7. Congenital Lumbar Hernias: About 6 Cases Collected
  8. Profile Of Paediatric Chest Wall Tumours And Management Outcome In A Tertiary Health Facility In Southern Nigeria
  9. A Persisting Menace: Ascariasis Causing Childhood Intestinal Obstruction In An Urban Centre.
  10. Internal Hernia: A Rare Complication Of Appendectomy
  11. Outcome Of Reversal Of Gastrointestinal Stoma In Children
  12. Childhood Intussusception In South-West Nigeria: A Multicentre Study
  13. Clinical Predictors And Outcome Of Bowel Resection In Paediatric Intussusception

 

  1. Appendicitis In Children: Early Versus Late Presentation
  2. Pyloroduodenal Duplication Cyst Presenting Like Hypertrophic Pyloric Stenosis
  3. Outcome Of Operative Management Of Intussusception At A Tertiary Health Centre In North-Western Nigeria
  4. Improving The Outcome Of Neonatal Surgeries In Nigeria: NNSQI Project Phase I Progress Report
  5. Anterior Abdominal Wall Defects: The University Of Abuja Teaching Hospital (UATH) Experience
  6. Right Posterior Diaphragmatic Hernia With Omphalocele; Management Challenges And Benefits Of Multidisciplinary And Multicentre Collaboration In A Resource Poor Setting
  7. Meconium Peritonitis Simulating Gastrochisis
  8. Multiple Perineal Fistulae: An Unusual Presentation Of A Low Anorectal Anomaly
  9. Comparative Analysis Of Management Of Gastroschisis By Improvised Silo Versus Extended Right Hemicolectomy; A Preliminary Report
  10. Assessment Of House Officers’ Knowledge Of Neonatal Surgical Emergencies
  11. . Surgical Intervention Time In A Tertiary Hospital-A Local Experience
  12. Impact Of Malnutrition On Outcome Of Surgery In Children
  13. An Audit Of Operations Among Adolescent Patients In Aminu Kano Teaching Hospital: A 5 Year Review
  14. Accessibility Of Available Surgical Health Services, A Reflection Of Cost Affordability By Parents Of Children?
  15. Challenges In Paediatric Surgical Research In Nigeria
  16. Surgical Site Infection In Nigerian Children: A Systematic Review
  17. Patient Family/Relatives As Adjunct To Health Care Delivery
  18. Analysis Of The Cost Of Patent Ductus Arteriosus Ligation For Paediatric Patients: A Call For Nationwide Health Insurance Coverage
  19. Improving The Paediatric Surgical Workforce In Nigeria: Implications From A Community Based SOSAS Study In Nigeria
  20. Neonatal And Paediatric Surgery Across Sub-Saharan Africa: Results From A Multi-Centre Prospective Cohort Study
  21. Management And Outcomes Of Congenital Anomalies In Low-, Middle-, And High-Income Countries: Protocol For A Multi-Centre, International, Prospective Cohort Study
  22. Knowledge And Use Of Biostatistics Among Resident And Junior Doctors At University Of Port Harcourt Teaching Hospital, Port Harcourt
  23. Challenges of Management of Intestinal Atresia in Kano, Nigeria
  24. Neonatal Intestinal Obstructions In Kano: Outcome Of Management
  25. Serum Electrolytes Profile Of Children With Typhoid Intestinal Perforation In Aminu Kano Teaching Hospital, Kano- Experience Over 5 Years
  26. Emergency Presentation Of Anorectal Malformation In Kano

POSTERS

  1. Idiopathic Neonatal Priapism: A Case Study and a Review of the Literature

 

 

  1. HYPOSPADIAS REPAIRS IN NNEWI , NIGERIA: PRESENTATIONS, TECHNIQUES AND OUTCOMES

 Ugwu J O1, Ekwunife O.H1, Modekwe V I1, Mbaeri T U2, Osuigwe A N1.

1Paediatric Surgery Unit, Nnamdi  Azikiwe University Teaching Hospital, PMB 5025, Nnewi , Nigeria

2Division of Urology, Nnamdi  Azikiwe University Teaching Hospital, PMB 5025, Nnewi , Nigeria

 

Background

Hypospadias is the most common congenital abnormality of the penis. Its incidence is rising however reconstructive repairs remain a huge challenge. We aim to review our approach to repairs and their outcomes.

 

Patients and Methods

This is a five and half –year retrospective evaluation of all consecutive cases of hypospadias repair in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Data on demographics, presentations , type of anomaly, repair technique and outcome were extracted and analysed using Statistical software package for Social Sciences (SPSS)

 

Results

A Total of 64 boys had primary repair for hypospadias within the study period (Jan 2013 –June 2018). The median age at presentation was 17months while the median age for repair was 25 months, 32.8% were already circumcised before presentation and 77% of them were done by nurses.  The most common associated anomaly was inguinal hernias in 3 (4.7%) while 39(60.9%) had chordee. The location of the meatus were as follows; Glansular 2 ( 3.1%), coronal 20(31.3%), distal penile17 (26.6%), midpenile 6(9.4%), proximal penile 5(7.8%), penoscrotal  7((10.9), interscrotal  2(3.1%) and perineal 5(7.8%). Case volume doubled in two successive years and had peak of 15 per year. Techniques of repair were modified tabularized incised plate urethroplasty 51(79.7%), Modified koyanagi 7(10.9%), Modified Thiersh- Duplay 4(6.3) and staged repair (2(3.1%). Urethrocutaneous fistula occurred in 16 (25%) however 12(75%) healed spontaneously. There was a drrop in fistula rate from 40% in 2015 to 6.3% in 2018.

 

Conclusion

Our case volume of hypospadias is on the increase, sustained learning and modifications of techniques evidently reduce complications

Keywords: Hypospadias, urethroplasty, urethrocutaneous fistula

 

 

  1. EXPERIENCE WITH THE USE OF MOHAN’S VALVOTOME FOR POSTERIOR URETHRAL VALVE ABLATIONA PRELIMINARY REPORT

Oyinloye AO, Abubakar AM,Wabada S,Oyebanji LO

 

Background

Posterior urethral valve  is a common cause of lower urinary tract obstruction.. It continues to be a major cause of  morbidity, mortality and  progressive renal impairment in children. The aim of the study was to highlight  the clinical  presentation, management and initial outcomes following valve ablation using  Mohan’s valvotome in boys   at Federal Medical Centre, Yola.

 

Materials and methods

This was a retrospective study of boys with a diagnosis of Posterior urethral valve  managed between September 2014 to June 2018.The demographic characteristics, clinical features ,investigations , treatment and initial outcome  were reviewed. The main outcome measures were improved postoperative urinary stream, serum creatinine values at presentation, after  4-5days  of catheter drainage and  at   follow up.

 

Results

There were 10 boys with a diagnosis of PUV within the period. Eight patients had adequate information for the analysis. The mean age at presentation was 2.5 years(range 3weeks to 7years) with half of patients presenting  after 1 year. All the patients presented with symptoms of   lower  urinary tract obstruction, fever in 6(75%) patients and recurrent urinary tract infections 5(62.5%)patients. Seven(87.5%) patients had suprapubic  masses, while 1(12.5%) had ballotable kidneys and ascites. Valve ablation was achieved with  Mohan’s valvotome after successful initial catheter drainage. There was a significant improvement  in urine stream in all patients. The mean serum creatinine at presentation  was  3.54mg/dl±2.33mg/dl compared to   mean  serum creatinine of 2.16mg/dl ± 1.69mg/dl after 4-5days  of initial  catheter drainage. The mean duration of follow up was 15.5 months.  Mean serum  creatinine was 0.94mg/d± 0.41mg/dl at follow up (p=0.034)

 

Conclusion

Initial drainage and definitive valve ablation with Mohan’s valvotome is associated with improved serum creatinine and urinary stream.

 

 

  1. NEPHROBLASTOMA: 10 YEAR EXPERIENCE IN A TERTIARY INSTITUTION IN SOKOTO, NORTHWESTERN NIGERIA

 

Musa N, Nuhu AK, Abubakar Y, Lukong CS

Paediatric Surgery Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria.

 

 

Background

Nephroblastoma or Wilms’ tumour (WT) is the most common renal tumour in childhood. Management is challenging. Multidisciplinary treatment and advent of neoadjuvant therapy has improved the outlook.

Objectives: The purpose of this is to discuss the presentation, treatment and challenges of managing nephroblstoma based on our experience.

 

 

Materials and methods

A retrospective hospital based study at UDUTH, Sokoto, Nigeria. Medical records of children with nephrolastoma operated upon between January 2009- August 2018 were retrieved. Relevant information was extracted and entered into prepared data collection format. Data was summarized and analyzed using SPSS version 20.

 

 

Result

Twenty eight (28) patients had nephrectomy for renal tumours. Record of 18 patients was available and analyzed. Mean age (±SD) was 4.6±3.7 years, M: F of 1.3:1, the mean duration of symptoms was 5.8±8 months (range 0.5- 36). Common presentations were abdominal mass (100%), weight loss (83.3%) as well as abdominal pain (38.9%). One (5.6%) patient had Beckwith-wiedemann syndrome. All (100%) patient had abdomino-pelvic USS, 10(55.6%) CT scan and 5(27.8%) IVU. Tumour involve right kidney in 9 (50%) and left kidney in 9(50%). Thirteen (72.2%) received neoadjuvant chemotherapy. Six (33.3%) patients had stage 2 disease, 8 (44.4%) stage 3 and 4 (22.2%) stage 4. Nephrouretectomy was the commonest procedure performed in 15 (83.3%) patients. Bleeding (16.3%) and intestinal injury (16.7%) were the commonest intraoperative complications. Three (16.7%) had intraoperative cardiac arrest. WT was the commonest renal tumour found in 11 (61.1%) patients. Twelve (66.7%) received adjuvant chemotherapy. Respiratory tract infection (27.8%) and nausea and vomiting (27.8%) were the commonest postoperative complications. Mean follow up was 7.8±10.5 months (0-36 months). Six (33.3%) patients were alive, 5(27.8%) died and 7 (38.9%) were lost to follow up.

 

 

Conclusion

Late presentation, anaesthetic complications were major challenges. Neoadjuvant chemotherapy with postoperative chemotherapy, together with multidisciplinary approach are measures that were employed to improve treatment outcome.

 

 

  1. PERITONITIS AMONG ADOLESCENTS AT AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA

1Sheshe AA, 1Nwachukwu UC*, 1El-Yakub A, 1Nasiru AI, 1Suleiman IE, 2Muzammil A, 1Bello UM, and 1Mohammed AB.

1 Division of General Surgery, 2 Division of Urology, Department of Surgery, Bayero University /Aminu Kano Teaching Hospital, PMB 3452, Zaria Road, Kano

 

Background

Peritonitis is a common life threatening surgical abdominal condition in the sub-Saharan Africa. Untreated it can lead to electrolyte derangements, shock, sepsis, multiple organ failure and death. So, early and prompt diagnosis, aggressive resuscitation, monitoring and timely surgical treatment are essential in the proper management of the patient. The aim of this study is to see the pattern of peritonitis and to identify the causes of morbidity and mortality among this age group with peritonitis in a tertiary hospital in North-Western Nigeria.

 

Materials And Methods

This is a retrospective descriptive study in which the case folders of all adolescents who presented to the Aminu Kano Teaching Hospital, aged 13 – 24 years and were managed for peritonitis and had exploratory laparotomy from January 2016 to January 2018 were retrieved and analysed. Data is being inputted into Microsoft Excel Spreadsheet and later test of statistical significance would be done using IBM SPSS Statistics version 23.

 

Results

Preliminary results revealed a total number of 33 folders are being analysed. 54.5% of patients are males. There were two age peaks 13 – 16 years bracket and 21 – 24 years bracket with 39.4% each. Typhoid ileal perforation is the commonest cause of peritonitis in this study with a frequency of 51.5%.

 

Conclusion

At the end of the study, we should be able to state the prevalence of peritonitis among the socioeconomic status of their parents and their level of education. The morbidity and mortality rate and the factors influencing mortality.

Keywords: Peritonitis, adolescents, morbidity, mortality.

 

  1. ELECTIVE MASS HERNIA REPAIR IN CHILDREN: PROSPECTS AND CHALLENGES

Sheshe A A, Nasir I A, El-Yakub A, Yunusa B

Department of Surgery, Aminu Kano Teaching Hospital, Kano

 

Introduction

Pediatric hernias are common developmental anomalies which have different managements from their adult equivalents. Surgery remains the most effective form of treatment recognized. Complications are common especially in the younger age groups. The recognition of this disastrous potential led the intension to carry out a mass pediatric hernia repair along that of the adult in the hernia campaign of the Kano state government in 2006.

 

Aim

To review the prospect and Challenges in the elective mass repair of Hernia in the Pediatric age group.

 

Method

This was a prospective study carried out during a free mass hernia campaign in six hospitals across Kano State in Northwestern Nigeria. The campaign was carried out over a period of three weeks between 4th and 22nd December 2006. The demographic data, clinical findings, investigations Operative findings as well as treatments given to each patient were entered into a proforma. High risk patients for day care were excluded from the study.

 

Results

A total of 2824 patients with hernia and or hydrocele were screened during the campaign out of which 1155 stable patients were operated. Among these 204 were below the age of 15. Ninety seven percent were males giving a M: F of 28:1. The lowest age range was 4months, with a mean of 8years. Congenital Right Inguinal hernia repair was the commonest procedure done. Follow up period was limited to a week after the campaign. There was no complication recorded in the repair if hernia in the children operated during the period of campaign.

 

Conclusions

Hernia is a common ailment among children in this region and surgery remain the best option of treatment. Congenital Right inguinal hernia/hydrocele remains the commonest among children.

Key words:   Mass hernia repair, Children, Northwestern Nigeria

  1. EPIDEMIOLOGICAL ASPECT AND OUTCOMES OF PATENT DUCTUS ARTERIOSUS LIGATION FROM A NEW CARDIOTHORACIC PROGRAMME

T.N Oyebanji, M.I Inuwa, J.I Ahmad

Cardiothoracic Unit, Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria.

 

Background

Surgical ligation still remains the widely available management modality for patent ductus arteriosus (PDA) in our environment unlike in developed countries where transcatheter closure is the preferred method of treatment for children beyond the neonatal period. Herein, we describe the epidemiological pattern of our patients and the outcomes of PDA ligation.

 

Methods

Data relating to patients with PDA between January, 2012 and December, 2017 were retrospectively collected from case folders and analyzed with SPSS version 23. Data analyzed included patients’ demographics, period between diagnosis and surgical intervention and outcome of treatment.

 

Results

The records of 22 patients were analyzed. There were 16 (72.7%) females and 6 (27.3%) males. The female/male ratio was 2.7:1. Median age at presentation was 24 months (SD = 39.2; mean, 42.1; range, 2-144 months). Mean length of hospital stay was 8.1±2.2 days. The median duration between diagnosis and surgery was 14.7 months (SD = 20.8; mean, 22.8; range, 0-84 months). There were no mortalities. One (4.5%) patient had chylothorax which was managed conservatively and four (18.2%) had residual shunts at sixth month of follow up visit.

 

Conclusion

Our experience strengthens the knowledge that the surgical ligation of the PDA is safe and that hospital mortality approaches zero.

 

 

7.CONGENITAL LUMBAR HERNIAS: ABOUT 6 CASES COLLECTED IN TEN YEARS WITH A LITERATURE REVIEW

 

O Habou1*, MI Amadou2, H Adamou2, MO Ali Ada3, H Moustapha3, A Magagi4, R Sabo5, H Abarchi3.

1: Pediatric Surgery Department, Zinder National Hospital, Faculty of Health Sciences, University of Zinder (Niger)

2: General Surgery Department, Zinder National Hospital, Faculty of Health Sciences, University of Zinder (Niger)

3: Pediatric Surgery Department, Lamordé National Hospital, Niamey, Faculty of Health Sciences, Abdou Moumouni University, Niamey (Niger)

4: Anesthesia-Resuscitation Department, Zinder National Hospital, Faculty of Health Sciences, University of Zinder (Niger)

5: Anesthesia-Resuscitation Department, National Lamordé Hospital, Niamey, Niger

 

* Corresponding author: Dr. HABOU Oumarou, Pediatric Surgeon, Assistant Professor, Faculty of Health Sciences, University of Zinder (Niger); BP: 656 Zinder, Niger

Tel: 00227 9014964/00227 9600046

Email : bhomar70@yahoo.fr

 

Introduction

Congenital lumbar hernias are rare. We report a series of 6 cases and discuss the clinical and therapeutic aspects.

 

Patients and methods

This is a 10-year retrospective study (January 2005 to December 2014) of children managed for congenital lumbar hernia in the two pediatric surgery departments of Niger.

 

Results

The median age of patients at the time of management was 8.5 months (ranges: 6 and 22 months). There were 4 boys and 2 girls. The hernia was left in 3 cases and no bilateral cases were reported. Four patients had a Grynfelt hernia, and two had a hernia of Jean Louis Petit. The mean diameter of the collar was 6 cm (extremes: 4 and 9 cm). Three patients had an associated abnormality: a costo-lumbosacral syndrome, a right testis migration abnormality and a cardiac abnormality. All patients were operated according to the same procedure. Infection of the surgical site was found in 1 case. Two (2) cases of recurrences operated again by prostheses were recorded. The overall result was satisfactory with an average follow-up of 18.33 months (range: 13 and 32 months). No deaths have been reported.

 

Conclusion

Lumbar hernia is rare. Its diagnosis is relatively easy and, its management is not well codified. The direct approach by lumbotomy with closure of the defect without the use of prosthetic material gives satisfactory results.

Key words: lumbar hernia, congenital hernia, surgery, child.

 

 

8.PROFILE OF PAEDIATRIC CHEST WALL TUMOURS AND MANAGEMENT OUTCOME IN A TERTIARY HEALTH FACILITY IN SOUTHERN NIGERIA

Okoro PE1, Gbobo I1, Obiora C2

 Department of Surgery1, Department of Pathology2, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Correspondence: Dr Philemon E Okoro. Paediatric Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. E mail- philemon.okoro@uniport.edu.ng

 

Introduction

Swellings on the chest wall of infants and older children are not common. These chest wall tumours can pose major challenge either due to their size or ease with which they directly invade the chest cavity. Reports on paediatric chest wall tumours are generally scanty, and virtually non- existent in our region.

 

Aim

To report our experience of chest wall tumours in our region, to highlight the peculiar features and management outcome.

 

Patients and Methods

This is a 5 year retrospective study of consecutive cases of chest wall tumours in children 15 years and below seen in our service between August 2013 and July 2018. Records searched for included: age, gender, duration before presentation, presentation feature, previous interventions, treatment offered, histology, follow-up period, outcome. Data was subjected to simple statistical analysis.

 

Results

A total of 53 children with chest wall tumours were seen during the period under review but 42 had adequate records to be included in the review. Histological reports showed non neoplastic lesion in 13 cases and neoplastic in 29 cases.  There were 4 mortalities, 2 recurrences.

 

Conclusion

Chest wall tumours are among the surgical problems encountered in children in our region. These tumours are often presented late and a significant percentage a malignant. Surgical removal can be tasking in advanced malignant lesions. Skin closure in large tumours often entails difficult flap movement even in benign tumours.

 

 

  1. A PERSISTING MENACE: ASCARIASIS CAUSING CHILDHOOD INTESTINAL OBSTRUCTION IN AN URBAN CENTRE

 

O.M. Faboya, M. Abdusallam, R.I. Osuoji

 

Background

Ascariasis is the most common nematode infestation among humans. Highly endemic in regions of poor sanitation and low socio-economic status, it is more common between ages 2-10years. Surgical complications can follow massive infestation in this age group.

 

Case report

We present a 7-year-old girl who presented to the emergency room with 3days history of colicky abdominal pain, bilious vomiting and constipation. Clinical examination revealed a left iliac sausage shaped mass suggestive of intussusception. An abdominal ultrasound scan however elicited multiple worms in the small bowel. A laparotomy with enterotomy and evacuation of worms was done. The worms were intertwined and extended from the duodeno-jejunal junction to the terminal ileum, 6cm from the ileo-caecal junction. Child had good post-operative recovery and had oral Mebendazole.

 

Conclusion

While publications on surgical complications of Ascariasis exist as few case reports in recent times, it must still be considered a very likely differential of intestinal obstruction in children. Preventive chemotherapy (deworming) as prescribed by WHO should be encouraged not just in vaccination centres but other levels of healthcare including the surgical clinic.

 

  1. INTERNAL HERNIA: A RARE COMPLICATION OF APPENDECTOMY

Abdulraheem, N.T; Abdullahi, I; Mohammed, S; *Umar, I. A

Department of Surgery & *Department of Medicine, IBB Specialist Hospital, Minna, Niger State

 

Internal hernia complicating appendectomy is a rare occurence. We report a case of internal hernia in a patient who had appendectomy 30 months earlier.

AZ is a 12year old boy on account of persistent and worsening colicky abdominal pain. Pain had started 2 months earlier located mainly in the right lumbar region. It was initially mild and not associated with vomitting, constipation or abdominal distention.It later became constantly present necessitating admission on 27th August 2018. Started vomiting after admission, but no abdominal distension. No fever or vomiting. Had a. Not a known HbSS or diabetic and no prior Hx of trauma to the abdomen.

Physical examination was not remarkable.

Laboratory work up were unremarkable too. Abdominal ultrasound revealed features suggestive of partial intestinal obstruction.

Patient had Exploratory laparotomy and adhesiolysis. Post operative period was unremarkable and patient is doing well on follow up.

High index of suspicion is key in prompt diagnosis and successful management of this patient.

 

  1. OUTCOME OF REVERSAL OF GASTROINTESTINAL STOMA IN CHILDREN

OO Ogunsua; TT Sholadoye; S Baba; PM Mshelbwala; EA Ameh

 

Background

Reversal of gastrointestinal stoma is a procedure performed by paediatric surgeons which is highly anticipated by patients and care givers due to the morbidity associated with living with a stoma, especially the psychological effect. The aim of this study is determine the outcome of reversal of gastrointestinal stoma with emphasis on the morbidity and mortality.

 

Method

A retrospective review of children who had reversal of gastrointestinal stoma in a 6 year period .

 

Result

There were 45 patients {boys 26, girls 19(Male: female – 1.4:1)} aged 8 – 180 months (mean 70months). There were 25 colostomies (55.6%) and 20 ileostomies (44.4%). Only one patient had reversal of loop stoma.   The mean duration between stoma creation and closure was 27.5months (range =4-108months) while the median length of postoperative hospital stay was 9 days (range= 3-33days). Twenty patients commenced oral intake by the second postoperative day. Eleven (24%) patients had complications within the immediate postoperative period, with SSI (15.6%) being the commonest, other complications were enterocutaneous fistula one (2.2%), intestinal obstruction 2 (4.4%), anastomotic dehiscence one (2.2%). Three patients (6.6%) had incisional hernia during follow-up. No mortality was recorded

 

Conclusion

Reversal of gastrointestinal stoma, though highly desire by patients living with stoma, is still associated with significant morbidity and the duration between stoma creation and closure is a major challenge

 

  1. CHILDHOOD INTUSSUSCEPTION IN SOUTH-WEST NIGERIA: A MULTICENTRE STUDY

 

A.E. Ajao1, F.O. Kumolalo2, O.O. Ogundoyin, T.A. Lawal, D.I Olulana

1Bowen University Teaching Hospital, Ogbomoso, Nigeria

2Ondo State Trauma and Surgical Centre, Ondo, Nigeria

University College Hospital, Ibadan, Nigeria

 

Background

Intussusception is the most common cause of intestinal obstruction in infants and young children. This study aimed to determine the current pattern and management of childhood intussusception in South-West Nigeria using a multi-centre approach.

 

Methods

Records of children managed for intussusception at the UCH, Ibadan, OSTSC, Ondo and the BUTH, Ogbomoso were obtained and analyzed.

 

Results

One hundred and ninety-four children were managed for intussusception during the study period. The male-to-female ratio was 1.8:1. The median age was 7 months with a peak age incidence of 3-6 months. Peak incidence was recorded during the dry season. Passage of bloody stool, vomiting, abdominal pain and fever were the most common presenting features. Seventy-three (38.4%) of the patients presented with the classic triad. The median duration of symptoms was 3 days and only 19 (10.1%) patients presented in less than 24 hours. Ileocolic intussusception was the most common anatomic type, occurring in 166 (87.4%) patients and there was a significant association between this type and age. Twenty-two (56.4%) had successful hydrostatic reduction, while 165 (88.2%) required surgery. Forty (21.1%) patients suffered post-operative complications. Eleven (5.8%) of the patients died. The median duration of hospital stay was 6 days. There was a weak but significant correlation between the duration of symptoms and the length of hospital stay

 

Conclusion

Delayed presentation is a persisting challenge in the management of childhood intussusception. Presentation of an infant with fever, vomiting and abdominal pain during the dry season should raise the physician’s index of suspicion.

 

 

  1. CLINICAL PREDICTORS AND OUTCOME OF BOWEL RESECTION IN PAEDIATRIC INTUSSUSCEPTION

 

A.E. Ajao1, T.A. Lawal, O.O. Ogundoyin, D.I Olulana,

 

University College Hospital, Ibadan, Nigeria

1.Bowen University Teaching Hospital, Ogbomoso, Nigeria

 

Background

Non-operative reduction is the treatment of choice in childhood intussusception. However, surgery remains the mainstay in this environment. The aim of this study was to assess factors associated with bowel resection and its outcome in childhood intussusception.

 

Methods

This was a review of records of children managed for intussusception between January 2006 and December 2015 at the University College Hospital, Ibadan, Nigeria. The patients were categorized based on treatment modality and analyzed using SPSS v23.

 

Results

One hundred and twenty-one patients were managed for intussusception. Fifty-three (43.8%) patients had bowel resection. The median age at presentation was 7 months and median duration of symptoms was 3 days (range: 2 hours – 21 days). Passage of bloody stool, vomiting, abdominal pain and fever were the most common presenting features. Forty (75.5%) of the resections were right hemi-colectomies for gangrenous ileocolic intussusception. The presence of fever, abdominal pain, abdominal distension, rectal mass, age < 12 months, heart rate > 145/min and duration of symptoms > 2 days were significantly associated with need for eventual bowel resection (p < 0.05). However, only age and abdominal pain independently predicted probability of the need for resection. Bowel resection was significantly associated with the development of post-operative complications and increased length of hospital stay (p < 0.05).

 

Conclusion

Infants presenting with significant abdominal pain and abdominal distension after two days of onset of symptoms were more likely to require bowel resection. Bowel resection in intussusception is significantly associated with post-operative complications and prolonged stay in the hospital.

 

 

 

  1. APPENDICITIS IN CHILDREN: EARLY VERSUS LATE PRESENTATION

 

O.A.  Adesanya, A.  Aremo, O.O. Adesanya

 

Background

Late presentation has been suggested as a factor influencing the outcome of management of appendicitis in children. We aimed to determine the effects of late presentation on the outcome of appendicitis in children managed at a tertiary hospital in Abeokuta, Southwest Nigeria.

 

Methods

A retrospective analysis of all children treated for appendicitis at the Federal Medical Centre , Abeokuta, between April 2013 and March 2018 was done. Intra-operative findings, post operative complications, length of hospitalization and cost of care were compared between children who presented early, within 48 hours of first episode of symptoms, and those who presented later.

Results: A total of 96 children aged between 4 and 16 (mean 10.9 ± 0.25) years were treated for appendicitis. They comprised of 52 males and 44 females ( male/female ratio 1.18:1). They all had open appendicectomy which accounted for 13.7% of total pediatric surgical operations and 35.2% of emergency pediatric operations in the centre. Only 36 (37%) children presented within 48 hours of symptoms while 60 (63%) presented after 48 hours.

Children who presented late had: a higher incidence of complicated appendicitis at surgery, more post-operative complications, longer duration of hospitalization and higher cost of treatment compared with children who presented early (p<0.05).

Conclusion: Delayed presentation is a common feature among children with appendicitis in our setting. Prompt diagnosis and timely surgical intervention may reduce the high morbidity associated with late presentation.

 

 

 

 

  1. CASE REPORT: PYLORODUODENAL DUPLICATION CYST PRESENTING LIKE HYPERTROPHIC PYLORIC STENOSIS

 

  1. U. Abdulkarim, T.T. Sholadoye, O. O. Ogunsua, S. Baba, H. O. Aliyu

 

Background

Gastrointestinal duplication cyst is a rare congenital anomaly. When it involves the pylorus or the first part of the duodenum, it may present with features of gastric outlet obstruction.

A 4 month old baby girl, second of a set of twins who presented with projectile, non-bilous, postprandial vomiting noticed since third week of life. Baby cries following each bout of vomiting and stops after feeding. No associated abdominal distention, constipation or jaundice. She was not growing well compared to her twin sister. On examination, she was pale, dehydrated, weighed 3.7kg and had visible peristalsis, an ovoid sub-hepatic epigastric mass was palpated. A diagnosis of gastric outlet obstruction querying hypertrophic pyloric stenosis was made and she was resuscitated. Abdominal ultrasonography showed a cystic mass in the region of the left lobe of the liver. Intraoperative findings was a cystic non communicating duplication cyst involving the pylorus and the first part of the duodenum. Partial excision and mucosal stripping was done. Oral intake commenced after 48hours and child was discharged home 4th day postop. She is doing well at follow-up in clinic weighing 5.2kg at 6months of life.

 

Conclusion

Pyloroduodenal duplication cyst is a rare congenital anomaly of the gastrointestinal tract and a close differential for patient who present too early or too late with features of gastric outlet obstruction.

Keywords: Pyloroduodenal, duplication cyst, gastric outlet obstruction

 

 

  1. OUTCOME OF OPERATIVE MANAGEMENT OF INTUSSUSCEPTION AT A TERTIARY HEALTH CENTER IN NORTH-WESTERN NIGERIA

Farinyaro AU, Muhammad AM, Anyanwu LJC, Abdullahi LB, Aliyu MS, Liman BI, Sa’ad B

Paediatric Surgery Unit, Department of Surgery, Aminu Kano Teaching Hospital, Kano.

 

Background

Intussusception is the invagination of one part of the intestine into an adjacent part. It is one of the most frequent causes of intestinal obstruction in infants and toddlers. This study aimed to determine the outcome of operative management of intussusception at our center.

 

Materials and methods

We retrospectively reviewed the records of children managed for intussusception at the paediatric surgery unit of our center, from March 2012 to August 2018. Relevant data was extracted and entered into prepared data sheet and analysed with SPSS version 22.0

 

Results

Out of the 73 documented patients managed within the study period, records of 49 patients were retrieved and analysed. Of this number, 29(59.2%) were males, while 20(40.8%) were females, with a ratio of 1.5:1. Their ages ranged from 2 months to 6 years (median = 7 months); 42 (85.7%) were infants. Duration of symptoms at presentation ranged from 1-10 days (median = 4 days); 1-8 days(mean=3days) and 1-10 days(mean=5.2 days) in those that had manual reduction and bowel resection, respectively. The triad of abdominal pain, vomiting and red-currant jelly stools was observed in 47(95.9%) patients. In 32 (65.3%) of them, a mass was palpable per abdomen, 5(10.2%) palpable per rectum and 4(8.2%) prolapsed. Upper respiratory tract infection and diarrhoeal disease were the identified predisposing factors in 27(55.1%) and 4(8.2%) respectively. Abdominal ultrasound scan was done in 35(71.4%), positive in 32(65.3%) and negative in 3(6.1%). Interval between presentation and surgical intervention ranged between 12 hours to 5 days (median=2 days). With respect to the type of intussusception, Ileocolic was the most common type, noted in 39 (79.6%) patients, followed by ileo-ileal in 5(10.2%) and colo-colic in 3(6.1%); Waugh’s syndrome was seen in 1(2.0%) only. Manual reduction was achieved in 21(42.9%), with bowel resection done in 26 (53.0%); 2 (4.1%) were found to have spontaneous reduction intra-operatively. Post-operative complications observed were surgical site infection 13(26.5%), wound dehiscence 7(14.3%), anaemia 6(12.2%) and overwhelming sepsis 4(8.2%). The duration of hospital stay was between 3-30 days (median=9 days). Mortality  was 4(8.2%), recorded in those that had bowel resection.

 

Conclusion

Late presentation was associated with high rate of bowel resection and unfavourable outcome.

 

Keywords: Intussusception; Intestinal obstruction; Red-currant jelly; Ileo-colic; Reduction

 

 

  1. IMPROVING THE OUTCOME OF NEONATAL SURGERIES IN NIGERIA: NNSQI PROJECT PHASE I PROGRESS REPORT

 

NNSQIPROJECT Team

In Alphabetical order : Ademuyiwa A, Ameh EA, Akpanudo E, Alakaloko, Bwala Kefas, Emehute, Ekenze SO, Ekwunife OH, Ezomike U, Igwilo, Ladipo-Ajayi, Lukman A, Lukong C,Modekwe V, Nasir AA,Okoro Philemon, Seyi-Olajide OA, Sholadoye T, Suleiman AF, Taiwo JO, Taiwo Lawal, Tanimola, A Ugwu JO

 

 

Background

Mortality rate from neonatal surgeries in Nigeria ranges from 12% to 62%. Overall rates have not significantly improved in the last 20 years. Documented outcomes are still very few.

 

Objective

To create a Quality Improvement System to improve the Outcomes via generation and analysis of data; implementation of Interventions and monitoring of same to ensure continuous outcome improvement

 

Methodology

PHASE I: Six months multi centre, cross sectional study of neonatal surgeries involving institutions from the different geographical regions of the country. Online data collection tool is used.

Pilot survey already concluded

 

Result

Study in progress. Interim progress report is to be presented. At the end of the study, we expect to produce general and disease specific National rates for morbidity / mortality for neonatal surgical conditions, and also to establish outcome benchmarks for neonatal surgical cases

 

Conclusion (expected):

The phase I when concluded hopes to bridge the gap of absence of data for planning and outcome improvement.

 

 

  1. ANTERIOR ABDOMINAL WALL DEFECTS: THE UNIVERSITY OF ABUJA TEACHING HOSPITAL (UATH) EXPERIENCE

 

Mbajiekwe N., Osagie O., Mshelbwala P., Chinda J., Olori S.,

UATH Gwagwalada

 

Introduction

Management of anterior abdominal wall defects including gastroschisis and omphalocele has continued to be a major challenge to paediatric surgeons in low resource setting despite various management options.

 

Objectives

To determine outcomes of various modalities of treatment of gastroschisis and omphalocele in UATH.

 

Materials And Methods

A 3 year retrospective review of patients’ data managed for gastroschisis and omphalocele in paediatric surgery unit in UATH  was done. The biodata, clinical conditions, treatment modalities and outcomes were recorded.

 

Results

There were 39 patients with M:F=1:1.2. Maternal age ranged between 17 years and 40 years. Six(15%) had gastroschisis and 33(85%) had omphalocele. Nineteen had omphalocele major while 14 had omphalocele minor. Four omphaloceles presented ruptured. Two omphalocele patients were syndromic and 13 omphalocele patients had other congenital anomalies. Age at presentation ranged between 3 hours and 21 days. Thirty-seven were term(95%) and 2(5%) were preterm. All gastroschisis were managed operatively. Three had improvised silo application [all died], 1 had simple closure (survived), 1 had skin flap closure (survived), and 1 had bowel resection and exteriorization (died). Thirteen omphalocele patients were managed operatively, all had simple closure (5 died).Twenty omphalocele patients were managed non-operatively.Average number of days on admission by all patients is 19.6 days. Total mortality was 13(33.3%).         

 

Conclusion

Management of anterior abdominal wall defect is very challenging in UATH with a mortality rate of 33.3%.

 

  1. RIGHT POSTERIOR DIAPHRAGMATIC HERNIA WITH OMPHALOCELE; MANAGEMENT CHALLENGES AND BENEFITS OF MULTIDISCIPLINARY AND MULTICENTRE COLLABORATION IN A RESOURCE POOR SETTING

Ugwu J O1, Etukokwu K C2, Ufuegbunam3,  Ugwunne  C A1, Ugwu N O4

1Paediatric Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria

2Cardiothoracic Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria

3Department of Anaesthesia, University of Nigeria Teaching Hospital, Enugu Nigeria

4Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria

 

 

Right posterior congenital diaphragmatic hernias (CDH) with liver herniation pose a huge management challenge to the paediatric surgeons world over. Its association with anterior abdominal wall defects portends a poorer prognosis.

We seek to report a case of a day old male referred to our centre with breathlessness, anterior abdominal wall defect and persistent poor oxygen saturation. Clinical and imaging evaluations aided the diagnosis of a right posterior congenital diaphragmatic hernia with omphalocele and divarication of recti. Due to dearth of resources a multidisciplinary team of paediatric surgeons , cardiothoracic surgeon, paediatricians and an intensivist were assembled and care was undertaken in two centres to complement in manpower and facility deficiencies . This in so many ways mitigated against likely management difficulties, morbidities and even mortality

Conclusion

Right congenital diaphragmatic hernias (CDH) in a resource constrained environment can be successfully managed with good clinical and multicentre collaborations.

KeywordsCongenital diaphragmatic hernias, omphaloceles, multidisciplinary care

 

  1. MECONIUM PERITONITIS SIMULATING GASTROCHISIS

 

Sani Adamu*, Jalo I+, S A Faruk*,  Y S Alkali+,  I, A Lawan#, Y Abdullahi#, Abbas Ajayi@

*Consultant Paediatric surgeon/Senior Lecturer COMS GSU, + Consultant Paediatrician/Senior Lecturer COMS GSU, # Consultant Histopathologist/Senior Lecturer COMS GSU, @Medical officer, Department of Surgery, FTH, Gombe

 

Background

Meconium peritonitis (MP) is an aseptic chemical peritonitis, which results from perforation of the gut in utero. Most cases of meconium peritonitis are due to intestinal atresia, meconium plug, cystistic fibrosis, colon atresia.  Wide range of presentation of MP is reported  in the literature.

 

Objective

We report this rare and peculiar case to sensitize clinicians about this atypical presentation of meconium peritonitis

 

Case Presentation

A 24hour old neonate presented with a protruding mass through the umbilicus since birth. No significant maternal history, pregnancy and delivery were uneventful. He Passed meconium 8hours after delivery, a diagnosis of gastroschiasis was made. Intra –operatively a cystic mass continued with the omentum containing a jelly like material and another loculated cystic mass was found in the right illiac fossa. Histological examination of both masses confirmed meconium peritonitis.

 

Conclusion

Meconinium peritonitis has different modes of presentation; a high index of suspicion is required to prevent delay in diagnosis and treatment

 

  1. MULTIPLE PERINEAL FISTULAE: AN UNUSUAL PRESENTATION OF A LOW ANORECTAL ANOMALY

Authors: S Olori, Musa Momoh

Institution: Kutunku Alheri Clinic & Maternity Ltd, Gwagwalada.

Corresponding author: S Olori

Email: samsonolori@yahoo.com

 

Perineal fistula is a term low anomalies such as bucket handle deformities, ectopic anus, anocutaneous fistula among others.

The deformities are often obvious at the time of presentation. However, in some deformities the fistula opening may not be obvious due its tiny size or is blocked by inspisated meconium and such children may present with neonatal intestinal obstruction. Such cases may be mistaken for deformities without fistula as fecal discharge from the opening may not be apparent. But following appropriate investigations, a posterior sagittal anorectoplasty corrects the anomaly. Low anorectal anomalies are safe to operate upon without a diverting colostomy

We present a case of neglected low anorectal malformation resulting in acquired multiple perineal fistulae. We are not aware of such clinical presentation of low malformation hence we present our experience.

 

Case History

MS was a11month old boy who was referred to our clinic on account passage of feces from multiple sites on the perineum. Stools were infrequent, very offensive, watery and occasionally thread-like. There was recurrent constipation lasting between 3days to 7days associated with passage of very offensive flatus, abdominal distention which was relieved after defecation. He had minimal posterior sagittal anorectoplasty and now defecates two to three times per day through the neoanus.

 

  1. COMPARATIVE ANALYSIS OF MANAGEMENT OF GASTROSCHISIS BY IMPROVISED SILO VERSUS EXTENDED RIGHT HEMICOLECTOMY; A PRELIMINARY REPORT

Okoro P E, Ngaikedi C

 

Background

Gastroschisis is one of the major abdominal wall defects encountered commonly in paediatric surgery. Whereas complete reduction and abdominal closure is achieved easily sometimes, a daunting situation arises when the eviscerated bowel loops and other viscera cannot be returned immediately into the abdominal cavity. This dilemma is the question in this study.

 

Aim

To report our experience in management of gastroschisis and to compare the management outcome using our improvised silo, and performing a right hemicolectomy

 

Patients and Methods

Study is both retrospective and prospective and spans from June 2006 to May 2018. Data was collected retrospectively from the records of the patients seen before 2013 and prospectively from patients seen thereafter, and included   gender, age at presentation and intervention, viscera seen on the outside, method of repair, any nutritional support, outcome. Data obtained were subjected to simple statistical analysis.

 

Results

Thirty nine cases were analyzed. Simple closure could not be achieved in 28 cases. In the absence of standard silos, improvised ones were constructed from amniotic membrane (3 cases), urine bag (4 cases), and latex gloves (9 cases) giving a total of 16 cases managed with silos,(Figure 1).  An extended right hemicolectomy was performed in 12 cases.

 

Conclusion

Given the peculiarities of circumstances in our region regarding human and material resources in the care of gastroschisis patients, an extended right hemicolectomy, to make it possible to close the abdomen primarily in gastroschisis is a more viable option than the use of improvised silo.

 

  1. ASSESSMENT OF HOUSE OFFICERS’ KNOWLEDGE OF NEONATAL SURGICAL EMERGENCIES

Author: S Olori       

University of Abuja Teaching Hospital Gwagwalada,

Correspondence: S Olori

Email: samsonolori@yahoo.com

 

 Introduction

Excellence in medical profession is a function of knowledge and its application. Surgery which forms major part of the medical curriculum has several sub-divisions one of which is Paediatric Surgery. How well a houseman functions can be related to the knowledge and willingness to learn.

 

Aim

This was to find out the knowledge of neonatal surgical emergencies among house officers at our University Teaching Hospital.

 

Material & Method

It was a cross sectional study in which pretested questionnaires were administered to two sets of serving house officers over a period two years.

The data obtained included the medical school attended, the year of graduation, number of rotations done, four symptoms of surgical abdomen in the neonate, five neonatal surgical emergency conditions, among others. The data was analyzed and findings presented in tables and graphs.

 

Result

There were 65 respondents from seventeen (17) medical schools. Of these 33.4% correctly listed three symptoms of neonatal surgical abdomen while only 29.2% listed five neonatal surgical emergency conditions however there were no statistical significance in their responses neither the number of rotations done on required action in an emergency.

Conclusion

It is imperative for the houseman to be knowledgeable in neonatal surgical emergencies to be able to take basic lifesaving actions when presented with one.

 

  1. SURGICAL INTERVENTION TIME IN A TERTIARY HOSPITAL-A LOCAL EXPERIENCE

RUNNING TITLE: What are the causes of delay in emergency surgical intervention of digestive tract disorders at our institution?

Elebute OA, Ademuyiwa AO, Seyi-Olajide JO, Ladipo-Ajayi O, Alakaloko FM, Bode CO

Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria

 

Aims

To determine causes of delay in surgical intervention of digestive tract disorders in paediatric surgical patients presenting at the Emergency department and to ascertain if surgical outcome is predicated on surgical intervention time

 

Background Summary

It is well documented that early presentation at the Emergency department for most surgical conditions portends a good prognosis. It is equally known that several factors act in concert or independently to determine surgical outcome; ascertaining the weight of contribution of each of these factors to the overall surgical outcome can assist the clinician to address them and thus in turn improve prognosis.

 

Methodology

This is an ongoing prospective cross-sectional study from September, 2012 to August, 2013. Consecutive patients with digestive tract disorders who presented at the Emergency department requiring operative intervention were recruited into the study. Demographic data such as age and sex were noted for each patient. Other information obtained included diagnosis, duration of symptoms; time interval between presentation at the emergency department to review by the Paediatric Surgery team, the interval between time of  decision for surgery to actual surgery time, duration of surgery and the form of anaesthesia. The outcome variable was the surgical outcome following surgical intervention, expressed as dead or alive. The data obtained was analysed using Epi info version 3.5. Categorical variables were analysed using Chi-square test.

 

Result

A total of ninety four patients were seen during the study period. The age range was 1 to 6935 days and the median age was 210 days (7 months). The male to female ratio was 1.7:1. Intussusception and acute appendicitis accounted for over half of the entire cases seen (52.1%) at the Emergency Department.

The median time interval from the time of presentation at the emergency department to the Paediatric surgery team review was 5hours. The median time interval from the time decision was taken for surgery to arrival of the patient at the theatre was 12 hours and that for arrival of the patient to induction of anaesthesia was 2 hours. The mean duration for surgery was 2.2±1.0 hours. All these did not contribute significantly to the surgical outcome. There was however a strong correlation between the presence of anaemia, electrolyte derangement and use of general anaesthesia to poor surgical outcome (p < 0.05).

Conclusion

Surgical intervention time in our study did not contribute significantly to surgical outcome

 

 

  1. IMPACT OF MALNUTRITION ON OUTCOME OF SURGERY IN CHILDREN

 

 OO Ogunsua; TTt Sholadoye; S Baba; PM Mshelbwala; EA Ameh

 

 

Background

There is a high prevalent rate of malnutrition among hospitalized paediatric patients in the developing countries. The aim of this study is to ascertain the impact of malnutrition on outcome of surgery in children with emphasis on wound complications, hospital stay and mortality.

 

Methods

This is a prospective study of seventy-three (73) patients that were admitted to paediatric surgical ward for both elective and emergency surgery. Nutritional status was determined at admission and discharge. The clinical outcomes including 30-day mortality, length of hospital stay and wound complications were assessed.

 

Results

Of seventy-three patients who were included in this study, 44 were male while 29 were female (male: female – 1.5:1); mean age was 3.6years. Forty-one children (56.2%) were undernourished, none was over-nourished while 32 children (43.8%) were well nourished, thus the malnutrition prevalence rate was 56.2%. 16  (21.9%) patients developed surgical site infection (SSI); 10 (24.4%) were malnourished and 6 (18.8%) well-nourished (p =0.563). Eight (19.5%) malnourished patients had partial wound dehiscence compared with 2 (6.25%) well-nourished patients (p-0.102). Overall mortality was 7 (9.5%); 5 (12.2%) were malnourished while 2 (6.3%) were well-nourished (p= 0.392). Mean postoperative hospital stay was significantly longer in malnourished patients compared to well-nourished patients (8.37 days versus 17.38 days respectively, p = 0.047).

 

Conclusion

Malnutrition is common among paediatric surgical patients in this setting and significantly prolongs hospital stay. Early recognition and nutritional rehabilitation would be helpful in shortening the postoperative stay in this and similar settings.

 

 

  1. AN AUDIT OF OPERATIONS AMONG ADOLESCENT PATIENTS IN AMINU KANO TEACHING HOSPITAL: A 5 YEAR REVIEW

 Muhammad AB1, Sheshe AA1, El-yakub AI1, Abdullahi NI1, Suleiman IE1, Nwachukwu CU1, Abdulmajid UF1, Bello UM1.

1 Department of Surgery, Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria.

 

Background

Age is an important determinant of disease; this however, may be redefined by the environmental factors. The adolescent presents with various surgical conditions that often require different Surgeries. Several studies showed Appendicectomy as the predominant surgery in this age group. In this study, we aimed to determine the predominant surgery offered to Adolescent patients in our environment

 

Methods

The study was a retrospective study conducted in Surgery department of Aminu Kano Teaching Hospital, between January 2013 and January 2018 (5-years). During this period, the records of all adolescent patients who had surgery in the hospital were retrieved and analysed. Patients who had orthopaedic, urologic, cardiothoracic, gynaecological, neurosurgical and other specialised operations (ENT, MFU, Opthalmology) were excluded. The information collected includes the Age, Sex, Surgical condition and type of surgical procedure offered.

 

Results

A total 152 patients met the inclusion criteria but only the records of 104 patients were fully available and analysed. The Age range of the patients that completed the study was 12-17 years with a Mean Age of 15.16 ± 1.47 years. The Male to Female ratio was 1: 1.04.

Thirty seven patients (35.58%) had Major operation, 28(26.92%) had intermediate operation while 39 (37.5%) patients had Minor operation. Also, 61(58.65%) patients had emergency operation. The predominant Surgery offered was laparatomy for sepsis in 26 (25.0%) patients, then Appendicectomy in 24 (23.08%) patients. Out of the 26 patients that had Laparatomy for Sepsis, 18 had Intra operative diagnosis of Typhoid ileal Perforation.

 

Conclusion

Emergency exploratory laparatomy is the commonest procedure among adolescents in our environment. The majority of these arose from typhoid ileal perforation. There is need for improvement in personal hygiene and provision of safe drinking water in our setting to help reduce the incidence of typhoid fever and its possible complications.

Key Words: Audit, Adolescents, Surgical operations.

 

  1. ACCESSIBILITY OF AVAILABLE SURGICAL HEALTH SERVICES, A REFLECTION OF COST AFFORDABILITY BY PARENTS OF CHILDREN?

S Olori, PM Mshelbwala, Chinda JY, Osagie O, Mbajekwe N, Ikanador EO

University of Abuja Teaching Hospital, Gwagwalada, Abuja.

Corresponding Author: Dr S. Olori, Division of Paediatric Surgery,

 University Abuja Teaching Hospital (UATH), Gwagwalada.

Email: samsonolori@yahoo.com

 

Introduction

Pricing is a major integral component of the health care delivery. From the perspective of the providers and the consumers of the healthcare services, the role of the price of the health commodity cannot be overlooked. Recently, prices of health care services including surgical fees were reviewed upwards in our hospital to match up with the effect of inflation of surgical and medical consumables. Are there negative or positive impacts of this development on the health services utilization?

 

Objective

To find out the impact of price adjustment on the accessibility of available surgical health services by parents of children with surgical disease conditions.

 

Materials/Method

It was a cross sectional study in which pretested questionnaires tailored towards assessing the health services cost and affordability were administered to parents /guardians of children who accessed paediatric surgical service at our hospital.

The data were analyzed using SPSS version 20 and results are presented in tables and graph.

 

Results

There were 23(46%) male and 27(54%) female with M:F 1:1.2. Children of nineteen parents (38%) have been treated while those of 31(62%) have not. 8(17%) parents admitted that the price increase had affected their ability to pay for their children’s treatment while 38(83%) were not affected with P=0.038. Seven (7) of the respondents had postponed treatment on account of the increase in price.

 

Conclusion

Assessing surgical care services for children is to large extent a function of the ability of the parents to pay for the health commodity.

 

 

  1. CHALLENGES IN PAEDIATRIC SURGICAL RESEARCH IN NIGERIA

Osagie O., Mshelbwala P.,  Chinda J.,  Olori S.

Division of Paediatric Surgery, University of Abuja Teaching Hospital Gwagwalada.

 

Background

In Nigeria, the ability and opportunity  to expand knowledge in Paediatric Surgery  is limited largely by  lack of funds, dearth of research skills, absence of required technology, inefficiency of record keeping, inability to build collaborations and difficulty in implementing results.

 

Objective

To highlight the challenges experienced in Paediatric Surgical Research in Nigeria.

 

Methods

This was a multi-method approach involving a  desktop review of abstracts presented at APSON Scientific Conferences from 2003 to 2017,  a review of  studies accepted  for the part 2 postgraduate  examinations and a cross-sectional survey using a semi-structured questionnaire  sent to paediatric surgeons in Nigeria.

 

Results

A total of 599 abstracts were presented at 14 APSON scientific conferences. Average of 42 every year.

Since their inception, 12 papers were presented for the part 2 examination of the National Postgradute Medical College of Nigera (NPMCN) and 35 presented for West African College of Surgeons (WACS).

There are 185 paediatric surgeons registered with APSON. One hundred and forty two received the questionnaire and 68 responded. Their ages were 32 – 65years.

Fifty eight males and 10 females. Thirty five senior registrars and 33consultants. Forty seven (69.1%) receive support for research from their hospitals. Seven have not done any study in the last 3years .

Thirty five(51.5%) complained about poor hospital records while 25(36.8%) complained about lack of funds. Continuous training and education of paediatric surgeons was the most selected (89.7%) as what will bring about improvement in paediatric surgery research in Nigeria.

 

Conclusion

It is important to establish a less challenging  means of  breaking new ground in Paediatric Surgery in Nigeria. Improvement in funding and efficient hospital record keeping is essential. There is a need for continuous training of surgeons and more interaction between paediatric surgeons.

 

  1. SURGICAL SITE INFECTION IN NIGERIAN CHILDREN: A SYSTEMATIC REVIEW

Farinyaro AU1, Ameh EA2                                                

1 Paediatric Surgery Unit, Department of Surgery, Aminu Kano Teaching Hospital, Kano

2 division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja

 

Introduction

Surgical site infection remains the most common complication following surgical procedures. It is a major source of morbidity and less frequently a cause of mortality. Although there are a few single institution publications on this SSI in children in Nigeria, the burden and impact has not been ascertained.

 

Aims/Objectives

This study aimed to review the prevalence rates, morbidity and mortality of SSI in children in Nigeria as well as economic impact.

 

Materials and Method

We did a literature search on PubMed, google scholar, Mendeley, and manually for publications on paediatric surgical patients in Nigeria, using surgical site infection, wound infection, Nigerian children, as keywords. Data was extracted on types of study and surgical wound, predictors of surgical site infection and rates, isolates, wound management and outcome, burden on cost and length of hospital stay.

 

Results

A total of 59 publications from different tertiary health centres across the country met the inclusion criteria. The publications covered a period of 24 years, 1995 to 2018. Out of the 59 papers, retrospective studies were 40 (67.8%) while 19 (32.2%) were prospective. Only 9 (15.3%) of the studies were strictly on surgical site/wound infection. About half of the studies, 30(50.8%) were on emergency procedures, with 8(13.6%) being elective and 21(35.6%) combination of the two. The sample size ranged from 9 to 902 patients, with a mean of 15.4. With respect to the types of surgical wounds studied, 4(6.8%) publications were on clean wouns, clean contaminated 1(1.7%), contaminated 11(18.6%), dirty16(25.4%) and combination of the different types of wounds 29(49.2%). The rates of surgical site infection reported were, clean 4.3% – 10.4%( mean=7.2%), clean contaminated 16.7%, contaminated 2% – 27.1%( mean=14.7%), dirty 18.9% – 100%( mean=56.4%). Only 8(13.6%) studies mentioned the organisms isolated from the infected wounds, with Staphylococcus aureus being the commonest ranging from 29.4% – 61.3%(mean=40.5%) of the organisms, followed by were E. coli and Klebsiella spp. Of the 59 studies, only 13(22.0%) mentioned the interventions carried out due to the surgical site infection; 10 (16.9%) mentioned local wound care/antibiotics ( range = 2%-59.4%, median=18.6%), secondary suturing in 3(5.1%) with a range of 10.1%-35.8%, median 14.8%, wound debridement (1.5%) and shunt revision (4.0%) in 1(1.7%) each. Prolonged hospital stay and increased cost of care due to SSI were mentioned in 7(11.9%) and 1(1.7%) studies, respectively; mortality was reported in only 1(1.7%), which was 17.6%. Duration of hospital stay indicated in 3 papers was 21.1 days (mean), 7-15 days range (median 10 days) and 8-37 days range (median 25 days), each. However, no data regarding the actual cost due to SSI were available. Predictors/risk factors for surgical site infection were explicit in 6(10.2%) studies, which included age, preexisting medical conditions, longer pre- and post-operative stay, degree of wound contamination, longer operating time, anaemia, and hypoalbuminaenia.

 

Conclusion

The burden of surgical site infection in Nigerian children is still high, more studies need to be done to determine the predictors/risk factors, cost and ways to ameliorate the situation.

Keywords: surgical site infection; wound infection; Nigerian children.

 

  1. PATIENT FAMILY/RELATIVES AS ADJUNCT TO HEALTH CARE DELIVERY

Ikenador E.O, Chinda J.,Mshelbwala .P., Olori .S.,Osagie .O.,

University Of Abuja Teaching Hospital (UATH ) Gwagwalada

 

Background

Growing body of evidence shows that the more engaged a patient and patient relative are in the management of a pathology the better the outcome of health care . The term patient engagement encompasses a number of related concepts, including patient-centred care and shared decision-making all of which build on the idea of involving patients as partners in their care. Involvement was based on participation of at least 3 out of 8 components of care, 28(48.3%) were involved while 30(51.7%) were not

 

Objective

To ascertain determinants for involvement and satisfaction of patient family/relatives in health care delivery.

 

Materials and method

Cross sectional study with 58 questionnaires administered and analysed to ascertain the determinants of patient family/relative involvement and satisfaction in health care delivery.

 

Results

Mean child’s age is mean±SD 63.793±52.316 months, 70.7 %(41)of them were males and 17(29.3%) were females. 69.0%(40) of the caregivers were married/co-habiting while the rest were single.

Determinants to involvement of patient relative/family in care giving when compared to these variables were statistically significant which were, marital status (χ2 value 4.392 and p-value 0.036), mother’s level of education χ2 value 13.128 and p-value 0.011), distance from hospital (χ2 value 6.846 and p-value 0.009), and ethnicity (χ2 value 12.190 and p-value 0.032).There were no significant association between the variables and satisfaction.

 

Conclusion

Patient family/relative involvement has a significant role in health care delivery

 

 

  1. ANALYSIS OF THE COST OF PATENT DUCTUS ARTERIOSUS LIGATION FOR PAEDIATRIC PATIENTS: A CALL FOR NATIONWIDE HEALTH INSURANCE COVERAGE

 

T.N Oyebanji, M.I Inuwa, J.I Ahmad

Cardiothoracic Unit, Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria.

 

Background

The management of patent ductus arteriosus (PDA) in this environment is often delayed for pecuniary reasons. Majority of our patients are not covered by the National Health Insurance Scheme (NHIS) and surgery has to be funded out-of-pocket. We therefore aimed to perform a cost analysis of operating a patient with PDA at the Aminu Kano Teaching Hospital (AKTH).

 

Methods

This was a prospective analysis of the cost of operating a patient with PDA. The study period was from January 2012 to December 2017. Data were obtained from consecutive patients’ receipts and case folders. Information analyzed included patients’ demographics, length-of-hospital-stay, cost of hospital admission, surgery and investigations. Data analysis was done using SPSS version 23.

 

Results

The records of 22 patients ≤144 months old were analyzed. Median age at presentation was 24 months (SD = 39.2; mean, 42.1; range, 2-144 months). Mean length of hospital stay was 8.1±2.2 days. The mean overall cost was #61,887.27±1,900 ($172±5.25) with a minimum of #60,100.00 ($167.01) and a maximum of #68,600.00 ($190.63).

The mean cost of hospital admission was #2,831.80 ($7.85), investigations #12,500.00 ($34.67) and operation #37,500.00 ($104.02).

 

Conclusion

The mean overall cost of PDA ligation is 344% of the national minimum wage. This could hinder patients’ presentation in an environment where most people live on less than one dollar a day. Nationwide coverage of the NHIS should be encouraged.

 

  1. IMPROVING THE PAEDIATRIC SURGICAL WORKFORCE IN NIGERIA: IMPLICATIONS FROM A COMMUNITY BASED SOSAS STUDY IN NIGERIA

 

Ademuyiwa AO, Odugbemi OO, Bode CO, Elebute OA, Alakaloko FM, Alabi EO, Bankole O, Ladipo-Ajayi O, Seyi-Olajide JO, Okusanya B, Abazie O, Ademuyiwa IY, Onwuka A, Tran T, Makanjuola A, Gupta S, Ots R, Harrison EM, Poenaru D, Nwomeh BN

 

Aim of the study

Hospital-based records are often used to estimate prevalence of medical need; however, in low-resource settings, many medical needs never present to the hospital setting. Relying on hospital-based estimates of illness might lead to a severe underestimation of medical need in these communities. Rather, community-based prevalence studies may better estimate surgical need and enable proper allocation of resources and prioritization of needs. This pioneer study aims to document the prevalence of common surgical conditions using a community-based study in a diverse rural and urban population in a LMIC.

 

Methods

A descriptive cross-sectional, community-based study to determine the prevalence of congenital and acquired surgical conditions among children in a diverse rural-urban area of a LMIC was conducted. Households, defined as one or more persons ‘who eat from the same pot’ or slept under the same roof the night before the interview, were randomized for inclusion in the study.  Data was collected using an adapted and modified version of the interviewer-administered questionnaire – Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool.    Data was analysed using the REDCap analytic tool.

 

Main Results

Eight-hundred-and-fifty-six households were surveyed with 1998 children. Ninety surgical pathologies were identified among the children, suggesting a prevalence rate of 4.5%. The most common conditions were umbilical hernias (70/10,000), inguinal hernias (50/10,000), injuries (85/10,000), abscesses/furuncle (30/10,000), hydroceles (25/10,000) and undescended testes (25/10,000). Children with surgical pathologies had similar sociodemographic characteristics to healthy children in the sampled population.

 

Conclusion

The most common congenital surgical conditions in our setting are groin hernias, while injuries and umbilical hernias account for the most common acquired condition. With an estimated national population of 98 million children and 97 paediatric surgeons, the surgical burden to surgeon ratio is 45,463:1. This suggests an acute need for training of more paediatric surgeons and allied staff.

 

  1. NEONATAL AND PAEDIATRIC SURGERY ACROSS SUB-SAHARAN AFRICA: RESULTS FROM A MULTI-CENTRE PROSPECTIVE COHORT STUDY

 

Lofty John Chukwuemeka Anyanwu1, Aminu Mohammed1, Lawal Abdullahi1, Emily Smith2, Luc Malemo3, Jacques Fadhili-Bake3, Elisee Bake3, Bertille Ki4, Albert Wandaogo4, Bernadette Bere4, Sharon Cox5, Collins Nwokoro6, Aderibigbe Shonubi6, Niyi Ade-Ajayi7, Kokila Lakhoo8, Emmanuel Ameh9, Dan Poenaru10, Andrew Leather11, Naomi Wright11 PaedSurg Africa Research Collaboration11

 

1 Aminu Kano Teaching Hospital, Kano, Nigeria.

2 Baylor University, Texas, USA.

3 HEAL Africa Hospital, Goma, Congo, the Democratic Republic of the.

4 Charles De Gaulle Pediatric University Teaching Hospital, Ouagadougou, Burkina Faso.

5 Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.

6 Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.

7 King’s College Hospital, London, United Kingdom.

8 John Radcliffe Hospital, Oxford, United Kingdom.

9 National Hospital, Abuja, Nigeria.

10 McGill University, Montreal, Canada.

11 King’s Centre for Global Health and Health Partnerships, School of Population

Health and Environmental Science, King’s College London, London, United

Kingdom.

 

Background

Sub-Saharan Africa (SSA) has the highest unmet need for surgical care in the world with an estimated shortfall of 41 million cases/ year. Children constitute up to 50% of the population yet there is limited research on neonatal and paediatric surgery from the region.

 

Aim

To undertake the first large-series multi-centre prospective cohort study comparing outcomes of five common neonatal and paediatric surgical conditions between SSA and high-income countries (HICs).

 

Methods

Data was collected using REDCap on all patients presenting primarily with gastroschisis, anorectal malformation, appendicitis, intussusception and inguinal hernia over a continuous 1-month period of collaborators choice between October 2016 and April 2017. Primary outcome was all-cause in-hospital mortality; secondary outcomes included post-intervention complications. Differences between observed outcomes in SSA and published benchmark data from HICs were compared using Chi-squared analysis and Fisher’s exact test. Multi-level, multivariate logistic regression analysis was used to identify factors affecting outcomes. p<0.05 was deemed significant.

 

Results

220 collaborators from 76 hospitals in 23 SSA countries participated in the study. 1407 patients were included: 111 with gastroschisis, 188 with anorectal malformation, 250 with appendicitis, 225 with intussusception and 633 with inguinal hernia. Mortality was significantly higher for all five conditions in SSA (10.02%) compared to HICs (0.65%) p<0.0001 (Table 1). Gastroschisis had the greatest disparity in outcome with 75.5% mortality in SSA compared to 4% in HICs (p<0.0001).

 

Conclusion

These results highlight the need for enhanced neonatal and paediatric surgical services across SSA and incorporation of children into National Surgical Plans being developed.

 

 

Keywords: Neonatal, Paediatric, Surgery, Sub-Saharan Africa, Outcomes, Mortality, Complications

 

 

Table 1: A comparison of the mortality rates of five common neonatal and paediatric surgical conditions between sub-Saharan Africa (SSA) and high-income countries (HICs)

 

 

   Mortality SSA 

 (%)

 Mortality HIC

 (%)

Chi-squared or Fisher’s exact test*,

p value

 Odds ratio

 (95% CI)

 All conditions 10.02 0.65 <0.0001 17.1

(8.7-33.6)

p<0.0001

 Gastroschisis 75.5 4.0 <0.0001 74.0

(35.9-152.5)

p<0.0001

 Anorectal  

 malformation

17.3 2.9 <0.0001 6.9

(3.5-13.8)

p<0.0001

 Appendicitis 0.4 0.004 0.02 99.8

(6.2-1601.0)

p=0.001

 Intussusception 9.4 0.2 <0.0001 52.7

(27.7-100.4)

p<0.0001

 Inguinal hernia 0.3 0 0.003 82.0

(3.9-1709.0)

p=0.0045

*Fisher’s exact test was used if there were less than 10 patients in a group.

 

 

  1. MANAGEMENT AND OUTCOMES OF CONGENITAL ANOMALIES IN LOW-, MIDDLE-, AND HIGH-INCOME COUNTRIES: PROTOCOL FOR A MULTI-CENTRE, INTERNATIONAL, PROSPECTIVE COHORT STUDY

 

Wright N.1, Ade-Ajayi N.2, Ademuyiwa A.O.3, Ameh E.4, Davies J.1, Lakhoo K.5, Poenaru D.6, Sevdalis N.7, Leather A.1, Lawal T.A.8, Olulana D.I.8, Ogundoyin O.O.8, Global PaedSurg Research Collaboration9

 

1King’s Centre for Global Health and Health Partnerships, School for Population Health and Environmental Science, King’s College London, UK

2King’s College Hospital, London, UK

3Paediatric Surgery Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria

4National Hospital, Abuja, Nigeria

5University of Oxford, Oxford, UK

6McGill University, Montreal, Canada

7Centre for Implementation Science, King’s College London, UK

8Paediatric Surgery Division, Department of Surgery, University of Ibadan and University College Hospital, Ibadan, Nigeria

9Participating institutions from across the globe.

 

Background

Congenital anomalies have risen to become the 5th leading cause of death in children under 5-years of age globally, yet limited literature exists from low- and middle-income countries where most of these deaths occur. This collaboration aims to undertake a multi-centre prospective cohort study of congenital anomalies to compare outcomes between low-, middle- and high-income countries (LM&HICs).

 

Methods

The Global PaedSurg Research Collaboration will be established consisting of children’s surgical care providers from around the world to participate in the study; collaborators will be co-authors of resulting presentations/publication(s). Data will be collected on patients presenting primarily with seven congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos/ omphalocele, anorectal malformation and Hirschsprung’s disease) for a minimum of 30 consecutive days between Oct 2018 and April 2019. Data will be collected on patient demographics, clinical status, interventions and outcome. Data will be captured using the online data collection tool REDCap.

The primary outcome will be all-cause in-hospital mortality and secondary outcomes will be post-operative complications. Chi-square will be used to compare mortality and multivariate logistic regression to identify factors affecting outcomes. P<0.05 will be deemed significant. Ethical approval will be sought from all participating centres. Funding is by the Wellcome Trust.

 

Outcomes

The study aims to be the first large-scale, geographically comprehensive, multi-centre prospective cohort study of a selection of common congenital anomalies across the globe to define current management and outcomes, aid advocacy and global health prioritisation, and inform future interventional studies aimed at improving outcomes.

 

  1. KNOWLEDGE AND USE OF BIOSTATISTICS AMONG RESIDENT AND JUNIOR DOCTORS AT UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL, PORT HARCOURT

 

Okoro PE, Karibi EN,

Address: Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt

Correspondence: C/o Dr Philemon Okoro, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt. E mail:philemon.okoro@uniport.edu.ng

 

Background

The place of research in the generation of facts and evidence upon which contemporary medicine can be based cannot be over emphasized. Medical and surgical research is now more crucial than ever before for advancement of clinical practice and career progression for medical professionals. This requires good understanding and application of biostatistics among clinicians.

 

Aim

To evaluate the appreciation and use of biostatistics among resident doctors at the University of Port Harcourt Teaching Hospital, Port Harcourt.

 

Subjects & Methods

This is a questionnaire based study carried out in the University of Port Harcourt Teaching Hospital. Completed questionnaires were retrieved immediately after completion. Data was subsequently collated and subjected to simple statistical analysis on the Excel spread sheet.

 

Results

There were a total of one hundred and nine (109) respondents,but sixty nine (69) (63.3%) were included in the study. The vast majority of respondents (79.7%) indicated that they understood the basic concepts of biostatistics, but only 16(23.2%) are able to apply their knowledge practically in research.

 

Conclusion

The level of appreciation and use of biostatistics among resident doctors in UPTH is inadequate. This may possibly be a reflection of the situation with resident doctors in other institutions in the country. There is need for a curriculum review both at the undergraduate and postgraduate levels to prepare medical professionals for the task of high quality research and advancement of knowledge.

 

Keywords: Biostatistics; Knowledge, Resident doctors, Biomedical research

 

 

  1. CHALLENGES OF MANAGEMENT OF INTESTINAL ATRESIA IN KANO, NIGERIA

Aliyu MS, Mohammad AM, Anyanwu LJC, Abdullahi LB, Farinyaro AU, Liman BI, Sa’ad B

Paediatric Surgery Unit, Department of Surgery, Aminu Kano Teaching Hospital, Kano

 

Background

Intestinal atresia is increasingly becoming a common cause of neonatal intestinal obstruction in our environment. The presentation, diagnosis and surgical intervention are often delayed, with attendant increase in morbidity and mortality.

The aim of this study was to evaluate the presentation and challenges in the management of intestinal atresia at our hospital.

 

Materials and Method

We conducted a prospective study on all neonates who were managed for intestinal atresia in the paediatric surgery unit of Aminu Kano Teaching Hospiatal between August 2015 to  July 2018.

 

Results

A total of 19 patients were managed during the study period. There were 9 males and 10 females (M:F= 0.9:1). Age at presentation ranged between 5 hours – 23 days (mean  – 6.19).  Mean birth weight was 2.21 and 61.1% of the patients weigh ˂2.5kg. Six (31.6%) were premature and 21.1 had other associated congenital anomalies.  Fourteen (73.7%) were jejunal atresia, 2(10.5%) ileal atresia and 3(15.8%) duodenal atresia. Type I atresia was the commonest type accounting for 52.6%, followed by type IV  seen in 8(42.1%) patients. All the patients in this study presented with bilous vomiting while 78.9% had failure to pass meconium. Seventeen (89.5%) were severely dehydrated and 15.8% were anaemic at the time of presentation. Intestinal resection and anastomosis was the commonest procedure performed, while duodenoduodenostomy was done in 2 patients with duodenal atresia. One patient with duodenal atresia had associated proximal jejuna atresia and duodenojejunostomy was one. Two (10.5%) had reoperation for anastomotic leak. Malnutrition was the commonest complication, seen in 26.3% of our patients, followed by surgical site infection (21.1%). Mortality was 36.8%. Of the 7 patients that died 2 were premature, 2 had associated congenital anomalies, and 4 had admission-operation interval more than 48 hours.

 

Conclusion

Intestinal atresia has significant mortality in our centre. Most patients presents late with fluid and electrolytes derangements. Delay in diagnosis and referral from the peripheral hospitals might be responsible for this.

Keywords: Atresia, Intestinal obstruction, Challenges

 

  1. NEONATAL INTESTINAL OBSTRUCTIONS IN KANO: OUTCOME OF MANAGEMENT

Aliyu MS, Mohammad AM, Anyanwu LJC, Abdullahi LB, Farinyaro AU, Liman BI, Sa’ad B.

Paediatric Surgery Unit, Department of Surgery, Aminu Kano Teaching Hospital, Kano.

 

Background

Intestinal obstruction occurring in the neonatal period is one of the commonest reasons for admission of surgical neonates. It is associated with significant morbidity and mortality, especially in our environment where home delivery and late presentation are common.

The aim of the study was to evaluate the presentation, causes and outcome of management of neonatal intestinal obstruction at our center

 

Materials And Method

We conducted a prospective study on neonates who were managed for intestinal obstruction over a three year period, from August 2015 to July 2018.

 

Results

A total of 58 neonates were managed during the study period, age ranged between 5hours – 27days  with a mean age of 6.6 days. There were 39 (67.2%) males and 19(32.8%) females. Abdominal distention and failure to pass meconium were the commonest presenting symptoms, seen in 79.3% and 65.5% of patients respectively. Thirty five (60.3%) patients had bilous vomiting. Anorectal malformation (ARM) was the commonest cause of obstruction accounting for 50%, while 16 (27.6%) neonates had jejunoileal atresia. Other causes were Hirschsprung’s disease (10.3%), intestinal malrotation with midgut volvulus (5.2%) and obstructed inguinal hernia(3.4%). Two patients had duodenal atresia(3.4%).The mean duration of admission was 11.1 days (3 – 42 days). Fifty four patients, representing 93.1%, had emergency surgical intervention, while in 4 (6.9%) patients obstruction was initially relieved by non-operative means such as rectal washout and manual hernia reduction. Surgical site infection was the most common complication, seen in 10.3% of operated patients. Mortality was 22.4%. of the 13 patients that died, 5 (38.5%) died of sepsis. Eight (61.5%) of the patients that died had jejunoileal atresia.

 

Conclusion

Delayed presentation is common in our environment. Anorectal malformation is the commonest cause of intestinal obstruction. The high mortality and morbidity in this study may be improved by sensitization of both the public and heath workers on early presentation, early referral and early and appropriate intervention.

Key words: Intestinal obstruction, Outcome, Neonate

 

  1. SERUM ELECTROLYTES PROFILE OF CHILDREN WITH TYPHOID INTESTINAL PERFORATION IN AMINU KANO TEACHING HOSPITAL, KANO- EXPERIENCE OVER 5 YEARS

Liman BI, Mohammad AM, Anyanwu LJC, Lawal AB, FarinYaro AU, Aliyu MS, Sa’ad B

 

Background

Typhoid fever is a common infection ravaging the sub-Saharan Africa; it is of public health importance. Typhoid intestinal perforation is the commonest surgical complication of this common disease. This study aims to review serum electrolyte profile of children with typhoid intestinal perforation that were managed in retrospect over a 5 year period (2009-2013).

 

Method

The study is a retrospective study in which 129 consecutive patients managed for peritonitis 20 typhoid intestinal perforation were recruited. Their records were retrieved and entered in to the proforma made for the study. Data was analyzed using SPSS version 20. Quantitative variables were summarized using means, SD, median and ranges, while qualitative variables were summarized as frequencies, proportions, tables and charts. X2-test was used to test associations of categorical variables while t-test was used to compare means.

 

Results

A total of 129 patients were studied, out of which 78(60.50%) were males and 51(39.50%) were females. The male: female ratio was 1.5:1. The mean age of the patients was 8.18 (SD ±2.63) and the mean duration of admission was 18 days (SD±15). The mean concentrations were Na+ 125.87(SD±26.38), K+ 3.51(SD±1.20), and HCO- 20.13 (SD±6.16), Cl- 89.33 (SD±21.26), Urea 6.9 (SD±5.20). There was statistically significant association between the serum level of urea and mortality X2-test (p-Value 0.005).

 

Conclusion

This study has demonstrated the serum electrolyte profile of patients with typhoid intestinal perforation differs with the normal values and serum urea level at presentation significantly associates with outcome.

KEY WORDS: Serum electrolytes, typhoid intestinal perforation, children

 

 

  1. EMERGENCY PRESENTATION OF ANORECTAL MALFORMATION IN KANO

Abdullahi LB, Mohammad AM, Anyanwu LJC, Farinyaro AU, Aliyu MS, Liman BI, and Saad B.

Pediatric surgery unit, Department of Surgery

 Amin Kano Teaching Hospital/ Bayero University Kano.

 

 

Introduction

Anorectal malformations (ARMs) are congenital anomalies affecting the rectum and anal canal, are group of anomalies commonly encountered in pediatric surgical practice. The incidence is said to be 1 in 3000- 5000 live birth with some variation between different regions in the world.

Aim

The aim of this study is to evaluate the neonatal presentations of ARMS including the outcome of their management.

Materials and Method

We conducted a prospective study of patients with features of neonatal intestinal obstruction and review all patients with anorectal malformation presented during neonatal period as emergency admitted to special care baby unit (SCBU) of our Hospital.

Results

During the study period between August 2015 to July 2018, 58 neonates were admitted with features of intestinal obstruction, out of which 28 patients have anorectal malformations. 22 (79%) of them are male while 6 (21%) are female. The age at presentation ranges between 1day to 11days with median age of 4days. The symptoms at presentation are usually absent anal opening in 24 patients, abdominal distension (22), vomiting (4), fever (3). Only one patient present with features of peritonitis (abdominal tenderness and abdominal wall odema). 18 patients have high anomaly (2 rectal atresia) while 10 have low anomaly (2 bucket handle deformity and 1 anal membrane). 4(14%) of the patient had primary anoplasty and the remaining had colostomy. One of the patient was re operated due to complete wound dehiscence about 5 days after colostomy. 2 patients died from respiratory failure and sepsis respectively while 26 patients were discharge home alive. The common complications observed were surgical site infection, wound dehiscence, stoma necrosis and skin excoriation.

Conclusion

Anorectal malformation is the commonest cause of neonatal intestinal obstruction in our center.

 

Poster

IDIOPATHIC NEONATAL PRIAPISM: A CASE STUDY AND A REVIEW OF THE LITERATURE

 

H Moustapha, M.O Ali Ada¹, R Bana ¹, H Oumarou ², I Chaibou 3, H Idé ¹,

A Diori¹, S Boubacar ¹, M Chérif ¹, H Abarchi ¹

1- Department of Pediatric Surgery, National Hospital Lamordé, Niamey (Niger), FSS-UAM

2- Department of Pediatric Surgery, National Hospital of Zinder (Niger), FSS-UZ

3- Department of Radiology, Mother and child clinic of Gazobi, Niamey (Niger)

 

Summary

Neonatal Priapism is a rare and relatively benign condition. We report a case of a new 15 days admitted for spontaneous erection; painless evolving since 5 days. The clinical and paraclinical assessment did not reveal a particular etiology. The diagnosis of idiopathic priapism was retained. The evolution was favorable with a spontaneous and complete detumescence at the 3rd day of hospitalization. The patient was regularly followed for 3 months; no recurrence was found with preservation of physiological erection.

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