Background: Chronic Leg Ulcers (CLU) are common cutaneous manifestation of sickle cell disease (SCD) and a major cause of debility. CLU results from vaso-occlusion, poor venous pressure, hypercoagulabilty and trauma. The incidence of CLU is variable based on geographical region. Treatment modalities include debridement and skin grafting. The aim of this study was to determine the prevalence, incidence, hematological parameters and treatment modalities of CLU among SCD patients in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Patients and Methods: It was a retrospective study of adult SCD patients between January-December 2012 at ABUTH Zaria. Case notes of SCD patients were retrieved and data on socio-demographics, hematological parameters and CLU were extracted and analyzed using Epi Info. Data was analysed using descriptive analysis and comparisom of mean by student's t-test. Results: Of the 446 SCD patients attended to during the study period 14 had CLU. The incidence of CLU was 0.45% among the SCD patients studied. The male to female ratio was (M: F = 1.3:1). CLU occurs commonly around the malleoli in 78.6% whereas other sites constituted 21.4%. In 77.8% of CLU low steady state PCV was seen, 76.9% had reticulocytosis whereas 81.8% had high platelet count > 477 × 10⁹/l. Recurrence rate was 78.5% with osteomyelitis (16.7%) and limitation of movement (16.7%) as a frequent complications of CLU. Wound debridement and dressing was the commonest surgical management option but with a high recurrence rate. Conclusion: Prevalence of CLU is low in SCD patients in Zaria; occurring commonly in patients with low steady state PCV, reticulocytosis and thrombocytosis. Debridement and skin grafting has good cure rate and lower recurrence of CLU.

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Background: Gallstone disease is a common surgical problem requiring cholecystectomy. It is known to produce diverse histopathological changes in the gallbladder ranging from acute or chronic inflammation to metaplasias and even malignancies. The aim of this study was to emphasize the importance of a detailed microscopic examination and to study the diverse range of histopathological lesions in cholecystectomy specimens. Materials and Methods: This is a retrospective study of 360 cholecystectomy specimens received in the Department of Pathology over a period of 2 years from November 2010 to October 2012. Clinical details and histopathological data were retrieved from the records. The variety of morphological changes in the diseased gall bladder were correlated with the clinical findings. Results: Overall, there were 360 cases consisting of 74 (21%) males and 286 (79%) females. Maximum number of patients was between 31 and 40 years (30.2%). Most common pathology noted in our study was chronic cholecystitis seen in 280 cases (77.7%). Other benign lesions were cholesterosis in 36 (10%) and acute cholecystitis in 10 (2.7%). Various other associated lesions and variants of cholecystitis were also encountered. A total of nine malignant lesions of gallbladder were observed, which included eight cases of incidental adenocarcinomas and one case showing lymphomatous involvement. Conclusion: Our study emphasizes that a routine cholecystectomy performed for a common condition like gallstone disease can result in a diverse and wide spectrum of histopathological lesions ranging from benign diagnosis to an unexpected gallbladder malignancy.

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The gastrointestinal tract (GI tract) is the most common site for extranodal lymphomas with the majority of the non-Hodgkin's B-cell type. It involves any part of the GI, the most frequent sites in the order of occurrence are the stomach, small intestine, and ileocecal region. A 17-year-old male presented with intermittent abdominal pain, altered bowel habits associated with vomiting of 1 month duration. Computerized tomography of the abdomen revealed an eccentric mass in the jejunum with significant luminal narrowing. Limited resection of jejunum showed an intraluminal polypoidal growth with a homogenous cut surface. Microscopic examination of the mass revealed a diffusely infiltrating monotonous population of large lymphoid cells with round to oval vesicular nucleus, prominent nucleoli and moderate to scanty cytoplasm, admixed with few multinucleated giant cells with wreath like arrangement of nuclei, binucleated cells, and atypical mitosis. The tumor was involving the submucosa, infiltrating the muscularis propria and extending into the sub serosa. Immunohistochemistry showed diffuse positivity for CD45, CD30, anaplastic lymphoma kinase-1 (ALK-1), and focal positivity for CD43. The immunohistochemical stains for B-cell lineage CD20, CD79a, T-cell markers CD3, CD2, CD4, CD8, CD7, and other markers namely bcl2, bcl6, CD5, CD138, CD56, Mum1, and PAX-5 were negative. Six lymph nodes isolated showed features of reactive follicular hyperplasia and were free of tumor. A diagnosis of primary ALK positive anaplastic large cell lymphoma of T-cell type of jejunum was made. Patient has completed three cycles of chemotherapy comprising of cyclophosphamide, prednisone, vincristine, and doxorubicin and is in remission until the last follow-up.

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Background: The fundamentals in the treatment of acute peritonitis include resuscitation, treatment of septicemia, control of the contaminating source and peritoneal toilet. Numerous studies have shown the roles of different solutions such as normal saline, antibiotics and betadine as intraperitoneal lavage, in reducing morbidity and mortality of peritonitis. The objective of this study was to present our findings on the role of intraperitoneal lavage with normal saline and normal saline followed by super-oxidized solution in patients with acute peritonitis. Materials and Methods: The patients were randomly allotted by slip method into two groups of 50 each. In the control group, after the definitive surgery for the pathology of peritonitis, the peritoneal cavity was lavaged with normal saline and closed after putting drains. In the study group, after the definitive surgery the peritoneal cavity was lavaged with saline followed by 100 ml of super-oxidized solution and drains were closed for 1 h after abdominal closure. The patients were followed-up for morbidity and mortality. Results: Surgical site infection (SSI) was present in 27 out of 100 cases in both groups. In the study group, out of 7 infected cases, intraperitoneal fluid cultures were positive in 6 cases, but only 3 had positive swab cultures. In the control group, out of 20 infected cases, swab culture was positive in 16 cases (p = 0.0399). Among the study group, bowel sounds return in 4.10 ± 1.20 days compared to 5.9 ± 1.17 in the control group. In the study group, fever >100°F developed in 14 (28%) patients in the post-operative period whereas in the control group it was 29 (58%) (p < 0.0024). SSI rates in the two groups were (7/50) 14% and (20/50) 40% respectively (p = 0.0034). Conclusion: This study suggests that super-oxidized solution is effective and safe in reducing post-operative complications including SSI, burst abdomen and episodes of post-operative fever.

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The child development from conception through early years of life is marked by many changes. Tooth eruption follows the chronology corresponding to the date, when tooth erupts into the oral cavity. These dates have been established in the literature and are subject to small variations depending upon hereditary, endocrine, and environmental factors. However, the chronology of tooth eruption suffers a more significant alteration in terms of onset and the first tooth or teeth may be present at birth, called as natal teeth. Natal teeth are rare in extremely preterm infants. In this paper we present a rare case regarding the eruption of mandibular natal tooth in a 10-day old, 7-month preterm normally delivered infant.

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Small bowel obstruction is a common condition, encountered in the emergency room of the surgery department. Uncommon causes include gallstone ileus, worm infestation, internal hernias, mesentric ischemia, trichobezoars or phytobezoars, Crohn's disease, postoperative strictures, and diverticulosis. Even more uncommon is primary enterolithiasis. Enterolith, the enterogenous foreign bodies, are rare clinical and radiological entities. True enteroliths are formed due to precipitation and deposition of substances from alimentary chime. Primary enterolithiasis is a rare entity, occurring in association with pathological conditions that lead to hypomotility and stasis, like Crohn's disease, small intestine diverticulae, traumatic or postoperative strictures of ileum, ulcerative colitis and blind loops. Primary enterolithiasis may be asymptomatic or may present with sub-acute or acute intestinal obstruction, but specific radiological diagnosis of primary enterolithiasis is uncommon. Definitive treatment of enterolithiasis with small intestinal obstruction is essentially surgical. The options at laparotomy are manual lysis of the calculus without enterotomy or removal by enterotomy. Bowel resection is indicated in cases with definitive bowel pathology. We are presenting five cases of enterolithiasis, which we encountered in the Surgery Department of L.L.R.M. Medical College, Meerut from January 2006 to December 2012. Clinical presentation, diagnosis, investigations and treatment have been discussed along with a review of literature.

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Background: Ureterocele is a cystic dilatation of the distal ureter. It remains a rare urologic condition in non-Caucasians and is even less common in adults. Single-system ureteroceles are usually found in adults, and thus the name "adult" ureterocele. Though uncommon, urologists practicing in this region should be acquainted with the management. Materials and Methods: A retrospective review of folders of 10 adult patients who were admitted for surgical treatment of ureterocele in our center between 2000 and 2009 was done. The information obtained included: age, sex, type and number of ureterocele, associated disease, type of surgical intervention, complications, and follow-up. Results: The age range was 20-49 years, with a mean age of 31 years. Of these patients, seven were females and three were males. Six patients had unilateral ureterocele while four had bilateral disease, making a total of 14 ureteroceles. The presenting symptoms were flank pain and painful micturition, each occurring in 60% of the patients. Genitourinary tuberculosis was diagnosed in 4 (40%) patients. Other associated pathologies were impacted stone in the ureterocele and vesical schistosomiasis. The treatment was mainly by open method (70%), while the rest had endoscopic treatment. All the patients did well and there were no significant perioperative complications. Conclusion: The finding of associated pathology in our patients supports the theory of an acquired origin. Urologists practicing in this region need to have a high index of suspicion and be acquainted with the variable clinical presentations, radiographic features, and treatment options in order to be able to effectively manage these occasional cases.

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Abcess within a brain tumor is very rare and is usually seen in a pituitary tumor. We present a patient with glioblatoma that was found to contain abcess at operation. A 50-year-old man presented with a rare case of glioblastoma associated with intra-tumoral abscess formation manifesting as seizures, headache and vomiting after fever, cough, and chest infection. Computed tomography and magnetic resonance imaging demonstrated a ring-enhanced lesion mimicking malignant glioma. Craniotomy and tumor removal were performed. Abscess formation within the intra-axial tumor was found intra-operatively. Histological examination revealed glioblastoma with abscess and the etiological agent was anaerobic gram-negative bacilli. The post-operative recovery of the patient was satisfactory. Abcess in a gliobastoma is uncommon. The suspected route of microbial migration and colonization in this tumor was probably bacteremia from chronic lung infection. Careful evaluation and appropriate treatment would lead to a good outcome.

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Tumoral calcinosis is a disease characterized by peri-articular deposition of calcium phosphate mostly around major joints of the body. A 60-year-old female was suffering from painful swelling over the left greater trochanteric area for past 4 months. No similar lesion was detected on any other part of the body. Thorough biochemical and radiological work up was done followed by excision of swelling. Pathology revealed Tumoral calcinosis. Patient is being followed up regularly for any recurrence.

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Pyomyoma (suppurative leiomyoma) is a rare disease that can result in very serious complications. Though most cases have occurred in pregnant or postmenopausal women with a predisposing factor, we present a case that apparently presented spontaneously. A young nulligravid woman presented with a history of abdominal pain and swelling of 2 weeks duration which became worse despite use of potent broad-spectrum antibiotics. She had no fever or predisposing factors, but had history of leiomyoma. Ultrasonographic scan showed an enlarged uterus with a solitary large mass. Internal heterogeneous echogenicity was noted within the mass in the anterior wall of the body of the uterus. With a clinical impression of degenerated leiomyoma, she underwent abdominal myomectomy. However, intraoperative findings showed a leiomyoma with abscess formation. The postoperative course was uneventful. Pyomyoma is rare and may be difficult to diagnose clinically, especially in women with a nonspecific clinical presentation. A strong clinical suspicion and prompt surgical intervention with the use of broad-spectrum antibiotics can be lifesaving.

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Background: Rapunzel syndrome is an extremely rare form of trichobezoar extending from the stomach to the small intestine and sometimes even beyond the ileocecal valve. Approximately 50 cases of Rapunzel syndrome have been reported in the literature, and most of them being young women. The aim of this study was to review the clinical features and outcome of pediatric patients with Rapunzel syndrome. Patients and Methods: We present a retrospective study performed from January 1995 to December 2013. The study included eight paediatric patients. The clinical features including history of trichophagia, intraoperative findings, bezoar characteristics and operative were analyzed. Results: The age of patients ranged from 4 years to 15 years. Only one (12.5%) child was in teenage group, whereas the rest of the patients (87.5%) were below the teenage group. There were five (62.5%) females and three (37.5%) males. Patients had varied presentations like chronic abdominal pain (100%), abdominal distension (75%), epigastric fullness (75%), features of intestinal obstruction (50%), and anorexia (25%). Trichophagia could not be elicited in four patients (50%). Impending intestinal perforation and Intussusception was seen in one (12.5%) each. Six (75%) patients had trichobezoar, while plastobezoar (plastic bezoar) and mixed bezoar was present in one (12.5%) each. Conclusions: Rapunzel syndrome is also seen in children below the teenage group. Although more common in females, it is seen in both sex. Chronic abdominal pain and distension are main presenting features, while history of trichophagia is absent in 50% cases. It should be included in the differential diagnosis in children, especially females with chronic abdominal pain, even if history of trichophagia is absent.

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Background: Nail avulsion is a commonly performed office procedure. It can be used successfully along with other adjuvant therapies in various nail disorders. The objective of this study was to evaluate the efficacy and safety of nail avulsion in nail disorders. Patients and Methods: A total of 35 patients with nail changes of onychomycosis, ingrown toenail, subungual or periungual wart and dystrophic nail were studied over a period of 2 years. Nail avulsion was carried out in each patient with adjuvant therapy in the form of electrosurgery, chemical matricectomy and systemic antifungal medications. Each patient was reviewed for any postoperative complication and recurrence. Results: Most common nail disorder was onychomycosis (60%). Male: Female ratio was 1: 1.3. Maximum recurrence rate was seen in subungual or periungual wart (20%). No postoperative long-term complications were seen. Conclusion: Nail avulsion is a simple, easy-to-carry procedure. Recurrence of certain nail disorders can be decreased by combining nail avulsion with other adjuvant therapy.

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Background: The intima-media thickness (IMT) has been established as an early predictor of general arteriosclerosis in patients with hypertension. The aims of this study were to establish the relationship between carotid IMT (CIMT) and blood pressure of hypertensive adult patients and to correlate CIMT with age and body mass index (BMI) in hypertensive adult patients. Patients and Methods: This prospective study was carried out from November 2012 to February 2013 on 200 hypertensive patients aged 21-70 years. The common carotid artery (CCA) was scanned using an ALOKA SSD-3500 ultrasound scanner with Doppler facility and a 7.5MHz linear transducer. Three measurements of the CIMT were obtained at 1cm proximal to the right and left carotid bulb and the mean value of the three measurements was recorded. Results: There were 200 patients comprising 67 males and 133 females. Their ages ranged 21-70 years, mean of 50.62 ± 10.46 years. The right and left mean CIMT was 0.99 ± 0.13 and 0.99 ± 0.18, respectively; while the overall mean CIMT for both sides was 0.99 mm ± 0.13. The mean BMI for the studied group was 29.09 ± 5.68. The mean systolic and diastolic blood pressure (SBP and DBP) was 157.0 ± 15.5 and 97.6 ± 11.2 mmHg, respectively. There was a significant difference in the mean CIMT value for each SBP and DBP groupings. CIMT correlated positively with age and blood pressure, but had a negative correlation with BMI. Carotid plaques were seen in the CCA wall of 20 patients (10%). Conclusion: In hypertensives, age and blood pressureare the most important determinants of CIMT. The incidence of carotid plagues in our patients was high; therefore, good control of blood pressure in hypertensives may reduce the incidence of carotid plaques and stroke.

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Background: Episiotomy continues to be increasingly performed in our labor wards despite current scientific evidence restricting its use. The objective of this study was to determine the incidence, indications, and establish reference point for future studies on episiotomy in Aminu Kano Teaching Hospital. Patients and Methods: This was a 3-year retrospective study of vaginal deliveries in Aminu Kano Teaching Hospital, Kano, from January, 1, 2010 to December 31, 2012. The parturients who had episiotomy were identified from the labor ward register and the following information was extracted: Parity, type of vaginal delivery, gestational age at delivery, birth weight, Apgar scores, and estimated blood loss. The information obtained were analyzed and presented. Results: The episiotomy rate was 41.4%. Episiotomy was commonly performed in primigravidae (79.4%) than multigravidae (X² = 3017, P < 0.001), fetal macrosomia in 86.9% of the cases (X² = 669.7, P < 0.001) and assisted vaginal delivery seen in 75% of the cases (X² = 172.4, P < 0.001). Episiotomy was also associated with more postpartum blood loss when compared with parturients without episiotomy and was statistically significant (t = 95.82, P < 0.001). Conclusion: Episiotomy rate is high in Aminu Kano Teaching Hospital. Midwives and doctors conducting deliveries should be educated on the indications for episiotomy and early repair to reduce associated postpartum blood loss.

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Background: Cholecystitis is a common indication for major abdominal surgeries. It may occur with or without obstruction of common bile duct. Obstruction leads to secondary bacterial infection of bile. Bactibilia is an important predisposing factor for post-operative complications. Hence, this study was designed to determine the prevalence of bacteria in bile samples of cholecystitis patients and to correlate bactibilia and post-operative wound infection. Materials and Methods: Bile samples collected intra-operatively were subjected to gram stain, culture, and antibiotic sensitivity testing. The patients were followed-up for post-operative complications. If post-operative wound infection was found, cultures were done and correlated with bacteria isolated from bile samples. Results: Bactibilia was found in 27/50 (52%) of patients. Polymicrobial flora was found in 10% of bile samples. Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis were the predominant organisms isolated. None of the anaerobes were isolated. Extended spectrum β-lactamase and AmpC β-lactamase (AmpC) production was seen in 47% and 31.5% of Enterobacteriaceae isolates respectively. Post-operative wound infection was found in six (12%) patients who had bactibilia. Combination of piperacillin-tazobactam and amikacin was most effective in prophylactic regimen. Conclusion: The organisms responsible for bactibilia were found to cause post-operative infections in the same patient warranting the use of prophylactic antibiotics in every patient undergoing cholecystectomy. All patients undergoing open cholecystectomy should receive prophylactic antibiotics to prevent post-operative wound infections.

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Introduction : The incidence of AIDS-associated Kaposi's sarcoma (AAKS) is increasing in the West African sub-region. The objective of this study was to describe the epidemiologic and clinical features of AAKS. Materials and Methods : This study was carried out in a tertiary health center with a federal government supported AIDS treatment program in Zaria, Nigeria. The subjects comprised 137 consecutive patients evaluated for AAKS from 2006 to 2011. Following evaluation appropriate specimens were taken for histologic, virologic, and immunologic assessment. Result : There were 137 patients representing 1.4% of HIV infected patients seen during the study period. The male to female ratio was 1.3:1. Their ages ranged from 2 to 58 years, mean of 32 ± 6 and females were younger than males. Mean duration of symptoms was 4.2 ± 1.5 months. Kaposi's sarcoma was the AIDS-defining disease in 95 (69.3%) patients while in 42 (30.7%) it was diagnosed between 1 and 15 months after the diagnosis of HIV infection. The lower limbs were the most frequent sites of lesions. Females had more disseminated lesions involving an increased number of lesions at multiple anatomical sites compared with more localized lesions in the males (OR 2.7, 95% CI 1.5-7.0). The CD4 count ranged from 19 to 798 cells/mm ³ , median 132; interquatile range 102-317 cells/mm ³ while the median HIV RNA copies/ml of plasma was 51,723 (ranged 250-917, 254). Conclusion : The prevalence of AAKS is increasing in our institution. Female patients were younger and had more disseminated disease that progressed faster than in males. Timely identification of HIV-infected patients is essential to avoid the consequences of immunological deterioration associated with delayed anti-retroviral therapy.

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Background: Hypospadias is a common congenital condition affecting the male phallus. It is characterized by abnormal opening of the urethra on the ventral aspect of the penis with ventral curvature of the phallus (chordee). Various surgical techniques have been described in the treatment of hypospadias. Evaluate the surgical outcome of anterior hypospadias repair including different procedures used to repair distal hypospadias. A retrospective observational study conducted by the Department of Pediatric Surgery, Kempegowda institute of medical sciences hospital, Bangalore from January 2014 to January 2018 over a period of 4 years. Patients and Methods: All children with anterior hypospadias were included in the study. Children underwent either meatal advancement and glanuloplasty (MAGPI) or Snodgrass urethroplasty depending on the type of hypospadias. On follow–up, children were evaluated for complications. Chi square test was used to test for relationships between categorical variables. Results: Fifty children were included in the study. Age ranges of children were between 9 months to 14 years. Coronal hypospadias was the most common variety (32%). Chordee, undescended testis, inguinal hernia, and penile torsion were observed in 44%, 4%, 6%, and 4%, respectively. On preoperative ultrasonography, renal anomalies were observed in 4 (8%) children. Out of 50 children, 25 underwent MAGPI and remaining 25 underwent Snodgrass repair. Postoperative complication was seen in nine children (18%). Most common complication was urethral fistula seen in five (10%) children followed-by meatal stenosis. Of these nine children with complication, only three children required resurgery. Conclusion: Distal hypospadias is uncommonly associated with renal anomaly, which was once again reiterated in our study. Undescended testis and inguinal hernia were the most common associated anomalies with distal hypospadias. MAGPI is choice in case of glanular and coronal hypospadias with minimal chordee. Snodgrass technique is excellent choice in subcoronal and distal penile hypospadias with chordee.

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Background: The Zaria Cancer Registry (ZCR) documents cancer cases within Zaria and environ with the objective of monitoring, planning, and screening of population at risk of developing cancer. The objective of this paper is to review the pattern and distribution of cancers as documented in the ZCR. Materials and Methods: A 5-year analysis of cancer cases recorded from January 2009 to December 2013 was made. Data sourced were grouped into those primarily from the hospital (A) and referrals from hospitals within (B) and outside (C) Kaduna state. Data compilation was done using CANREG4 software and the International Classification of Diseases (ICD)-0 classification and coding system. Results: A total of 2,536 new cancers were recorded with 1,014 males and 1,522 females. Cancer diagnosis from the histology of primary disease cases accounted for 86.3%, while cytology diagnosis cases comprised 10.6%. Over 90% of the diagnosis was based on symptomatic presentation by patients, while 81.6% were well-differentiated cancers. The peak age distribution was in 4 ^th -6 ^th decades of life in 58.9% cases, while 138 cancers were recorded in children aged 10 years and below. A total of 68 (2.7%) cases were also recorded in adolescents. Morphologically, squamous cell carcinoma (SCC), adenocarcinoma (not otherwise specified (NOS)), and infiltrating duct carcinoma were the commonest. About 60% of patients received two or more treatment modalities. Conclusion: The cancer distribution pattern from this registry is reflective of the cancer distribution in the larger population. Breast cancer was most common in females and ranked first overall, while prostate cancer was the commonest in males. This information is useful in planning for effective cancer screening, prevention, and management.

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In maxillofacial surgery, head and neck reconstruction of surgical defects caused by oral cancer is considered a challenging problem. Till recently, most oral and pharyngeal defects were closed primarily using skin flaps or tubed-pedicle flaps of skin from the trunk such as forehead flap, deltopectoral flap, pectoralis major myocutaneous flap; however, these were associated with compromised aesthetic and functional results. The advent of microvascular free tissue transfer over the past two decades has helped us overcome these disadvantages and has enabled the ablative surgeon to undertake surgical procedures that could not have been attempted in the past. Innovations in the field of microsurgery have resulted in better techniques, microscopes, and microinstruments, which have made free flap harvesting much easier. This article will review the various techniques of microvascular anastomosis used in head and neck reconstruction and analyze the newer techniques and methods employed today. It also attempts to provide a brief gist of the various free flaps used in head and neck reconstruction and the ones most expedient in the surgeons' arsenal.

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Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.

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Ectopic pancreas in the ileum is a rare entity. Herein, we present a 45-year-old male admitted with complete rectal prolapse. Clinical evaluation of the patient did not reveal any predisposing factor. During abdominal rectopexy a nodule in the ileum was found which was excised and histologically reported as an ectopic pancreas. The simultaneous occurrence of rectal prolapse and ectopic pancreas in the ileum has not been reported in the literature. We present this case for its rarity and to inform that a thorough examination of the abdomen should be done to detect such incidental pathology.

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Background: Between 50% and 70% of children with exomphalos have other associated anomalies, which may involve the heart, abdominal viscera and urogenital organs resulting in high morbidity and mortality. The aim of this study is to review the management of patients with syndromic exomphalos in our center and to highlight the management challenges. Materials and Methods: We retrospectively reviewed the records of patients with pentalogy of cantrell, cloacal exstrophy and Beckwith-Wiedemann syndrome who presented to our unit between January 1997 and December 2007. Results: There were a total of 10 patients. Pentalogy of cantrell was the diagnosis in three patients while four of them had cloacal exstrophy and another three patients had Beckwith-Wiedemann syndrome. Their ages at presentation ranged between 2 h and 6 weeks, with a median of 27 h. Their birth weights ranged between 1.6 kg and 4.95 kg, median 2.45 kg. 5 patients (50%) had a low birth weight (<2.5 kg). Of the 10 patients, 4 (40%) were discharged against medical advice (1 was readmitted) and 2 (20%) were lost to follow-up. There were 5 (50%) mortalities during the course of treatment. None of them had karyotyping done. Conclusion: The management of congenital ventral body wall defects is challenging in resource poor settings like ours, due to lack of appropriate facilities and relevant manpower.

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Background: Blunt abdominal trauma is a common cause of morbidity and mortality in children. The objectives of the study are to evaluate the specific patterns of organ injury in pediatric patients as illustrated by ultrasonography and computed tomographic (CT) scan and assess the role of nonoperative management in such cases depending upon the severity of injury and the organ injured. Materials and Methods: This prospective study was conducted on pediatric patients with blunt abdominal trauma that presented to the casualty of Jawaharlal Nehru Medical College over a period of 2 years. A total of 45 patients were examined. The ultrasonographic evaluation of the patients was performed and thereafter CT scan of the patients were performed within 24 h of hospital admission if on ultrasonography any evidence of intraperitoneal free fluid was detected with or without any detectable visceral organ injury. Results: Ultrasonography detected hemoperitoneum in 15 patients (51.72%) as compared to CT which detected it in 23 cases (79.31%). Spleen was the most common solid organ injured, encountered in 10 cases (34.48%) on ultrasonography and 15 cases (51.72%) on CT scan. Liver was the second most common injured organ which was demonstrated by ultrasonography in five cases (17.24%), while CT detected hepatic parenchymal injuries in nine cases (31.03%). CT was also significantly more sensitive than ultrasonography in the detection of renal injuries which were illustrated by ultrasound in only one case (3.44%), while CT showed renal injuries in three cases (10.34%). Pancreatic injuries were least common and were seen in two cases and were detected equally by ultrasound and CT scan. Conclusion: Ultrasonography is a very useful and sensitive investigation for the detection of hemoperitoneum and visceral injuries. However, CT better delineates the solid organs injuries and grades the injury as well, thus guiding the management protocol. Nonoperative management is the rule in hemodynamically stable patients in correlation with radiological and clinical scenario.

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Background: Management of colorectal cancer (CRC) in Nigeria is associated with such challenges as operating on locally advanced tumors. We performed a prospective observational study to assess the prevalence of surgical site infection (SSI) following CRC resection in a low resource setting. Materials and Methods: Consecutive patients, who had standard oncologic resection for CRC at Ahmadu Bello University Teaching Hospital, Zaria over a 5-year period from 2008 to 2012, were enrolled into the study. From 2010, patients with locally advanced rectal cancers were given neoadjuvant chemoradiation with concurrent 45 Gy external beam radiation over 5 weeks and fortnightly FOLFOX 4 regimen to downstage tumor followed 6 weeks later by surgery. Surgical resections were performed through open laparotomy. The outcome of interest was the development of SSI within 30 days of surgery. Patient and surgical variables were evaluated for association with SSI. Results: Of 188 patients seen with CRC, 78 (41.5%) had surgical resection and 75 were analyzed for SSI. The prevalence of SSI was 13.7% following transabdominal colectomy, 50% following abdominoperineal resection and 25.3% following overall CRC resection (P < 0.05). There was no SSI in patients whose local tumors were confined to the bowel wall, but 35.2% of patients with locally advanced tumors had SSI (P <0.05). Treatment with neoadjuvant chemoradiation, sex, body mass index, wound classification, surgical procedure duration, use of diverting stoma and perioperative blood transfusion were the significant variables (P < 0.05) for SSI. Conclusion: We observed that the prevalence of SSI in our setting is high and is possibly due to the difficulties of surgical resection of tumors most of which were locally advanced at the time of surgery among other factors.

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