A 6-year retrospective clinical review of iatrogenic ureteric injuries repaired in a resource-deprived setting.

BACKGROUND: Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. OBJECTIVE: The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. PATIENTS AND METHODS: This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients' demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. RESULTS: Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. CONCLUSION: Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.

Solitary kidney functional damage due to caesarean ureteric injury monitored for 2 years after acute management: A case report.

Caesarean section with associated ureteric injuries that damage kidney function is uncommon. Such injury in women with a solitary kidney has far-reaching effects if the diagnosis is delayed. The case report describes the successful acute management with stenting of ureteric damage after caesarean section in a woman with a solitary kidney. A 29-year-old woman presented with anuria, hypertension (174/101 mmHg) and flank pain 3 days after caesarean section. Physical examination was significant for peri-orbital oedema, left flank tenderness, pallor and delirium. A diagnosis of acute kidney injury was confirmed by elevated blood urea and creatinine levels. An ultrasound scan revealed a solitary hydronephrotic left kidney. She had successful acute management at a resource-deprived facility, with normal renal function at a 2-year follow-up. Proteinuria lasted for about three months after surgery. Recovery of solitary kidney function with acute kidney injury due to caesarean section ureteric injury may be associated with prolonged proteinuria without evidence of further functional deterioration.

HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome.

INTRODUCTION AND IMPORTANCE: Surgical site infection (SSI) is an inevitable occurrence in bowel perforation with faecal soiled hernia wound(s) especially in retroviral patients. Unfortunately, the increased antibiotics and wound care demands do not prevent delayed healing, increased risk of hernia recurrence, or multiple surgeries to control the infection. The standard open or endo-laparoscopic Mesh repairs are either deferred or avoided with alternative tissue-based hernia repairs after bowel surgery. The reported success of open tissue-based repairs remains mixed. Nylon monofilament that have been used in infected wounds was chosen for the patient in anticipation of wound infection. CASE PRESENTATION: A 48-year-old man presented with a 7-days complicated hernia at the emergency unit, Margaret Marquart Catholic Hospital. Clinical examination revealed signs of shock, intestinal obstruction, and peritonism, laboratory investigation was remarkable of anaemia, septicaemia, deranged renal function, and positive retroviral test. He had concurrent right hemicolectomy and nylon darn after optimisation. The outcome we evaluated after surgery included postoperative pain, scrotal collection, anastomotic breakdown, postoperative analgesic use, wounds infection, prolonged hospital stays, recurrence, and the need for a second surgery. Though he developed prolonged deep SSI, he has intact hernia repair after 6-years. CLINICAL DISCUSSION: The postoperative critical clinical events presented in this case were unexpected but might have been precipitated by his retroviral status. Thus, a weight loss of over 13 kg within 2 weeks was highly unusual. Furthermore, the positive retroviral status couple with the perforated caecum and soiled peritoneum was the cause of the surgical site infection. CONCLUSION: Nylon darning in a retro-positive patient developing prolonged SSI appeared beneficial. It should be considered in patients with anticipated long period wound infection.

Perception and Attitude of Medical Students towards Cadaveric Dissection in Anatomical Science Education.

BACKGROUND: Cadaveric dissection is essential and effective teaching method of anatomy in medical schools. In cadaveric dissection, the learner plays the central role of the teaching process and to view structures in their natural location. Cadaveric dissection is however perceived as tedious and time consuming by most students which influence their perception and attitude towards the teaching method. This study was therefore designed to evaluate UHAS medical students' perception and attitude toward dissection in the teaching and learning of human anatomy. METHOD: This was a cross-sectional and descriptive study. A Likert-style questionnaire, comprising 26 items was sent to study population via online using google form. Ethical issues were duly dealt with approval and consent. RESULT: Majority of the students (84.5%) perceived dissection more interesting, and the better way to really learn and understand the human body. About 87% of students also indicated that it assists in retention of what they learnt in theory. Majority of the students (74.5%) felt dissection should not be replaced by other forms of learning. CONCLUSION: There is a strong positive perception and attitude towards the use of cadaveric dissection as a teaching and learning method of anatomy. Cadaveric dissection brings about the skills, courageous and the ability to confidently work on the human body without any fear for future practice. It is therefore, recommended that more time should be allocated to cadaveric dissection.

Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report.

BACKGROUND: Disorders of sex development are anomalies in which the development of urogenital ridge is undifferentiated for the male and female child. Imaging plays a vital role in investigating the gross anatomy and associated anomalies. Ultrasonography, such as genitography and magnetic resonance, is the primary modality for demonstrating internal gonads and genitalia. Early multidisciplinary approach in the management of ambiguous genitalia including early surgical intervention is the predominant practice, with few current considerations on deferral of genital reconstruction until adolescent age. CASE PRESENTATION: We report the rare case of a 24-year-old adult female from a majority ethnic group of the Volta region, Ghana who was diagnosed and raised as male, now requiring surgical restoration to the female gender. The surgical team decided to assign external genitalia to correspond with the already intact internal organs, thus constructing the vulva. Consent was given by the client and her family members for management and surgical intervention. The surgery was scheduled and duly performed with a successful outcome. Understanding and consent was sought from the patient for the purpose of using her images for teaching, scientific publication, and demonstrations. CONCLUSION: The advantages of deferring surgical reconstruction with psychological counseling after early assessment need to be considered to prevent inappropriate gender assignment.

Penile skin bridge multiple liathiasis, a diagnosis made in a complication of circumcision in a 24 year old young adult: Case report.

Penile skin bridge stones are rare complications which has never been reported in literature hence information about management is non-existent. This case reports a 24-year-old man presenting with recurrent inflammatory symptoms in his sizeable penile skin bridge. Clinical examination revealed multiple calculi which was confirmed after surgical division of the SB. Phimosis and stone migration are the pathological basis underlying all reported cases of non-urethral calculi in uncircumcised elderly phallus. Extra-luminal urolithiasis in a young circumcised man, we believe have different predisposing factors and prognosis. Treatment involved stone removal and debridement of the skin bridge which yielded successful outcome.

Complete Penoscrotal Transposition with Other Extragenital Anomalies in a Neonate Delivered at Term.

A complete penoscrotal transposition (CPST) is a very uncommon congenital maldevelopment that is always associated with other abnormal body variations (malformations). We report a rare case of a term neonate delivered with CPST, which had a flaccid penis and an intact scrotum with unilateral limb and digital deformity, imperforate anus, cardiac malformation a facial deformity. Neonate died two hours after delivery. The foetal abnormality was not detected through routine antenatal services received by the mother.

Corrigendum to "A Rare Anatomical Variation of the Termination of Right and Left Cephalic Veins".

[This corrects the article DOI: 10.1155/2018/5809656.].

A Rare Anatomical Variation of the Termination of Right and Left Cephalic Veins.

Clinically, the cephalic vein is preferred for haemodialysis in patients with chronic renal failure (CRF), to remove waste products from blood. The cut-down of cephalic vein in the deltopectoral groove is preferred when superior vena caval infusion is necessary. However, cephalic veins exhibit a wide array of developmental variations in terms of formation, course, and termination. In this report, we describe a case of an anomalous cephalic vein with a bifid course of terminations on both left and right upper limbs which has not been described by the previous literature [corrected]. During routine gross anatomy dissection of the neck, we observed a rare case of variation of the termination of the cephalic vein in both right and left upper limbs, of a male cadaver. Knowledge of the variations of cephalic vein is important not only for anatomists but also for surgeons and clinicians as the vein is frequently used for different surgical procedures and for obtaining peripheral venous access as well.