ANATOMICAL SITES OF COLORECTAL CANCER IN A SEMI-URBAN NIGERIAN HOSPITAL: IS THERE A TRUE RIGHTWARD SHIFT.

BACKGROUND: Recent report on colorectal tumours in Nigeria and Africa sub-region from big urban cities have shown that the incidence of colorectal cancer is rising and with a proportionate right-ward shift. OBJECTIVE: To assess the sub-site distribution and surgical treatmentpatterns of colorectal cancer in a semi-urban tertiary Nigerian hospital. DESIGN: A retrospective descriptive study. SETTING: Tertiary health institution in a semi-urban (rural) community. SUBJECTS: All consecutive in-patients, admitted and managed for acute intestinal obstruction due to colorectal cancer. MAIN OUTCOME: The right colon was the site of predilection (60.6%) while the left colon was only (6.06%). Young adults were mostly affected. RESULT: A total of thirty three (33) cases of colorectal cancer (CRC) were seen during the study period. There were 20 (60.6%) males and 13 (39.4%) females. The male:female ratio was 1.5:1. The age range was between 22-87 years (mean 57.09 years). The peak age of occurrence was the 6th decade. All patients'were symptomatic at presentation. The caccum (36.365) was the predominant site affected; followed by the rectum (24.24%) and the hepatic flexure (21.21%). Of the colonic tumours, 60.6% were on the right colon while only 6.06% were on the left colon. Tumours of the descending and sigmoid colon were conspicuously absent. Fifteen patients (45.5%) had curative resection and 33.3% had palliative surgery. Twenty one point two percent mortality was recorded, while 21.2% refused surgery and opted for alternative care. CONCLUSION: Colorectal cancers are seen among rural dwellers in Nigeria. Presentations are often late. The right colon is the dominant site affected; this calls for a change in strategy for formulating a preventive policy for the country.

Laparoscopic cholecystectomy in Ile-Ife, Nigeria.

BACKGROUND: Laparoscopic cholecystectomy is not yet routinely performed in most public tertiary hospitals in Nigeria. OBJECTIVES: To assess the feasibility and early outcoe of laparoscopic cholecystectoy in Ile-ife, Nigeria. METHOD: Consecutive patients who were selected for the procedure from June 2009 through December 2010 at the Ife State Hospital of the ObafemiAwolowo University Teaching Hospitals Complex, Ile-Ife were prospectively studied. RESULTS: Eighteen female (75%) and six male patients had laparoscopic cholecystectomy within the study period. They were aged 19-83 years with a mean age of 33.4 years. Six (25%) patients had acute calculous cholecystitis while the rest presented with chronic calculous cholecystitis. Their Body Mass Indices ranged from 21 to 32kg/m2. Operation time ranged from 65 to 105 minutes. One procedure (4%) was converted to open due to bleeding from the gallbladder bed. Another patient who had a minor common bile duct injury presented with generalized dull abdominal pain on the sixth postoperative day. She had open repair of the injury over a T-tube. Three patients (12.5%) were discharged on the first postoperative day while 15 (62.5%) others were discharged on the second postoperative day. No mortality was recorded. CONCLUSION: Laparoscopic cholecystectomy is feasible in our setting with outcome comparable to previous pioneering experiences in other African countries centre in spite of resource limitations.

Complete recovery of renal allograft function after sixty days of delay following living related transplantation.

Delayed graft function (DGF), a term employed when a newly transplanted organ does not function efficiently is commonly observed following cadaveric renal transplantation but is very rare after living related transplants. We present a 31-year-old female recipient of a related donor kidney (mother) who had DGF following trans-plantation due to acute tubular necrosis, probably caused by partial allograft arterial thrombosis, which recovered function after 60 days. Appropriate use of allograft biopsy should be encouraged even in resource-limited settings lest the allograft be assumed to have failed irreversibly.

Pattern and validity of clinical diagnosis of upper gastrointestinal diseases in south-west Nigeria.

BACKGROUND: Diagnosis of upper gastrointestinal (UGI) diseases is often made on clinical grounds alone in Nigeria due to lack of endoscopic facilities. The validity of using such diagnosis is presently unknown. OBJECTIVE: The study aimed to determine: age and sex distribution of patients presenting for UGI endoscopy; pattern of clinical and endoscopic diagnoses in patients with UGI diseases; and, the validity of clinic-based diagnosis. METHODS: Medical records of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria for UGI endoscopy between September 1999 and August 2003 were reviewed. Data was analysed for sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis using endoscopic diagnosis as "gold" standard. RESULTS: Males constituted 53.4% of subjects and mean age was 45 years (+/- 1.69 SD). Peptic ulcer disease (PUD) constituted 67.6% of referral diagnosis but 33.9% of endoscopic diagnosis. PUD had the highest sensitivity value (0.72) while gastritis had the least (0.04). Specificity ranged from 0.40 for PUD to 1.00 for corrosive oesophagitis. Positive predictive value ranged from 0.29 (oesophageal cancer) to 0.67 (corrosive oesophagitis) and negative predictive value ranged from 0.66 for gastritis to 0.99 for corrosive oesophagitis. CONCLUSION: The validity of clinical diagnosis in UGI conditions varied widely, and in general, there is poor agreement between clinical and endoscopic diagnoses.

Pancreatic pseudocyst in Ile-Ife revisited: 5 more cases.

BACKGROUND: Pancreatic pseudocyst is a major health problem in the developed countries and its incidence is noted to be getting higher among the Caucasians as a result of better diagnostic techniques. This retrospective study was done to review the cases of pancreatic pseudocyst seen between 1991 and 1999 at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria. The 5 cases seen over this period of study were used to illustrate its rarity. METHOD: The case notes of the patients managed for pancreatic pseudocyst during the period under review were studied and analysed to evaluate the different modes of presentation, investigations done and the modes of treatment. RESULTS: The age range of the patients varied between 23 and 70 years with three of them being male while two were female. The most common presenting symptom and sign were abdominal pain and abdominal mass. Abdominal ultrasonography, chest X-ray, upper gastrointestinal endoscopy and laboratory blood tests were the investigative procedures carried out. The treatment modalities were either conservative or surgical (operative). One patient had spontaneous resolution of the pseudocyst, 2 had external drainage while the remaining 2 had cystogastrostomy. Two of the patients responded well to treatment and were being followed up in the Surgical Out Patient Clinic, one died within 24 hours of surgery while the other developed diabetes mellitus 3 months post surgery and was referred to the physicians for follow-up. CONCLUSION: Though pancreatic pseudocyst remains uncommon in Nigeria, ultrasonography can play an essential role in assisting diagnosis while successful management of this condition is still possible in the absence of current endoscopic techniques of drainage.

Attitudes toward kidney donation.

The Renal Unit of Obafemi Awolowo University Teaching Hospital Ile-Ife in Southwest Nigeria intends commencing a kidney transplantation program. This cross-sectional study aimed at examining the willingness of Nigerians to be living-related kidney donors. Three hundred and sixteen Nigerians (96 first-degree relatives of end-stage renal disease patients, 69 rural dwellers and 151 health workers) were interviewed regarding their willingness to donate kidneys using an interview schedule designed to elicit socio-demographic information, knowledge about kidney transplantation and attitude toward kidney donation. Sixty-two percent of health workers, 52.1% of the patients' relatives and 27.1% of rural dwellers expressed willingness to donate. Higher proportions of health workers and patients' relatives--compared with the rural dwellers--were willing to donate a kidney to their children, full-siblings and parents (P<0.05). The level of awareness about kidney transplantation was highest among health workers and least among rural dwellers (P<0.001). Altruism was the primary motivation for those willing to donate a kidney. The most important reason for refusal to donate was fear of adverse health consequences. Among the rural dwellers, never-married persons were more willing than the married to donate (P<0.05). Programs aimed at increasing awareness about the safety of kidney donation, reducing adverse beliefs about kidney donation, and encouraging altruistic tendencies will increase the availability of kidney donors.

Pattern and presentation of large bowel neoplasms in Nigerians.

It is generally believed that colonic neoplasms are uncommon amongst Blacks. One hundred and twenty seven cases of large bowel neoplasms were treated at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between 1981 and 1990. There were 84 males and 43 females. The mean age was 53 years. Duration of illness prior to presentation at the hospital varied between two weeks to three years with a mean time lag of 15 months. Intestinal obstruction was found in 83 patients and these also presented with anaemia. However massive rectal bleeding was noticed only in 38 cases. Most of the lesions were rectosigmoid. Some of these patients accounting for 87 cases (69 pc) refused permanent colostomy due to social embarrassment. Histopathologic appearance of the tumours were mostly adenocarcinoma in 97 cases. Thirty five patients died within the first year of their presentation and management. Twenty eight patients are still being followed up while other patients have been lost to follow up. This study shows that a sizeable number of patients suffer from colonic neoplasm in our community.

Typhoid and paratyphoid fever: a retrospective study.

Sixty-eight proved cases of typhoid and paratyphoid fever were reviewed in a retrospective study covering 5 years (1986-1990). Patients within the age range of 10 to 39 years constituted 82.3 per cent of cases and there was equal incidence in both sexes. The mean duration of illness before presentation was 9.67 days. The major clinical features were fever (97%), abdominal tenderness (-9.4%), headache and abdominal pain (70.58%) each). Intestinal perforation was the commonest complication (27.9%) with a male preponderance (M:F-3:1). Perforation occurred after the first week of illness in 73.7 per cent of cases. Fourteen out of the nineteen patients who perforated were not on therapy at the time of perforation and they constituted 80 per cent of those cases of mortality in which perforation played a role. Surgical management of perforation gave better results than conservative management (mortality rates of 16.7% and 40% respectively). Salmonella was sensitive to Chloramphenicol in all the cases where the organism was grown. There were 10 recorded deaths (14.9%) of whom 60 per cent (i. e. 6 patients) presented after two weeks of illness.

Management of rectal prolapse in Ile-Ife, Nigeria.

Complete rectal prolapse is uncommon in adults. Out of 129,525 patients treated at our teaching hospital over a five-year period, only 29 patients were managed with complete rectal prolapse. The total mean-age was 52 years with an approximate 1:2 male-female ratio. Two of the patients had their prolapse for 16 years before presentation. Major clinical features included constipation, diarrhoea, soiling and rectal bleeding. 51.72% of the cases had partial to complete incontinence of faeces. 22 patients were treated with the simple technique posterior fixation of both rectum and sigmoid colon. Follow-up was from 6 months to 4 years, mortality was 3.44%. There had been no recurrences of the complete rectal prolapse to date.

Omental and mesenteric cysts in Nigerian children.

Omental and mesenteric cysts are rare intra-abdominal lesions which may be congenital, traumatic, neoplastic or infectious in origin. They give rise to non-specific clinical features and may be a cause of the surgical acute abdomen, especially in children. Correct preoperative diagnosis is infrequent but a high index of suspicion and use of ultrasonography when available would improve clinical diagnosis. Six omental and mesenteric cysts encountered in five children over a 10-year period (1978-87) are reported. All the cysts were congenital. Three patients presented with non-specific symptoms and two presented with acute abdomen. Correct preoperative diagnosis was made in two patients. All five patients had surgery. Two had enucleation of the cysts, two had excision of the cysts with adjacent bowel segment and one patient with two cysts had partial excision of the wall of the cysts with free internal drainage into the peritoneal cavity. All patients survived.

Primary tuberculous mastitis in a Nigerian woman.

Tubercolous mastitis is an uncommon lesion even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is still very high. At the Ife University Teaching Hospital only one case of tuberculous mastitis has been seen over a ten-year period during which 671 breast biopsies were examined. This was in a 36-year old Nigerian woman who developed a left breast mass during pregnancy. She was seen after her delivery and was initially diagnosed as a case of carcinoma of the breast. Subsequent excisional biopsy and pathological examination of the mass confirmed tuberculosis of the breast. She has responded favourably to anti-tuberculous therapy.

Fistula in ano in Nigerians.

Over a five-year period (1982-86), 77 patients (59 males, 18 females; mean age 41.32 y) with fistula in ano treated at the University of Ife Teaching Hospitals Complex were reviewed. As many as 66.24 per cent of these patients presented rather late at the hospital after 2 yr from the onset of illness. Significant clinical presentation included rectal pain, perianal itching, lax-anal-sphincteric tone and purulent fistula discharge. Low and posterior fistula was seen in as many as 49 cases, while 29 patients presented with high fistula. Fistulograms were done in 69 patients. All the patients had surgery with no post-operative complications and recurrence.

Colonoscopy in the emergency treatment of colonic volvulus in Nigeria.

The commonest cause of large-bowel obstruction in Nigeria is sigmoid volvulus. Patients usually present late, dehydrated, and in very poor condition. The mortality of emergency colonic surgery is undoubtedly high, more so in developing countries poorly equipped to cope with such a condition. To reduce the mortality rate and improve management of the patients, a four-year prospective study of detorsion followed by elective surgery after adequate resuscitation and bowel preparation was carried out between January 1979 and December 1982. Volvulus is classified into three groups: torsion, obstruction, and strangulation. Criteria for short colonoscopic detorsion of torsion and obstruction types are discussed, and the contraindication in the case of strangulation type mentioned. This article describes the management of 92 cases of sigmoid volvulus between 1979 and 1982.