PATTERNS OF TRAUMA IN PATIENT SEEN AT THE EMERGENCY CLINICS OF PUBLIC HOSPITALS IN MEKELLE, NORTHERN ETHIOPIA.

BACKGROUND: Injuries are a neglected health problem in developing countries. Ethiopia has a high incidence of road traffic accidents and trauma constitutes about half of surgical emergencies among patient seen at health facilities. The objective of this study was to determine the pattern of trauma among patient seen at emergency outpatient departments of public hospitals in northern Ethiopia METHODS: Retrospective data on patient seen at the hospitals during a one-year period (January 1, 2013-December 31, 2013) was collected. The source population was all patients who visited the emergency OPD of two public hospitals in Mekelle, Tig ray. RESULTS: The 16-25 year old age group was the most commonly affected age group, accounting for 38.5% followed by the 26-35 year old group (21.4%) of the cases. Males were more frequently involved than females ((74.3%) vs 25.7%). Eighty-three per cent of the patients were from urban areas. Interpersonal violence (31%), accidental falls (19.2%) and Road Traffic Accidents (RTA) (14.1%) were the most common causes of injury. The Head (33.5%) was the most commonly involved part of the body. CONCLUSION: This study indicates a high burden of trauma in the study area and the need for interventions to control the problem. Given the morbidity and mortality associated with trauma, trauma registry system will be beneficial in Tigray and perhaps for the whole country.

Heterotopic Pregnancy with Ipsilateral Adnexal Cyst Causing a Diagnostic Dilemma: A Case Report.

Background: Heterotopic pregnancy is the coexistence of intrauterine and extrauterine (ectopic) pregnancies. This is a relatively rare phenomenon with an incidence of 1 in 30,000 in spontaneously conceived pregnancies and 1 in 100 pregnancies achieved through assisted reproduction. Due to its relative rarity, diagnosis can be challenging. The presence of adnexal cystic masses complicating pregnancies can obscure the examination of the pelvis to rule in/out heterotopic pregnancy further adding to the complexity of the diagnosis. Case Presentation: In this study, we present a 26-year-old primigravid, ethnic Tigrayan lady from the Tigray region of Ethiopia. She presented to our hospital with the complaint of progressively worsening abdominal pain of three days duration. She also had a subjective period of amenorrhea of 2 months duration. Pregnancy test was positive a few days prior to her current presentation. She reported that she had a history of treatment for pelvic inflammatory disease three months prior to her current conception. At presentation to our hospital, she was acutely ill-looking in pain, tachycardic, and hypotensive. Pelvic ultrasound showed an adnexal mass, hemoperitoneum, and an intrauterine pregnancy at 7 weeks + 5 days gestation. With the impression of ruptured ovarian cyst to rule out heterotopic pregnancy emergency, an explorative laparotomy was done which was pertinent for significant hemoperitoneum, ruptured left tubal ectopic pregnancy, and intact left ovarian cyst. Conclusion: Physicians should consider a broad range of differential diagnosis in pregnant mothers who present with acute abdominal pain. Moreover, in the presence of an adnexal mass and hemoperitoneum, there is a need to maintain a low threshold for rare but life-threatening complications such as heterotopic pregnancy. The presence of an intrauterine gestation does not rule out extrauterine gestation. Thus, the presence of a viable intrauterine gestation should not stop physicians from carefully examining patients for the coexistence of an ectopic pregnancy.