Penile Agenesis Associated with Anorectal Malformation and Bilateral Renal Agenesis: A Case Report and a Review of the Literature.

ABSTRACT: Penile agenesis is complete absence of the penis in an otherwise normal phenotypic and genotypic male at birth that results from failure of development of the genital tubercle. It is an extremely rare anomaly that may be associated with anomalies in other organ systems, the extent and severity of which may affect the prognosis. The management is challenging and may have far reaching implications for the individual and family. While gender reassignment with bilateral orchidectomy and feminising genitoplasty has been carried out for most patients, significant psychosexual and social issues related to the male identity may occur due to foetal or postnatal sex steroid imprinting. We report a neonate with penile agenesis with bilateral renal agenesis and anorectal malformation.

Perioperative mortality in children in a tertiary teaching hospital in Nigeria: a prospective study.

Background: Perioperative mortality is one of the tools that can help to assess the adequacy of healthcare delivery in a nation. This audit was conducted to determine the 24-hour, 7-day and 30-day perioperative mortality rates and the predictors of mortality in a pediatric surgical cohort. Methods: This was a prospective study of children whose ages ranged from a few hours to 15 years and who were operated on between May 2019 and April 2020. The primary outcome was to determine the incidence of in-hospital perioperative mortality. Results: A total of 530 procedures were done in 502 children. Their ages ranged from a few hours to 15 years with a median of 36 months. The 24-hour, 7-day and 30-day mortality rates were 113.2 per 10 000 procedures [95% confidence interval (CI) =40 to 210], 207.6 per 10 000 procedures (95% CI=110 to 320) and 320.8 per 10 000 procedures (95% CI=190 to 470), respectively. Congenital anomalies complicated by postoperative sepsis contributed to death in the majority of cases. The predictors of mortality were neonatal age group [adjusted odds ratio (AOR)=19.92, 95% CI=2.32 to 170.37, p=0.006], higher American Society of Anesthesiologists Physical Status III and above (AOR=21.6, 95% CI=3.05 to 152.91, p=0.002), emergency surgery (AOR=17.1, 95% CI=5.21 to 60.27, p=0.001), congenital anomalies (AOR=12.7, 95% CI=3.37 to 47.52, p=0.001), and multiple surgical procedures (AOR=9.7, 95% CI=2.79 to 33.54, p=0.001). Conclusion: Perioperative mortality remains high in our institution.

Mitigating the challenges of laparoscopic paediatric surgery in Ile Ife: The trend so far and lessons learnt.

BACKGROUND: Paediatric laparoscopic surgery is fast growing worldwide, with many pathologies now being treated even in the youngest of patients. We hereby report our experience with the first 114 cases. OBJECTIVES: Our aim was to highlight our progress and lessons learnt practicing laparoscopic paediatric surgery in our institution. MATERIALS AND METHODS: This is a retrospective study of the first 114 children who underwent laparoscopic surgery in our hospital. We focussed on demographics, indications, procedures performed, rate of conversion to open and complications. Records were retrieved from January 2011 to December 2019. Data were analysed using the SPSS software version 23 (SPSS Inc., Chicago, Illinois, USA). RESULTS: There were 83 males and 31 females (ratio of 3:1). Age groups included infants (13.2%), 1-5 years (21.9%), 5-10 years (33.3%) and > 10 years (31.6%). There was a remarkable increase in the frequency and complexity of cases performed from an average of 5 per year between 2011 and 2015 to an average of 23.5 per year between 2016 and 2019. The conversion rate was 6%, 5 appendectomies, 1 Swenson pull-through, 1 diagnostic laparoscopy and 1 Ladd's procedure. Four complications were noted; one recurrent adhesive intestinal obstruction, one residual intra-abdominal abscess, one port site abscess and one excessive bleeding from liver biopsy requiring conversion to open surgery. CONCLUSION: We have demonstrated that the routine use of laparoscopy in children is feasible and safe in our environment. However, the need for training, endurance through a steep learning curve and the willingness to battle the technical challenges are necessary for success.

Comparative Study of Laparoscopic and Open Inguinal Herniotomy in Children in Ile Ife, Nigeria: A Prospective Randomized Trial.

Background: Inguinal hernia in children is currently treated through a groin incision with access to the inguinal canal and handling of the spermatic cord. In the face of the growing utilization of laparoscopic surgery in Nigeria, it was important to compare the outcome of laparoscopic and open herniotomy (OH) in our local teaching hospital to create a basis for recommendation. Objectives: We compared OH with laparoscopic needle assisted hernia repair (LNAR) in children in Obafemi Awolowo University Teaching Hospital Complex, Ile Ife. Methodology: A prospective study involving children who presented with uncomplicated inguinal hernia, carried out within the period of 1 year in our center. Results: In the LNAR group, there were 24 (75%) males and 8 (25%) females, while in the OH group, there were 29 (90.6%) males and 3 (9.4%) females. The age range for LNAR was 2-156 (median = 44) months and OH was 2-168 (median = 36) months. Higher complication rate for OH was found to be statistically significant (P = .001). The total operating time was found to be similar between the two groups for both unilateral and bilateral hernias (P = .636 and P = .334, respectively). Two contralateral patent processus vaginalis (PPV) were identified during laparoscopy and were repaired at the same sitting. Conclusion: Postoperative complications are significantly lower with LNAR. Duration of surgery for LNAR is similar to OH. Incidence of contralateral PPV seen following unilateral LNAR is low.

A 10-year retrospective review of perioperative mortality in pediatric general surgery at Ile-Ife Hospital, Nigeria.

BACKGROUND/PURPOSE: The analysis of perioperative mortality as well as surgery- and anesthesia-related death in pediatric patients may serve as a potential tool to improve outcome. The aim of this study is to report the 24-h and 30-day overall, and surgery and anesthesia-related, mortality in a tertiary hospital. METHODS: This is a retrospective review of perioperative mortality in children ≤15years at a general pediatric surgery unit. All pediatric general surgery cases operated under general anesthesia between January 2007 and December 2016 were included in the study and data analyzed. RESULTS: A total of 4108 surgical procedures were performed in 4040 patients. The age was 1day to 15years with a median age of 2years. The all cause 24-h mortality was 34 per 10,000 procedures and the all cause 30-day mortality was 156 per 10,000 procedures. Septicemia was the most common cause of death. The determinants of mortality were neonatal age group (Adjusted Odd Ratio (AOR)=0.033, 95% CI=0.015-0.070, p=0.001), emergency surgery (AOR=90.91, 95% CI=27.78-333.33, p=0.001), higher ASA status (AOR=0.014, 95% CI=0.005-0.041, p=0.001) and multiple operative procedures (AOR=38.46, 95% CI=10.64-142.85, p=0.001). CONCLUSIONS: Neonatal age group, children with poorer ASA status, emergency and multiple surgeries were predictors of perioperative mortality. LEVEL OF EVIDENCE: Retrospective study.

Trend Over Time for Cholecystectomy following the Introduction of Laparoscopy in a Nigerian Tertiary Hospital.

BACKGROUND: There still exist some concerns about the desirability of laparoscopic surgery in lower-middle income countries. We recently adopted laparoscopy for common general surgical procedures and observed many benefits. This study aims to describe the changing rate of cholecystectomy before and after the introduction of laparoscopy in our hospital. METHODS: We reviewed the records of cholecystectomies performed before and after the introduction of laparoscopic cholecystectomy (LC) in 2009 in a single general surgery unit of the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Cholecystectomy was reviewed as a percentage of general procedures performed, and postoperative length of stay was calculated. RESULTS: A total of 173 cholecystectomies were performed in the hospital between January 2005 and December 2015. The yearly number rose from 7 in 2005 to 31 in 2015 corresponding to 2.7% of total elective major general surgery procedures in 2005 and 9.1% in 2015. A marked progressive increase was observed in the number and rate of cholecystectomies from 2009 following introduction of LC. From 0% in 2005, LC rose to 90% of all cholecystectomies in 2015. The mean postoperative length of stay of patients undergoing cholecystectomy declined from 5.2 days in 2005 to 3 days in 2009 and 1.8 days in 2015. CONCLUSION: This study demonstrates an increased rate of cholecystectomy following the introduction of LC in our setting. We recommend increased adoption of laparoscopy and other forms of minimally invasive surgery across the country.

Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria.

BACKGROUND: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion. PATIENTS AND METHODS: The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16. RESULTS: Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123). CONCLUSION: DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.

Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria.

BACKGROUND: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. MATERIALS AND METHODS: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. RESULTS: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. CONCLUSIONS: The initial treatment outcome was good but most had poor prognostic factors.

Groin exploration for the nonpalpable testes: a single center experience.

BACKGROUND: Management of non-palpable testes in Nigeria can be difficult due to late presentation and poor resources. Surgical exploration is often required for diagnosis and treatment. AIM: This study reviews the management outcome of clinically non-palpable testeis in a tertiary center in Nigeria. MATERIALS AND METHODS: Ten years retrospective review of all clinically non-palpable testes in children aged 2-15years managed at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria. RESULTS: Thirty two children with 44 testicular units were managed. The right side was involved in 12 (37.5%); left in 8 (25.0%) and bilateral in 12 (37.5%) patients. Pre-operative ultrasound was done in 12 patients with localization in just 4 patients (33.3% success rate). At groin exploration, 34 (77.32%) testicular units were located in the inguinal canal. Eight patients with 10 The remaining 10 (22.7%) testicular units required additional mini-laparotomy for which six (13.6%) and 4 (9.1%) testicular units respectively were either in the retroperitoneum or not found. Of the testes in the groin, twenty two (64.7%) testicular units were normal while 12 (35.3%) were atrophic. Four of the retroperitoneal testes were normal while 2 were atrophic. Eight (22.5%) testicular units among the inguinal group had multi-staged orchidopexy; while 2 each of the retroperitoneal group had orchidectomy, one stage orchidopexy, two staged Fowler Stephens (F-S) procedure or lost to follow up after first stage of F-S procedure. Mean follow up period was 2 months. 2 testicular units each had retracted or vanished respectively during follow up. CONCLUSION: Groin exploration still offers a viable approach Surgical exploration is still useful in to the management of non-palpable testes in low resource environment despite the lack of laparoscopy.

Early experience with laparoscopic surgery in children in Ile-Ife, Nigeria.

BACKGROUND: Laparoscopy is not yet routinely employed in many Paediatric Surgical Units in Nigeria despite the advantages it offers. This study describes the preliminary experience with laparoscopic procedures in a single centre. PATIENTS AND METHODS: A retrospective analysis of all children who had laparoscopic surgery between January 2009 and December 2013 at the Paediatric Surgical Unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis. RESULTS: Eleven (44%) diagnostic and 14 (56%) therapeutic procedures were performed on 25 children whose age ranged from 5 months to 15 years (Median: 84 months, Mean: 103 ± 64.1 months), including eight (32%) females and 17 (68%) males. Indications included acute appendicitis in 12 (48%), intra-abdominal masses in six (24%), three (12%) disorders of sexual differentiation, two (8%) ventriculoperitoneal shunt malfunctions and impalpable undescended testes in two (8%) children. The procedures lasted 15-90 minutes (Mean = 54 (±21.6) minutes). Conversion rate was 17% for two patients who had ruptured retrocaecal appendices. No intra operative complications were recorded while three (12%) patients had superficial port site infections post-operatively. All diagnostic (11) and two therapeutic procedures were done as day case surgery. The mean duration of hospital stay was 3.1 (±3.3) days for those who had appendectomies. CONCLUSION: Laparoscopic surgery in children is safe and feasible in our hospital. We advocate increased use of laparoscopy in paediatric surgical practice in Nigeria and similar developing settings.

Predictors of mortality in children with typhoid ileal perforation in a Nigerian tertiary hospital.

PURPOSE: Childhood typhoid ileal perforation is associated with high morbidity and mortality. Our aim was to ascertain the predictors of survival in children. MATERIALS AND METHODS: This is a tertiary hospital-based retrospective review of patients aged ≤15 years managed for typhoid ileal perforations between January 2005 and December 2013. The details of their biodata, potential risk factors and outcome were evaluated. RESULTS: Forty-five children out of a total of 97 with typhoid fever had typhoid ileal perforation. The age range was 2-15 years, mean (±SD) = 9.3 (±3.31) years, median = 10 years. There were more males than females (26:19). Thirty-nine (86.7%) patients were >5 years old. There were nine deaths (20% mortality). The mean (±SD) age of survivors was 9.8 (±2.9) years and 7.1 (±4.2) for non-survivors (p = 0.026). The duration of illness at presentation, gender, admission temperature, nutritional status and packed cell volume, perforation-operation interval, number of perforations, surgical procedure, and the duration of surgery did not statistically influence survival (p > 0.05). The age of the patients and burst abdomen attained statistical significance (p < 0.05). CONCLUSION: The patients' age and postoperative burst abdomen were significant determinants of survival in children with typhoid ileal perforation.

Wound complications following laparoscopic surgery in a nigerian hospital.

BACKGROUND: Different complications may occur at laparoscopic port sites. The incidence of these varies with the size of the ports and the types of procedure performed through them. OBJECTIVES: The aim was to observe the rate and types of complications attending laparoscopic port wounds and to identify risk factors for their occurrence. PATIENTS AND METHODS: This is a prospective descriptive study of all patients who had laparoscopic operations in one general surgery unit of a University Teaching Hospital in Nigeria between January 2009 and December 2012. RESULTS: A total of 236 (155 female and 81 male) patients were included. The laparoscopic procedures include 63 cholecystectomies, 49 appendectomies, 62 diagnostic, biopsy and staging procedures, 22 adhesiolyses, six colonic surgeries, eight hernia repairs and 22 others. Port site complications occurred in 18 (2.8%) ports on 16 (6.8%) patients including port site infections in 12 (5.1%) and hypertrophic scars in 4 (1.7%) patients, while one patient each had port site bleeding and port site metastasis. Nine of 11 infections were superficial, while eight involved the umbilical port wound. CONCLUSION: Port site complications are few following laparoscopic surgeries in our setting. We advocate increased adoption of laparoscopic surgeries in Nigeria to reduce wound complications that commonly follow conventional open surgeries.

Impact of introduction of laparoscopic surgery on management of unresolved intra-abdominal malignancies in a West African hospital.

BACKGROUND: Intra-abdominal malignancies often pose diagnostic problems to surgeons in resource-challenged centers such as ours due to limitations in modern imaging and other facilities. This prompted the adoption of laparoscopy in our hospital as an adjunctive tool in diagnosing these conditions. METHOD: Pre- and per-operative data of consecutive cases of clinically unresolved advanced intra-abdominal tumors subjected to laparoscopy from January 2009 through June 2013 were reviewed. Anatomic diagnosis and tissue biopsies were carried out during the procedures. RESULTS: Of the 152 patients seen with intra-abdominal tumors, 74 (48.7 %) had advanced conditions that could not be resolved clinically. Of these, 33 (44.6 %) were able to afford and had computed tomography (CT), scan while the remaining (N = 41; 55.4 %) less endowed only had an ultrasound scan. This cohort underwent laparoscopic evaluation, and biopsies confirmed the following: 27 (36.5 %) metastatic adenocarcinomas, 12 (16.2 %) primary hepatic malignancies, 11 (14.9 %) cases each of lymphomas and colonic adenocarcinomas, 4 (5.4 %) gastrointestinal stromal tumors, 3 (4.1 %) pancreatic carcinomas, 2 (2.7 %) cases each of carcinoid tumors and abdominal tuberculosis, and one case each of schistosomiasis and HIV-related Kaposi's sarcoma. Additionally, 26 (35.1 %) had ascites, while 29 (39.1 %) had peritoneal surface malignancies. With local adaptations and improvisations, laparoscopy was cheaper than an abdominal CT scan in our setting, with the additional benefit of obtaining tissue diagnosis to institute treatment. CONCLUSION: Although laparoscopy is commonly used for staging intra-abdominal tumors, we found it useful in complementing clinical diagnosis and attaining histopathological confirmation in a setting where access to and funding of modern imaging is limited.

Childhood intussusception in Ile-ife: what has changed?

BACKGROUND: Intussusception is one of the most common causes of intestinal obstruction in children. While the outcome has improved in the developed nations, the same cannot be said of the developing countries, more especially in the sub-Saharan region. This study aims to review our current experience in the management of childhood intussusception and factors affecting surgical outcome at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife. PATIENTS AND METHODS: This was a retrospective study of 78 patients treated for intussusception at paediatric surgical unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife between January 1993 and December 2011. The case notes of the patients were retrieved and the following information was recorded: Demographic characteristics, month of occurrence, clinical presentation, investigations, and management as well as the post-operative outcome. The patients were divided into two groups in terms of outcome. RESULTS: There were 58 males and 20 females (M:F = 2.9-1). The age of most of the patients was between 3 months and 9 months with peak incidence at 6 months. Most patients 46 (58.9%) were seen during the dry season of December to April. Only six patients (7.7%) presented within 24 hours of onset of illness. More than half of the patients presented after 24 hours. Passage of red currant stool, vomiting, abdominal pain, fever, and abdominal distension, passage of watery stool, anal protrusion and palpable abdominal mass in various combinations were the clinical features. All the patients had surgical operations. The most common type of intussusception was ileo-colic type in 64 patients (82.1%). Intestinal resection rate was 41%. The overall mortality rate was 15.4%. CONCLUSION: There was a delay in presentation of children with intussusception with high post-operative mortality.

Situs inversus in association with duodenal atresia.

Situs inversus in association with duodenal atresia is very rare. A high index of suspicion coupled with appropriate evaluation is necessary for diagnosis and operative planning. We report a case of a 5-day-old who presented with duodenal atresia associated with polysplenia and situs inversus with a review of the medical literature.

Survey of teaching, research and conference experiences of paediatric surgical trainees in Nigeria.

AIM: To determine the teaching methods used by residents in paediatric surgery in Nigeria and their exposure to research and conferences. MATERIALS AND METHODS: A structured questionnaire was administered to trainees in paediatric surgery in Nigeria seeking information regarding different teaching methods used, frequency of use, involvement in research and participation in conferences. RESULTS: There were 11 respondents (91.6%) of 12 questionnaires that were distributed. All of them were training in accredited teaching hospitals in Nigeria. All of them had been involved in teaching medical students. Ten residents were involved in teaching in wards/bedside two times or more in a week and all were involved in teaching at the clinics. Only one resident used audiovisual aid at least once a week to teach students. Eight trainees used tutorial or seminar group discussion as a teaching tool once a week. Four trainees had not used written essay as a way of teaching students while five had never given students lectures in a classroom before. All the respondents had participated in retrospective research while nine had been involved in prospective research. Nine residents had attended conferences nationally while two had attended international conferences. Six trainees presented a paper or more at national conferences while one presented at an international conference. CONCLUSION: Trainees in paediatric surgery in Nigeria are significantly involved in the teaching of undergraduate medical students and clinical research. This should be encouraged and further enhanced by motivating the trainees to attend international conferences.

Ten-year experience with the Swenson procedure in Nigerian children with Hirschsprung's disease.

BACKGROUND: Hirschsprung's disease (HD) is a common cause of intestinal obstruction in children. Definitive treatments consist of excision of the aganglionic segment and anastomosing the normal colon to the anal remnant. The outcome of this approach in Nigerian children is not known. The aim of this study was to analyze the short to mid-term outcome of children who have undergone the Swenson Procedure (SPT) as a treatment of HD over a period of 10 years. PATIENTS AND METHODS: The clinical data of biopsy-proven cases of HD managed at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, between 1998 and 2007 were reviewed. RESULTS: There were 33 children 28 were males and five were females (M 5.6: F = 1). The median age at presentation was eight months (range three days to 11 years). Eighteen (54.5%) patients had primary pull-through without colostomy while 15 (45.5%) patients had a two-staged operation. The operation was carried out at a median age of 14 months with a range of seven weeks to 11 years, four months. Twenty-one (64%) of the patients were older than one year at the time of surgery. The level of aganglionosis was in the recto-sigmoid area in 30 (91%) patients. The commonest post-SPT complication was intestinal obstruction from adhesions. Bowel opening varied from once daily to eight times daily, median thrice daily. CONCLUSION: The Swenson's Procedure is an effective procedure in the treatment of HD in children in Ile Ife, Nigeria.

Macrostomia: a report of three cases.

Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse properly to form the corners of the mouth. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the tragus. It is usually partial, but rarely complete. Transverse facial clefts are more common in males, and commoner on the left when unilateral. We report on 3 patients with macrostomia managed in our unit. There were 2 girls with a bilateral transverse facial cleft and a boy with a left unilateral transverse facial cleft. All had a 3 layered repair of their clefts with Z-plasty repair of the skin. The longest duration of follow-up was 2 weeks. Strict adherence to the principles of surgical reconstruction is advised in the repair of macrostomia to prevent a poor treatment outcome.

Management of ambiguous genitalia in Ile Ife, Nigeria: challenges and outcome.

BACKGROUND: Ambiguous genitalia are a major cause of parental anxiety and can create social problems if not properly managed. Diagnosis and management can however be challenging. The aim of this study is to highlight some of the challenges in management of ambiguous genitalia in our environment. PATIENTS AND METHODS: All cases of ambiguous genitalia managed at the Paediatric surgical unit of the Obafemi Awolowo University Teaching hospital, Ile Ife, Nigeria, between January 1993 and October 2007 were analysed for age, sex at presentation, investigation modality, and final sex of rearing and outcome of surgery. RESULT: Nine patients had surgical reconstruction for ambiguous genitalia during the study period. Their age ranges from 5 weeks to 19 years at presentation. The causes of genital ambiguity in the patients was congenital adrenal hyperplasia (CAH) in 6, true hermaphroditism in 2 and male pseudo-hermaphroditism in 1. Seven patients were reconstructed as females while 2 were raised as males. Change of sex of raring was necessary in 2 patients. CONCLUSION: The diagnosis and management of ambiguous genitalia is a challenging problem in our environment. Early presentation and treatment is necessary to avoid psychological and social embarrassment.

Pediatric surgery in Nigeria.

BACKGROUND: Pediatric surgery is a well-established specialty in many developed countries, but little is known about the status of the specialty in most developing countries. METHOD: The status of pediatric surgery in Nigeria was reviewed. RESULT: Nigeria currently has an estimated population of 126 million people with a growth rate of 2.8%, one half of whom are children. Pediatric surgery is a well-recognized specialty in the country. At the moment, there are 35 trained pediatric surgeons but only 26 are fully functional (1 pediatric surgeon:2.2 million children). Most of the available pediatric surgeons are in tertiary hospitals in major cities and towns. There is a well-established formal training program and certification run by the West African College of Surgeons; it takes an average of 4.5 to 6 years to train in pediatric surgery, 2 years of which must be spent in general surgery. Only 1 to 2 trainees graduate every year, and there are less than 10 trainees in the 5 accredited training centers at the moment. Funding for training is poor, and pediatric surgical research receives little or no funding. CONCLUSION: There is a need for more pediatric surgeons in Nigeria. More trainees need to be mentored and encouraged to take up the specialty. Collaboration with centers in developed countries and other parts of Africa and improved funding are necessary to improve the profile of the specialty.