Diagnostic and Therapeutic Roles of Microdochectomy and Subareolar Ducts Excision for Pathological Nipple Discharge in Lagos.

BACKGROUND: Pathological nipple discharge (PND) comprises less than 10% of presentation in breast clinics. Data on the management of nipple discharge (ND) in our environment are scarce. AIM: To review management outcome in cohorts of patients with PND in our institution between December 2010 and October 2020. METHODOLOGY: This is a retrospective review of consecutive patients managed for PND between 2010 and 2020. Demographical characteristics, clinical features, investigation results and management outcome were retrieved from the clinical records for analysis. A cross-sectional survey via telephone conversation/clinic consultation was carried out to monitor patients for post-operative complications and recurrence. RESULTS: There were 25 patients (18 microdochectomies and 7 subareolar duct excisions) in the study with a median age of 44 (37.5-49.5) years. The median duration of symptoms before presentation was 3 (2.5-5.5) months. The major characteristics of ND in the study cohort were: single duct orifice in 18 patients (72%) spontaneous ND in 14 patients (56%); right ND in 15 patients (60%); and bloody ND in 21 patients (84 %). Only one patient had a family history of breast cancer. Intraductal papilloma diagnosed in 9 patients (36%) was the most common cause of PND. Breast cancer was an underlying aetiology in 28% of patients in the series. Six out of 7 patients with breast cancer diagnosis were <50years. CONCLUSION: Most women with PND in our practice were young with predominance of spontaneous bloody discharge. Intraductal papilloma was the most common cause of PND in this study. Breast cancer accounted for about a third of cases.

CONTEXTE: L'écoulement mamelonnaire pathologique (EMP) représente moins de 10 % des cas présentés dans les cliniques du sein. Les données sur la prise en charge de l'écoulement mamelonnaire (EM) dans notre environnement sont rares. OBJECTIF: Examiner les résultats de la prise en charge dans des cohortes de patientes présentant un écoulement mamelonnaire pathologique dans notre établissement entre décembre 2010 et octobre 2020. MÉTHODOLOGIE: Il s'agit d'une revue rétrospective des patientes consécutives prises en charge pour un DP entre 2010 et 2020. Les caractéristiques démographiques, les caractéristiques cliniques, les résultats des examens et les résultats de la prise en charge ont été extraits des dossiers cliniques pour analyse. Une enquête transversale par conversation téléphonique/consultation en clinique a été réalisée pour surveiller les complications post-opératoires et les récidives chez les patients. RÉSULTATS: L'étude a porté sur 25 patients (18 microdochectomies et 7 excisions du canal sous-aréolaire) dont l'âge médian était de 44 ans (37,5-49,5). La durée médiane des symptômes avant la consultation était de 3 (2,5-5,5) mois. Les principales caractéristiques de la MN dans la cohorte de l'étude étaient les suivantes : orifice unique dans 18 patients (72 %), MN spontanée chez 14 patients (56%), MN droite chez 15 patients (60 %) et MN sanglante chez 21 patients (84 %). Une seule patiente avait des antécédents familiaux de cancer du sein. Le papillome intraductal diagnostiqué chez 9 patientes (36 %) était la cause la plus fréquente de la MN. Le cancer du sein était une cause sous-jacente chez 28 % des patientes de la série. Six des sept patientes chez qui un cancer du sein a été diagnostiqué avaient moins de 50 ans. CONCLUSION: Dans notre pratique, la plupart des femmes souffrant de DPN étaient jeunes, avec une prédominance d'écoulements sanglants spontanés. Le papillome intraductal était la cause la plus fréquente de DPN dans cette étude. Le cancer du sein représentait environ un tiers des cas. Mots-clés: Cancer du sein, Écoulement, Mamelon, Pathologique.

Development and practice of laparoscopic surgery in a Nigerian tertiary hospital.

BACKGROUND: For the benefits of less postoperative pain, early recovery and discharge, and better cosmesis, laparoscopic surgery is rapidly gaining acceptance amongst surgeons as a better alternative to traditional open procedures. In January 2015, bookings for laparoscopic surgery became a more regular feature on our operation list. AIMS: We reported the indications, management outcome, and challenges in patients who had laparoscopic surgery in our institution. This is to document the trends in our surgical practice. METHODOLOGY: This is a descriptive study of 137 patients who had laparoscopic surgery for general surgical indications in our institution over a period of 5 years. Patients data as collected from the records department were evaluated for demographic characteristics, medical comorbidities, type of procedures done, and perioperative outcome. Data analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: A total of 137 Patients had laparoscopic general surgery between January 2015 and December 2019. There were 48 males and 89 females with a male-to-female ratio of 1:1.9. The mean age of the patients was 38.8 ± 3.4 years (range 16-87 years). Laparoscopic cholecystectomy (35%) and laparoscopic appendicectomy (29.9%) were the most common procedures performed. Five (3.7%) cases were converted to open surgery. Superficial surgical site infection (5.8%) following laparoscopic appendicectomy was the most common postoperative complication. There was no 30-day postoperative mortality. CONCLUSION: Laparoscopic surgery is safe and can be applied to wide variety of general surgical conditions in developing countries. Minimal postoperative morbidity of laparoscopy is a major benefit to the patients.

Laparoscopic Transgastric Sutured Cystogastrostomy for Post-traumatic Pancreatic Pseudocyst in a Low Resource Setting: Case Report and Literature Review.

Pancreatic pseudocyst (PPC) complicating blunt and penetrating abdominal injury is well documented in paediatric age groups. In adults, PPC is often one of the sequelae of acute pancreatitis rather than trauma. Blunt abdominal trauma accounts for most documented cases of post-traumatic PPC. To the best of our knowledge, PPC following penetrating abdominal gunshot injury is a rare event. Laparoscopic drainage of PPC is fast gaining acceptance as the procedure of choice amongst experts as it offers many advantages and benefits of minimal access surgery to the patient. We report our experience and challenges with our first case of laparoscopic cystogastrostomy for a large post-traumatic PPC in a 24-yearold man who was diagnosed 8 months after laparotomy for a penetrating thoraco-abdominal gunshot wound. We also conduct a review of the literature on laparoscopic management of Pancreatic pseudocyst.

An Obstructing Small Bowel Phytobezoar in an Elderly Female Nigerian: A Case Report and Literature Review.

Small bowel obstruction secondary to phytobezoars is an unusual presentation in surgery. We present a case of an elderly female patient with an insidious onset of abdominal pain, abdominal distension, and bilious vomiting diagnosed radiologically to be small bowel obstruction. Exploratory laparotomy revealed a trapped mass of vegetable matter in the distal ileum. She had enterotomy with primary closure for removal of obstructing ileal phytobezoars. Her postoperative recovery was uneventful.

Eosinophilic colitis presenting as a right iliac fossa mass--a case report.

BACKGROUND: Eosinophilic colitis is an inflammatory condition characterized by infiltration of the colonic wall by eosinophils with submucosal oedema. Involvement of caecum, appendix, ascending colon and the omentum by the inflammatory process could mimic a right iliac fossa neoplasm. OBJECTIVE: To highlight the diagnostic challenges posed by eosinophilic colitis and the import of histopathological diagnosis in the treatment of such a patient. METHODS: A47-year old perimenopausal woman presented to hospital with a 6-month history of intermittent lower abdominal pain. Besides clinical evaluation, an abdominal ultrasonography and full blood count were carried out. She subsequently had exploratory laparatomy. RESULTS: The lower abdominal pain was intermittent but not associated with vomiting or diarrhea. There was a tender right iliac mass extending to the suprapubic region. The ultrasound revealed a right-sided tubo-ovarian mass. At surgery, the mass was found to be a complex of caecum, ascending colon, appendix and the omentum. Histological diagnosis of the resected mass was eosinophilic colitis with peritonitis. She was placed on steroid therapy following a course of antihelminthics with sustained clinical improvement six months after surgery. CONCLUSION: Eosinophilic colitis is rare and could mimic a right iliac neoplasm if it is right-sided. Histopathological diagnosis of all specimens removed at surgery particularly in a peripheral district hospital is very important in patient's management.