Advanced-stage Wilms tumor arising in a horseshoe kidney of a 9-year-old child: a case report.

BACKGROUND: Horseshoe kidney (HK) is one of the most common renal fusion abnormalities, with an incidence of 1:400 in the normal population. However, Wilms tumor (WT) arising in an HK is a rare occurrence. We report the case of a 9-year-old boy who presented with an advanced WT in an HK and also highlight the management challenges in a resource-poor setting such as ours. CASE PRESENTATION: The patient was a 9-year-old Nigerian boy presented to the Pediatrics Outpatient Clinic of the University of Maiduguri Teaching Hospital (UMTH) with a history of progressive abdominal swelling, weight loss, abdominal pain, and cough. Abdominal examination revealed an irregular, firm, and non-tender mass in the right lumbar region. A computed tomography (CT) scan of the abdomen showed a heterogeneously dense mass that was predominantly to the right side of the abdomen and crossed the midline to the left side, where it continued with the relatively normal renal tissue. Chest CT revealed pulmonary metastases. A diagnosis of WT in an HK was made. The patient had a 6-week course of neoadjuvant chemotherapy, and a right nephrectomy and left partial nephrectomy was performed. The final histologic diagnosis of WT was made. Radiotherapy was intended but was not available in our facility, and the parents could not afford referral to another center. CONCLUSIONS: Children with a clinically suspected HK with WT should undergo a careful imaging evaluation such as CT before any surgical intervention. Neoadjuvant chemotherapy to reduce tumor bulk might be a good treatment method to reduce surgical morbidity and aid in complete excision and potential for preserving renal function.

A retroperitoneal extra-renal wilms' tumour: A case report.

Wilms' tumour originates predominantly in the renal tissue; in rare cases it can also arise from extra-renal sites accounting for 0.5-1% of cases of Wilms' tumours seen. A diagnosis of extra-renal Wilms' cannot be easily established with clinical and radiological features except when the histological facts are provided. Wilms' tumours arising from extra-renal sites may not be different in clinical features, protocol of treatment and outcome from a typical intra renal Wilms' tumour. A 2-year-old boy presented with an asymptomatic abdominal swelling for 3 months. Abdominal ultrasound and CT scans revealed an extra-renal mass. Intravenous urogram (IVU) showed prompt excretion bilaterally. Post excision histology of the tumour confirmed a Wilms' tumour.

Giant median lobe enlargement of the prostate mimicking advanced bladder tumour: a case report.

BACKGROUND: Giant Prostate (more than 100 g) is rare worldwide but Common in Africa. However Giant Median Lobe Enlargement is rare even in Africa. This Uncommon entity may pose a diagnostic puzzle especially when associated with haematuria, necroturia and suprapubic mass with background history of childhood haematuria. OBJECTIVE: To present a rare case of a giant benign median lobe enlargement of the prostate. METHODS: A 75 year old retired police officer presenting with 18 months history of intermittent total Painless hematuria, necroturia, increased frequency and feeling of incomplete bladder emptying. There was hesitancy and difficulty in passing Urine improved by manual pressure on the lower abdomen by the patient. Patient was evaluated clinically, radiologically, and also had Urine Cytology suggestive of malignancy. Cystoscopy and Biopsy revealed Inflammation. Patient sought medical Treatment in several hospitals and finally referred to our hospital. RESULTS: He was found to be clinically preserved, not pale, with a mobile suprapubic mass of about 12 cm above pubic symphysis,. Digital Rectal Examination revealed prostate not enlarged. Abdomino-Pelvic ultrasound scan, Intravenous Urography, and Urethrocystography all suggested a huge bladder Tumour at the base occupying almost half of the bladder. Patient was prepared for Cystectomy and Urinary diversion. However, intra-operative finding revealed a giant median lobe enlargement of the prostate (225 g) with normal lateral Lobes, no other bladder mass seen. Transvesical prostatectomy was carried out. Patient did well postoperatively and was discharged. CONCLUSION: Giant Median Lobe Enlargement of the Prostate is rare and may present with hematuria, necroturia and supra pubic mass with normal digital rectal examination.

Exstrophy anomalies: preliminary review of 18 cases in Maiduguri, North-Eastern Nigeria.

BACKGROUND: Exstrophy anomalies, although rare, pose a tremendous challenge to both surgeons and surrogates. Management is intricate and experience with large members is restricted to a few centres worldwide. This report is a review of 18 cases of these anomalies managed in University of Maiduguri Teaching Hospital (UMTH) over 8 years, highlighting the intricacies of management, and contributes to the existing data bank on this subject matter in our environment. MATERIALS AND METHODS: We reviewed the records of all cases of anomalies that were managed in the index hospital from December 2002 to December 2010. RESULTS: Eighteen cases were studied. The youngest was a 2-day-old neonate and the oldest was 6 years at repair, with a median age of 4 months. There were 7 boys and 9 girls with bladder exstrophy, and the remaining two were girls with cloacal exstrophy, giving a male-female ratio of 7:11 for the exstrophy anomalies. Eight patients (33.5%) had associated congenital anomalies; 16.7% had undescended testes (UDT), anorectal malformation (ARM) and patent processus vaginalis (PPV); and duplicate bladder occurred in 5.6% of the patients. All but one patient had bilateral posterior iliac osteotomy at bladder closure. Out of the 17 patients that had osteotomy, 76.5% had satisfactory bladder closure (no complication), 5.9% had superficial wound dehiscence, 11.8% had bladder neck dehiscence and 5.9% had complete disruption. The lone patient that did not undergo osteotomy had complete bladder dehiscence. Postoperative immobilization was done for 3 weeks for 16 cases; one was discontinued after 1 week because of complication. The longest follow-up was for 2 years and the shortest for 2 weeks. Four patients (22.2%) did not turn up for follow-up. CONCLUSION: Exstrophy anomalies although rare remain a major challenge in paediatric surgery. Iliac osteotomy, among other technical considerations, remains a cornerstone for successful bladder closure.

Epidemiology and management of head injury in paediatric age group in North-Eastern Nigeria.

BACKGROUND: Paediatric head injury (HI) is the single most common cause of death and permanent disability in children world over, and this is increasingly becoming worrisome in our society because of increased risks and proneness to road traffic accidents on our highways and streets. The study set to determine causes and management of HI among children in our society. PATIENTS AND METHODS: A retrospective review of all children aged 0-15 years with traumatic head injury (THIs) who were managed at the University of Maiduguri Teaching Hospital between July, 2006 and August, 2008. RESULTS: A total of 45 children with THIs presented to the casualty unit of the hospital; 30 (66.7%) were boys and 15 (33.3%) were girls. Three (6.7%) children were less than 1 year of age, 21 (46.7%) were between 1 years and 6 years while 16 (35.6%) and 5 (11.0%) were aged 7-11 years and 12-15 years respectively. Thirty six (80.0%) of the children were pedestrians, 6 (13.4%) fell from a height, while 2 (4.4%) and 1 (2.2% were as a result of home accident and assault, respectively. Twenty one patients (46.7%) had mild HI, while 53.3% had moderate to severe category. Forty one (91.1%) of children were managed as in-patients, mostly (95.1%) by conservative non-operative management, while 4 (8.9%) were treated on the out-patient basis. The mortality rate was 17.8%. CONCLUSION: H1 among children is of a great concern, because of its incremental magnitude, due to increasing child labour and interstate religious discipleship among children, with attendant high mortality and permanent disabilities. Necessary laws and legislations should be formulated and implemented with organized campaigns and public enlightenment to prevent and mitigate this menace.