Determinants of mortality in neonatal intestinal obstruction in Ile Ife, Nigeria

Background: Neonatal intestinal obstruction (NIO) is a common cause of mortality. This study determined the causes of mortality in patients with NIO at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC); Ile Ife. Patients and Methods: Records of all cases of NIO managed at OAUTHC between January 1996 and December 2005 were retrospectively reviewed and the possible factors that may result in mortality were analysed. Results: Sixty-three neonates with intestinal obstruction were managed; representing 24.3of the neonatal admissions during the study period. Forty-two were males and 21 were females (M:F = 2:1). The majority (71.4) of the patients presented within the first week of life. Anorectal malformation constituted 57.1of the causes of NIO. Other causes included Hirschsprung's disease; duodenal atresia; intestinal malrotation with midgut volvulus and jejunal atresia. There were 18 deaths; with a mortality rate of 28.6. Reoperation; postoperative bleeding and peroperative sepsis were significant determinants of mortality. Conclusion: NIO is associated with significant mortality in our centre. Repeat surgery; postoperative bleeding and sepsis were the significant factors that contributed to mortality in NIO

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Background: Abdominal wounds following surgery for typhoid perforation are classified as dirty; with an infection rate of over 40. To date; the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice; is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife; Nigeria; and advocates a multidisciplinary wound management protocol. Patients and Methods: This is a retrospective study of children aged 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria; over a period of ten years. Results: Thirty-two patients; 18 males and 14 females; in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8) patients; while 19 (59.4) patients had surgical site infections. Wound dehiscence; intraabdominal abscess; and faecal fistulas were the other complications documented in the study. Conclusion: Abdominal wounds of typhoid perforation; though classified as being dirty; can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs

Circumcision Mishaps: A Continuing Challenge In The Developing Countries

Objective: Circumcision has been described as the most commonly performed surgical operation in the boys and is probably the oldest surgical procedure in man. This prospective study was aimed at establishing the pattern; treatment outcome and cost of major complications of neonatal circumcision seen in a tertiary center in Nigeria. Methods: Consecutive cases of complications of circumcision presenting at the Paediatric Outpatient Department in a tertiary centre in Nigeria were prospectively studied over a period of 3 and half years from July 2003 to December 2006. Information regarding the age of the patient; time of circumcision; the surgeon; place of circumcision was recorded as well as the type of mishap; outcome and cost of management were noted. Results: Forty five patients with major complications of circumcision representing 6.2of the patients. Their age at presentation ranged between 2 weeks to 10 years (Median = 3months). All the patients were circumcised during the neonatal period. The commonest complication reported is urethro-cutaneous fistula in 25 (56); Meatal Stenosis in 4(8.9); Severe bleeding in 4(8.9); Epidermoid cyst in 3 (6.7); and 2 (4.4) cases each of Buried penis; penile amputation; penile degloving with glans amputation; glanular adhesions and redundant prepuce respectively. The cost of treatment for the repairs varies from 4500 -35;000NGN (40-305 Dollars) Conclusion: The prevalence of complications of circumcision is high in our environment

Typhoid Perforation: Determinants of Outcome in Children in Ile-Ife; Nigeria

Background: Ileal perforation can be a fatal complication of typhoid fever in children as its clinical presentation is often atypical. The risk of death from intestinal perforation in typhoid fever is more than four times when compared with patients without perforation. A high index of suspicion therefore; and early intervention are mandatory to reduce morbidities and deaths due to this disease in children. Aim: To highlight the factors that adversely influence treatment outcome following typhoid ileal perforation in a paediatric population and how they could be modified to reduce morbidity and mortality. Methods: This was a retrospective study whereby medical records of children aged 1 to 15 years with typhoid fever admitted to OAUTHC; Ile-Ife; over a 10-year period; 1994-2004. Results: A total of 38 patients; 20 males and 18 females in the ratio 1.1:1; were managed for typhoid perforation during the 10-year study period. Twenty-nine patients (76.3) survived while 9 (23.7) died. Of the many factors evaluated; only the duration of time before operation was found to significantly influence treatment outcome adversely (P=0.009); while large single or large multiple perforations (P=0.256); severe peritoneal contamination (P=0.291) and extensive surgery (P=0.089) did not. Conclusion: Typhoid ileal perforation has a poor treatment outcome in children in Ile-Ife; Nigeria. The duration of time before operation was the single most important factor that adversely affected treatment outcome. Therefore; swift preoperative resuscitation and early surgical intervention will enhance overall outcome irrespective of the number of perforations; severity of faecal contamination and extent of surgery

Day Case Surgery in Nigerian Children: Influence of Social Circumstances of Patients

Background: In order to achieve good results in day surgery and avoid pitfalls; selection of appropriate procedures and patients is required with attention given to the social circumstances among other considerations. The aim of this prospective study therefore was to evaluate the influence of the social circumstances of the patients on the performance of day surgery practice in our environment. Method: This was a prospective study carried out between April; 2004 and December; 2004; during which time 88 children aged 15 years and below with uncomplicated inguinal hernias were treated at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The parents of the patients were interviewed about their social circumstances to determine the possibility of compliance with postoperative instructions. The data generated were then analyzed. Results: More than half (54.6) of the patients were from Ile-Ife. A few came from towns varying in distances from 65 to 80 km and spent an average time of 75 to 90 minutes to reach the hospital. Majority of the patients used public vehicles as a means of transport to and from the hospital in escort of their mothers. Despite the long distances and difficult traveling conditions; the parents still preferred day case surgery and were willing to obey postoperative instructions. Conclusion: From the findings in this study; day case surgery in children in our environment is feasible; despite the poor social circumstances of most of them. There is; however a compelling need to raise the standard of living of the people to enable them benefit maximally from day case surgery

Day case inguinal hernia surgery in Nigerian children: prospective study

Background: There has been an increase in day case surgery for children worldwide; but there have been few reports of the practice (most of them being retrospec-tive) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. Materials and Methods: This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. Results: Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients; (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side; while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8. In all; the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. Conclusion: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction