Anasarca as a manifestation of childhood volvulus: Diagnostic and management challenges in an 11-year old Nigerian boy.

Background: Small intestine volvulus occurs more commonly among younger children. It often poses diagnostic challenges when it occurs in older children and adults. For good clinical outcomes, it is essential to have prompt presentation, diagnosis and early intervention. Anasarca is not a common clinical manifestation of small intestine volvulus. Case Presentation: We report this unusual presentation of small intestine volvulus in an 11-year old Nigerian boy who first presented only with anasarca. While being investigated for the cause of the anasarca, he developed features of acute abdomen thought to be spontaneous bacteria peritonitis initially. He had surgery where the diagnosis of small intestine volvulus was made. Conclusion: The diagnosis and management of both anasarca and small intestine volvulus could be fraught with challenges. It is possible that anasarca can be the first manifestation of small intestine volvulus.

Renal arterial resistance index among subjects with liver cirrhosis in a Nigerian population.

PURPOSE: To describe the relationship between renal artery resistance index (RARI) and liver function based on Child-Pugh system among patients with liver cirrhosis (LC) in Southwest Nigeria. METHODS: About 50 patients with LC and 50 controls were consecutively recruited into this prospective comparative case control study. Each LC patient was classed based on Child-Turcotte-Pugh (CTP) system after relevant tests. Subjects underwent abdominal ultrasonography with triplex Doppler examination of the right kidney to obtain RARI. RESULTS: About 50 cirrhotic and 50 controls completed the study. Age range of cirrhotic subjects was 19-69 years (mean ± SD = 47.5 ± 13.3) while that of controls was 18-69 years (46.9 ± 15.0). RARI was higher (P = <.001) in patients with LC (0.68) than in controls (0.57). RARI was also significantly higher (P = <.001) in cirrhotic subjects in CTP class C (0.72) than in those in classes B (0.66) and A (0.58). Additionally, RARI showed significant correlation with CTP total score (r = .662; P = <.001), serum bilirubin (r = .297; P = .036), serum albumin (r = -.494; P = <.001), serum sodium (r = -.369; P = .008), Model for End Stage Liver Disease (MELD) score (r = .316; P = .026) and MELD-Na score (r = .470; P = .001). RARI showed no significant relationship with serum creatinine (r = .110; P = .445) and blood urea nitrogen (r = .112; P = .437). CONCLUSION: Liver cirrhosis is associated with renovascular changes which manifest as increased resistance in the renal arteries. RARI is a useful noninvasive tool for the assessment of these changes and should be done routinely in the evaluation of patients with LC.

Correlation of Foetal Liver Length with Gestational Age and Foetal Weight in Pregnant Nigerian Women.

Background: This study aims to determine the relationship(s) of fetal liver length (FLL) to the gestational age, biometric parameters (BPD, FL, AC, HC), and fetal weight in third trimester pregnancies. Methodology: This was a hospital-based cross-sectional study of 400 fetuses in normal third trimester pregnancies recruited from the Obstetrics and Gynaecology department of OAUTHC, Ile-Ife, Nigeria. The participants were between 20-45 years of age and their gestational ages ranged from 27-40weeks. The FLL, liver thickness and transverse diameter were measured on B-mode ultrasound. Fetal liver volume (FLV) was calculated using the ellipsoid formula. The expected gestational age (EGA) was determined from the date of the last menstrual period (LMP), early first-trimester crown-rump length (CRL), or early second-trimester biparietal diameter (BPD) ultrasound. The estimated gestational age (EGA) and EFW were calculated using computer-assisted analysis of ultrasound fetal biometrics. Results: The mean height, weight, and body mass index (BMI) of the participants were 1.62±0.08m, 72.07±13.26kg and 27±4.70kg/m2 respectively. FLL had a linear relationship and a positive correlation with EGA and EFW. There was also a positive correlation between FLL and fetal biometrics, maternal weight, and BMI. Percentile distribution of FLL and FLV for the GA 27-40weeks was developed. Conclusion: FLL could be used to predict GA in normal pregnancies especially when LMP is uncertain.