Obesity and the Need for Bariatric Surgery in Nigeria: A Review.

Obesity was mainly regarded as a disease of developed countries, but currently there is a growing rise in the population of patients with obesity in developing countries of Africa. A body mass index of 30 kg/m2 or higher is regarded as obesity, and this may be associated with comorbidities such as metabolic and cardiovascular diseases, orthopaedic and psychiatric conditions, and cancer. There is conclusive scientific evidence that shows that obesity is caused by complex psychosocial, genetic and environmental factors. Diet and exercise are not effective as sole management of severe obesity. Bariatric surgery is the most cost-effective definitive treatment for all classes of obesity, and the associated weight reduction causes improvement or complete resolution of obesity-associated comorbidity, improves the quality of life and reduces all-cause mortality. It is estimated that about 15% of adults in Nigeria are obese, and in the year 2023, it was reported that only 214 bariatric procedures were done locally, with 134 (62.6%) being gastric balloon insertions, 75 (35.1%) primary weight loss surgeries and 5 revisional surgeries (2.3%). In this article, we discussed the existing weight loss options in Nigeria, the current state of bariatric surgery and the need to improve the practice of bariatric surgery for obese Nigerians and complications of obesity.

Abdominal Trauma Imaging in a Nigerian Tertiary Hospital-Our Experience with 87 Adult Patients.

Introduction: Abdominal trauma is a major cause of morbidity and mortality in low- and medium-income countries (LMICs). Abdominal trauma imaging is important in determining the location and severity of organ injury, the need for surgery, and the identification of complications. The choice of imaging in abdominal trauma in LMICs is influenced by peculiar problems, which include the availability of imaging modality, expertise, and cost. There are few reports on options of trauma imaging in LMICs, and this study aimed to identify and characterise the type of imaging done for patients presenting with abdominal trauma at the University of Ilorin Teaching Hospital. Materials and Methods: This was a retrospective observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from 2013 to 2019. Records were identified, and data were extracted and analysed. Results: A total of 87 patients were included in the study. There were 73 males and 14 females. The abdominal ultrasound was the commonest modality done in 36 (41%) patients, whereas abdominal computed tomography was done in five (6%) patients. Eleven patients (13%) had no imaging done, and 10 of these patients proceeded to having surgery. In patients with intraoperative finding of perforated viscus, the sensitivity of radiography was 85% and specificity was 100%, whereas that of the ultrasound was 86.7% and 50% for sensitivity and specificity, respectively. The ultrasound scan was the commonest imaging done for patients who presented with features of haemorrhage (P = 0.04), odds ratio (OR) = 1.29 (95% confidence interval [CI] = 1.08-1.6), and patients with severe injury, P = 0.03, OR = 2.07 (95% CI = 1.06-4.06). Gender (P = 0.64), shock at presentation (P = 0.19), and mechanism of injury (P = 0.11) did not influence the choice of imaging. Conclusions: Abdominal trauma imaging in this setting was majorly via ultrasound and abdominal radiographs. Factors suggested to influence the pattern of abdominal trauma imaging in LMICs include the availability of specific imaging modality, cost, lack of standardisation and definite abdominal trauma protocols.

Pattern of Presentation and Outcome of Adult Patients with Abdominal Trauma - A 7-Year Retrospective Study in a Nigerian Tertiary Hospital.

Introduction: Abdominal trauma is a major cause of morbidity and mortality in low- and middle-income countries. There is a paucity of trauma data in this region and this study aimed to show the pattern of presentation and outcome of patients with abdominal trauma at a North-Central Nigerian Teaching Hospital. Methods: This was a retrospective, observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from January 2013 to December 2019. Patients with clinical and/or radiological evidence of abdominal trauma were identified, and data extracted and analyzed. Results: A total of 87 patients were included in the study. There were 73 males and 14 females (5.2:1) with a mean age of 34.2 years. Blunt abdominal injury occurred in 53 (61%) patients with 10 patients (11%) having concomitant extra-abdominal injuries. A total of 105 abdominal organ injuries occurred in 87 patients with the small bowel being the most frequently injured organ in penetrating trauma, while in blunt abdominal injury, the spleen was most commonly injured. A total of 70 patients (80.5%) had emergency abdominal surgery with a morbidity rate of 38.6% and negative laparotomy rate of 2.9%. There were 15 deaths in the period accounting for 17% of patients with sepsis as the most common cause of death (66%). Shock at presentation, late presentation >12 h, need for perioperative intensive care unit admission, and repeat surgery were associated with a higher risk of mortality (P < 0.05). Conclusion: Abdominal trauma in this setting is associated with a significant amount of morbidity and mortality. Typical patients present late and with poor physiologic parameters often resulting in an undesirable outcome. There should be steps targeted at preventive policies focused on reducing the incidence of road traffic crashes, terrorism, and violent crimes as well as improving health care infrastructure to cater to this specific group of patients.

Peritonitis following unsafe abortion: a retrospective study in a tertiary health facility in North Central Nigeria.

INTRODUCTION: surgical complications following unsafe abortion (UA) are not uncommon and are associated with high morbidity and mortality in developing countries. The commonest need for the general surgeon following UA is after a diagnosis of peritonitis which can occur following use of sharp objects introduced through the vagina. This study aims to highlight the presentation, management types and outcome of patients who presented with peritonitis following UA. METHODS: this study is a retrospective review of cases of peritonitis following UA seen over 4 years from January 2015 to December 2019 in a tertiary health facility in North Central Nigeria. RESULTS: a total of 14 patients with peritonitis following UA were included in the study. The mean age of patients who presented was 27.4 years (19-40 years) with a mean estimated gestational age at abortion of 7.8 weeks. The average time from the UA procedure till presentation at the hospital was 8.6 days. There were 9 bowel injuries and 5 pelvic abscesses. A total of 3/9 patients had primary resection and anastomosis while 6/9 had stoma formed as part of their management. Pelvic abscesses were drained. In patients with bowel injury, those who had primary anastomosis had a 100% incidence of enterocutaneous fistula formation with associated sepsis requiring repeat exploration and formation of stoma. Mortality in this group was 67% (2/3) compared to the 0% (0/6) mortality rate seen in patients who had stoma. The overall mortality was four out of fourteen patients (28.6%). CONCLUSION: peritonitis following UA is associated with marked morbidity and mortality as many of the patients present late. Initial preoperative resuscitation and stabilization should be followed by a swift laparotomy. Patients with bowel injury who had primary anastomosis had higher morbidity, reoperation rates and mortality than patients who had stomas.

Primary jejunal melanoma as a cause of adult intussusception: a case report and review of literature.

Primary melanoma of the small bowel is a rare clinical entity with a paucity of published reports in literature. Most cases of gastrointestinal melanomas are metastatic lesions arising from skin or ocular origins. This is a case report of a 63 year old female with adult intussusception with jejunal melanoma as the lead point. The index patient had a long history of abdominal pain associated with significant weight loss and presented with features of intestinal obstruction. The possibility of a regressed or unidentified extra-intestinal site cannot be absolutely excluded as the patient did not have a PET scan. Due to the vague nature of clinical symptoms and signs, the diagnosis of small bowel melanoma is difficult, especially in patients with no obvious cutaneous pathology. A high index of suspicion for melanoma as a malignant lead point for adult intussusception should always be entertained.