Diagnostic Accuracy of Mammographic Findings in Patients 35 Years and Older Presenting with Palpable Breast Lump in University of Benin Teaching Hospital, Benin City.

BACKGROUND: Mammography has become an invaluable tool for diagnosing breast lesions and detecting early breast cancer in women of 35 years and above. AIMS: To correlate the mammography Breast Imaging Reporting and Data System (BI-RADS) categories with the histology in breast lesions and to determine the predictive values, sensitivity, specificity and accuracy of mammography. PATIENTS AND METHOD: This was a one- year prospective study carried out from March 2015 to February 2016. Consecutive female patients of 35 years and above with breast lesions at the University of Benin Teaching Hospital, Benin-City were recruited. Patients with fungating breast lesions and those who declined recruitment were excluded. All patients had mammography and core biopsy of the breast lesion which was examined histologically. RESULTS: A total of 101 patients were studied. Five patients had bilateral breast lesions making a total of 106 biopsies that were performed. The mean age of patients with benign breast disease was 47.0 ± 4.9 years while those with malignant breast disease was 49.9 ± 8.5 years; P-value was 0.080 which was not statistically significant. Fibrocystic disease 6 (5.6%) was the most common benign disease while invasive ductal carcinoma was the most common malignant breast disease 84(79.2%). BI-RADS 5 correlated mostly with malignant breast disease (97.0%); P value < 0.001 and was statistically significant. CONCLUSION: This study showed that mammography is useful in the diagnosis of breast lesions in women who are 35 years and older. Patients with BI-RADS category 3, 4 and 5 had an increasing correlation with malignant breast disease.

CONTEXTE: La mammographie est devenue un outil inestimable pour diagnostiquer les lésions mammaires et détecter précocement le cancer du sein chez les femmes de 35 ans et plus. OBJECTIFS: Corréler les catégories du Breast Imaging Reporting and Data System (BI-RADS) de la mammographie avec l'histologie des lésions mammaires et déterminer les valeurs prédictives, la sensibilité, la spécificité et la précision de la mammographie. PATIENTES ET MÉTHODE: Il s'agit d'une étude prospective d'un an réalisée de mars 2015 à février 2016. Les patientes consécutives de 35 ans et plus présentant des lésions mammaires à l'Hôpital Universitaire de Benin, à Benin-City, ont été recrutées. Les patientes présentant des lésions mammaires fungiques et celles qui ont refusé de participer à l'étude ont été exclues. Toutes les patientes ont subi une mammographie et une biopsie au trocart de la lésion mammaire, qui a été examinée histologiquement. RÉSULTATS: Un total de 101 patientes ont été étudiées. Cinq patientes présentaient des lésions mammaires bilatérales, soit un total de 106 biopsies réalisées. L'âge moyen des patientes atteintes de maladie mammaire bénigne était de 47,0 ± 4,9 ans, tandis que celui des patientes atteintes de maladie mammaire maligne était de 49,9 ± 8,5 ans ; la valeur P était de 0,080, ce qui n'était pas statistiquement significatif. La maladie fibrokystique 6 (5,6%) était la maladie bénigne la plus fréquente, tandis que le carcinome canalaire infiltrant était la maladie mammaire maligne la plus fréquente 84 (79,2%). Le BIRADS 5 corrélait principalement avec les maladies mammaires malignes (97,0%) ; la valeur P était < 0,001 et était statistiquement significative. CONCLUSION: Cette étude a montré que la mammographie est utile dans le diagnostic des lésions mammaires chez les femmes de 35 ans et plus. Les patientes ayant des catégories BI-RADS 3, 4 et 5 présentaient une corrélation croissante avec les maladies mammaires malignes. MOTS-CLÉS: Mammographie, Lésion mammaire féminine, Histologie, Corrélation, Précision diagnostique.

OUTCOMES OF POSTERIOR SAGITTAL ANORECTOPLASTY FOR HIGH ANORECTAL MALFORMATION IN BENIN CITY, NIGERIA.

BACKGROUND: Surgical treatment for high anorectal malformations has evolved over the years with introduction of posterior sagittal anorectoplasty in the early 80s. Posterior sagittal anorectoplasty is being perfomed in many centres which necessitates a review of its outcomes in Benin City, Nigeria. AIM: To report a 10-year outcome and experience gained with posterior saggital anorectoplasty for children diagnosed with high anorectal malformation. METHODS: A retrospective analyses of the records of all children with high anorectal malformation and managed with posterior sagittal anorectoplasty between April 2006 and March 2016 at the University of Benin Teaching Hospital. RESULTS: A total of 96 children were managed for anorectal malformation during the period. High anorectal malformation accounted for 33 (34.4%) cases, the intermediate 15 (15.6%) and the low types were 48 (50%). The 33 radiologically confirmed high type were19 males and 14 females with a male/female ratio of 1.3: 1. They were aged between 2 days and 4 years with a mean of 6.8 ± 3 months. A child each had additional prune belly syndrome, multiple limbs anomalies and unilateral undescended testis. Recto-bladder neck/recto-prostatic and recto-vaginal fistulae were recorded in 31 (94%) children. Five (15%) clinically stable neonates had primary posterior sagittal anorectoplasty without colostomy which was well tolerated. The majority, 28 (85%), had conventional posterior sagittal anorectoplasty that involves initial colostomy. Minor postoperative morbidities recorded in 10 (30.3%) children included superficial wound infection in 3 (9%), anal stenosis in 3 (9%) and fecal incontinence in 2 (6%) children which resolved on conservative treatment while 2 (6%) with rectal mucosal prolapse required refashioning. The functional clinical anal outcomes of posterior sagittal anorectoplasty recorded showed that the majority 18 (54.5%) of children were continent while 4 (12.1%) had voluntary bowel controls corresponding with their ages. Anal stenosis in the 3 and incontinence in the 2 children were the common anal dysfunctions recorded. The child with prune belly syndrome had breakdown of colostomy closure which resulted in the one (3%) death recorded. CONCLUSION: Anorectal malformation was common in this setting during this study with a large proportion of the children diagnosed with the high type and were managed with good outcome using posterior sagittal anorectoplasty.

Outcome of primary posterior sagittal anorectoplasty of high anorectal malformation in well selected neonates.

BACKGROUND: Conventional posterior sagittal anorectoplasty (PSARP) for high anorectal malformation (ARM) involves initial colostomy creation with its attendant complications, but primary PSARP in neonates requires no initial colostomy. OBJECTIVES: To report on locally adapted inclusion criteria and outcomes of primary PSARP in neonates in Benin City. MATERIALS AND METHODS: Babies who presented during the first week of life in clinically stable conditions, without cardiac anomaly, and had hemogram and blood chemistry within normal ranges, were included in this prospective study undertaken at the University of Benin Teaching Hospital in 2008-2011. RESULTS: Fifty children with ARM comprising 19 (38%) low/intermediate and 31 (62%) high anomalies were treated during the period. Five (10%) singletons delivered via spontaneous vaginal delivery at term. Aged at operation between two and seven (mean 4) days and comprised three males and two females (ratio 1.5:1), met the inclusion criteria for primary PSARP. The procedure was well tolerated by all the babies; oral intake was commenced on the second post-operative day with nine days median hospitalization duration. No mortality was recorded on six months to four years follow-up. Apart from minor superficial perianal surgical site infection in one baby which responded to antibiotics, no post-operative sepsis or breakdown of repair was recorded. Continence and other anal functions were found excellent using the modified Wingspread scoring during follow-up. CONCLUSION: These outcomes showed that with meticulous selection, primary PSARP in neonates was feasible and safe in a developing country. Multicenter studies and long-term follow-up are advocated World-wide.

Postoperative wound infection and perioperative prophylactic versus therapeutic antibiotics in paediatric abdominal surgeries: a five-year review.

BACKGROUND: Outcome of a most successful surgical procedure may be affected by infective complications. This is a report of postoperative wound infection and outcome of perioperative antibiotics used in children with surgical abdomen. METHODS: Postoperative wound infection and perioperative antibiotics used in children who had abdominal surgeries at two referral paediatric surgical centres between June 2004 and May 2009 were analyzed in a retrospective study. RESULTS: All 1298 childrenaged between one month and 16 years with a male: female ratio 1.5:1 managed with surgical abdomen who presented after an average of 48 hours of symptoms had antibiotics; 458 (35.3%) prophylactic versus 840 (64.7%) therapeutic.Antimicrobials in penicillin, aminogycoside, quinolone, cephalosporingroups, and metronidazole were used either as single or combined agents in 458 (35.3%) children with clean-contaminated, 459 (35.4%) contaminated and 381 (29.3%) dirty wounds. Emergency operations performed on 791 (60.9%) children resulted in 157 (19.8%) postoperative wound infection compared to 507 (39.1%) operated on elective bases with 30 (5.9%) (P<0.0001). The wounds were superficial 71 (38%), deep 47 (25.15%) and intraperitoneal 39 (20.9%) in emergency cases, and 21 (1.6%) deaths occurred overall. Postoperative wound infection recorded in 16.7% (140/840) was higher in children who had therapeutic than in 10.3% (47/458) who received prophylactic antibiotics (P=0.0022). It was lower, 25% (38/152), using single agents for prophylaxis than therapy 60.6% (134/221) (P=0.0091), and also lower, 9.1% (84/925), using combined agents that included cephalosporin for both prophylaxis and therapy than 46.1% (172/373) using single agents (P<0.0001). CONCLUSION: Early referral to reduce emergency operations and timely commencement of combined antimicrobials which includes cephalosporins are advocated.

Outcomes of skin closure with suture materials in clean paediatric surgical procedures.

Except through natural orifices, all surgical operations involve making skin incisions which are often closed with suture materials to which the skin may react. This is a five-year (2005-2009) retrospective study of postoperative outcomes of 998 clean skin incisions closed with continuous subcuticular suture materials in 796 children at two Nigerian centres. The children were aged between 1 day and 18 years (mean 6.5 +/- 3.4 years) with a male to female ratio of 2.5:1. The location of the incisions ranged from groin in 678 (67.9%) cases to lower limbs in 15 (1.5%), these were associated with 414 (61.1%) and 13 (86.7%) postoperative complications respectively. Sutures were not removed from the skin in 734 cases and were associated with 558 (76%) postoperative complications whereas sutures were removed between 5-7 postoperative days in 264 cases and were associated with 39(14.8%) postoperative complications (P < 0.0001). Whereas postoperative wound infection in 69 (6.9%) cases occurred before ten days, stitch abscess/sinus, 156 (15.6%), suture extrusion, 80 (8%), hyperpigmentation, 211 (21.1%), pruritus, 182 (18.2%), hypertrophied scars, 128 (12.8%), and keloid formation, 9 (0.9%), occurred after the tenth postoperative day among those whose sutures were not removed in direct proportion to patients' age/ suture size. These postoperative complications gave rise to 343 (34.3%) good, 245 (24.5%) fair, and 9 (0.9%) poor cosmetic outcomes, whereas 401 (40.2%) incisions without postoperative complication gave excellent cosmetic outcomes. It is suggested from this study that continuous subcuticular suture materials which should be removed not later than the tenth postoperative day be used for skin closure in children.

Neck masses in children: etiopathology in a tertiary center.

BACKGROUND: Neck masses are common in children; they could present diagnostic challenges, and some may be malignant. This study determines the etiology, histopathology, and outcome of treatment in a Nigerian tertiary center. MATERIALS AND METHODS: This is a three-year retrospective study of children managed with neck masses at the University of Benin Teaching Hospital between January 2007 and December 2009. The biodata, side distribution of the masses, clinical conditions of the children at presentation, methods of biopsy, histopathology results, definitive treatment options, follow-up, and outcome were analyzed. RESULTS: A total of 35 children who were aged between one month and 16 years (mean, 8.1 ± 2.6 years) with a male : female ratio of 1.9 : 1 (23 males to 12 females) were managed with 26 (74.3%) acquired and nine (25.7%) congenital neck masses. The masses were located in the anterior triangle in 14 (40%) cases, right side of the neck in 12 (34.3%), and left side of the neck in seven (20%), with two (5.7%) bilateral/confluent. Twelve (34.3%) cases were enlarged lymph nodes; five (41.7%) of them due to malignant lesions. Except for the neck mass, 16 (45.7%) of the children enjoyed clinically stable health on presentation. Twenty (57.1%) acquired tumors were malignant compared with 15 (42.9%) mainly congenital tumors which were benign. Four malignant tumors (11.4%) were rare in anterior triangle. Hodgkin's lymphoma, 9 (25.7%), and thyroglossal duct cyst, 5 (14.3%), were most common malignant and nonmalignant masses, respectively. Surgical excision was curative in 12 (34.3%) cases, but others required additional chemo and/or radiotherapy, with two (5.7%) mortality recorded due to late referral of children with Hodgkin's lymphoma. CONCLUSIONS: Many neck masses in otherwise healthy children in our setting were malignant. We advocate early surgical consultation and thorough histopathologic analysis of neck masses in children in our subregion.

Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?

BACKGROUND: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. PATIENTS AND METHODS:This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. RESULTS: Adhesive intestinal obstruction accounted for 21 (8.8%) of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 +/- 6.4 years), comprising 13 males and eight females (ratio 1.6:1). Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%), perforated appendix (five, 23.8%), perforated volvulus (three, 14.3%), penetrating abdominal trauma (two, 9.5%) and perforated typhoid (two, 9.5%) were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6%) children due to poor response to nonoperative management, 11-13 days in 12 (57.1%) who responded minimally and 2-5 weeks in three (14.3%) who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%), multiple bands/adhesions (13, 61.9%) and encasement, including one bowel gangrene (six, 28.6%). Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. CONCLUSION: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and mortalities in settings with limited resources

Adult Patients Presenting with Undescended Testis in Awareness-Poor Region

Objectives The majority of patients with undescended testis present during childhood with minimal complications owing to straightforward treatment with excellent postoperative outcome. This paper reports the mode of presentation; challenges and outcome of management of adult patients with undescended testis. Methods. This prospective study included consecutive cases of adult patients managed with undescended testis from January 2004 to December 2008 in Evbuomore; Nigeria. Results Eighteen adults with a mean age of 38.3 years (range 19-61) were managed during the period. Ten (55.5) had bilateral; 5 (27.8) right and 3 (16.7) left lesions. Awareness was poor as they presented due to infertility in 8 (44.4); associated hernia 5 (27.8); wife/self discovery 4 (22.2) and accidental discovery by a health worker 1 (5.6); with 9 men (50) presenting between 30 and 40 years of age. On inguinal exploration; only 3 (10.7) patients had viable but significantly reduced testicular volume; 17 (60.7) were atrophic/fibrotic while in 8 (28.6) the vas deferens ended blindly in the inguinal canal with no viable testicular tissue. Apart from three patients who had children before presentation; infertility persisted even after treatment despite adequate hormone profiles and satisfactory sexual performance. Counseling of spouses was a major challenge; with 8 couples adopting children and three marriages ending in separation. conclusion: Management of adults with undescended testis was challenging due to irreversible complications; psychological effects and poor outcome of treatment which shows the importance of awareness programs that will result in childhood presentation

Small intestinal tubulovillous adenoma--case report and literature review.

Benign small intestinal tumour, though rare, have been reported. We report a case of sessile and extensive tubulovillous adenoma in a 13-year-old girl. She presented in a private hospital with three months history of abdominal pain, abdominal distension, vomiting, constipation, weight loss and anorexia. Significant findings on examination were weight loss, dehydration, and a huge smooth, not tender, mobile and indentable mass which extended from the left lumbar region to right iliac fossa. Visible peristalsis coursing from left to right was seen on the mass. Erect and supine plain abdominal x-rays revealed features of partial intestinal obstruction and abdominal ultrasound scan revealed dilated and hypertrophied bowel segment but could not say the bowel segment affected. The affected segment was found to be a 55cm portion of terminal ileum at operation which was resected due to hypertrophied proximal and collapsed distal segments, features in keeping with chronic intestinal obstruction, and ileo-ileal anastomosis done. Histology report was that of benign tubulovillous adenoma and the girl has enjoyed stable health for more than a year on close follow up in surgical outpatient clinic. This case highlights the unusual presentation and unusual gross nature of this small intestinal adenoma, which was found to be a benign adenoma on histological examination.

Outcome of trans-anal posterior anorectal myectomy for the ultrashort segment Hirschsprung's disease--Benin City experience in five years.

OBJECTIVE: The conventional treatment of Hirschsprung's disease involves colostomy creation, excision of aganglionic segment, pull through using normally ganglionated proximal bowel segment and colostomy closure. The ultrashort segment variety is treated with posterior anorectal myectomy which requires no prior colostomy creation. This study sought to evaluate the benefits and outcomes of the procedure in a tertiary hospital in Nigeria. PATIENTS AND METHODS: All children diagnosed with ultrashort segment Hirschsprung's disease between January 2003 and December 2007 at the University of Benin Teaching Hospital, Benin City, were prospectively studied. RESULTS: Of 64 children managed with Hirschsprung's disease in five years, 11 (17.2%) were diagnosed with ultrashort segment variety and had posterior anorectal myectomy without prior colostomy. They comprised 7 males and 4 females with male/female ratio 1.8:1 and were aged between 1 month and 9 years (mean 1.5 +/- 0.8 years). The procedure was well tolerated and gave satisfactory results in all the patients as no wound infection or any life threatening morbidity and mortality was recorded. Postoperative pain which responded to paracetamol in the majority of children was statistically significant in older compared to younger patients (P<0.0001). Oral feeds were commenced and tolerated earlier, length of hospitalisation was shorter and no incontinence was recorded unlike the conventional treatment. Also, postoperative nursing care was easier and the single procedure resulted in availability of theatre space for other paediatric operations. All the children did well on 9 months to 4 years follow-up. CONCLUSION: The procedure was found to be beneficial and effective for ultrashort segment Hirschsprung's disease, and should be employed in this subregion.

Causes, spectrum and effects of surgical child abuse and neglect in a Nigerian city.

BACKGROUND: Children are dependent on parents and care givers for the quality of health care services received and in developing countries, where they are not protected against child abuse; many die as a result of denial of appropriate treatment. OBJECTIVE: The objective of this study was to determine the causes, spectrum and effects of abuse and neglect on surgical children. METHODS: Analysis of cases of surgical child abuse and neglect between January, 1998 and December, 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria, was done. RESULTS: A total of 281 children aged two days and 12 years comprising 113 males and 168 females with male to female ratio 1:1.4, mainly with congenital malformation, suffered surgical child abuse and neglect ranging from delayed presentation, to child abandonment which was perpetuated by ignorance, poverty, superstitious beliefs, customs as well as non availability of free medical services for children. Counselling and home visits in addition to surgeries were done and 198 (70.5%) children were successfully treated with those abandoned happily reunited with their families, while 56 (19.9%) mortality was recorded due to complications of the primary surgical pathology, and this was statistically significant compared with other children with similar lesions but without abuse or neglect during the period (p=0.0102). Whereas 27 (9.6%) among those discharged against medical advice were lost to follow-up, of the 198 children that survived, 22 suffered psychological trauma and were co-managed with psychologists while seven were transferred to orphanage homes. CONCLUSION: Surgical child abuse/neglect is rampant, hence, it is hoped that these findings will influence policy makers in this sub-region to formulate policies that will protect children against this form of child abuse.

Circumcision mishaps in Nigerian children.

BACKGROUND/OBJECTIVE: Circumcision may be associated with complications which are usually minor but could be life threatening on certain occasions. This study determined contributory factors, pattern of presentation, challenges of management and outcome of circumcision mishaps in Benin City, Nigeria. METHODS: A retrospective analysis of all male children managed for circumcision mishaps between January 1998 and December 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: There were 346 male children aged between 6 days and 12 years. Period of presentation to the unit ranged between 1 hour and 12 years. Redundant prepuce, 51 (14.7%); glandulopenile adhesions, 30 (8.7%); implantation cyst, 10 (2.9%); penile chordee, 11 (3.2%); local wound infection, 17 (4.9%); and proximal migration of plastibell ring, 11 (3.2%), were common mishaps treated with good outcome. On the other hand, urethrocutaneous fistula, 73 (21.1%); hemorrhage, 46 (13.3%); glandular amputation, 9 (2.6%); penile tissue avulsion, 24 (7.0%); and transmission of infections, 4 (1.2%), were challenging mishaps to manage. These resulted in 18 children with residual penile deformity and 4 deaths. Challenging mishaps and late referrals were common among children circumcised by traditional circumcisionists (P < 0.0001). Inadequate training of circumcisionists; circumcision in unhygienic environment; circumcision with unsterilized instruments; circumcision without the use of anesthesia, analgesia and antibiotics - which were compounded by late referrals - influenced the development and final outcome of circumcision mishaps. CONCLUSION: Circumcision mishaps presenting very late with resultant poor outcome are still common in our setting. Hospital circumcision by experts, health awareness campaigns, adequate training of circumcisionists and early referrals of affected children should be encouraged.

Challenges of giant ventral hernia repair in children in an African tertiary care center with limited resources.

OBJECTIVE: The objective of this study is to report the challenges and outcome of giant ventral abdominal hernia repair in infants/children in a tertiary care center in Africa. DESIGN: A retrospective analysis of infants/children who had a repair of giant ventral abdominal hernia between January 1998 and December 2007 at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was carried out. RESULTS: A total of 41 children aged between 9 months and 12 years (mean 2.6 +/- 1.8 years) comprising 25 males and 16 females with a male:female ratio of 1.6:1 had a repair of giant ventral abdominal hernias which were due to healed omphalocele in 37 (90.3%), incisional hernia in three (7.3%), and following initial skin closure of gastroschisis in one (2.4%). They had an average hernia defect of size 7.1 x 8.3 cm, which contained both solid and hollow viscera in all of the patients, along with 11 (29.7%) syndromic omphalocele. The major challenge was inadequate intraabdominal volume needed to accommodate the herniated viscera in nine children, which was compounded by the nonavailability of silastic materials, a pediatric ventilator, facilities required for intraabdominal pressure monitoring during closure, as well as undiagnosed associated cardiac anomaly. Overall, 39 (95.1%) children survived, while two (4.9%) mortalities were recorded due to postoperative aspiration in one child and cardiopulmonary failure in the other. Of those who survived, 29 (74.4%) had a smooth postoperative course, while ten (25.6%) had morbidity, with a mean hospitalization duration of 10 +/- 2.5 days. There was no recurrence recorded on follow-up for 5 years at the surgical outpatient clinic. CONCLUSION: Despite the challenges, better results were achieved with repairs in infants/children compared to repairs performed in neonates.

Inguinal hernia in Nigerian female children: beware of ovary and fallopian tube as contents.

BACKGROUND: The risk of injury to the ovary and fallopian tube during herniotomy in female children is quite high, and reports on the frequency of these organs as inguinal hernia contents and, as such, prevention from injuries are not available in this subregion. This study was designed to determine the frequency of ovary and fallopian tube as contents of inguinal hernias sacs in Nigerian female children. METHODS: An eight-year prospective study was undertaken at two Nigerian healthcare institutions between July 2000 and June 2008. All female children treated with herniotomy during the period had their hernia sacs opened and inspected for their contents, which were documented on a pro forma. RESULTS: A total of 138 female children aged between 2 months and 12 years (mean 5 +/- 3.4 years) were diagnosed with 176 inguinal hernias treated with herniotomy at the two centers and comprised 11.1% of children with hernias in eight years. On inspection, 145 (82.4%) hernias contained either ovary and/or fallopian tube, with the ovary being the only content in 82 (46.6%) sacs. The ovary and fallopian tube were the contents in 43 (24.4%), while fallopian tube alone was the content in 20 (11.5%) hernias. It was only in 31 (17.6%) that they were not contents of the hernia sacs, as 21 (11.9%) of these hernias contained peritoneal fluid, seven (3.9%) omentum, and three (1.7%) loop of bowels. In the majority of children below the age of 5 years and in eight (4.5%) older children, the hernias were sliding, with ovaries forming part of the inferomedial wall with a high probability of injury during herniotomy. CONCLUSION: Ovary and fallopian tube were common contents of inguinal hernia sacs in Nigerian female children. Efforts should be made to inspect the contents of hernia sacs during herniotomy, while blind transfixion without first opening them to inspect and reduce the contents should be avoided.

Pattern and Outcome of Childhood Teratoma: a 10-Year Review

Background: Teratomas are neoplasms which originate from pluripotent stem cells. They are composed of a wide variety of tissues foreign to the organ or anatomic site in which they arose. This study sought to determine the clinical manifestations and outcome of treatment of childhood teratomas. Method: A retrospective analysis of the case files of children treated for teratoma at the University of Benin Teaching Hospital Benin City; Nigeria between January 1999 and December 2008 was done. Results: Fifty-three children aged between 5 days and 16 years; comprising 15 males and 38 females with male:female ratio of 2:5 were treated for teratoma; gonadal 27(50.9) and extragonadal 26 (49.1). Ovarian; 23 (43.4) and sacrococcygeal; 17 (32.1) sites were frequently involved. Other sites included testicular; 4 (7.5); retroperitoneal; 4 (7.5) and renal; 2 (3.8); while posterior mediastinal; cervical and breast involvement were 1 (1.9) each. Despite late presentation; no frankly malignant primary teratoma was diagnosed. Benign cystic teratomas with malignant elements comprising yolk sac tumour and immature neuroepithelial elements (mixed germ cells tumour) were the major histological types. Complete tumour resection that included total coccygectomy; oophorectomy and orchidectomy; plus combination chemotherapy using vincristine; actinomycin; and cyclophosphamide was curative in 25 (47.2) children. Eighteen (34) cases of recurrence were all malignant. They presented very late with rapid disease progression that resulted in 10 (18.8) deaths during the five years of follow-up. Conclusion: Although all primary teratoma were benign; recurrent malignant tumours with rapid progression to carcinomatosis; multiple organs failure and deaths were common in childhood teratoma. We advocate close follow-up of all children with teratoma to detect and commence early treatment

Causes; Spectrum and Effects of Surgical and Neglect in a Nigerian City

BACKGROUND: Children are dependent on parents/care givers for the quality of health care services received and in developing countries; where they are not protected treatment. OBJECTIVE: The objective of this study was to determine the causes; spectrum and effects of abuse/neglect on surgical children. METHODS: Analysis of cases of surgical child abuse/neglect between January; 1998 and December; 2007 at the University of Benin Teaching Hospital; Benin City; Nigeria; was done. RESULTS: A total of 281 children aged two days and 12 years comprising 113 males and 168 females with male/female ratio 1:1.4; mainly with congenital malformation; suffered surgical child abuse/ neglect ranging from delayed presentation; to child abandonment which was perpetuated by ignorance; poverty; superstitious beliefs; customs as well as non availability offree medical services for children. Counselling and home visits in addition to surgeries were done and 198 (70.5) children were successfully treated with those abandoned happily reunited with their families; while 56 (19.9) mortality was recorded due to complications of the primary surgical pathology; and this was statistically significant compared with other children with similar lesions but without abuse or neglect during the period (P=0.0102). Whereas 27 (9.6) among those discharged against medical advice were lost to follow-up; of the 198 children that survived; 22 suffered psychological trauma and were co-managed with psychologists while seven were transferred to orphanage homes.CONCLUSION: Surgical child abuse/neglect is rampant; hence; it is hoped that these findings will influence policy makers in this sub-region to formulate policies that will protectchildren against this form of child abuse

Hazards of pentazocine for neonatal analgesia: a single-centre experience over 10 years.

BACKGROUND: In developing countries, neonatal analgesia for surgical procedures is a major challenge where postoperative care is inadequate. AIM: To report experience of pentazocine for neonatal surgery in a Nigerian tertiary hospital. METHODS: A retrospective study of surgical neonates who received pentazocine at the University of Benin Teaching Hospital in Benin City between January 1998 and December 2007. RESULTS: During the period, 2590 paediatric operations were performed including 368 (14.2%) neonates, 49 (13.3%) of whom had pentazocine. The other neonates received a variety of analgesics. Of 56 neonates who developed respiratory depression, 40 (71.4%) had pentazocine (p<0.0001). Fifteen (30.6%) neonates aged between 9 hours and 28 days [mean (SD) 12 (1.2) days] died between 1 and 36 hours following 8-hourly administration of 0.5 mg/kg pentazocine. In older children who had pentazocine, over-sedation was also a problem but there were no deaths. Deaths in neonates were mainly owing to persistent respiratory depression which was compounded by the unavailability of a paediatric ventilator. However, many neonates responded to naloxone. All neonates who died had an autopsy and no lesion was found which could have compromised respiratory function. CONCLUSION: The use of pentazocine in neonates was associated with high morbidity and mortality. Caution is required when using pentazocine for neonatal analgesia where post-operative respiratory support is insufficient.

Indirect inguinal hernia in Nigerian older children and young adults: is herniorrhaphy necessary?

BACKGROUND: In many centers in sub-Saharan Africa, adults and children aged over 12 years with indirect inguinal hernias are treated with Bassini's herniorrhaphy with many avoidable complications. The objective of this study was to determine the applicability of herniotomy in patients aged between 12 and 45 years. METHODS: A prospective study was carried out on patients aged between 12 and 45 years with indirect inguinal hernias who were treated with herniotomy at the Leadeks Medical Center, Benin City, Nigeria, between January 2002 and December 2007. RESULTS: A total of 316 patients aged between 12 and 45 years (mean 25 +/- 5.3 years), comprising 305 males and 11 females with a male:female ratio of 27.7:1, had 326 herniotomies, which accounted for 27.5% of pediatric operations during the study period. Two hundred and eighty-three (86.8%) patients had elective while 43 (13.2%) had emergency surgery following features of obstruction and strangulation, with a mean duration of surgery of 30 min (range 20-40 min). All of the patients were operated on day case with a mean observation period of 8 +/- 3.5 h (range 2-24 h), and no significant immediate postoperative complication was recorded. Postoperative pain was extremely statistically significant in those cases that had strangulation before operation (P < 0.0001), but paracetamol was an adequate analgesia. The patients resumed normal duties between 5 and 14 days after repair and have been followed up for 1-5 years, with one (0.3%) patient, who was also being treated for chronic cough, who had recurrence 3 years after operation. CONCLUSION: Herniotomy was found to be safe, applicable, beneficial, and cost-effective in this age group, with many advantages over Bassini's herniorrhaphy.

Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria.

OBJECTIVE: To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. PATIENTS AND METHODS: All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. RESULTS: A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term (P=0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4-6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. CONCLUSION: Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.