Outcomes of Proximal Spleno-Renal Shunt Operations for Idiopathic Portal Hypertension in Tertiary Hospital in the Sub-Sahara.

Purpose: Idiopathic portal hypertension (IPH) also known as non-cirrhotic portal hypertension is an entity of hepatic conditions including disorders of blood vessels that leads to portal hypertension (PHT). Current management of PHT includes medical or endoscopic therapy. A proximal spleno-renal shunt (PSRS) operation has been shown to improve the outcomes of patients with IPH with upper gastrointestinal bleeding refractory to medical and endoscopic therapy in high income countries but the same has not been well described in our resource limited setting. Patients and methods: This study consecutively included patients who were diagnosed with IPH on pre-operative imaging and underwent PSRS surgery. Data on four patients across the time period of 3 years was obtained with a male to female ratio of 1:1 and age range of 7 to 34 years. Results: All patients in this study had features of upper gastrointestinal bleeding and, after an endoscopy they were all diagnosed with grade IV esophageal varices. Symptom duration prior to admission varied between 3 months to 8 years. All these patients had multiple episodes of rebleeding varices with recurrent admissions and were managed conservatively by multiple blood transfusions and propranolol tablets, pre-operatively. Only one patient had previous variceal band ligation done though he developed rebleeding. All four patients underwent both PSRS surgery and splenectomy and were intra-operatively verified to have a normal smooth liver and thus IPH was the cause of the esophageal varices. After an average follow-up period of 26.5 months, we found that all patients were alive with early symptomatic relief, no recurrent bleeding and no long-term complications. Conclusion: Good outcomes were achieved in terms of symptom resolution, endoscopic variceal resolution at follow-up endoscopy, length of stay ranging from 8 to 15 days and all four patients were alive at the time of follow-up, that ranged from 14 to 46 months.

Outcomes of bowel resection following non-mechanical intestinal obstruction due to mesenteric vein thrombosis in Uganda: A case series.

INTRODUCTION AND IMPORTANCE: Mesenteric venous thrombosis (MVT) is one of the common occlusive causes of compromised bowel perfusion. Contrast-enhanced CT angiography is the diagnostic imaging study of choice for MVT. In-hospital mortality following acute mesenteric infarction is 63 %. Surgical resection may be life saving for patients with peritoneal signs or refractory to conservative management. CASE PRESENTATION: We consecutively included records of five patients from Lubaga Hospital with intestinal obstruction who underwent bowel resection following intraoperatively confirmed acute mesenteric ischemia between May 2017 and November 2021. Three of the patients were female. Patients were between 21 and 45 years. One patient had comorbid conditions and an identifiable underlying etiology of polycythemia for MVT. Duration of symptoms ranged from 1 to 11 days. All patients underwent open laparotomy, the length of bowel resection ranged from 77 cm to 600 cm (mean length of 337 cm). Two patients developed short bowel syndrome (SBS) and one patient developed intestinal fistula. There was one in-hospital death due to multi-organ failure. CLINICAL DISCUSSION: Morbidity and mortality are associated with delay to diagnose the condition. Revascularization is the primary goal, resection of all non-viable regions and preservation of viable bowel. Mortality is commonly related to multi-organ failure. Advanced intensive care and parenteral nutrition have improved survival rates over the years. 2-year and 5-year survival rates have been reported to be 70 % and 50 %. CONCLUSION: Good outcomes are still possible for post-operatively optimized patients despite the high mortality and morbidity associated with bowel resection following extensive mesenteric thrombosis.

Pneumatocele in a Ugandan female with SARS-CoV2 infection: A case report.

Pneumatocele may complicate the course of SARS-CoV2 infection. Our article exhibits the value of early radiological imaging for the timely diagnosis and management of COVID-19 and its complications. Conservative management is the mainstay of the treatment of pneumatoceles; however, prompt surgical intervention is imperative for complicated pneumatoceles.

Isolated Dextrocardia with Situs Solitus - Dextroversion in a Ugandan Baby: A Case Report.

BACKGROUND: Dextrocardia is a rare congenital abnormality in the general population, with an estimated incidence of 1 in 12,000 live births. Isolated dextrocardia, the condition of right-sided heart with situs solitus is most commonly referred to as dextroversion. CASE PRESENTATION: A 2-month-old Ugandan baby boy discovered to have isolated dextrocardia with situs solitus presented with fever, cough, and difficulty in breathing. Physical examination revealed moderate respiratory distress, bilateral basal fine crepitations, tachycardia with regular pulse, and heart sounds best heard on the right hemithorax, but no murmurs. Chest X-ray confirmed right-sided cardiac shadow with cardiac apex pointing to right. Echocardiography showed D-loop ventricular morphology with right cardiac axis and ventricular apex to right, plus tiny patent ductus arteriosus. Abdominal ultrasound showed normal situs solitus; however, the left kidney was noted in pelvic space. CONCLUSION: Isolated dextrocardia with situs solitus (dextroversion) is a rare scenario. This case exhibits a learning point in the significance of routine medical examination of patients to identify anomalies and upon suspicion a thorough evaluation to prevent wrong diagnosis or poor prognosis due to delayed management.

Cystocolostomy as an unusual approach to recurrent pancreatic pseudocyst in a Ugandan male with dense hepatogastroduodenal adhesions: A case report.

INTRODUCTION AND IMPORTANCE: Pancreatic pseudocyst is one of the most frequent late complications of acute pancreatitis with increasing prevalence in chronic pancreatitis. Other causes include abdominal trauma, biliary tract disease, and other idiopathic causes. 85% resolve spontaneously within 4-6 weeks. Interventions are required for persistently symptomatic, large and complicated pancreatic pseudocysts. Cystocolostomy is a rarely reported pancreatic pseudocyst drainage option. CASE PRESENTATION: 20-year-old male with large recurrent pancreatic pseudocyst following trauma underwent 2 exploratory laparotomies from a peripheral hospital, before referral to Lubaga hospital. Ultrasound-guided cyst drainage was performed. He was readmitted two weeks later with features of cyst recurrence. Re-laparotomy was done and the stomach, duodenum and proximal jejunum were inaccessible due to extensive dense non-obstructive adhesions. Therefore, we performed a transverse cystocolostomy. Patient improved and was discharged on 5th post-operative day. Review was unremarkable at 6 weeks and 3 months post-surgery. CLINICAL DISCUSSION: Current management of pancreatic pseudocyst is percutaneous, endoscopic or laparoscopic drainage. However in cases of large recurrent cysts despite the above interventions, open surgery still has a role. Cystogastrostomy, cystoduodenostomy or cystojejunostomy are the commonly performed drainage options. These 3 options were not possible in this patient due to dense adhesions, hence we performed a transverse cystocolostomy with no post-operative complications. Possible complications from the procedure might include recurrent pancreatitis, pancreatic abscess and stool leak into the pancreatic duct. CONCLUSION: In cases of inaccessibility to the stomach, duodenum and jejunum due to non-obstructing dense adhesions, a pancreatic cystocolostomy can be performed with equally good outcomes.

Case Series: Management of Hypernatremia in DKA in a Tertiary Healthcare Setting in a Developing Country.

Diabetic ketoacidosis (DKA) commonly presents with hyponatremia, but hypernatremia is a rare case. We report two cases of hypernatremia, a 54-year-old woman (case 1) admitted with altered sensorium with blood glucose unrecordably high, serum sodium 134 mmol/L and an 18-year-old girl (case 2) admitted with reduced levels of consciousness, a random blood sugar of 21.2 mmol/L and serum sodium of 121 mmol/L. Case 1 was hydrated with isotonic saline and serum sodium values then escalated to 154 mmol/L on day 2, reaching 166 mmol/L on day 4. Case 2 was hydrated with isotonic saline and also given hypertonic saline for treatment of hyponatremia, and the sodium levels for this patient rose to 153 mmol/L on day 2 reaching a maximum of 176 mmol/L on day 3. On day 2, both patients were switched to half strength Darrow's for correction of the hypernatremia along with insulin therapy. The patients recovered fully and were discharged without any sequelae. These reports exhibit a learning point in the choice of intravenous fluids for the treatment of DKA. They also show the need to delay the correction of hyponatremia in patients with high blood glucose levels.