Duodenal obstruction due to missed pre-duodenal portal vein in a patient with intestinal malrotation.

Pre-duodenal portal vein (PDPV) is a rare anomaly and a rare cause of duodenal obstruction (DO), with only a few cases reported in the literature. We present an infant whose bilious vomiting persisted despite having Ladd's procedure for intestinal malrotation due to a missed diagnosis of DO from PDPV that was found at re-exploration. The patient was diagnosed with malrotation and had Ladd's procedure at 12 weeks of age, but bilious vomiting persisted post-operatively. The patient presented to us after 4 weeks, was clinically malnourished and dehydrated, resuscitation was done and re-exploratory laparotomy performed, where an obstructing PDPV was found and a duodeno-duodenostomy was performed anterior to PDPV. However, the patient died on post-operative day 7 probably from severe malnutrition due to delayed diagnosis and absence of parenteral nutrition. We conclude that PDPV may be a cause of DO in infants with malrotation and should be properly sought for during Ladd's procedure for possible bypass surgery if found.

Haemangioma in the Oro-Facial Region: A Report of Fifteen Cases and Review of Literature

Objective: A haemangioma is a benign vascular tumour consisting of an abnormal overgrowth of tiny blood vessels. Haemangioma may not be present at birth but may appear at 6 months of life. This vascular tumour is not common. We therefore report fifteen cases of haemangioma occurring in the oro-facial region: eight occurred in the cheek, one in the floor of the mouth, four in the lower lip and two in the maxillary gingivae. The objective of this study was to outline the clinical presentation and management of haemangioma in the oro-facial region treated in our Centre. Methods: This is a retrospective study of all the patients that were treated from July, 2009 to July, 2019. Information was extracted from case files of patients. Data collected included: age at presentation, sex, location of the tumour, treatment given, findings and histological diagnosis. Results: The result showed fifteen cases, nine (60.0%) were males and six (40.0%) females. Male to female ratio is 1.50 to 1.00. Our diagnostic tool was the aspiration of frank blood from the tumour which had similar clotting time with the normal blood and our mode of treatment included: injection of sclerosants and excision of the fibrous tissues. Conclusion: It is essential to treat the tumour as early as possible especially in large lesion with disfigurement or where it is complicated by haemorrhage or infection

Paediatric day-case surgery in a new paediatric surgical unit in Northwestern Nigeria.

BACKGROUND: Day-case surgery is defined as when the surgical day-case patient is admitted for investigation or operation on a planned non-resident basis and who nonetheless requires facilities for recovery. A significant number of our patients were treated as day cases. This study was conducted to audit paediatric day-case surgery practice at our centre, to determine the indications as well as morbidity and mortality from day-case surgeries. PATIENTS AND METHODS: This is a prospective study over a period of 14 months. The patients scheduled for surgeries were assessed in the paediatric surgical outpatient clinic and information obtained for each of the patients included age, sex, diagnosis, type of operation, type of anaesthesia and post-operative complications. The data were analysed using SPSS version 15.0 for windows. RESULTS: A total of 182 patients were operated during the study period. The age range of patients was 0.5-156 months and the mean age was 46.6 months. There were 152 male patients (83.5%) and 30 female patients (16.5%). Most of the patients had intact prepuce for circumcision (34.1%). Two patients who had herniotomy developed superficial surgical site infections which were managed as outpatients. There were no readmissions or mortality. CONCLUSION: Intact prepuce for circumcision as well as hernias and hydroceles is the most common day cases in our centre and is associated with low morbidity and no mortality.

Outcome of primary closure of abdominal wounds following laparotomy for peritonitis in children.

BACKGROUND: Primary wound closure following laparotomy for peritonitis is generally believed to be associated with wound complications and long hospital stay. Open wound management has long been the most common practice after laparotomy for peritonitis. Primary closure (PC), however, has recently been advocated to reduce cost and morbidity. This study determined the incidence and severity of wound complications and their impact on hospital stay and overall outcome when PC of abdominal wounds is done following laparotomy for peritonitis. PATIENTS AND METHODS: A prospective review of patients who had PC of abdominal wounds following laparotomy for peritonitis over a 6-year period. RESULTS: Fifty-six children were analysed (35 boys and 21 girls), aged 11 months to 13 years (median: 8 years). The indication for laparotomy was typhoid intestinal perforation 47 (83.9%), perforated appendicitis 4 (7.1%), complicated cholecystitis 3 (5.3%) and penetrating abdominal injury with bowel perforation and intestinal obstruction with bowel perforation, 1 (1.8%) each, respectively. Postoperatively, 34 patients had wound complications. Nine patients (16.1%) had superficial wound infection alone, 12 (21.4%) had superficial wound infection with partial wound dehiscence, 6 (10.7%) had deep wound infection, 7 (12.5%) had deep wound infection with complete wound dehiscence, whereas 22 (39.3%) had no wound complication. Overall, wound complications in 13 (23.2%) patients were considered to be severe, but none resulted in mortality. Hospital stay in patients who developed wound complications was 8-37 days (median: 25 days) and 6-22 days (median: 10 days) in patients who had no wound complications (P = 0.02). CONCLUSION: The rate of wound complications following PC of dirty abdominal wounds remain but PC is safe and gives good healing outcomes.