Local anesthesia versus saddle block for open hemorrhoidectomy: cost-analysis from a randomized, double blind controlled trial.

BACKGROUND: Despite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first line technique in low-income countries such as Uganda; therefore, we aimed at comparing the cost of OH under LA versus Saddle block among patients with 3rd or 4th degree hemorrhoids. METHODS: This trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time, and direct costs in (US$) including medical and non-medical were recorded. We analysed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0. RESULTS: Findings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p < 0.05). The mean operating time was 15.52 ± 5.34(SD) minutes versus 33.72 ± 11.54 min for OH under LA and SB respectively. The mean cost of OH under LA was 57.42 ± 8.90 US$ compared to 63.38 ± 12.77US$ in SB group. CONCLUSION: The use of local anesthesia for OH was found to have less operating time with high-cost effectiveness. Being affordable, local anesthesia can help to increase the turnover of patients who would otherwise wait for the availability of anesthesia provider. Policy makers should emphasize its applicability in low-income settings to help in the achievement of 2030 global surgery goals. TRIAL REGISTRATION: Pan African Clinical Trials Registry, PACTR202110667430356. Registered on 08/10/2021.

Prevalence and Factors Associated with Syphilis among Mothers with Missed Opportunities for Antenatal Syphilis Testing in Rural Western Uganda: A Cross-Sectional Study.

Background: Early prenatal syphilis testing and treatment are essential preventative measures for maternal syphilis and associated adverse pregnancy outcomes of pregnancy; however, data shows that two-thirds of all cases are missed among women who visit prenatal care center at least once but are not tested for syphilis. This study determined the prevalence and factors associated with syphilis infection among mothers with missed opportunities for antenatal syphilis testing in rural western Uganda delivered at Fort Portal Regional Referral Hospital (FRRH). Methods: A cross-sectional study was done during the period from April 2022 to June 2022. A total of 124 participants had been recruited consecutively from postnatal ward of FRRH. Pretested questionnaires were used to obtain information on data required for analysis. Venous blood sampling (2 ml taken from the forearm using anticoagulant free vacutainer) was done for all mothers who missed opportunity for prenatal syphilis testing using both RPR and TPHA. Descriptive statistics followed by binary logistic regression analysis was done using SPSS version 22.0. Results: The prevalence of syphilis infection was 27 (21.8%). After adjusted analysis, having more than one sexual partners in the past one year was associated with higher odds of syphilis infection (aOR = 24.922, 95% CI: 4.462-139.201, p < 0.001), and staying with the partner was found to be associated with lower odds of syphilis infection (aOR = 0.213, 95% CI: 0.040-1.142, p = 0.050). Conclusions: The study identified high prevalence of syphilis infection among mothers with missed opportunities for antenatal syphilis testing, and this was positively associated with having more than one sexual partners in the past one year and negatively associated with not staying with partner.

Pain assessment following open hemorrhoidectomy under local anesthesia versus saddle block: a multicenter randomized controlled trial.

BACKGROUND: There is disparity in evidence on pain assessment post open hemorrhoidectomy (OH) using local anesthesia and its use in developing countries compared to developed countries. Therefore, we conducted this study to assess the occurrence of postoperative pain following open hemorrhoidectomy under local anesthesia versus saddle block for uncomplicated 3rd or 4th degree hemorrhoids. METHODS: This was a prospective equivalence randomized, double blind controlled trial conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. Pain severity was assessed at 2, 4 and 6 h post open hemorrhoidectomy using visual analogue scale (VAS). Data was analysed using SPSS version 26 at a p < 0.05 as statically significant using visual analogue scale (VAS). RESULTS: We recruited 58 participants in this study who underwent open hemorrhoidectomy under local anesthesia or saddle block (29 participants per group). The sex ratio was of 1.15 of female to male and a mean age of 39 ± 13. VAS was found to be different at 2 h post OH compare to other time of pain assessment but not statically significant by area under the cover (AUC) (95% CI = 486-0.773: AUC = 0.63; p = 0.09) with a none significance by Kruskal-Wallis's test (p:0.925). CONCLUSION: Local anesthesia was found to be having a similar pain severity occurrence in post operative period among patients undergoing open hemorrhoidectomy for primary uncomplicated 3rd or 4th degree hemorrhoids. Close monitoring of pain in postoperative period is mandatory especially at 2 h to assess need of analgesia. TRIAL REGISTRATION: Pan African Clinical Trials Registry, PACTR202110667430356. Registered on 8th October, 2021.

House advancement flap anoplasty in anal stenosis post hemorrhoids surgery. A case report.

INTRODUCTION AND IMPORTANCE: Anal stenosis following hemorrhoids surgery is rare, and very distressing to the patients. It is graded according to its severity namely mild, moderate or severe. Majority of severe cases require surgery. The treatment is complex shown by the multiplicity of flaps and techniques described in the literature. This case report then reminds surgeons about the complications of hemorrhoidectomy and the complexity of their management. In addition, it challenges the surgeons about their practice on hemorrhoids. CASE PRESENTATION: A 30-year-old male who presented with difficulty in passing stool with intermittent low abdominal pain for 4 weeks following a surgery for hemorrhoids. A House Advancement Flap was designed to match the transverse incisions and hence the width of the mucosal defect to be replaced. Any intra- or postoperative complications were noted and the patient was discharged on the second postoperative day from the hospital. Patient had no complaints in the post-discharge period. CLINICAL DISCUSSION: Overzealous hemorrhoidectomy is one of the primary causes of stenosis of anal canal. Other causes that have been reported include anorectal diseases, other anorectal surgeries and radiotherapy. Physical examination majorly leads to the diagnosis of anal stenosis. Its treatment is conservative in mild cases while in severe anal stenosis a House Advancement Flap is one of the possible surgical management options. CONCLUSION: Anal stenosis is a rare condition which requires good evaluation for its better management. Given its simplicity and successful results, a House Advancement Flap anoplasty is a reliable treatment of severe anal stenosis.

Hirayama disease with proximal upper limb involvement in an adolescent female: A case report.

INTRODUCTION AND IMPORTANCE: Hirayama disease is a rare benign motor neuron disorder that involves a single upper limb. It affects the lower cervical myotomes and presents clinically by muscle wasting and weakness. CASE PRESENTATION: We report the case of a 17-year-old female who presented with a four weeks history of progressive weakness of the left upper limb. The blood investigations and image reported unremarkable findings. Patient improved on physiotherapy. CLINICAL DISCUSSION: Hirayama disease is rarely encountered in clinical settings and should be suspected in female patients presenting with unilateral or asymmetrical bilateral lower motor weakness of hands and forearms. CONCLUSION: We present a rare condition in a 17-year-old female with a left upper extremity monomelic amyotrophy, a Hirayama disease.

Bilateral concomitant inguinal and femoral hernias in an adult male: A case report.

INTRODUCTION AND IMPORTANCE: Bilateral concomitant inguinal and femoral hernias are an uncommon presentation clinically. If not managed in time, femoral hernias may be associated with incarceration or even strangulation. CASE PRESENTATION: We report the case of a 75-year-old male who presented with bilateral inguinal and femoral swellings which were diagnosed clinically and by ultrasound scan as uncomplicated inguinal and femoral hernias. Surgical management was done using the inguinal approach. His postoperative period was uneventful and was discharged without any complaint on the 4th post-operative day. CLINICAL DISCUSSION: Bilateral concomitant inguinal and femoral hernias are a rare presentation. Surgery was done as the best option to prevent complications. The literature suggests that it remains the gold standard of management in groin hernias in adults. CONCLUSION: We present a rare condition in a 75-year-old male with uncomplicated bilateral concomitant inguinal and femoral hernias.

Endometriosis arising in a cesarean section scar: A case report.

INTRODUCTION AND IMPORTANCE: Scar endometriosis is an uncommon variant of extra pelvic endometriosis, which develops at the scar site of previous abdominopelvic surgery and is seen in women during their reproductive period. CASE PRESENTATION: We report a 38-year-old female who presented with a nine-months history of a painful ulcerative mass that developed on a cesarean section scar. The mass was removed by a wide excision and confirmed by histology to be endometriosis. CLINICAL DISCUSSION: Wide surgical resection of ectopic endometriosis is the treatment of choice. It is usually curative and ensures the confirmation of the diagnosis. CONCLUSION: Cesarean section scar endometriosis can undergo malignant transformation. This case highlights the need for early detection and treatment.

Alobar Holoprosencephaly with Cebocephaly in a Neonate Born to an HIV-Positive Mother in Eastern Uganda.

BACKGROUND: Holoprosencephaly (HPE) is a rare cerebrofacial abnormality resulting from the complete or partial failure of the diverticulation and cleavage of the primitive forebrain. It has an incidence at birth of 1:16000. Case Presentation. We report a case of a 2600 g newborn female delivered by an HIV-infected mother in whom an antenatal ultrasound scan at 34 weeks' gestation reported features of fetal alobar holoprosencephaly. The neonate was born with cebocephaly, a monkey-like head, and did not survive for more than 30 minutes following delivery by caesarian section despite oxygen therapy. CONCLUSION: Alobar HPE with cebocephaly remains incompatible with life. In this resource-limited setting, the diagnosis was made clinically, and only an ultrasound scan was performed to confirm the diagnosis. Chromosomal analysis could have given more information.

A neonate with Klippel-Trénaunay syndrome: a case report.

BACKGROUND: Klippel-Trénaunay syndrome is a rare congenital capillary-lymphatic-venous condition characterized by the clinical triad of capillary malformations (port wine stains), varicose veins with or without venous malformations, and bony and/or soft-tissue hypertrophy. It has a very low incidence of about 1:100,000. CASE PRESENTATION: We report the case of 21-day-old neonate Black African female (born in Uganda) with Klippel-Trénaunay syndrome who presented with macrodactyly and ectrodactyly on the left foot, as well as numerous port wine stains on the left thoracoabdominal region and anteroposterior left lower limb. Color Doppler ultrasound examination of the left lower limb and abdomen revealed varicose veins without signs of arteriovenous fistula. CONCLUSION: The report presents the case of a neonate with a rare congenital vascular disorder type Klippel-Trénaunay syndrome.

Sigmoid volvulus in an adolescent female: A case report.

INTRODUCTION AND IMPORTANCE: Sigmoid volvulus is a rare cause of intestinal obstruction in children and adolescent population. It's considered a disease of the elderly with a widely varying incidence worldwide. It is more common in areas referred to as "volvulus belt" (Middle East, Africa, the Indian subcontinent, Turkey, and South America). CASE PRESENTATION: We report a 16-year-old female who underwent emergency laparotomy for intestinal obstruction. We found a twisted sigmoid volvulus in 3600 degree clockwise. The sigmoid colon was distended and edematous with no perforation or gangrene. Resection of the redundant colon was performed followed by primary anastomosis. CLINICAL DISCUSSION: Sigmoid volvulus remains an uncommon cause of intestinal obstruction among the adolescent age group. A high index of suspicion is necessary to reach a diagnosis and manage accordingly. Delay in diagnosis can lead to complications such as necrosis and perforation of the twisted colon. CONCLUSION: We present a rare cause of intestinal obstruction in a 16-year-old female due to sigmoid volvulus. Early diagnosis and management reduce morbidity and mortality.

Cecal volvulus in an adult male: A rare cause of intestinal obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Cecal volvulus is uncommon cause of intestinal obstruction. It affects the ascending colon and the terminal part of the ileum which are twisted around the mesenteric pedicle. CASE PRESENTATION: We report the case of 37-year-old male who underwent emergency laparotomy for intestinal obstruction and found a twisted cecum with ileal knotting and anterior part of cecum necrosed. Resection of cecum and terminal ilium followed by end-to-end anastomosis of ileum to ascending colon were performed. CLINICAL DISCUSSION: Cecal volvulus remains an uncommon cause of intestinal obstruction with a surgical incidence of 2.8-7.1 cases per year per 1 million people. Delay in diagnosis can lead to complications such as necrosis and perforation of the cecum. CONCLUSION: We present a rare case of cecal volvulus in a 37-year-old male with necrosed part of the cecum without perforation. Early diagnosis and management can prevent perforation and reduce morbidity related to the cecal perforation.

Incidental discovery of Amyand's hernia in an adult female: A case report.

INTRODUCTION AND IMPORTANCE: Amyand's hernia is a rare type of inguinal hernia with an incidence of about 0.1% of all inguinal hernias with most in occurring in childhood. It is characterized by the presence of the vermiform appendix within the hernia sac. CASE PRESENTATION: We report the case of 40-year-old female who underwent inguino-labial hernia repair with an incidental finding of a normal appendix within the sac; this was not predicted by the pre-operative ultrasound scan. CLINICAL DISCUSSION: We recommend that a detailed ultrasound scan be done for all patients with an inguinal hernia to help to manage the patient timeously and safely. CONCLUSION: We present a rare condition in a 40-year-old female with a right inguinal hernia, an Amyand's hernia.