Management of adult incisional hernias at the University of Maiduguri Teaching Hospital.

BACKGROUND: Incisional hernias (IH) represent a breakdown or loss of continuity of a fascial closure. They are thus unique as the only external wall hernias that are iatrogenic in aetiology. Incisional hernias are not uncommon complications of laparotomy closure with reported incidence of 2 to 11%. OBJECTIVES: To review our experience,with incisional hernaia identify possible risk factors and proffer preventable strategies. PATIENTS AND METHODS: All case records of adult patients managed with IH at the University of Maiduguri Teaching Hospital between January 1995 and December 2004 were retrieved from the Medical Records Department. Relevant data on age, sex, type and institution of index surgery (General Hospital or Private Hospital), premorbid factors, type of repair, post-operative complications were extracted. Case records with inadequate information were excluded. RESULTS: Between January 1995 and December 2004 a total of 440 patients with external abdominal hernias were treated at UMTH. Out of these: 38 (11.6%) were Incisional hernias and form the basis of this study. Their ages ranged between 18 and 80 years, with peak age range of 40-49 years. There were 6 males and 32 females giving a male to female ratio of 1:5.3. The commonest index surgeries were caesarean section in 12 patients (31.6%) and appendicectomy 10 patients (26.3%). Of the index surgeries 26 (68.4) and 10 (26.3) were performed in general and private hospitals respectively. Only 2(5.3%) were done at UMTH. Wound sepsis, in 18 patients (47.4%), postoperative cough, 8 (21.1%) and obesity 6 (15.8%) were the commonest risk factors. Poor surgical technique was found in 36 patients (94.7%) Most of the patients presented late; 8(21.1%) with recurrence and 6(15.8%) were giant in size. All but one were successfully repaired. Only one (2.3%) had recurrence. There was no mortality. CONCLUSIONS: Incisional hernias are not uncommon constituting 11.6% of all adult external abdominal wall hernias repaired at UMTH. Most of the causes are preventable with 94.7% of the index surgery done at peripheral hospitals where poor surgical technique was common to all. There is urgent need to re-train our general duty doctors on proper surgical techniques of abdominal wound closure.

Gastric outlet obstruction in Maiduguri.

In a review of sixty-four (64) cases of gastric outlet obstruction (G.O.O.) seen at the University of Maiduguri Teaching Hospital between 1991 and 1996, cicatrising chronic duodenal ulcer accounted for 65.7% of cases, followed by antral carcinoma of the stomach 15%, congenital hypertrophic pyloric stenosis 9.4%, carcinoma of the head of pancreas 6% and congenital bands 3%. The usual presentations were forceful vomiting in a patient with background history of dyspepsia of varying duration depending on cause, visible persistalsis, weight loss, abdominal masses and electrolyte imbalances. Diagnoses was easy clinically and confirmed by barium studies and/or gastroduodenoscopy. Treatment offered depended on the cause of gastric outlet obstruction.

Histopathology of lymphadenopathy in a tropical country.

A review of 1153 lymph node biopsies received at the Pathology Department of the University College Hospital (UCH), Ibadan within a five year period was done. Analysis showed that 427 of the lymph nodes (37%) had normal or non-specific reactive changes, 27.7% showed granulomatous inflammation and 35.5% showed malignancy, lymphoid or metastatic tumours. Tuberculosis was the single most common granulomatous inflammatory condition constituting 94.5% of the granulomatous inflammatory lesions. Tuberculosis was also the commonest cause of lymph node enlargement in childhood (0-14 years) whilst malignant condition was the commonest above forty five years of age.

Recurrent intussusception reduced by the patient: a case report.

A case of recurrent acute intussusception associated with a palpable abdominal mass which patient reduces with relief of symptoms is presented. Surgery revealed multiple colonic polyps and a total colectomy with ileorectical anastomosis was done and the patient has remained well after 3 years of follow up.