Nigerian Journal of Surgical Research

The incidence of cancer in women presenting with bloody nipple discharge at a specialist breast clinic

M Ohene-Yeboah

Objectives: To determine the frequency of breast cancer in patients presenting with bloody nipple discharge at the Komfo Anokye Teaching Hospital Breast Care Centre (KATH –BCC) Kumasi.
Setting: Komfo Anokye Teaching Hospital Breast Care Centre (KATH –BCC) Kumasi.
Materials and Methods: All patients reporting to the centre for the assessment and treatment of a bloody nipple discharge. The age of the patients, the duration of the discharge, whether the discharge was
spontaneous or provoked and whether it was unilateral or bilateral, a single or multiple duct discharge and the presence of a lump. The mammographic findings and the histology of the excised ducts or lump
were also recorded.
Results:. The most common age group affected was 35-44 years (56.7 %). A palpable mass was detected in 25 women or (20.8%). Mammographic abnormalities were found in 15 (12.5%) of the women. In 80 patients (66.7%) there were no palpable masses or abnormal mammographic findings. Of the 120 patients carcinoma (CA) was found in 31(25.8%),, duct papilloma (DP) was the cause of the bleeding in
80(66.7%), duct ectasia (DE) in 7(5.8%) and fibrocystic breast changes (FBC) in 2 (1.7%). Of the 80 patients with bleeding only and no palpable mass or abnormal mammogram, DP was the cause in 73
(91.3%), CA in 2 (2.5 %) and DE in 5 (6.1%). In bleeding with associated palpable mass, DP was the cause in 3 (12%), CA in19 (76.0 %), DE in 1(4%) and FBC in 2 (8%). Of the 31 cases of carcinoma, 19 (61.5%) had a palpable mass, 10 (29.0%) had an abnormal mammogram and 2 (6.5%) only a bloody discharge.
Conclusion: This paper concludes that carcinoma of the breast is found in one out of four women attending the Komfo Anokye Teaching Hospital Breast Care Centre (KATH –BCC.) with a bloody nipple discharge. The evaluation of these patients must always include the excision of the discharging ducts for histopathologic examination.

Penile fracture a review of management

GO Sanda, CF Heyns, A Soumana, S Rachid

Objective: To discuss the clinical features and treatment of penile fracture in the light of the current practice.
Patients/Method Three patients with penile fracture were seen at the Urology Clinic of Lamordé National Hospital in Niamey, Niger between January 2003 and April 2006. All underwent emergency
surgery which involved an elective incision at the site of the fracture, debridement and primary repair of the tear in the tunica albuginea.
Results: The mean age of patients was 32, 6 ± 7 years. Two of them were married and one was single. One patient presented within 3 hours after injury, the others within 7 and 15 days. Penile fracture was
due to “faux pas of coït” in two cases and manipulation of the erect penis in one. The mean hospital stay was 16, 4 days (range 7 to 28 days). The only postoperative complications were wound infection,
residual fibrosis due to extensive surgery, mild dysuria and penile angulation in one patient. All patients had full erection and no one needed additional treatment.
Conclusion. To avoid serious complications and preserve penile function, immediate surgical intervention is recommended in case of penile fracture.

Mesenteric ischemia: Results of surgical treatment and a review of literature

M Mozaffar, P Kharazm, MT Far, K Firoozi

Background: Acute Mesenteric Ischemia (AMI) is one of the causes of acute abdomen which occurs because of significant decrement in bowel perfusion. Mortality rates of 60 to 100 percent have been reported in different studies in relation to this fatal disease(1, 5, ,11, 16,18,28). In this study, we review clinical features, laboratory findings, abdominal x rays, ECGs, intraoperative findings and results of treatment in 32 patients who were admitted in Shohada-E-Tajrish hospital with final diagnosis of AMI from March 1996 to March 2002.
Methods: 32 patients with final diagnosis of AMI who were admitted in Shohada-E-Tajrish hospital were included in this retrospective study by means of review of their files and medical records.
Results: The disease was more common in men than women, with a 2:1 male: female ratio. The mean age of patients was 60 years. Abdominal pain was the most common symptom of patients followed by nausea, vomiting, obstipation, hematemesis, and melena. On physical exam tachycardia was prevalent. Oliguria was seen in approximately 70% of patients and it was related to mortality. 10% of patients were in shock status related to mortality. 30% of patients had peritoneal signs, but it was not related to mortality. In laboratory tests, leukocytosis was present in 95% of patients, and in 50% of cases it was more than 20000/mm³. Acidosis was seen in 80% of patients and overall mortality rate was 75%.
Conclusion: The final advice of the study is to pay intensive attention to resuscitation of the patients, correction of metabolic and homodynamic derangements, and performing laparotomy as soon as these derangements were corrected. In some patients it is necessary to perform second look operation to evaluation of the viability of the intestine.

Human Bites of the Face with Tissue Losses in Cosmopolitan Northern Nigeria

ME Asuku, DS Adeola, AC Obiadazie, CN Ononiwu

A retrospective series of thirty-six cases of human bites to the face with tissue losses requiring reconstruction during a five-year period, January 1999 to December 2003 is presented. The unmarried female in her third decade dominated both as victim and assailant in incidences related to love affairs and love gone sour. The middle third of the lower lip was the most commonly bitten part with a majority of these presenting early. Copious larvage under broad-spectrum systemic antibiotic cover as well as anti-tetanus regimen allowed delayed primary repair in the first week of injury in a majority of the patients. Our reconstructive armamentarium included V-excisions and closure for lip defects, the superiorly based naso-labial flap for nasal ala defects and the retro-auricular tubed flap for helical rim and ear-lobe defects. Outcome was generally satisfactory though a longer follow-up data is desirable. Experience with hypertrophic scarring and keloid formation in our patient population continues to be a major factor in the choice of reconstructive techniques in our regional practice.

Pattern of skeletal metastases from breast cancer in an Asian population

SA Adewuyi, ND Chom, M Humera, MOA Samaila

Objectives:: To evaluate the pattern of skeletal metastases from breast carcinoma in an Asian population. To study the radiological pattern and distribution of bone metastases from breast cancer .
Background: Breast cancer is a disease that is prevalent world wide and frequently metastasis to the bones . Bone metastasis is associated with increase morbidity and poor quality of life in breast cancer patients. Prompt identification and treatment is the best way of improving the patients’ quality of life. Skeletal x-rays and bones scan of relevant bones should be part of staging investigations and metastatic survey in breast cancer.
Methods: This study was prospective, non-randomized, and single institution based. A total of 30 consecutive patients having bone pains with radiological evidence of bone metastases were included. Questionnaire was designed for the collection of patients’ data for evaluation, which was then entered on database and analyzed on the Statistical Package for Social Sciences (SPSS). Patient were staged using TNM Classification.
Results: The radiological pattern was Osteolytic in (28) 93.3% and mixed pattern (osteolytic & osteoblastic) in (2)6.7%. The commonest site of bone metastases was Lumbar spine (51.5%) followed by the Thoracic spine (21.6%). There was involvement of multiple, non-contiguous skeletal bones in(7)23.3% of the patients. Majority of the patients were stage III (56.6%) at first presentation. At presentation (6) 20% had painful bone metastases and 16.7% developed painful bone metastases within 12 months, 30.0% from 12 to 24 months, and 33.3% after 24 months of diagnosing breast cancer. 20.0% of patients had painful bone metastases for < 3 months prior to local field irradiation (LFI); 46.7% had pain for 4 – 6 months; 6.7% had pain for 7 – 9 months; 10.0% had pain for 10 – 12 months; and 16.7% had pain for more than 12 months prior to treatment with LFI.
Conclusion: The predominant x-ray finding in bone metastases from breast cancer was osteolytic and the Lumbar spine was the commonest site of involvement . Involvement of Multiple bones in 25% of the patients suggest widespread search in a staging protocol.

Ultrasound in the diagnosis of appendicitis: a plea for caution

ES Garba, ND Chom

Background/Objectives: Acute appendicitis is one of the most frequent causes of acute abdomen. The clinical diagnosis is based on the case history and the physical examination. However, in some cases the typical clinical symptoms are equivocal or misleading at which time, making the diagnosis of appendicitis may be considerably difficult. Ultrasound may play a role in this class of patients. This article assesses the accuracy of this adjunctive test at our centre
Methods: This is a six-year retrospective study from July 2000 to July 2005 looking at patients that had appendicectomy done at Ahmadu Bello University Teaching Hospital Kaduna Nigeria. We analyzed postoperatively those with histological diagnosis of appendicitis who at the same time had preoperative ultrasound assessment for the main purpose of establishing appendicitis. The final histopathological evaluation was used as the standard to rate the efficacy of ultrasonographic diagnosis of appendicitis.
Results: One hundred and forty nine patients 149 were documented. 128 had adequate data for further analysis and only. 78patients (60%) had ultrasound before surgery. The actual diagnostic accuracy of ultrasound in our environment is 24.4%.
Conclusions: Ultrasonography routine use in all our patients suspected of having classical appendicitis cannot be advocated at present.

Oral and Maxillo-facial soft tissue sarcomas in an Africa population

ET Adebayo, SO Ajike, A Adebola, EO Adekeye

Background: Soft tissue sarcomas (STS) are not common and account for less than 1% of all malignancies in the maxillofacial region. These tumours are under reported in Africa South of the Sahara in current literature. This report is a review of our experience with STS over a 23 year period at a busy Tertiary Oral care centre in Kaduna, Northern Nigeria.
Methods: Patients presenting to the Maxillofacial Unit, of the Ahmadu Bello University Teaching Hospital, Kaduna, with oral and maxillofacial malignancies between the years 1977 and 1999 were retrospectively studied. Soft tissue sarcomas were studied. Demographic features, clinical presentation, treatment options , outcome and histologic variants were studied.
Results: There were 38(<1%) soft tissue sarcomas out of 415 oral and maxillofacial malignancies recorded within the study period. Male to female ratio was 1.6:1. Age range was 24 days to 60 years (
median 28 years). There were more adults (79%) than children (21%). There were eleven histologic types but the more frequent ones were rhabdomyosarcoma (10/38,(), fibrosarcoma (10/38 (26%),
liposarcoma ( 5/38 (13%) and malignant fibrous histiocytoma (5/38(13%) . Site of primary occurrence was mainly the mandible (32%), palate (21%) and cheek (18%). Surgery was the mainstay of treatment 28/38 (74%) while 10/38(26%) patients had no active treatment.
Conclusion: Most patients present late with difficult deforming tumours. We can blame patients knowledge, Socio-economic

Oro-facial carcinoma in kaduna

DS Adeola, AC Obiadazie

Background To review the epidemiology and morbidity Oro-Facial cancers seen and managed at Ahmadu Bello University Teaching Hospital (ABUTH).To estimate the incidence and prevalence of Oro-facial Cancer presenting at the clinic. To highlight the poor prognosis inspite of better facilities for management.To evaluate the various factors affecting the poor prognosis.
Patient and Method A 5-years retrospective study of 211 patients with Oro-facial cancers in the maxillo-facial unit of Ahmadu Bello University Kaduna, was carried out. The demographic pattern, clinical features, Histopathological findings and treatments modalities as obtained from the patients’ folder were studied.
Result From the 211 Oro-facial cancers studied, Squanmous cell carcinoma accounted for 136 (64%), Adenocystic carcinoma 30 (14%), Adeno carcinoma 11 (5%), metastatic carcinoma 8 (4%), other 26 (13%). House wives, farmers and trader accounted for 152 (71%) of all the patients. 92% (192 patients) presented at very advanced stage of the disease when little or no help can be rendered. The age of presentation ranged between 15 to 84 years with median age at 44.5. There were 135 (64%) males affected and 76 (36%) females with a male to female ratio of 1.8:1.
Conclusion: Public enlightenment is necessary to encourage early presentation, since majority of people in this environment has access to radio media.

Outcome of undiagnosed traumatic diaphragmatic injuries: A review of our management

KG Soro, A Coulibaly, P Yapo, GM Koffi, SF Ehua, MJB Kanga

The authors relate on the outcomes of traumatic diaphragmatic injuries unknown early. The files of three patients have been reviewed retrospectively. All of them presented early undiagnosed injuries. The first patient had a left diaphragmatic injury consecutive to a stab wound to the left hypochondrium. The diagnosis was made 18 days later. He died 2 days after operation because of septicaemia. The second patient presented a colonic strangulation through a left diaphragmatic rupture consecutive to a stab wound three years before. A resection and anastomosis to the colon was performed. The patient left the hospital with a definitive pachypleuritis. The third patient was admitted for blunt trauma to the chest with dyspnoea. The chest X-ray showed the diaphragmatic rupture. The peri- operative exploration showed an old rupture with fibrosis banks. The lesion had been respected. The outcomes of early missed traumatic diaphragmatic rupture are various. Their treatment is sometime difficult and dangerous.

Wound dressing where there is limitation of choice

GA Rahman, IA Adigun, IF Yusuf, CKP Ofoegbu

Background Many sophisticated dressings are available to the wound care practitioner in the developed countries. These materials are made from a wide range of products like polyurethane, salts of alginic acid and other gelable polysaccharides. The situation is different in the developing countries where what is commonly available to wound care provider are traditional agents such as sodium hypochlorite, hydrogen-peroxide, cetrimide solution, chlorhexidine and others. The aim of this study is to reappraise the problem of limitation of wound dressing selection in the developing countries and to sensitize the wound care practitioner on the use of the commonly available products based on the needs of a different wound or even the same wound throughout its healing course.
Patients and methods Patients attending the General Outpatient Department (GOPD) of our hospital for wound dressing were used for the study. Five surgeons who are familiar with wound care management visited the dressing unit of the GOPD daily for one week in October 2005. A proforma was designed where information on each of the patient was recorded.
Results Fifty-three patients attended the dressing unit of our GOPD during the study period. Twenty-six patients (49.1%) had their wounds dressed with hypochlorite solution (Eusol), seventeen patients (32.1%) had their wounds dressed with honey and two patients, wound were being dressed with hydrogen peroxide.
Conclusion While we are still awaiting the availability of the newer products in the developing countries, we should make use of the traditional products that are readily available to us according to the need of a particular wound, by this, our choice of wound dressing will not be arbitrary, ineffective and wasteful both in terms of time and physical resources.

Experience With Ventral Penile Skin Island Flap urethroplasty

IO Ntia, IA Mungadi

Background:Island flap techniques currently used in urethroplasty utilize the prepuce and the dorsal penile skin. Our experience with a one-stage island flap urethroplasty for urethral strictures utilizing the ventral penile skin is described.
Patients and Method: This is a longitudinal study of seventy six consecutive patients with impassable and complicated urethral strictures treated using this technique over a seven-year period. Sixty were bulbous while sixteen were bulbomembranous urethral strictures. Following operation the patients were assessed using urine flow rates, urethrograms and some urethroscopy. Restrictures were successfully reoperated.
Results: Sixty-eight patients (89.5%) had satisfactory voiding with good urine stream without complication at one year after operation. Five patients (6.6%) had restricture and three (3.9%) others had urethral bagginess and postmicturition dribbling. The overall complication rate was 10.5%. At three years after initial operation and reoperation seventy-five patients (98.7%) were voiding satisfactorily. There was one complete failure, no death.
Conclusion: This technique has produced satisfactory results compared with other similar techniques in current use. Further work is required to make valid conclusions about the value of this procedure.

Surgical management of pelvic floor prolapse in women using mesh

IA Yakasai, RJ Hawthorn — Fri, 28 May 2010 00:00:00 +0000

Objective: To evaluate surgical handling, prolapse correction and complication rate of polypropylene mesh.
Methods: A retrospective review of patients who had pelvic floor repair using polypropylene mesh(PPM) and intra-vaginal sling(IVS), between January 2003 and July 2005. All patients were followed-up for a period of 6weeks to 12months.The effectiveness and complications following PPM insertion were carefully documented.
Results: A total of 57 repairs of various types of prosthetic materials were carried out over the study period. 30 patients had polypropylene mesh inserted, while 27had IVS. Of the patients who had PPM inserted 27(90%) had successful repair after 12 months follow-up, while 3(10%) had failed repair. Most of these patients had previous vaginal surgery. The main complication of PPM was vaginal erosion in 3(10%) patients
Conclusion: Polypropylene mesh (Prolene) is a simple effective method of treatment of pelvic floor prolapse. It is associated with minimal complications.

Surgical gastrointestinal endoscopy in Ibadan, Nigeria

DO Irabor

No Abstract.

Current concepts in the management of anterior urethral strictures

IA Mungadi, NH Mbibu

Objectives: This review paper presents the current trends in the evaluation and treatment of anterior urethral strictures. Stricture disease is recorded as one of the oldest afflictions of mankind and even in the millennium; it is the one disease associated with rapid turn over in treatment options and continuous evolution of new options. The stricture is still a significant burden on the urologist workload right from initiation of treatment and follows up. It may be associated with significant morbidity and deteriorating quality of life and may be frustrating to treat. Current trends are to discover a long lasting satisfactory treatment suitable in most cases ‘the gold standard’.
Methods A review of current concepts in anatomy and the patho-physiologic mechanisms of the anterior stricture has been done. A structured literature search through a MEDLINE search was performed. New urethral substitutes have been compared to other techniques of urethroplasty as seen over the. last decade. Expert surgical consensus and opinion have been reviewed.
Results The anterior urethral stricture is a consequence of major peri-urethral fibrosis and may be very complex if the inflammation is complicated or prolonged. It can be satisfactorily assessed by routine retrograde urethrography and endoscopic assessment for type and complexity. The urethral ultrasound appears to provide more information about the extent of fibrosis and the length of strictures. In review of recent experience, it has proven to be accurate convenient and a cheap complement to already established studies. Oral mucosa, rectal mucosa, bladder mucosa , dermal grafts, tunica vaginalis, tissue culture and synthetic polymers have all been applied over the last decade in the search for the suitable urethral substitute.
The bucccal mucosa is outstanding among several options in the repair of the diseased anterior urethra as popularized by Barbagli. It appears to provide the solution for most situations in the anterior urethral stricture..
Conclusions: The Bucccal mucosal graft(BMG) may as well be the new ‘gold standard' in the management of anterior urethral stricture .

Retained Copper Sleeve and haematometria, an unusual complication of Copper-T use

SE Adaji, SO Shittu, SB Bature

Retained copper sleeve of copper-T IUCD and haematometria was observed in a patient. Same was retrieved with drainage of haematometria under general anesthesia with satisfactory outcome.

Malignant haemangiopericytoma of the left thigh with metastases to the bones and lungs: A case report

OM Atalabi, OP Ibinaiye, MO Obajimi, O Ogunseyinde, EEU Akang

Haemangiopericytoma is an uncommon mesenchymal neoplasm. Haemangiopericytoma is believed to arise from the pericytes, contractile spindle cells that surround the capillaries and post-capillary venules. We present an unusual case of histologically confirmed malignant haemangiopericytoma of the left thigh in a 70 year old male with metastasis to the lungs and left femoral bone.

Acute abdomen from gossypiboma: A Case series and review of literature

ME Asuquo, N Ogbu, J Udosen, R Ekpo, C Agbor, M Ozinko, K Emelike

Gossypiboma though uncommon is under-reported. It is an infrequent but avoidable surgical error. The retained sponge induces two types of reactions, fibrinous response resulting in granuloma formation and exudative response leading to abscess formation. This serious medical condition may result in significant morbidity and mortality with serious medico legal implications. We present two cases of retained guaze(gossypiboma) seen in a busy surgical unit within three months. The pathogenesis is due to gauze induced adhesions that may cause intestinal obstruction and abscess formation resulting in peritonitis . The plain abdominal radiograph was very valuable in the first line investigation of these patients. It is possible that gossypiboma is underreported and standard protocols are not common except for routine concern for detail while doing laparotomy.

Anterior Abdominal wall Rhabdomyoma mimicking fibroid: A Case Report

AO Oguntayo, AG Adesiyun, PI Onwuhafua

We report a case of a 27 year old Para 1+O house wife who presented with a four months history of a rapidly increasing tumor of the anterior abdominal wall. The abdomen was swollen to the size of a 16 weeks gravid uterus. At laparatomy a tumor measured 15cm by 10cm attached to the posterior aspect of the rectus sheath. The resected mass proved on histology to be Rhabdomyoma of the anterior abdominal wall. Rhabdomyoma is an exceedingly rare tumor in females and when it does occur, it is found in the genitalia (Genital Rhabdomyoma). The origin in the anterior rectus is extremely rare.

Malignant transformation in Pre-existing Naevi. A review of two cases

MOA Samaila, AG Adesiyun

Pigmented naevi (melanocytic naevi) are common and are widely distributed all over the body. The average number of naevi seen in a Caucasian is between twenty and thirty. They are either congenital or acquired benign neoplasm of melanocytes. They may occur as giant lesions at birth, and are more prone to malignant transformation. However, the risk of malignant transformation associated with naevi irrespective of size is well established and a variety of malignancies have been reported to arise from a naevus. The incidence of malignant transformation in naevi is 4% to 9%. We present two cases of malignant tumours arising from pre-existing naevus. The first was a 60-year old woman with a malignant melanoma arising in a vulva intradermal naevus. The second was a 51-year old woman with a basal cell carcinoma arising in a facial naevus.