Table of Contents  
CONFERENCE PROCEEDING
Year : 2015  |  Volume : 25  |  Issue : 2  |  Page : 41-57

Proceedings of the 49 th AGM and Scientific Conference, International College of Surgeons, Nigeria National Section. Held in Port Harcourt, Rivers State Nigeria from 17 th to 20 th June 2015 (ICS PHCITY 2015)


Date of Web Publication19-May-2016

Correspondence Address:
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

How to cite this article:
. Proceedings of the 49 th AGM and Scientific Conference, International College of Surgeons, Nigeria National Section. Held in Port Harcourt, Rivers State Nigeria from 17 th to 20 th June 2015 (ICS PHCITY 2015). Niger J Surg Sci 2015;25:41-57

How to cite this URL:
. Proceedings of the 49 th AGM and Scientific Conference, International College of Surgeons, Nigeria National Section. Held in Port Harcourt, Rivers State Nigeria from 17 th to 20 th June 2015 (ICS PHCITY 2015). Niger J Surg Sci [serial online] 2015 [cited 2019 Aug 22];25:41-57. Available from: http://www.njssjournal.org/text.asp?2015/25/2/41/182679

1.1 Surgical inpatient cancer related mortality in a Nigerian Tertiary Hospital

Ekeke ON, Igwe PO, Okonta KC


Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Cancer is a distressing condition that imposes so much physical, psychological and economic burden on the patients. The difficult task of relaying the result of histology and prognosis to patients and patients'Trelatives also imposes a huge burden on the attending physicians. It is like passing a death sentence. Preventive strategies and early diagnosis will reduce the mortality associated with cancer. The cancer mortality patterns following surgical admissions at the University of Port Harcourt Teaching Hospital are yet to be documented. Aim: To present the cancer mortality patterns in the surgical wards of University of Port Harcourt Teaching Hospital. Methods: This is a retrospective study of all patients who died from cancer during admission into the surgical wards of University of Port Harcourt Teaching Hospital from 2007 to 2012. Data on demography and events leading to death were collected from all surgical wards, the emergency unit, surgical outpatients and theatre records. The data were analyzed using computer based statistical software SPSS version 16.0 (IBM Inc., Chicago, USA). Results: A total of 171 (32.4%) cancer-related deaths of 527 mortalities occurred among the 8230 patients admitted during the 6-year period giving a mortality rate of 2.1% of the patients treated. Three hundred and forty five 108 (63.2 %) were male, while 63 (36.8 %) were females. The leading causes of mortality were cancer of prostate 50 (29.2 %) and breast cancer 40 (23.4 %), Gastric and pancreatic each 12 (7.0 %), Ca rectum 11 (6.4%), Ca colon 9 (5.3 %) then others 12 (7.0 %) Most of the deaths (42.2 %) occur between 50 and 70 years old. Conclusion: Prostate, breast, and gastro-intestinal cancers constitute a great deal of health burden in our region. Strong legislative actions, early detection and timely interventions will be needed to reduce this burden.

Key words: Breast, cancer, deaths, port-harcourt prostate

1.2 Prevalence of premalignant and malignant lesions of the upper gastrointestinal tract

Ray-Offor E, Obiorah CC 1


Departments of Surgery and 1 Anatomical Pathology, University of Port Harcourt Teaching Hospital, Oak Endoscopy Centre, Port Harcourt Rivers State Nigeria

Introduction: A proper evaluation of cancerous pathologies of the upper gastrointestinal tract mandates an endoscopy with the added benefit of tissue biopsy and treatment of early stage disease. Patients and Methods: A prospective observational study of all patients referred for upper gastrointestinal endoscopy to a referral ambulatory care endoscopy facility in Port Harcourt from February 2014 to May 2015 (15 months). The variables studied were sociodemographics, indications, endoscopic and histopathologic findings. Statistical analysis of data was done using SPSS 20 (IBM Inc., Chicago, USA). Results: A total of 87 upper GI endoscopies were performed during the study period. The age range was from 15 months to 80 years with 41 males and 46 females; a male to female ratio of 1:1.1. Dyspepsia was the most common presenting complaint t 54 cases (62%). Most pathologies were seen in the stomach (2 gastric cancers and 32 chronic gastritis with a sole case of chronic atrophic gastritis). The least finding was in the duodenum (a case of duodenitis with moderate dysplasia). There was an H. pylori detection rate of 63% from reported biopsies. Conclusion: There is a low prevalence of malignant conditions of the upper digestive tract in the study population but a high prevalence of a known risk factor for gastric cancer-H. pylori.

Key words: Malignant, premalignant, upper digestive tract

1.3 Rare malignancies in children: A report of two cases and review of literature

Okoro PE, Umeogu C, Gbobo I, Igwe WP


Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Background: The challenges of early diagnosis and treatment of cancers are well recognised in the developing world. Whereas surgical oncologists and surgeons are familiar with the common malignancies, and advances are being made in those areas, uncommon malignancies pose even more serious challenges particularly in circumstances of low resource. Aim: To report our experience with two cases of uncommon malignancies in childhood and to review the literature. Methods: The case notes of two patients who were managed in our unit for uncommon malignancies were reviewed in detail. We took particular note of the challenges of diagnosis and treatment. Results: We report a case of a 14-year-old male who had adenocarcinoma of the colon. He had an appendicectomy initially but was later recognised as a case of colorectal cancer. The second is a 5 year old female who had a rhabdomyosarcoma of the urinary bladder. She had a neoadjuvant chemotherapy with a transient resolution followed by a flare with consequent obstructive uropathy. Conclusion: Uncommon malignancies pose a peculiar challenge to surgical care. Low index of suspicion and inadequate resources contribute significantly to the morbidity and mortality presently. There is need for caregivers to begin to brace up to recognise and appropriately treat malignancies which were previously not commonly seen in children.

Key words: Childhood, colorectal cancer, malignancy, rhabdomyosarcoma

1.4 Pattern of gestational trophoblastic diseases in South-South, Nigeria: A 5-year review

Bassey G, Nyengidiki TK, Inimgba NM, Orazulike NC, Amadi C


Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Gestational Trophoblastic Diseases are a spectrum of inter-related but histologically distinct tumours originating from the placenta. They are relatively common in our environment, have excellent prognosis when diagnosed and treated early with the potential for childbearing preserved. Aim: This study seeks to determine the incidence, clinical presentations, management and outcome of gestational trophoblastic disease in the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Methods: This was a retrospective study of women who were treated for gestational trophoblastic disease in the UPTH over a 5-year period from 1 st January 2008 rosp st December 2012. Results: A total of 38 cases of GTD were treated in UPTH during the study period and there were 16,720 deliveries giving a prevalence of 2.3 per 1000 deliveries. The mean age and parity were 31 during the study period and there were 16,720 deliveries giving a prevalence of 2.3 per 1niversity of Port Harcourt Teaching Hospital, Por(P = 0.0000). The mean gestational age at presentation was 16.24 tional age at presentation was 16.24 tudy period and thamenorrhoea in 38 (100%) patients, abnormal vaginal bleeding and uterine size greater than date were each found in 36 (94.7%) of patients respectively. Conclusion: There is a high prevalence of GTD in Port Harcourt and with mortality amongst patients with malignancy. This study underscores the need to send all uterine evacuation products for histo-pathological analysis. Early diagnosis, prompt and adequate treatment will improve the prognosis of the disease in our environment.

Key words: Choriocarcinoma, gestational trophoblastic disease, hydatidiform mole, Port Harcourt

1.5 Post hysterectomy intussuception: A case report

Etuk EB, Umeh KU, Abasiattai AM 1 , Ikpat FJ


Departments of Surgery and 1 Obstetrics and Gynaecology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria

Introduction: Intussusception is the invagination of a proximal segment of bowel into the lumen of the adjacent distal segment. It is primarily a childhood disease, where it is idiopathic. It is rare in adults, where it has a demonstrable cause in over 90% of cases. It may be a rare complication following hysterectomy. Aim: To report an unusual case of intussusceptions recognised post abdominal hysterectomy. Case Report: We present a 42 year old P5 +0 woman that had total abdominal hysterectomy from painful multiple uterine myomata. Post hysterectomy the lower abdominal pains did not abate and in addition she developed vomiting, abdominal swelling, constipation and one episode of haematochezia. She had exploratory laparotomy. The intra-operative diagnosis was ileo-ileo-caecal Intussusception. Ileal resection and end to end anastomosis was done for gangrenous Ileal segment. The intussusception might had been a complication of the hysterectomy or it could had co-existed with degenerative fibroid and was missed intra-operatively or it could had been the only cause of the lower abdominal pains and was missed both pre and intra-hysterectomy. Conclusion: There is need for a surgeon to also assess a fibroid patient with lower abdominal pains.

Key words: Intussusception, posthysterectomy, laparotomy, uterine myoma

1.6 Insight into malignant pleural effusion in University of Port Harcourt Teaching Hospital: What significance does it hold

Ocheli EO, Okonta KE


Department of Surgery, Cardiothoracic Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: The pleura is a common site of metastasis of many malignant diseases. Malignant lesions of the breast, lung, intraabdominal organs are among the frequently occurring spectrum of cancers. Presence of this complication signifies advanced stage of the disease with increased mortality. Objectives: To study the pattern of malignant pleural effusion presenting to this institution and how it impacts on the final outcome of patients.Materials and Methods: This is a prospective study of cases seen in the Cardiothoracic service of the UPTH over an 18-month period. Data collected was analysed using the SPSS g the SPSS he SPSS r an 1 (IBM Inc., Chicago, USA). Results: Thirty-eight patients were captured in this study. More females than males were affected. The mean age was 48.7 years. Eighty-four percent were between 21-70 years. Dyspnoea 33 (86.8%), Cough 22 (57.9%), Weight loss 15 (39.5%), and Chestpain 14 (36.8%) constitute the most frequent symptoms. Over 50% had a left-sided pleural effusion, 1% being bilateral and haemorrhagic effusion occurred predominantly. Breast (39%), Lung (26.3%), Ovarian and Intestinal cancers (7.9%) were the commonest malignancies seen. All patients had normal platelet count with anaemia in 2/5 th of cases at presentation. Only 4 (10%) received chemotherapy at the time of tube thoracostomy drainage. Only 11 patients had Pleuridesis. Thirteen (34.2%) of patients died with I month while on admission. Conclusion: Breast cancer remains the commonest malignancy involving the pleura, thus explaining the ad Pleuridesis. s '. Dyspnoea and cough were the most frequent symptoms while chestpain ranks second in western countries. The mortality confirms the prognostic value of malignant pleural effusion.

Key words: Breast, malignant lesion, port-harcourt, pleural effusion

2.1 Pheochromocytoma: Is it that uncommon?

Adotey JM, Jebbin NJ, Onwuchekwa AC 1 , Dodiyi-Manuel A, Aria ON


Departments of Surgery and 1 Internal Medicine, University of Port Harcourt Teaching Hospital, P.M.B. 6173, Port Harcourt, Rivers State, Nigeria

Introduction: Pheochromocytoma has been described as a rare condition in the literature. Aim: To present five cases of Pheochromocytoma seen in the University of Port Harcourt Teaching Hospital within a 5 years period believing it will raise awareness of the condition. Case Reports: During a five year period of our practice, we have encountered and treated five cases of pheochromocytoma. The oldest of the patients was 40 years of age and the youngest 11 years. There were three males and two females. A consistent feature in all the patients was severe hypertension which tended to be paroxysmal. Other features included recurrent blackouts, throbbing frontal headache, easy fatigability, tremors, palpitation and excessive sweating. All the patients had adrenalectomy. One patient died within 24 hours of surgery. Conclusion: Having seen 5 cases of a condition that is reported as rare within a period of five years raises the question as to whether pheochromocytoma is as rare as it is generally recorded. For the reason outlined in the discussion, it is possible that some cases are missed.

Key words: How rare (uncommon), pheochromocytoma, UPTH

2.2 Experience with anaesthesia for malignancies at the University of Port Harcourt Teaching Hospital, Port Harcourt - Nigeria

Briggs OT, Obasuyi BI


Department of Anaesthesiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Malignancies constitute a huge burden in healthcare and anaesthesia for surgical malignancies is associated with peculiar challenges. Aim: This ongoing study aims to identify the characteristics of patients who undergo anaesthesia for surgical malignancies, problems encountered and outcome. Methods: A prospective study of all patients with various forms of surgical malignancies scheduled for anaesthesia was conducted between February and May 2014. Data was obtained from patientrom patiented for r surgianaesthesia records and included demographic and patient characteristics, as well as perioperative data which was analysed using the SPSS v.20 (IBM Inc., Chicago, USA) and presented as frequencies. Results: Of a total of 509 patients who had surgery over the study period, 51 (10.0%) had anaesthesia for various malignancies, mean age was 42.4 ΁ 18.2, M:F ratio was 1:2, adults were 46 (90.2%). Seventeen (33.3%) belonged to ASA Class III, while 43 (84.3%) were booked electively. Twenty-seven (52.9%) belonged to general surgical unit, 13 (25.5%) had mastectomy and 10 (19.6%) had exploratory laparotomy and these were the commonest procedures. GA was offered in 39 (76.5%) cases. Anaemia was the commonest preoperative challenge 14 (27.5%), with homologous blood transfusion being the commonest intervention pre (8/15.7%) and intraoperatively (33/60.8%). ICU admission was required in 8 (11.8%) cases. Conclusion: Malignancies in our setting was found in a wide range of ages, but more in females and adults and at incapacitating levels, Mastectomy was the commonest surgical procedure and perioperative anaemia requiring blood transfusion constituted significant burden.

Key words: Anaemia, anaesthesia, malignancy, mastectomy

2.3 Laryngeal tumours: Clinical features and management challenges in Port Harcourt, Nigeria

Onotai LO, Nwosu C


Department of ENT Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Laryngeal tumours especially the malignant varieties are not uncommon with a number of factors affecting their management in most resource poor countries. Late clinical presentation and diagnosis is commonplace in the Sub-Saharan region of Africa. Aim: To highlight the challenges encountered in the management of laryngeal tumours in Port Harcourt, Nigeria. Patients and Methods: This was a retrospective study carried out in Port Harcourt using records of patients who presented to the authors with laryngeal tumours. The data collected spanned from January 2003 to December 2014. Data extracted included age, gender, histopathologic diagnosis and treatment modalities. Data was analyzed using simple descriptive statistical methods. Results: A total of thirty five (35) cases were seen during the 12 years period. There were 30 males and 5 females (M:F ratio of 6:1). The age range was 40 years to 70 years. The mean age was 56.5 years. The time of presentation ranged from 3 months to 5 years. Twenty five cases (71.43%) were advanced malignant diseases with only 5 (14.29%) benign diseases. The predominant (42.86%) histopathological type was well differentiated squamuos cell carcinoma. Conclusion: Early presentation and prompt diagnosis of laryngeal tumours will help curb the menace of laryngeal tumours in our environment. Furthermore, public enlightenment campaign and provision of standard oncologic treatment centers with trained personnel will help in alleviating most of the challenges encountered in our environment.

Key words: Challenges in management, laryngeal tumours, Port Harcourt, total laryngectomy

2.4 Overview of pattern and operative management of musculoskeletal neoplasms in ABUTH Zaria, Kaduna State

Maitama MI, Lawal YZ, Dahiru IL, Ejagwulu FS, Ogirima MO


Department of Orthopaedic Surgery, Ahmadu Bello University, Zaria, Nigeria

Introduction: The burden of management of patients with musculoskeletal neoplasms in Zaria is significant. Aim: To evaluate the pattern of neoplasm as it affects the upper and lower limbs, highlighting various surgical options of treatment offered. Methods: Sixty five (65) patients with histologically confirmed neoplasm of the upper and lower limbs arising from bone, cartilage, synovium and tendon sheath were retrospectively selected over seven (7) year period from 2008 to 2015. Results: Forty (61.5%) patients were males while 25 (38.5%) were females. Age range is between 5 to 75 years, average of 30.8 years. Lower limb involvement was recorded in 40 (61.5%) patients, with remaining 25 (38.5%) in upper limbs. 28 (43.1%) patients had benign lesion, while 37 (56.9%) were malignant. Of the benign type giant cell tumour appear to be the most frequent (50%), while osteogenic sarcoma top the list on the malignant variety (32.4%). Surgical treatments includes excision and curettage, excision and bone grafting, excision and bone cementing, excision and joint replacement, and finally, limb amputation/disarticulation. Conclusion: In our center, giant cell tumours and osteogenic sarcomasare the most frequently encountered benign and malignant neoplasms respectively.

Key words: Giant cell tumours, musculoskeletal, neoplasm, zaria

2.5 Metastatic skin nodules in breast cancer: A report of five cases

Igwe PO, Dodiyi-Manuel A, Adotey JM, Aria ON


Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Breast cancer is the most common cause of cancer related death in female patients admitted in surgical wards of tertiary hospitals. It is common in elderly women and now being reported even in younger patients. Skin nodules from metastasis are rare probably due to early presentation. However late presentation is still being noted signifying need for more enlightenment. Aims and Objectives: This is to report five cases of metastatic skin nodules from breast cancer; an auditing tool of the breast cancer awareness campaign. Case Reports: The first was a 55-year-old female who presented with a history of generalized skin nodules and progressive weight loss. She was pale and cachectic. Her pulse rate was 110 per minute and blood pressure was 90/50 mmHg. The second case was 60-year-old female who presented with right breast lump and multiple anterior chest wall nodules. She was not pale but mildly respiratory distress. Her pulse rate was 94 per minute and blood pressure 110/70 mmHg. She had right tube thoracostomy.The third was a 35-year-old female who presented with a left breat lump. She had excision biopsy and was lost to follow-up. Four years later the father presented with a picture of hers having multiple cutaneous nodules. The fourth case was 48-year-old female who presented with left breast ulcer and multiple anterior chest wall nodules. She was pale and severe respiratory distress. Her pulse rate was 121 per minute and blood pressure 80/50 mmHg. She had left tube thoracostomy. The fifth was a 58-year-old female who presented with left breast ulcer, skin nodules and paraplegia. She is currently receiving treatment. Four of these patients nodule biopsy results revealed infiltrative ductal ca of the breast. We lost all cases except the last patient currently on admission. Conclusion: Death arising from metastatic cutaneous breast cancer is a good index for surgical audit. The findings of these cases in our environment depict need for more effort in awareness campaign for reducing mortality from breast cancer.

Key words: Biopsy, breast cancer, breast lump, metastatic skin nodules

2.6 Appreciation and use of biostatistics among resident doctors at University of Port Harcourt Teaching Hospital, Port Harcourt

Karibi E, Okoro PE


Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: The place of research in the generation of facts and evidence upon which contemporary medicine can be based cannot be over emphasised. Medical and surgical research is now more crucial than ever before for advancement of clinical practice and career progression for medical professionals. This requires good understanding and application of biostatistics among clinicians. Aim: To evaluate the appreciation and use of biostatistics among resident doctors at the University of Port Harcourt Teaching Hospital (UPTH). Subjects and Methods: This is a questionnaire based study carried out in May 2014 in the University of Port Harcourt Teaching Hospital. Completed questionnaires were retrieved immediately after completion. Data was subsequently collated and subjected to simple statistical analysis on the Excel spread sheet. Results: There were a total of one hundred and nine (109) respondents, but sixty nine (69) (63.3%) were included in the study. Others were excluded either due to incomplete response or nonretrieval of the questionnaire. The vast majority of respondents (79.5%) indicated that they understood the basic concepts of biostatistics, but only 16 (25%) are able to apply their knowledge practically in research. Sixty one (93.8%) respondents believe that their knowledge of biostatistics was inadequate. Conclusion: The level of appreciation and use of biostatistics among resident doctors in UPTH is inadequate. This may possibly be a reflection of the situation with resident doctors in other institutions in the country. There is need for a curriculum review both at the undergraduate and postgraduate levels to prepare medical professionals for the task of high quality research and advancement of knowledge.

Key words: Biostatistics, port-harcourt, resident doctors

3.11 Percutaneous nephrostomy using ultrasound guidance in Nigeria

Omodu OJ, Robinson E


Department of Surgery, Colworths Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Background: Percutaneous nephrostomy is a technique in which percutaneous access to the kidney is achieved under radiological guidance. The access is often maintained with the use of an indwelling catheter. Ultrasound scan guidance has been shown to aid access into the kidney and this is the first documented in Port Harcourt. Aim: To report a successful passage of a percutaneous nephrostomy using ultrasound as a guide. Case Report: A 64 year old male who had castration resistant prostate cancer infiltrating the base of the bladder and encasement of bilateral ureteric orifices with resultant bilateral hydronephrosis for which a double J stent couldn't be passed cystoscopically. He therefore required a percutaneous nephrostomy. Conclusion: In developing nations where cost of fluoroscopy poses a major challenge as a guide to access the kidney, ultrasound scan comes in as a cheap and effective means of access to kidney during a percutaneous nephrostomy.

Key words: Challenge, nephrostomy, percutaneous, ultrasound

3.12 Endourology: Current trend and experience in Port Harcourt

Omodu OJ, Nwidada S, Ebirien-Agana G


Department of Surgery, Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Endourology has advanced in developed countries and is rapidly advancing in developing countries. The practice in Port Harcourt is also catching up with the trend of treatment. Aim: To review the current practice of endourology in a government specialist hospital and a private specialist hospital in Port Harcourt, Rivers state, Nigeria. Patients and Methods: This study was a prospective study of all endourological procedures carried out in the two centres between November 2012 and April 2015. Information obtained include age, gender, diagnosis, procedure, duration of surgery, prostate size, preop serum sodium, postop serum sodium, complications, duration of surgery and were analyzed. Results: During the period of study, 218 endoscopic procedures were performed on 112 patients with age range of 3-89 years with mean age of 66.99. There were 107 males and 5 females. Initial cystoscopies were performed for all 112 patients, 2 ureterolithotripsies, I PUV ablation, 53 TURP, 5 TURBT, 1 percutaneous nephrostomy, 19 direct visual internal urethrotomies, 6 single cystoscopies, 6 cystolithotripsies, 15 channelization, 2 bladder mass biopsies, 1 bladder neck incision, 1 DJ stent retrieval. 1 case of channelization was abandoned due to bleeding and 2 cases of DVIU was stopped due to false passage. Some complications were also noted but there was no mortality recorded. Conclusion: Endourology is a safe procedure and is also regularly performed in Port Harcourt Nigeria. This desired technology requires improved funding, training, procurement of equipment by government and private hospitals to take urology practice to world standard to reduce capital flight via medical treatment abroad.

Key words: Developing countries, endourology, practice, scope

3.13 Fracture of the penis in the Niger Delta region

Ekeke, ON, Raphael JE, Eke N


Division of Urology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Penile fracture is a surgical emergency which often frightens the patient and partner. Varying incidents rates, precipitating mechanisms and outcomes of treatment have been reported from different parts of the world. The clinical presentation and outcome of management of penile fracture in the Niger Delta is yet to be documented. Aim: To determine clinical presentation, aetiological factors and outcome of treatment of penile fracture in Port Harcourt. Methods: This was a retrospective study of all patients who presented with penile fracture to our institution from 2007 and 2015. Data on age of patient, event leading to the injury, mode and time of presentation, mode and outcome and complications of treatment were collected and analysed with SPSS 20.0 software (IBM Inc., Chicago, USA). Results: Twenty one patients with a median age of 32.0 years (21-45) were treated within the study period. Nine patients were married. Sex-related events were responsible for penile fracture in 17 patients (80.6%). Seven injuries were self inflicted while in 14 patients (66.7%), partners were involved. All patients presented with pain, swelling, sudden detumescence and deviation of the penis. The right side was affected in 61.9% of the cases. The penile mid-shaft was the site of injury in 57.1% of cases. Six patients (28.6%) had associated urethral injuries. Eighteen patients (85.7%) had immediate surgery, 2 patients (9.5%) refused surgery and were treated conservatively. One patient who presented late was also managed conservatively. All but one patient had satisfactory penile erections with no significant complications. Conclusion: Over enthusiastic/vigorous sexual activity was the most common cause of penile fracture. A third of the patients had associated urethral injuries. Early surgical repair led to satisfactory outcome.

Key words: Niger Delta, penile fracture, sexual intercourse, trauma

3.14 Johanson urethroplasty for recurrent long segment anterior urethral stricture

Ugwumba FO, Echetabu KN, Okoh AD, Mbadiwe OM


Department of Surgery, Urology Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria

Introduction: Recurrent long segment urethral strictures are not uncommon with patients having up to 3 prior attempts at repair often including use of pedicled penile skin flaps. Presentation is often attended by local infection especially ecially prior attempts. Aim: To assess the outcome of Johansons urethroplasty in the management of recurrent long segment anterior urethral strictures. Methods: All patients who had Johanson urethroplasty for recurrent long segment urethral strictures at the University of Nigeria Teaching Hospital and Royal Hospital from January 2008 -UDecember 2014 were included in the study. Parameters assessed were hospital stay duration, complications of repair, other morbidities and patency/Qmax at follow up. Results: 41 patients were seen. Etiologies of stricture were urethral catheterization, inflammatory in 89% of cases. Mean hospital stay 1 st stage surgery was 2 weeks with severe wound infection seen in 26.2% of cases. Intervals between 1 st and 2 nd stages ranged from 12 weeks to 61 weeks. Satisfactory voiding was achieved in 97% at 1 year, with mean Qmax at 1 year being 21.3 ml/sec. Conclusion: Johannson urethroplasty is a valuable salvage tool for recurrent long segment anterior strictures especially those associated with local sepsis. Qmax is remained normal at 1 year of follow-up.

Key words: Stricture, urethra, urethroplasty

3.15 Urological complications of obstetrics and gynecology surgeries in a developing country

Ekeke ON, Amusan EO, Eke N


Department of Surgery, Division of Urology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Background: Urological complications of obstetrics and gynecology surgeries are associated with significant morbidity and occasional mortality. Certain factors affect the prevalence and outcome of treatment. We aim to evaluate the risk factors and outcome of treatment of these complications in a developing country. Methods: This is a retrospective study of patients who had Obstetrics and Gynecology surgeries in our centre between 2009 and 2014. Patients with urological complications were identified. Data on age, clinical presentations, investigations, treatments and outcome of treatment were extracted and analysed using SPSS 20.0 (IBM Inc., Chicago, USA). Results: During this period, 8270 obstetrics and gynecology surgeries were performed; Twenty five patients (0.31%) had urological complications. The mean age was 38.4 years (range 24-62). The commonest initial diagnosis was uterine fibroids in 9 patients followed by uterine rupture in 8 patients. Total abdominal hysterectomy (12 patients) was the commonest surgery. Twenty-one patients had ureteric injury. Seven patients had bladder injury, 1 patient had bladder and both ureteral injuries. Eight injuries were identified intra-operatively. Ureteric re-implantation was the commonest repair. Twenty two (88%) patients had satisfactory outcome, 1 (4%) patient died due to chronic renal failure while 2 (8%) patients had sepsis. Conclusion: Conditions that distort pelvic anatomy and emergencies were the major risk factors. Early operative repairs achieved satisfactory results. Good knowledge of anatomy of urogenital system and meticulous surgical technique by the surgeon will reduce the incidence.

Key words: Gynaecology, injury, obstetrics, ureter

3.16 Managing fire disaster: The Okogbe experience

Kejeh BM, Gbeneol T, Ovusike A


Department of Surgery, Burns and Plastic Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Background: Okogbe is located in Ahoada West LGA, along the East/West road, close to Mbiama in Rivers State. There was a fire incident in July, 2012 when an accidented petrol tanker emptied its contents into a gutter and later caught fire. Many people died at the scene and some were admitted in the University of Port Harcourt Teaching Hospital. Aim: To share the experience in Fire disaster management and the outcome of admitted patients. Methods: Following the burns, several patients were brought to the Accident and Emergency Department of the University of Port Harcourt Teaching Hospital as well as other Public and private hospitals in Ahoada and Port Harcourt. Because of the severity and the number of casualties, the Rivers State Government set up a committee to handle the surviving burn cases from the incident. The patients were then moved to the UPTH. Financial and material assistance were made available. Results: Twenty seven patients were admitted in UPTH. Male to Female ratio was 5.8:1. The youngest was 18 years and oldest was 42 years. All had severe burns with inhalational component. The least TBSA was 30% and highest was 90%. Only 7 survived (25.92%) Mortality rate was 59.25% (16), 4 (14.81%) Sjgned against medical advice. Keloid was a major complication. Conclusion: Fire disasters are best prevented. The outcome is usually poor.

Key words: Accident and emergency, burns, fire disaster

3.21 Unusual presentation of uterine rupture

Iwo-Amah RS, Wenike SN


Department of Obstetrics and Gynaecology, Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Rupture of the pregnant uterus is an obstetric catastrophe. The typical clinical picture of marked suprapubic tenderness, haemoperitoneum and cardiovascular compromise may not be present in all cases of uterine rupture. Aim: To report an unusual presentation of uterine rupture. Case Report: A case of ruptured uterus in a 37 year old G 5 P 4 , referred from a health centre, is presented. She was unbooked, but presented at the health centre at 38 weeks gestation with sharp lower abdominal pains. No history of massaging or trauma. She was managed as a labour case. After repeated oxytocin infusions for augmentation of labour with no progress, obstetric ultrasound scan done 48 hours later noted abdominal pregnancy at 38 weeks gestation with fetal demise. She was then referred to our hospital. Examination findings revealed a haemodynamically stable patient with no marked abdominal tenderness. Pre-operative preparation was done and patient had a laparotomy for abdominal pregnancy. A diagnosis of uterine rupture was made intra-operatively when a rent, measuring 6 cm in length was detected in the lower uterine segment. There was no active bleeding because the fetus and placenta, already extruded into the peritoneal cavity, were acting as a tamponade on the edges of the rupture, thus maintaining haemostasis. Conclusion: There is need for a high index of suspicion of ruptured uterus when obstetric ultrasound scan reports an advanced abdominal pregnancy, irrespective of clinical findings.

Key words: Abdominal pregnancy, ultrasound, uterine rupture

3.22 Limb loss following deep venous thrombosis associated with huge uterine fibroid

Nyengidiki TK, Bassey G, Inimgba N, Mmom CF


Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Background: Uterine fibroids are common amongst nulliparous women in our environment. Vascular occlusion resulting in deep venous thrombosis as a complication is however rare. Aim: To report a rare complication of uterine fibroids and to review the literature. Case Report: A review of the medical record of a 40 year old nullipara, known diabetic and hypertensive who presented with left lower limb gangrene due to left iliac vein thrombosis secondary to extrinsic compression by a uterine fibroid. She had a total abdominal hysterectomy and an above knee amputation of the left lower limb. Conclusion: Considering the high prevalence of uterine fibroids in our environment, it is pertinent for physicians to have a high index of suspicion when a woman presents with hip or left calf pain and a pelvic mass. This will ensure early intervention and prevent morbidities.

Key words: Amputation, Gangrene, huge uterine fibroid, thrombosis

3.23 Hysteroscopic evaluation of the uterine cavity in adult female patients in a metropolitan population: A preliminary report

Nyengidiki TK, Ray-Offor E 1 , Aneke NC 2


Departments of Obstetrics and Gynaecology and 1 Surgery, University of Port Harcourt Teaching Hospital, 2 Oak Endoscopy Centre, Port Harcourt, Rivers State, Nigeria

Introduction: Endoscopic evaluation of the uterine cavity is very useful in abnormal uterine bleeding and impaired fertility conditions in adult females. The practice of hysteroscopy is evolving in our environment. Patients and Methods: A prospective observational study of all patients referred for hysteroscopy to an ambulatory care endoscopy facility in Port Harcourt from June 2014 to May 2015. Variables studied were sociodemographics, clinical history, hysteroscopic procedure findings and outcome. Data were collated and statistically analysed using SPSS 20 (IBM Inc., Chicago, USA). Results: A total of 30 hysteroscopies were performed during study period. The age range of patients was 28- 48 years with a mean of 36.89 years. The majority of patients presented with infertility 12 (52.2%) with 21 (70%) been nulliparous. Endometrial polyp and intrauterine adhesions were the most common hysteroscopic findings in 6 (26.1%) and 4 (17.4%) cases respectively. No malignant condition was recorded. The procedures were successfully completed with no complications. Conclusion: Hysteroscopy is a safe and valuable gynaecologic procedure in our environment. Evaluation of impaired fertility is the leading indication for hysteroscopy.

Key words: Hysteroscopy, infertility, Port Harcourt

3.24 Chronic uterine inversion from submucous fibroid and vaginal myomectomy: A case report

Oriji VK, Ikimalo JI, Ibe V


Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Chronic nonpuerperal uterine inversion is a rarity. When occurring in a young nulliparous female, management will aim towards fertility conservation. Aim: To report the management of chronic total inversion of the uterus induced by a fundal submucous fibroid. Case Report: The case of a 34-year old Nullipara who presented with chronic uterine inversion and profuse vaginal bleeding is presented. She was resuscitated with intravenous fluids and blood transfusions. She had vaginal myomectomy and the uterus replaced into the pelvis through the vagina several days later. Conclusion: Among several options in management of chronic inversion of the uterus in the reproductive age is a delayed vaginal replacement of the uterus into the pelvis after the precipitating factor(s) has been corrected.

Key words: Fibroid, myomectomy, uterine inversion

3.25 Distribution of rhesus negative blood group among antenatal clinic attendees at Aminu Kano Teaching Hospital, Kano

Umoru JU, Ajuluchukwu EU 1 , Takai IU, Omole-Ohonsi A, Yakasai IA


Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano State, 1 Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin Kudu, Jigawa State Nigeria

Introduction: Rhesus isoimmunisation is a common cause of haemolytic disease of the newborn, with consequent neonatal morbidity and mortality. Aim: This study was undertaken to determine the prevalence of Rhesus negative blood group among pregnant women attending antenatal clinic at Aminu Kano Teaching Hospital, Kano. Methods: It was a retrospective study of all women attending antenatal clinic at Aminu Kano Teaching Hospital, Kano, and had Rhesus negative blood group as documented on the antenatal record registry, over a two year period, between first of May 2012 to thirtieth of April 2014. Data obtained was analysed using simple statistical methods. Results: There were 178 Rh negative blood group among the 61,667 antenatal clinic attendees over study period, giving an institutional prevalence of 0.288%. Ninety-four (52.8%) of the blood group were O Rhesus negative, 42 (23.40%) were B negative, 38 (21.35%) A negative and AB negative accounted for only 4 (2.25%). Conclusion: The prevalence of Rhesus negative blood group in this study was extremely low. There is need for advocacy to improve awareness of the Rhesus D negative factor during the antenatal period to reduce the risk of haemolytic disease of the new born.

Key words: AKTH, antenatal clinic, pregnant women, rhesus D negative

3.26 Factors undermining good outcome of therapy in patients with choriocarcinoma in a Tertiary Health Facility in Nigeria

Nyengidiki TK, Bassey G


Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Gestational trophoblastic diseases have been generally associated with good outcome however certain factors undermine success of treatment in most developing countries where higher mortalities are observed. Objective: This study seeks to determine the possible indicators of poor outcome in patients undergoing therapy for gestational choriocarcinoma at the University of Port Harcourt, Nigeria. Methods: This was a retrospective study of women who were treated for gestational choriocarcinoma at the UPTH and assessment of the factors undermining successful treatment over a 5-year period from 1 st January 2008 nd a st December 2012. Results: A total of 13 cases of gestational choriocarcinoma were treated in UPTH during the study period and there were 16,720 deliveries giving a prevalence of 0.8 per 1000 deliveries with a mortality rate of 38.5%. Majority of patients (76.9%) were of low socioeconomic class and had a two times risk of death from choriocarcinoma (0D = 2.0; RR = 1.17). Ninety two point three percent of patients presented with amenorrhoea periods of 28 weeks. Histological examination of tissues extracted from previous miscarriages were not performed in 100% of patients (P = 0.1, RR = 4.0). Eighty percent of all mortalities were associated with antecedent pregnancies been miscarriages (P = 0.3; OD = 4.0). All patients managed were lost to follow up within 32 weeks. Conclusion: Choriocarcinoma in Port Harcourt is with associated high mortality amongst patients. Low socioeconomic class, late presentation, prior miscarriages, lack of histological examination of previously extracted products of conception are likely to be associated with poor outcome. The poor response to follow up schedules is a milleu for delayed diagnosis of possible relapse.

Key words: Choriocarcinoma, mortality, poor outcome, Port Harcourt

4.11 Safety of sterile water as an irrigation fluid for transurethral resection of the prostate with emphasis on serum sodium

Omodu OJ, Ndee E


Department of Surgery, Urology Unit, Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Irrigating fluid is necessary for transurethral resection of the prostate (TURP). Initially water was used and paved way for newer irrigating fluids such as glycine because of attendant complications noted. Water is now used safely in many centers as an irrigating fluid. Aim: To determine the serum level of sodium and safety of sterile as irrigating fluid for transurethral resection of the prostate. Patients and Methods: This prospective study was conducted at a private hospital and government specialist hospital in Port Harcourt on 53 patients from November 2012 to April 2015. All patients presented with lower urinary tract symptoms and diagnosed as benign prostate hyperplasia (BPH) and planned for TURP were evaluated further for their serum sodium level preoperatively as well as postoperatively. Patients analysis used were no of patients, age, pre op sodium, postop sodium, packed cell volume. Results: The change in plasma sodium concentration was not statistically significant, however hyponatremia was observed in two patients. There was operative postoperative hematuria requiring blood transfusion in 3 patients and no clinical evident related postoperative renal impairment. Conclusions: Sterile water is a relatively safe solution as an irrigating fluid for TURP, but attention must be paid to the inevitable blood loss during surgery.

Key words: Hyponatremia, sodium, transurethral resection of the prostate

4.12 Endourology in Port Harcourt: The journey so far

Ekeke ON, Raphael JE, Amusan OE


Department of Surgery, Division of Urology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Endourology is an important aspect of urology. Though developed several years ago, different parts of the world are at different stages of development. This was not readily available in sub-Saharan Africa. Some centres in Nigeria have acquired the technology and only few have made progress in delivering the service to the populace. Aim: To present the practice of endourology in Port Harcourt in the past 9 years. Methods: All patients who had endourologic procedures by the authors in 4 hospitals in Port Harcourt were retrospectively studied. Data obtained from their case notes included: sociodemographic parameters, indications for surgery, procedure done and outcome of treatments. The data was analysed with the aid of SPSS version 20.0 (IBM Inc., Chicago, USA) computer software. Results: There were 486 patients (Male to Female ratio 6.0). The age range was 4 months to 95 years with the mean age of 51.8 years. One hundred and ninety four (39.9%) were diagnostics and 292 (60.1%) therapeutic procedures. Of diagnostic, 155 (79.9%) were rigid urethroscopy or urethrocystoscopy while 39 (20.1%) are flexible cystoscopy. Trans-urethral resection was the commonest therapeutic procedures; others are direct vision internal urethrotomy (DVIU), cystolitholaplaxy. Two patients had general anaesthesia, 378 had regional anaesthesia (347 spinal and 31 caudal epidural), and 106 patients had local infiltration. The complication rate 4.8% this include haemorhage, epididymo-orchitis, UTI, re-stricture, poor stream of urine and urinary retention, 1 patient had urethra-rectal fistula. Conclusion: Endourology is now well established in our city. Only Lower urinary tract endoscopy is presently offered. There is satisfactory outcome. Development of Upper urinary tract endoscopy should be encouraged.

Key words: Cystoscopy, endoscopy, urethroscopy, urology

4.13 Urinary stone disease: The Port-Harcourt experience

Ekeke ON, Anyadike CC


Division of Urology, University of Port-Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Urinary stone disease was considered uncommon in our environment. Previous studies in Nigeria had suggested seasonal variations, varying prevalence rates and association with high consumption of calcium and magnesium in diet. Several technological advances have been made in the treatment of stones. The increasing number of cases seen in our centre prompted us to review our experience in the past 8 years. Aim: To present our experience with management of urinary tract stones in our centre. Materials and Methods: An eight-year retrospective study of patients treated for urolithiasis was conducted in the University of Port-Harcourt Teaching Hospital and Potter's Touch Medical Consultants from 2007 to 2014. Data on the age, sex, underlying clinical condition, location of the stone as well as surgical procedures done was collected. Qualitative analysis of the stones was carried out. Data analysed with SPSS version 20.0 (IBM Inc., Chicago, USA). Results: A total of 80 patients presented during this period, 53 (66.3%) were males and 27 (33.7%) were females. The mean age presentation was 43 years (16-72). The most common symptoms were pain and haematuria. The most common underlying conditions were urinary tract obstructions. The location of stones were the kidney 44 {right kidney 25 (32.5%), left kidney (12 (15.6 %,) bilateral 6 (7.8%}, followed by the bladder 23 (24.7%) ureter 10 (13.0%), and urethra 3 (3.9%). Conclusion: Urinary tract stone disease is not uncommon in our environment. More males are affected. Mainly open surgical operations are offered our patients. Most of the stones contain calcium. Attention to diet and adequate treatment of urinary tract obstruction will reduce the prevalence of urinary tract stones. Epidemiology studies are required to investigate the reason for the apparent increase in urinary tract stones in our environment.

Key words: Port-harcourt, stone disease, urinary tract

4.14 Buccal mucosal graft urethroplasty: Comparison of single versus two team approach

Ugwumba Fred O, Orji FT 1 , Echetabu KN, Okoh AD, Nnabugwu II, Udeh EI


Departments of Surgery and 1 Otorhinolaryngology, UNTH, Ituku-Ozalla, Enugu, Nigeria

Introduction: Increasingly long segment urethral strictures that arise due to catheter induced urethritis, trauma or infective urethritis are seen in Enugu, Nigeria. Often these patients require urethral substitution with BMG's. We hypothesized that using a 2 team approach may reduce operating time and improve outcome. Aims: To assess the impact of a single versus two team approach on BMG urethroplasty using measurable outcomes as well as highlight challenges in formation and maintenance of a BMGU team. Methods: Audit of patients who had BMG urethroplasty at the University of Nigeria Teaching Hospital, Saint Mary's Hospital, between 2005 to 2014 using the single team and two team approach. Assessment of length of surgery, donor site morbidity, complications of repair and patency and flow rate was done. Challenges encountered in forming a team and problem solving methods were also assessed and presented. Results: 51 patients were evaluated. Operating time was significantly longer in the single team method (mean; 193 mins). Donor site morbidity and complications of repair were greater in group A, (P < 0.05). Urethral patency, flow rate and mean IPSS scores were similar in bothgroups. Conclusion: A two team approach to BMGU reduces operating time and donor site morbidity. Functional outcomes were similar in both groups.

Key words: Buccal mucosal graft, Enugu, urethroplasty

4.15 Effect of warm irrigating fluid during transurethral resection of the prostate on post operative temperature and shivering

Ugwumba FO, Ajuzieogu OV 1 , Okoh AD, Echetabu KN


Departments of Surgery and 1 Anaesthesia and Critical Care, UNTH, Ituku-Ozalla, Enugu, Nigeria

Introduction: Postoperative hypothermia and shivering after TURP with irrigating fluid at room temperature is not uncommon and can increase morbidity. Aim: To determine the effect of using warm irrigating fluid for TURP, on the incidence of postoperative hypothermia and shivering. Methods: Between January 2011 and December 2014 47 patients who had TURP for Benign Prostatic Hyperplasia at the Royal Hospital Enugu and Saint Mary's Hospital and met the inclusion criteria were duly consented and randomized to receive irrigation fluid at room temperature and warm irrigation fluid at 39 degrees Celsius. Both groups received IV fluids at room temperature. Body temperature was monitored continuously using a patient monitor and recorded every 5 minutes and compared. Results: There mean decrease in body temperature in the room temperature group was significantly greater than in the warm irrigation fluid group (P <0.05) and there were more cases of complaints of cold, post op shivering and reduced body temperature in the room temperature group. Conclusions: The use of warm irrigating fluid for TURP appears to reduce but not eliminate the incidence of postoperative shivering. Buccal mucosal graft urethroplasty; comparison of single versus two team approach.

Key words: Enugu, hypothermia, shivering, TURP

4.16 Obstructive jaundice in University of Port Harcourt Teaching Hospital: A 5-year review

Ray-Offor E, Achor MT, Igwe PO, Jebbin NJ, Adotey JM


Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Jaundice from an extra-hepatic origin often requires surgical intervention. There is significant morbidity and mortality associated with obstructive jaundice. Aim: To review the pattern of presentation, and management outcome of patients with obstructive jaundice. Patients and Methods: The hospital records of all patients managed with obstructive jaundice in the Surgery Department of University of Port Harcourt Teaching Hospital from June 2008 to June 2013 were retrospectively studied. The study variables were: sociodemographics, clinical features, investigations, surgery, diagnosis and outcome. Data was analysed using SPSS version 20 (IBM Inc., Chicago, USA). Results: A total of 57 cases were managed during the study period with 33 case records available for review. Twelve were females and 21 males, with a male to female ratio of 1:1.8. The age range of patients was from 28 to 80 years with mean age of 56.9 ΁ears with mean age of 56.9as from 28 to 80with 33 case records availablecoloured stool and progressive jaundice, seen in 30 (90.9%), 26 (76.8%) and 25 (75%) respectively. Pancreatobiliary malignancy was the predominant diagnosis confirmed intra-operatively with bypass surgeries done in 11 cases. Conclusion: Pancreatobiliary malignancy is the most common cause of obstructive jaundice in our environment. There is the need for early referral and modern direct imaging techniques for biliary stenting and stone retrieval.

Key words: Bypass surgery, biliary stenting, obstructive jaundice, pancreatobiliary cancer

4.21 Vascularised fibular graft for a radial defect following tumour excision at the University of Port Harcourt Teaching Hospital

Ibeanusi SEB, Orupabo F


Department of Orthopaedics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Options for bridging large segmental bone defects following tumour resection are numerous. Various methods have been outlined, each having its advantages and drawbacks. In developing countries, the choices are limited due to unavailability and high cost of sophisticated implants and materials, and the relative lack of expertise to carry out some of these procedures. Aim: To highlight the use of a free vascularised fibular graft to bridge a large radial bony defect following tumour resection at a tertiary hospital in Nigeria. Case Report: Mr J. A, a 30 year old businessman, had an excision biopsy of mass originating from his distal right radius, which histology reports confirmed to be a giant cell tumour. He was however left with a large (approx 10 cm) radial defect, which was subsequently bridged by a vascularised fibular graft. Post operative hand and wrist function were satisfactory. Conclusion: Free vascularised fibular graft is a viable option for bridging large bone defects in developing countries. As long as the expertise is available, it is less complicated and more economical than other advanced methods. In addition, it has fewer drawbacks than other methods currently in use in our environment.

Key words: Bone defects, bone graft, fibular, vascularised graft

4.22 How safe are the grandmother's hands

Onumaegbu O


Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria

Introduction: Burns in the paediatric age are not uncommon. They are often caused by hot liquids (typically hot water) accidentally spilled on or tripped over by the toddler or infant or its caregiver or sibling. Burns to neonates are however an uncommon presentation as are non-assault direct application of burn agent to the burn victim's skin. Aims: To report an unusual and uncommon mode of burn injury causation and to highlight the possible danger in an otherwise innocuous activity. Case report: A 2-day old female neonate sustains a 10% total body surface area (TBSA) scald injury when her grandmother, a retired nurse but a known diabetic patient attempts to bathe her. The -warm water'awas applied to her trunk, groin and thighs via the bathing sponge resulting in second degree burns to these sites. Results: Comprehensive conservative burn wound care by occlusive and exposure methods resulted in complete re-epithelialisation and uneventful recovery. Conclusion: Carefully guided wound care yields satisfactory healing in partial thickness burn injuries even in neonates. Care givers for neonates need to be ascertained free of thermoreceptor neuropathies to avoid inadvertent thermal injury to neonates.

Key words: Burns, care givers, neonates, thermoreceptor neuropathies

4.23 Sural Island musculofasciocutaneous flap: A reliable source of well vascularised tissue for management of osteomyelitis of the tibia

Opara KO, Nwagbara IC, Jiburum BC


Department of Surgery, Imo State University Teaching Hospital, Orlu, Imo, Nigeria

Introduction: Management of dead space and soft tissue defect following sequestrectomy has remained a challenge. The sural musculofasciocutaneous flap provides a novel option for a one stage reconstruction. Aim: To report our experience with the use of the sural island musculofasciocutaneous flap in the management of osteomyelitis of the tibia. Patients and Methods: Consecutive patients with osteomyelitis of the tibia requiring soft tissue cover, who met our inclusion criteria were managed using the sural island musculofasciocutaneous flap, and the outcome analyzed. Results: There were 21 patients, 15 males and 6 females. Their ages ranged from 21 years to 62 years. Most (71%) were in the 3 rd and 4 th decades of life. Twelve (12) patients had involvement of the distal third of tibia, eight (8) involved the middle third, while five (5) patients had involvement of the proximal third. A vast majority of our patients (17) developed osteomyelitis following open fractures of the tibia; road traffic accidents accounting for thirteen (13) of these, and gun shot injuries for the other four. All donor sites were skin grafted primarily, with 95 to 100% graft take. Conclusion: The sural island musculofasciocutaneous flap is a reliable source of richly vascularised soft tissue for management of chronic osteomyelitis of the tibia. It has the added advantage of a providing sizeable tissue, with good reach to all segements of the tibia.

Key words: Osteomyelitis, sural Island musculofasciocutaneous flap, well vascularised

4.24 Reconstruction of soft tissue defects around the knee using the proximally based sural island fasciocutaneous flap

Opara KO, Uzoho AO, Aaron FE 1


Department of Surgery, Imo State University Teaching Hospital, Orlu, Imo State, 1 Department of Surgery, Braithewaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: The proximally based sural island fasciocutaneous flap provides thin sensate tissue ideal for coverage of soft tissue around the knee. However there have been limited reports on its use for this purpose. Aim: This study presents the use of the proximally based sural island fasciocutaneous flap in 18 cases. Patients and Methods: Case records of patients with soft tissue defects around the knee joint who had their defects reconstructed using the proximally based sural island fasciocutaneous flap were reviewed. The data were analyzed using descriptive statistics. Results: There were 15 cases (13 males) with an average age of 29 years and a median follow-up time of 12 months. Ten of the defects were a result of road traffic accidents while 5 were gunshot injuries. The anterior and lateral surfaces of the knee were more often involved while the posterior surface was least involved. The flap sizes ranged from 8 cm Χ 6 cm to 16 cm 2 Χ 12 cm 2 , and the pedicle length ranged from 6 cm to 12 cm. All 15 flaps had full survival. All donor sites were skin grafted primarily with 96 to 100% graft take. Conclusion: The proximally based sural island fasciocutaneous flap is useful and reliable option for reconstruction of soft tissue defects around the knee.

Key words: Flap, knee, proximally based, soft tissue defects, sural island

4.25 Bilateral polydactyly: A case report

Harry AM, Omodu OJ, Jaja P


Department of Surgery, Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Polydactyly is the commonest congenitaldigital anomaly of the hand and foot with a range of defects from minor soft tissue duplications to major bony abnormalities. When duplication occurs alone, it is usually unilateral and sporadic. Aim: To report this case of polydactyly of 14 digits with functional preaxial polydactyly. Case Report: An eleven month old female twin who had 14 digits comprising of 4 thumbs and 10 fingers. The thumbs were well formed and functional while the last finger digits were attached via a stalk. There were no obvious other congenital abnormalities noted. Conclusion: Polydactyly is the commonest digital anomaly of the hand and foot. Surgery is necessary to create a single functioning digit and also improve cosmesis. The functional outcome seems to be related to the stability of the interphalangeal and metacarpo-phalangeal joints.

Key words: Digits, functional, polydactyly

4.26 The use of wire cutter in removing metal ring from entrapped fractured finger

Aaron FE, Onifade J


Department of Surgery, Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Finger entrapment by metal ring is uncommon in our environment, especially when it follows the phalangeal fracture of the involved finger. Ring removal is indicated in this circumstance to manage or prevent tourniquet effect on the digit. It is also known that some rings may defy commonly known methods of removal. Aim: To report a pragmatic technique of removing an entrapped ring using an orthopaedic wire cutter. Case Report: We report a case of ring entrapment on a fractured finger that defied the usual removal methods, but was successfully removed with an orthopaedic wire cutter in a poorly resourced hospital in Port Harcourt. The patient was a 33 year old male automobile mechanic who sustained the injury following a motorcycle accident. Conclusion: We therefore think that the orthopaedic wire cutter may be a handy instrument when other conventional methods fail.

Key words: Entrapped finger, metal ring, orthopaedic wire cutter, phalangeal fracture

5.11 Trend of otomycosis in Nigerian populace: University of Port Harcourt Teaching Hospital experience

Onotai LO, Osuji AE


Department of Ear, Nose, and Throat, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Otomycosis is one of the commonest causes of otitis externa seen in otorhinolaryngology clinics in tropical regions of the world. Aim: The aim of this study is to determine the prevalence and pattern of otomycosis in Port Harcourt. Materials and Methods: This is a retrospective study of patients seen in Ear, Nose, and Throat clinics of the University of Port Harcourt Teaching Hospital, within a period of 5 years (from January 2009 to December 2013), who were diagnosed clinically with Otomycosis. Results: Out of 7486 patients seen in our clinic, 1115 were diagnosed with Otomycosis, comprising 553 (49.6%) males, and 562 (50.4%) females. The study showed that otomycosis has dual peak, the first at age 1-10 years with 343 (30.7%) patients, and the second at age 21-30 years with 292 (26.2%) patients. Conclusion: This study has shown that otomycosis has a likely trend, with dual peaks and a decreasing incidence with age following the second peak. Uninterrupted medical treatments with antifungal ear drops/wick packing with antifungal creams give a good clinical outcome.

Key words: Antifungal ear drops, humidity, Nigerian, otomycosis, tropics

5.12 Toothbrush! An unusual ingested foreign body in a child: case report and literature review

Ray-Offor OD 1 , Ray-Offor E 1],[2 , Aneke NC 1 , Nwankwo NC 3 , Onubiyi CCB 3


Departments of 3 Radiology and 2 Surgery, University of Port Harcourt Teaching Hospital, 1 Oak Endoscopy Centre, Port Harcourt, Rivers State Nigeria

Introduction: Foreign body ingestion is a common clinical emergency and reports abound in literature. However, the ingestion of tooth brush and the extraction by a flexible gastroscope is rare in our environment. Case Report: We report a case of a 6 year old boy who inadvertently swallowed an adult-sizedtooth brush while his mother was brushing his teeth. It was successfully extracted using a flexible endoscope. There was mild transient sore throat as the only complication. The patient was discharged home on the same day. Conclusion: Tooth brush ingestion in paediatrics is uncommon; prompt intervention with removal is strongly recommended to avoid complications.

Key words: Endoscopy, foreign body, tooth brush

5.13 Rhinosinusitis with orbital/intracranial complications: A report of two cases

Nwogbo AC, Lilly Tarriah, Ediriverere O, Eghwrudjakpor P


Department of Otolaryngology and Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Rhinosinusitis implies inflammation of the mucous membrane lining the nose and sinuses resulting in nasal obstruction and Rhinorrhea, with or without associated symptoms. Complications of paranasal sinus disease are more common in children and adolescent than adults, especially the ethmoid sinus. Aim: To report two cases of orbital and intracranial complications from Rhinosinusitis in each of 2 young male. Case Reports: Case 1: 10 years old boy with history of left orbital swelling, fever, and ipsilateral weakness. Examination reveal ill looking child, semiconscious, with massive left orbital swelling and left sided paresis. CT scan of brain and sinuses showed density in the ethmoidal sinuse and epidural abscess. Child was offered external orbital decompression and epidural abscess drainage. Response was good. Case 2: 12 years old boy with history of frontal swelling and discharge. Also associated with history of fever and headache. Examination revealed semiconscious child, frontal and orbital swelling. Frontal swelling discharged purulent materials on pressure. CT scan of brain and sinuses showed density of fronto/ethmodal sinuses and cerebral abscess. He was offered external orbital decompression and drainage of cerebral abscess. He responded well to treatment. Conclusion: Orbital and intracranial complications following Rhinosinusitis is an uncommon presentation in children/adolescent. Early diagnosis and surgical treatment is mandatory to avoid mortality.

Key words: Intracranial abscess, orbital abscess, rhinosinusitis

5.14 Optic disc size in glaucoma patients attending a Tertiary Institution in Nigeria

Awoyesuku EA, Pedro-Egbe CN


Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Assessment of optic disc size is an important component of optic nerve head examination and is often overlooked in the diagnostic evaluation for glaucoma. Aim: To report the clinical disc diameters of small, average and large optic discs and produce data on the disc sizes of Nigerian patients who are currently being treated for glaucoma. Methods: One hundred eyes of 100 non-consecutive glaucoma patients were studied. The vertical and horizontal disc diameters were recorded after mydriasis, at the slit lamp with a +78 D double-aspheric fundus lens. Discs were classified as small (<1.3 mm 2 ), average (1.3-1.75 mm 2 ) and large (>1.75 mm 2 ). The relationship between disc size, age, sex and type of glaucoma was assessed. Descriptive and comparative statistical analyses were performed. A P < 0.05 was considered statistically significant. Results: 100 eyes of 100 individuals were studied comprising 64 (64.0%) males and 36 (36.0%) females. Age range was 20-80 years with a mean age of 50 ΁ 13.664. Mean disc size was 1.996 ΁ 0.239. 82% of discs were large size (>1.75 mm 2 ). Males (61%) had larger discs than females (21%) (P = 0.001). There was no correlation between disc size and age (P = 0.871) or clinical types of glaucoma (P = 0.582). Conclusion: Majority had large optic discs in our study (82%). Large discs have large cup: disc ratio. These differences must be considered while evaluating the optic disc to prevent over diagnosis of glaucoma and its attendant economic burden on the patient.

Key words: Glaucoma, Nigerians, optic disc

5.15 Pattern of strabismus in a Tertiary Hospital in Nigeria: A 6-year review

Awoyesuku EA, Fiebai B, Onua AA


Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Aim: To determine the prevalence and clinical features of patients presenting with strabismus in the ophthalmic clinic in the past 6 years. Methods: This was a hospital based study of all the patients diagnosed having strabismus in University of Port Harcourt Teaching Hospital between January 2007 and December 2013. The Medical records of a total of 74 patients who visited the ophthalmic clinic and diagnosed having strabismus were retrospectively reviewed and subsequently analysed using SPSS-17 (IBM Inc., Chicago, USA) computer soft ware package. Ethical clearance was obtained from the Ethical Committee of the University of Port Harcourt Teaching Hospital. Results: Among the 74 patients with manifest strabismus, 2 (2.7%) had hypertropia, 21 (28.4%) had exotropia, 23 (31.1%) had esotropia, 28 (37.8%) had alternating squint. Conclusions: This study confirmed the relatively high prevalence of alternating squint and esotropia in patients with strabismus.

Key words: Pattern, prevalence, strabismus

5.16 Managing macular holes in a developing economy

Fiebai B, Pedro-Egbe CN


Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Macular holes are a common cause of visual impairment with a variety of etiological factors. Advances in its management are encouraging and are now available in developing countries albeit scarce. The need to understand this disease has therefore become pertinent in all retina clinics. Aim: To evaluate the pattern of presentation of macular holes and its management in a retina clinic in South-South Nigeria. Methods: A 5 year retrospective, non comparative review of 24 consecutive cases presenting to a retinal clinic was carried out. Results: Three hundred and sixty four cases were seen in the retina clinic from January 2009 to December 2013. Twenty four cases had macular holes, 10 (41.7%) had bilateral presentation with a total of 34 eyes. The incidence of macular holes was 6.6%. The mean age was 46 years (SD uary 2009 to December 2013. Twenty four cases had mac holes formed the bulk 14 (58.3%), others were trauma, 4 (16.7%), posterior uveitis 2, (8.3%), chemotherapy 2 (8.3%) and retinitis pigmentosa 1 (4.2%). Nineteen (55.9%) of the 34 eyes were visually impaired (BCVA teen ). Nineteen eyes had full thickness holes (55.9%) requiring surgery, however only 3 (12.5%) of these could afford surgery with one reoperation. Four eyes (11.8%) had retinal detachments as complications at presentation. Conclusion: The incidence of macular holes in the developing world is significant and resources to manage these cases are grossly lacking. Specialist training, with government subsidizing costs will alleviate these difficulties and reduce visual loss from macular holes.

Key words: Developing country, macular holes, retinal detachment

5.21 Spring active drain using bladder (50-60 ml) syringe (De Adotey modified Singh drain)

Igwe PO, Dodiyi-Manuel A, Adotey JM


Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Closed active drainage system with a syringe is an accepted way to let out fluid in a surgical wound. We present a simple spring active (negative suction) drainage (SAD) system using locally improvised metallic spring and 60 ml (bladder syringe); SAD of Adotey, a newly designed compression-expansion spring mechanism which serve especially in situations where an active drainage system is of utmost importance. Conclusion: De Adotey's drain is a 60 ml bladder syringe with spring mechanism which is used to provide a negative pressure as an active drain.

Key words: 60 ml bladder syringe, negative suction drainage, spring active drain (De adotey's drain)

5.22 Spring active drain using bladder (50-60 ml) syringe (De Adotey's drain) versus Redivac drain: A preliminary report

Igwe PO, Dodiyi-Manuel O, Adotey JM


Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Negative suction drains are used to forestall hematoma and seroma in surgical areas or to maintain effective pressure to obliterate a dead space. The conventional redivac drain is well known for this function. Simple spring active (negative suction) drainage (SAD) system using locally improvised metallic spring and 60 ml (bladder syringe); SAD of Adotey, a newly designed spring mechanism serves a similar function. Aims: This was a preliminary comparative report of Adoteys drain and the conventional Redivac drain in subcutaneous wound drainage. Methods: A preliminary prospective randomized control clinical trial was done to compare De Adotey's drain with redivac drain in subcutaneous wound drainage. This study was conducted between August 2014 and April, 2015. Both devices were used in 18 patients with thyroid disease conditions. Results: A total of 18 thyroidectomies, 4 simple mastectomies and 5 epigastic/supra umbilical hernia repairs were included in the study. SAD was used in 9 of the thyroidectomies, and all of the mastectomies and hernia repairs. Redivac was used in 9 of the thyroidectomies. The mean drainage was 29.7 mls and 28.3 mls in first post-operation day for SAD and Redivac respectively. Drainage of 23.0 mls, 19.0, for second day and 13.1, 10.0, for third day, and 4.9, 5.2 for fourth day in SAD and redivac respectively in the thyroidectomy cases. Mann Whitney U-test done showed no Statistical significance difference in both systems P value = 0.6. Conclusion: The negative pressure provided by De Adotey's drain, used for active drainage was found to be comparable to redivac drain and even with a higher post drainage pressure likewise being cost effective in this preliminary report.

Key words: Haematoma, Negative suction drainage, redivac, spring active drain (De Adotey's drain)

5.23 Colorectal cancer in Port Harcourt Nigeria: A multicentre analysis of lower gastro-intestinal endoscopies

Ray-Offor E 1],[2 , Igwe PO 1 , AnekeNC 2 , Jebbin NJ 1 , Adotey JM 1

1 Department of Surgery, University of Port Harcourt Teaching Hospital, 2 Oak Endoscopy Centre, Port-Harcourt, Rivers State Nigeria

Introduction: Colorectal cancer (CRC) is a major cause of cancer mortality in countries of Europe, North America, Australia and Japan. An increasing incidence has been reported in Africa. Endoscopy is the gold standard for investigating diseases of the colon but not common practice in our environment. Patients and Methods: A prospective study of all patients referred to two private health facilities with Endoscopy units for lower gastro-intestinal endoscopy from April 2013 to May 2015 was done using a proforma. Variables studied were; sociodemographics, indication, endoscopy/histopathology findings and outcome of CRC patients. Data were collated and analysed using SPSS version 20 (IBM Inc., Chicago, USA). Results: A total of 104 lower GI endoscopies were performed during the study period. There were 85 males and 19 females with age range of 18 to 86 years and a mean of 51.83 SD 14 years. CRC was seen in 7 (6%) cases, chronic inflammatory bowel disease 3 (2%) and 9 (8%) cases of polyps-5 hyperplastic, 1 adenoma, 1 malignant polyp. Screening was the indication for endoscopy in only 4 (3%) cases. Conclusion: Colorectal cancer is becoming more common but late presentation and rarity of premalignant lesions is the trend in our environment. A screening program with the benefit of early detection and probable cure is needed.

Key words: Colorectal cancer, endoscopy, screening

5.24 Surgical management of recalcitrant peripheral bronchopleural fistula with empyema: A preliminary experience

Okonta KE, Ocheli EO, Gbeneol TJ 1


Department of Surgery, Division of Cardiothoracic Surgery, University of Port Harcourt Teaching Hospital, 1 Division of Plastic and Reconstructive Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Peripheral bronchopleural fistula (BPF) and empyema from necrotising infections of the lung and pleural is difficult to treat resulting in increased morbidity and mortality rates. The aim of this study was to show the effectiveness of the Latissimus Dorsi muscle (LDM) f lap and patch closure techniques in the management of recalcitrant peripheral BPFs with the aid of thoracotomy. Materials and Methods: Five patients with BPF and empyema out of 26 patients who were initially treated for empyema thoracis by single or multiple chest tube insertions and/or ultrasound-guided drainage were prospectively identified and followed up for 2 years, postoperatively. The postoperative hospital stay, dyspnoea score, function of the ipsilateral upper limb and any deformity of chest wall were assessed at follow- up visits by asking relevant questions. Results: The mean age was 46.8 years (23-69 years) (4 males and 1 female). The cause of the BPF in 18 patients was  Mycobacterium tuberculosis Scientific Name Search d 8 was pneumonia. The mean total months of the chest tube insertions was 1.5 months (range 2.5-6 months) prior to the thoracotomy and closure of fistula procedures performed on the 5 patients (with LDM f lap in 4 patients and pleural patch in 1 patient). The complications recorded were: subcutaneous emphysema, residual pus and haemothorax in three patients. The mean postoperative hospital stay was 20.8 days (13-28 days). There was improved dyspnoea score to 1 or 2 in the 5 (19.2%) patients. There was no recurrence of BPF or residual pus in all the patients; no loss of function or deformity of the chest wall. Conclusion: The use of LDM Flap was effective in treating peripheral BFP without any adverse long-term outcome.

Key words: Latissimus dorsi muscle flap, peripheral bronchopleural fistula, recalcitrant

5.25 Percutanous vertebroplasty for vertebral compression fracture in a 94-year old: A case report

Diamond T 1],[2 , Ogedemgbe F 1 , Ekwe K 1

1 Department of Surgery, Cedar Crest Hospital, Abuja, 2 Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Introduction: Osteoporotic vertebral body fractures are common in the geriatric age group. Surgical options are influenced by the severity of symptoms, the presence or otherwise of spinal cord compression, level of spinal compression, degree of vertebral height collapse and the integrity of the posterior spinal elements. Aim: We report vertebroplasty of the twelfth thoracic vertebrae for compression fracture in a 94 year old female. Case Report: Mrs. I. H., a 94 year old widow, slipped off the floor and fell in her sitting room, making direct impact with the buttocks. There was marked tenderness on palpation and percussion, localized to T 11 - L 1 vertebral region but no neurologic deficit and no sign of radiculopathy. Evaluation of the other systems was unremarkable. Plain radiograph of the thoraco-lumbar spine showed a compression fracture of the twelfth thoracic vertebral body with minimal vertebral collapse. Non contrast magnetic resonance imaging of the thoraco-lumbar spine demonstrated s burst fracture of T 12 with intact posterior spinal elements. She had T 12 vertebroplasty using an injectable non-resorbable, vertebroplasty cemebt the day after the injury. She ambulated with a walking frame six (6) hours post-surgery. Post-operative plain was minimal (Visual Analog Score of 2). Conclusion: Percutaneous vertebroplasty offers effective, immediate and sustained pain relief in osteoporotic vertebral fractures. It also allows early ambulation, reduced hospital stay and minimal morbidity, which makes it quits suitable in geriatric patients.

Key words: Fracture, percutanous vertebroplasty, vertebra

5.26 Management of skin cancers in albinos

Jiburum BC, Opara KO


Department of Surgery, IMSUTH, Orlu, Imo State, Nigeria

In our practice Albinos present some of the most grotesque skin cancers seen in contemporary times. Most of these lesions occur in the head and neck region. Because of poverty, ignorance and stigmatization, late presentation is the norm with these patients. These large lesions frequently compromise the integrity and function of vital organs and structures in the head and neck region. They also interfere with the aesthetic role of the face. Their management present enormous challenges in achieving total or near total tumour clearance and reconstruction to establish the integrity of the affected structures. This papper is to discuss the treatment options and management challenges we encountered with some cases in the recent past.

Key words: Albinos, cancer, skin




 

Top
 
 
  Search
 
Similar in PUBMED
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article

 Article Access Statistics
    Viewed1626    
    Printed123    
    Emailed0    
    PDF Downloaded173    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]