East and Central African Journal of Surgery最新文献

{"title":"Aetiology and Imaging Findings in Traumatic Spine Injury among Patients Attending Muhimbili Orthopedics Institute in Dar es Salaam","authors":"J. Mboka, P. Sohal, R. Kazema","doi":"10.4314/ECAJS.V21I3.9","DOIUrl":"https://doi.org/10.4314/ECAJS.V21I3.9","url":null,"abstract":"Background: The main objective of the study was to determine etiology and imaging features of traumatic spine injury in spine injured patients attending Muhimbili orthopedics institute Methods: The study was a hospital based cross-sectional and consecutively included 87 with traumatic Spine Injury. Data was collected through a structured questionnaire. Statistical package for social science (SPSS 20) was used for data analysis. Results: Eight seven (87) patients with traumatic spine injury were studied. The age range was 4 to 81 years, with a mean age of 33 years. Males were more affected than females. Young individuals aged 16-30 years were the most affected. The commonest cause of spine trauma was motor traffic crashes. The commonest vertebral spine injury seen was compression wedge fracture (35.6%), followed by dislocation (18.4%). The most frequent spine level involved was lumbar spine (37.9%). Paraplegia (33.3%) and quadriplegia (10.3%) were the common clinical presentations. Fifty six percent of patients had associated injuries Conclusion: Traumatic spine injury is common at our settings. Young individuals below 30 years of age are most affected and the most common cause is motor traffic accident (MTA). The use of Computed Tomography (CT) in this study helped to identify several types of injuries especially injury to vertebral bodies and their effect unto neuro structures. MRI helped to identify patients with spinal cord injury which was not evident on CT. Key words : Spine trauma, vertebral fracture, Computed Tomography","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116553692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral Pharyngeal Diverticulum presenting with Dysphagia","authors":"N. Berhanu, K. Philipos, T. Ayalew","doi":"10.4314/ECAJS.V21I3.19","DOIUrl":"https://doi.org/10.4314/ECAJS.V21I3.19","url":null,"abstract":"Lateral pharyngeal diverticulum (Pharyngocele) is the protrusion of pharyngeal mucosa through the pharyngeal wall, usually through either of two weak areas in the pharyngeal wall as an acquired or congenital case. Lateral diverticula are very rare and not to be mistaken for the rather more frequent and abundantly reported cases of posterior pharyngo-esophageal diverticula (Zenker`s). Here, we present a case of this very rare condition in a young boy who presented with severe dysphagia since childhood. Key words : Lateral, pharyngeal, diverticulum dysphagia","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125332990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Surgical Management of Primary Hyperparathyroidism: The Experience in Tikur Anbessa Specialized Tertiary Referral and Teaching Hospital, Addis Ababa, Ethiopia","authors":"S. Wondimu, B. Nega","doi":"10.4314/ecajs.v21i3.10","DOIUrl":"https://doi.org/10.4314/ecajs.v21i3.10","url":null,"abstract":"Primary hyperparathyroidism is an endocrine disorder characterized by excessive and inappropriate release of Parathormone (PTH) from parathyroid glands resulting in diverse clinical manifestations involving the skeletal system in the form of bone and joint pains and pathological fractures, the gastrointestinal system in the form of dyspepsia from Peptic ulcer disease and pancreatitis, nephrolithiasis and other neuropsychiatric and nonspecific symptoms. There is nothing known about the epidemiology of this condition in our country and experience in Parathyroidectomy is very limited. In the biggest tertiary referral and teaching hospital in the country, only seven cases have been seen and treated over a period of seven years from 2007-2014 and only three had complete medical documents. We therefore present these three cases in detail and review the available literature in the management of primary hyperparathyroidism. Key words : Primary hyperparathyroidism, hungry bone disease, parathyroid adenoma","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127222293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acalculous cholecystitis: Three Case Reports","authors":"S. Mungazi, H. Mungani","doi":"10.4314/ECAJS.V21I3.17","DOIUrl":"https://doi.org/10.4314/ECAJS.V21I3.17","url":null,"abstract":"Acute acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder. Whilst acalculous cholecystitis accounts for approximately 10 percent of acute cholecystitis cases it is associated with a high morbidity and mortality.The condition rapidly progresses to complications such as gangrene, perforation and empyema of the gallbladder. Gangrenous cholecystitis is the most severe form and complication of acute cholecystitis. Acute acalculous cholecystitis warrants urgent surgical intervention to prevent catastrophic outcomes. We report a series of three patients that we managed for acute acalculous cholecystitis. The first patient was a 65-year-old, male who was positive of Human Immunodeficiency Virus (HIV) with a CD4 count of 165 cells/mm3 and was on antiretroviral treatment. The second patient was a 73-year-old male with no comorbidities. The last patient was a 72-year-old female with congestive cardiac failure due to hypertension. One patient had a successful laparoscopic cholecystectomy and the other two had open cholecystectomies. Two of the patients did well and were discharged whilst the third patient died in intensive care unit day 2 postoperatively. All the three patients had no evidence of gallbladder stones. Two of the histology reports confirmed acalculous gangrenous cholecystitis and the third histology showed acalculous haemorrhagic cholecystitis. Acalculous cholecystitis is a surgical emergency. Once suspected, principles of management include resuscitation, hospital admission, broad spectrum antibiotics, adequate analgesia and emergency surgery. Key words : Acalculous cholecystitis, Gangrenous cholecystitis, Cholecystectomy","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114473878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Short Term Outcomes of Chest Injuries at Mbarara Regional Referral Hospital in Uganda","authors":"M. Mwesigwa, D. Bitariho, D. Twesigye","doi":"10.4314/ecajs.v21i3.6","DOIUrl":"https://doi.org/10.4314/ecajs.v21i3.6","url":null,"abstract":"Background: This study was conducted to establish the causes, injury patterns and short-term outcomes of chest injuries at Mbarara Regional Referral Hospital. Methods: This was a prospective study involving chest injury patients admitted to Mbarara Regional Referral Hospital (MRRH) for a period of one year from April 2014 to 31st March 2015. Results: A total of 71 chest injury patients were studied. Males (91.6%) were the majority and the ages ranged from 8 to 76 years (mean 32.9 years (+/- 14.0). Majority of the patients (57.7%) sustained blunt injury. RTA was the most common cause of injury, affecting 49.3%.The commonest injury patterns were chest wall injuries and lung and pleural injuries accounting for 69.0% and 64.8 respectively. Rib fractures were the commonest chest wall injury (71.4%) while hemopneumothorax was the commonest (34.9%) finding among those with lung and pleural injury. Associated injuries were found in 64.2% and out of these, abdominal injuries were the commonest extra thoracic injury (39.1%) followed by head injury(37.0%),cuts and lacerations(37%) andfractures (28.3%).The commonest abdominal organs injured were spleen(44.4%), liver (27.8%) and stomach (16.7%). Majority of the patients had thoracostomy (47.9%) while 33.8% had non surgical treatment. Laparotomy and thoracotomy were done in 11(15.5%) and 3 (4.2%) of the patients respectively. Complications occurred in 20(28.2%) and the commonest complication was pneumonia 6 (30%).The mean length of stay was 7.14 days, SD=±6.1) and the mortality was 16.9%.The significant determinants of mortality were associated injuries (X 2 =4.57, F.E=0.046), complications (X 2 =36.82, F.E=0.000) and severe head injury (X 2 =13.85, F.E=0.001). Conclusion: The causes, patterns and short-term outcomes of this study are similar to those observed in other developing countries. Chest injury in our setting causes high mortality and measures to reduce road traffic accidents are urgently required. Key words : Chest injury, pattern, outcomes","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128213914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wandering Spleen with Splenic Vein Thrombosis: A Case Report","authors":"M. Ismael","doi":"10.4314/ecajs.v21i3.18","DOIUrl":"https://doi.org/10.4314/ecajs.v21i3.18","url":null,"abstract":"A wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2%1, 2. The spleen is an important component of the reticuloendothelial system, which is involved in immunological defence and can serve as a storage site for red blood cells3. The spleen is normally supported by the gastrosplenic, splenorenal and splenocolic ligaments, whereby failure of attachment of these ligaments to the spleen’s overlying peritoneum results in a hypermobile spleen3, 4. All cases of a wandering spleen have been found associated with a long splenic pedicle which consists of the splenic vessels and the tail of the pancreas2-4. A wandering spleen can be either congenital or acquired. In the congenital condition the ligaments fail to develop properly, whereas in the acquired form the hormonal effects of pregnancy and abdominal wall laxity are proposed as determining factors 5-7. In addition, failure of fusion of the dorsal mesogastrium during foetal development resulting in the characteristic long vascular pedicle has been attributed8. However, the precise aetiology of the wandering spleen is not known 2. Key words : Spleen, wandering, splenic, vein, thrombosis","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115885869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria","authors":"A. Etonyeaku, A. Talabi, A. Akinkuolie, O. Olasehinde, C. Omotola, A. Mosanya, E. Agbakwuru","doi":"10.4314/ECAJS.V21I3.23","DOIUrl":"https://doi.org/10.4314/ECAJS.V21I3.23","url":null,"abstract":"Background: Surgical abdomen traverses all age groups. We sought to define the aetiology, patients’ characteristics, and outcome of management amongst children Methods: Two years prospective review of patients aged 5-15 years managed for surgical abdomen at the Wesley Guilds Hospital Ilesa and Mishmael Medical Centre Akure, Nigeria. Results: Fifty two patients were treated. The male: female ratio was 1:1. The age range was 5years to 15years (mean=11.25 ±2.24years). Mean duration of illness was 29.5hours (range 2-72hours). Gut perforation was the most common aetiology (n=39; 75%); with perforations due to infections most prevalent (n= 34; 87.2%). Ten cases (19.2%) were trauma related and showed male predominance. Obstructed gut accounted for 15.4% (n=8) of cases; and showed female predominance. Five out of the eight small bowel obstructions (62.5%) were due to post operation adhesions. Pre-operative and post-operative diagnoses were congruent in 90.4% (n=47) of cases. Major post-operative complications were surgical site infection (20; 38.5%), and pneumonia (5; 9.6%). The average hospital stay was 9days (range 4-21days). Mortality rate was 1.9% (n=1). Conclusion: Acute abdomen requiring surgical intervention is mainly infective origin. The male child is more at risk of abdominal trauma while gut obstruction was more common in females. Keywords : Surgical, Abdomen, Children, Emergency","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"18 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134283730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Sigmoid Volvulus in Northern Uganda. An Observational Study","authors":"Richard Wismayer","doi":"10.4314/ecajs.v21i3.12","DOIUrl":"https://doi.org/10.4314/ecajs.v21i3.12","url":null,"abstract":"Background: Sigmoid volvulus (SV) has a considerable geographical variation in its incidence. The purpose of this study was to determine the incidence of SV in Northern Uganda.Methods:A two year retrospective and one year prospective study in 19 hospitals in Northern Uganda from January 2010 to December 2012 was conducted to determine the incidence of sigmoid volvulus. All patients’ records with a diagnosis of sigmoid volvulus were included in the study. Ethical approval was obtained from the IRB Gulu University and Uganda National Council for Science and Technology (UNCS&T). Data analysis was conducted using STATA/IC version 12.1.Results:The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. Cases were least observed from May to November and most cases were seen in the dry season from December to April. Conclusions:The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. The proportion of bowel obstructions due to sigmoid volvulus in Northern Uganda was 23.4% and similarly comparable with the proportion found in other African countries and higher than those indeveloped countries. Keywords : Sigmoid volvulus, incidence","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131297502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Jejunal Serosal Patch Procedure: A Successful Technique for Managing Difficult Peptic Ulcer Perforation","authors":"A. Bekele, S. Kassa, Mulat Taye","doi":"10.4314/ecajs.v21i3.11","DOIUrl":"https://doi.org/10.4314/ecajs.v21i3.11","url":null,"abstract":"Background: The selection of the most appropriate technique for the repair of peptic ulcer perforations, especially when the initial attempt of closure has failed have been the concern of many surgeons. Since the experimental report regarding the jejunal serosal patch procedure by Koboldin in 1963, authors have reported its use with encouraging outcome. The main objective of this paper is to describe our experience with the Jejunal Serosal Patch procedure in patients with failed Omental patch procedure following perforated peptic ulcer disease. Methods: This is a retrospective report of cases with failed pedicled omental patch procedure initially performed for perforated peptic ulcer disease and who subsequently underwent Jejunal Patch Procedure at the Minilik II Hospital in Addis Ababa, Ethiopia. Details of their surgical procedure, complications observed and outcome is presented. Results: Five patients, who are all male with mean age of 32.2 years (Range= 31-40 years) were included in the study. The duration of illness of all patients before their first surgery ranged from 48- 360 hours (mean= 153.6 hours). All patients had significant collection of gastric and purulent material in the peritoneum during the first surgery and the mean size of the perforation was 1.3 cm (Range 1-2cm). All five patients were re-operated for the first time after a mean of 76.8 hours and all were managed with re-patching of the duodenal perforation. The second re-operation for jejunal patch procedure was within 24 hours in one patient and > 24 hours in four patients (Mean=34.8 hours). The omental patch was found completely detached in 4 patients and partially separated in one. All patients were treated in a similar fashion by using a standardized Jejunal omental patch procedure. Post operatively, a total of 16 complications were seen in the five patients. One patient died, yielding an overall mortality rate of 20%. The mean hospital stay was 25.5 days of (Range 17- 51 days) mean 25.4 days. Conclusion: The management of the leaking omental patch is very difficult. Although some leaks transform into fistulas and will eventually close after prolonged period of hyperalimentation and continuous nursing care, this approach requires extended hospitalization and the associated morbidity, mortality and financial/social depletion on the patient is enormous. On the other hand, prompt closure of these defects by serosal patching can result in a rapid return of fluid and electrolytes to normal and permits early oral feedings. Our limited experience with this procedure is encouraging and our post operative complications and mortality are within the acceptable range. We believe this procedure is learnable, and has the potential to be utilised in difficult perforations involving the other parts of the GIT. Key words : Jejunal, Serosal, Patch Procedure, perforation, peptic ulcer","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115564203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study","authors":"Richard Wismayer","doi":"10.4314/ecajs.v21i3.14","DOIUrl":"https://doi.org/10.4314/ecajs.v21i3.14","url":null,"abstract":"Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction in Uganda. The purpose of this study was to determine the factors influencing the outcome of SV in Northern Uganda. Methodology: A prospective observational study was conducted on 103 sigmoid volvulus patients admitted between January 2012 to December 2012 and surgically managed in 19 hospitals in Northern Uganda and followed up postoperatively for 30 days. Surgical management was by resection and primary anastomosis or Hartmann’s procedure or double barrel colostomy. Patients 13 years and above with sigmoid volvulus and who had consented/Assented were included in the study and followed up to the 30th postoperative day. Ethical approval for the study was obtained from the Institutional Review Committee of Gulu University and Uganda National Council for Science and Technology. Data analysis was carried out using STATA/IC version 12.1. The outcome events were uneventful recovery, morbidity and mortality. Results: Eighteen(17.48%) patients developed complications including wound sepsis 10 (9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, giving a mortality rate of 7.7%. The factors associated with a high risk of adverse outcome were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95% CI: 1.30-18.78). Resection and primary anastomosis had a better outcome compared to Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099). Conclusion: The risk factors associated with morbidity and mortality were preoperative hypernatraemia and ileo-sigmoid knotting. Colostomy was associated with a higher risk of morbidity and mortality than resection and primary anastomosis. Keywords : Sigmoid volvulus, factors, influence, outcome","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123057535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}