African Journal Of Paediatric Surgery[JOURNAL]
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200 papers
Management of intussusception in children: A comparative study of hydrostatic reduction with saline under ultrasound guidance versus laparoscopic assistance.
Chandra N, Dey SK, Narwar P
Afr J Paediatr Surg · 2023 · PMID 37470551 · Full text
INTRODUCTION: Intussusception is a common cause of intestinal obstruction in infants and children. Ultrasound-guided hydrostatic reduction (USGHR) with saline is considered the gold standard with a success rate of more t...
INTRODUCTION: Intussusception is a common cause of intestinal obstruction in infants and children. Ultrasound-guided hydrostatic reduction (USGHR) with saline is considered the gold standard with a success rate of more than 90%. Hydrostatic reduction with laparoscopic assistance has its own advantage of direct visualisation, assessment of bowel vascularity and controlled distension. The choice of procedure depends on available resources and surgeon's preference. This study aims to compare the outcomes of the two methods, i.e., laparoscopic-assisted hydrostatic reduction (LAHR) and USGHR under general anaesthesia (GA). MATERIALS AND METHODS: This was a prospective study carried out at two different centres over a 3-year period. All patients of intussusception were managed by either hydrostatic reduction with saline under ultrasound guidance or hydrostatic reduction with laparoscopic assistance. Both the procedures were done in operation theatre under GA. The operating time and amount of fluid used for reduction were noted. RESULTS: There were 27 patients in Group 1 (USGHR) and 20 patients in Group 2 (LAHR). The two groups were similar in terms of demographic parameters. The various outcomes such as number of attempts for reduction, fluid required for reduction, time to start oral feeds, complication and length of stay were similar in both the groups. The mean operating time for Group 1 was 19.4 ± 4.5 min and for Group 2 was 34.9 ± 4.8 min (P < 0.001). CONCLUSION: Both the procedures fare equally in terms of outcome except mean operating time, therefore, LAHR is a good alternative to USGHR in resource-poor nations where logistics of intraoperative ultrasound may not be present.
Improving patient handover: A narrative review.
Khalaf Z
Afr J Paediatr Surg · 2023 · PMID 37470550 · Full text
INTRODUCTION: The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine...
INTRODUCTION: The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective. METHODS: MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review. RESULTS: A number of handover interventions were explored. One intervention was changing the handover location to patients' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events. CONCLUSION: The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive.
Conjoined thoracopagus twins: A systematic review of the anomalies and outcome of surgical separation.
Saxena R, Sinha A, Pathak M … +1 more , Rathod KJ
Afr J Paediatr Surg · 2023 · PMID 37470549 · Full text
INTRODUCTION: Conjoined twin is an extremely rare condition and requires a thorough knowledge of anatomy, and a multidisciplinary approach is essential to successfully separate the twins. Thoracopagus twins lie face to f...
INTRODUCTION: Conjoined twin is an extremely rare condition and requires a thorough knowledge of anatomy, and a multidisciplinary approach is essential to successfully separate the twins. Thoracopagus twins lie face to face and are attached from chest to upper abdomen. They are the most common among all the varieties but have a poor survival rate. MATERIALS AND METHODS: This study is a review of literature from 2019 to the oldest via PubMed and Google Scholar using keywords: Conjoined twins, Thoracopagus twins, Thoracoomphalopagus and Thoraco-omphalopagus twins. The articles were reviewed for the description of the anatomy of shared organs, management and outcome of these twins. RESULTS: One hundred and fifty-eight sets of thoracopagus and thoraco-omphalopagus twins including our twins were included in this study. Out of 158 reported thoracopagus twin sets in literature, with M: F ratio of 1:2.3, 71 sets were found to be non-operable and all of them subsequently expired; 82 sets were operated upon, out of which 83 babies survived, suggesting an overall surgical success rate of about 50%. CONCLUSION: Thoracopagus twins have a dismal prognosis. The most important decisive parameter for successful separation is the extent of sharing of organs between twins. The role of a motivated multidisciplinary team is also indispensable and cannot be overemphasised.
Paediatric surgery on the african continent: How far have we come; How far can we go?
Numanoglu A
Afr J Paediatr Surg · 2023 · PMID 37470548 · Full text
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Diagnostic dilemma in left flank mass in an infant: A rare case of intrarenal neuroblastoma.
Kaushik A, Sherwani P, Saurya … +1 more , Garnaik DK
Afr J Paediatr Surg · 2023 · PMID 36960513 · Full text
Neuroblastoma (NBL) and nephroblastoma present with abdominal mass and various imaging features help in differentiating the two; however, localisation is difficult in large masses and at times imaging features can be con...
Neuroblastoma (NBL) and nephroblastoma present with abdominal mass and various imaging features help in differentiating the two; however, localisation is difficult in large masses and at times imaging features can be confusing. Here, we describe the case of large left-sided NBL arising from the adrenal and involving the left kidney with moderate hydronephrosis.
Tummy pain is not often what we think - Imaging findings in uncommon causes of abdominal pain in children and adolescents - A case series.
Somashekar Karanth KK, Mijar M, Shetty KB … +1 more , Sultanpuri CS
Afr J Paediatr Surg · 2023 · PMID 36960512 · Full text
Acute abdominal pain is a common complaint in children. We came across several unusual causes of acute abdomen including jejunal haematoma, perforation and abdominal abscess following hydrostatic intussusception reductio...
Acute abdominal pain is a common complaint in children. We came across several unusual causes of acute abdomen including jejunal haematoma, perforation and abdominal abscess following hydrostatic intussusception reduction, twisting of mesenteric cyst, perforation of sigmoid colon and Meckel's diverticulum presenting with intussusception. In this article, we aim to present imaging features of these entities so that paediatric surgeons, radiologists and other health-care providers are aware of these unusual manifestations of acute abdomen.
Peritonitis by perforation of the gall bladder of typhoid origin in children.
Nandiolo KR, Lohourou FG, Celestin BA … +2 more , Traoré I, Ahua Kpangni JB
Afr J Paediatr Surg · 2023 · PMID 36960511 · Full text
Peritonitis by perforation of the gall bladder of typhic origin is a rare condition. In Côte d'Ivoire, no studies to our knowledge have addressed the vesicular complications of typhoid fever in children. The aim of this...
Peritonitis by perforation of the gall bladder of typhic origin is a rare condition. In Côte d'Ivoire, no studies to our knowledge have addressed the vesicular complications of typhoid fever in children. The aim of this work was to describe the epidemic-clinical, therapeutic and evolutionary aspects of the perforation of the gall bladder of typhic origin in subjects under 15 years of age. In 6 years, five children showed a vesicular perforation of typhic origin or 9.4% of peritonites of typhic origin. They were 5 boys with an average age of 07.4 years 5-11 years. The children were from low socioeconomic backgrounds. No history was noted. Clinical examination revealed peritoneal syndrome. X-ray of the abdomen without preparation carried out in all children had objectified a diffuse greyness. Leucocytosis was present in all cases. Treatment in all children initially consisted of resuscitation and antibiotic therapy with the 3 generation cephalosporin and an imidazole. Surgical exploration revealed gangrene and perforated gallbladder without damage to other organs or the presence of stones. A cholecystectomy was performed. The following procedures were simple in 4 patients. A patient died of sepsis following postoperative peritonitis by biliary fistula. Perforation of the gall bladder of typhic origin is rare in children. It is usually discovered at the stage of peritonitis. The treatment combines antibiotic therapy and cholecystectomy. Systematic screening should reduce the progression to this complication.
Successful management of oesophageal atresia in Cameroon, Sub-Saharan Africa.
Fola OK, Jemea B, Bayiha JE … +1 more , Nonga BN
Afr J Paediatr Surg · 2023 · PMID 36960510 · Full text
BACKGROUND: Oesophageal atresia (EA) is the most common congenital anomaly of the oesophagus. Despite improvement of survival observed over the previous two decades in developed countries, the mortality remains very high...
BACKGROUND: Oesophageal atresia (EA) is the most common congenital anomaly of the oesophagus. Despite improvement of survival observed over the previous two decades in developed countries, the mortality remains very high and the management greatly challenging in resource-poor settings such as Cameroon. We report our experience of management of EA in this environment, with a successful outcome. MATERIALS AND METHODS: We prospectively assessed patients diagnosed with EA and operated in January 2019, at the University Hospital Centre of Yaounde. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures and outcomes. The study has received approval from the Institutional Ethics Committees. RESULTS: In total, six patients (three males and three females, sex ratio, 0.5; mean age at diagnosis, 3.6 days; range, 1-7 days) were assessed. A past history of polyhydramnios was found in one patient (16.7%). All patients were classified Waterston Group A at diagnosis, with Ladd-Swenson type III atresia. Early primary repair was performed in four patients (66.7%) and delayed primary repair in two patients (33.3%). Operative repair mainly involved resection of the fistula, suture of trachea and oesophagus end-to-end anastomosis, followed by interposition of vascularised pleural flap. Patients were followed up 24 months. With one late death, the survival rate was 83.3%. CONCLUSION: Improvement has been achieved in the outcomes of neonatal surgery in Africa in the past two decades, but EA-related mortality remains relatively too high. Using simple techniques and available, reproducible equipment can improve survival in resource-poor settings.
Investigation of Serum Interleukin 6, High-Sensitivity C-Reactive Protein and White Blood Cell Levels during the Diagnosis and Treatment of Paediatric Appendicitis Patients Before and during the COVID-19 Pandemic.
Gürünlüoglu K, Zararsiz G, Aslan M … +7 more , Akbas S, Tekin M, Gürünlüoglu S, Bag HG, Cin ES, Macit B, Demircan M
Afr J Paediatr Surg · 2023 · PMID 36960509 · Full text
INTRODUCTION: In this study, we prospectively investigated changes in serum interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP) and full white blood cell (WBC) counts during the diagnosis and treatment of p...
INTRODUCTION: In this study, we prospectively investigated changes in serum interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP) and full white blood cell (WBC) counts during the diagnosis and treatment of paediatric patients with appendicitis. We also investigated the effects of the COVID-19 pandemic on the diagnosis and treatment processes of paediatric appendicitis patients. MATERIALS AND METHODS: A non-perforated appendicitis group (n = 110), a perforated appendicitis group (n = 35) and an appendicitis + COVID-19 group (n = 8) were formed. Blood samples were taken upon admission and every day until the three studied parameters returned to normal values. To investigate the effects of the COVID-19 pandemic on paediatric appendicitis patients, the perforated appendicitis rates and the times from the onset of the first symptoms to the operation before and during the pandemic were compared. RESULTS: WBC, IL-6, and hsCRP dropped below the upper limits on the second postoperative day in the non-perforated appendicitis group, four to six days postoperatively in the perforated appendicitis group, and three to six days postoperatively in the appendicitis + COVID-19 group. These parameters were not within normal range in patients who developed complications during follow-up. The time from the onset of abdominal pain to the surgery was significantly longer during than before the pandemic in both the non-perforated appendicitis group and the perforated appendicitis group. CONCLUSIONS: Our results show that WBC, IL-6, and hsCRP are useful laboratory parameters that can complete clinical examinations in the diagnosis of appendicitis in paediatric patients and the identification of complications that may develop postoperatively.
Parents/Caregivers' perceptions towards use of analgesic suppositories in paediatric elective surgery.
Mgoqo N, Mogane P, Chakane PM
Afr J Paediatr Surg · 2023 · PMID 36960508 · Full text
INTRODUCTION: Despite the benefits of analgesic suppositories, there remains controversy around their administration. The perceptions of the parents and caregivers regarding this are unknown in our population. We investi...
INTRODUCTION: Despite the benefits of analgesic suppositories, there remains controversy around their administration. The perceptions of the parents and caregivers regarding this are unknown in our population. We investigated the perceptions of parents/caregivers towards the use of analgesic suppositories in elective paediatric surgery. We also explored whether parents/caregivers perceived a need for additional consent for the administration of suppositories. MATERIALS AND METHODS: This was a prospective cross-sectional study conducted at Charlotte Maxeke Johannesburg Academic Hospital, South Africa. The primary outcome was to describe perceptions of parents/caregivers towards analgesic suppositories. Questionnaire-guided interviews were conducted with parents/caregivers of children presenting for elective paediatric surgery. RESULTS: Three hundred and one parents/caregivers were enrolled in the study. Two hundred and sixty-two (87%) were female and 174 (13%) were male. Two hundred and seventy-six (92%) were parents and 24 (9%) were caregivers. There was a high level of acceptability of suppository use in 243 (81%) parents/caregivers. Majority (235, 78%) felt that they should be asked for permission before their child was given a suppository, and more than half (134, 57%) expressed that it should be in a written consent format. The parents/caregivers did not believe that suppositories would cause pain (unadjusted odds ratio [uOR]: 2.49; 95% confidence interval [CI]: 1.29-4.79; P = 0.006) but were unsure whether they would relieve post-operative pain (uOR: 0.25; 95% CI: 0.11-0.57; P = 0.001). Those who had previously used a suppository themselves were significantly more likely to accept the use of suppositories in children (uOR: 4.34; 95% CI: 1.56-12.07; P = 0.005). CONCLUSION: There was a high level of acceptability of the use of analgesic suppositories. Our population showed a unique preference for written consent over verbal consent. There was a strong positive association between previous use of suppositories by parents/caregivers and acceptance for use in children.
Simultaneous bilateral femoral fracture in children.
Modeste Ouédraogo SF, Diallo M, Tapsoba WT … +3 more , Thiombiano K, Ouedraogo I, Wandaogo A
Afr J Paediatr Surg · 2023 · PMID 36960507 · Full text
INTRODUCTION: Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting facilities are unknown. This study aims t...
INTRODUCTION: Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting facilities are unknown. This study aims to describe our experience in managing BFFC. PATIENTS AND METHODS: A 10-year ongoing study spanning from 2010 to 2020 was held in a level-1 paediatric facility. We included all cases of BFFC on a bone-free disease with at least 10 months of follow-up time. Data were collected and analysed with statistical software. RESULTS: A total of eight patients with ten BFFC were collected. It involved mainly boys (n = 7/8) with median age of 8 years. Mechanism of injury were a road traffic accident (n = 4), a fall from height (n = 3), and been crushed by a falling wall (n = 1). Associated injuries were frequent (n = 6/8). Patients were managed nonoperatively with spica cast (n = 5) and by elastic intramedullary nails (n = 3). After 6.11 years of mean follow-up time, all fractures healed. The outcome was excellent and good in 7 cases. One patient sustained knees stiffness. CONCLUSION: Non-operative management of BFFC showed satisfactory outcomes. Early surgical care must be developed in our low-income settings to reduce in-hospital stay and encourage early weight-bearing.
Caustic oesophageal stricture treated by instrumental dilatation: A review of 6 years of practice at the pediatric university hospital charles de gaulle of Ouagadougou.
Francis Modeste OS, Thiombiano K, Damba JJ … +4 more , Ouedraogo A, Doulkom PN, Ouedraogo I, Wandaogo A
Afr J Paediatr Surg · 2023 · PMID 36960506 · Full text
BACKGROUND: Oesophageal stricture is one of the most important and redoubtable complications following caustic ingestions in children. Instrumental dilatation is usually considered the first line of treatment. AIMS AND O...
BACKGROUND: Oesophageal stricture is one of the most important and redoubtable complications following caustic ingestions in children. Instrumental dilatation is usually considered the first line of treatment. AIMS AND OBJECTIVES: This study aims to evaluate the outcomes of caustic stenosis treatment when using Lerut dilatators. MATERIALS AND METHODS: This is a descriptive retrospective study from May 2014 to April 2020. All children under 15 years hospitalised in our department for caustic oesophageal stricture and had a gastrostomy and oesophageal dilatation with insertion of an endless wire were included. RESULTS: A total of 83 patients were included. The sex ratio was 2.2. The mean age was 4 years. The mean time from caustic ingestion to presentation was 90 days. Oesophageal stricture was mostly caused by caustic soda (n = 41) and potash (n = 15). We performed in total 469 dilatations and had only three oesophageal perforations. After a mean follow-up of 17 months, we had 60.2% good results (n = 50) and 7.2% (n = 6) failures. The mortality rate was 13.2% (n = 11). CONCLUSION: The results of the dilations by Lerut dilatators give encouraging results in our department. It is easy to perform and its complications remain rare. Mortality could be reduced by adequate nutritional support.
Management of ventriculoperitoneal shunt complications in children: A review of 34 cases.
Ghritlaharey RK
Afr J Paediatr Surg · 2023 · PMID 36960505 · Full text
OBJECTIVES: The primary objective of this study was to analyse the demographics of the children who presented with ventriculoperitoneal shunt (VPS) complications. The secondary objectives were to review the clinical char...
OBJECTIVES: The primary objective of this study was to analyse the demographics of the children who presented with ventriculoperitoneal shunt (VPS) complications. The secondary objectives were to review the clinical characteristics, surgical procedures performed for the management of VPS complications and the final outcome. MATERIALS AND METHODS: This is a single-institution observational study that included children below 12 years of age who required VPS revisions during the study period. RESULTS: During the study period of 10 years, n = 336 VPS catheters were implanted for the treatment of hydrocephalus in children. Forty (11.90%) children developed various VPS complications and required VPS revisions in the follow-up period. A total of n = 30 (8.92%) children (n = 21 boys and n = 9 girls) were selected/recruited for the present study, and they required n = 34 revision procedures. The mean interval from VPS insertion to the diagnosis of the complication was 7.29 months. VPS complications that required revisions occurred in the following order of frequency: (1) VPS catheter, cerebrospinal fluid (CSF) or shunt tract infection n = 8 (2.38%); (2) malfunction of distal VPS catheter n = 7 (2.08%); (3) coiling of distal VPS catheter at abdominal area n = 6 (1.78%); (4) extrusion of VPS catheter n = 5 (1.48%); (5) CSF leak from abdominal wound site/umbilicus n = 4 (1.19%); (6) malfunction of ventricular catheter n = 3 (0.89%) and (7) CSF pseudocyst peritoneal cavity n = 1 (0.29%). Surgical procedures were performed for the treatment of abovementioned complications in the following order of frequency: (1) revision of distal VPS catheter n = 14 (4.16%), (2) removal of entire VPS catheter ± external ventricular drainage (EVD) n = 7 (2.08%), (3) distal VPS catheter converted as EVD n = 6 (1.78%), (4) revision of proximal VPS catheter n = 3 (0.89%), (5) revision of entire VPS catheter n = 3 (0.89%) and (6) CSF pseudocyst excision n = 1 (0.29%). This study also documented n = 2 (6.6%) deaths during the post-operative period. CONCLUSION: VPS insertion done for the treatment of hydrocephalus in infants and children was associated with various complications. Seventy per cent of the complications occurred within the first 6 months after the VPS insertion. Two-thirds of the complications were related to the distal VPS catheter.
Experience with accelerated ponseti technique for treatment of idiopathic clubfoot in a regional orthopaedic hospital in Nigeria.
Lasebikan OA, Anetekhai WI, Asuquo JE … +5 more , Anikwe IA, Oguzie GC, Abang IE, Omoke NI, Asuquo BJ
Afr J Paediatr Surg · 2023 · PMID 36960504 · Full text
INTRODUCTION: Idiopathic talipes equinovarus (ITEV) 'aka clubfoot' is the most common foot deformity in children. Ponseti technique had been accepted as a standard method for correction. The traditional Ponseti technique...
INTRODUCTION: Idiopathic talipes equinovarus (ITEV) 'aka clubfoot' is the most common foot deformity in children. Ponseti technique had been accepted as a standard method for correction. The traditional Ponseti technique for correction is well known. Accelerated Ponseti technique is said to offer some advantages over the standard technique. The aim of this study was to determine and document the efficiency and success rate of accelerated Ponseti technique. METHODS: This was a prospective interventional study which lasted 26 months from February 2017 to April 2019. Twenty-eight patients with 42 feets who met the inclusion criteria were recruited. They had serial manipulation and casting twice every week till percutaneous tenotomy was done as indicated. Final cast usually applied after tenotomy and left for 3weeks. Each patient was followed up for a year corresponding to 9 months after the commencement of night bracing. Data were analysed using SPSS version 20. RESULTS: The mean age was 8.1 months with a range of 1-36 months. The mean Pirani score recorded was 4.4, while the mean number of casting sessions was 3.6 and the mean duration of treatment was 12.4 days. The tenotomy rate recorded was 42.9%. Pre-bracing assessment of Pirani score, passive ankle dorsiflexion and foot abduction done and repeated after a year revealed optimal correction. The relapsed rate at 1 year was 4.8%. The only complication observed was pressure sore in a patient. CONCLUSION: The accelerated Ponseti technique is an efficient method of treatment of ITEV in a much shorter time with a higher success rate. It facilitates compliance with treatment.
Urinary flow rates in anterior hypospadias: Before and after repair and its clinical implication.
Sharma SP, Chowdhary S, Kumar R … +3 more , Yadav MK, Sharma SP, Panigrahi P
Afr J Paediatr Surg · 2023 · PMID 36960503 · Full text
CONTEXT: Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. AIMS: We aimed to detect changes in urinary flow parameters both before and after tubularised incised pl...
CONTEXT: Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. AIMS: We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry. SETTINGS AND DESIGN: Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation. MATERIALS AND METHODS: This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically. RESULTS: The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively (P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement. CONCLUSION: The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty.
Delayed presentation of duodenal atresia.
Tiwari C, Borkar NB, Singh S … +2 more , Mane S, Sinha C
Afr J Paediatr Surg · 2023 · PMID 36960502 · Full text
BACKGROUND: The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients w...
BACKGROUND: The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients with delayed presentation of DA. MATERIALS AND METHODS: Retrospective review of hospital records of six patients with delayed presentation of DA due to fenestrated web managed in Paediatric Surgery Department at a tertiary care institute over a period of 2 years (January 2019 to December 2020) was done. The data of these patients were analysed on the basis of age at presentation, clinical presentation, associated anomalies, radiological findings, intra-operative findings, management and postoperative course. RESULTS: The median age at presentation was 6.5 months (range: 1 month to 10 years). There were four males and two females. The most common presentation was emesis seen in all six patients. Two patients had Down syndrome. Associated congenital anomalies were cardiac in one patient, anterior ectopic anus in one patient and malrotation of midgut in one patient. Upper gastrointestinal contrast suggested incomplete duodenal obstruction in all patients. At laparotomy, fenestrated duodenal membrane was observed in all patients - preampullary in three patients and postampullary in three patients. Lateral duodenotomy, web excision and transverse closure was done in all six patients. The postoperative period was uneventful in all patients and mean duration of hospital stay was 9 days. CONCLUSION: Fenestrated duodenal webs present a diagnostic challenge to the paediatric surgeons because of delayed and variable clinical presentation. A modification of the present classification of DA has been proposed in this study which would help in better reporting of epidemiology and aid in early diagnosis of this congenital anomaly.
Post-circumcision urethrocutaneous fistulae: presentations, repairs and outcomes in a tertiary centre.
Ugwu JO, Ekwunife OH, Modekwe VI … +3 more , Mbaeri TU, Obiechina SO, Ugwunne CA
Afr J Paediatr Surg · 2023 · PMID 36960501 · Full text
BACKGROUND: Circumcision is regarded as the most common surgical procedure world over. It is also perceived to be a simple and safe procedure; however, it could be fraught with major urological complications such as uret...
BACKGROUND: Circumcision is regarded as the most common surgical procedure world over. It is also perceived to be a simple and safe procedure; however, it could be fraught with major urological complications such as urethrocutaneous fistula (UCF). Repair of these fistulae poses a great reconstructive challenge to the paediatric surgeon/urologist with varied outcomes. AIM: We seek to review the presentations, repair and outcome of post-circumcision UCFs managed in a tertiary centre. PATIENTS AND METHODS: This is a retrospective review of all the consecutive cases of repaired post-circumcision UCFs in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria, over a period of 9 years (January 2012-December 2020). Data on demography, size of fistula, type of repair and outcome were retrieved from the Records Department and patients' case notes and were analysed using SPSS (version 22, Chicago, Illinois). RESULTS: A total of 22 boys had post-circumcision UCF repair within the period, and they were aged between 2 weeks and 108 months with a median age of 4 months at presentation and aged between 8 months and 144 months with a median age of 24 months at the time of surgery. Circumcisions were by freehand technique in 21 (95.5%). Nurses performed most of the circumcisions in 19 (86.4%), and most of the circumcisions were performed in private hospitals 7 (31.8%), maternity homes 3 (13.6%) and general hospitals in 10 (45.5%) each, respectively. Most 17 (77.3%) fistulae were coronal, and the size of defect ranged from 1 mm to 10 mm. The most commonly employed technique of repair was simple closure in 16 (72.2%). Meatal stenosis and re-fistulation occurred in 2 (9.1%) and 4 (18.2%), respectively. Only two (12.5%) required reoperation. There was no relationship between the size of defect and re-fistulation, P = 0.377. CONCLUSION: Majority of the Post-circumcision urethrocutaneous fistulae were from free hand technique of circumcisions . These were performed mostly by nurses in general, private hospitals and maternity homes. Hence, there is a need to ramp up training of providers of neonatal circumcision in our environment. Most UCF in children could be repaired with simple closure technique reinforced with dartos flap.
The candle as an improvised anal dilator following surgery for anorectal malformation.
Oyinloye AO, Wabada S, Abubakar AM … +1 more , Rikin CU
Afr J Paediatr Surg · 2023 · PMID 36960500 · Full text
INTRODUCTION: Anal dilation with Hegar dilator is recommended as part of the post-operative management following surgical correction of anorectal malformation (ARM) in children to prevent strictures. Parents usually cont...
INTRODUCTION: Anal dilation with Hegar dilator is recommended as part of the post-operative management following surgical correction of anorectal malformation (ARM) in children to prevent strictures. Parents usually continue dilation at home with a personal set of dilators. However, in low-resource settings, many parents cannot afford the Hegar dilator. Devices that have been improvised as dilators include appropriately sized candles, spigot from Foley catheter, rounded ball pen ends and mothers' fingers. We aimed to report our preliminary experience with the use of candle as an improvised anal dilator following surgeries for ARM in our practice. MATERIALS AND METHODS: A review of records of children who had surgery for ARMs and commenced on candle dilation between February 2018 and July 2019 at our centre was done. Relevant demographic information, type of anomaly, duration of dilation, availability of health insurance coverage, complications and parents' acceptance of improvised dilator (evaluated during scheduled follow up visits) were retrieved. The data were analysed using SPPSS version 21 (Chicago, Illinois). RESULTS: Nineteen patients underwent anal dilation with improvised candles during the period. Rectobulbar and rectovestibular fistulas were most frequent anomaly in boys and girls, respectively. The median age at surgery was 6 months. The median duration of dilation (completed in 9 patients) was 7 months. Candle dilation was well tolerated, and all parents were comfortable using the device. CONCLUSION: The candle as an improvised anal dilator following anorectal surgeries in children is a useful alternative to the conventional dilator. It is more affordable and gives satisfactory results.
Factors contributing to mortality in neonates with congenital diaphragmatic hernia and eventration.
Vasudev RB, Kumar N, Gadgade BD … +3 more , Radhakrishna V, Basavaraju M, Anand A
Afr J Paediatr Surg · 2023 · PMID 36960499 · Full text
INTRODUCTION: Despite all the advances, the mortality rate of congenital diaphragmatic hernia (CDH) ranges from 30% to 60% for isolated CDH and as high as 89% when they are associated with additional structural or chromo...
INTRODUCTION: Despite all the advances, the mortality rate of congenital diaphragmatic hernia (CDH) ranges from 30% to 60% for isolated CDH and as high as 89% when they are associated with additional structural or chromosomal anomalies. Hence, a study was conducted to evaluate the factors contributing to the mortality of neonates treated for CDH or the eventration of diaphragm. MATERIALS AND METHODS: A retrospective study was conducted in the department of paediatric surgery at a tertiary centre. The neonates admitted with a diagnosis of CDH or eventration requiring surgery, between March 2013 and March 2021, were included in the study. RESULTS: A total of 123 neonates were included in the study. The variables, earlier median age at presentation (1 [1-23] vs. 3 [1-28]; P < 0.001; Mann-Whitney U-test), preterm birth (10/79 vs. 0/44; P = 0.01; Fischer's exact test), inborn (68/79 vs. 27/44; P = 0.002; Chi-square test), weight ≤2 kg (18/79 vs. 1/44; P = 0.003; Chi-square test), central cyanosis at presentation (21/79 vs. 1/44; P < 0.001; Chi-square test), antenatal detection (47/79 vs. 14/44; P = 0.003; Chi-square test) and earlier mean age at surgery (3.66 ± 1.47 vs. 7.66 ± 6.88; P < 0.001; Independent sample t-test) were associated with increased mortality. On multinominal logistic regression analysis, the factors preterm (odd's Ratio [OR] =4.735; P = 0.03), weight ≤2 kg (OR = 5.081; P = 0.02), central cyanosis at presentation (OR = 6.969; P = 0.008) and antenatal detection (OR = 7.471; P = 0.006) were found to be independently associated with increased mortality in CDH/eventration. CONCLUSION: The factors: prematurity, weight <2 kg, cyanosis at presentation and antenatal diagnosis were independently associated with increased mortality in neonates with CDH/eventration requiring surgery.
Prof Michael Akintayo Bankole: A gentle giant and pioneer paediatric surgeon in Nigeria.
Ademuyiwa A, Ekwunife H, Nasir A
Afr J Paediatr Surg · 2023 · PMID 36722577 · Full text
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