Acute urinary retention in adolescent females is rare, just like imperforate hymen. We present a case of acute urinary retention secondary to imperforate hymen in a 14-year-old Nigerian girl. Its diagnosis and treatment are discussed with a brief review of literature. We highlight the need for a thorough evaluation in the female patient presenting with acute urinary retention, and also the need to provide better health facilities in rural areas in developing countries such as ours.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

A 40-year-old, apparently healthy farmer presented with a 4-day history of progressively painful penile erection with no known predisposing or precipitating factor. He had an emergency El-Ghorab shunt which resulted in almost complete detumescence. He was noticed to have developed ischemic changes of the distal part of the penile skin which progressed to gangrene of the distal part of the penis on the 4th day post intervention. Abdomino-pelvic ultrasound revealed an intravesical mass and urine and corpus cavernosa aspiration cytology were positive for malignant cell. The patient, however, declined further treatment and was discharged against medical advice.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Two cases of fetus-in-fetu, on which we performed surgery in 2003 and 2006, are being reported. Both the cases presented with a lump in the abdomen. Radiology confirmed the diagnosis. The lumps were found in the retroperitoneum and successfully excised. Because of the rarity of the condition, these two cases are being reported with relevant salient features and are discussed in the light of available literature.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background and Objective : The Stracathro approach to the hip is a modification of the lateral approach, which was popularized by Hays and McLauchlan. It has a high safety profile and a low rate of hip dislocation. However, the need for osteotomy increases blood loss, risk of intraoperative fracture, and postoperative heterotopic calcification. In sub-Saharan Africa, where traditional healers dabble in the treatment of all musculoskeletal conditions, extensive soft tissue contractures and disuse osteoporosis arise and further complicate the lateral approach. The objective of this article is to highlight modifications made to the stracathro approach and present the short-term results in a group of 26 patients, who had hemiarthroplasty using this technique. Materials and Methods: All patients presenting with subcapital or transcervical fracture of the femoral neck after the age of 50 years were offered hemiarthroplasty using the modified Stracathro approach, with follow-ups for a period ranging from 28 - 84 months. Results: A majority (23 out of 26 - 88.5%) of patients presented late for the treatment, due to the patronage of traditional bonesetters. In spite of the soft tissue contractures and osteoporosis associated with late presentation, there was no case of intraoperative fractures. The patients had good hip abduction postoperatively. In addition, there was no intraoperative nerve or vascular injury. Conclusion: The short-term results in this group of patients showed that the modified Stracathro approach was safe and useful in hemiarthroplasty, for patients with soft tissue contracture and osteoporosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objectives: Foraminotomy is a simple posterior surgical approach useful for treatment of radicular (nerve root) pain in TB spondylitis. It doesn't affect the stability of the facet joint, requires neither fusion nor implants. It is therefore cheap and affordable for patients with low income. We describe a simple form of posterior spinal surgery for patients with tuberculous spondylitis. Methods: Out of the 45 cases of Pott's disease managed from Jan 2006-Jan 2008, three patients had foraminotomy due to failed medical treatment. An additional discectomy was performed in one patient. Foraminotomy involves the removal of lateral half of adjacent laminae and medical half of the facet joint. The ligamentum flavum and the epidural fat are cleared to free the nerve root. No implant or fusion is required. Results : All the three patients improved post operatively. Physiotherapy was started on 7 ^th day after surgery. The pain completely resolved in two patients while the third one had a remarkable improvement at discharge. They were all able to walk without support. One patient is still on regular follow up and has a power of 5/5 in both lower limbs while the remaining two were lost to follow up at 5 and 8 months post surgery. They both had power of 4/5 at the time they defaulted. Conclusion : Foraminotomy with or without discectomy is a simple posterior surgical approach to T B spine with good neurological outcome. It is adapted to our environment because no fusion or implant is required.

[ABSTRACT]  [FULL TEXT]  [PDF]

Cranioplasty is a common, but formidable surgical procedure for neurosurgeons, in patients with scalp and / or calvarial defects. This procedure can be simple or complex. The main objectives of cranioplasty are: To achieve primary wound healing, obliterate dead space, and seal off sterile cranial areas from contaminated oronasal cavities, to restore the normal barriers protecting the intracranial structures (together with a satisfactory cosmetic result) and obtain a permanent or very durable reconstruction, using biologically inert materials, and also to restore the aesthetics. The greatest problem is selecting the optimum material for repair of the cranial defect. Many synthetic substitutions of the dura and bone are often used for reconstruction of the skull base; unfortunately, these methods bear significant disadvantages and can induce chronic inflammation, carry a high risk of infection, and are inferior to biological sources in terms of strength and sealing quality [with the exception of some materials, such as titanium mashes and CortossTM (Orthovita^® , Malvern, USA), which are seen to have more strength than the thin split thickness calvarial bone]. The primary aim of this article is to review the basic principles to use the split calvarial graft for the reconstruction of the skull defect.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Remote supratentorial hematoma soon after posterior fossa surgery for the removal of a space-occupying lesion is a rare but dramatic and dreaded complication, carrying significant morbidity and mortality. A 47-year-old woman presented with headache of 1-year duration that worsened over last 2 months, progressive ataxia of 2 months' duration, blurring and diminution of vision of 2 months' duration and forgetfulness of 2 months' duration. Fundus showed bilateral papille dema, and visual acuity was 6/9 in both eyes. She had left-sided cerebellar signs. There were no focal motor or sensory neurological deficits. MRI brain with contrast showed a large posterior fossa tumor with obstructive hydrocephalus. The patient underwent left paramedian suboccipital craniectomy in prone position with left side up. In the immediate postoperative period, the patient did no recover from anesthesia and was persistently drowsy. Immediate repeat CT scan showed diffuse subarachnoid hemorrhage spread all over the bilateral cerebral hemispheres with diffuse cerebral edema. The patient recovered with conservative management without deficits. This case stresses the importance of early postoperative CT scan and optimal management of the hemorrhage for good outcome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Although autogenous materials have been used in abdominal wall hernioplasty for a long time, the introduction of prosthetic materials diminished their popularity. However, these materials may be expensive, inappropriate or unavailable. The aim of this study is to determine the place of de-epithelialized dermal flap in the reconstruction of abdominal wall hernias. Materials and Methods: A five-year prospective, descriptive analysis of eligible patients with difficult abdominal wall hernias closed with de-epithelialized dermal flap in a Nigerian Tertiary Health Institution, from January 2001 to December 2005. Results: Over the five-year period, 37 patients were recruited into the study. There were 11 males and 26 females, giving a male: female ratio of 1: 2.4. The ages ranged from 8 months to 47 years (mean = 12.6 years). The defects consisted of 15 incisional hernias, 12 intermuscular/inferior lumbar hernias, nine healed exomphalos major and two giant umbilical hernias. The size of the hernia defects ranged from 4.5 cm to13cm (mean = 6.4 cm). Three patients had bowel resection and end-to-end anastomosis, in addition to the flap reconstruction. Morbidity was minimal and included skin dimpling in 11 patients, seroma in three, and wound infection in two patients. Neither recurrence of herniation nor mortality was recorded during the period of follow-up, which ranged from three months to 4.5 years (mean = nine months). Conclusion: The results suggest that this is a useful technique that can easily be applied in many centers with minimal resources. It is cheap, effective and associated with minimal morbidity.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

To present anastomosis with cyanoacrylate as a cheap, simple, fast, and available technique for anastomosis in urological, vascular, gynecological, and general surgical procedures. This method may in the future be a good alternative to microsurgery, particularly in centers where facilities are unavailable and the financial implication is unbearable for the patient. Cyanoacrylate is an adhesive or glue that is available in different chemical forms ranging from ethylcyanoacrylate (superglue) to Isobutylcyanoacrylate and octylcyanoacrylate (dermerbond), which is in clinical use. Anastomosis with cyanoacrylate requires the application of stay sutures, a luminal stent and the subsequent application of the adhesive. The adhesives with lower molecular weights produce a rigid and patent region of anastomosis, while the higher molecular compounds produce a consistency close to the normal tissue. This technique presents a surgical method that is socially, culturally, and ethically acceptable, which is affordable to a larger majority of patients in our subregion. Cyanoacrylate anastomosis may in the future present a fast, convenient, simple, and affordable option in the treatment of patients requiring anastomosis. In our subregion where the socio-cultural, psychological, and economic burden of failed anastomosis is high, associated with the low per capital income, this may be a novel option for the management of urogynecological, vascular, neurosurgical, and general surgical procedures requiring either microscopic or macroscopic anastomosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Advanced laryngeal cancers presenting with upper airway obstruction are a common scenario in Sub-Saharan Africa, requiring operative intervention as a priority. Objective: To assess outcome of total laryngectomy as a treatment option in the surgical management of advanced laryngeal cancers in a tertiary health institution in northwestern Nigeria. Materials and Methods: A retrospective analysis of total laryngectomies for laryngeal cancers carried out by one surgeon from December 2000 to August 2009. Results: Out of 30 patients with histologically diagnosed laryngeal cancer, 18 were treated with total laryngectomy Fourteen (77.8%) were males, while 4 (22.2%) were females, with a male-to-female ratio of 3.5:1. The age range was 20-70 years with a mean age of 47years for males and 33.8 years for females. Total laryngectomy was carried out on T4 lesions (100%), with preoperative tracheostomy (100%) carried out as an emergency measure to relieve upper airway obstruction. Two female patients had safe vaginal deliveries after their surgeries. Although all patients were referred for radiotherapy, only 6 (33.3%) patients could afford postoperative radiotherapy, with a 5-year survival rate of 33.3%; while all others could not afford the cost of radiotherapy treatment, which was to be carried out at a center about 5 hours drive away from our center. Seven (38.9%) patients presented with recurrent neck nodal disease, while 3 (16.7%) had carotid blow-out hemorrhage that was fatal. Conclusion: Total laryngectomy remains an important surgical modality of treatment for advanced laryngeal cancers, as it affords the patient an opportunity of longer survival when combined with postoperative radiotherapy. It is superior to 'radiotherapy only' or 'surgery only' or nothing.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Mucoceles of the paranasal sinuses are not common, but usually present as cystic lesions causing facial asymmetry requiring surgery. Hitherto surgical attempts at excision were external surgical approaches with the use of stents to drain the frontoethmoidal sinus, if they were the principal sinus involved, for a variable period. Recent advances in endoscopic sinus surgery have made the endoscopic approach to surgically manage paranasal sinus mucoceles the new trend. A total of 18 patients were seen over a ten-year period with paranasal sinus mucocele; 14 cases were managed through the external approach, while four were consecutively managed endoscopically. The endoscopic approach in the surgical management of mucoceles of the paranasal sinuses and the external approach are discussed in this article with the intent of showing the advantages of the two approaches, with more emphasis on the endoscopic approach and caution that should the endoscopic approach prove difficult, reversal to the external approach should be undertaken immediately, so as to avoid unnecessary complications.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome is a rare anomaly characterized by congenital aplasia of the uterus and vagina in women showing normal development of secondary sexual characters and normal 44 XX karyotype. We report our experience in the management of two patients with congenital absence of the vagina due to the MRKH syndrome. The first case was a 24-year-old student, who presented with primary amenorrhea, uterovaginal agenesis, right pelvi-ureteric junction obstruction, and left renal agenesis. The second patient was a 24-year-old housewife, who presented with primary amenorrhea and inability to achieve penetrative sexual intercourse. She had vaginal atresia and a grossly hypoplastic uterus. Both had successful sigmoid colovaginoplasty and are sexually active. Vaginal reconstruction using the sigmoid colon saw an immediate and satisfactory outcome in both patients

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction : Foot disorders such as ulceration, infection and gangrene are the most common, complex and costly sequelae of diabetes mellitus. ^[1],[2],[3] Even for the most superficial wounds, treatment is often difficult with poor healing responses and high rates of complications. The purpose of this study is to compare the rate of ulcer healing with the negative pressure dressing technique to conventional moist dressings in the treatment of diabetic foot ulcers. Materials and Methods : The study was conducted on 30 patients, which were divided into two groups. One group received negative pressure dressing while other group received conventional saline moistened gauze dressing. Results were compared for rate of wound healing. Results : There was a statistically significant difference in the rate of appearance of granulation tissue between the two groups; with granulation tissue appearing earlier in the study group. The study group promised a better outcome (80% complete responders) as compared to the control group (60% complete responders). Conclusions : Negative pressure wound therapy has a definitive role in healing of diabetic foot ulcers.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Aim: To determine cosmetic and functional outcome following lateral strip procedure (LSP) for involutional entropion. Materials and Methods : This study was a prospective analysis of 15 patients (20 eyelids) of involutional entropion, who needed surgical repair. After thorough evaluation, the surgical treatment (LSP) was done in all 15 patients. Results: Cosmetic and functional outcome was excellent in all cases following LSP. No complications and recurrence were encountered in any case. Conclusions : LSP is simple, physiologic, easy and quick to perform as OPD procedure for involutional entropion under local anesthesia without hospitalization by a general ophthalmologist.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The introduction of circular end-to-end stapling devices (CEEA OR EEA stapler) into colorectal surgery have revolutionised anastomotic techniques. The EEA stapler is generally regarded as an instrument that is safe, reliable, and simple to operate. Despite it's popularity, very little information is available regarding the technical difficulties encountered during surgery. The routine technique to perform an end-to-end circular colonic anastomosis is to introduce the instrument distally through the anus (transrectal/transanal approach) and attach it to the anvil which is purse stringed at the distal end of the proximal bowel to be anastomosed. Two cases of reversal of Hartmann's procedure for perforated diverticulitis are described in the present study, where difficulty was experienced while using the EEA stapler in the routine method. Hence, an alternative reverse technique which was used is presented.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Objectives : The level of fibular osteotomy has a role in the incidence of peroneal nerve palsy (PNP). This study aims to compare the prevalence of PNP among patients who had fibular osteotomy at two different levels. Materials and Methods: Sixty-nine limbs in fifty-two patients had valgus osteotomy of the proximal tibia and fibular osteotomy at two different levels - the proximal half (Group 1) and distal half (Group 2). The results of these were compared. Results: The incidence of peroneal nerve palsy was 23.6 and 3.2% in Groups 1 and 2, respectively ( P < 0.025). Conclusion: This study supports the choice of the distal half for fibular osteotomy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objective: To present a technique of stricture exposure in Quartey's urethroplasty. Methods: A retrospective analysis of case files of seven patients that underwent perineo-penile degloving (PPD) exposure for Quartey's urethroplasty was done and formed the basis of this communication.The perineo-penile degloving exposure involves a midline perineal incision to expose the bulbar urethral and a circumcising incision to deglove the penis which is later delivered to the perineum through the retro-scrotal tunnel. The urethroplasty is then done in a single operation field. Results : Seven patients with long segment urethra stricture were repaired using PPD exposure during the study period. The age ranged from 35 to 70 years with a mean of 48.6±11.1 years. The peno-bulbar site was involved in six (85.7%) of the patients. The mean intra-operative length of the stricture is 7.6±1.5cm. All the patients had Quartey's flap for their reconstruction under spinal anaesthesia with mean operation time of 3.16±0.50 hours (range 2.30 - 4.00 hours). They all had ventral on-lay repair except for one patient who had tubularization of the flap and anastomosis. Three of the patients had excellent short-term outcome. However, one patient developed slight distal penile skin necrosis, two patients had perineal wound infection and one patient could not void despite patent urethra post­operatively. Of the patients, only one had extravasation of contrast on pericatheter urethrogram which warranted leaving the urethral catheter for one more week. The mean follow-up period was 8.3΁4.5 months with a range of 3 to 14 months. There has being no evidence of recurrence clinically or urodynamically thus far. Conclusion : PPD is convenient and allows tension-free, water-tight reconstruction in a single operation field with a comparable short-term outcome.

[ABSTRACT]  [FULL TEXT]  [PDF]

Myelomeningocele is the most common form of the spinal dysraphism. The objective of this paper is to describe a simple surgical technique for repair of myelomeningocele as it is carried out in our centre. Most of our patients present beyond the 'golden hours' (24-36hours) for emergency repair with an already infected or ruptured lesions and therefore have to be on dressing of the wound to allow for complete healing. Surgery is just one aspect of management of patients with myelomeningocele. The urologist, orthopaedic surgeon, paediatrician, psychotherapist and physiotherapist all play a major role in the early and late management of these patients as a team. The aim of surgery is to recreate anatomic barriers over the delicate neural tissues preventing their desiccation and retrograde infection. It is to be emphasized that the repair does not improve the neurological deficits already present at birth and this must be properly explained to the family of the patient.

[ABSTRACT]  [FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Spinal dural meningoceles and diverticula are meningeal cysts that have a myriad of clinical presentations and sequelae, secondary to local mass effect. Our objective is to report a technical case report, illustrating a traumatic spinal injury with multiple pedicle fractures, secondary to atrophic lumbar pedicles as well as the diagnostic workup and surgical management of this problem. Posterior lumbar decompression, resection of the meningeal cyst, ligation of the cyst ostium, instrumentation, and fusion were performed with the assistance of intraoperative isocentric fluoroscopy. The cyst's point of communication was successfully located with intraoperative fluoroscopy and the lesion was successfully excised. We suggest that patients with traumatic spinal injuries, having evidence of pre-existing anomalous bony architecture, undergo advanced imaging studies, to rule out intraspinal pathology. The positive clinical and radiographic results support the removal and closure of the pre-existing meningeal cyst at the time of treatment of traumatic spinal injury. Intraoperative isocentric fluoroscopy is a helpful tool in the operative management of these lesions.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Objective: Tumors of the nose and paranasal sinuses are of various aetiology. They originate from different sites and cause facial asymmetry. Cystic lesions are rare but may mimic tumours. This study reports surgical excision of cystic upper jaw lesions. Materials and methods : A prospective recruitment of all cases of cystic lesions of the upper jaw seen in two tertiary health centres and analysis of surgical management were carried out over a nine and a half year period (Sept1999-feb 2009). Results :Ten cases of cystic lesions were seen 6 in females and 4 males aged between 13 and 45years.They accounted for 9% of 111cases of tumours of the nose and paranasal sinuses seen during the period. Five cases were naso-alveolar or nasolabial cysts, 3 were dentigerous cysts, while 2 were mucoceles of the maxillary sinus.These were excised without recurrences after a minimum period of one year follow up for nine cases while one case is still being followed up. Causes and management of cystic swellings of the maxilla are discussed and compared with world literature. Conclusion : Cystic lesions of the maxilla causing facial asymmetry constituted 9% of cases of tumours of the nose and paranasal sinuses seen in north western Nigeria. Although cystic lesions of the upper jaw are rare, they are amendable to surgical excision if the root or sources are completely extirpated.

[ABSTRACT]  [FULL TEXT]  [PDF]

Snake-bite can be both life and limb threatening, especially when there is envenomation. Early intervention in a fairly equipped health facility can go a long way in preventing the morbidity and mortality that can result from delay in initiating treatment. In this paper we report two cases of snakebite to the lower limbs in children that were both complicated by gangrene which led to major limb amputation in both. These are avoidable complications that should have been averted by appropriate care immediately after the snake-bite.

[ABSTRACT]  [FULL TEXT]  [PDF]

Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]