Background: The pattern of abdominal surgical emergency may not be the same in different settings because of changes in demography, diet, socioeconomic or geographical factors. We present the pattern, management and outcome of such emergencies in Ile Ife, South Western Nigeria. Aim: To document the pattern of abdominal surgical emergency in our environment with a view to highlighting the management and outcome. Because, superstitiously our people mostly think toward poison as the cause of abdominal pain, it is justified to do this study. The societal meaning of poison refers to a situation whereby someone's friend or relative introduces a deadly substance or material into his drink or food which will eventually lead to morbidity or mortality. It is thought that the introduction of deadly poison could be physically done or diabolically in form of spiritual attack. Materials and Methods: This was a retrospective review of data collected in Obafemi Awolowo University Teaching Hospital Ile Ife, Osun State, Nigeria between June 2006 and June 2012. Patients with abdominal surgical emergencies exclusive of gynecological cases were consecutively entered into the study at the time of presentation and followed-up. The frequencies of different diagnosis and age distribution were recorded. The indications for operative intervention, management and outcome were also highlighted. Results: Of the 8001 cases presenting with abdominal pain in our hospital, 2408 (28.8%) required surgery. Males were 1445 (60.1%), while 963 (39.9%) were female patients with a mean age of 35.9 years. Uncomplicated appendicitis was the most common indication for surgery (61.3%), obstructed hernias constituted the most common etiological factor in intestinal obstruction (51.2%), while postoperative bands and adhesions accounted for 14.6%. Ruptured appendix and typhoid perforation accounted for 32.4% and 18.9% of peritonitis, respectively. The spleen was the most affected intra-abdominal organ in cases of abdominal trauma. Three patients had repair of the spleen. 16 (0.7%) had emergency surgery for complicated duodenal ulcer, repair of burst abdomen accounted for 48 (2.1%) cases of emergency abdominal surgery. Postoperative death was 1.1%. Delayed presentation increased mortality. Conclusions: Surgery for appendicitis is the commonest emergency abdominal surgery. Others include operations for peritonitis, trauma and strangulated inguinal hernia. Delayed presentation contributed to delayed intervention in some cases which impact negatively on treatment outcome. No single case of abdominal pain secondary to ingestion of the so called poison was seen during the study period

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Laryngomalacia is the most common cause of stridor in infants. It is diagnosed clinically. Treatment is not required in the majority of cases, only 10% require some surgical intervention. We present a case report of a 2-month-old child with severe laryngomalacia for whom we did supraglottoplasty and achieved good results.

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Background: Various multimodal techniques have been employed time and again to allay visceral pain after laparoscopic cholecystectomy. Aim: The aim of this study was to assess and compare the postoperative pain relief in patients undergoing laparoscopic cholecystectomy with intraperitoneal administration of bupivacaine, magnesium sulfate and their combination. Materials and Methods: Patients were randomly divided into four groups of 20 each. Patients in group I "C" received 50 ml of 0.9% saline, group II "B" received 50 ml of 0.25% bupivacaine, group III "M" received 50 ml of 30 mg/kg magnesium sulfate, while patients in group IV "MB" received 0.125% of bupivacaine with 15 mg/kg of magnesium sulfate to a total volume of 50 ml after surgery. Postoperatively pain was assessed using visual analog scale (VAS) and postoperative pain (VAS > 3) was managed with intravenous tramadol 50 mg. Time to the first request of analgesia, the total number of analgesic doses of tramadol, the incidence and severity of postoperative shoulder pain in 24 h and presence of complications if any were noted. Results: Demographic profile of patients of all the four groups was comparable and statistically nonsignificant. Intraperitoneal instillation of 0.25% bupivacaine provided longest duration of analgesia for 541.5 ΁ 131.48 min with a significant reduction in the number of doses of intramuscular tramadol in 24 h. Intraperitoneal instillation of 30 mg/kg magnesium sulfate provided analgesia for 82.25 ΁ 35.37 min with no significant reduction in a number of doses of intramuscular tramadol in 24 h when compared to control. Intraperitoneal instillation of mixture of bupivacaine and magnesium sulfate in reduced doses, that is, 0.125% bupivacaine and 15 mg/kg magnesium sulfate provided analgesia for 305 ΁ 65.64 min with a significant reduction in a number of doses of intramuscular tramadol in 24 h. There was reduced incidence and severity of shoulder pain, which was comparable in all the four groups. No significant side-effects were seen in any of the groups. Conclusion: Intrape-ritonel administration of bupivacaine, magnesium sulfate and their combination in reduced doses provides effective postoperative analgesia in laparoscopic cholecystectomy patients though their combination when the doses of both the drugs were reduced to half was less effective than bupivacaine group alone. Furthermore, bupivacaine and magnesium sulfate serve as useful adjuncts to postoperative analgesics.

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Background: Adhesive small bowel obstruction (ASBO) is the commonest form of small bowel obstruction. The treatment regime for ASBO is not universal. Contrast-enhanced computed tomography (CECT) has been advocated as a valuable procedure to evaluate ASBO. The aim of the present study was to evaluate the contribution of CECT in decision making in the management of patients with ASBO due to postoperative adhesions. Materials and Methods: The duration of this study was 2 years. All patients clinically diagnosed as ASBO with history of clinical symptoms for more than 24 h and any abdominal operation more than a month ago were included in this study. They underwent CECT, which was evaluated for the presence of dilated bowel loops proximal to the transition zone and collapsed distal small bowel loop, presence of complication viz. strangulation and closed loop/volvulus. Results: A total of 30 patients was evaluated. Based on CT findings, the level of obstruction was determined in all the 30 patients. The level of obstruction could be confirmed in nine patients, in which laparotomy was performed, and was same. Complicated small bowel obstruction was predicted in ten patients. The diagnostic accuracy of CT scan was excellent having sensitivity of 100%, specificity of 95.3%, and accuracy of 96.7%. Conclusion: Contrast-enhanced computed tomography abdomen appears to be a safe, quick to perform, and reliable adjunct to clinical examination in the management of patients with ASBO. It is sensitive, specific, and accurate for diagnosis of obstruction, detection of level of obstruction, and complication of obstruction. CT scan appears to be able to sort patients of complicated ASBO, who will require immediate surgical management.

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Endometrioid adenocarcinomas are the most common form of endometrial adenocarcinoma in postmenopausal women. It is stressed that histological grade corresponds to the stage of the tumor and has an impact on the prognosis and survival of the patient. We present a case of 45-year-old female patient who presented with grade 1 endometrioid adenocarcinoma involving bilateral ovaries and peritoneal washings, corresponding to stage IIIa tumor. She also showed the synchronous presence of serous cystadenoma of the right ovary. We report this case as it is an advanced stage endometrioid adenocarcinoma with lower histological grade and also due to the synchronous presence of right ovarian serous cystadenoma.

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Migration of femoral Küntscher intramedullary nail (K-nail) proximally or distally within the femoral medullary cavity is a well-known documented complication, but spontaneous extrusion of a distally migrated K-nail through a sinus is a complication which has not been previously reported in the literature. This is the case report of a 32-year-old woman who presented with spontaneous extrusion of a Küntscher nail 6 years postinsertion. The underlying etiology and pathogenesis of the extrusion is subject to controversy and speculation. Infection and delayed union with shortening are etiological possibilities. Faulty selection of K-nail size: Loose fitting nail, disuse osteoporosis, and premature weight bearing may also be contributory factors.

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Background: Cervical cancer is a preventable disease; however, the incidence is still regrettably high in most countries of sub-Saharan Africa. Aim: To ascertain the socio-epidemiological determinants of invasive cervical cancer at the Imo State University Teaching Hospital, Orlu. Patients and Methods: A retrospective analysis of all patients with histologically confirmed cancer of the cervix at the Department of Obstetrics and Gynecology of the Imo State University Teaching Hospital, Orlu from June 1, 2004 to December 31, 2013. Results: Cervical cancer accounted for 54.0% of all histologically confirmed cancers. The ages of the patients ranged from 21 to 90 years with a mean of 51.6 ± 3.2 years. Majority of the patients were aged 35-63 years. Most of the patients, 175 (88.8%) belonged to the poor socioeconomic class and 177, (89.3%) were married. The incidence of the disease increased with increasing parity with grand multiparous patients constituting 161, (81.4%) of the cases. The commonest symptom at presentation was abnormal vaginal discharge 84, (82.4%) with 70 (35.3%) of the patients presenting within 2-5 months of the onset of symptoms. Advanced disease, stage III and above, 66 (64.7%) was the commonest stage at presentation. Conclusion: The incidence of cervical cancer is still unacceptably high at Orlu. Opportunistic Cervical cancer screening needs to be adopted as an interim measure, while awaiting an organized systematic screening with a good call and recall system.

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Carcinoma of the prostate is the most common malignant tumor in men over 65 years of age, and the prostate is the most common site of origin for skeletal metastases. The femur is the long bone most commonly affected by metastatic prostate disease resulting in pathologic fractures. Internal fixation with the proper constructs is the standard treatment for metastatic diaphyseal femoral fractures secondary to carcinoma of the prostate in well-equipped hospitals in developed countries. In developing countries such as ours where many of the hospitals are ill-equipped, and these constructs are hardly available, cast splintage is a viable alternative to being considered. It is efficacious as demonstrated in this case report of a patient with bilateral metastatic diaphyseal femoral fractures treated with bilateral high above knee full casts. Casting materials are cheap, readily available, and affordable, and patients are discharged home early.

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