Lipomas are benign tumors composed of mature fat and are usually encapsulated. Majority of them are small and grow slowly. They are derived from mesenchymal tissue and are usually found wherever there is fatty tissue. Lipomas rarely occur in the breast and can cause diagnostic uncertainty. We present a case of a 40-year-old female who anxiously presented with a mass in her right breast that she thought it was cancer, but later confirmed after excision on histology as lipoma.

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Aim: The aim of the following study is to document the outcome of cervical cerclage in pregnancy. Materials and Methods: A retrospective analysis was undertaken of patients who had cervical cerclage for cervical incompetence at the Obstetrics and Gynecology Department of the University of Benin Teaching Hospital, Benin-City, Nigeria from January 2007 to December 2012. The cerclage was termed successful if the pregnancy was carried to term. Multiple demographic and clinical characteristics and their relationship to cerclage outcome were analyzed. Results: The records of 123 patients who underwent cerclage over the 6 years period reviewed were analyzed. The mean age was 33.3 ± 3.9 and majority (68.3%) were multiparous, with most of them (90.2%) having had a previous miscarriage. Majority (90.2%) had elective cerclage and 4 (3.3%) had emergency cerclage. Overall majority of patients delivered at 37 and 38 weeks gestation 23.6% and 19.5% respectively. Outcome of cerclage was adjudged successful in 92 (74.8%) of cases and failed in 31 (25.2%) cases. The most frequent complication was pre-viable or preterm rupture of membranes (14.6%). Cerclage outcome was not influenced by age, parity, gestational age at cerclage or experience of the surgeon. The mean duration for which pregnancy was prolonged after an emergency cerclage was 2.6 ± 2.4 weeks and emergency procedure was significantly associated with a failed cerclage. Of the 111 patients with previous miscarriages who had cerclage procedure, 68 (61.3%) had term deliveries and 23 (20.7%) preterm births. Fetal salvage rate of 98 (79.7%) was observed. Conclusion: Use of cerclage for suspected cases of cervical incompetence can have an important beneficial effect in carefully selected cases of cervical incompetence even amongst pregnant black African women.

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Background: Upper gastrointestinal (GI) bleeding is a medical emergency that remains a common cause of morbidity and mortality worldwide. The aim of this study was to determine the common causes of upper GI bleeding in the University of Benin Teaching Hospital, South-Southern Nigeria. Methods: Records of all patients referred with upper GI bleeding to the endoscopy unit of the University of Benin Teaching Hospital from February 2006 to January 2013 were reviewed. Relevant data and findings at diagnostic upper GI endoscopy were retrieved from the endoscopy register. Data obtained were analyzed using Statistical Package for Social Sciences version 15.0. Results: A total of 1084 patients had upper GI endoscopy during the study, of those 311 (28.7%) had upper GI bleeding. The mean age of patients with upper GI bleeding was 51.48 ± 17.5. Range was 14–90 years and the male: female ratio was 2.04:1. The most common cause of upper GI bleeding was peptic ulcer disease (PUD), found in 102 (32.8%) cases, followed by gastritis in 88 (28.3%) cases. Esophageal varices accounted for 47 (15.1%) cases whereas duodenitis was found in 16 (5.1%) cases. Carcinoma of the stomach occurred in 13 (4.2%) cases while 12 (3.9%) patients had esophagitis. Gastroesophageal reflux disease accounted for 11 (3.5%) cases whereas esophageal ulcers occurred in 3 (1.0%) cases. Carcinoma of the esophagus and esophageal candidiasis each constituted 2 (0.6%) cases. The cause of bleeding was not found in 15 (4.8%) patients. Conclusion: PUD is the most common cause of upper GI bleeding in patients undergoing endoscopy in the University of Benin Teaching Hospital, South-Southern Nigeria.

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Introduction: Inflammation has been shown to play a major role in the pathogenesis of most malignancies including breast cancer. The inflammatory basis of breast cancer has not been evaluated in our environment. Objective: The purpose of this study is to determine the level of some biomarkers of systemic inflammation in patients with breast cancer compared to those of apparently healthy subjects without the disease in Benin City, Nigeria. Methodology: This is a case control study conducted in Benin City, Edo State, Nigeria. Breast cancer patients from Central hospital, Benin City and controls from the general population had their venous blood sampled and analyzed for Erythrocyte Sedimentation Rate (ESR) and C-Reactive Proteins (CRP) levels using standardized laboratory methods. Data were analyzed using SPSS (version 17). Results: Results showed a statistical significant increase (P < 0.05) in both ESR and CRP levels of patients with breast cancer compared to the control. There is also a significant positive correlation (P < 0.001) between ESR and CRP in the study population. Conclusion: These findings support the fact that inflammation is a risk factor for the development of breast cancer and this association might be of clinical significance as these inflammation markers might be of prognostic value.

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Background: The treatment protocol for penetrating chest injury has not been previously documented in our setting for open pneumothorax. We decided to use the horizontal mattress suture closure (HMSC) because of the initial problems of using the traditional three taping method to abolish the open pneumothorax following penetrating chest injury. This retrospective study was to evaluate the effect of HMSC of open pneumothorax in penetrating chest trauma and to determine the outcome. Methods: We retrospectively examined 65 patients with open peumothorax following penetrating chest trauma treated at the Thoracic Surgery Unit of University of Port Harcourt Teaching Hospital and the Federal Medical Centre, Owerri between January 2012 and December 2014. We assessed the impact of HMSC on chest wound following penetrating thoracic trauma. Excluded were patient who required a thoracotomy. No ethical consideration was required for this retrospective study. Results: Sixty-five (25.4%) patients out of 256 who had chest trauma were managed for open pneumothorax following penetrating chest injury. There were 59 males and 6 females, aged 4-55 years (mean age, 29.9 ± 9.7 years). The causes of penetrating chest injury were gunshot injury in 44 patients (68%), stab injury in 20 patients (30%), and gunshot and stab injury in two patients (3%). The mean time between sustaining the injury and presentation at the emergency was 16.1 ± 34.2 h with 40 patients (61.5%) presenting within 12 h. Thirty-three patients had pneumohemothorax, 12 had only pneumothorax and 20 had subcutaneous emphysema with "sucking" chest wound and the sizes of the chest wall defects were between 3-8 cm. The mean volume drainage at the insertion of closed tube thoracostomy drainage was 724.4 ± 557.6 ml while the total drainage was 1115 ± 724 ml, three patients (4.6%) had empyema thoracis, three patients (4.6%) died and the total number of days on admission was 13.2 ± 7.8 days. The diagnosis of open pneumothorax was made by clinical evaluation of the patient. Conclusion: The technique of HMSC for open pneumothorax and insertion of a chest tube is a useful method for the treatment of penetrating chest injury and pleural fluid collections and, therefore, the method is recommended in well-selected patients.

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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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Aims: This study aims to determine the profile of patients as well as identify predisposing factors of patients presenting with low back pain (LBP) in Irrua Specialist Teaching Hospital Irrua, Edo state of Nigeria. Subjects and Methods: A retrospective study in which case records of all newly diagnosed patients with LBP from January 2011 to December 2013 were analyzed and the following data were extracted: demographic indices, duration of symptoms before presentation, predisposing factors, etc. Results: Within the study periods, 3120 patients presented at the orthopedic clinic, out of these, 101 patients had LBP. The prevalence rate was 3.24%. Median age was 58 years. Peak age incidence was 61–70 years. Age range 13–84 years. Male:female 1:1. Most affected occupational age groups were farmers 24 (23.76), traders 23 (22.77%), and civil servants 17 (16.83%). The most common predisposing factors to LBP were trauma to the lower back 23 (22.8%), lifting of heavy objects 11 (10.9%), and obesity 8 (7.9%). Spondylosis was the leading Diagnosis. L4/L5, L5/S1 were the most affected segments The percentage of patients presenting as acute, subacute, and chronic LBP were 28.7%, 9.9%, and 61.4%, respectively. Conclusions: Chronic LBP rank the highest among patients with LBP in our environment. Middle and elderly age brackets were other highlights. Trauma, lifting of heavy weights and obesity were notable predisposing factors.

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Objectives: We sought to determine the current trends in groin hernia characteristics and surgical care in our hospital. Materials and Methods: A prospective descriptive study from Wesley Guild Hospital Ilesa Nigeria: A tertiary hospital unit in a semi-urban community. All adults who had groin hernia repair between September 2008 and August 2013 were reviewed for age, gender, occupation, hernia type, repair technique and anaesthesia, complications of surgery and duration of hospital stay were analyzed for descriptive and inferential statistics. The main outcome measures were post-operative complications and recurrence. Results: Totally, 270 patients with 296 hernias were treated. Majority were males (256; 94.8%). The modal age group was 51-60 years (20.4%). Hernias were unilateral in most patients (251; 93%) with the majority of them right-sided (162/270; 60%). There were 295 inguinal hernias and one femoral hernia. Indirect inguinal hernia was most common (205 patients; 73.3%); while 79 (27.7%) were direct and 11 (4%) pantaloon hernias. Repairs were for recurrent hernias in 17 cases (3.8%) while 64 patients (23.7%) presented with complications requiring emergency operation. Local anesthesia (LA) was most commonly used (80.7%), and day-case surgery was common (206, 76.3%). Nylon darn (155; 52.4%), mesh hernioplasty (94, 31.8%) and Bassini (43; 14.5%) techniques were commonly used. Morbidity (17, 6.3%) was mainly from the surgical site infection (6, 2.2%). Mortality rate was 0.7%. Follow-up ranged from 3 to 30 months (mean = 9.8 months); no recurrence was recorded. Conclusion: Most repairs are now done using LA as day-case procedures. Mesh hernioplasty is becoming popular.

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Introduction: With the increased awareness and use of breast cancer screening programs, detection of nonpalpable lesion of breast is also increasing in incidence. Previously, wire guidance under ultrasonography was used for localization of these occult lesions, and in the second stage, sentinel node biopsy (SNB) was taken under radioactive guidance or blue dye injection. Materials and Methods: We conducted a study to combine radioactive-guided occult lesion localization (ROLL) with SNB. Results and Conclusion: We concluded that ROLL is an efficient method for the detection of these occult lesions, enabling more effective planning of skin incision, precise excision of the lesion with minimal normal tissue edge excision, and ultimately better postoperative cosmetics. When combined with SNB, it effectively decreases the intraoperative time.

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Idiopathic polypoidal scrotal calcinosis (IPSC) is a rare and benign condition with disputed etiology and it is characterized by multiple calcific nodular deposits in scrotal skin. Here we report a case of a 45-year-old male patient with testicular tumor and 7 years history of scrotal calcinosis is reported. Discussed is the delay in diagnosis of testicular tumor due to IPSC and difficulty in performing fine-needle aspiration cytology in such cases. In our case, no evidence of cystic structure was found around calcified materials. It was indicated that IPSC might be idiopathic. In addition, highlighted the importance of meticulous clinical examination to accurately diagnose the clinical entity and avoid delay in treatment. They are slow growing asymptomatic tumors. Complete excision of the lesion along with the involved scrotal skin with scrotoplasty of the residual scrotal skin is the treatment of choice. Reports of such rare calcified scrotal nodular lesions especially when associated with other malignant conditions need publication and the treatment protocol shared among the surgeons.

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Duodenal duplication cyst is a rare condition but can be associated with serious complications. Keeping this in mind, we are reviewing the topic and presenting a rare case report of isolated duodenal duplication cyst emphasizing the importance of computed tomography scan in reaching the diagnosis.

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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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A 36-year-old primiparous woman with one living child presented to our facility with 4 years history of secondary infertility and 20 weeks gestational age sized painful solid pelvic mass. Ultrasound scan, hysterosalpingography and intravenous urography revealed degenerated fibroids, bilateral tubal occlusion and single ectopic right pelvic kidney. Laparotomy revealed the absence of the left ovary and fallopian tube. This is a very rare finding. Whenever unilateral renal agenesis is found, the patient should be investigated for possible genital anomaly.

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Aim and Objective: The purpose of this study was to determine the frequency and morphological patterns of non-melanoma skin cancers (NMSCs) in University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. Materials and Methods: Data of surgical biopsies from the skin received at the Department of Histopathology over a 26-year period (from January 1982 to December 2007) were reviewed. The sources of information were surgical pathology day books, duplicates of histology request form and reports. Corresponding slides were retrieved for histopathology examination. Data were analyzed with SPSS version 17. Results: A total of 187 skin malignancies were encountered. Of these, 63 accounting for 33.7% were NMSCs. Squamous cell carcinoma (SCC) accounted for 45 cases, constituting 24.1% of all malignant skin tumors and 71.4% of NMSCs. Basal cell carcinoma (BCC) accounted for 18 cases (9.6%) of all malignant skin tumors and 28.6% of NMSCs. The peak incidence of SCC and BCC was in the 5 ^th decade of life. The mean age for SCC and BCC was 51.4 ± 1.3 and 46.3 ± 5.2 years, respectively. The male to female ratios for SCC and BCC were 2.4:1 and 1.6:1, respectively. Conclusion: In conclusion, SCC was the most common NMSC. This is similar to reports of other studies in Africans and Black Americans. In contrast, in Caucasian series, BCC was the most common NMSC. The head and neck region was the most common site of these skin cancers.

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Aim: This article aims to determine the clinicodemographic pattern and histopathological types of the maxillary antral lesions in a Nigerian population. Materials and Methods: Eleven years retrospective review of case records of patients with histologically diagnosed maxillary antral lesions seen at the Otorhinolaryngological and Oral Pathology/Medicine Departments, University of Benin Teaching Hospital, Benin City, Nigeria was performed. Result: A total of 108 patients with maxillary lesions were seen during the period under review, comprising of 57 (52.8%) males and 51 (47.2%) females, giving a ratio of 1.1:1. The patients' mean age was 41 years (±1.9 standard deviation) and the peak age group was the third decade of life (n = 22, 20.4%). The most frequent clinical features were painless maxillary swelling (n = 91, 84.3%), nasal discharge (n = 41, 38.0%), nasal obstruction (n = 34, 31.5%) and toothache (n = 30, 28.0%). Most patients (n = 31, 28.7%) presented for treatment within a year of onset of the lesion (n = 69, 63.9%) and the left maxillary antrum was the most commonly affected site (n = 64, 59.3%). The antral lesions were mostly malignant lesions (n = 56, 51.9%), with squamous cell carcinoma accounting for 37 (34.3%) of the cases; followed by benign lesions (n = 23, 21.3%), inflammatory/infective lesions (n = 13, 12.0%), cystic lesions (n = 9, 8.3%), and reactive lesions (n = 8, 7.4%). Conclusion: A high prevalence of neoplastic maxillary antral lesions, consisting mostly of malignant lesion was observed in this study. Routine histopathological examination of recurrent or persistent maxillary antral lesions is recommended for early detection of malignant lesions or malignant transformations among reactive or benign antral lesions.

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Objective: Uterine rupture is one of the major obstetric complications of labour which contributes significantly to maternal and perinatal mortality in the low resource and developing countries This study determined the incidence, predisposing factors and feto-maternal outcome of ruptured uterus. Methods: A 10-year retrospective study of all cases of uterine ruptures that were managed in University of Benin Teaching Hospital, Benin City, Nigeria between 1st January, 2005 and 31st December, 2014 was undertaken. Data collected from maternity records were transferred to a data sheet. The data were entered and analyzed using SPSS statistical software, version 15.0. Results: Out of 15,818 deliveries over the study period, 92 had uterine rupture, giving a prevalence of 0.58% or 1 in 172 deliveries. The majority of the patients 56, (60.8%) were Para 1 and 2. Majority (77.2%) were unbooked. Of the 92 patients with uterine rupture, 73 (85.9%) had emergency caesarean section. Fourteen patients had prolonged labour: 2 were primigravidas and 12 were multigravidas. Case fatality rate was 2.2% while the perinatal mortality rate was 61.9%. Conclusion: Uterine rupture constituted a major obstetric emergency in the study hospital and its environs. An "unbooked" status was a key associated factor. The incidence and perinatal mortalities were high. There is therefore a need for education of women on health-related issues, utilization of available health facilities, adequate supervision of labour and provision of facilities for emergency obstetric care.

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Objective: Bicipital groove along with the transverse humeral ligament bridging it offers stability and smooth functioning of the tendon of long head of biceps brachii muscle and prevents its subluxation during multidirectional biomechanical movements of arms. Hence, various anatomical information of the bicipital groove is vital as deformities of the bicipital tendon and its synovial sheath have been associated with a variety of reasons of shoulder pain and disability. Therefore, an attempt is made in this study to determine the length, width, and depth of bicipital groove along with the transverse diameter, anterior-posterior diameter and length of the humerus. Materials and Methods: The study was carried out on 60 unpaired dry humeri (right = 33, left = 27). The length, depth and width of the bicipital groove were measured using the vernier caliper. Results: The mean length, width and depth of the bicipital groove in the present study were 7.41, 1.08 and 0.55 cm. The mean length, width and A-P diameter of the humerus in the present study were 30.4, 3.0 and 2.6 cm. In the present study, the mean length of the bicipital groove corresponded to 24.37% of the total length of humerus, the mean width was 36% of the total humeral width, and the mean depth was 21.1% of the total anteroposterior width of the humerus. There was no significant correlation between right and left side as P > 0.05. Conclusion: This study determined the morphometric parameters of the bicipital groove and will be important for anthropologists, orthopedic surgeons, and clinical anatomists.

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Primary vascular leiomyosarcoma (LMS) is a rare tumor accounting for 2% of all LMSs, with the most common site being inferior vena cava (IVC). Overall prognosis is poor, with a median survival of 2 years only. Definitive treatment strategy has not been defined yet, due to the availability of small case series or reports only. However, extrapolating from the treatment of other sarcomas, definitive surgery followed by adjuvant treatment in the form of radiation and chemotherapy is usually followed. This review article focuses on presentation, diagnostic workup, the treatment options for IVC LMS, and their effect on the outcome, so that optimal management can be planned for individual cases. For this, a literature PubMed/Medline search was performed from January 1995 to December 2013 and reviewed to define the rare presentation of these vascular tumors, diagnostic workup, surgical options and reconstruction methods available, and the indications for the use of adjuvant chemotherapy and radiation.

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This is a case report of a day-old 5.6 kg female baby delivered by cesarean section of a known diabetic and hypertensive mother who presented with gangrene of the right forearm and hand. The diagnosis of congenital gangrene in this neonate was purely clinical and maternal diabetes associated with hypertension an etiological possibility.

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Hepatoid adenocarcinoma is one of the rarest tumors of the stomach. These tumors produce alpha-fetoprotein (AFP), which can be used as a diagnostic marker. The prognosis is poor compared to conventional adenocarcinoma of the stomach. A case of AFP-producing hepatoid adenocarcinoma stomach in a 55-year-old woman is presented. The patient underwent partial gastrectomy. We focus on the clinical features, imaging, histopathological and biochemical characteristics of the hepatoid variety of adenocarcinoma stomach.

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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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Objective: The objective of the following study is to assess the outcome of treatment with tunica vaginalis flap cover in cases of proximal penile hypospadias cripples. Materials and Methods: This retrospective study included cases of proximal penile hypospadias cripples managed by thiersch-duplay urethroplasty. Cases were divided into three groups. Group I included cases with tunica vaginalis flap, group II with dartos flap and group III included staged hypospadias repair on Bracka's principle. All cases were managed by a uniform protocol. Outcome was assessed at day 10 after stent removal and at first follow-up. Urethroplasty was considered successful in case with no leak. P value was considered to be significant if less than 0.05. Results: Out of 67 cases, 18 cases were in group I, 24 cases were in group II and 24 were in group III. They formed the study group. Leak at the time of stent removal was present in 1/18 (5.57%), 4/24 (16.67%), 2/24 (8.33%) cases in group 1, II and III respectively (P = 0.04 and 0.4). Leak at the time of first follow-up was present in 1/18 (5.55%), 5/24 (20.83%) and 3/24 (25%) cases in group I, II and III respectively (P = 0.03 and 0.3). Complete disruption of urethroplasty was present in 1/18 (5.57%), 2/24 (8.83%) and 1/24 (4.16%) cases in group I, II and III respectively (P = 0.1). The overall success rate in group I, II and III were 15/18 (83.83%), 13/24 (54.16%) and 18/24 (75%) respectively (P = 0.01 and 0.1). Conclusions: Tunica vaginalis flap reinforcement in cases of hypospadias cripples is a viable and reliable option. This should be favored over dartos flap.

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