Orient Journal of Surgical Sciences

Intussusception, the invagination of a segment of the bowel into the lumen of a contiguous segment, is an uncommon cause of abdominal pain and bowel obstruction in adults. Due to the often incomplete nature of the obstruction, presentation in the adult patient may be delayed and the diagnosis is either missed or made at exploratory laparotomy in regions where sophisticated imaging facilities such as computed tomography (CT) scan are not readily affordable or available. A high index of suspicion is required for the
earlier detection of this condition in the adult patient for prompt and successful surgical intervention.

Objective: To compare the outcome of unilateral versus bilateral simultaneous cataract surgery at the Guinness Eye Center Onitsha, Nigeria.
Materials and Methods: The visual outcome and complications rates in patients who had bilateral simultaneous cataract surgery (BSCS) intraocular lens implant between 01 January, 2014 and 31 December, 2016 and had been followed up for 6 months were compared with those who had unilateral cataract surgery (UCS) within the same period. Information on socio-demographic characteristics, domicile, pre-operative visual acuity, visual acuity on last follow up, intra-operative complications, post-operative complications and causes of poor vision were analyzed.

Results: Thirty nine patients with bilateral simultaneous surgery and 142 with uniocular surgery were studied. The age range was 6 – 93 years, median – 66years. There were 104 males (57.5%). Pre-operatively 62 (79.5%) and 134 (94.4%) eyes had visual acuity <3/60 in bilateral and uniocular surgery patients respectively. Post-operatively, 36 (46.1%) and 60 (42.3%) eyes of bilateral and uniocular surgery patients respectively had unaided acuity ≥6/18. Post-operative acuity significantly improved in both unilateral (X² = 9.626; p<0.05) and bilateral (X² = 9.556; p<0.05) surgeries. However, there was no statistically significant difference in the improvement in visual acuity between unilateral and bilateral surgeries (X² = 0.562; p>0.05)
Intra-operatively, vitreous loss occurred in one (1.3%) BSCS and 2 (1.4%) UCS patients. Post-operatively posterior capsule opacification occurred in 10(12.8%) and 22 (15.5%) eyes of bilateral and uniocular surgery patients respectively. Recurrent uveitis occurred in 8 (10.3%) and 13 (9.2%)eyes of bilateral and uniocular surgery patients respectively. Post-operative endophthalmitis occurred in one (0.7%) eye of a uniocular surgery patient.

Background: Exploratory laparotomy is a surgical procedure performed in a patient who requires surgery when the actual cause and nature of the disease is not certain. Exploratory laparotomy is usually carried out as an emergency procedure in patients who are acutely ill and require urgent operation for control and stabilization of their disease condition.

Objective: The aim of this study is to evaluate the common indications for exploratory laparotomy among general surgery patients and to assess their post-operative outcome and complications. Methodology: This is a three-year retrospective study extending from January 2014 to December 2016. All the consecutive general surgery patients who had exploratory laparotomy within the study period were recruited into the survey. Patient's demographics including: age, sex, diagnosis, intra-operative findings, operative procedures, complications and outcomes were extracted and analysed. Analysis was done using the SPSS version 21.0.

Results: A total of 120 exploratory laparotomies were performed out of 1,908 surgical operations conducted within the study period (6.29% of total surgery). The age range was 4 - 85 years with a mean of 40.25±17.23 years and peaks in the 21-30 years and 31-40 years age groups. Seventy-six patients were males and 44 females giving a male to female ratio of 1.73:1. Intestinal obstruction from colonic tumours was the commonest indication constituting 28 (23.3%) followed by complicated appendicitis at 26 (21.6%). Bowel obstruction from post-operative bands, perforated peptic ulcer disease (PPUD) and abdominal trauma accounted for 25 (20.8%), 17 (14.2%) and 16 (13.3%) respectively. A total of 12 patients had complications following surgery representing a complication figure of 10.0%. Mortality rate was 4.2%.

Conclusion: Exploratory laparotomy is still very relevant in general surgery practice. Intestinal obstruction from colonic tumour was the commonest indication in the study. Post-operative complications and mortality rate were relatively low at 10.0% and 4.2% respectively.

Keywords: Laparotomy, Indications, Complications, Mortality.

AIM: To determine the incidence and pattern of ocular injuries at the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, Nigeria

METHODS: This is a retrospective hospital based study carried out at the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka. The case notes of new patients seen at the Eye unit of the hospital from July 2016 to June 2018 were examined. Those with eye injuries were further reviewed. Relevant information was extracted for the study. The results were analysed using the scientific calculator and presented with frequency tables and bar chart.

RESULTS: Out of the 2559 new patients seen, 156 (6.1%) had unilateral eye injuries while four patients sustained bilateral ocular trauma giving rise to 160 injured eyes. Of the 156 patients, 97 (62.2%) were males while 59 (37.8%) were females, with male to female ratio of 1.6 : 1. The age range was 6 months to 92 years, mean age 33.4 years. Fist 45 (28.8%) was the most common agent causing injuries followed by missiles 26 (16.7%). Activities leading to injuries included fighting 39 (25%), playing 22 (14.7%), vocational work 19 (12.2%) and farming 18 (11.5%). Seventy-two eyes (45%) had visual acuity of 6/6 to 6/18 and 56 (35%) had acuity of <3/60 in the injured eyes. Ocular contusion 39 (25%) was the most common diagnosis. Fifty- eight patients (37.2%) presented within 24 hours whereas 3 cases (1.9%) came after one month.

CONCLUSION: Ocular injury can be encountered in any activity engaged by man. It may be accidental or deliberately inflicted. Males and younger age group are more at risk. Fight was the most common activity leading to eye trauma in our audit. Generally, there was delayed presentation at the hospital following the injury. However, the severer the injury, the earlier the presentation.

Keywords: Incidence; Pattern; Ocular injury; Presentation.

Stargardt's disease is a bilateral symmetrical and progressive macular dystrophy that is transmitted in autosomal recessive or dominant pattern. It usually starts between the ages of 6 and 20 years and typically leads to a rapid loss of central vision.

The authors describe clinical features of a 28-year old male patient with fundus findings of Stargardt's disease whose symptoms were said to have started about 19 years prior to presentation. Previously there has been a single reported case in Nigeria.

We present this case that would be discussed along the lines of presentation, pathophysiology, management. We introduce an innovative and cost effective method of fundus examination using mobile phone technology.

Keywords: Stargardt's; Central vision; Mobile Phone.