Thyroidectomy is a safe surgery with minimal risk of complications. Grouping and cross-matching of blood in elective thyroidectomy is not an essential pre-operative preparation for all patients just as antibiotic therapy/prophylaxis made no difference in patient outcome. Simple multinodular goiter is the commonest histological diagnosis.
Background:To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions.Materials and Methods:A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed.Results:Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis.Conclusion:Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission.
Sharp foreign body ingestion and management pose a great challenge to the surgeon. Majority of ingested foreign bodies pass through the gastrointestinal tract spontaneously. Organ perforations and possible migration should be kept in mind in patients with abdominal pain when the progress of the foreign body through the gastrointestinal tract cannot be ascertained by radiography. A 26-year-old male psychiatric patient presented with epigastric pain following ingestion of 18 sewing needles. His abdominal radiograph showed multiple metallic foreign bodies in the abdominal cavity consistent with the shape of sewing needles. He passed some needles spontaneously while the others which were retained were removed via a laparotomy after a successful pre-operative localization. Post-operative period was uneventful. A deliberate ingestion of foreign bodies should be kept in mind in patients with psychiatric disorders and mental retardation when they present with abdominal pain to the emergency department. An initial wait and see line of management may be instituted with the hope of spontaneous passage which can be monitored via radiological means. However, if the objects fail to pass naturally, surgery is indicated. Sharp foreign bodies which fail to pass spontaneously should be surgically removed after a proper localization since they could cause life threatening complications.
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