A 5-year prospective study of 699 children with various renal disorders from around the Rivers State, which is in the eastern part of Nigeria, was carried out to investigate the prevalence and significance of renal disorders in a third world country with no facilities for paediatric dialysis and transplantation. Renal disorders accounted for 1.1% of the total outpatients and hospital admissions. The commonest renal disorders were urinary tract infection (UTI, 68.9%); nephrotic syndrome (NS 14.6%) and acute post streptococcal glomerulonephritis (11.4%). Patients with UTI had no vesico-ureteric reflux (VUR); 22.5% of NS patients were steroid sensitive. Wilms' tumour (1.6%) was the second commonest childhood malignant tumour; 8 of 17 cases of obstructive uropathy were secondary to meatal stenosis following circumcision. Fifteen children developed end-stage renal failure (ESRF), mainly due to chronic glomerulonephritis, giving a prevalence rate of 7.5 children per year per million childhood population. Hence, renal disorders are common in Nigeria and although VUR is rare, ESRF may approximate figures seen in the western world. This highlights the need to improve the country's socioeconomic conditions, make medical facilities more available to children and prevent renal diseases that may lead to ESRF.
A 9-week-old boy developed massive postoperative abdominal distension following a Fredet-Ramstedt pyloromyotomy for hypertrophic pyloric stenosis. A plain abdominal X-ray film was suggestive of a tension pneumoperitoneum. Passage of a cannula into the peritoneal space resulted in forceful expulsion of air, resulting in relief of the distension, which recurred after a few hours. At laparotomy, the tension pneumoperitoneum was due to a pyloric fistula at the proximal end of the pyloromyotomy, although a mucosal breach at the first operation had been at the distal end. Closure of the fistula resulted in complete resolution. A limited review of the literature is undertaken.
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