The commonest cause of large-bowel obstruction in Nigeria is sigmoid volvulus. Patients usually present late, dehydrated, and in very poor condition. The mortality of emergency colonic surgery is undoubtedly high, more so in developing countries poorly equipped to cope with such a condition. To reduce the mortality rate and improve management of the patients, a four-year prospective study of detorsion followed by elective surgery after adequate resuscitation and bowel preparation was carried out between January 1979 and December 1982. Volvulus is classified into three groups: torsion, obstruction, and strangulation. Criteria for short colonoscopic detorsion of torsion and obstruction types are discussed, and the contraindication in the case of strangulation type mentioned. This article describes the management of 92 cases of sigmoid volvulus between 1979 and 1982.
We conducted a review of eight ureteric injuries associated with major gynecologic surgery in seven patients over an 11-year period. Our low incidence of 0.36% is comparable with other reports. Diagnosis was made either intra-operatively or postoperatively. Immediate ureteric repair is advocated for all injuries discovered intra-operatively. Attention to preventive measures both before and during gynecological operations will reduce the incidence of ureteric injuries.
A hundred and fifty-two patients with recurrent inguinal hernias, 10 females and 142 males seen over a ten-year period have been reported. The patients, none of whom were earlier seen or operated on by the author were managed with two parallel rows of four-layer fascioplasty held with nonabsorbable Astralen sutures. The complications which may arise from the method applied were reviewed. The recurrence rate in advanced countries ranges between 7% and 30% for all types of inguinal hernias, but in Nigeria is higher. The author does not claim that recurrence cannot occur with this method but he has not recorded any. The technique has also alleviated the fears of many and removed the social problems of having just one testis, an important factor in this environment.
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