Enterocutaneous fistula is an abnormal connection between the intra-abdominal gastrointestinal tract and skin. It causes considerable morbidity and mortality. The goals of management are restoration of gastrointestinal continuity and allowance of enteral nutrition with minimal morbidity and mortality. A multidisciplinary approach is essential in the successful management and this has led to closure rates ranging from 5-20% following conservative management and 75-85% with operative treatment. This article seeks to review the current concepts in the management of enterocutaneous fistula. A systematic search of literature on enterocutaneous fistula was conducted. Relevant materials were selected and selected references from relevant books, journal articles and abstracts using Medline, Google scholar and Pubmed databases were critically reviewed. Enterocutaneous fistulas can be classified by the anatomy, aetiology or physiology. Anatomically, enterocutaneous fistula has been classified based on the organ of origin and this is useful in the consideration of management options: type l (abdominal oesophageal and gastroduodenal fistula), type ll (small bowel fistula), type lll (large bowel fistula) and type IV (enteroatmospheric, regardless of origin. The anatomy also depends on the presence or absence of associated abscess cavity and the length and characteristics of the fistula tract. Aetiologically, the majority of enterocutaneous fistulas are iatrogenic (75-85%) while between 15 and 25% occur spontaneously. The physiological classification is based on the volume of its output. High output fistulas drain more than 500mls in 24 hours, moderate output between 200 and 500mls in 24 hours and low output less than 200mls in 24 hours. Successful management requires a multidisciplinary approach and would consist of initial resuscitaion with fluids and electrolytes, control of sepsis, good and adequate nutrition, wound care and skin protection and definitive management. The treatment of enterocutaneous fistula is multidisciplinary and remains a challenge despite the recent improvement in supportive care. Once enterocutaneous fistula occurs, adequate stabilization of the patient and non-operative management should be commenced. If surgery is required, careful planning, meticulous dissection, restoration of bowel continuity and reconstruction of abdominal wall are critical.
<p class="abstract"><strong>Background:</strong> The biochemical constituents of gallstones predict its etiopathogenesis. Hence, this study is conducted to investigate the biochemical constituents of gallstones from indigenous Nigerian patients.</p><p class="abstract"><strong>Methods:</strong> It was a retrospective study of the biochemical constituents of post-operative gallstones from 48 adult patients of the University of Port Harcourt Teaching Hospital, Nigeria. Records on age, sex, and concentrations of gallstone biochemical constituents (total cholesterol, triglyceride, total bilirubin, and calcium) from 1<sup>st</sup> January 2007 to December 2016 were extrapolated from laboratory records and analyzed using SPSS version 15. </p><p class="abstract"><strong>Results:</strong> The gallstones were of more females than the males (70.8% versus 29.2%; p=0.004). The mean age of the study cohorts was 46.88±7.96 with age range 31–64 years. No sex difference in age was observed, however, females were younger (males 50.39±8.31 versus females 45.47±7.52; p=0.056) with a lower age range (males 40–64 versus females 31- 63) than the males. The gallstone comprised of cholesterol stones (64.7%), mixed stones (22.9%), and pigment stones (12.5%). Though the females dominated among the three types of gallstones, the predominant stone type in both sexes remained cholesterol stones. Cholesterol lipid was the main constituent of the gallstones with no sex difference (p=0.227).</p><p class="abstract"><strong>Conclusions:</strong> Cholesterol gallstones are the most common type of gallstones in this study and the cholesterol lipid is the most prevalent constituent of these gallstones. The females presented with more of the gallstones disease than the males.</p>
Background: Low serum calcium is hypothesized to influence colorectal carcinogenesis. Hence, this study was set out to investigate the pattern of plasma calcium in patients with colorectal cancer, and to determine the relationship between the mineral with carcinoembryonic antigen (CEA) among patients with colorectal cancer. Methods: This was a retrospective study of 45 colorectal cancer patients who presented to a tertiary hospital in Nigeria. The laboratory characteristics of these patients were evaluated. Records of sex, age, serum albumin, plasma total calcium, and serum CEA test results from 1st January 2008 to 31st December 2017 were retrieved from laboratory and medical records and analyzed with SPSS software version 20. Results: There were a total of 45 records of colorectal patients in this study, among them were 62.2% males and 37.8% females. The majority (57.8%) of the study cohorts are within the age group 50 to 59 years. Low total calcium was observed in 37.8% of the study cohort while 66.7% tested positive for CEA. The positive CEA group had lower total calcium level than those with negative CEA results (p = 0.001). Negative but weak correlations of total calcium and serum CEA was observed among the overall study cohort (r = -0.485; p = 0.001) and those with positive test for CEA (r = -0.384; p = 0.036). Conclusions: The evidence from this study suggests that low serum calcium could be a risk factor for colorectal cancer and is also associated with higher serum level of the CEA biomarker.
Aim: The aim of this study was to ascertain the opinion of patients on counselling of the surgical patient in tertiary healthcare facilities in Port Harcourt in the months of May and June 2020. Background: Counseling of the surgical patient is a dynamic process and its scope which is individualized should arm the patient with information on the purpose and nature of the disease and treatment, etc. Materials and Methods: Four hundred and twenty respondents were recruited for this cross-sectional descriptive study carried out in the wards and specialist surgical out-patient clinics of Teaching Hospitals in Port Harcourt, Nigeria between the months of May and June 2020 using semi-structured questionnaires. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Two hundred and twenty-five (53.6%) respondents asserted that they had counselling sessions for the surgical operation, 108 (25.7%) respondents opined that they did not have counselling session, while 87 (20.7%) were not sure if they had or not. Forty-five (10.7%) respondents asserted that the surgeons carried out the counselling. Only, 227 (54.0%) of the respondents affirmed that they were satisfied with the counselling sessions, while 104 (24.8%) respondents asserted that there was no counselling session at all. Conclusion: The opinion of patients on the counselling service experience is not entirely satisfactory. There is need for closer attention to be paid to issues of counselling of the surgical patient in order to ensure the full benefits of the services rendered.
Background: Various clinical and biochemical parameters have been hypothesized to predict cholesterol gallstone formation. Hence, this study was structured to evaluate the degree of some of these suggested predictors among inhabitants of Port Harcourt in Nigeria.Methods: This was a retrospective study of the clinical and biochemical parameters of 42 cholesterol gallstones formers within a tertiary hospital in Nigeria. Records of age, gender, weight, height, calculated body mass index and plasma biochemical parameters (total cholesterol, total bilirubin, and total calcium) of cholesterol gallstone formers from 1st January 2008 to 31st December 2017 were abstracted from medical and laboratory records and analysed using SPSS version 20.Results: There were more females (70%) than males (30%) with a ratio of 2.3:1. The age ranged from 31-64 with mean 46.78±9.33. Obesity was observed among 40.5% of study population. Female gender (OR = 2.823; 95% CI = 2.446-3.200; p<0.001), obesity BMI status (OR = 1.534; 95% CI = 1.436 - 1.632; p = 0.012) and abnormal plasma cholesterol status (OR = 3.011; 95% CI = 2.916 - 3.106; p<0.001) were significant predictors of cholesterol gallstone formation. Abnormal plasma cholesterol status was the strongest of the predictors with AUC of 0.920 (p<0.001), seconded by female gender (AUC = 0.889; p<0.001) and obesity BMI status (AUC = 0.834; p<0.001).Conclusions: Abnormal plasma cholesterol status is the strongest independent predictor of cholesterol gallstone formation, seconded by female gender and high BMI status, among inhabitants of Port Harcourt in Nigeria.
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