Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.

IntroductionSignificant deaths of between 21% and 38% occur from non-trauma surgical conditions in the accident and emergency room. Access to emergency surgical care is limited in many developing countries including Nigeria. We aimed to study the spectrum of non-trauma surgical emergencies, identify challenges in management and evaluate outcomes.MethodsA one year prospective cohort study of all non-trauma emergencies in adults seen at the surgical emergency room of LASUTH from 1st October, 2011 to 30th September, 2012 was conducted. Data was analyzed using SPSS version 15.0.ResultsOf a total of 7536 patients seen, there were 7122 adults. Those with non-trauma conditions were 2065 representing 29% of adult emergencies. Age ranged between 15 and 97 years and male to female ratio was 1.7:1. Acute abdomen (30%), urological problems (18%) and malignancies (10%) were the most common. Among 985 patients requiring admission only 464 (47%) were admitted while the remaining 53% were referred to other centers. Emergency surgical intervention was carried out in 222 patients representing 48% of admitted patients. There were 12 (24%) non-trauma deaths in the emergency room. They were due to acute abdomen and malignancies in half of the cases.ConclusionFacilities for patients needing emergency care were inadequate with more than half of those requiring admission referred. Attention should be paid to the provision of emergency surgical services to the teeming number of patients seen on yearly basis in the Teaching Hospital.

Context:Abnormal abdominal distension in a child is usually a source of great concern and apprehension in both the parents and the pediatric surgeon. Although Wilms’ tumor is the most common malignant abdominal childhood tumor, usually causing abdominal distension, many other less common causes can also result in abdominal distension. Therefore, early diagnosis of Wilms’ tumor and distinguishing it from all these other causes is essential.Aims:We intend to document the pattern of computed tomography (CT) scan findings in patients with Wilms’ tumor and the peculiarity of its radiological presentation in this environment, highlighting its accuracy and advantages over other imaging modalities.Settings and Design:This is a prospective descriptive study conducted between January, 2011 to January 2012, where all infants, 6-96 months of age, who were suspected to have Wilms’ tumor were made to undergo CT scan examination as part of their management work-up. It was carried out in a teaching hospital.Subjects and Methods:The study performed on 12 children age range of 6-96 months old underwent abdominal CT scans as part of their clinical work-up using a GE Hi-speed dual CT scanner®. Pre- and post-contrast images were acquired and assessed by the radiologists. They were operated and their radiological and histopathology results were correlated.Statistical Analysis:All data was entered into a Microsoft word excel spread sheet and analyzed by simple analysis. Percentages and proportions were determined for categorical variables.Results:Of the 12 patients seen, nearly 75% were males, with a male to female ratio of 3:1 and an average age of 37 months. The right sided tumors were slightly more than the left and nearly 25% were bilateral. Approximately 17% showed punctuate calcifications. Heterogeneous contrast enhancement was seen in all the cases, vascular encasement in three and lymphadenopathy in six cases. There was no bony involvement in any of them but 75% of the masses seen, crossed the midline. Histological confirmation of Wilms’ tumor was obtained in all cases.Conclusions:Majority of the tumors seen in this study crossed the midline and a few of them showed calcification. CT scan is relevant and accurate in investigating children with Wilms’ tumor as it reveals concomitant lesions with involvement of the abdominal vessels and lymph nodes.

This study suggests a high incidence and significant underreporting of pedestrian injuries. A reduction in morbidity and mortality is possible (from head and lower limb injuries) by traffic calming techniques in crossing the highway, especially injuries due to being struck by motorcycles, cars, and buses.

Introduction: Herniotomy is a common procedure performed by Paediatric Surgeons. However, opinions differ as to whether to open the inguinal canal when performing this procedure or not. Those who advocate performing herniotomy without opening the inguinal canal believe that in early childhood, the superficial inguinal ring is directly superimposed on the deep inguinal ring, there being no appreciable inguinal canal in this age group. Our study was planned to open the inguinal canal and simply measure the distance between the pubic tubercle medially and the inferior epigastric vessels laterally. Finding a measurable inguinal canal in all cases studies debunks the belief that the superficial inguinal ring frequently overlaps the deep inguinal ring. the inguinal canals of 75 children from 1 day to 2 years old were measured during herniotomies and orchidopexies. Premature babies were excluded from this study. The inguinal canals were all opened. Using a simple sterilized metallic ruler, the distance between the ipsilateral inferior epigastric vessels and the ipsilateral pubic tubercle was measured. Results: The lengths of the inguinal canals ranged from 1cm to 4.5 cm (mean 2.88cm+/-.71cm SD). The shortest inguinal canal length was 1 cm while the longest inguinal canal was 4.5 cm. Conclusion: Children with inguinal hernia up to the age of 2 years have a measurable inguinal canal and we suggest the excision of the hearnial sac superficial to the external inguinal ring runs the risk of leaving substantial sac behind proximal to the transfixing suture, even when some traction is applied to the sac before applying the transfixing suture.

The equal sex incidence, worse female fatality despite similar exposure and injury severity with male, deserve further research. Improved pre-hospital and SER care is needed.

Introduction: Intestinal atresia is one of the most common causes of neonatal intestinal obstruction worldwide. The pattern of presentation and management in our institution is reviewed. The objective of the study was to evaluate the pattern of intestinal atresias and stenoses in newborns who presented to our unit. Materials and Methods: A retrospective study of patients with intestinal atresias and stenoses who presented between September 2004 and November 2008. The clinical presentation, diagnoses, operative management, post operative care and outcome were obtained from the case notes. Results: Thirty cases were seen in that period, M:F; 1:1.5. Eleven (36.7%) were duodenal pathologies and 19 (63.3%) were jejunoileal. The main presenting symptom was bilious vomiting. Overall mortality is 40.9%. Prematurity and delayed presentations are the major contributing factors to mortality. Conclusion: Improvement of health care facilities as well as public health education to seek early intervention will improve outcome. Maternal awareness of this condition would lead to prompt seeking of treatment for paediatric patients.

Background: Although apple peel intestinal atresia is rare and is associated with a high mortality and morbidity, there is a dearth of its report in African literature. This study reviews four of the cases seen in a state teaching hospital in Lagos, considering the radiographic findings, surgical management and outcome. A brief review of literature is also undertaken. Aims and Objectives: To correle the plain radiographic findings with the surgical findings of neonates gathered over a six year period and to evaluate their surgical management, hoping to further help improve management of such neonates' in future in resource limited regions such as ours. Methodology: It was a retrospective case series of four neonates who were brought in over a period of six years and operated after an initial plain abdominal X-ray. They were done as emergency cases, consent was obtained from their parents and the study was approved by the research and ethics committee. Operative findings were subsequently correlated with their radiographic findings and the surgical outcomes and follow up were documented. Conclusion: This study revealed that "the triple bubble sign" is a common radiographic finding in Apple Peel deformities, as well as gangrene of the jejunum and ileum at surgery.