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Objectives: To determine the aetiology, pattern of presentation, treatment regimen and outcome of management of priapism in our environment and to compare our findings with previous studies in this country and elsewhere.

Background Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries.Methods FALCON was a 2 × 2 factorial, randomised controlled trial stratified by whether surgery was cleancontaminated, or contaminated or dirty, including patients undergoing abdominal surgery with a skin incision of 5 cm or greater. This trial was undertaken in 54 hospitals in seven countries (

Objective: To determine the incidence, pattern and outcome of obstructed abdominal wall hernia in a semi-urban and rural community. Design: A proforma was drafted to study all consecutive patients operated for obstructed anterior abdominal wall hernia over a period of five years. Clinical findings, preoperative treatment, operative findings and postoperative outcome were documented. Setting: Teaching hospital located in a semi-urban community comprising mostly agrarian population. Patients: A total 110 adult patients with obstructed anterior abdominal wall hernia who had operative intervention and other postoperative management. Results: There were 110 patients with 111 obstructed hernias, accounting for 26.4% of all abdominal wall hernias. The age ranged from 19-79 years with mean of 49.7 years. Males accounted for 81%. Inguinoscrotal hernia was the commonest occurring in 75.7%, 16.2% patients presented with inguinal hernia and five patients with femoral hernia. The greater proportion of inguinal hernia occurred in female. Eighty seven patients (79%) had emergency operations and elective in 23 patients (21%) who had spontaneous reduction while awaiting surgery. Ninety two percent of inguinoscrotal/ inguinal hernia were indirect. Omentum was trapped in 52 hernias (47.%), while in 15 patients (13.6%), gangrenous bowel segments were discovered. Scrotal oedema was the commonest complication accounting for 21%, while wound infection occurred in 20%. There were three deaths in elderly men with clinical symptoms and signs of acute intestinal obstruction and gangrenous bowel segments, accounting for 2.7% of the patients. Twenty eight per cent of patients were discharged within the first and second postoperative days. Two patients spent 36 and 56 days each in the hospital. Conclusion: This study showed that 26.4% of abdominal hernia presented with obstruction. With inguinoscrotal hernia predominating: male accounted for 81% and 13.6% of the obstructed hernia contained gangrenous bowel segments. Post-operative complications were common, mortality occurring mainly in elderly patients with late presentation.

Background:  Generalized surgical acute abdomen is a significant cause of morbidity and mortality in the Nigerian environment. Severity assessment is useful in order to prioritize treatment and reduce morbidity and mortality. High severity scores are often faced with high morbidity and mortality; these patients, often require more intensive treatment than those with low severity scores. The purpose of this study was to assess the severity of generalized surgical acute abdomen in adult patients using the Acute Physiological and Chronic Ill Health Evaluation (APACHE II) score. Methods:  All patients (184) aged 16 years and above, admitted and operated for generalized acute abdomen over a period of 6 years from January 1993 to December 1998 were prospectively studied. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Severity of illness was assessed using APACHE II parameters. Postoperative outcome and severity of illness were compared to determine the significance of severity of illness on postoperative outcome. Results:  Thirty‐one patients (17%) died and 78 (42.4%) developed other postoperative complications. The APACHE II scores significantly correlated with the mortality and such other postoperative complications as residual intra‐abdominal abscess, abdominal sepsis, chest infection and faecal fistula (P < 0.05) and the duration of hospital stay (P < 0.05). The APACHE II scores ranged from 0 to 18, the mean score for survivors was 5.7, while it was 12.3 for those who did not survive. Only three (4%) patients who scored 0–5 died, six (9.4%) patients who scored 6–10, 15 (50%) patients who scored 11–15 and seven patients (87.5%) died who scored 16–20. Conclusion:  The study showed that the severity of generalized peritonitis can be suitably assessed by APACHE II score in our environment and may serve as means of objective assessment of the quality of care. APACHE II score predicted mortality and morbidity in the patients studied. A further study is needed involving a larger number of patients to further validate our findings. We recommend to surgeons practicing in an environment similar to ours and to use the APACHE II scoring system in the assessment of patients with acute generalized peritonitis.