Surgery

Management of Failed Back Surgery Syndrome (FBSS) Mohammed K Abubakar, Shamsuddeen Mohammad Archives of International Surgery 2018 8(2):47-53 This article aims to highlight the current management of failed back surgery syndrome (FBSS) based on a systematic review of current literature. Literatures reviewed were from the Internet medical search engine such as PubMed, MEDLINE, and Embase. The search was narrowed down to the topic under review. In all, 1,345 articles were initially obtained. These were subsequently narrowed to 83 reviews so as to meet the objective of the review which describes persistent or recurring low back pain with or without sciatica following one or more spine surgeries. The increase in the number of patients undergoing back surgery has led to a corresponding increase in patients whose expectations are not met. Poor outcome following back surgery ranges from 10% to 40%. Outcome worsens with increase in the number of reoperation. Evaluation of this patient should be by detailed history, physical examination, and investigation. The treatment approach should be holistic and all encompassing. Patients psychological state and expectations should be assessed. Etiology of FBSS may include wrong diagnosis, failure to address the primary pathology, and intraoperative surgical errors. Treatment of FBSS is multidisciplinary. The treatment modalities include pharmacological, physical, interventional, spinal cord stimulation, psychological, and surgical.

Pattern of breast ultrasound findings in Zaria, North Western Nigeria Sefiya A Olarinoye-Akorede, Halima Aliyu, Haruna G Yunusa Archives of International Surgery 2018 8(2):54-58 Background: With increasing level of breast cancer awareness among Nigerians, more patients are presenting with breast symptoms. Ultrasound is relied upon significantly since mammographic facilities are few and breast magnetic resonance imaging is either too expensive or unavailable. Our study aimed at presenting the breast ultrasound findings among symptomatic and asymptomatic patients at Ahmadu Bello University Teaching Hospital, Zaria. Patients and Methods: This was a retrospective review of 603 patients who were referred from Surgical and general out-patient departments of our hospital for breast ultrasound scan between January 2015 and July 2017. Whole breast scans were performed using a single Mindray DC-8 (2011) Ultrasound machine, fitted with a 7–12 MHz transducer. The findings were described, recorded, and a final assessment category assigned using the American College of Radiology (ACR) Breast Imaging Reports and Data systems (BI-RADS) classification as follows: 1 (negative), 2 (benign), 3 (probably benign), 4 (suspicious), 5 (highly suggestive for malignancy), and 6 (known biopsy proven malignancy). Histological diagnoses were sought for abnormal ultrasound findings. Data analysis was done using Statistical Package for Social Sciences (SPSS) software for Windows version 20, Chicago, IL. Results: The patients comprised of 591 females and 12 males, with a mean age of 35.7 ± 13.0 years. The most common indication was breast lump (44.3%). BI-RADS 1 was the most common category (44.6%), followed by BI-RADS 3 (25.9%). Mass lesion was the most frequent sonographic finding (45.3%). Others were calcifications, 33 (5.5%); architectural distortion, 67 (11.1%); edema, 52 (8.6%); vascular lesion, 1 (0.16%); and ductal abnormalities, 55 (9.1%). The incidence of breast cancer increased with increasing age. Conclusion: Our predominant ultrasound findings were negative (normal or benign). This supports the use of ultrasound as a first-line diagnostic breast imaging modality in our community. Its added advantage of availability, radiation safety, and less cost makes it an indispensable tool.

Peculiarities of renal cell carcinoma in young adults Muhammed Ahmed, Nasir Oyelowo, Ahmad Bello, Ahmad Tijani Lawal, Hussein Yusuf Maitama, Khalifa Abdulsalam, Adetola Musliu Tolani Archives of International Surgery 2018 8(2):59-62 Background: We observed an increase in incidence of sporadic renal cell carcinoma in young adults (< 40years). The presentation and outcome seems to be different from those in the elderly. We retrospectively reviewed the clinical presentations, pathological findings, management and outcomes in these patients as well as comparison with those in older patients. Patients and Methods: The age, clinical presentation, pathological findings and outcomes following treatment of patients diagnosed and managed for renal cell carcinoma at this center from January 2008 to January 2017 were retrieved from hospital records and analyzed. Patients where divided into young adults (< 40 years) or older adults (> 40 years). Results: A total of 61 patients were reviewed within the period with young adults n = 25 (41%) vs older adults n = 36 (59%). A male:female ratio of 2:1 was found in both groups. Flank pain (77.8% in older adults compared to 72% in young adults) and Hematuria (63.9% of Older adults compared to 52.0% of Young adults.) were both higher in older adults but not statistically significant with P values not <0.05 however Flank mass (100% in older adults and 72.0% in younger adults) was also higher in older adults as well as statistically significant with P value of 0.001. Metastasis and stage of the diseases were equally statistically significantly higher in older adults with P values 0.001. Mean 5 year survival in months for young adults was 25 months (56-3 months) and older adults was 15 months (45- 5 months). Conclusion: Sporadic RCC in young adults presents commonly with an early disease. It seldoms presents with flank mass as compared to the older adults. Hematuria, flank pain and histological type and grade occurs in similar distribution in both groups survival was better in the young.

A randomized comparison of patient satisfaction with oral and vaginal misoprostol for induction of labor at term Umar S Hauwa, Oladapo S Shittu, Bala M Audu, Hajaratu–Sulayman Umar Archives of International Surgery 2018 8(2):63-68 Background: Induction of labor has the potentials for preventing maternal complications and improving pregnancy outcome especially in low-resource settings like Nigeria. The various routes of administration of misoprostol have been proven to affect the safety and efficacy of the drug. However, there is paucity of studies that compared the satisfaction of women regarding the oral and vaginal routes. The aim of this study is to compare patient satisfaction with administration of oral and vaginal misoprostol for induction of labor at term. Patients and Methods: A randomized comparative study, where 169 women admitted for induction of labor at the delivery suite of Ahmadu Bello University Teaching Hospital were assessed for their satisfaction with regard to the oral and vaginal routes of misoprostol administration using the 5-point Likert scale. Data were analyzed using SPSS version 20. Results: The request for analgesia was similar in both groups [17.9% vs 17.9%, relative risk (RR); 1.00 95% confidence interval (CI) 0.5–1.9]. However, more women in the oral group were very satisfied compared with the vaginal group (57.6% vs 33.3%), and a significant proportion of women in the oral group expressed their willingness to use the same route of labor induction in subsequent pregnancies (RR 1.1, 95% CI 1.0–1.3, P = 0.04). There was no difference in terms of maternal and neonatal outcomes for both routes. Conclusion: Women had higher satisfaction with oral misoprostol and preferred the oral route compared with the vaginal route.

Study of the effect of Tamsulosin in the spontaneous expulsion of ureteric calculi Ravikumar , Saikalyan A Guptha, Sriharsha Kurabalakota, Jay Prakash, Sanjay Parachuri, AS Karthik Archives of International Surgery 2018 8(2):69-74 Background: To increase the expulsion rate and reduce the analgesic requirement, there is a great deal of enthusiasm for adjuvant pharmacological interventions which is non-invasive and cost-effective. Tamsulosin shortens hospital stay, decreases operative interference. Tamsulosin increases stone expulsion rate and decreases expulsion time and has been shown to be safe and cost effective. The aim was to study the effect of Tamsulosin in the spontaneous expulsion of calculi in the ureter and to study the side effects of use of Tamsulosin for ureteric stones. Patients and Methods: A prospective, randomized controlled study was conducted to compare the effect of Tamsulosin between two groups. This study included a total of 50 patients, 25 patients were chosen randomly and advised to take plenty of oral fluids and treated with NSAIDs (Diclofenac sodium) and the other 25 patients were treated with Tamsulosin (alpha blocker) 0.4mg HS for one month along with oral fluids and NSAIDs (Diclofenac sodium). The patients were then observed weekly and ultrasound scan was repeated after 15 days to look for any passage of calculi. If the stone was passed successfully, it was confirmed with ultrasonography. After one month if treatment failed, conservative management was discontinued and the patient was advised surgery. Independent t-test and Chi-square test' was the test of significance. Results: Majority of the patients were in the age group of 20-40 yrs. The mean size of the calculus was 7.18 mm on the right side and 6.62 mm on the left side. Out of the 25 patients who were on alpha 1 blocker (Tamsulosin) 16 patients had passed the calculi and 9 patients had no results with a success rate of 64%. In the 25 patients who were not on Tamsulosin 6 patients passed the calculi and 19 patients did not pass the calculi. Conclusion: Tamsulosin is an effective and safe drug in the management of calculi in the ureter and should be considered before ureteroscopy or extracorporeal lithotripsy for uncomplicated ureteral calculi.

Spontaneous rupture of an unscarred uterus in a multipara at 32 weeks of gestation: A case report Caleb Mohammed, Joel A Adze, Stephen B Bature, Mohammed-Durosinlorun Amina, Taingson C Matthew, Abubakar Amina, Jonah Musa Archives of International Surgery 2018 8(2):75-77 Uterine rupture is still a public health problem in developing countries. Most spontaneous uterine rupture in this region occurs in unscarred uterus due to prolonged obstructed labor and injudicious use of oxytocics. Antepartum uterine rupture is uncommon; the diagnosis is not always obvious; and maternal, fetal morbidity and mortality are high. A 30-year-old gravida 7 para 5 +1 2alive, at 32 weeks of gestation, booked in a primary healthcare center and presented with sudden onset abdominal pain and vaginal bleeding of 4-h duration. Ultrasound scan revealed a major degree placenta previa; however, intraoperatively an anterior uterine rupture was detected with a fresh still-born male fetus weighing 1,650 g with intact membranes within the abdominal cavity. She had a subtotal hysterectomy performed. This case highlights the occurrence of spontaneous uterine rupture in an unscarred uterus; increased awareness on the need for early presentation enables prompt diagnosis and treatment.

Incidental finding of multiple splenosis in patient who had ventral hernia repair Purav Goel, Mohit Bhatia, Sachin Ambekar Archives of International Surgery 2018 8(2):78-80 Splenosis in itself is a rare condition and its presence in a patient with ventral hernia can pose an unusual challenge. Ventral incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair to various mesh repairs and laparoscopic repair. Splenosis is a benign condition caused by an ectopic autotransplantation of splenic tissues after splenic trauma or surgery. It is usually diagnosed accidentally and usually occurs within the abdominal and pelvic cavity. We report a female patient who had undergone splenectomy for abdominal trauma at the age of 12 years and was diagnosed as a case of abdominal splenosis at the age of 47 years on laparoscopy done for paraumbilical incisional hernia. This case report intends to share some important aspects of ventral hernia and splenosis and the approach followed in the repair of ventral hernia in our case.

Fatal tetanus infection originating from fungating advanced breast cancer: Case report and review of the literature Abdullahi Adamu, Zubair Hadi Ismail, Muhammad Inuwa Mustapha, Sefiya Adebanke Olarinoye-Akorede Archives of International Surgery 2018 8(2):81-86 Tetanus is an acute and potentially fatal disease caused by an exotoxin produced by a bacterium, Clostridium tetani. The cultural habit of application of concoctions made from mud and animal dung to chronic and necrotic wounds in our environment may provide a portal of entry for serious tetanus infection. There is a paucity of published data of tetanus infection arising from a necrotic breast tumor as a possible portal of entry in study area necessitating our report on a 48-year-old woman with extensive and fungating invasive ductal carcinoma of the breast who acquired fatal tetanus infection presumably from application of animal dung to the necrotic chest wall tumor. Patient and caregiver's education, clinical awareness, timely treatment, and proper tetanus vaccination in predisposed patients before surgical excision, debridement, or chemotherapy might be necessary to prevent this catastrophe.

Primary extragnathic osteosarcoma with visual loss in an adolescent female Modupeola O Samaila, Shehu Abdullahi, Halima O Aliyu, Benjamin Fomete, Abdullahi Jimoh Archives of International Surgery 2018 8(2):87-90 The majority of primary osteosarcoma cases affect the metaphyseal plates of long bones, while approximately 5%–10% cases involve the craniofacial bones and are mainly located in the maxilla and mandible. Primary osteosarcoma of the cranial vault is uncommon, and it usually occurs as a metastatic focus from primary diseases elsewhere in older patients. An 18-year-old female presented to our hospital with a 6-month history of a left-sided skull mass involving the forehead and part of the left orbit and 3 months of left visual loss. Clinical examination revealed a 32 × 26 cm firm to soft mass involving the left frontal, parietal and temporal bones, and part of the left orbit. She had no other contributory complaints or significant medical history. A clinical diagnosis of orbital malignancy was made with differential of metastatic left-sided skull tumor. A computed tomography scan revealed a sclerotic lesion arising from the left parietal–temporal bones with sunburst appearances, while fine needle aspiration cytology of the mass showed loose clusters and singles of malignant spindle cells. Incisional biopsy of the mass was diagnosed as fibroblastic variant of osteosarcoma. Extragnathic primary osteosarcoma is uncommon and accounts for less than 1% of craniofacial osteosarcoma. In general, osteosarcoma has a bimodal age of occurrence in adolescents and adults >65 years, and the preferential sites of involvement are the femur, tibia, humerus, and gnathic bones in decreasing frequencies. Our patient is within the first age group; however, the site is unusual and is often associated with secondary osteosarcoma in adults >65 years.

Mucocele of the appendix: A case report and review of literature Ibrahim Umar Garzali, Amina I Elyakub, Ibrahim Eneye Suleiman, Nasirudeen L Oloko, Ibrahim Abba Muktar Archives of International Surgery 2018 8(2):91-94 Mucocele represents mucinous dilation of the lumen of vermiform appendix resulting from obstruction or increase secretion. It is a rare disease with an incidence of 0.2–0.7% of all appendectomies and 8–10% of all appendiceal tumours. The clinical presentation is atypical with most cases usually asymptomatic. Mucocele of the appendix indicates dilation of the appendix lumen irrespective of the aetiology. Four types of appendiceal mucocele are defined by the cause of obstruction: retention cysts, epithelial hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. Mucocele of the appendix is a rare condition of the appendix that requires high index of suspicion for a definitive preoperative diagnosis. The treatment for appendiceal mucocele is typically surgical resection. We report a case of a 37-year-old woman with recurrent right iliac fossa pain of 20 years duration. Abdomen was full, moved with respiration with a positive pointing sign. There was marked right iliac fossa tenderness with rebound tenderness and guarding. She had an abdominopelvic ultrasonography that revealed features of acute appendicitis. She had surgery with intraoperative finding of marked distension of the appendix from the tip to the base with necrosis at the base, a right hemicolectomy was done.

Alexandros Sfakianakis
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