Background. Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. Objective. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. Methods. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZuluNatal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and softtissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. Results. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3%) grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0%) grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. Conclusion. Children are particularly vulnerable to snakebite, and the consequences can be devastating. While the majority of patients in this study were shown to have secondary bacterial infection, debridement and subsequent wound management is considered the mainstay of treatment. Common organisms are Enterobacteriaceae and enterococci. There appears to be a role for antibiotics in the management of these patients. A good antibiotic policy is strongly advocated.

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Background Intestinal failure as a result of congenital or acquired massive bowel loss is an extremely difficult problem to manage and has traditionally been associated with a very poor outcome. In this study, the aim was to describe the current management of this problem, give an updated estimate of the survival and a description of the factors associated with survival and achievement of enteral autonomy in our context. Methods: A retrospective chart review was done for children managed with intestinal failure at Inkosi Albert Luthuli Central Hospital, South Africa from November 2015 to February 2023. Results: Twenty-two patients were managed with intestinal failure during the study period. The diagnosis was type 4 jejunal atresia with 3b component in 5 (22.7%); type 3b jejunal atresia in 5 (22.7%); type 4 jejunal atresia without 3b component in 3 (13.6%) and malrotation with volvulus in 3 (13.6%). One patient each had necrotizing enterocolits, gastroschisis with atresia, intussusception, type 1 jejunal atresia with volvulus, type 3a jejunal atresia and volvulus around an ileostomy. Average bowel length was 34.7cm, and average length of stay was 122 days. Enteral autonomy was achieved in 10 patients (45%) and survival in 9 patients (41%). Surgical complication requiring early re-operation (OR 18) and bowel length equal to or less than 20cm were associated with non-survival. Conclusion A substantial proportion of children with intestinal failure can achieve enteral autonomy and survival in our context. The treatment process is, however, resource intensive. Avoiding early re-operation and bowel length >20cm are associated with a good outcome.

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Fulminant amoebic colitis is rare and has a high mortality. The role of surgery in the management of this condition is examined using examples from two cases presenting one year apart at Ngwelezane Hospital in KwaZulu Natal, South Africa. Both patients presented in an extremely unwell state with distended, peritonitic abdomens. Evidence from these cases confirms findings from others in the literature that the best management for fulminant amoebic colitis associated with extensive involvement, multiple perforations and gross contamination is total or subtotal colectomy and exteriorization of proximal bowel with or without mucous fistula.