Sixty-four consecutive cases of intussusception in 48 infants and 16 older children managed at Jos University Teaching Hospital between January 1990 and December 1998 are reviewed. The age range was between 3 months and 15 years (mean 2.2 years) and the male to female ratio was 3.6:1. The quartet of abdominal pain, bloody mucoid stools, abdominal mass and palpable rectal mass was present in 70% compared with the classical triad (abdominal pain, bloody mucoid stools and abdominal mass) which occurred in only 32%. All the children had surgery. In 26 (41%) of the children, no associated cause was found, in three polyps formed the lead point and in five children a buried appendicectomy stump formed the lead point. In 30 (47%) other children, mesenteric lymphadenopathy and inflamed Peyer's patches were noted. Ileo-colic intussusception occurred in 32 (50%) children. Manual reduction was successful in 67%. Bowel resection for gangrene, irreducibility and an iatrogenic colonic tear was done in 30% of patients. Two (3%) had spontaneous reductions. There were four deaths. The commonest complications were wound infection and adhesive intestinal obstruction.

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Background-In many patients presenting with an acute surgical abdomen, the outcome of management is determined by the promptness of the appropriate surgical intervention. The average interval the patient has to spent waiting for treatment at first presentation to hospital with an acute abdominal emergency is unknown in our center. This study was designed to evaluate the waiting time between hospital presentation and operation,to highlight causes of the delay and outcome of treatment among patients admitted with emergency abdominal events in a Nigerian tertiary health Centre. Only 13(9.6%) of the patients were operated within 6-hours of hospital admission, considered prompt treatment. Operations after six hours in 123 others was due to several reasons but the commonest reason in [65.4%] was financial constraint. The commonest complication responsible for significant morbidity was wound infection in 31 (22.8%) patients, the majority of whom had delayed surgical operation (n=23/31). Twenty-eight (20.6%) patients died in this study. All but one were from the group operated beyond 6-hours of hospital presentation. Conclusion: The adverse consequences of prolonged waiting time in our center among patients admitted with acute surgical abdomen are most commonly due to financial difficulties. A hospital-based credit scheme available to emergency aptients will rapidly improve the quality of care we give our patients.

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We studied the terminal events preceding death in all patients dying in hospital over a period of 10 years. Hepatomegaly, massive ascites, cachexia, jaundice, massive pleural effusion and haemoptysis were the most frequent terminal events. The predominance of visceral-related terminal events is unexplained but may be related to site-specific metastasis and premorbid organ pathology.