BackgroundThe management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution.Materials and methodsA prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction.ResultsThe age range was 3 months to 48 months with a mean of 10.8 ± 9.1 months. Forty percent (N = 18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N = 38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p > 0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p = 0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment.ConclusionOur study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.

Background and Objective: There is paucity of data on the pattern and factors affecting the management outcome of patients with spina bifida cystica in the Ife-Ijesa zone, Nigeria. This study was designed to address this research question. Method: One hundred and six consecutive cases of spina bifida cystica who presented in our hospital from January 1990 to December 2004 were reviewed. We obtained information on sociodemographic factors, medical history and management as well as clinical outcome. SPSS was used to analyze the data. Result: Males constituted 54.7% and females 45.2% of cases. Mortality was high in those presented after the 4th week of life (p = 0.04). The malformation occurred in the lumbar and lumbosacral regions in 77.4%. Myelomeningocele was the most common type (86.8%). Hydrocephalus was recorded in 53.8% of patients. Surgical closure was done for 91.5% of the patients. About 77% of all the patients were discharged while 22.7% died. This was significantly related to age at presentation (p = 0.04) and infection before surgery (p = 0.045). Postoperative complications were more frequent in patients with ruptured lesions (p = 0.025), a larger size of defect (p = 0.028) and a lower birth weight (p = 0.006). Conclusion: Myelomeningocele is the most common type of spina bifida cystica in our environment. Late presentation and preoperative infection are associated with high mortality in our patients.

Objective: To determine the pattern and various factors that can affect the outcome of emergency surgical management of the neonate in a developing country. Methods: A retrospective study of all neonates who had emergency surgery over a 10-year period at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Results: There were 72 males and 38 females. The age at presentation ranged between 2 h to 30 days (mean Ϯ SD: 6.62 Ϯ 7.14 days). The weight at presentation was 1.3 to 3.9 kg (mean Ϯ SD: 2.62 Ϯ 0.53 kg). The mean birthweight of the survivors (mean Ϯ SD: 2.84 Ϯ 0.44 kg) was significantly higher than those that died (mean Ϯ SD: 2.26 Ϯ 0.49 kg) (P < 0.01). The mean interval to surgery from onset of symptoms in the survivors (mean Ϯ SD: 42.720 Ϯ 41.769 h) compared well to those that died (mean Ϯ SD: 51.85 Ϯ 65.52 h) (P = 0.424). The admission weight, duration of operation, level of gastrointestinal obstruction and type of operation significantly influenced the outcome. Closure of ruptured exomphalos, thoracostomy with oesophageal anastomosis, and intestinal resection with anastomosis are associated with high mortality. Sepsis/septicaemia was the commonest postoperative complications accounting for 16 deaths. Overall, there were 59 deaths (53.6%). Conclusion:The morbidity and mortality following emergency surgical management of the neonate is still very high in this environment. Lower admission weight, long duration of operation, type of operation performed and presence of upper gastrointestinal obstruction are significantly associated with increased neonatal surgical mortality in our hospital

The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.

There was a delay in presentation of children with intussusception with high post-operative mortality.