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   Table of Contents - Current issue
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April-June 2022
Volume 19 | Issue 2
Page Nos. 61-122

Online since Saturday, January 1, 2022

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ORIGINAL ARTICLES  

Role of Hyperbilirubinaemia as a Predictor of Complicated Appendicitis in Paediatric Population p. 61
Dinesh Prasad Koirala, Amit Kumar Gupta, Geha Raj Dahal, Bibek Man Shrestha, Suraj Shrestha, Subita Neupane, Rameshwar Prasad Pokharel
DOI:10.4103/ajps.AJPS_131_20  PMID:35017372
Background: Acute appendicitis is a common surgical emergency amongst the paediatric population. Available diagnostic tools are focussed to make a diagnosis of acute appendicitis. A definitive predictive factor for the diagnosis of complicated appendicitis is lacking. Thus, this aims to analyse hyperbilirubinaemia as a predictor of complicated appendicitis amongst the paediatric population. Materials and Methods: A prospective observational study was conducted in a tertiary hospital from November 2018 to October 2019. All children undergoing emergency appendectomy were included in the study. Preoperatively, patients were evaluated clinically, and routine investigations including total and direct serum bilirubin were sent. All patients were grouped as 'simple appendicitis' or 'complicated appendicitis' based on intra-operative and histological findings. Bilirubin level was compared between these groups and analysed. Results: A total of 52 children fulfilling the inclusion criteria were included. The mean age was 13.2 ± 4.2 years, and the male: female ratio was 2.1:1. Thirty-four (65.4%) had simple appendicitis and 18 (34.6%) had complicated appendicitis. Total bilirubin was 23.83 ± 5.94 mmol/L in the complicated appendicitis group and 13.15 ± 3.29 mmol/L in the simple appendicitis group. Direct bilirubin was 5.28 ± 2.22 mmol/L in complicated appendicitis and 2.62 ± 0.83 mmol/L in simple one. Both total and direct bilirubin were significantly high in the complicated group (P < 0.001) compared to the simple appendicitis group. On the Receiver operating curve (ROC), the best cutoff value for total and direct bilirubin was 21 and 5.5 mmol/L, respectively. The sensitivity and specificity of total and direct bilirubin were 72.2%, 100%, and 61.1%, and 85.3%, respectively. Conclusion: It is concluded that hyperbilirubinaemia is a good predictor for paediatric complicated appendicitis.
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Impact of the COVID-19 lockdown on the epidemiologic and clinic profiles of domestic accidents in children p. 65
Zineb Benmassaoud, Fatoumata Binta Balde, Zineb Oudghiri, Mohammed Tazi Charki, Hicham Abdellaoui, Karima Atarraf, My Abderrahmane Afifi
DOI:10.4103/ajps.AJPS_49_21  PMID:35017373
Background: Domestic accident (DA) is any harmful accidental event that occurs suddenly in the home or its immediate surroundings. Our study aims to describe the impact of the COVID-19 lockdown in the epidemiological and clinical profiles of DAs in children and their management. Materials and Methods: This was a mixed descriptive study, comparing DAs occurring during the COVID-19 lockdown and the same period of the previous year. We exhaustively included all children aged from 0 to 15 years admitted for DAs. Results: The incidence of DAs remains above 50% in both groups. The average age was 7 years and boys were more affected. Before the COVID-19 lockdown, the most common mechanism encountered was accidents on the public highway 20.75%, while during the lockdown, it was represented by falls from a high place with a height of 2 m or more. During the lockdown, 33.86% of patients consulted after more than 24 h of the trauma. Supracondylar fractures and burns remained the most frequent. In all cases, the cumulative frequency of fractures decreased during the lockdown. The COVID-19 lockdown had no impact on patient's management. Conclusion: The COVID-19 lockdown has negatively increased the consultation delay. However, it has considerably reduced the incidence of fractures.
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Totally ultrasound-guided minimally invasive percutaneous nephrolithotomy in children: Is it safe? p. 68
Ali Eslahi, Mohammad Mehdi Hosseini, Faisal Ahmed, Delara Tanaomi, Seyyed Hossein Hosseini, Mohammad Reza Askarpour, Hossein-Ali Nikbakht, Khalil Al-Naggar
DOI:10.4103/ajps.AJPS_13_21  PMID:35017374
Objective: The objective of the study was to assess the outcome and feasibility of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL) in children. Materials and Methods: Twenty-five children with upper urinary tract stones who had undergone US-guided mini-PCNL from June 2017 to June 2020 were enrolled in this study. Patients' demographic information and post-treatment results were retrospectively gathered and analysed. Pyelocaliceal system was punctured in prone position using US guidance, and the tract was dilated using single-shot dilation technique. All steps of renal access were done using only US. Mini-PCNL in all cases was done by using 15 Fr rigid nephroscope. Stones were fragmented with a pneumatic lithotripter and evacuated. Results: The patients' mean age was 6.30 ± 3.25 years (range: 1.5–15). The mean stone size was 16.04 ± 3.93 mm (range: 10–30). The mean access time to the stone was 1.50 ± 0.62 min (range: 1–4). The mean operation time was 94.66 ± 3.05 min (range: 90–100 min). The final stone-free rate was 96%. Post-operation fever occurred in 4 (16%) patients who were treated successfully with an antibiotic. No major complications occurred. Conclusions: We recommend US-guided mini-PCNL as a harmless alternative treatment option, in children with renal calculi due to its excellent outcomes and little complications.
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Evaluation of maternal preferences for neonatal male circumcision in Enugu Nigeria p. 73
Uchechukwu Obiora Ezomike, Josephat Maduabuchi Chinawa, Joseph T Enebe, Euzebus Chinonye Ezugwu, Elias C Aniwada, Nkeiruka Elsie Ezomike, Awoere T Chinawa, Sebastian Okwuchukwu Ekenze
DOI:10.4103/ajps.AJPS_41_21  PMID:35017375
Background: Although circumcision in male neonates is one of the most common procedures performed in neonatal surgery, mothers' preferences concerning the aspects of circumcision are not well-known. Since mother is the likely parent to present child for circumcision, her preferences should be given adequate consideration. Objectives: The objective of this study is to evaluate maternal preferences for neonatal male circumcision in Enugu. Methodology: A cross-sectional study where questionnaire was distributed by the researchers to consenting pregnant women attending antenatal clinics in two teaching hospitals in Enugu. Data analysis was performed using the SPSS. The results presented as means, percentages and tables. Test for significance was done using the Chi-square test. Results: Four hundred and sixty-one pregnant women participated in the study. Ninety-five percent (438/461) wanted circumcision and 83.5% (385/461) wanted it on or before the 8th day of life. The reasons were cultural/religious in 69% (302/447). Fifty-four percent (250/461) had no preferences as to methods, but for those who had, Plastibell was most preferred method in 28% (129/461) while 76% (235/309) preferred circumcision to be done in hospital. In 49.2% (227/461) preferred personnel were nurses but 79.6% (367/461) wanted doctors to attend to post-circumcision complications. In 79.2% (365/461), mothers will not insist on the use of anaesthesia for circumcision. Mothers with circumcised husbands were significantly more willing to circumcise a male child (P = 0.0018). Higher educational status of mother was significantly related to willingness to insist on the use of anaesthesia (P = 0.046) and use of analgesics after circumcision (P = 0.001). Conclusions: Most mothers prefer neonatal male circumcision by nurses, while preferring doctors for post-circumcision complications. These choices are not affected by parents' educational status. Mothers with circumcised husbands accepted circumcision more than those with uncircumcised husbands. Higher maternal education encourages anaesthesia during circumcision and post-circumcision analgesia.
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Paediatric osteoarticular infections caused by staphylococcus aureus producing panton–valentine leucocidin in morocco: Risk factors and clinical features p. 78
Kaoutar Moutaouakkil, Hicham Abdellaoui, Btissam Arhoune, Karima Atarraf, Samira El Fakir, Ghita Yahyaoui, Mustapha Mahmoud, Moulay Abderrahmane Afifi, Bouchra Oumokhtar
DOI:10.4103/ajps.AJPS_18_21  PMID:35017376
Objective: We aimed to estimate the prevalence of Staphylococcus aureus producing Panton–Valentine leucocidin (PVL) isolated from children diagnosed with osteoarticular infections (OAIs), and to examine risk factors and clinical features. Methods: This prospective study was conducted from January 2017 to December 2018. All hospitalised children diagnosed with S. aureus OAI are included. Blood cultures, articular fluids, synovial tissues and/or bone fragments were collected for bacteriological culture. Antimicrobial susceptibility tests were determined by disk diffusion method. Genes encoding methicillin resistance (mecA) and PVL virulence factors (luk-S-PV and luk-F-PV) were detected by multiplex polymerase chain reaction. The demographic, clinical, laboratory, radiographic and clinical features were reviewed prospectively from medical records. Results: A total of 37 children with S. aureus OAIs were included, 46% of them have PVL-positive infection and 70.6% were male. The mean age was 8.12 years (±4.57), and almost were from rural settings (76.5%). Children with Staphylococcus aureus producing Panton–Valentine leucocidin (SA-PVL) were significantly associated with type of infection (P = 0.005), location of infection (P = 0.037) and abnormal X-ray (P = 0.029). All strains SA-PVL+ are sensitive to methicillin, but one strain SA-PVL negative was methicillin-resistant S. aureus, confirmed by gene mecA positive. Conclusion: The prevalence of S. aureus infections producing PVL toxin was high in OAIs amongst Moroccan children, mainly due to methicillin-susceptible S. aureus. Type and location of infections and abnormal X-ray were significantly associated with SA-PVL. Routine diagnostic testing of PVL-SA, continuous epidemiological surveillance and multidisciplinary management of OAI is essential to prevent serious complications.
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A 5-year multidisciplinary care outcomes in children with wilms' tumour managed at a tertiary centre: A retrospective observational study p. 83
Felix M Alakaloko, Adeseye M Akinsete, Justina O Seyi-Olajide, Adedayo O Joseph, Olumide O Elebute, Oluwaseun A Ladipo-Ajayi, M Olatokunboh Odubanjo, Omodele A Olowoyeye, Adesoji O Ademuyiwa, Edamisan O Temiye, Adebola A Akinsulie, Christopher O Bode
DOI:10.4103/ajps.AJPS_155_20  PMID:35017377
Background: Over the last two decades, there has been significant improvement in the outcomes of children with Wilms' tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT. Methodology: This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients' case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant. Results: Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1–7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant. Conclusion: The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.
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Albumin haemoglobin index: Anovel pre-operative marker for predicting mortality and hospital stay in patients under one-year undergoing gastrointestinal surgeries p. 89
Musa Silahli, Mehmet Tekin
DOI:10.4103/ajps.AJPS_4_21  PMID:35017378
Aim: The aim of this study was to evaluate the mortality and morbidity of infants <1 year of age with intestinal obstruction requiring surgical intervention and to investigate the factors affecting mortality and hospital length of stay in paediatric surgery, including albumin-haemoglobin index. Patients and Methods: The records of gastrointestinal paediatric surgeries in the past 10 years of patients who were <1-year-old at Baskent University Konya Hospital were obtained from the hospital and retrospectively studied. Patient characteristics, especially the relationship between albumin haemoglobin index (AHI) and hospital duration and mortality, were examined. According to the surgical areas, it also subjected this relationship to further analysed in subgroups. Results: There were 144 cases who fulfilled the inclusion criteria. Pre-operative serum AHI was analysed using receiver operating characteristics (ROC) curve analyzes. In the ROC analysis, AHI had a diagnostic value in predicting case discharge rates (area under the curve: 0.755, P = 0.001). When the cut-off point was set at 46.18, the sensitivity of the test was 57.5% and the sensitivity for predicting survival was 84%. In the logistic regression model to estimate survival, the odds ratio of AHI was 1.063 (confidence interval: 1.020–1.108, P = 0.004). In subgroup analyzes, AHI positively predicted survival in the NEC group and in the other group. In a linear regression model analysing the effect of AHI on hospital stay of length, AHI explained 10% of the variance in the hospital stay of length variable and significantly and negatively influenced the hospital length variable (β = −0.319, P = 0.05). In the linear regression model for subgroup analyzes, AHI significantly and negatively predicted hospital length of stay in the NEC and pyloric surgery groups, but positively predicted hospital length of stay in the perforation group. Conclusion: The AHI can be used as a valuable marker to predict the likelihood of discharge and length of hospital stay in paediatric surgical cases <1-year-old.
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Annular pancreas in neonates; Case series and review of literatures p. 97
Haithem Hussein Ali Almoamin, Sadik Hassan Kadhem, Ansam Mahmood Saleh
DOI:10.4103/ajps.AJPS_180_20  PMID:35017379
Background: The annular pancreas is a rare congenital disorder of the pancreas first recognized in 1818. It is believed to result from faulty rotation of the ventral pancreatic bud in its course around the posterior aspect of the duodenal anlage. The duodenum is encircled and might be obstructed by normal pancreatic tissue. The management of the annular pancreas is still developing and under revision. Case Presentation: Six cases of neonatal intestinal obstruction secondary to the annular pancreas diagnosed, operated on, and involved in our study. Age, gender, maturity, age at referral, birth weight, clinical presentation, imaging findings, associated congenital anomalies, treatment, complications, and hospital stay were all studied. Polyhydramnios is found in 3 cases (50%). Down syndrome was diagnosed in one case. One patient has associated malrotation. Symptoms started earlier within the first 24 hours. Vomiting was bile stained in 4 cases (66.7%). Passing meconium, sometimes frequent, does not exclude the annular pancreas. Most patients show double bubbles sign on plain abdominal X-ray. All six neonates were treated with duodenoduodenostomy with excellent results. Survival was 100% and complications were minimum. Conclusion: The annular pancreas, although rare, is an important cause of neonatal duodenal obstruction. The accurate diagnosis is usually performed during laparotomy. Vomiting may contain bile or not, furthermore, passing meconium does not exclude this condition. The best and the excellent surgical option is diamond duodenoduodenostomy. This case series might be added to the registered cases of the annular pancreas to standardize the method of diagnosis and to define the best management.
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Management of trichobezoar: About 6 cases p. 102
Besma Haggui, Saida Hidouri, Amine Ksia, Meriem Oumaya, Sana Mosbahi, Marwa Messaoud, Sabrine Ben Youssef, Lassaad Sahnoun, Mongi Mekki, Mohsen Belghith, Abdellatif Nouri
DOI:10.4103/ajps.AJPS_110_20  PMID:35017380
Background: Trichobezoar is an uncommon clinical entity in which ingested hair mass accumulates within the digestive tract. It is generally observed in children and young females with psychological disorders. It can either be found as an isolated mass in the stomach or may extend into the intestine. Untreated cases may lead to grave complications. Material and Methods: We retrospectively analyzed the clinical data of six patients treated for trichobezoar in Monastir pediatric surgery department during 16-year-period between 2004 and 2019. Imaging (abdominal computed tomography and upper gastroduodenal opacification) and gastroduodenal endoscopy were tools of diagnosis. Results: Our study involved 6 girls aged 4 to 12. Symptoms were epigastric pain associated with vomiting of recently ingested food in 3 cases and weight loss in one case. Physical examination found a hard epigastric mass in all cases. The trichobezoar was confined to the stomach in 4 cases. An extension into the jejunum was observed in 2 cases. Surgery was indicated in all patients. In two cases, the attempt of endoscopic extraction failed and patients were then operated on. All patients had gastrotomy to extract the whole bezoar even those with jejunal extension. Psychiatric follow-up was indicated in all cases. The six girls have evolved well and did not present any recurrence. Conclusion: open surgery still plays a crucial role in Trichobezoard management . After successful treatment, psychiatric consultation is imperative to prevent reccurrence and improve long term prognosis
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Advance oropharyngeal mucoepidermoid carcinoma in a 9-year-old boy: A case report and review of literature p. 105
Abdulrazak Ajiya, Iliyasu Yunusa Shuaibu, Mansur Adamu Yahuza
DOI:10.4103/ajps.AJPS_133_20  PMID:35017381
Primary malignant salivary gland tumours are uncommon among the paediatric population, accounting for <10% of all head-and-neck tumours in childhood. Less than 5% of all salivary gland cancers occur during childhood, most of them are diagnosed over the age of 10 years and are histologically low or intermediate grade. Mucoepidermoid carcinoma (MEC) occurring in the oropharynx of children and arising from the posterior pharyngeal wall is rare and probably never reported. We hereby report a case of advanced MEC arising from the posterior wall of the oropharynx in a 9-year-old boy, managed via a transcervical excision in a resource-poor setting.
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Duodenal obstruction due to missed pre-duodenal portal vein in a patient with intestinal malrotation p. 109
Stephen Akau Kache, Danjuma Sale, Victoria Ijeoma Chinwuko, Philip Mari Mshelbwala
DOI:10.4103/ajps.AJPS_146_20  PMID:35017382
Pre-duodenal portal vein (PDPV) is a rare anomaly and a rare cause of duodenal obstruction (DO), with only a few cases reported in the literature. We present an infant whose bilious vomiting persisted despite having Ladd's procedure for intestinal malrotation due to a missed diagnosis of DO from PDPV that was found at re-exploration. The patient was diagnosed with malrotation and had Ladd's procedure at 12 weeks of age, but bilious vomiting persisted post-operatively. The patient presented to us after 4 weeks, was clinically malnourished and dehydrated, resuscitation was done and re-exploratory laparotomy performed, where an obstructing PDPV was found and a duodeno-duodenostomy was performed anterior to PDPV. However, the patient died on post-operative day 7 probably from severe malnutrition due to delayed diagnosis and absence of parenteral nutrition. We conclude that PDPV may be a cause of DO in infants with malrotation and should be properly sought for during Ladd's procedure for possible bypass surgery if found.
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Induced membrane technique for reconstruction of a 25cm humerus diaphyseal defect secondary to chronic osteomyelitis in an adolescent p. 112
Jean Baptiste Yaokreh, Guy Serge Yapo Kouamé, Thierry-Hervé Odéhouri-Koudou, Ossénou Ouattara
DOI:10.4103/ajps.AJPS_40_21  PMID:35017383
The surgical treatment of long bone defects in septic environments remains a challenge for any orthopedic surgeon. The two-stage reconstruction technique described by Masquelet AC is a better alternative in our regions where expertise in microsurgical techniques is rare. We report our first experience with this technique through the reconstruction of the humeral diaphyseal bone defect. We presented a 12-year-old boy diagnosed with chronic osteomyelitis of the left humerus with sequestrum, a pathologic fracture with overly joint involvement. The first stage consisted of a sequestrectomy removing the entire humerus shaft (25 cm) with conservation of the humerus paddle followed by the implantation of cement spacer into the bone defect and stabilization with 2 Kirschner wires (22/10th) and a thoraco-brachial cast. Eleven months later, we performed a cancellous autograft associated with a free non-vascularised fibula graft (12 cm). The bone corticalisation was obtained after 11 months. At the 43-month follow-up, despite joint stiffness and unequal length of brachial segments, the patient and his parents were satisfied.
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ABSTRACTS Top

2nd Virtual (online) Conference of Pan African Paediatric Surgical Association (PAPSA) 26 – 27 november 2021 p. 115

DOI:10.4103/0189-6725.333595  
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