Background: Ascariasis is the infestation by the largest intestinal nematode of man, a common problem in the tropics attributed to poor hygienic and low socioeconomic conditions. The aim of this research is to analyse the presentation, diagnosis and management of bowel obstruction caused by Ascaris lumbricoides, with special emphasis on the role of conservative management. Materials and Methods: This is a single centre, two consultant based 5 year retrospective study of childhood intestinal obstruction due to worms. Diagnosis in the suspected patients was based on history of passage of worms per mouth or rectum and on x-ray and ultrasonography findings. Only the patients of intestinal obstruction with documented evidence of roundworm infestation were included in the study and were followed for one year. Results: One hundred and three children with intestinal obstruction due to Ascaris lumbricoides were treated in the past five years at our centre. Abdominal pain was the most common presentation seen in 96 children followed by vomiting in 77 children. 20 children had history of vomiting worms and another 43 had history of passing worms in stool. Abdominal tenderness was present in 50 children, 48 had abdominal distension of varying degree, 50 had abdominal mass due to worm bolus, and 16 had or developed abdominal guarding or rigidity. All the children were managed as for acute intestinal obstruction along with hypertonic saline enema. The aim of management was "to starve the worm and hydrate the patient". 87 patients (84.47%) responded favourably and were relieved of the obstruction by the conservative management, 16 children (15.53%) had abdominal guarding or rigidity and underwent emergency exploration. Conclusion: Roundworm obstruction should be considered in the differential diagnoses of all cases of intestinal obstruction in children. Clinical history and examination along with X-ray and ultrasonography are very helpful for diagnosis of this surgical emergency. Most cases of intestinal obstruction due to Ascaris can be managed conservatively; however emergency surgery is needed in patients with abdominal guarding and rigidity.

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Background: The congenital constriction ring syndrome is characterised by fibrous bands that encircle, strangle and even amputate parts of the foetus. It is a common condition amongst Ghanaian patients, but data on it is quite scanty. Materials and Methods: A prospective study of patients presenting at a plastic surgical clinic in Ghana with the characteristics of the congenital constriction ring syndrome was undertaken. The patients were examined clinically and the findings recorded. An x-ray and clinical photograph of the affected limbs was taken. Treatment required several staged operations. Surgical correction of the constriction ring was done by excision and Z-plasty to prevent or alleviate lymphoedema, separation of distally fused digits and skin grafting of defect. Results: Sixteen patients made up of 10 males and six females were seen. The age at presentation ranged from nine days to 12 years with a mean age of 14.6 months. Twenty-two limbs were affected, made up of four right upper limbs, six left upper limbs, seven right lower limbs and five left lower limbs. In the upper limb malformations involved 42 digits; in the lower limb malformations involved 33 toes, one foot and five legs. Four main types of lesions were found: constriction rings, intrauterine amputations, acrosyndactyly, and simple syndactyly. Conclusion: Congenital constriction ring syndrome is of uncertain aetiology and could cause morbidity in the newborn. The syndrome and its complications are amenable to corrective surgery with good results. Early intervention is desirable for a successful outcome.

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Background: There has been an increase in day case surgery for children worldwide, but there have been few reports of the practice (most of them being retrospective) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. Materials and Methods: This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. Results: Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients, (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side, while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8%. In all, the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. Conclusion: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction.

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Congenital pulmonary agenesis or aplasia is extremely rare. Although more than fifty percent of patients die before first five years of age, some individuals may remain asymptomatic throughout their life. A three-month-old female child with right pulmonary agenesis presented to us with severe respiratory distress. She was misdiagnosed as a case of foreign body bronchus at the peripheral health centre. Bronchoscopy confirmed the diagnosis and relieved the symptoms. It is recommended that invasive diagnostic procedures and prophylactic surgery should not be done in asymptomatic cases.

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Background: Although abdominal pain is common in the paediatric age group, problems of misdiagnosis and serious consequences are more particular in an emergency setting. This study examined the aetiologies of acute abdominal emergencies in children. Materials and Methods: This was a retrospective study of 100 children below the age of 12 years presenting with acute abdominal emergencies (gastrointestinal) requiring operative interventions. All patients were operated on an emergency basis and the intraoperative findings were correlated with the clinical findings. Results: Acute abdominal emergencies in the paediatric age group were heterogenous, with a myriad of aetiological factors. Overall, 73% of patients were greater than 3 years of age. Early neonatal period formed the second most common group (12%). Acute appendicitis was the most common cause except in the infancy period where congenital abnormalities predominated. Conclusion: The correct diagnosis of acute abdomen in children requires attention to clinical details and a high degree of suspicion. Early surgical intervention in doubtful cases may be necessary to solve diagnostic problems.

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Background: In most children proximal humeral fractures are treated non-operatively with generally good results. This review discusses the indications of operative treatment and assesses the treatment results. Materials and Methods: The charts of 20 patients (14 girls; mean age: 12.3± 2.8 years; range: 7-16 years) with proximal humeral fractures who were operated on at our institution were reviewed from 1992 to 2002. Results: There were five metaphyseal fractures and 15 physeal injuries which were angulated according to Neer-Horowitz score as grade III in four cases and grade IV in 16 cases with a mean angulation of 47.8±39.1 degrees (range: 6-148 degrees). Associated lesions comprised open fracture and head trauma in two cases each. Patients with associated injuries were operated on primarily and the 16 others by secondary intention. All but one were reduced via an anterior approach with internal fixation. They were assessed for clinical and radiological healing at a mean follow up of 3.6 years ranging from 1.2 to 7.8 years. Conclusion: Based on our study, surgical option is indicated for severely displaced and unstable fractures in older children and adolescents.

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Bilateral single system ureteral ectopia (BSSEU) is one of the rarest entities in urology, with less than 80 cases reported so far. Incontinence resulting from the underlying anomaly can be devastating to the child. It is generally agreed that suitable urinary continence and long dry intervals are seldom obtainable because of poorly developed trigone and bladder neck area. We herein report a case of BSSEU managed by bilateral ureteric reimplantation, achieving satisfactory continence and bladder capacity without the need for urinary diversion or bladder neck reconstruction.

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Fetus-in-fetu is a malformed parasitic monozygotic diamniotic twin found inside the body of the living child or adult. We report a case of lumbar mass having superficial rudimentary phallus, labioscrotal fold, testes, pedunculated thumb-like digit and rudimentary pelvis in addition to bowel loops in a 6-month-old Nigerian girl. The mass was excised and the baby did well. We propose based on these that dizygotic parasitic foetiform twin could exist.

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Background: Gynaecological problems in children and adolescents are often both medically and psychologically unique and require a highly skilled approach differing from those utilized for an adult female population. There is paucity of data on childhood gynaecological problems in our environment. The purpose of this study was to document the prevalence and pattern of common gynaecological problems in the prepubertal child at Ahmadu Bello University Teaching Hospital Zaria, Northern Nigeria. Materials and Methods: This was a retrospective study involving case file-based data analysis over a 10-year period (1995-2004) of 62 children aged 1 month-12 years at the Gynaecology unit of Ahmadu Bello University Teaching Hospital Zaria, Northern Nigeria. Results: Sixty-two children were seen, 17 infants, 14 under 5 years of age, and the rest (31) were aged 6-12 years. The commonest condition was labial fusion (33.9%), urethral prolapse (14.5%), and suspected sexual assault (12%). Ambiguous genitalia (9.7%), vaginitis (6.5 %), and ovarian tumour (4.8%) were also encountered. Conclusion: Labial fusion, urethral prolapse, and suspected sexual assault are the commonest childhood gynaecological morbidities in Zaria. Provision of gynaecological services at every level of health care system to cater for young females is advocated.

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Introduction: Fetus-in-fetu (FIF) is a pathological condition in which the malformed foetus is found in the body of its twin. We report this rare case of a 3-month-old female baby whose diagnostic work-up suggested a mesenteric cyst but the mass at surgery was a FIF. Discussion: Although current imaging modalities like computerized Tomography and magnetic resonance imaging have a higher Sensitivity for accurate delineation of tissues, cheaper imaging alternatives like plain abdomen and ultrasonography still have a place in the preoperative work-up of FIF.

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Background: In children with congenital chest wall deformities, the vertical expandable prosthetic titanium Rib (VEPTR) has recently been developed to move the emphasis away from corrective spinal fusion, to expanding the deformed hemithorax. The aim of this paper is to demonstrate the need for paediatric surgeons in what is primarily an orthopaedic procedure. Materials and Methods: All patients less than 5 years old who had primary congenital scoliosis with poor respiratory function and were treated by VEPTR at our institution in conjunction with the spinal orthopaedic surgeons were reviewed. Results: All 6 cases required rib exposure and thoracostomy by a paediatric surgeon. One required exposure of the ribs only, 3 required an extrapleural thoracotomy and 2 required intrapleural thoracotomy with a patch repair of the rib space. None of the patients required blood transfusion and there were no early complications. All patients showed radiological improvement of their spinal and thoracic deformity as well as improvement in their respiratory function. Conclusion: Paediatric surgeons play an important role in the thoracic exposure required for this orthopaedic procedure. The benefit of a multidisciplinary approach is highlighted in this paper. The VEPTR implant may replace major spinal fusion surgery in this challenging group of patients.

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The solid pseudopapillary tumour (SPT) of the pancreas is an uncommon cystic pancreatic neoplasm mostly seen in young females. We present a large SPT in a 16-year-old female who presented with acute onset upper- and mid-quadrant abdominal pain associated with nausea and vomiting for 4 days. The lesion was demonstrated by abdominal ultrasound and by computed tomography, which was successfully removed surgically.

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Isolated congenital fusion of the gums is a rare anomaly. Early surgical treatment is indicated, as longstanding cases will impair normal feeding leading to nutritional and growth problems. We report the first case in the Yaoundι Gynaeco-Obstetric and Paediatric Hospital, which was successfully managed surgically.

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