Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society

The clinical dilemma of management of isolated contralateral axillary metastasis (CAM) in carcinoma breast remains unsolved. We report a case of metachronous contralateral left axillary metastasis in a 54-year-old postmenopausal woman, its management, and review of literature. After ruling out distant metastasis and occult primary in the opposite breast, curative treatment was planned. She underwent left axillary lymph node dissection which on histopathology showed metastatic carcinoma. Management of CAM with curative or palliative intent and whether to consider them as locoregional or distant metastasis remains controversial...

Apart from iatrogenic causes, many of the foreign bodies in the bladder and urethra are self-inserted through the urethra as a result of psychiatric disturbances, sexual gratification, or erotic curiosity while intoxicated. Despite the reports on the presentation of urethrovesical foreign bodies in the medical literature, the insertion of foreign bodies through the urethra for the purpose of erotic satisfaction remains an enigma. Here, we report a case of a knotted earphone jack as an urethrovesical foreign body inserted for erotic reason by a 32-year-old man with no history of psychiatric disturbances...

Paraduodenal hernias are of congenital origin and may present with symptoms and signs of small intestinal obstruction. These hernias are rare in our practice, and a definitive preoperative diagnosis is often not made as the symptoms are not specific. Early assessment and prompt and adequate resuscitation and surgery obviate the risk of strangulation and intestinal resection. This report highlights a rare cause of intestinal obstruction in a young male who presents with all the classical features of obstruction: colicky abdominal pain, distension, vomiting, and inability to pass stool or flatus...

Schwannomas are the most common benign tumors of peripheral nerves but are rare in adults. They have an extremely slow rate of growth before the onset of symptoms such as pain, paresthesia, and tingling. Giant schwannomas of the extremities can significantly affect the quality of life. With a correct diagnosis, the tumor can be extirpated with preservation of nerve function and a very low risk of recurrence. A case of a symptomatic giant schwannoma on thenar eminence of the right hand in an adult male is discussed in this report...

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare neoplasm arising from the antigen-presenting cells of the immune system. It usually involves the lymph nodes, and extranodal sites are rarely affected. Here, we report a first known case of spontaneous hemoperitoneum caused by the rupture of IDCS of the small bowel. A 61-year-old male presented with complaints of abdominal pain and fever for 3 days and breathlessness for 1 day. Ultrasound abdomen revealed a 15 cm × 7 cm heterogeneous collection with thick septations in the periumbilical region...

A number of options exist for patients with anticipated difficult intubation on account of a retrosternal goiter compressing on the trachea. The chosen technique(s) to secure the airway in this delicate situation often depends on the location and degree of airway obstruction, available resources/facilities, and an anesthetist's experience and preferences. We report the case of a 68-year-old woman with severe airway obstruction from a retrosternal goiter coming for total thyroidectomy. Airway management started with an awake fiber-optic intubation, proceeded to a tracheostomy and finally to use of a rigid bronchoscope following failure of the earlier techniques to achieve adequate ventilation...

Ectopic kidney is a congenital anomaly of renal position, which is commonly asymptomatic. Symptoms arising from pelvic kidneys can closely mimic pathological processes of nearby organs and vice versa. We report an 18-year-old girl who presented with acute onset of a painful lump in the right iliac fossa. Although the clinical features mimicked an appendicular abscess, the judicious use of cross-sectional imaging aided in the proper diagnosis. Pyonephrosis of a right-sided lumbar kidney was confirmed on further imaging and nephrectomy was performed...

The aim of this report is to highlight the challenges involved in the diagnosis and treatment of anal melanoma in a tertiary hospital in Nigeria. It is a case report of an 84-year-old man who was managed for anal malignant melanoma. Despite inadequate investigative tools and less radical surgical treatment, the survival period of the index patient was comparable to the median survival quoted in the literature. Despite its rarity, mucosal melanomas also occur in the tropics. Prompt diagnosis, adequate imaging, and standardized treatment may improve its outlook in the nearest future...

Renal ectopia, even though a benign condition, presents diagnostic challenges when its complications arise. Cold abscess in an abnormally sited kidney may, therefore, create a diagnostic conundrum for the clinician. We present the case of a 55-year-old male who had a suppurating ectopic kidney that mimicked an abdominal visceral mitotic lesion necessitating initial laparotomy, reviewed the literature, and highlighted the need to consider the differential diagnosis, especially in patients who have been referred from peripheral hospitals where generous antibiotic therapy has been instituted...

BACKGROUND: Penetrating neck injury is a major trauma mechanism present in about 5%-10% of trauma patients with an estimated mortality of 3%-10%. The management of these injuries is dependent on the anatomical level of injury. OBJECTIVES: The objective of the study was to document the clinical and operative findings as well as the treatment outcome among our patients who underwent neck exploration for penetrating neck injuries. MATERIALS AND METHODS: A retrospective review of patients who had neck exploration for penetrating neck injury between January 2012 and December 2018 was done...

Introduction: Anterior cruciate ligament (ACL) is a common injury which has been conventionally managed by various graft reconstruction using bone patellar tendon bone, or quadruple hamstring autograft, to name a few. However, all these grafts are associated with many complications. Lately, peroneus longus tendon (PLT) autograft has shown promising results in this field, although there is still a dearth of data on its use. We, therefore, aimed at carrying out a study to evaluate the functional outcome and knee stability results of ACL reconstruction using PLT graft...

Objectives: Thyroglossal duct cyst (TDC) is the most common congenital anterior neck mass in clinical practice. Due to its congenital origin, presentation in adulthood is uncommon with only 7% of cases presenting in this age group. Data are therefore limited on the management of TDC in adults, particularly in Sub-Saharan Africa. This study describes the pattern of the presentation and treatment outcomes, following the management of TDC in a series of adults in a Nigerian tertiary hospital...

Aim: The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria. Patients and Methods: This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria...

Objectives: The aim of this study was to evaluate outcomes, survival, patterns of recurrence, and morbidity in both early and recurrent operable cervical cancer patients following radical hysterectomy, pelvic lymph node dissection, and adjuvant radiotherapy. Materials and Methods: This was a prospective analysis of 55 patients of stage IA-IIA and recurrent operable cervical cancer treated with radical hysterectomy, pelvic lymphadenectomy, and adjuvant radiotherapy from 2014 to 2017...

Introduction: Prostate cancer has an increasing global burden. The clinical course varies from an indolent disease to a rapidly aggressive cancer. It is associated with higher mortality in less developed nations due to late presentation. The Gleason scoring system for prostatic adenocarcinoma has prognostic implications in diagnosed cases. Obesity has been associated with the evolution of many cancers including prostate cancer. There are conflicting reports on the relationship between obesity, as measured by body mass index (BMI), and prostate cancer aggressiveness, as measured by Gleason score...

Introduction: Acute mesenteric ischemia (AMI) is the sudden onset of small intestinal hypoperfusion, which can be due to reduction or cessation of arterial inflow. It can be embolic or thrombotic. AMI is a potentially fatal vascular emergency, with overall mortality of 60%-80%. The present study was designed to study presentation, risk factors, and various outcomes of AMI patients, who were treated in the tertiary hospital. Methodology: All patients with features suggestive of AMI were taken in study...

Background: Trauma is a worldwide problem that results in significant morbidity and mortality in developing countries. Objective: This study looks at the demography of trauma from data abstracted from a Nigerian trauma registry and considers the peculiarities of a low-resource setting from this perspective. Methods: Trauma registry data from January 2013 to June 2014 were analyzed. Results: A total of 542 patients were included in the study...

OBJECTIVE: The objective is to study the role of antibiotic prophylaxis, if any, in the prevention of wound infection after open mesh repair of primary inguinal hernias. MATERIALS AND METHODS: Patients coming to outpatient department for open mesh repair of inguinal hernia were randomized into the placebo group and antibiotic group, a total of 150 patients were enrolled in the study. Follow-up was done up to 1 month to look for any evidence of surgical site infection using the criteria of Centers for Disease Control on wound infection...

Background: COVID-19 pandemic has affected surgical practice worldwide. Laparoscopic procedures utilizing gas for pneumoperitoneum require specific consideration. Method: A panel of experts of the Laparoscopic Surgery Society of Nigeria (LASSON) was constituted to draft recommendations on the conduct of minimal access surgical (MAS) procedures during and after the pandemic in Nigeria. Results: The Society strongly believes that laparoscopy and other (MAS) procedures can be safely performed during and after the current COVID-19 pandemic if appropriate safety measures are adhered to...

Desmoid-type fibromatoses (DTFs), also known as desmoid tumors, are benign but infiltrative neoplasms that often appear next to previous surgical site. Intra-abdominal tumors usually involve the mesentery, but splenic hilum is an unusual localization. We present a case of a desmoid tumor of the splenic hilum laparoscopically resected in a 70-year-old male with a previous history of chromophobe renal cell carcinoma and ocular spindle melanoma. Although benign, desmoid tumors might be infiltrative and produce serious complications...