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Objective: To evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of disease., Design: Retrospective observational study., Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya., Subjects: Two hundred and fifty three tumours were categorised as right colonic (RCC), left colonic (LCC) and rectal (RC) lesions. The distribution of symptoms (rectal bleeding, tenesmus, change in bowel habits, abdominal pain, intestinal obstruction, rectal mass), anaemia, transfusion requirement, and the Dukes' stages were compared for right colon, left colon and rectal tumours., Results: There were 54 RCC, 59 LCC, 140 RC lesions. Patient delay from onset of symptom(s) to presentation was a mean of 26.6 +/- 43, 20 +/- 25 and 33.7 +/- 42 weeks for right, left and rectal lesions respectively (p = 0.092). The proportion of patients presenting with rectal bleeding was 21%, 44% and 79% for RCC, LCC and RC lesions, respectively. The prevalence of intestinal obstruction was 14.8%, 27.1% and 43.6% in right, left and rectal lesions, respectively. The haemoglobin levels were significantly lower for right sided lesions (p = 0.05 for right colon/rectum pair; p = 0.059 for right colon/left colon pair). The sites of the lesions had no relationship to the stage of disease at presentation., Conclusion: In patients with colorectal cancer, the duration of symptoms was prolonged irrespective of the anatomical sub-sites. Symptoms were evenly distributed across the anatomical regions except for bleeding and obstruction which predominated in rectal and left colon cancers respectively. This underlines the need for early investigations in patients with rectal bleeding, change of bowel habit, intestinal obstruction and anaemia.

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical-legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze. The case illustrates the fallibility of the men and women in the operating theatres and the vital role of correct instrument and sponge counts.

Only 2% of patients with Meckel's diverticulae (MD) will manifest clinical problems. Diverticulitis occurs in approximately 10-20% of patients with symptomatic MD and more often in the elderly population. We report a case of Meckels diverticulitis presenting with perforation and mesenteric abscess in a young African man. The authors present information on diagnostic pitfalls and advise a lower threshold for consideration of MD as a differential diagnosis of acute right iliac fossa pain especially when the CT scan denotes a normal appendix in a male patient.

Objective: To describe the emergency care of injuries at a main city hospital., Design: A prospective study., Setting: Data were collected between February 1st, 1999 and 30th April, 1999 from the records of the 2000 bed Kenyatta National Hospital (KNH) in Nairobi, Kenya., Subjects: Two hundred and forty injury patients admitted at KNH were analysed., Methods: All patients were analysed for demographics, environment of injury hospital arrival and Emergency Department times. The effects of injury severity, place of injury and time of day on these time intervals were analysed statistically., Results: Road injury admissions formed 31% of all injury admissions. The mean age was 30 years. Males comprised 84.6% of all patients. The proportions of patients under 20 years of age was 20% with a peak age of 20-29 years. Majority (43.3%) of the injured resided in deprived neighbourhood of East Nairobi. The mean pre-hospital time was 2.56 hours. The Emergency Department disposition time was 3.36 hours. Injuries of all severities, as determined by the Injury Severity Score (ISS), were treated. The pace of care did not match severity of the injuries. Only 17.5% reached their areas of definitive care within sixty minutes., Conclusion: Injuries following road traffic accidents (RTAs) are common in Nairobi. The response to injury is slow and haphazard. The insitution of a care incorporating the city's health centers and pre-hospital triage may optimise care.

Background: The negative appendicectomy rates have remained high. The integration of clinical scores into the diagnostic process in acute appendicitis has had the purposes of improving decision making and reducing the negative rates in this common condition. The performance of these score systems have however, not been uniform., Objective: To assess the usefulness of a modified Alvorado score (1986) to predict groups of patients with suspected appendicitis for definite surgery, observation or discharge from hospital., Design: Prospective study., Setting: Kenyatta National Hospital (KNH), a central referral and teaching hospital in Nairobi, Kenya., Patients: One hundred and eighty nine patients with suspected acute appendicitis were studied over a period of twelve months., Methods: Five symptoms and four signs were assigned numerical values and the patients scored out of a total of 10 points. A score of >7 predicted mandatory operation, 5-6 observation and score 1-4 predicted those not considered for surgery. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical suspicion and not the diagnostic score., Results: The proportion of patients with scores >7 was 40.7%. The mean score was 6.02. The mean ages and the gender ratios were similar across score groups. The negative appendicectomy rate was 17.6% for group 1-4, 16.5% for 5-6 and 19.7% for >7. These were similar to the overall negative rate of 18% based on clinical suspicion. The overall sensitivity and sensitivity for the scoring system was 80.3% and 16.8% respectively., Conclusion: High scores were found to perform poorly in predicting diagnosis of acute appendicitis preoperatively and in the reduction of negative appendicectomies. The integration of a scoring system does not offer advantage over degree of clinical suspicion.

Objective: To evaluate the clinical and epidemiological data on automobile injuries and to assess the adequacy of road trauma documentation at the Nairobi Hospital., Design: A retrospective descriptive study., Setting: The Accident and Emergency Centre of the Nairobi Hospital., Subjects and Method: Medical records of randomly selected road trauma patients who presented at The Accident Centre between 1st July 1997 and 31st August 1998 were analysed., Results: The mean age was 32 years with a peak incidence in the 21-30 year age group. Males comprised 63.1% of the injured. The predominant category of the road user injured was the vehicle occupant (70%). Pedestrians only constituted 21.3%. Major city roads or highways were the commonest scenes of injury (38.3%). Most of the responsible vehicles were small personal cars (65.8%). The public service minibuses (popularly known as matatu) caused 20% of the injuries. Most of the injuries were mild and transport of the injured to hospital was uniformly haphazard. A quarter of the injuries were severe enough to warrant admission. Trauma documentation was poor with less than 30% accuracy in most parameters., Conclusion: The pre-hospital and initial care of the injured is not systematized. The study calls for re-orientation of trauma care departments to the care of the injured.

Objective: To provide an overview of the changing epidemiology of acute appendicitis in the developed and developing countries and the presumptive reasons., Data Source: Major published series of the last two decades were reviewed using Medline Search and Index Medicus. The myriad of diagnostic approaches currently employed to reduce the hitherto high rates of negative appendicectomy were examined and current trends of management analysed., Conclusion: The treatment modalities of acute appendicitis have undergone tremendous changes in the last decade.