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Background/Purpose: The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods: Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative findings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. Results: There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had significantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month-8 years). Two (9.5%) had recurrent disease after primary excision; five (23.8%) had some degree of functional impairment at the follow-up. Conclusion: While SCT is usually benign, recurrence, malignant transformations in patients who present late and longterm functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivors. [ABSTRACT FROM AUTHOR]

Background: Childhood cancer is fast becoming an important paediatric problem in Nigeria and several parts of Africa, with the progressive decline of infectious and nutritional diseases. The following study was a 5-year retrospective review of paediatric solid tumours as seen at the Jos University Teaching Hospital, Nigeria. Objective: To determine the relative frequencies of childhood solid malignant tumours in Jos, Central Nigeria and compare with reports of previous studies both locally and abroad. Materials and Methods: Cancer registers and medical records of patients were used to extract demographic data, specimen number and/or codes. Archival materials were retrieved from the histopathology laboratory and sections were made from paraffin embedded blocks of these specimens. Slides of these histological sections were reviewed and reclassified where necessary. The relative frequencies were then determined. Results: One hundred and eighty one solid tumours of children were diagnosed within the study period. Ninety-four (51%) were benign and 87 (49%) malignant. Male: Female ratio was 1.3:1. The commonest malignant tumour diagnosed was rhabdomyosarcoma which accounted for 27 (31%), comprising of 15 (55.6%), 11 (40.7%) and 1 (3.7%) embryonal, alveolar and pleomorphic rhabdomyosarcomas, respectively. Non Hodgkin lymphoma and Burkitt lymphoma accounted for 17 (19.5%) and 12 (13.8%), respectively. Conclusion: Based on the result of our study, we conclude that the commonest solid malignancy of childhood in Jos, Nigeria is rhabdomyosarcoma. This has implications for diagnosis, management and prognosis of theses soft tissue sarcomas in our paediatric population. [ABSTRACT FROM AUTHOR]

Acute appendicitis is a common occurrence in children. The current trend is to perform appendicectomy once acute appendicitis is diagnosed. The aim of this study was to evaluate the types of pathology seen in appendices removed for acute appendicitis and correlate them with clinical features. The clinical, operative and histological records of 302 children who had appendicectomy at the Jos University Teaching Hospital from 1995-2003 were retrospectively reviewed. There were 123 (40.7%) boys and 179 (59.3%) girls (m: f = 1: 1.5). Their ages ranged from 2-15 years (median: 12 years). The main symptoms and signs at presentation were right lower quadrant abdominal pain, anorexia, nausea, vomiting, right quadrant tenderness, guarding and rigidity. Clinical impressions included simple acute appendicitis in 260 and perforated appendicitis in 42 patients. Of the 302 children who had clinical diagnosis of acute appendicitis, only 144 (47.7%) were confirmed at histology. Lymphoid hyperplasia was the most common pathology seen in the appendix specimens. The clinical impressions of acute appendicitis made by the surgeon agreed with pathologists' report in 63.9% and disagreed in 36.1% of cases. Negative appendicectomy rate was 52.3%. Although appendicectomy is the most commonly performed emergency abdominal surgery in children, the procedure is still associated with a high negative appendicectomy rate. [ABSTRACT FROM AUTHOR]

Background: Until recently, surgical conditions in children requiring operation were managed by the traditional open method. The introduction of the laparoscopic surgical technique seems to be reversing this trend in many centres. We are pioneering some laparoscopic surgery procedures in our environment and the aim of this study was to document our experience with laparoscopic paediatric surgical procedures in a developing country. Materials and Methods: This was a prospective analysis of all consecutive children that had laparoscopic surgery at 5 hospitals in Northern Nigeria from June 2008 to February 2011. Results: Twenty-one patients had laparoscopic surgeries during the study period with a mean age of 12.5 ± 2.6 years and age range of 10-16 years. There were 14 females and 7 males with a M:F ratio of 1:2. Seven patients (33.3%) had cholecystectomies and 13 (61.9%) had appendicectomies and the remaining one patient (4.8%) had adhesiolysis for partial adhesive intestinal obstruction following previous open appendicectomy. The mean operating time was 89 min with a range of 45-110 min for appendicectomies, 55-150 min for cholecystectomies and the adhesiolysis took 50 min. The mean hospital stay was 2 days except for the conversions that stayed up to 7 days. There were 2 (9.5%) conversions with no mortality. Conclusion: We solicit a paradigm shift in our approach to surgical management and implore other centres to embrace laparoscopic surgery in the management of surgical conditions in children since it confers obvious advantages over open surgery. [ABSTRACT FROM AUTHOR]

Spontaneous scrotal faecal fistula is a rare complication of incarcerated inguino-scrotal hernia in the neonate and infants. Only five previous cases have been reported in the English medical literature. We report another case of a 28-day-old neonate, who presented with fecal fistula following prolonged incarceration of a right inguino-scrotal hernia. The etiology and management of this rare complication is discussed. [ABSTRACT FROM AUTHOR]

Purpose: Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma., Patients and Methods: From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome., Results: There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries, one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries., Conclusion: Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice.

Background: Childhood Wilms' tumour or nephroblastoma represents one of the challenges for paediatric oncologists in developing countries., Objective: To review the clinical characteristics and outcome of management of childhood nephroblastoma in North- Central Nigeria., Methods: The clinical, operative and histological records of children aged 15 years and below, that were managed for Wilms' tumour at the Jos University Teaching Hospital between 1998 and 2005 were retrospectively reviewed., Results: There were 32 children (M:F=1.9:1) with histologically confirmed nephroblastoma seen over the 7-year period. Their median(range) age was 4 (3-15) years. The patients invariably presented with a palpable abdominal mass, but haematuria was exceptional. The neoplasm tended to be larger on average than those reported previously among Caucasian children. At presentation, 1 (3.1%) patient was in stage I, 8 (25%) stage II, 11 (34.4%) stage III and 12 (37.5%) stage IV. About 72% of the patients presented with stage III-IV disease. Poorly differentiated neoplasm was more common in male than in female patients. Nephrectomy and chemotherapy were the modality of treatment. Fifteen (46.9%) of the patients received little or no induction chemotherapy due to unavailability of drugs while only 12 (37.5%) received the prescribed maintenance treatment with the remainder getting erratic or no treatment. Overall, only 43.8% were alive between 1 and 9 months (median: 6 months) of follow-up period, but there was no survivor at two years after treatment., Conclusion: Childhood nephroblastoma has a high mortality rate in north central Nigeria because of late clinical presentation with advanced disease, poor availability of cytotoxic drugs and frequent interruptions in treatment and inadequate follow-up.

Objective: To determine the pattern of admissions to the intensive care unit (ICU) of the Jos University Teaching Hospital (JUTH), a tertiary level referral hospital., Method: This is a retrospective study of the record of patients admitted between January 1994 and December 2002 to the ICU of the Jos University Teaching Hospital. The information obtained from the admission/discharge record as well as the patients' case notes included demographic data, working diagnosis, type of treatment, length of stay (LOS) in the ICU and outcome., Result: A total of 738 patients were admitted over this period and comprised 403 males (54.6%) and 335 females (45.6%) giving a male: female ratio of 1.2:1. The age ranged from one day to 98 years with a mean of 28.3 +/- 19.8 years. Postoperative surgical patients accounted for 48.2% of all admissions, while 15.2% were medical cases. Other indications for admissions included polytrauma (9.5%), Obstetrics and Gynaecological complications (16.1%) and burns (11%). The length of stay (LOS) in the unit ranged from 1 to 56 days, with a mean of 4.5 +/- 5.1 days. A total of 241 patients died while on admission giving an overall mortality of 42.8%. Postoperative surgical admissions accounted for 38.6% of deaths followed by burn and polytraumatised patients with 23.2% and 11.6% respectively. The lowest mortality of 8.7% was in the obstetrics and gynaecology patients., Conclusion: The pattern of admission into the unit and the outcome of treatment has not significantly changed after 1-2 decade of an initial report. There is need to increase the number and quality of equipment to cope with the increasing need for ICU care, as well as draw up a policy on the type of cases to be managed in order to improve the out come of care.

Background: In developed countries, the availability of advanced imaging techniques has reduced the necessity for laparotomy following blunt abdominal trauma in children. Laparotomy rates still remain high in developing countries where these advanced imaging techniques are lacking. A simple management protocol to identify patients who require laparotomy could reduce the laparotomy rate in children with blunt abdominal trauma in these countries., Patients/methods: This is a review of children aged 15 years or below managed in our institution over a 5 1/2-year period for blunt abdominal trauma. The children were divided into two groups. Group A consisted of children managed from January 1999 - December 2000. During this period, there was no protocol. Group B consisted of children managed from January 2001 - June 2004. During this period, a simple management protocol was introduced. The laparotomy rates in the two groups were analysed using a simple chi-square., Results: A total of 48 children, representing 63 % of children with abdominal trauma during the study period, were examined (Group A 17; Group B 31). Their ages ranged from 1.5 years - 15 years (median 9 years). Thirty-four were boys, 14 were girls (M:F = 2.4:1). Road traffic accidents accounted for 38 (79.1 %) and falls from heights for 9 cases (18.75 %), and one boy with a hydronephrotic kidney fell off the staircase at home. The diagnosis was clinical, supported by abdominal ultrasound scan (USS) and plain abdominal film. Twenty-eight (58.3 %) children had laparotomy (15 in Group A; 13 in Group B). There was a statistically significant difference in the laparotomy rates between Group A and B (p < 0.01). Nineteen children were managed nonoperatively (2 in Group A; 17 in Group B); one child died before an operation could be performed. There were 59 abdominal organ injuries in 45 children. In 2 children, ultrasound could not diagnose any organ injury. There were 33 splenic injuries; 15 children had splenic conservation, 7 underwent a splenectomy, while 10 were managed nonoperatively. One child with splenic injury died before operation. Of 7 liver injuries, 4 required suturing of lacerations, 1 subcapsular haematoma was left undisturbed at laparotomy, while 2 were managed nonoperatively. There were 4 pancreatic injuries. Three were managed nonoperatively, while 1 associated with duodenal injury had a laparotomy. All 6 gastrointestinal injuries had laparotomy. There were 5 renal injuries: 3 had laparotomy with suturing, while 2 were managed nonoperatively. There were 4 bladder injuries: 2 had laparotomy with suprapubic catheter insertion, while 2 were managed nonoperatively. There were 7 retroperitoneal haematomas in association with other organ injuries. Associated injuries included head injury in 2, long bone fracture in 2, spinal injury and chest trauma in 1 each. There were 4 deaths, 1 before surgery could be performed., Conclusion: Blunt abdominal trauma in children resulted mainly from road traffic accidents. The use of a simple protocol supported by ultrasound scan could reduce the laparotomy rate in countries with limited facilities.

Background: The management of anorectal anomaly remains a challenge to Surgeons. This study was carried out to determine the pattern and outcome of management of anorectal malformations (ARM) in a Nigerian tertiary hospital., Patients and Methods: The clinical and operative records of consecutive children with anorectal anomaly managed between October 1990 and September 2000 at the Jos University Teaching Hospital, Jos, were reviewed., Results: There were 82 patients, (57.3%) males and 35 (42.3%) females (m:f=1.3:1). There were 20 (24.4%) cases each of the high and intermediate types, 40 (48.8%) low variety and 2 (2.4%) cases of persistent cloaca. The high type was proportionately commoner in the males. Less than one-third presented within 24 hours. Eighty three percent of patients (mainly males) presented in acute intestinal obstruction. Passage of stools from abnormal sites and "imperforate" anus were complaints in 60 (73.1%) patients each. A total of 63 patients had definitive corrective procedure. Four patients with stenotic anus were treated by serial anal dilatations while 29 with low anomaly had anoplasty during the neonatal period. Twenty eight patients with intermediate or high anomalies or persistent cloaca had definitive repair or pull-through operations carried out 6-12 months after an initial colostomy. The definitive pull-through operations included abdominoperineal pull-through in 11 patients, PSARP in 15, while 2 girls with persistent cloaca had posterior sagittal anorectovaginoure-throplasty (PSARVUP). Twenty nine children were fully continent of stools after surgery; three patients developed occasional faecal soiling; while six patients had faecal incontinence., Conclusion: Anorectal anomaly is common, but presentation is late in our environment. Although mortality rate was high (26%), early results of definitive operation among survivors were generally good after a mean follow-up period of 19 months.

Background: The clinical diagnosis of intestinal malrotation in the older child is not always easy because of its non-specific presentations. The aim of this study was to determine the pattern of presentation of malrotation in older Nigerian children., Methods: The clinical, radiological and operative records of all the children aged 2 years or above, managed for malrotation at the Jos University Teaching Hospital between March 1992 and December 2002 were retrospectively reviewed., Results: There were 9 patients, with a median age of 5 years (range: 3-14 years). The commonest complaint was intermittent colicky abdominal pain in 9 (100%), followed by recurrent vomiting in 8 (88.9%), haematemesis and constipation each in 5 (55.6%) and repeated episodes of bloody stools and diarrhoea. Other features included abdominal distension in 5 (55.6%) and failure to thrive in 4 (44.4%). Preoperative diagnosis was possible only in 3 patients, through the use of barium meal. Operative findings included obstructing bands of Ladd, partial volvulus and mesocolic hernias. Surgery promptly and satisfactorily relieved the symptoms., Conclusion: The diagnosis of intestinal malrotation should be considered in any child with prolonged history of recurrent colicky abdominal pain, vomiting or diarrhoea, especially if there is associated history of failure to thrive. Surgical intervention provides satisfactory relief of symptoms and should be implemented as soon as the diagnosis is made.

Background: Despite the claims that umbilical hernia (UH) is common among Nigerian children, the socio-economic class-related prevalence or incidence rate of UH in the Nigerian children is not known. We therefore undertook this study to determine the prevalence of UHs among Nigerian children of high socio-economic class., Patients and Methods: This 7- years prospective study assessment of the prevalence of primary umbilical hernias among a private school admission seeking Nigerian children. Clinical evaluations of the umbilicus were conducted on 7,968 Nigerian children, attending interview into Nigerian Airforce Military schools from across the country., Results: Umbilical hernia was present in 102 (1.3% ) out of 7968 children, giving a prevalence of 12.8 per 1,000. Fifty-three (52.% ) were boys and 49 (48% ) were girls; their ages ranged from 6 to 9 years (mean 6.5 years). Umbilical hernia was 1.4 times as common in the girls as in the boys, with a prevalence of 15.3 per 1,000 and 11.1 per 1,000, respectively. The overall prevalence in this study is comparatively lower than those previously reported., Conclusion: Our study suggests that there is a low prevalence rate of UH among the children of high socio-economic class in Nigeria.

This is a retrospective study of 36 children with thyroglossal duct lesions managed at a tertiary hospital in Nigeria, between 1993 and 2003. The aim was to determine the pattern of presentation and outcome of management. The majority of patients presented with a chronic thyroglossal sinus with associated recurrent inflammation. The location and relationship of the lesions to the hyoid bone were similar to those encountered in the rest of the world. Despite their well-documented clinical features, thyroglossal duct lesions were misdiagnosed in some patients. The main complications were surgical site infections and recurrence. A plea is made for clinicians to pay attention to clinical and operative details so as to diagnose these lesions accurately and manage them properly.

Background: Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with high morbidity and mortality., Aims and Objectives: To determine the pattern and outcome of management of typhoid perforation in Aminu Kano University Teaching Hospital, Kano., Method: A retrospective Analysis of patients treated for typhoid perforation over a 6-year period., Results: There were 47 patients: 35 males and 12 females, ratio 2.9 to 1. The patients were aged 4 years to 58 years (mean 18.9 years). Typhoid perforation occurred all the year round with a peak prevalence in September; Six (12.8%) patients perforated in the first week, 29 (61.7%) second week, and 12 (25.5%) third week, of illness. Single perforation was found in 91.5% of cases, and two to three perforations in 8.5%. Surgical treatment was by simple closure in 72.3%, wedge resection in 8.5%, ileal resection in 17.1% and right hemi-colectomy in 2.1%. Of the 41 survivors (87.2%), wound infection was the most common postoperative complication in 44.7% of cases. The mortality rate was 12.8% mostly due to overwhelming sepsis., Conclusion: Typhoid perforation requiring surgical intervention is still endemic in our subregion, and emphasis should be on preventive measures such as safe drinking water and appropriate sewage disposal, and typhoid vaccination.

Background: Intestinal obstruction is a common cause of childhood surgical emergency in the tropics. The aim of this paper was to assess the pattern and the outcome of mangement of intestinal obstruction in Nigerian children., Study Design: The clinical reccords of all the cases of childhood intestinal obstructions managed at a teaching hospital in northwestern Nigeria between 1999 and 2003 were retrospectively reviewed., Results: There were 54 children, 44(81.5 %) were boys and 10 (8.5 %) were girls (m:f=4.4:1). Fifteen (27.8%) and 22 (46.2%) were neonates and infants, respectively. The causes of the intestinal obstruction were intussusception 16(29.6 %), Hirschprung's disease 14(25.9%), anorectal anomaly 12 (22.2%), external hernias 6(11.1%), atresia 5(9.3%) and congenital bands 1(1.9 %). The clinical features were consistent with those reported from other parts of the world, except that many patients with intussusception presented late with gangrenous intestines. The overall mortality was 6(11.1 %); the mortality in the neonates was 5(33.3 %)., Conclusion: Apart from the obvious absence of worm infestation, the aetiological pattern and the clinical presentation of childhood intestinal obstruction in this study agrees with those reported from other parts of the country. Their management is associated with high mortality in our environment, especially when there are associated anomalies or the presentation is late.

Objective: To compare post operative complications, rates of wound healing, and cost effectiveness between the closed and open methods of haemorrhoidectomy., Design: Prospective., Setting: Jos University Teaching Hospital (JUTH), Jos and Evangel Hospital, Jos., Patients and Methods: Consecutive patients who presented with second and third degree haemorrhoids were randomised into an open group A and a closed group B. Time taken for wound to heal, the postoperative complications and cost of management in each group were assessed. Each patient was followed up for at least three months., Results: There were 59 males and 20 females, distributed between group A (n=39) and B (n=40). The average postoperative hospital stay was 5 days in group A and 3 days in group A. There were no differences in the complication rate between the two groups. Post operative retention of urine was the commonest complication and occurred in 12 patients: 7 in group A and 5 group B. This was followed by reactionary haemorrhage in 6. All of which occurred in group A. There were 8 patients with skin tags: 5 in group A and 3 in group B. Other complications included secondary haemorrhage (2), wound dehiscence (4) and wound infection (2), all in group B. The average wound healing time was significantly shorter in group B (2.8 vs 5.0 weeks). The financial difference between the two treatment groups was not statistically significant (N4,593.00 and N4,598.00, or 34.02 dollars and 34.06 dollars in groups A and B, respectively)., Conclusion: The cost per patient and morbidity did not show any statistically significant differences between the open and closed methods of haemorrhoidectomy. However, healing was significantly faster in group B.

In order to determine the pattern and the factors that influenced outcome, we retrospectively studied fifty-seven patients with torsion of the testis admitted to the Jos University Teaching hospital between August 1993 and July 2001. The age ranged from 2 to 55 years with a mean of 22.7 years. Majority (79%) of the patients were in the second and third decades of life. The main suspected precipitating factors in this study were cold weather and scrotal trauma: in 28% of the cases no cause could be ascertained. Eight (14%) patients presented within 4 hours and 35 (61%) presented after 24 hours of the onset of symptoms. Both sides were equally affected. Testicular pain, retraction and scrotal swelling were the most common presenting complaints. The highest incidence 65%) occurred between November and February when the weather on the Jos plateau is coldest. At surgery, 34 (60%) patients were found to have associated congenital anomalies; in 22 (39%) patients, the testis was non-viable. There was no mortality in this series and the complications were superficial wound infection (14%), testicular atrophy (7%) and sub-fertility (16%). High index of suspicion in a patient with acute scrotum, prompt and effective surgery will improve testicular salvage.

Fluid and electrolyte disorders are common occurrences in Paediatric surgical practice. Despite this, the management of fluid and electrolyte imbalance in the paediatric surgical patients remains problematic. This is partly because authorities vary considerably in their recommendations for therapy, despite the great advances being attained in the understanding of the fluid and electrolyte homeostasis in the Paediatric age group. This has, in no doubt, resulted in a number of morbidity and mortality that could have been prevented based upon rational and acceptable recommendations for fluid and electrolyte therapy in children. In this review, the normal homeostasis, disorders and management of fluid and electrolyte and corrections of metabolic disorders in children are highlighted, with the aim to update the practice of fluid and electrolyte therapy in children.

The syndrome of acute colonic pseudo-obstruction popularly known as Ogilvie's syndrome is an infrequent pathology and has been the subject of numerous medical communications in the past two decades. Its aetiology and pathophysiology remains poorly understood and patients are still treated inappropriately. In this report, a patient with acute colonic pseudo-obstruction managed surgically is presented. The pathogenesis and surgical management of this condition is also reviewed.

The open method of haemorrhoidectomy has been criticized because of slow wound healing, severe pain and prolonged post operative care. This has led to a shift of interest to other methods of haemorrhoidectomy. These grounds of criticism need to be re-appraised for a rational conclusion and recommendation. Thirty nine consecutive patients who had open haemorrhoidectomy between 2nd and 3rd degree haemorrhoids from May, 1998 to April, 1999 were prospectively assessed for wound healing rate and complication rate. There were 26 males and 13 females (ratio 2:1). The average length of hospital stay was 3 days. Post operative pain and acute retention of urine were the commonest complications. The mean wound healing rate was 5 weeks, with a peak (30.8%) in the 5th post operative week. The mean cost of management was thirty eight U.S. Dollars ($38.00) or four thousand, five hundred and ninety three Naira. (N4,593.00). Open haemorrhoidectomy remains a safe and simple surgical technique that should not be discarded in complete preference to newer innovative methods.

Twenty two consecutive cases of adult intussusception managed between January 1990 and December 1998 at Jos University Teaching Hospital formed the basis of this study. Thirteen (59.1%) of the patients were males and 9(40.9%) females, with a male to female ratio of 1:4:1 and a mean age of 49.6 years. Most patients were referred late to our service as a result of poor index of suspicion and misdiagnosis. Laparotomy was done in all the cases and in 5(22.7%) patients no cause could be found, but in the remaining 17(77.3%) definite causes were identified which were mainly polyps in 7(31.8%) patients and colonic malignancies in 4(18%). The ileocolic intussusception was the commonest variety. Sixteen (72.7%) patients had bowel resection for colonic carcinoma, gangrenous bowel and irreducibility of the intussusception while manual reduction was successful in the other 6(27.3%) patients. The morbidity rate was 22.7% and the complications were wound infection and adhesive intestinal obstruction. Two deaths were recorded with a mortality rate of 9.1%. The pattern of adult intussusception as seen in the western world was observed in this tropical highland.

A case of a 37 years old veterinary surgeon who sustained right sided fracture of the base of the penis during masturbation is presented. He was seen more than 48 hours after his injury with the typical painful swelling, angulation and tenderness at the fracture site. The tear was promptly repaired using the Laubscher's subcoronal sleeve technique. He regained his ability to achieve erection on the third post operative day. This is a rare injury on the Jos Plateau--being the only documented case in 11 years in this tertiary health facility and so we consider it necessary to highlight salient points in the diagnosis and treatment. Psychotherapy was found very useful in this patient in order to wean his off masturbation especially during the immediate post operative period. His short term follow up has been uneventful; he is now able to achieve normal and straight erection and sexual intercourse without pain--a view corroborated by his wife.