BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had full clinical assessment and laboratory investigations which indicated small bowel obstruction following perforation of the uterus at induced abortion, and was commenced on treatment. RESULTS: She was para 5+0. Her main complaints were abdominal and weight loss following induced abortion of a 12- week pregnancy, four months prior to presentation. At presentation the tools (ultrasound scan, plain abdominal radiograph and barium enema) used for diagnoses only suggested some form of intestinal obstruction and were unremarkable. Correct diagnoses indicating small bowel obstruction was only made at laparotomy. An exploratory laparotomy, adhesiolysis, small bowel resection, end to end anastomosis and bowel decompression was done after bowel preparation. CONCLUSION: Laparotomy has an enviable place in bowel injuries secondary to uterine perforation especially when there is a diagnostic dilemma. Nigerian female population requires continuous health education on widespread and effective use of contraception. Physicians need training and retraining on abortion techniques and management of abortion complications.

In underdeveloped countries, where abortion is still illegal and not easily accessible, the number of unsafe abortions is soaring, as are the associated complications. However, in developed countries, where termination of pregnancy is legal and freely accessible, unsafe methods are uncommonly seen and reported. We report one such case of self induced abortion with instrumentation that presented to an accident and emergency department in the United Kingdom.

Eight patients managed for bowel injury following induced abortion were studied for the pattern of morbidity and mortality. The patients were aged 18-39 years. Three of them were married, five were single. Two of the cases were detected at the time of termination of pregnancy. The interval from termination of pregnancy to presentation in hospital was two days to two weeks in the other six patients. Injury was in the ileum in three, jejunum in two and the sigmoid colon in three. Twenty surgical interventions were performed for primary treatment and management of complications. Major complications were abdominal wound dehiscence (5), faecal fistula (2) and postoperative diarrhoea (1). The duration of hospitalisation at the first admission ranged from seven to 163 days. The excessive morbidity is attributed to delay in presentation; most patients been seen after 72 hours. Primary repair of colonic injury is discouraged. No death was recorded. Literature is reviewed on the condition in West Africa and suggestion made on means of reducing morbidity from induced abortion.

Background/Objectives: Menarche, the first menstrual period, is influenced by many factors including socio-economic status and rural or urban dwelling. The aims of the study were to compare the age at menarche between rural and urban girls and evaluate the anthropometric indices at menarche. Materials and Methods: A cross-sectional study of rural secondary school girls and urban school girls. A structured questionnaire was used to obtain information on their age at menarche and other relevant data. Their weights and heights were measured using computerized scales and calibrated walls. Results: Two hundred and twenty eight (228) rural girls and four hundred and eighty (480) urban girls that had attained menarche within a year were studied. Mean age at menarche for all the girls was 15.26 years. Mean menarcheal age for the rural and urban girls were 15.32 years and 15.20 years, respectively. Mean weight and height were 47.6 kg and 156.76 cm, respectively for the rural girls and 48.12 kg and 156.8 cm, respectively for the urban girls. There was no significance difference in age of menarche among the groups (P > 0.05). Conclusion: The mean age at menarche for the school girls is 15.26 years. There was no difference in menarcheal age between the rural and urban school girls. Further longitudinal studies to compare rural school girls and urban school girls in private schools are required.

Background/Objectives: It is possible that not all women would want the disclosure of fetal gender by the sonologist during a prenatal scan. The objectives of this study were to determine the proportion of women who do not want fetal gender disclosure at the time of prenatal ultrasonography and document their reasons. Method: A cross-sectional survey of women that were 20 weeks or more pregnant that had prenatal ultrasound at a private health facility in January 2006. The sonologist asked each of the women during the procedure whether they wanted to know fetal sex or not. Those that consented had disclosure of fetal sex while those that declined gave their reasons, which were documented. Results: Two hundred and one (201) women were studied within the study period. Most of the women (82%) were of the Hausa/Fulani ethnic group and were predominantly of the Islamic faith (90%). One hundred and ninety women (94.5%) consented to disclosure of fetal gender, while eleven (5.5%) declined. The main reason for not wanting to know fetal sex was:'Satisfied with any one that comes'. Conclusion: Most of the pregnant women (94%) would want disclosure of fetal gender at prenatal ultrasound scan. Only 5.5% of the women would not want fetal sex disclosure because they were satisfied with whichever that was there. It is advisable for the sonologist to be discrete on what to say during the procedure especially as it relates to fetal sex so as not to hurt those that do not want disclosure.

Background : So much has been written on vesicovaginal fistula (VVF) but there is little on the patients' perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fistula and their attitude toward measures that would prevent future occurrence. Methods : The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling. Results : One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-five (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confirmed that pre and post-operative counseling were inadequate. Conclusion : Even though majority (70%) of the patients knew the cause of their fistula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fistula in order to prevent a recurrence.

This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.

BACKGROUND: Burn injury is one of the most severe forms of trauma that can afflict mankind. Although several forms of suicide and para suicide have been reported worldwide, severe burn injuries from deliberate self-harm have been poorly documented in Africa. AIM: To evaluate the pattern of deliberate self-harm by burning in our environment. METHOD: This is a 5-year retrospective analysis of all patients who sustained burns from deliberate self-harm (DSH) seen at the Usmanu Danfodiyo University Teaching Hospital, Sokoto from June 1998 to May 2003. The patients' data and other necessary information were extracted from the case notes. RESULTS: Seven patients were seen over the study period. There were six females and one male, giving a female to male ratio of 6:1. All the injuries occurred at home from kerosene flame burns. In all cases, the intent was to take the patient's own life. The triggering factors were mainly psychosocio-economic. Six patients had up to secondary education while one patient had a degree certificate. None of the patients was gainfully employed at the time of incidence. Two patients had previously attempted suicide. Only one patient had a history of psychiatric illness. All sustained severe flame burns ranging from 45%- 98% body surface area (BSA). Compliance to treatment was generally poor. All patients were managed at the intensive care unit (ICU) of the hospital.. Five patients died, while the remaining two signed against medical advice (SAMA) during the course of management. The duration of hospital stay ranged from 2 - 10 days. CONCLUSION: Severe burn injury from DSH, although previously poorly documented in Africa, is not uncommon in our environment. The morbidity and mortality are high, not only because of the nature of injury, but probably because of poor compliance to treatment. We advocate community based studies and routine screening of adolescents to identify those at risk. The need for the establishment suicide information, intervention and prevention centre in Nigeria cannot be overemphasised.

The basic component of the new World Health Organization (WHO) antenatal care model prescribes reduced number of clinic visits and limited investigations for low-risk pregnant women. The objectives of this study were to determine the proportion of pregnant women seeking antenatal care in a Nigerian teaching hospital who qualify for the basic component and to document difficulties that may arise with the classifying form. In December 2004, 234 pregnant women who had initiated antenatal care were enrolled for the study. Using the classifying form, 157 (67%) were eligible for the basic component, 41 (18%) for special care, but 36 (15%) women could not be classified. Those that did not know the birth weight of their last babies accounted for most (89%) of the unclassified group. The WHO antenatal care model was the most appropriate and relevant method for our hospital where a large percentage (67%) of prenatal women were eligible for the basic component. However, we consider that the classifying form should be adapted to accommodate all pregnant women.

The occurrence of eclampsia in an extra uterine pregnancy is a very rare entity. We report a case of a patient with eclampsia and advanced extra-uterine pregnancy. The fits were controlled with diazepam and the patient had laparotomy for the evacuation of the fetus from the abdominal cavity. She had an uneventful post operative recovery and was discharged home in good health after 10 days.

OBJECTIVES: To review the management of watering-can perineum (WCP) in a Nigerian centre and to outline challenges of its management. DESIGN: A retrospective review of cases of watering-can perineum over a seven-year period. SETTING: Usmanu Danfodiyo University Teaching Hospital, Sokoto, a Nigerian tertiary health centre. SUBJECTS: Forty one patients with the diagnosis of watering-can perineum managed from January 1997 to December, 2003. RESULTS: There were 41 cases of watering-can perineum. The mean age at presentation was 46.0 years (range: 7 to 80). Characteristically, all the patients had long standing neglected urethral stricture. Eighteen (43.9%) presented with single active fistulae while eight (19.5%) had more than four (9.8%) active external openings. Fistulae were located in the perineum (58.5%), scrotum (41.6%), penis (14.6%), penoscrotal junction (9.8%) and thigh (49%). The strictures were post inflammatory in 73% of patients. Bulbar strictures constituted 63.4% of cases. At presentation, patients were in general planned for initial suprapubic cystostomy (SPC) followed by assessment of stricture and finally urethroplasty in six months. Patients who could not afford urethroplasty were offered dilatation. The immediate outcome of urethroplasty was satisfactory in 70.6% of patients. CONCLUSION: Watering-can perineum was a common sequel of long standing neglected inflammatory urethral stricture. SPC followed by urethroplasty gave the best results. Prevention and adequate treatment of urethritis, prompt treatment of urethral stricture, and affordable and accessible reconstructive urologic service are recommended to reduce the incidence of WCP and suffering of the patients.

CONTEXT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. OBJECTIVES: To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction. MATERIALS AND METHOD: Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor. RESULTS: Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80%(120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture. CONCLUSION: Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.

OBJECTIVE To study the mortality and morbidity of unsafe abortion in a University Teaching Hospital. METHODS A cross-sectional, descriptive study was conducted in Department of Obstetrics and Gynaecology, Unit III, Dow Medical College and Civil Hospital Karachi from January 2005 to December 2009. Data regarding the sociodemographic characteristics, reasons and methods of abortion, nature of provider, complications and treatment were collected for 43 women, who were admitted with complications of unsafe abortion, and an analysis was done. RESULTS The frequency of unsafe abortion was 1.35% and the case fatality rate was 34.9%. Most of the women belonged to a very poor socioeconomic group (22/43; 51.2%) and were illiterate (27/43; 62.8%). Unsafe abortion followed an induced abortion in 29 women and other miscarriages in 14 women. The majority of women who had an induced abortion were married (19/29, 65.5%). A completed family was the main reason for induced abortion (14/29; 48.2%) followed by being unmarried (8/29, 27.5%) and domestic violence in 5/29 cases (17.2%). Instruments were the commonest method used for unsafe abortion (26/43; 68.4%).The most frequent complication was septicaemia (34; 79%) followed by uterine perforation with or without bowel perforation (13, 30.2%) and haemorrhage (9; 20.9%). Majority of induced abortions were performed by untrained providers (22/26; 84.6%) compared to only 3/14 cases (21.4%) of other miscarriages (p = 0.0001). CONCLUSION The high maternal mortality and morbidity of unsafe abortion in our study highlights the need for improving contraceptive and safe abortion services in Pakistan.

Unsafe abortion is a significant medical and social problem worldwide. In developing countries, most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity CASE REPORT: A 30 year-old female, gravida 7, para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation. The procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound, an unusual complication of unsafe abortion. Illiteracy, unawareness about health services, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications.

We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case.

BACKGROUND: Intussusception is a rare cause of intestinal obstruction in adult patients. The etiology of malignant nature has been reported to be more frequent in this group and the diagnosis is usually made at operation. Few reports are published for this clinical entity from Middle East. METHODS: The medical records of all adult patients admitted with the diagnosis of intussusception in a tertiary care center between 1989 and 2009 were reviewed. RESULTS: There were 15 cases of intussusception in this 20 years period. The mean age of patients was 33.6 years, 8 females and 7 males. In 14 cases the leading point of intussusception was in small bowel. Resection and primary anastomosis was the selected procedure in 13 patients; one patient underwent colostomy and one reduction alone. Malignant cause was detected in only 2 cases. 7 patients were operated on with diagnosis of intussusception according to imaging findings. The diagnosis was made at operation in the remaining 8 cases. Only one anastomotic leakage occurred in patient on systemic steroids. CONCLUSION: The mean age of our patients is relatively low with more benign etiologies in small bowel. The CT scan may be the most helpful imaging modality in suspected cases but decision for operation in acute presentations should not be deferred for definite diagnosis. Resection of the involved bowel segment and primary anastomosis is associated with a good outcome.

ABSTRACT : INTRODUCTION : Uterine leiomyosarcomas are relatively uncommon soft tissue neoplasms and rarely metastases to small bowel. In the current case; a patient is suffering from intestinal perforation due to metastatic leiomyosarcoma of the small bowel. CASE PRESENTATION : A 59-year-old woman underwent a modified radical mastectomy for infiltrating ductal cancer of the breast six years ago and a total abdominal hysterectomy for leiomyosarcoma of the uterus two years ago. About 2400 cGy total dose radiotherapy has also been applied after total hysterectomy for bone metastasis of breast cancer. She admitted to our clinic with the complaints of acute abdomen due to perforated small bowel metastasis of leiomyosarcoma during the radiotherapy. Laparotomy was performed and leiomyosarcoma of the ileum was removed totally. Histopathologic examination of the specimen confirmed the presence of the leiomyosarcoma in intestinal tissue samples. CONCLUSION : We aimed to present this unusual case which perforated presentation of the intestinal metastasis of uterine leiomyosarcoma.

AIM: Point to an extremly rare complication of a curettage during abortion and follow up surgical treatment of this complicated state. CASE: In the case of 32 years old woman, multipara, was perforated cervix uteri during the abortion curettage and fat tissue of mesentery was aspirated into canulla. Apendix vermiformis was aspirated into cannula with its protrusion through the neck of the womb during repeated revision. Surgeon made appendectomy lege artis after abdomen revision and looking after haemoperitoneum. Because of serious devastation of right fallopian tube, salpingektomy was performed. Perforation of cervix in the lenght of three cm was sutured. Extensive incomplete rupture continuing from perforation gap was sutured from ligamentum sacrouterinum I.dx to fundus uteri. Intact foetus of 5,5 week of gestation was leaved in toto because of the high risk of the womb wall disruption during repeatedly attempted abortion. CONCLUSION: In case of the suspection of the uterus injury a revision and interdisciplinary approach to the solution of complications is necessary.

Uterine perforation by a contraceptive intrauterine device (IUD) is a relatively rare event. These events may result secondary to mechanical force applied during placement (primary perforation) or migration by uterine contractions or surgical manipulation after placement (secondary perforation). A 33-year-old woman with an IUD placed 9 years before admission visited the emergency department with an early pregnancy and a 3-day history of vaginal bleeding. Vaginal examination revealed IUD strings visible at the cervical os, and transvaginal ultrasound confirmed the presence of an IUD in the lower uterine segment and upper cervix. The IUD migrated spontaneously to the fundal myometrium at 15 weeks' gestation. Premature rupture of membranes ensued at 20 weeks' gestation, and, at delivery, the IUD could not be retrieved. Subsequent computed tomography confirmed that the IUD was incompletely embedded in the fundal myometrium and partially extending into the peritoneal cavity. At laparoscopic sterilization 6 weeks later, the IUD had perforated the small bowel, and the device was removed with concomitant bowel repair. This case documents spontaneous migration of a copper IUD from the lower uterine segment through the fundus during early pregnancy and supports removal of asymptomatic ectopic IUDs whenever possible.

OBJECTIVE: To investigate the value of using protective new intracolonic drainage in decreasing low colorectal anastomotic leakage. METHODS: One hundred and nineteen cases of rectal cancer accepted low anterior resection were randomly assigned to study group (n=55) and control group (n=64). The study group was added with a new intracolonic drainage composed of biofragmentable anastomosis ring and condom during operation. The control group was added with protective ileostomy during operation. The results of surgery were compared between the two groups. RESULTS: All the cases were followed up over three months and there were no perioperative death. There were no significant differences in physiopathological factors such as age, sex, body type, site of tumor, size of tumor, differentiation of tumor, site of anastomosis, condition of nutrition, concomitant disease between the two groups. In the study group, anastomotic leakage occurred in 4 cases (7.3%), the drainage devices were ablated 18.3 days after operations and there were no drainage-related complications; light anastomotic stenosis occurred in 3 cases (5.5%) three months after operations. Among the cases with leakage, no severe abdominal infection was found, the time of abdominal drainage was 4.8 days, and the amount of abdominal drainage was 12.8 ml/d in primary three days after leakage. In the control group, anastomotic leakage occurred in 7 cases (10.9%), stomy-related complications occurred in 29 cases (45.3%), anastomotic stenosis occurred in 18 cases (28.1%) and severe anastomotic stenosis occurred in 4 cases (6.3%) after three months. Among the cases with leakage, severe infection occurred in two cases, anastomotic spoiled occurred in one case, the amount of abdominal drainage was 35.4 ml/d in primary three days after leakage, and the time of abdominal drainage was 17.1 days. There was no significant difference in the rate of anastomotic leakage between the two groups (P>0.05). But there were significant differences in the amount of abdominal drainage, the time of abdominal drainage and abdominal infection in the cases of anastomotic leakage (P<0.01). There was significant difference in anastomotic stenosis after three months between the two groups (P<0.01). CONCLUSIONS: The intracolonic drainage is a simple, safe and effective method in protecting low colorectal anastomotic leakage, and avoiding harmful results caused by anastomotic leakage. Compared with protective ileostomy, intracolonic drainage can avoid stomy-related physical mental suffering and complications, the rate of later anastomotic stenosis is less, and the time of abdominal drainage is shorter in the cases with leakage.

INTRODUCTION: Anastomotic leak or disruption is a grave complication of colorectal surgery. Protection of an at-risk anastomosis by an upstream open diverting colostomy (OC) reduces this gravity. An unopened upstream loop colostomy is a surgical alternative which may diminish the unpleasant consequences of an open colostomy while maintaining the option of diversion in case of need. The aim of this study is to report the results of this approach and to define its indications. MATERIAL [corrected] AND METHODS: We report a retrospective series of 34 cases of unopened diverting loop colostomy to protect an at-risk colorectal anastomosis. Indications for this procedure were stool-laden bowel (59%), low serum albumin (11.5%), local inflammation (11.5%), and very low placed anastomosis (17.5%). RESULTS: The loop colostomy was eventually opened after surgery in six cases because of anastomotic leakage diagnosed clinically and/or detected by water soluble contrast opacification which was performed routinely on the sixth post-operative day. In all six cases, there was no need for an urgent surgical intervention. In 28 cases, the anastomosis healed without complication and the exteriorized loop was returned to the abdominal cavity seven days after the initial surgery. This was a short, simple procedure with an average operating time of ten minutes. Average hospital stay after returning the unopened colostomy to the abdomen was two days. CONCLUSION: Unopened loop colostomy offers the advantages of protection of a colorectal anastomosis without proper morbidity or mortality, shorter hospitalization, and improved psychological comfort for the patient. It's principal indication is to minimize the risks related to leakage from an at-risk colorectal anastomosis.

Primary repair of traumatic colonic perforation is progressively gaining acceptance as the best method of management. However, when delayed, the risk of infection-related complications may increase. Here, we present a new method of repairing colon perforation in the presence of peritonitis. Acute colon injury was simulated in 22 German shepherd dogs. The dogs were randomly divided into two groups of 11 and after 24 hours they were operated on. The perforations were repaired by subserosal suture technique. In the first group (group A), ileal patch was used. In the other group (group B), the colon was closed by debridement and anastomosis. After 6 weeks, the repairs were assessed on the basis of survival, gross and histological assessments. Nine (82%) dogs in group A and six (56%) in group B survived. Ileal patch utilization significantly decreased the mortality rate (p < 0.05). The cause of death in two group A dogs and five group B dogs was peritonitis and intra-abdominal abscess formation. None of the surviving dogs showed evidence of anastomotic leakage or breakdown. Small bowel patch used in primary repair of colon injury in the presence of peritonitis may decrease the risk of postoperative infection-related complications and the mortality rate.