Abstract: BACKGROUND: Radiological imaging is paramount for defining the genitourinary fistulae commonly associated with anorectal malformations prior to definitive surgery. The imaging options are resource-limited in many parts of the world. Nonfluoroscopic pressure colostography after colostomy is a cheap method for the evaluation of anorectal malformations. OBJECTIVE: To describe our experience with nonfluoroscopic pressure colostography in the evaluation of anorectal malformations in boys. MATERIALS AND METHODS: The study included 12 boys with anorectal malformation who had colostomy and nonfluoroscopic pressure-augmented colostography with water-soluble contrast medium between January 2006 and December 2007. RESULTS: Patient ages ranged from 2 days to 1 year. The types of genitourinary fistula were rectovesical (7.7%) and rectourethral (92.3%). Oblique radiographs were of diagnostic value in all patients. The types of anorectal malformations were high, intermediate and low in 75%, 8.3% and 16.7%, respectively. Short-segment urethral constriction was a common feature of rectourethral fistula (75%, n=9). CONCLUSION: Our experience has shown that genitourinary fistulae associated with anorectal malformations can be demonstrated reliably by nonfluoroscopic pressure colostography with two oblique radiographs, providing an option in resource-poor settings where fluoroscopic equipment is scarce.
Abstract: Pyogenic liver abscess [PLA] is a rare and life-threatening disease in children. Appendicitis was the leading source of PLA in the Preantibiotic era, but it essentially has been eliminated in recent times. Most patients with persistent fever after exploratory laparatomy for perforated appendicitis are often found to have residual abdominal collection. We report a 12-year old girl with PLA after laparotomy for perforated appendix. She developed persistent fever and respiratory distress post operatively. Physicians had an impression of pneumonia but abdominal ultrasound showed cystic mass with mobile internal echoes within the right lobe of the liver suggesting an abscess. Patient was successfully managed by percutaneous drainage under ultrasound guidance. Culture of the pus yielded no growth. She was discharged after 7 weeks of hospital stay. Aetiology, evaluation and treatment modalities were reviewed.
Abstract: INTRODUCTION: Giant meconium cyst resulting from antenatal bowel perforation is rare and hardly reported in multiple gestations. We found only four documented cases in the electronic literature. CASE PRESENTATION: We report a giant meconium cyst in an 11-hour-old Nigerian boy of a discordant twin having ultrasonographic and plain radiographic diagnosis and surgical confirmation. Increasing abdominal girth from 35 cm to 41 cm within four hours of admission without ascites, pneumoperitneum and significant bowel distension make us assumed the meconium cyst to be "growing" in size. We reviewed the literature and proposed that where the fibrinous wall of meconium cyst allows for distensibility and the communication between the perforated bowel and meconium cyst persists, the meconium cyst acting as reservoir may continue to "grow" in size without remarkable intestinal distension probably, until the elastic limit is lost. CONCLUSION: Meconium cyst can occur in twin pregnancy, grow to occupy the abdomen almost completely and may cause neonatal apnoea. The outcome is good post surgery.
Abstract: INTRODUCTION: Cystic lesion of the omentum and mesentery are rare. The incidence of both cyst types has been variously reported to vary from 1/27,000-100,000 hospital admission. Omental cysts occur three to ten times less frequently than mesenteric cyst. Preoperative diagnosis is infrequently made because of lack of characteristic symptoms and signs. CASE PRESENTATION: We present our diagnostic and management challenges in a 43-year-old man with an unusually giant omental cyst confirmed as fibrosarcoma at histology. The cyst gave the abdomen an anteroposterior diameter of about 74 cm that could not be penetrated sufficiently by X-ray photons to produce diagnostic image even at maximum attainable output. Patient benefited from surgical excision. The removed cyst contained about 35 litres of fluid. CONCLUSION: Neglected omental cysts as in this case may grow to enormous size, undergo malignant transformation and poses serious diagnostic and surgical challenges.
Abstract: A 25-year-old male Nigerian undergraduate who had earlier been treated with praziquantel for schistosomal epidydymitis presented with clinical features of pyelonephritis, and radiological appearances of bilateral hydroureteronephrosis with fibrosis of lower ureters. Surgical resection of the ureters, Boari flap and Psoas hitch reconstruction were done. The histology of the resected ureters proved schistosomiasis. He was subsequently treated with praziquantel and artemether. This case highlights the insidious nature of schistosomiasis infection, possibility of progression of primary infection with complications or probable reinfection in a previously treated individual. In any case, surgical intervention may be necessary in those who present late with severe ureteric stricture and also to prevent progressive renal damage.
Abstract: We present two sporadic cases of complete ulnar hemimelia, a rare congenital defect. In one case, ulnar hemimelia was associated with tridactyly and elbow malrotation with radiohumeral synostosis; in the second case, ulnar hemimelia was assciated with mono-metacarpal bidactyly and anterior cubital webbing of the elbow with fixed flexion. To the best of our knowledge, there is dearth of information on these combinations of anomalies in the literature and their management remains a challenge.
Abstract: ABSTRACT: INTRODUCTION: Foetus-in-foetu is a very rare congenital abnormality where a malformed foetus is included within the body of another foetus. Less than 200 cases have been reported with over 80% occurring in the abdomen. Only three cases of cervical foetus in foetu have been reported. The present case of giant orocervical foetus-in-foetu appears to be an index case. CASE PRESENTATION: This is a report of an extremely rare orocervical foetus-in-foetu with grotesque oddity diagnosed on prenatal ultrasonography at 35 weeks gestational age in a 28-year-old, G2P1+0, Nigerian woman who was unsure of her last menstrual date or month. The included foetus had two eyes, cranium, nose, long bones and a spine. The mother's attempts at vaginal delivery rather than the elective Caesarean delivery she was offered resulted in obstructed labour and intrauterine foetal demise. CONCLUSION: Giant cervical foetus-in-foetu is extremely rare. It could result in obstructed labour if vaginal delivery is attempted.
Abstract: A case of a male fetus with sonographic diagnosis of hydrops fetalis at 19-week gestation is reported. The fetus had anasarca, bilateral massive pleural effusion, and ascites, in addition to cardiac arrhythmia and congenital gastric outlet obstruction. Mother's clinical history and laboratory workup excluded immune hydrops. The etiological dilemma and fetal outcome are discussed. We concluded, based on this case, that when fetal hydrops occurs early and is associated with multiple congenital anomalies, prolonging the pregnancy may be futile.
Abstract: INTRODUCTION: the inclusion of a malformed parasitic twin (homunculus) in the body
of its partner (autosite) is an age long mystery first reported by Meckel in 1800. There has
been several postulated embryogenetic mechanisms such as defective twinning, genetic
imperfect embryo and the defective implantation that explained the variable locations and
the degrees of organ differentiation.
OBJECTIVE: retrospectively review the epidemiology, embryogenesis, pathology,
presentations and management of this rare condition to bridge the gap in knowledge of the
reported cases to date.
METHODS: electronic search of the abstracts and article of all available reported cases of
fetus in fetu was carried out and analysis done.
RESULTS: a total of 160 cases have been reported, majority (25.6%) of which originated
from Asia, Europe (16.3%) and North America (16.3%). The age at diagnosis ranges from
16 weeks in utero to the oldest at 47 year. The male to female ratio is 2:1. Nearly all body
parts have been identified. Acardiac and anencephaly are features in over 95% of cases.
While intra-abdominal is the commonest location. Radiology is paramount to the diagnosis.
CONCLUSION: The advents of modern imaging methods have enhanced the early and
improved diagnosis of fetus in fetu and in its differentiation from teratoma. Beaudion et al
theory of defective implantation of a twinning and variable impaired mesenchymal
induction of the homunculus by the autosite cells indeed explained all observable features
of FIF to teratoma.
