Context and Aims: Pneumatic reduction has a higher success rate and lower incidence of complications compared to barium enema and hydrostatic reductions. What is deterrent to its common use is the cumbersome technique. Our technique is simple that can be used in any hospital with locally available facilities. Settings and Design: This was a prospective study. Subjects and Methods: A total of 25 children were enrolled in the study between September 2015 and June 2016 at our institute. Patients were given air enema under US guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 100 mmHg. A total of three attempts of 3 min each were allowed. Statistical Analysis Used: We just used simple statistic to calculate average. Results: There were 17 males and 8 females. The average age of the patients was 8.5 months. Twenty-two (88%) of the cases were reduced successfully while 3 (12%) failed to reduce. A majority of those that did not reduced had symptoms for at least 4 days. No bowel perforation occurred in our study. All cases of the intussusception have length <5 cm were reduced with pneumatic reduction in our study. Conclusions: The technique described is easy to assemble, safe, and effective. We recommend it for regular use in pneumatic reduction of intussusception, especially in the center have limited resources.

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H-type rectourethral fistula in males is a rare congenital anorectal malformation. It is associated with anal stenosis at normal site which generally delays diagnosis. We describe a case of a 6-month-old male child who presented with intermittent passage of fecal matter in urine along with ribbon-shaped stools through anal orifice, on straining. Investigations revealed an H-shaped rectourethral fistula with anal stenosis. Minimal sagittal anorectoplasty with fistula ligation was done.

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Background: Despite the increasing incidence of colorectal cancer in Nigeria, there is no established colorectal screening program in Nigeria and only a few studies have been done on the pathologic features of colonoscopic biopsies in Nigeria. Materials and Methods: The lower gastrointestinal tract biopsy specimens were assessed in the histopathology surgical day books. The demographic information on the age and sex and the clinical information, presenting complaints and endoscopic findings were obtained from the original request cards. All of the archival slides were retrieved and reviewed with the diagnosis confirmed. Also, all available formalin fixed and paraffin embedded tissue blocks of lower gastrointestinal colonoscopic biopsies were sectioned at 3-5μm and stained with haematoxylin and eosin. Each lesion was diagnosed based on specific pathologic findings, clinical history and endoscopic findings as a guide. Neoplastic lesions were classified using the World Health Organization classification (2010]. Study Design: The study aims to describe the common lesions diagnosed on lower gastrointestinal (GI) endoscopy. The clinical history, endoscopic findings, slides, and paraffin-embedded blocks of all endoscopic biopsies of the lower GI tract seen from 2008 to 2012 were studied, and data obtained were analyzed using the SPSS version 16 software. Results: Two hundred and forty-nine specimens were studied. Fifty-seven (22.9%) of these biopsies were normal colonic mucosa and 192 (77.1%) of these biopsies had remarkable pathologies. The most common clinical indication for colonoscopy in this study was hematochezia and over half of these patients (48.6%) had malignant lesions. The most common lesions seen on endoscopy were polyps which were seen in 18.5% of cases. Seventy (36.5%) of these lesions were malignant, with epithelial cancers 67 (95.7%) being the vast majority. Thirty-five (18.2%) of the lesions were benign neoplastic lesions, 52 (27.1%) were inflammatory lesions, 18 (9.4%) were inflammatory bowel disease, 10 (5.2%) were hyperplastic polyps, and 7 (3.6%) were vascular lesions. Conclusion: A wide spectrum of lesions was diagnosed in this study with the predominant lesion diagnosed being malignant neoplastic lesions. The most common clinical indication for endoscopy was hematochezia with over half of these patients having a malignant lesion.

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Background: Hepatocellular carcinoma (HCC) has endemic proportions in some regions of the world, including the Sub-Saharan Africa, China, and the Far East. One of its known complications is tumor rupture, with a bleak prognosis. Aim: This study aims to report on our experience with the management of ruptured HCC. Materials and Methods: We reviewed our records to retrieve cases of ruptured HCC, from September 2013 to December 2015. Results: We were able to identify five patients, all of them were males with a median age of 70 years (range 26). One patient had hepatitis B, three had Schistosoma, and the status of the fifth was undetermined. In one patient, who eventually died, an emergency laparotomy deemed necessary to control the bleeding. In the other four, who were stabilized to undergo computerized axial tomography scan, angioembolization of the tumor feeding vessels succeeded to arrest the bleeding. Unfortunately, two patients died shortly after the procedure, while the other two survived and were discharged for follow-up. Conclusion: Spontaneous rupture of HCC is a grave event with a dismal prognosis. The optimal management should be individualized, based on the condition of the patient, the tumor characteristics, the facilities, and expertise available. Close collaboration between the interventional radiologist, gastroenterologist, oncologist, and surgeon is fundamental for success. The emergency laparotomy may be the appropriate action for the unstable patients. For those who could be stabilized, angioembolization with or without chemotherapy is an attractive option. Conservative treatment may be reserved for those with the worst prognosis.

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Introduction: Parasitic liver cysts are common in many areas of the world. In our country, hydatid disease is the commonest to cause cystic lesions. We reviewed our data to compare and analyze the outcome of laparoscopic management of these patients. This paper assesses the feasibility and safety of laparoscopic management of hepatic hydatid disease in a tertiary center in Egypt. Materials and Methods: We retrospectively reviewed our operative and inpatient data at the National liver institute, Menoufia university, Egypt for clinical and operative, postoperative details patients with preoperative diagnoses of a hepatic hydatid disease starting from June 2012 to June 2015. Results: 47 patients had operative management for hepatic hydatid cystic lesions. Twenty seven patients had laparoscopic management and 20 patients were managed through open procedures. Operative procedure included endocystectomy in all laparoscopic cases and while three of the open group had liver resection in addition. Hospital stay was at a mean of 3 days for lap cases and 6 cases for open group. Complications included one cases of bile leak and minor wound infections in the open group. While there were no complications in in the lap group. Follow up showed occurrence of recurrence in two of the open group only. Conclusions: With conventional laparoscopic instruments, the laparoscopic approach in the management of hepatic hydatid cysts is safe and feasible even. It showed shorter operative time and hospital stay with relatively decreased postoperative complication rate.

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Duodenal injury is an uncommon finding because of its retroperitoneal location, accounting for about 3%–5% of abdominal trauma, resulting from penetrating injuries (75%); mainly due to gunshot injuries and blunt trauma (25%), and it is associated with a significant mortality (6%–25%) and morbidity (30%–60%). In this article, we describe a case of a 17-year-old male, who presented with abdominal gunshot injury.

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Management guideline for infantile cholelithiasis and choledocholithiasis is still controversial; various therapeutic strategies were reported successfully. This is a report of an 11-month-old male infant who presented with obstructive jaundice due to cholelithiasis. Prematurity, previous bowel surgery, and total parenteral nutrition were predisposing risk factors. The patient was successfully treated with cholecystectomy and open exploration of the common bile duct.

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Objectives: To describe the clinical profile and imaging appearances of retained intra-abdominal sponges in a tertiary care center of a developing country over an 8-year period. Such cases are usually described as isolated case reports in literature, and case series on this subject are rare in literature. Materials and Methods: Seventeen cases are described with reference to the type of surgery, time between the surgery and diagnosis, computed tomography (CT) appearances, operative findings, and final outcome. The patients were traced from the imaging findings and clinical records and were followed until their discharge from the hospital. Results: The most common surgeries were cesarean section (five cases - 29%) and cholecystectomy (four cases - 23%). The time interval between surgery and diagnosis varied between 3 days and 9 months and most cases were diagnosed within 3 months. CT suggested the correct diagnosis in all but one patient. There were two fatalities in the cases; four patients required segmental small gut resection and one required partial gastrectomy. Ten cases followed elective surgeries and rest followed emergency procedures. Conclusion: Retained surgical sponges continue to be an embarrassing iatrogenic complication with devastating medicolegal implications and carry significant morbidity and mortality. Radiologists need to be familiar with this entity for a correct early diagnosis.

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