Annals of African Surgery

Surgical systems’ capacity in Africa—Where do we go from here?

Mumba Chalwe, James Kigera — Wed, 19 Feb 2025 00:00:00 +0000

No abstract.

Perioperative management of a patient with hereditary angioedema and intestinal obstruction secondary to an ileal tumor: A case report

Wed, 19 Feb 2025 00:00:00 +0000

Hereditary angioedema (HAE) is a rare genetic disorder resulting from deficiency or dysfunction of the C1-esterase inhibitor (C1-INH, C1-inhibitor) protein. It manifests with recurrent cutaneous and submucosal edema involving the extremities, abdomen, and/or larynx. Abdominal edema mimics other acute abdominal conditions including intestinal obstruction, potentially prompting unnecessary surgery if misdiagnosed. Prompt treatment with C1-INH typically alleviates abdominal angioedema symptoms within 24 hours, while untreated cases resolve within 2–5 days. Persistence of abdominal symptoms warrants further evaluation for other etiologies of acute abdomen. Surgical procedures with tracheal intubation can induce life-threatening upper airway edema in HAE patients. We describe the successful management of a 41-year-old female with HAE presenting with features of intestinal obstruction, which only partially resolved with the administration of C1-INH and conservative bowel decompressive management. Imaging revealed a small bowel tumor necessitating surgical intervention. Pre-operative prophylactic C1-INH was administered, followed by open laparotomy under general anesthesia with endotracheal intubation. Although C1-INH concentrates are the principal treatment for abdominal HAE attacks, other causes of acute abdomen should be considered, particularly in cases of persistent symptoms, to guide appropriate management. This case highlights the importance of multidisciplinary collaboration and careful perioperative planning to optimize outcomes for HAE patients requiring surgery.

Staged surgery with autologous fibula grafting for humeral non-union - A case report

Stephen Kamau Mwaura, Mordicai Atinga — Wed, 19 Feb 2025 00:00:00 +0000

Recalcitrant humeral non-unions after multiple fixation attempts pose a challenge to the surgeon when it comes to selecting effective and reliable management strategies. Confounding factors such as infection and bone segment loss may hamper achieving osteosynthesis even with suitable fixation. This is a case report of a 35-year-old man with a 4-year complex history of recalcitrant humerus non-union. It highlights a combination of various accessible strategies that encompass biological stimulation and mechanical stabilization toward timely bone union with minimal morbidity and return to optimal function. The use of a free fibular intramedullary strut autograft with a locking compression plate (LCP) has been infrequently described in the literature and this report adds to the data bank of this treatment strategy.

The Kenya surgical capacity study: An audit of surgical equipment/infrastructure in Level 4 public hospitals

Wed, 19 Feb 2025 00:00:00 +0000

Background: Access to surgical equipment is critical to providing safe and equitable operative care. This is the first nationwide study to provide data on the availability of surgical equipment in Kenya. Methods: This cross-sectional study collected data from May to July 2018 on the availability of non-pharmaceutical equipment, patient care, intra-operative, and anesthesia supplies in level 4 hospitals. Information regarding infrastructure such as the number of functional operating rooms, sterilization capacity, and sources of water and electricity was also collected. Results: The availability of intra-operative and anesthesia equipment was 44.5% and 47%, respectively. Nearly 60% of facilities had general patient care supplies. Over 80% of the facilities had running water in maternity wards (83.1%). Sterilization equipment was present in about half of the facilities (range: 42.6–68.3%). Additionally, 79.1% had a generator as a backup source of electricity. Only 35% of facilities always had an X-ray on-site, and 52.6% of the facilities obtained blood from the national or a regional center. Conclusion: This study provides data on the availability of surgical equipment and infrastructure in level 4 hospitals in Kenya. Availability of radiology services and blood supply was lower than that in other sub-Saharan African countries, highlighting the need for improved surgical care resources in these community-based facilities.

Fournier’s Gangrene: A 4-year retrospective study in a tertiary academic hospital

Wed, 19 Feb 2025 00:00:00 +0000

Background: Fournier’s gangrene (FG) is a necrotizing fasciitis disease that affects the genital, perianal, and perineal regions. This study investigated the demography and treatment methods of patients with FG in a 4-year period in our hospital. Methods: Medical records of 14 patients with Fournier’s gangrene who underwent treatment were analyzed retrospectively. Data on the patients were collected such as gender, age, length of stay (LOS), comorbidities, wound treatment, bacteriological cultures, and reconstructive procedures. Results: There was no significant correlation between age (p = 0.776), comorbid disease (p = 0.954), LOS or age (p = 0.221), comorbid disease (p = 0.928), and patient outcome. Wound treatment using negative pressure wound therapy (NPWT) was performed in 14% of the patients. Wound treatment had a statistically significant effect toward LOS (p = 0.044). Flaps were the most common reconstructive procedure (71.4%) followed by skin grafts (14%). Age and comorbid disease did not have an effect toward hospital LOS or patient outcome. The use of NPWT is likely related to the increased complexity of the lesion. Flaps provided a reliable method of reconstruction for patients. Conclusion: Patients who were treated with NPWT had a longer LOS compared to other methods.