South African Journal of Surgery最新文献

Summary: Obesity complicates clinical evaluations of acute abdominal conditions like appendicitis, with excess fat limiting the accuracy of physical examinations and delaying diagnosis. This report presents a case of a 49-year-old morbidly obese female with uncontrolled diabetes who developed acute peritonitis secondary to retrocaecal appendicitis, which presented as retroperitoneal necrotising fasciitis (NF). Diagnostic delays were attributed to atypical clinical signs and limitations of ultrasound in obese patients. A computed tomography (CT) scan eventually revealed extensive retroperitoneal fluid collections, confirming the diagnosis. Surgical intervention, including appendicectomy, drainage, and debridement, was complicated by septic shock, requiring intensive care. This case highlights the diagnostic complexity of NF in high-risk patients, emphasising the role of advanced imaging modalities and diagnostic scoring systems. Improved diagnostic strategies and early imaging are crucial for managing life-threatening conditions in obese populations.

Summary: Testicular torsion (TT) is the most important cause of acute scrotum in children, which can lead to testicular loss and requires emergency surgery. Fibrotic bands around the epididymis/spermatic cord that can cause severe testicular ischemia are extremely rare. The origin of these bands is unknown. Although scrotal colour doppler ultrasonography (CDUS) has an important place in the diagnosis of TT, it may be insufficient in the diagnosis of the bands. We aimed to present two rare cases in which a band was detected surrounding the distal spermatic cord and causing testicular ischemia in patients who had no previous scrotal pathology and emergency surgery was performed considering TT.

Summary: Wilkie's syndrome, also known as superior mesenteric artery (SMA) syndrome, is a rare condition characterised by the compression of the third portion of the duodenum between the abdominal aorta and the overlying SMA. Due to its rarity, the exact number of documented case reports is limited. As of recent literature, approximately 500 cases have been reported worldwide with a reported incidence of 0.013-0.3%.

Background: Penetrating neck injuries account for a significant trauma burden on the provincial healthcare system. Penetrating neck trauma ranges from obvious aerodigestive and/or vascular injuries with unstable physiology, to stable patients with subtle injuries which may cause morbid complications in the future if overlooked. The majority of the hospitals in the province have major inadequacies in terms of radiology staff and equipment, leading to a significant burden on Inkosi Albert Luthuli Central Hospital (IALCH).

Methods: A retrospective descriptive study was performed using data from the IALCH trauma unit databases, reviewing patient charts between 1 January 2018 and 31 December 2020. Data retrieved encompassed the age, demographics, referral hospitals, mechanism of injury, type of injuries, zones, imaging indications and results.

Results: Patients were referred from surrounding hospitals, the majority of which were young males and the lead mechanism was stab wounds. The vast majority of injuries were found in zone 2 and the majority of patients were referred exclusively due to proximity of skin injury and positive imaging findings formed the minority.

Conclusion: For patients with soft signs of vascular injury there is room for clinical observation without routine imaging. Similarly, patients with soft signs of oesophageal injury, such as proximity, dysphagia, dysphonia, odynophagia, retropharyngeal air on CT and hematemesis may be admitted for observation rather than routinely imaged, provided they can access surgical care if they fail non-operative management.

Background: Chemical burns worldwide are caused by highly concentrated acidic and alkaline substances being placed onto exposed skin surface with resultant tissue injury. These chemical substances have high toxicity and deep tissue penetrability causing significant morbidity and mortality to patients. This study describes the epidemiology and mortality of acid-related burn injuries to improve patient assessment and management strategies.

Methods: A cross-sectional retrospective analysis of the records of 66 patients admitted to Chris Hani Baragwanath Academic Hospital Adult Burns Unit over a period of 9 years between 2015 and 2024.

Results: This study found that 91% of cases were due to assault, compared to 8% accidental injury. Patients admitted were predominantly male (n = 43; 65%). The mean total body surface area (TBSA) involved was 17.7% with the most common areas involved being the face and arms (n = 47, 72%). The neck was affected in 35 cases (54%), and the chest in 34 cases (52%). Other affected areas included the back (n = 24, 37%), eyes (n = 14, 22%), legs (n = 12, 19%), buttocks (n = 4, 6%), and genitalia (n = 3, 5%). Patient mortality is limited in cases where TBSA < 25%; however, when TBSA > 25% mortality is 75%, further increasing to 100% when patients were ventilated.

Conclusion: This study showed a high rate of acid burns associated with domestic violence and assaults. Prevention strategies should be coordinated with strategies aimed at reducing interpersonal violence.

Background: Inguinal hernia repairs are among the most common surgeries worldwide, with laparoscopic techniques being increasingly popular due to benefits like reduced pain, faster recovery, and better cosmetic outcomes. This study evaluated the outcomes of laparoscopic inguinal hernia repairs performed by a single surgeon in private practice.

Methods: A retrospective audit was conducted on adults who underwent laparoscopic inguinal hernia repair between January 2010 and December 2020. Data on patient and procedural characteristics and outcomes were collected from hospital records and following telephonic contact with patients. The study was approved by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BREC/00005605/2023).

Results: The study included 188 patients (91.5% male, median age 49 years). All repairs were performed using the total extraperitoneal (TEP) approach for unilateral and bilateral hernias. Conversion to open surgery occurred in 13.8% of cases. The median procedure time was 94.9 minutes, the postoperative hospital stay was two days, and the return to work was two days. The median operative time was shorter in the latter study period (2015-2020) than the former (2010-2014): 81 minutes (IQR: 70-102) minutes versus 131 minutes (IQR: 108-148 minutes), p < 0.01. At the end of the follow-up period in 2024, 20.2% (38/188) were lost to follow-up. Of the remaining 150 patients who were contactable, 88.7% had no further complications, 4.7% had hernia recurrence, 4.0% reported inguinodynia, and 2.7% had demised.

Conclusion: This study provides valuable insights into laparoscopic hernia repair performed by a single surgeon over an 11-year period. Laparoscopic inguinal hernia repair, even for primary cases, is feasible with shorter operative times and low complication and hernia recurrence rates when performed by an experienced surgeon.

Summary: We report an unusual case of complete bowel obstruction as a result of an intramural haematoma (IMH) in the ascending colon, resulting from blunt abdominal trauma. The patient presented with acute abdominal pain, nausea and vomiting, preceded by four days of constipation, obstipation and worsening abdominal distention. Symptoms were preceded by a history of sustaining a kick to the abdomen during an altercation. Explorative laparotomy was performed, revealing an obstructing ascending colon mass, where a right hemicolectomy and primary anastomosis was performed. Histology confirmed the mass to be an IMH.

Background: Different disease entities that cause gastrointestinal (GI) obstruction have been studied in isolation; however, no description of GI obstruction in neonates and infants in South Africa could be identified. This study aims to describe the profile of GI obstruction in neonates and infants at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2016 to December 2019.

Methods: This was a retrospective record review conducted on all patients < 1 year of age with GI obstruction admitted to CHBAH. Data on age at presentation, sex, presenting symptoms, aetiology, diagnostic imaging, operative and non-operative management, complications, and 30-day mortality were collected.

Results: A total of 299 patients were enrolled in this study. They were predominantly male (n = 175, 58.53%) and were neonates at presentation (n = 177, 59.20%). Congenital malformations (n = 203, 67.89%) were more common than acquired conditions (n = 96, 32.11%). Anorectal malformation (ARM) and small bowel atresia were the most common congenital condition (n = 61, 20.40%; n = 34, 11.37% respectively). Intussusception was the most common acquired condition (n = 78, 26.08%). The morbidity rate was 95 (31.77%) with nosocomial sepsis and surgical site sepsis accounting for 49 (51.58%) of the morbidities. Mortality rate was 16 (5.35%) and 10 (62,5%) of the mortalities had associated nosocomial sepsis.

Conclusion: Congenital malformations of the GI tract are more common than acquired pathologies in neonates and infants in CHBAH. Sepsis causes significant morbidity in the postoperative period.

We thank Professor Thomson for his highly insightful letter to our manuscript "Procedures most frequently performed by South African-trained general surgeons - implications for training and assessment"¹ and the opportunity it creates to further discuss this important issue. Our data shows that colonoscopy is an important procedure for general surgeons to learn and to perform competently, considering the real-life practices and expectation of general surgeons in the current healthcare system. The data also suggests that there may be enough supervised colonoscopies during training to allow for reliable workplace-based assessment of trainees' competence in performing the procedure. However, it does not tell us whether enough cases are done during training to actually achieve competence.

Background: Motorbike collisions (MBC) pose significant public health challenges in low- to middle-income countries (LMICs), particularly in urban settings. This study examines the injury patterns of patients involved in MBCs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) trauma unit over a two-year period (May 2022 to April 2024).

Methods: This was a retrospective review of all patients involved in MBCs.

Results: A total of 134 patients were identified, predominantly male (97.1%), with a mean age of 32 years (SD ± 8.8). Most of these incidents were work-related, highlighting the increasing use of motorbikes for commercial purposes, including food delivery. The analysis revealed that head injuries were present in 22.4% of patients, with 9.7% sustaining facial fractures and one patient presenting with a cervical spine injury. Chest injuries were reported in 21.6% of cases, while abdominal and pelvic injuries occurred in 8.2% and 6.7% of patients, respectively. The predominant injuries were long bone fractures, with 58 patients affected. The mean injury severity score (ISS) was 25 (SD plus-minus 2), indicating high levels of trauma. The mortality rate after an MBC was 2.2%. Two patients died in the emergency department due to severe injuries. The findings underscore the complexity of injuries sustained in MBCs, which often involve multiple body regions.

Conclusion: This study highlights the urgent need for targeted interventions to enhance the safety of motorbike riders in urban areas, particularly as the prevalence of MBCs rises in association with commercial transport services. Improved trauma care and public health strategies are essential to address the ongoing challenge of motorbike-related injuries in Johannesburg and similar urban contexts.