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  • Title: Incarcerated and strangulated inguinal hernias in children in Zaria, Nigeria.
    Author: Ameh EA.
    Journal: East Afr Med J; 1999 Sep; 76(9):499-501. PubMed ID: 10685318.
    Abstract:
    OBJECTIVE: To reappraise the problem of incarcerated and strangulated inguinal hernias in children in Zaria, Nigeria. DESIGN: A retrospective study. SETTING: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. PATIENTS: Eighteen children aged below two years with incarcerated and strangulated inguinal hernias managed over a 10 year period. MAIN OUTCOME MEASURES: Incarceration and strangulation rate, resection rate, testicular infarction, wound infection. RESULTS: The overall incarceration and strangulation rate was 4.8%. The rate in neonates was 80%, 33% in those less than six months and 21% in those below one year. There was no incarceration or strangulations after two years of age. The intestinal resection rate for gangrene was 11% (two neonates) and ipsilateral orchidectomy was necessary for testicular infarction in two neonates (11%). Wound infection occurred in three patients (17%) and there were no deaths. Overall, there has been an improvement in the incarceration and strangulation rate, resection rate and wound infection rate over earlier years (5.7%, 28% and 50% respectively for earlier years) due largely to early presentation. Testicular infarction, however, remains a major risk particularly in neonates. CONCLUSION: The policy of early repair of inguinal hernias in children especially below two years and particularly in neonates should be continuously emphasised to avoid morbidity. This retrospective study was undertaken to reappraise the problem of incarcerated or strangulated inguinal hernias in children in Zaria, Nigeria. A total of 18 children below age 2 years with incarcerated and strangulated inguinal hernias treated at the Ahmadu Bello University Teaching Hospital pediatric surgery records between January 1998 and December 1997 were studied retrospectively. The main outcome measures included incarceration and strangulation rate, resection rate, testicular infarction, and wound infection. The overall incarceration and strangulation rate was 4.8%. The rate was 80% in neonates, 33% in those under age 6 months, and 21% in those under age 1 year. No incarceration or strangulation occurred after 2 years of age. The intestinal resection rate for gangrene was 11% (2 neonates) and ipsilateral orchidectomy was required for testicular infarction in 2 neonates (11%). The rate of wound infection was 17% (3 patients) and there were no deaths recorded. Overall, there has been an improvement in the incarceration, strangulation, resection, and wound infection rates over earlier years (5.7%, 28%, and 50%, respectively, for earlier years) due largely to early presentation. However, testicular infarction remains a major risk particularly in neonates. These findings suggest that the policy of early repair of inguinal hernias in children, especially below 2 years of age and particularly in neonates should be continuously emphasized to avoid morbidity.
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