Somalia Turkiye Medical Journal (STMJ)

The Role of Urological Conditions in Cases Presenting to the Emergency Department with Acute Abdominal Pain: First Report from Somalia

Asir Eraslan — 2024-01-15

Objective: This study aimed to investigate the pattern and outcomes of Acute abdominal pain (AAP) in an adult population presented to the Emergency Department (ED) in the only tertiary care center of Somalia by analyzing the role of urological conditions in detail.

Materials and Methods: Demographic and clinical data of the adult (i.e., age>18) patients who presented to the ED for AAP between December 2021 and June 2022 were retrospectively analyzed.

Results: During the study period, 600 patients presented to the ED with the chief complaint of AAP. The mean age of the participants was 56.7±12.4(15–93). Most (34.8%) patients were aged between 18 and 30. The most frequent diagnosis was NSAP(24%), followed by appendicitis(11.1%), bowel obstruction(7.2%), renal colic(6.8%), and biliary colic-cholecystitis(6.5%). Appendicitis, renal colic, bowel obstruction, and perforated peptic ulcer were more frequent in males than females. Among the 273(45,5%) patients admitted to the hospital, 168(54.9%) were male, and 105(35,7%) were female. While 24.2% of all admissions were due to appendicitis, 15.4% were due to intestinal obstruction.

Conclusions: Non-specific abdominal pain is the most common diagnosis in both age and gender groups despite being slightly more frequent in younger and female patients. In addition to NSAP, appendicitis, bowel obstruction, and renal colic are the most common diagnoses in patients who presented to ED with the chief complaint of AAP.

Assessment of the Characteristics of Traumatic Urogenital Injuries at a Tertiary Care Center: First Report from Somalia

Asir Eraslan — 2024-01-15

Objective: Urogenital injuries (UGIs) are present in approximately 10% of adult and less than 3% of pediatric trauma patients. To date, no reports have been published regarding urogenital injuries in Somalia, a sub-Saharan African country. We aimed to analyze the data of urogenital trauma patients who presented to the emergency department of the only tertiary care center in Somalia.

Materials and Methods: Patients who presented to the emergency department of our institution following trauma between January 2019 and December 2022 and were admitted with the diagnosis of UGI constituted the target population. The collected data included demographic characteristics, type of trauma, involved urogenital organ, admission site, patient management type, and survival.

Results: Overall, 2426 trauma patients presented to the emergency department. Among these patients, 116 (4.8%) had UGI. The mean patient age was 28.31±5.2 [1-73]. Most (83.6%, n=97) patients were male. Kidneys were the most commonly injured organs (41.4%, n=48), followed by the urinary bladder (17.2%, n=20) and testis (13.7%, n=16). Nine patients with renal trauma underwent nephrectomy. Among 20 patients with bladder injury, half underwent surgical repair. Ten of 16 patients with testicular trauma underwent orchiectomy due to severe rupture. All 12 patients with penile injuries underwent primary repair. Among 10 (8.6%) patients with urethral injuries, 4 underwent immediate primary repair, 3 underwent endoscopic realignment, while the remaining 3 needed cystostomy and delayed urethroplasty. The mortality rate was 10.3% (n=12).

Conclusions: Surgical exploration was commonly performed due to the severity of the traumas and the presence of adjacent organ injuries. This finding arises from the fact that Somalia is a country affected by terrorism and low-density war.

Isolated Tubercular Epididymitis: A 10-Year Series

Shreyas Rai — 2024-01-15

Introduction: Genitourinary tuberculosis (TB) is considered a common form of extrapulmonary TB, being second only to lymph node tuberculosis, which is the most common site. Isolated TB of the epididymis is rare, and diagnosis of epididymal TB can be challenging. In this study, we report our series of isolated TB of the epididymis.

Materials & Methods: We retrospectively collected the outpatient and inpatient records of histologically confirmed epididymal tuberculosis. Data including age, clinical presentation, examination findings, and diagnostic tests were reviewed and analyzed.

Results: A total of 56 patients were diagnosed to have isolated tuberculosis of the epididymis during the 10-year study period. The mean age was 33 years. The clinical presentation included a hard nodule in the epididymis (100%), hydrocele in 16 (28.5%), posterior scrotal sinus in 6 (10.7%), and sensitivity in 14 (25%) and fever in 3 (5.3%). Four (7.1%) patients had bilateral epididymal nodules, 30 (53.5%) had left-sided, and 22 (39.2%) had right-sided involvement. Scrotal exploration and epididymal biopsy were performed in 16 (28.5%), and unilateral epididymectomy was performed in 40 (71.4%). The histopathological examination revealed a typical tubercular granuloma in all these patients. All patients were put on anti-TB drugs.

Conclusions: Isolated TB of the epididymis is a rare disease. Treatment with anti-TB drugs remains the first-line intervention in all cases. Surgery is indicated in cases of failure of pharmacological treatment or the development of complications.