Background: University of Maiduguri Teaching Hospital a major referable Centre in Northeastern Ni... more Background: University of Maiduguri Teaching Hospital a major referable Centre in Northeastern Nigeria over the years has been faced with management of complications of limb injuries arising from treatment of limb fractures and injuries by the traditional bone setters (TBS). This study is therefore aimed at determining the role of inappropriate traditional splintage in limb amputation and proffer interventional strategies to curb the menace. Methods: A retrospective study of data of patients that had amputation in University of Maiduguri Teaching Hospital between 1998 and 2002 was undertaken. Results: A total number of 82 patients were entered into the study; there were 66 males and 16 Females (M.F ratio 4:1). Their ages ranged between 2 – 80 years with a median of 27 years. Seventy three percent of our patients were below the age of 45 years. The most common indication for limb amputation was gangrene arising from treatment of limb injuries by TBS 31.7%, followed by trauma 24.3% and malignancies 14.6%. Majority of the amputations were in the lower limbs and 35%of the patients had 2 – Stage operation. Conclusion: Preventable severe complications often arise from TBS treatment of musculoskeletal injuries. There is need for sustained health education to discourage patronage of TBS and encourage utilization of modern health service. Basic training for TBS in safe splintage and early identification of signs of ischaemia may not be out of place. Key Words: Limb amputation, inappropriate traditional splintage Annals of African Medicine Vol.3(3) 2004: 138-140
Objective: To describe the demographic characteristics and anatomical distribution of skin malign... more Objective: To describe the demographic characteristics and anatomical distribution of skin malignancy as seen at the University of Maiduguri Teaching Hospital. Methods: This study retrospectively reviewed cases of skin cancer diagnosed between January 1991 and December 2000 in the Histopathology Department of University of Maiduguri Teaching Hospital. Results: A total of 313 cases of skin malignancy were histopathogically diagnosed. The male, female ratio was 1:5.1 and the peak age incidence was in 6th decades of life. The non-melanoma, skin cancer (squamous cells carcinoma) was the commonest epidermal malignancy and accounted for 148 (47.3%). Kaposi's sarcoma was the commonest cutaneous sarcoma with 49 (15.7%) and all the cases were of melanomas were diagnosed above the age of 40 years and all occurred on the leg and foot. The lower limb (leg and foot) was the mutual site of skin malignancy, which accounted for 160 (51.1%). Childhood skin cancers are rare. Conclusion: Skin cancer is not uncommon among the black population. Nigerians suffer from late presentation of the disease. The incidence of skin cancer can be prevented or reduced through public health education or early diagnosis of skin lesion and prompt medical treatment. Key words: Skin Malignancy, Epidermal, Cutaneous. Highland Medical Research Journal Vol.1(2) 2002: 38-40
Background: Ligation excision haemorrhoidectomies are usually done on inpatient basis. Over the y... more Background: Ligation excision haemorrhoidectomies are usually done on inpatient basis. Over the years however, there has been an increase in the numbers done on outpatient basis. This retrospective review was conducted to evaluate the results of day case haemorrhoidectomy in a developing country. Materials and methods: Forty three consecutive patients, who met the criteria for day case surgery, had ligation excision haemorrhoidectomy, between January 2004 and September 2005 at the Royal Victoria Teaching Hospital (RVTH) Banjul with the intention of same-day discharge from hospital. For each patient, data collected included age, sex, duration of symptoms, degree of haemorrhoids, and duration of rest after the procedure in minutes or hours, whether the patient was discharged same day or needed admission for complications. Local anaesthesia, 1% lignocaine was used for all the patients. Results: Forty three patients comprising 28 males (65.1%) and 15 females (34.9%), with a male female ratio of 1.87:1 underwent planned day case haemorrhoidectomy. Their mean age was 36.27 +/- 10.26 years and range was 25 to 56 years. Forty patients (93%) were discharged on the same day of surgery after a rest period in the day care theatre ranging between 25 minutes and 60 minutes with a mean of 41.2 +/- 11.08 minutes. Three (7%) of the patients required admission, two for acute urinary retention and control of excessive pain and the other 5 days postoperative on account of secondary haemorrhage. Pain control was achieved by oral non steroidal antiinflammatory agents. There were no deaths and majority of the patients were satisfied with the procedure. Conclusion: Ligation excision (Milligan-Morgan) haemorrhoidectomy is safe and can be performed successfully on out patient basis, saving inpatient health care costs. This is suitable for developing country.
Summary Background Risk of mortality following surgery in patients across Africa is twice as high... more Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov, NCT03853824. Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.
Background: Reported changes in the demography, modes of presentation and histological variants o... more Background: Reported changes in the demography, modes of presentation and histological variants of tumors of the breast have been published in developed and some developing countries. Although benign lesions have persistently accounted for most breast tumors, the incidence of malignant breast lesion in young women in sub-Saharan Africa has been disturbingly high. We reviewed the demographics, pattern and management of breast lumps excised at University of Maiduguri Teaching Hospital (UMTH) over a 6 year period. Patients and Methods: A retrospective study of patients with breast lumps at UMTH was carried out between January 2005 and December 2010. Details of their bio-data, clinical, and histopathology details were analyzed using descriptive statistics. Results: A total of 913 patients, comprising 887 females (97.2%) and 26 males (2.8%) were reviewed. The mean age was 33.1 ± 14.6 years (range: 12-80 years) and the mean duration of symptoms was 8 ± 2.14 months (range: 2-23 months). 359 (39.3%) were malignant and 577 (63.2%) were benign. The mean ages of women and men with invasive carcinomas of the breast were 45.58 ± 13.22 and 49.75 ± 18.28 years, respectively. The mean age of women with benign breast disease was 28.4 ± 10.0 for fibrocystic disease and 21.8 ± 5.31 years for fibroadenoma. Mode of presentations included ulcers (8.7%), axillary lymph node enlargement (30.0%), nipple discharge (13.0%) and breast pain (21.7%). The most common histological diagnoses were carcinoma of the breast, N = 340 (37.2%), fibroadenoma, N = 276 (30.2%) and fibrocystic disease, N = 199 (21.8%). The least common pathology was tuberculosis of the breast, N = 6; (0.7%). Conclusion: Though benign diseases are still more common, a high percentage of breast lumps in Maiduguri are due to malignant disease and this is frequent in younger women.
Background. Fournier’s gangrene is uncommon but increasingly being seen over the last two decades... more Background. Fournier’s gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier’s gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30–39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mort...
Background. Benign prostatic hyperplasia is the most common cause of lower urinary tract obstruct... more Background. Benign prostatic hyperplasia is the most common cause of lower urinary tract obstruction in the elderly male. Aim. To evaluate the effectiveness, safety, and outcome of open prostatectomy in a Nigerian teaching hospital. Material and Methods. Two hundred and fifty-three men with lower urinary tract obstruction clinically due to benign prostatic hyperplasia (BPH) underwent open prostatectomy over a ten-year period (January 2001–December 2010). Data on patients including age, clinical, laboratory, and histology were reviewed and analyzed to determine treatment outcome. Results. A total of 253 patients were studied. Their mean age was 69.11 ± 10.9 years (range 50–98). The most common symptoms at presentation included frequency 229 (90.5%) and poor stream 225 (88.9%). The most common complications at presentation were stones in 41 (16.2%) and bleeding in 37 (14.6%). The most common comorbid conditions were hypertension and diabetes found in 72 (28.5%) and 23 (9.1%), respecti...
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium... more Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Urethral stricture is a frequent cause of lower urinary tract obstruction worldwide. The aim of this study is to present our experience with one-stage urethroplasty. Methods. All males that underwent one-stage urethroplasty between January 2001 and December 2010 were retrospectively reviewed. Details of their biodata, clinical presentation, diagnostic investigations, operative treatment, postoperative complications, and other outcome of surgery were extracted and analyzed. Results. Ninety-one patients aged 8–76 years, (mean; 45.6 ± 19.7) with urethral stricture were studied. Postinfective strictures accounted for 58.2% and postprostatectomy strictures for 3.3%. Twenty-six (27.9%) of the strictures were in the posterior urethra of which 18 (59.2%) were posttraumatic. Fifty-seven strictures (61.3%) were in the anterior urethra of ...
Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society, 2013
Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carri... more Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture...
Background: University of Maiduguri Teaching Hospital a major referable Centre in Northeastern Ni... more Background: University of Maiduguri Teaching Hospital a major referable Centre in Northeastern Nigeria over the years has been faced with management of complications of limb injuries arising from treatment of limb fractures and injuries by the traditional bone setters (TBS). This study is therefore aimed at determining the role of inappropriate traditional splintage in limb amputation and proffer interventional strategies to curb the menace. Methods: A retrospective study of data of patients that had amputation in University of Maiduguri Teaching Hospital between 1998 and 2002 was undertaken. Results: A total number of 82 patients were entered into the study; there were 66 males and 16 Females (M.F ratio 4:1). Their ages ranged between 2 – 80 years with a median of 27 years. Seventy three percent of our patients were below the age of 45 years. The most common indication for limb amputation was gangrene arising from treatment of limb injuries by TBS 31.7%, followed by trauma 24.3% and malignancies 14.6%. Majority of the amputations were in the lower limbs and 35%of the patients had 2 – Stage operation. Conclusion: Preventable severe complications often arise from TBS treatment of musculoskeletal injuries. There is need for sustained health education to discourage patronage of TBS and encourage utilization of modern health service. Basic training for TBS in safe splintage and early identification of signs of ischaemia may not be out of place. Key Words: Limb amputation, inappropriate traditional splintage Annals of African Medicine Vol.3(3) 2004: 138-140
Objective: To describe the demographic characteristics and anatomical distribution of skin malign... more Objective: To describe the demographic characteristics and anatomical distribution of skin malignancy as seen at the University of Maiduguri Teaching Hospital. Methods: This study retrospectively reviewed cases of skin cancer diagnosed between January 1991 and December 2000 in the Histopathology Department of University of Maiduguri Teaching Hospital. Results: A total of 313 cases of skin malignancy were histopathogically diagnosed. The male, female ratio was 1:5.1 and the peak age incidence was in 6th decades of life. The non-melanoma, skin cancer (squamous cells carcinoma) was the commonest epidermal malignancy and accounted for 148 (47.3%). Kaposi's sarcoma was the commonest cutaneous sarcoma with 49 (15.7%) and all the cases were of melanomas were diagnosed above the age of 40 years and all occurred on the leg and foot. The lower limb (leg and foot) was the mutual site of skin malignancy, which accounted for 160 (51.1%). Childhood skin cancers are rare. Conclusion: Skin cancer is not uncommon among the black population. Nigerians suffer from late presentation of the disease. The incidence of skin cancer can be prevented or reduced through public health education or early diagnosis of skin lesion and prompt medical treatment. Key words: Skin Malignancy, Epidermal, Cutaneous. Highland Medical Research Journal Vol.1(2) 2002: 38-40
Background: Ligation excision haemorrhoidectomies are usually done on inpatient basis. Over the y... more Background: Ligation excision haemorrhoidectomies are usually done on inpatient basis. Over the years however, there has been an increase in the numbers done on outpatient basis. This retrospective review was conducted to evaluate the results of day case haemorrhoidectomy in a developing country. Materials and methods: Forty three consecutive patients, who met the criteria for day case surgery, had ligation excision haemorrhoidectomy, between January 2004 and September 2005 at the Royal Victoria Teaching Hospital (RVTH) Banjul with the intention of same-day discharge from hospital. For each patient, data collected included age, sex, duration of symptoms, degree of haemorrhoids, and duration of rest after the procedure in minutes or hours, whether the patient was discharged same day or needed admission for complications. Local anaesthesia, 1% lignocaine was used for all the patients. Results: Forty three patients comprising 28 males (65.1%) and 15 females (34.9%), with a male female ratio of 1.87:1 underwent planned day case haemorrhoidectomy. Their mean age was 36.27 +/- 10.26 years and range was 25 to 56 years. Forty patients (93%) were discharged on the same day of surgery after a rest period in the day care theatre ranging between 25 minutes and 60 minutes with a mean of 41.2 +/- 11.08 minutes. Three (7%) of the patients required admission, two for acute urinary retention and control of excessive pain and the other 5 days postoperative on account of secondary haemorrhage. Pain control was achieved by oral non steroidal antiinflammatory agents. There were no deaths and majority of the patients were satisfied with the procedure. Conclusion: Ligation excision (Milligan-Morgan) haemorrhoidectomy is safe and can be performed successfully on out patient basis, saving inpatient health care costs. This is suitable for developing country.
Summary Background Risk of mortality following surgery in patients across Africa is twice as high... more Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov, NCT03853824. Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.
Background: Reported changes in the demography, modes of presentation and histological variants o... more Background: Reported changes in the demography, modes of presentation and histological variants of tumors of the breast have been published in developed and some developing countries. Although benign lesions have persistently accounted for most breast tumors, the incidence of malignant breast lesion in young women in sub-Saharan Africa has been disturbingly high. We reviewed the demographics, pattern and management of breast lumps excised at University of Maiduguri Teaching Hospital (UMTH) over a 6 year period. Patients and Methods: A retrospective study of patients with breast lumps at UMTH was carried out between January 2005 and December 2010. Details of their bio-data, clinical, and histopathology details were analyzed using descriptive statistics. Results: A total of 913 patients, comprising 887 females (97.2%) and 26 males (2.8%) were reviewed. The mean age was 33.1 ± 14.6 years (range: 12-80 years) and the mean duration of symptoms was 8 ± 2.14 months (range: 2-23 months). 359 (39.3%) were malignant and 577 (63.2%) were benign. The mean ages of women and men with invasive carcinomas of the breast were 45.58 ± 13.22 and 49.75 ± 18.28 years, respectively. The mean age of women with benign breast disease was 28.4 ± 10.0 for fibrocystic disease and 21.8 ± 5.31 years for fibroadenoma. Mode of presentations included ulcers (8.7%), axillary lymph node enlargement (30.0%), nipple discharge (13.0%) and breast pain (21.7%). The most common histological diagnoses were carcinoma of the breast, N = 340 (37.2%), fibroadenoma, N = 276 (30.2%) and fibrocystic disease, N = 199 (21.8%). The least common pathology was tuberculosis of the breast, N = 6; (0.7%). Conclusion: Though benign diseases are still more common, a high percentage of breast lumps in Maiduguri are due to malignant disease and this is frequent in younger women.
Background. Fournier’s gangrene is uncommon but increasingly being seen over the last two decades... more Background. Fournier’s gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier’s gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30–39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mort...
Background. Benign prostatic hyperplasia is the most common cause of lower urinary tract obstruct... more Background. Benign prostatic hyperplasia is the most common cause of lower urinary tract obstruction in the elderly male. Aim. To evaluate the effectiveness, safety, and outcome of open prostatectomy in a Nigerian teaching hospital. Material and Methods. Two hundred and fifty-three men with lower urinary tract obstruction clinically due to benign prostatic hyperplasia (BPH) underwent open prostatectomy over a ten-year period (January 2001–December 2010). Data on patients including age, clinical, laboratory, and histology were reviewed and analyzed to determine treatment outcome. Results. A total of 253 patients were studied. Their mean age was 69.11 ± 10.9 years (range 50–98). The most common symptoms at presentation included frequency 229 (90.5%) and poor stream 225 (88.9%). The most common complications at presentation were stones in 41 (16.2%) and bleeding in 37 (14.6%). The most common comorbid conditions were hypertension and diabetes found in 72 (28.5%) and 23 (9.1%), respecti...
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium... more Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Urethral stricture is a frequent cause of lower urinary tract obstruction worldwide. The aim of this study is to present our experience with one-stage urethroplasty. Methods. All males that underwent one-stage urethroplasty between January 2001 and December 2010 were retrospectively reviewed. Details of their biodata, clinical presentation, diagnostic investigations, operative treatment, postoperative complications, and other outcome of surgery were extracted and analyzed. Results. Ninety-one patients aged 8–76 years, (mean; 45.6 ± 19.7) with urethral stricture were studied. Postinfective strictures accounted for 58.2% and postprostatectomy strictures for 3.3%. Twenty-six (27.9%) of the strictures were in the posterior urethra of which 18 (59.2%) were posttraumatic. Fifty-seven strictures (61.3%) were in the anterior urethra of ...
Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society, 2013
Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carri... more Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture...
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