Surgical Conditions

Description

These are injuries which are inflicted by animal or human teeth. Common animal bites are due to dogs, snakes, crocodiles, and hippo attacks

Signs and Symptoms

• Open wounds
• Bleeding
• Swelling which can lead to compartment syndrome
• Associated fractures or amputations if inflicted by large animals

Treatment

Supportive
• Generously irrigate the wound with normal saline
• Adequate debridement of the wound
• DO NOT SUTURE WOUNDS. Leave the wound open for delayed primary or secondary suture except for
facial bites and actively bleeding vessels
• Limb elevation to reduce swelling
• If there is compartment syndrome, fasciotomy must be done
• Partial-traumatic amputation requires surgical completion, aggressive debridement and wound care.

Pharmacological
• Tetanus toxoid, 0.5ml intramuscularly as a single dose.
• If the bite is from a suspected rabid animal, administer post-exposure rabies treatment.
• For snake bites, refer to section on medical emergencies (refer to Chapter 1.2.3)
• Major Bites
• Ceftriaxone Adult: 2g IV once daily. Children 50mg/kg once daily, maximum 2g daily.
• Metronidazole Adult: 500mg IV 3 times daily. Children 7.5mg/kg 3 times daily.
• Tramadol Adult: 50mg IV/PO 1-3 times daily
WITH
• Paracetamol Adult 500mg-1g IV/PO 3 times daily. Children 10-15mg/kg 3 times daily.
• Minor Bites
• Amoxicillin/Clavulanic Acid Adult: 625mg PO 2-3 times daily. Children 15-30mg/kg (based on
Amoxicillin component) 2-3 times daily.
• Metronidazole, adults; 200-400mg orally 3 times daily, children; 7.5mg/kg orally 3 times daily for 5 days
• Paracetamol Adult 500mg-1g IV/PO 3 times daily. Children 10-15mg/kg 3 times daily.
AND/OR
• Ibuprofen Adult: 400mg 3 times daily. Children: 10mg/kg 3 times daily

Complications

• Infection with both aerobic and anaerobic bacteria and viruses.
• Compartment syndrome
• Gangrene
• Loss of limb/disability

Description

Protrusion of a viscus or part of a viscus beyond its normal confines. Inguinal hernia is the commonest type of
a hernia

Signs and Symptoms

• Swelling in groin and scrotum
• Might be painful if irreducible
• Vomiting if obstructed

Investigations

• Abdominal Xrays if obstruction is suspected

Treatment

• Hernitotomy in children
• Herniorrhaphy/hernioplasty in adults
• Antibiotics (cover for aerobic and anaerobic infections)
• Analgesia (as per WHO pain management guideline

Complications

• Obstruction
• Strangulation

Description

This is the twisting of the testis along its vertical axis, resulting in compromised blood supply to the testis andthe adjoining spermatic cord. It may be spontaneous or following trauma.. It may also result from anomalies in the development of the tunica vaginalis and the spermatic cord.

Signs and Symptoms

• Severe local pain
• Nausea
• Vomiting
• Scrotal swelling
• Dark discolouration of the scrotum
• Fever

Investigations

This is clinical and confirmed on surgical exploration

Treatment

• Immediate surgical intervention within a few hours of suspected torsion and fixation of the contralateral
testis
• Antibiotics cover
• Analgesia (as per WHO pain management guideline)

Description

This is a condition characterised by the accumulation of fluid in the tunica vaginalis and it presents as a cystic scrotal mass.

Signs and Symptoms

• Painless scrotal swelling
• May be painful when severely distended and infected
• Mass is usually unilateral
• Translumination test is positive
• Spermatic cord is palpable above the cystic mass

Investigations

• Scrotal ultra-sound

Treatment

• Hydrocelectomy
• Appropriate antibiotic cover is require

Treatment

• Hydrocelectomy
• Appropriate antibiotic cover is required

Description

Confined pocket of pus that collects in tissues, organs or spaces inside the body. Commonly affected areas
include submandibular, axilla, cervical, perianal, gluteal, scalp and breast

Signs and Symptoms

• Painful swelling which is fluctuant
• Fever

Treatment

• Antibiotics (cover for aerobic and anaerobic infections)
• Analgesia (as per WHO pain management guideline)
• Surgical drainage

Description

This is an inflammatory condition of the testis caused by bacteria and mumps virus. About 20 % of post-
pubertal male patients have testicular inflammation, usually unilateral. Testicular atrophy may ensue

Signs and Symptoms

• Painful testicular swelling
• Fever
• Signs of STI (urethral discharge, dysuria, tender inguinal lymphadenopathy)
• If due to Mumps, there might be associated parotid swelling

Treatment

• Analgesics
• Antibiotics for STIs