Obinna Obinwa - Academia.edu (original) (raw)
Papers by Obinna Obinwa
An ingested mobile phone in the stomach may not be amenable to safe endoscopic removal using current therapeutic devices: A case report
International Journal of Surgery Case Reports, 2016
Early Rise in C-Reactive Protein Is a Marker for Infective Complications in Laparoscopic Colorectal Surgery
Surgical Laparoscopy Endoscopy Percutaneous Techniques, Feb 1, 2014
Infective complications are the most significant cause of morbidity associated with elective colo... more Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications. Between July 2010 and June 2012, 169 patients underwent elective laparoscopic colorectal surgery. Daily postoperative CRP was measured until discharge and infective complications were observed. A total of 169 patients underwent laparoscopic colorectal surgery. Twenty-one (12.4%) had infective complications, 6 (3.6%) had anastomotic leaks. There was a significant difference in CRP levels between those with infective complications and those without infective complications on postoperative days 3 and 5 (day 3 postop, P=0.0001; day 5 postop, P=0.0001). Of those with infective complications, there was a significant difference between CRP levels when comparing preoperative levels with those on day 3 and day 5 (preoperative vs. day 3, P=0.0001; preoperative vs. day 5, P=0.0003). A raised CRP is a predictor of infective complication from day 3 (odds ratio 1.012, P<0.001) where as white cell count is not an accurate predictor. A CRP cutoff of 148 on day 3 provided the highest sensitivity and specificity of predicting infective complications, 86% and 77%, respectively. CRP is effective as an early predictor of infective complications after laparoscopic colorectal surgery and may be a useful adjunct in conjunction with an enhanced recovery program in reducing morbidity. A CRP of >148 mg/mL on postoperative day 3 or a persistently elevated CRP should heighten clinical suspicion of an infective complication.
Removal of a sex toy under general anaesthesia using a bimanual-technique and Magill’s forceps: A case report
International Journal of Surgery Case Reports, 2015
Phallic objects may cause large bowel obstruction if not promptly removed. A bi-manual technique ... more Phallic objects may cause large bowel obstruction if not promptly removed. A bi-manual technique with the aid of a Magill's forceps is presented here. A 68-year-old man presented to the emergency department with severe lower abdominal discomfort, distension and inability to pass urine, flatus or bowel motions. He had inserted a phallic object in the rectum 10 hours prior to presentation and had been unable to remove same. Abdominal examination was remarkable for distension with tenderness also elicited suprapubically and in the left iliac fossa. The foreign body was barely palpable per rectum. Plain radiographs showed prominent left-sided colonic segments. Following the trial of a manual attempt at removal in the emergency department, a decision was made to remove this under anaesthesia due to worsening symptoms. The phallic object was successfully removed under general anaesthesia using bi-manual manipulation assisted by a pair of Magill's forceps. The method of removal of phallic objects varies from one individual case to another. In the presence of obstruction, a quick decision must be made for removal under general anaesthesia and the patient will also need to be consented for laparotomy. Previous literature described a "cork-in-bottle" technique using myomectomy screws as well as use of single-incision laparoscopic surgery (SILS) ports for removal of phallic objects. Extraction of phallic objects requires ingenuity. We describe another minimally invasive technique of removal that adds to the literature, thereby limiting the need for laparotomy and open removal of foreign bodies.
Introduction: Advanced appendicitis (perforation, mass, or abscess) is a significant cause of mor... more Introduction: Advanced appendicitis (perforation, mass, or abscess) is a significant cause of morbidity in children. This chapter reviews the risk factors for and the management of children with advanced appendicitis and associated complications. Methods: A search of the literature was conducted and manual cross-referencing was performed. Results: The incidence of perforation and outcomes vary according to age, gender, and geographical region. Advanced appendicitis is unlikely in the presence of a normal white blood cell (WBC) or C-reactive protein (CRP) measurement. The presence of fever, symptom duration > 24h, generalized abdominal tenderness, rebound tenderness and or rigidity, hypoactive and/or absent bowel sounds, right lower quadrant mass, leukocytosis, and fecalith on CT scans may suggest advanced appendicitis. Age, increased BMI, diarrhea, inadequate antibiotic therapy, and certain microbial isolates may predispose an individual to an increased risk of post-appendectomy ...
International Journal of Surgery Case Reports, 2015
A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency ao... more A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aortouniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.
A model predicting perforation and complications in paediatric appendicectomy
International Journal of Colorectal Disease, 2015
To analyse the diagnostic value of simple clinical measurements in ensuring an early and accurate... more To analyse the diagnostic value of simple clinical measurements in ensuring an early and accurate detection of advanced appendicitis (perforation, mass and peri-appendicular abscess) and possible complications. A retrospective, single-centre study of all paediatric (age 0-14 years) appendicectomies was conducted over a 14-year period. Preoperative symptoms, signs and laboratory results, intra-operative findings and postoperative complications were analyzed. Receiver operating characteristic (ROC) curves were used to estimate sensitivity and specificity of significant (p ≤ 0.05) predictor variables based on multivariate logistic regression models. One thousand and thirty-seven patients were included. Perforations were seen in 88 (8.5 %) cases, and abscesses were seen in 35 (3.4 %) cases. Of all the clinical variables evaluated, preoperative temperature ≥37.5 °C was most discriminatory for advanced appendicitis. Significant other discriminatory clinical variables were WBC count ≥15,100/μL, preoperative anorexia and rebound tenderness. Postoperative complications occurred in 74 (7.1 %) patients and were associated with pre-operative temperature ≥37.5 °C and advanced appendicitis. Independent clinical predictors of advanced appendicitis exist but lack individual accuracy. In this study, preoperative pyrexia is shown to be highly associated with both advanced appendicitis and development of postoperative complications. This independent factor may point to early need for antibiotic treatment, urgent imaging and subsequent intervention in patients with appendicitis.
Early Rise in C-Reactive Protein Is a Marker for Infective Complications in Laparoscopic Colorectal Surgery
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2014
Infective complications are the most significant cause of morbidity associated with elective colo... more Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications. Between July 2010 and June 2012, 169 patients underwent elective laparoscopic colorectal surgery. Daily postoperative CRP was measured until discharge and infective complications were observed. A total of 169 patients underwent laparoscopic colorectal surgery. Twenty-one (12.4%) had infective complications, 6 (3.6%) had anastomotic leaks. There was a significant difference in CRP levels between those with infective complications and those without infective complications on postoperative days 3 and 5 (day 3 postop, P=0.0001; day 5 postop, P=0.0001). Of those with infective complications, there was a significant difference between CRP levels when comparing preoperative levels with those on day 3 and day 5 (preoperative vs. day 3, P=0.0001; preoperative vs. day 5, P=0.0003). A raised CRP is a predictor of infective complication from day 3 (odds ratio 1.012, P<0.001) where as white cell count is not an accurate predictor. A CRP cutoff of 148 on day 3 provided the highest sensitivity and specificity of predicting infective complications, 86% and 77%, respectively. CRP is effective as an early predictor of infective complications after laparoscopic colorectal surgery and may be a useful adjunct in conjunction with an enhanced recovery program in reducing morbidity. A CRP of >148 mg/mL on postoperative day 3 or a persistently elevated CRP should heighten clinical suspicion of an infective complication.
Irish Journal of Medical Science, 2013
Risk factors associated with advanced appendicitis and complications after childhood appendectomy
International Journal of Surgery, 2012
Validation of a regression model to accurately determine the effects of ipsilateral critical carotid stenosis on contralateral duplex carotid velocities
International Journal of Surgery, 2012
Electronic audit tool for quality assurance in gastro-intestinal (GI) endoscopy
International Journal of Surgery, 2013
ABSTRACT Aim: To develop and implement an automated electronic audit tool for quality assurance i... more ABSTRACT Aim: To develop and implement an automated electronic audit tool for quality assurance in GI endoscopy in our institution. Methods: A computer system was designed and developed to capture key quality assurance data using Microsoft Access 2003 and Visual Basic for Applications (VBA). This replaced a cumbersome paper based audit process. Results: The introduction of an automated audit system ensures the capture of robust Quality Assurance data as per the Irish Conjoint Board for gastrointestinal endoscopy guidelines; allows for on-going performance monitoring and early identification of deviations from the norm and provides for comprehensive report generation evaluating various performance metrics. Conclusion: Our electronic audit tool has significantly improved and streamlined the endoscopy audit process without incurring a significant cost as compared to commercial endoscopy reporting systems. Key quality indicators are now captured and analysed in an easy and efficient manner with generated reports readily accessible to designated users and clinical managers. It is hoped that the system could be rolled out for use in other centres thus effecting a cost saving while ensuring harmonisation of endoscopic audit and reporting.
An ingested mobile phone in the stomach may not be amenable to safe endoscopic removal using current therapeutic devices: A case report
International Journal of Surgery Case Reports, 2016
Early Rise in C-Reactive Protein Is a Marker for Infective Complications in Laparoscopic Colorectal Surgery
Surgical Laparoscopy Endoscopy Percutaneous Techniques, Feb 1, 2014
Infective complications are the most significant cause of morbidity associated with elective colo... more Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications. Between July 2010 and June 2012, 169 patients underwent elective laparoscopic colorectal surgery. Daily postoperative CRP was measured until discharge and infective complications were observed. A total of 169 patients underwent laparoscopic colorectal surgery. Twenty-one (12.4%) had infective complications, 6 (3.6%) had anastomotic leaks. There was a significant difference in CRP levels between those with infective complications and those without infective complications on postoperative days 3 and 5 (day 3 postop, P=0.0001; day 5 postop, P=0.0001). Of those with infective complications, there was a significant difference between CRP levels when comparing preoperative levels with those on day 3 and day 5 (preoperative vs. day 3, P=0.0001; preoperative vs. day 5, P=0.0003). A raised CRP is a predictor of infective complication from day 3 (odds ratio 1.012, P<0.001) where as white cell count is not an accurate predictor. A CRP cutoff of 148 on day 3 provided the highest sensitivity and specificity of predicting infective complications, 86% and 77%, respectively. CRP is effective as an early predictor of infective complications after laparoscopic colorectal surgery and may be a useful adjunct in conjunction with an enhanced recovery program in reducing morbidity. A CRP of >148 mg/mL on postoperative day 3 or a persistently elevated CRP should heighten clinical suspicion of an infective complication.
Removal of a sex toy under general anaesthesia using a bimanual-technique and Magill’s forceps: A case report
International Journal of Surgery Case Reports, 2015
Phallic objects may cause large bowel obstruction if not promptly removed. A bi-manual technique ... more Phallic objects may cause large bowel obstruction if not promptly removed. A bi-manual technique with the aid of a Magill's forceps is presented here. A 68-year-old man presented to the emergency department with severe lower abdominal discomfort, distension and inability to pass urine, flatus or bowel motions. He had inserted a phallic object in the rectum 10 hours prior to presentation and had been unable to remove same. Abdominal examination was remarkable for distension with tenderness also elicited suprapubically and in the left iliac fossa. The foreign body was barely palpable per rectum. Plain radiographs showed prominent left-sided colonic segments. Following the trial of a manual attempt at removal in the emergency department, a decision was made to remove this under anaesthesia due to worsening symptoms. The phallic object was successfully removed under general anaesthesia using bi-manual manipulation assisted by a pair of Magill's forceps. The method of removal of phallic objects varies from one individual case to another. In the presence of obstruction, a quick decision must be made for removal under general anaesthesia and the patient will also need to be consented for laparotomy. Previous literature described a "cork-in-bottle" technique using myomectomy screws as well as use of single-incision laparoscopic surgery (SILS) ports for removal of phallic objects. Extraction of phallic objects requires ingenuity. We describe another minimally invasive technique of removal that adds to the literature, thereby limiting the need for laparotomy and open removal of foreign bodies.
Introduction: Advanced appendicitis (perforation, mass, or abscess) is a significant cause of mor... more Introduction: Advanced appendicitis (perforation, mass, or abscess) is a significant cause of morbidity in children. This chapter reviews the risk factors for and the management of children with advanced appendicitis and associated complications. Methods: A search of the literature was conducted and manual cross-referencing was performed. Results: The incidence of perforation and outcomes vary according to age, gender, and geographical region. Advanced appendicitis is unlikely in the presence of a normal white blood cell (WBC) or C-reactive protein (CRP) measurement. The presence of fever, symptom duration > 24h, generalized abdominal tenderness, rebound tenderness and or rigidity, hypoactive and/or absent bowel sounds, right lower quadrant mass, leukocytosis, and fecalith on CT scans may suggest advanced appendicitis. Age, increased BMI, diarrhea, inadequate antibiotic therapy, and certain microbial isolates may predispose an individual to an increased risk of post-appendectomy ...
International Journal of Surgery Case Reports, 2015
A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency ao... more A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aortouniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.
A model predicting perforation and complications in paediatric appendicectomy
International Journal of Colorectal Disease, 2015
To analyse the diagnostic value of simple clinical measurements in ensuring an early and accurate... more To analyse the diagnostic value of simple clinical measurements in ensuring an early and accurate detection of advanced appendicitis (perforation, mass and peri-appendicular abscess) and possible complications. A retrospective, single-centre study of all paediatric (age 0-14 years) appendicectomies was conducted over a 14-year period. Preoperative symptoms, signs and laboratory results, intra-operative findings and postoperative complications were analyzed. Receiver operating characteristic (ROC) curves were used to estimate sensitivity and specificity of significant (p ≤ 0.05) predictor variables based on multivariate logistic regression models. One thousand and thirty-seven patients were included. Perforations were seen in 88 (8.5 %) cases, and abscesses were seen in 35 (3.4 %) cases. Of all the clinical variables evaluated, preoperative temperature ≥37.5 °C was most discriminatory for advanced appendicitis. Significant other discriminatory clinical variables were WBC count ≥15,100/μL, preoperative anorexia and rebound tenderness. Postoperative complications occurred in 74 (7.1 %) patients and were associated with pre-operative temperature ≥37.5 °C and advanced appendicitis. Independent clinical predictors of advanced appendicitis exist but lack individual accuracy. In this study, preoperative pyrexia is shown to be highly associated with both advanced appendicitis and development of postoperative complications. This independent factor may point to early need for antibiotic treatment, urgent imaging and subsequent intervention in patients with appendicitis.
Early Rise in C-Reactive Protein Is a Marker for Infective Complications in Laparoscopic Colorectal Surgery
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2014
Infective complications are the most significant cause of morbidity associated with elective colo... more Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications. Between July 2010 and June 2012, 169 patients underwent elective laparoscopic colorectal surgery. Daily postoperative CRP was measured until discharge and infective complications were observed. A total of 169 patients underwent laparoscopic colorectal surgery. Twenty-one (12.4%) had infective complications, 6 (3.6%) had anastomotic leaks. There was a significant difference in CRP levels between those with infective complications and those without infective complications on postoperative days 3 and 5 (day 3 postop, P=0.0001; day 5 postop, P=0.0001). Of those with infective complications, there was a significant difference between CRP levels when comparing preoperative levels with those on day 3 and day 5 (preoperative vs. day 3, P=0.0001; preoperative vs. day 5, P=0.0003). A raised CRP is a predictor of infective complication from day 3 (odds ratio 1.012, P<0.001) where as white cell count is not an accurate predictor. A CRP cutoff of 148 on day 3 provided the highest sensitivity and specificity of predicting infective complications, 86% and 77%, respectively. CRP is effective as an early predictor of infective complications after laparoscopic colorectal surgery and may be a useful adjunct in conjunction with an enhanced recovery program in reducing morbidity. A CRP of >148 mg/mL on postoperative day 3 or a persistently elevated CRP should heighten clinical suspicion of an infective complication.
Irish Journal of Medical Science, 2013
Risk factors associated with advanced appendicitis and complications after childhood appendectomy
International Journal of Surgery, 2012
Validation of a regression model to accurately determine the effects of ipsilateral critical carotid stenosis on contralateral duplex carotid velocities
International Journal of Surgery, 2012
Electronic audit tool for quality assurance in gastro-intestinal (GI) endoscopy
International Journal of Surgery, 2013
ABSTRACT Aim: To develop and implement an automated electronic audit tool for quality assurance i... more ABSTRACT Aim: To develop and implement an automated electronic audit tool for quality assurance in GI endoscopy in our institution. Methods: A computer system was designed and developed to capture key quality assurance data using Microsoft Access 2003 and Visual Basic for Applications (VBA). This replaced a cumbersome paper based audit process. Results: The introduction of an automated audit system ensures the capture of robust Quality Assurance data as per the Irish Conjoint Board for gastrointestinal endoscopy guidelines; allows for on-going performance monitoring and early identification of deviations from the norm and provides for comprehensive report generation evaluating various performance metrics. Conclusion: Our electronic audit tool has significantly improved and streamlined the endoscopy audit process without incurring a significant cost as compared to commercial endoscopy reporting systems. Key quality indicators are now captured and analysed in an easy and efficient manner with generated reports readily accessible to designated users and clinical managers. It is hoped that the system could be rolled out for use in other centres thus effecting a cost saving while ensuring harmonisation of endoscopic audit and reporting.