Browsing by Author "Okello, Michael"

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    Cytoreductive Surgery for Giant Locally Advanced Intra Abdominal Tumors in Uganda
    (Journal of Surgical Case Reports, 2022) Okello, Michael; Nuwagaba, Julius; Ddungu, Henry; Okuku, Fred Machyo
    Cytoreductive surgery is removal of tumor as much as possible when complete resection is impossible because of advanced disease. It is a management option for giant intra-abdominal tumors with pressure symptoms. We present three patients who underwent cytoreductive surgery for giant intra-abdominal tumors between May 2019 and November 2021. Patient 1 had a gastrointestinal stromal tumor (GIST) involving stomach, spleen and transverse colon. En bloc resection of the GIST with the involved viscera was done. Patient 2 had a liposarcoma measuring 25.8 × 19.6 × 15.3 cm infiltrating the stomach, spleen and the left hemidiaphragm. Involved viscera and liposarcoma were resected en bloc. Patient 3 had a liposarcoma measuring 40 × 35 × 12 cm and encasing the left ureter. Mass was excised together with part of the left ureter and left ureter reconstructed. Giant intra-abdominal tumors are rare. Involvement of adjacent structures may necessitate multivisceral resections with or without organ reconstruction.
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    Gastroduodenal intussusception as a rare cause of pancreatitis in a young female Ugandan: A case report
    (International Journal of Surgery Case Reports, 2021) Okello, Michael; Kayondo, Derick; Ocama, Ponsiano
    acting as the lead point. Gastrointestinal stromal tumors (GISTs) commonly occur in the stomach (40–60%). Other gastric tumors include; adenocarcinomas, leiomyomas, lymphomas among others. When gastric tumors act as lead points in gastroduodenal intussusception, pancreatitis may arise due to compression of the ampulla of Vater or pancreatic head. Gastroduodenal intussusception may mimic other inflammatory upper gastrointestinal conditions leading to delays in early diagnosis and timely intervention. Case presentation: A twenty three year old female with gastroduodenal intussusception secondary to a gastric body GIST with associated pancreatitis. This gastroduodenal mass was initially diagnosed as a pancreatic head echo-complex mass by ultrasound. Confirmatory preoperative diagnosis was made after doing contrasted abdominal computed tomography (CT) scan and upper gastrointestinal endoscopy. Open gastric wedge resection was done. Patient had uneventful recovery and was discharged on the fifth postoperative day. Clinical discussion: Gastroduodenal intussusceptions have non-specific clinical features that may lead to delays in making the correct diagnosis. CT scan is a good imaging modality for diagnosing this condition but access is limited in low resource settings. Resection of the organic cause after reducing the intussusception leads to resolution of the symptoms caused by the intussusception, the GIST and the resultant pancreatitis. Conclusion: Gastroduodenal intussusception is rare and may present with nonspecific clinical features. Pancreatitis may arise due to the compression effects on the ampulla of Vater or pancreatic head. A high index of suspicion is key in making a timely diagnosis.
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    Pioneering endoscopic retrograde cholangiopancreatography in a Sub Saharan African hospital: A case series
    (International Journal of Surgery Open, 2018) Okello, Michael; Tumusiime, Gerald; Nabimanya, Viola; Baguma, Steven; Ocama, Ponsiano
    Background and study aims: Although endoscopic retrograde cholangiopancreatography (ERCP) was introduced in Europe, Asia and America over four decades ago, East Africa and Africa as a whole has been slow in taking up this very important minimally invasive procedure for the management of various hepatopancreaticobiliary conditions. This has led to reliance on open surgery for even simple benign biliary strictures, stones and malignant causes of biliary and pancreatic duct obstruction that can be treated endoscopically without a need for a morbid open surgical intervention. In Uganda, ERCP was introduced in January 2017 after obtaining training and equipment support from Senior Experten Service (SES), German. We therefore report the first six cases of ERCP performed at our endoscopy unit. Patients and methods: This is a case series report of six patients referred with yellowing of eyes and body itching as the main complaints. They predominantly had raised gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin and direct bilirubin. They also had different imaging investigations demonstrating hepatic ducts dilatation. Results: Four out of the six patients had complete post ERCP symptom resolution. One patient had partial symptom resolution and the other patient recovered after conversion to open surgery. Conclusion: Collaborative skills transfer made ERCP feasible in our institute and this marked the start of this specialised service in Uganda.
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    Serum lactate as a predictor of early outcomes among trauma patients in Uganda
    (International journal of emergency medicine, 2014) Okello, Michael; Makobore, Patson; Wangoda, Robert; Upoki, Alex; Galukande, Moses
    Trauma is the leading cause of death in the developed world. Accurate assessment of severity of injuries is critical in informing treatment choices. Current models of assessing severity of injury are not without limitations. The objective of this study therefore was to determine the diagnostic accuracy of serum lactate assays in assessing injury severity and prediction of early outcomes among trauma patients. Methods: This was a cross-sectional analytical study. Consecutive series of all eligible patients had a single venous blood sample drawn for lactate assay analysis (index test) and a concurrent Kampala Trauma Score (KTS) II value determination (reference test). Admitted patients were followed up to assess early outcomes (length of hospital stay and mortality). Results: Out of the 502 trauma patients recruited, 108 (22%) were severely injured, 394 (78%) had non-severe injuries, and 183 were admitted. There was a significant difference between median (interquartile range (IQR)) lactate levels among the severely injured (4.3 (2.6, 6.6)) and the non-severely injured (2.4 (1.6, 3.5), p < 0.001). After a 72-h follow-up of the admitted patients, 102 (56%) were discharged, 61 (33%) remained in the hospital, 3 (2%) remained in the ICU, and 17 (3%) had died. The area under the receiver operator characteristic (ROC) curve was 0.75 for injury severity. Serum lactate ≥2.0 mmol/l had a hazard ratio of 1.10 (p < 0.001) for emergency department disposition, 4.33 (p = 0.06) for the 72-h non-discharge disposition, and 1.19 (p < 0.001) for 72-h mortality. Serum lactate ≥2.0 mmol/l at admission was useful in discriminating severe from non-severe injuries with a sensitivity of 88%, specificity of 38%, PPV of 30%, and NPV of 92%.