搜索结果：South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie

Damage control laparotomy (DCL) is a life-saving strategy for the management of hemodynamically unstable abdominal injuries. Although the indications are well established, factors specific to local trauma ecosystems lead to delayed implementation of DCL. A retrospective review of prospectively collected data identified all patients who underwent DCL for trauma indications at Tygerberg Hospital between 1 January 2016 and 31 December 2020. Data were analysed using Python [version 3.10]. A hybrid costing model was used to determine the cost of DCL. One hundred and thirty-one (131) patients were included, of which 96.9% were male and the mean age was 33.4 years. Gunshots were the most common mechanism of injury (77.9%), followed by vehicle collisions (9.9%) and stabs (7.9%). The in-hospital mortality was 41.5%. The median time from incident to arrival at the trauma centre was 3 hours 7 minutes (187 minutes) and patients waited a median of 6 hours (360 minutes) for surgery once in hospital. The median duration of surgery was 120 minutes and the median time to relook laparotomy was 59 hours. The median ICU and ward stay was 9.7 days and 25.7 days, respectively. Cost was calculated using a hybrid costing model, with the cost of care for survivors estimated at R 464 951 (USD $25 200) and for non-survivors R 307 827 (USD $16 684). Total cost of care for this cohort was R 42 160 625 (USD $2 285 129). Delay in surgical care for DCL patients is worse for patients treated in our unit compared to those in other units, with associated cost placing significant economic burden on the healthcare sector.

Few studies on equestrian-related injuries have specifically focused on patients in South Africa. The aim of this study was to review the spectrum of injuries and of patients treated at state-funded trauma centres in South Africa. A retrospective study was conducted over a 12-year period from July 2012 to February 2025 on all patients treated for equestrian-related injuries. A total of 82 patients were included (83% male, median age: 17 years, median injury severity score (ISS): 9). The most common mechanism of injury was a fall (n = 41), followed by a kick (n = 38). Two were trampled, and one dragged. The most commonly injured body regions were head and neck (n = 49), face (n = 29), and chest (n = 17). Eighty-two per cent (67/82) were managed non-operatively. The overall morbidity was 21% (17/82). Respiratory complications were the most common (n = 7). The median length of hospital stay was two days (range 0-45). There were two mortalities (2%), both due to a fall from a horse resulting in severe traumatic brain injury (TBI). Horse-related injuries are serious and can result in significant injuries. A significant number of patients required major operative interventions. Both riders and non-riders are at risk of injury and appropriate safety equipment and education is essential.

Abdominal emergencies are common and often require emergency surgery with mortality between 14% and 20%. Strategies have been introduced to reduce complications after emergency abdominal surgery, but resources in low and middle-income countries (LMICs) countries are limited. There is a paucity of data on emergency abdominal surgery from the developing world. We aim to audit the mortality and morbidity of emergency laparotomies in the unique South African public health care system. Secondary endpoints were to identify system shortfalls to allocate quality improvement programmes to improve outcomes of acute abdominal emergencies. A retrospective review of a prospectively maintained database was conducted on emergency surgical procedures at all the public-funded health facilities in the Cape Town Metro West, South Africa. There were 1471 patients who required emergency abdominal operations. The mean age was 36.7 (standard deviation (SD) = 15.95) with a male preponderance of 64.7%. The median duration of symptoms was 2 days (interquartile range (IQR) = 0-84). Overall 30-day mortality was 8% (n = 118) where 0.95% (n = 14) demised within 24 hours post-surgery. Factors associated with mortality were higher ASA class, higher Eastern Cooperative Oncology Group (ECOG) score, increasing age, higher Codman score, length of the procedure, presence of consultant during procedure, faecal contamination, contamination of more than one abdominal quadrant and use of inotropes intraoperatively. Despite resource constraints, patients presenting with abdominal emergencies requiring emergency abdominal surgery received care with mortality outcomes comparable to reported literature. This audit can be used as guide to identify healthcare system shortfalls to improve outcomes.

Thyroid cancer is the most common endocrine malignancy globally. Fine needle aspiration cytology (FNAC) is used in the diagnostic workup of thyroid nodules. There have been discrepancies between FNAC and histology at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). This prompted a study to determine the performance of FNAC compared to histology in diagnosing thyroid cancer at CMJAH. A retrospective review of patients who underwent thyroid surgery at CMJAH between 1 January 2015 and 1 September 2022 was conducted. Patient details were accessed via the theatre registry and the department of nuclear medicine. FNAC and histology results were accessed using the National Health Laboratory Service (NHLS) website. The data was collected and entered into a Microsoft excel spreadsheet. STATA statistical software was used to analyse the data. A total of 369 patients were screened, of which 222 were included in the study. We found the prevalence of thyroid cancer at CMJAH to be 35.6%. FNAC was found to have a sensitivity of 83.6% and a specificity of 88.7%. Its accuracy was 0.861 and it had a PPV of 81.2% and a NPV of 90.3%. The likelihood ratio generated was 7.39. PTC was found to be the most prevalent subtype with the FNAC malignancy detection rate of 85%. Our study showed that FNAC performed well in diagnosing thyroid cancer preoperatively. Therefore, it should continue to be used in the diagnostic workup of thyroid nodules at CMJAH.

Hepatocellular carcinoma (HCC) is a fatal disease of the young in sub-Saharan Africa (SSA) and chronic hepatitis B virus (HBV) infection remains the predominant aetiology. There is paucity of data regarding HCC in the adolescent population globally. Adolescents, defined as individuals aged 10 to 19 years according to the World Health Organization (WHO), with HCC treated at Groote Schuur Hospital (GSH) in South Africa from 1 January 2012 and 31 December 2024 were studied. Five (0.5%) of the 726 HCC patients managed at GSH during the study period were adolescents. The median age was 18 (13-19) years and three were female. All five had chronic HBV infection and most presented with pain (60%) and/ or an abdominal mass (40%). All had advanced disease, with four (80%) having Barcelona Clinic Liver Cancer (BCLC) stage C and one (20%) with BCLC stage D. Two (40%) had extrahepatic metastases and three (60%) had portal vein tumour thrombosis. Treatment included liver resection (1), sorafenib (1), lenvatinib (1), and best supportive care (2). At the time of the study, only one patient was alive. The median survival was 137 (25-425) days. Despite national HBV vaccination programmes in South Africa, in our experience adolescent HCC was HBV-related in all five patients. Extrahepatic metastases and macrovascular invasion were frequently reported and restricted patient access to curative-intended therapies (ablation, liver resection, transplantation). These findings highlight the urgent need for improved early detection and prevention strategies against perinatal HBV transmission in South Africa, including the rollout of the WHO-recommended universal hepatitis B birth-dose vaccination rather than the current targeted prevention approach.

There is a paucity of epidemiological colorectal adenocarcinoma data in sub-Saharan Africa. This deficiency coupled with the rising trends of colorectal cancer (CRC) incidence and mortality necessitated the need for an epidemiological colorectal adenocarcinoma study to be conducted in the South African setting. A retrospective analysis of demographic and histopathological data of colorectal adenocarcinoma patients diagnosed in the Western Cape public health sector was performed through the utilisation of the National Health Laboratory Services (NHLS) Academic Affairs and Research Management System (AARMS) database. A total of 612 patients were diagnosed with colorectal carcinoma in the Western Cape during the study period. 595/612 (97.2%) were diagnosed with adenocarcinoma, of these 284 (48%) of patients with primary rectal adenocarcinoma, 304 (51%) with primary colon adenocarcinoma and 7 (1%) with synchronous colorectal adenocarcinoma or a lesion involving both the colon and the rectum. Rectal adenocarcinoma most commonly occurred in 99/284 (34.9%), in the > 60-70 age group, while colon adenocarcinoma occurred most commonly in the > 50-60 age group, 78/304 (25.7%). The commonest stage of rectal adenocarcinoma patients was IIA 35/119 (29.4%), whereas stage IIIB was the commonest colon adenocarcinoma stage comprising 66/212 (31.3%) patients. Forty patients had mutations of mismatch repair genes, 7 of which had a positive BRAF mutation. The study showed an even distribution of colorectal adenocarcinoma incidence between males and females, with the highest rates of diagnosis in patients aged more than 50 years. Patients with stage III and IV disease had a higher rate of serum CEA elevation as compared to stage I and II.

Pregnant patients in trauma present a unique challenge for clinicians to manage both foetal and maternal well-being, requiring specialised resuscitation algorithms. This study reviews the outcome of pregnant trauma patients in a major trauma centre in South Africa and the risk factors associated with foetal loss. This is a retrospective analysis of all pregnant patients admitted to the Pietermaritzburg Metropolitan Trauma Service (PMTS) from January 2012 to December 2023. Patient data abstracted included mechanism of injury, physiological parameters, injury severity score (ISS), gestational age, diagnostic and surgical procedures performed, complications, and maternal and foetal mortality. Univariate logistic regression analysis was used. During the study period, a total of 124 female pregnant patients were admitted, and 105 were analysed after excluding 19 patients with missing data. The mean age of the patients in the study was 26 years, with an average gestation age of 18 weeks. Blunt trauma accounted for majority of the injuries (62%). Foetal death occurred in 16% of cases. Risk factors associated with foetal death were high shock index (OR 38.0, 95% CI: 0.8-1793.0), high ISS (OR 1.2, 95% CI: 1.1-1.3), and the need for laparotomy (OR 6.9, CI: 1.4-34.1). Risk factors for foetal loss include injury severity, shock on admission and the need for laparotomy. Identifying these risk factors might improve management of foetal and maternal health.

Follicular thyroid carcinoma (FTC) accounts for approximately 17-20% of well-differentiated thyroid cancer (WDTC) worldwide. In South Africa (SA), FTC is more common than reported internationally, however, available SA studies included small patient numbers. This multi-institutional study comprehensively describes FTC patients who underwent surgery over a 5-year period, focusing on presentation, diagnosis, and management. A retrospective review of all patients with FTC operated at 13 academic hospitals throughout SA between January 2015 and December 2019 was conducted. The Thyroid Cancer Group of South Africa collectively entered data on the presentation, diagnosis, management, and short-term outcomes of 464 thyroid cancer patients into a REDCap database. Descriptive statistical analysis was performed. Of 464 cases captured in the database, 103 (22.1%) were FTCs. WDTC was reported in 87.9% (408/464) of operations, with FTC comprising 25.2% (103/408). Of the 103 FTC patients, 82.5% (n = 85) were female and 16.5% (n = 17) male. The mean age was 51.8 years (SD 17.3). In cases where staging was reported, more than half (53.9%) presented with T3 tumours. Distant metastases were found in 12.6% of patients. Thyroid lobectomy was the most performed procedure (57.4%), followed by total thyroidectomy (37.6%). SA presents a multifaceted picture of FTC, with a higher incidence than in developed countries but lower than some other African nations. Patients are frequently symptomatic, which may predict worse outcomes. Standardised reporting and a national thyroid registry could assist in treatment planning and consistency of care.

Motorbike collisions (MBC) pose significant public health challenges in low- to middle-income countries (LMICs), particularly in urban settings. This study examines the injury patterns of patients involved in MBCs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) trauma unit over a two-year period (May 2022 to April 2024). This was a retrospective review of all patients involved in MBCs. A total of 134 patients were identified, predominantly male (97.1%), with a mean age of 32 years (SD ± 8.8). Most of these incidents were work-related, highlighting the increasing use of motorbikes for commercial purposes, including food delivery. The analysis revealed that head injuries were present in 22.4% of patients, with 9.7% sustaining facial fractures and one patient presenting with a cervical spine injury. Chest injuries were reported in 21.6% of cases, while abdominal and pelvic injuries occurred in 8.2% and 6.7% of patients, respectively. The predominant injuries were long bone fractures, with 58 patients affected. The mean injury severity score (ISS) was 25 (SD plus-minus 2), indicating high levels of trauma. The mortality rate after an MBC was 2.2%. Two patients died in the emergency department due to severe injuries. The findings underscore the complexity of injuries sustained in MBCs, which often involve multiple body regions. This study highlights the urgent need for targeted interventions to enhance the safety of motorbike riders in urban areas, particularly as the prevalence of MBCs rises in association with commercial transport services. Improved trauma care and public health strategies are essential to address the ongoing challenge of motorbike-related injuries in Johannesburg and similar urban contexts.

The South African Journal of Surgery (SAJS), established in 1962, is the official publication of the Association of Surgeons of South Africa. As a quarterly, peer-reviewed journal, the SAJS plays a vital role in disseminating surgical research, clinical insights, and commentary relevant to South Africa and the broader continent. The journal is listed and indexed internationally on MEDLINE and locally for academic subsidy purposes on the Scientific Electronic Library Online (SciELO SA). At its helm, the editor, deputy editors, and editorial board serve not merely as administrators, but as custodians of academic integrity, scientific rigor, and editorial quality.

The scope of emergency general surgical care services varies among health institutions and countries. The burden, profile, and outcomes of patients in many low- to middle-income countries is not adequately investigated. Medical records of patients admitted to acute surgical care (ASC) team were reviewed for a year. Demographics, diagnosis, dates of admission and discharges, comorbidities, operative procedures and operative care providers, outcomes, and factors associated with outcomes were analysed. During the study period, 278 ASC admissions were made. The median age was 32 years. Males constituted 52.5%. The common admissions were acute appendicitis (57.2%), intestinal obstructions (15.5%), and soft-tissue infections (6.1%). Twenty-one point two per cent of the admissions had comorbidities and HIV infection was the commonest comorbidity. Seventy-one point nine per cent of the patients underwent operations. Appendicectomies (72.0%) were the commonest operations. Most of the operations (60.5%) were performed by residents. Complications occurred in 9.7% of the cases of which 6.5% were surgical site infection (SSI) and 2.2% resulted in mortality. Patients with complications had a significantly higher rate of mortality, p < 0.001. For all admissions and operated patients longer onset of illness was associated with longer hospital stays (p = 0.002 and 0.031) and mortality (p = 0.014 and 0.019) respectively. Patients operated by surgeons and residents together had a longer hospital stay than only by residents, p < 0.001. Similarly, when surgeons operated alone the hospital stay was longer than residents, p = 0.002. The commonest ASC pathology was acute appendicitis. Longer onset of symptoms was associated with longer hospital stay and mortality. This study provides foundational data relevant to surgical education and unit organisation, including the development of clinical guidelines, resident supervision, and workforce planning.

Patient registries in South Africa (SA) are not common. This study explored the perceptions and experiences of thyroid clinicians and members of existing patient registries in SA, aiming to establish a national thyroid cancer registry. This was an exploratory qualitative study based on surveys and semi-structured interviews of participants' experiences treating thyroid cancer and using registries in general. Convenience sampling was performed for the surveys (n = 27) and purposive sampling for the interviews (n = 20). Data collection and analysis were conducted concurrently, facilitating an iterative process. The thematic analysis followed the steps outlined by Braun and Clarke. Four themes were identified. The South African healthcare system, the perceived value of a patient registry, the role of various stakeholders, and barriers to registry implementation. Participants expressed the value of registries in SA for both clinical and research purposes. However, concerns were raised regarding perceived challenges, such as resource and time constraints. Developing a national thyroid cancer registry in SA requires responsiveness to national and local challenges and opportunities, necessitating an adaptable registry format. The principle of a registry is strongly supported by clinician stakeholders. The registry, as a clinical note-keeping system, will optimise clinicians' time efficiency in patient care, and standardisation of radiology and pathology reporting across a uniform platform will enhance patient care and data entry. The benefits of a registry strongly outweigh the challenges as it facilitates the development of local guidelines, improves patient outcomes, and promotes collaborative research among endocrine clinicians.

Trauma mortality exhibits three peaks: immediate, early, and late post-traumatic. Early deaths are often due to haemorrhage and central nervous system injury, whereas late deaths are associated with sepsis and multi-organ failure. The neutrophil-lymphocyte ratio (NLR) is a readily available and inexpensive marker of inflammation, and its prognostic value under various conditions has been established. However, the predictive ability of the NLR in trauma mortality remains unclear, with conflicting results from previous studies. This study aimed to investigate the correlation between NLR (on admission and at 48-hour post-admission) and trauma outcomes. This retrospective study analysed data of trauma patients (&#x2265; 18 years old) of which 372 were admitted to a level one trauma unit between January and June 2017. The data collected included demographics, mechanism of injury, injury severity score (ISS), new injury severity score (NISS), abbreviated injury scale (AIS), hospital length of stay (LOS), hospital disposition, and NLR values on admission and at 48 hours. Logistic regression models were used to analyse the association between the NLR and mortality, controlling for age, sex, ISS, and AIS. The sample size was calculated based on the anticipated mortality rate and desired power. The study included 288 patients for admission NLR analysis and 165 patients for the 48-hour NLR analysis. While factors such as ISS, NISS, emergency department (ED) probability of survival, NISS EU probability, and hospital disposition significantly predicted mortality, NLR at both 24 and 48 hours was not significantly associated with mortality. Although NLR showed good diagnostic accuracy, it did not improve the predictive power of the models, including established prognostic factors. The small sample size for 48-hour NLR analysis is a limitation. Although the NLR is a simple indicator of systemic inflammation, this study found that it does not independently predict mortality in trauma patients when other established prognostic markers are included. These findings suggest that NLR has limited additional prognostic value in this context, highlighting the importance of incorporating established injury severity scores and other clinical factors for accurate mortality risk assessment. Further research with larger sample sizes is needed to confirm these findings and explore the potential role of the NLR in predicting other trauma outcomes.

Chemical burns worldwide are caused by highly concentrated acidic and alkaline substances being placed onto exposed skin surface with resultant tissue injury. These chemical substances have high toxicity and deep tissue penetrability causing significant morbidity and mortality to patients. This study describes the epidemiology and mortality of acid-related burn injuries to improve patient assessment and management strategies. A cross-sectional retrospective analysis of the records of 66 patients admitted to Chris Hani Baragwanath Academic Hospital Adult Burns Unit over a period of 9 years between 2015 and 2024. This study found that 91% of cases were due to assault, compared to 8% accidental injury. Patients admitted were predominantly male (n = 43; 65%). The mean total body surface area (TBSA) involved was 17.7% with the most common areas involved being the face and arms (n = 47, 72%). The neck was affected in 35 cases (54%), and the chest in 34 cases (52%). Other affected areas included the back (n = 24, 37%), eyes (n = 14, 22%), legs (n = 12, 19%), buttocks (n = 4, 6%), and genitalia (n = 3, 5%). Patient mortality is limited in cases where TBSA < 25%; however, when TBSA > 25% mortality is 75%, further increasing to 100% when patients were ventilated. This study showed a high rate of acid burns associated with domestic violence and assaults. Prevention strategies should be coordinated with strategies aimed at reducing interpersonal violence.

Penetrating neck injuries account for a significant trauma burden on the provincial healthcare system. Penetrating neck trauma ranges from obvious aerodigestive and/or vascular injuries with unstable physiology, to stable patients with subtle injuries which may cause morbid complications in the future if overlooked. The majority of the hospitals in the province have major inadequacies in terms of radiology staff and equipment, leading to a significant burden on Inkosi Albert Luthuli Central Hospital (IALCH). A retrospective descriptive study was performed using data from the IALCH trauma unit databases, reviewing patient charts between 1 January 2018 and 31 December 2020. Data retrieved encompassed the age, demographics, referral hospitals, mechanism of injury, type of injuries, zones, imaging indications and results. Patients were referred from surrounding hospitals, the majority of which were young males and the lead mechanism was stab wounds. The vast majority of injuries were found in zone 2 and the majority of patients were referred exclusively due to proximity of skin injury and positive imaging findings formed the minority. For patients with soft signs of vascular injury there is room for clinical observation without routine imaging. Similarly, patients with soft signs of oesophageal injury, such as proximity, dysphagia, dysphonia, odynophagia, retropharyngeal air on CT and hematemesis may be admitted for observation rather than routinely imaged, provided they can access surgical care if they fail non-operative management.

Minimally invasive surgery has transformed surgery. Video-assisted thoracoscopic surgery (VATS) has been used for a few specific acute indications, however there is a paucity of data describing the management of intrathoracic foreign body removal compared to open thoracotomy. A retrospective observational chart review of patients requiring surgical management of retained intrathoracic FB during the period of January 2005 to December 2021 at Inkosi Albert Luthuli Central Hospital was undertaken. This was approved as a sub-study of BCA207-09 by the UZKN BREC. Forty-two patients were identified. Sixteen (38%) were paediatric patients and 26 (62%) adults, with average age of 24 years (6 months-69 years) and a male predominance (78.6%). VATS was used initially in 33 patients, successfully in 11 (26%) and 12 (28%) required conversion to thoracotomy, while in 15 (36%) a thoracotomy was the initial procedure. Four (10%) required other surgical options. Median hospital stay was 7 days. Fourteen patients required postoperative ICU admission, 50% being those post-aspiration injury. Mechanistically, 13 were FB aspiration (31%), 25 trauma (60%) and 4 iatrogenic (9%) causes. Aspiration occurred only in paediatric patients. Among the trauma patients, 23 were adult and 2 paediatric. These included 12 retained knife blades, 8 with bullets or bullet fragments in situ, 1 nail and 2 sewing needles. Of these, 8 were managed successfully with VATS (1 bullet and 7 knife blade extractions) and 12 required conversion to thoracotomy or sternotomy. Both paediatric patients with sewing needle FB required thoracotomy. Regarding the iatrogenic FB, two Malecot&#xae; drains were removed with VATS and one patient required bilateral thoracotomies for removal of intercostal drain caps. Approximately 25% of all intrathoracic retained FB can be successfully removed by VATS, while many still require thoracotomy. Most patients will recover without sequelae.

"Damage-control" surgery originated in trauma care, emphasising expeditious control of haemorrhage and contamination to avert physiological collapse. This concept has extended into emergency general surgery (EGS) for conditions such as peritonitis, bowel ischaemia, and abdominal catastrophes. Mortality in EGS may reach up to 17% in affluent settings. The precise role of abbreviated laparotomy remains ill-defined, especially in resourcediverse environments such as South Africa. Controversies persist regarding its timing and technique - particularly decisions around deferred versus immediate bowel reconstruction and the choice of temporary abdominal closure method - highlighting the need for context-specific guidance.1,2.

Obesity is a growing global health issue, with significant implications for comorbid conditions and overall mortality. Metabolic and bariatric surgery (MBS), particularly Roux-en-Y gastric bypass (RYGB), has proven effective in achieving sustained weight loss and improving comorbidity resolution. MBS is limited in the public sector within South Africa due to cost. This pilot study, taking into consideration the resource constrained setting in South Africa, aims to assess the outcomes of RYGB surgery in a low resource setting, focusing on weight loss, comorbidity resolution, and complications over a 3-year period. A retrospective analysis was conducted on 17 patients who underwent RYGB at New Somerset Hospital, South Africa, between August 2017 and February 2020. The primary outcomes included percentage total weight loss (%TWL), excess weight loss (%EWL), and excess body mass index (BMI) loss (%EBMIL), while secondary outcomes involved the resolution of type 2 diabetes, hypertension, gastro&#x2011;oesophageal reflux disease (GERD), and dyslipidaemia. At 3 years, the mean BMI decreased from 48.3 kg/m&#xb2; to 38.35 kg/m&#xb2;, with a mean %TWL of 20.3%, %EWL of 42.5%, and %EBMIL of 43.2%. Notably, there were significant improvements in comorbidities, with a 50% resolution of type 2 diabetes, 71.4% resolution of GERD, and 66.7% resolution of dyslipidaemia. The complication rate was low, with one reported port site hernia. This study highlights the feasibility and effectiveness of MBS in a resource-constrained setting and demonstrates its potential for improving patient outcomes in the context of the obesity epidemic in South Africa. Further studies with larger cohorts and longer follow-up are needed to validate these findings and explore the long-term impact of MBS on public health.

Tracheobronchial tree injuries (TBTI) represent a type of trauma that is rare among all trauma patients, with a paucity of literature available in Africa. These may result from blunt or penetrating trauma to the neck and thorax (chest). The purpose of this study was to document the spectrum of injury and the experience with surgical and nonsurgical management and outcome of TBTI in the KwaZulu-Natal setting. This was a single-centre retrospective analysis of all patients with TBTI referred to Inkosi Albert Luthuli Central Hospital (IALCH) over 21 years. Data collection extended from 1 January 2003 to 31 December 2023. Penetrating trauma was the most common cause of injury, with a total of 32 patients (86%), while blunt injuries were seen in five patients (14%). Anatomically, there were 20 cervical tracheal injuries, eight thoracic tracheal injuries, six bronchial injuries and three multiple site injuries. A total of 27 (73%) patients underwent surgery, while 10 (27%) patients were managed conservatively. Overall mortality was seen in four patients and one patient survived with long-term disease sequelae. The overall median duration hospital stay was 6 days (IQR 4-10). TBTI remains a rare injury. Sepsis was one of the main causes of death in both surgical and conservative management. Conservative management in selected cases is just as effective as definitive surgical management. Overall, there was good outcome with TBTI in this centre.