Perioperative outcomes after open biliary bypass for malignant biliary obstruction (MBO) in resource-limited setups; a multicenter prospective cohort study, 2023.

INTRODUCTION: Obstructive jaundice is the most common symptom of malignant diseases of the extrahepatic biliary system and necessitates either non-operative or operative biliary bypass. Because of percutaneous and endoscopic approaches, the use of palliative surgical procedures has decreased in recent years. However, in resource-limited situations, open biliary bypasses remain a viable option. This study aimed to identify factors associated with adverse perioperative outcomes following open biliary bypass. METHODS: From June 2022 to May 2023, 69 patients underwent open biliary bypass for malignant biliary obstruction. Postoperative morbidity and mortality within 30 days of surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log-rank test was used to determine the statistically significant difference between variables. A Cox regression analysis was conducted to identify factors associated to time to develop complications. RESULTS: The hazard of developing complications among those with preoperative cholangitis was 2.49 times higher than those without preoperative cholangitis (HR 2.49, 95% CI [1.06, 5.84]). For every hour increment in the length of surgery, the hazard of getting complications increased by 2.47 times (HR 2.47, 95% CI [1.28, 4.77]). As serum bilirubin increased by 1 mg/dl, the hazard of developing complications increased by 14% (HR 1.14, 95% CI [1.03, 1.17]). CONCLUSION: Patients who had long operation times, preoperative cholangitis, and elevated total bilirubin levels are at increased risk for poor perioperative outcomes. Clinicians may use these results to optimize these patients to decrease their elevated risk of serious morbidity and mortality.

Absence of the celiac trunk: The left gastric, the common hepatic, and the splenic arteries arising independently from the abdominal aorta: A case report.

The celiac trunk is the first branch of the abdominal aorta which arises from the anterior surface of the abdominal aorta and usually extends 1-2 cm before it branches into 3 branch arteries: the left gastric artery, the common hepatic artery, and the splenic artery. It is essential to comprehend the intricate arterial branch anatomy of the abdominal aorta to carry out abdominal surgeries as well as interventional radiology procedures safely. A 63-year-old woman who had been experiencing right upper quadrant adnominal pain for 2 months along with weight loss and appetite presented to the surgical unit of Tikur Ambessa Hospital. On exams, her vital signs were stable. Her abdominal exams were unremarkable. She was evaluated with an abdominal ultrasound which detected a mass arising from the gallbladder. With the impression of gallbladder mass contrast-enhanced computed tomography was done and revealed a rare anatomic variant of the celiac artery where the celiac artery was absent and the left gastric, the common hepatic, and the splenic arteries arise independently from the abdominal aorta. Clinicians should be aware of the presence of rare arterial variations because these changes can have a variety of therapeutic implications when performing surgical procedures like liver transplant, celiac artery resection such as the Appleby procedure for pancreatic and stomach cancer, or during interventional radiology procedures like transarterial chemoembolization.

Irreducible primary ventral abdominal hernia containing segment III of the liver: A case report.

INTRODUCTION AND IMPORTANCE: Herniation of the liver through the anterior abdominal wall is extremely rare entity; majority of cases are from incisional hernia after upper abdominal or cardiac surgery. CASE PRESENTATION: A 42-year-old woman who is known to have asthma presented to our emergency unit with, vomiting, epigastric pain, and swelling of 12 h duration. Upon examination, we found a mildly tender and irreducible epigastric abdominal swelling. Clinically, SBO (small bowel obstruction) secondary to irreducible epigastric hernia was suspected and abdominal ultrasound and non-contrast CT scan was done. Both ultrasound and CT revealed an epigastric hernia containing segment III of the liver. She underwent an emergent abdominal exploration that included non-anatomic resection of segment III of the liver and tissue-based hernia repair. CLINICAL DISCUSSION: Primary anterior liver hernia is herniation of the liver through the anterior abdominal wall defect in the absence of a previous abdominal incision. Diagnosis requires imaging studies such as abdominal ultrasound and CT scan. The management depends on the patient presentation, if there is any complication like vascular compromise and injury to herniated liver. CONCLUSION: Primary liver hernia through the anterior abdominal wall is extremely rare entity. To the best of our knowledge, only four cases of primary anterior liver hernia have been described in the literature.

A rare case of huge intrathoracic lipomatosis filling the right pleural cavity removed by open thoracic surgery: A case report.

INTRODUCTION AND IMPORTANCE: Lipoma is a benign tumor that arises from adipose tissue; subcutaneous fat is the most common site. It is the most common soft tissue tumor in adulthood. They are usually curable with simple excision. They are slow growing and can rarely become cancerous. Lipomatosis is when there are multiple lipomas with different pedicles. Lipomas arising from the thoracic pleura are rare and intrathoracic lipomatosis is exceptionally rare. Here we report a case of huge lipomatosis removed from the right pleural cavity in a 65 years old man. CASE PRESENTATION: A 65 years old male from southern region of Ethiopia, presented with shortness of breath associated with chest pain, productive cough, easy fatigability, and dyspnea on exertion. On exams, he had dullness on chest percussion and absent air entry on the right hemichest on auscultation. He had a history of treatment for pulmonary tuberculosis seven years back. Chest CT showed huge lobulated heterogeneous mass in the right pleural space with significant mediastinal shift to the left. All the large and small masses were removed by a thoracotomy and the specimen was subjected to histopathology examination which revealed myxoid lipoma. DISCUSSION: Lipoma is a benign tumor with no risk of malignant transformation. Intrathoracic lipoma is quite rare that we don't really find much reported cases. CONCLUSION: Intrathoracic lipomatosis is a rare condition that progresses without symptoms until it reaches a big size, at which point compressive symptoms appear. The primary approach for both diagnostic and therapeutic purposes continues to be surgical resection.

Spontaneous passage of accidentally ingested metallic nail in an adult: A case report.

INTRODUCTION AND IMPORTANCE: Foreign body ingestion is most common in children, as well as adults with neurodevelopmental and psychiatric problems. The most commonly swallowed foreign bodies in adults include fish bones, chicken bones, toothpicks, and dentures. Sharp and elongated ones are the most typical causes of gastrointestinal perforation among the aforementioned. In about 1% of cases, foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation. CASE PRESENTATION: A 23-year-old male construction laborer presented to the Emergency Surgical Unit of Debre Markos Hospital 7 h after he accidentally swallowed a nail while at work. He didn't have abdominal pain, vomiting, or rectal bleeding. On exams his vital signs were stable. His chest and abdominal exams as well as the digital rectal examination were unremarkable. He was evaluated with a plain erect abdominal x-ray based on his complaint, which revealed a long nail lying longitudinally in the right lower quadrant of the abdomen. Twenty-nine hours after swallowing the iron nail, he passed it through his rectum spontaneously. CONCLUSION: Plain radiography should be performed to locate and follow-up on radiopaque foreign entities before sophisticated imaging and invasive procedures. When treating people who have accidentally ingested a sharp foreign body, clinicians should find a balance between prompt action and careful follow-up.

Perforation of the cecum from ingested foreign body in a 14 year old adolescent with autism spectrum disorder and epilepsy: A case report.

INTRODUCTION AND IMPORTANCE: Although foreign body ingestion is a common medical issue, intestinal perforations following foreign body ingestion are rare. Diagnosing foreign body ingestion is challenging especially in children with neurodevelopmental disorders such as Autism Spectrum Disorder (ASD). It is believed that approximately 80-90% of ingested foreign bodies pass through the gastrointestinal tract without causing any luminal damage, and only approximately 1% of foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation. CASE PRESENTATION: A 14-year-old boy, diagnosed to have Autism Spectrum Disorder was brought in by his parents to our hospital with right lower quadrant (RLQ) abdominal pain and fever. On examination, he was tachycardic and there was direct tenderness over the RLQ of the abdomen. Acute appendicitis was entertained and the patient was examined with ultrasound. The ultrasound reported, "The tip of the appendix was dilated (0.62cm) and there is minimal RLQ intra-peritoneal fluid collection". With the impression of acute appendicitis, the patient was explored and he was found to have a cecum perforation due to an ingested foreign body (twig). Initially we did tube cecostomy but later we did right hemicolectomy because the cecostomy tube had leaked. CONCLUSION: Foreign body ingestion should be taken into account during the evaluation of children and adolescents with neurodevelopmental disorders who presented with acute abdominal pain. Since diagnosis is difficult clinicians who are involved in acute care medicine should take a thorough history with a high index of suspicion for foreign body ingestion.

Giant biliary mucinous cystadenoma mimicking mesenchymal hamartoma of the liver in a child: A case report.

INTRODUCTION: Biliary cystadenomas (BCAs) are rare benign tumors with malignant potential. They are most commonly found in middle-aged women and are quite infrequently reported in children. Even with advanced imaging, diagnosing and distinguishing BCA from other cystic liver lesions remain challenging. CASE PRESENTATION: A 5-year-old boy was brought in by his parents to our hospital with abdominal swelling that had been persistent for a year, along with loss of appetite and weight loss. On examination, the abdomen was distended and dull on percussion. We considered mesenchymal hamartoma of the liver (MHL) as the top differential after an abdominal CT scan with contrast showed a multi-loculated cystic tumour. For both definitive diagnosis and therapy, the patient underwent exploratory laparotomy with excision of the cystic mass. Surprisingly, histopathology examination of the resected specimen revealed biliary mucinous cystadenoma (BCA). CONCLUSION: Since conservative methods are associated with high recurrence rates, biliary mucinous cystic neoplasms require a high index of suspicion and should be handled with total surgical resection. In the post-operative phase, periodic surveillance imaging is recommended due to the risk of recurrence and malignant transformation.