The presentation pattern and surgical strategies in bronchopulmonary carcinoid tumors: a multicenter experience in a low-income country.

Background: Bronchopulmonary carcinoid tumors include typical and atypical carcinoids, with typical carcinoids accounting for 80%-90% of these types of tumor. The primary curative treatment for these tumors is surgical resection. To our knowledge, there are limited studies on the presentation patterns and treatment strategies of bronchopulmonary carcinoid tumors in Africa. Objective: To determine the presentation patterns and surgical strategies in bronchopulmonary carcinoid tumors in patients treated at multicenters in Ethiopia from January 2018 to December 2023. Materials and methods: A 5-year retrospective cross-sectional study was conducted using medical records and pathology record reviews of patients operated on in Tikur Anbessa Specialized Hospital, Menelik II Hospital, and Saint Peter's Specialized Hospital from 1 January 2018 to 31 December 2023. The completeness of the data was checked before being entered into EpiData version 4.6.1, and analysis was conducted using SPSS version 29. Logistic regression was applied to depict the association of the histological pattern with its predictors. A P-value of <0.05 was considered significant for the association of variables. Results: A total of 62 patients with bronchopulmonary carcinoid tumors were included in the study with a mean age of 35.29 ± 12.26 years ranging from 14 to 67 years, in which more than half [37 (56.5%)] were females, with a male-to-female ratio of 1:1.3. The majority of the patients were non-smokers (90.3%) and symptomatic (98.4%), with a mean duration of symptoms of 29.7 ± 26 months, ranging from 3 to 156 months. Nearly half of the patients (48.4%) were treated for pulmonary tuberculosis before a diagnosis of carcinoid tumor was made. The majority of the patients underwent surgery by open posterolateral thoracotomy (98.4%), and pneumonectomy was the most common (38.7%) resection performed. Typical carcinoids were observed in 85.5% of patients. Age, smoking history, duration of symptoms, location of tumors, and lymph node status were statistically associated with histological patterns. Recommendation: Based on our study findings, improving physician awareness on the clinical presentation of carcinoid tumors, training for surgeons in less invasive surgical approaches, and further nationwide studies are recommended.

Prevalence and treatment outcome of bronchopleural fistula: a multi-center study in Ethiopia.

PURPOSE: The study aimed to assess the magnitude, risk factors, and management outcome of patients with a bronchopleural fistula at multiple centres in Ethiopia. METHOD AND MATERIALS: A ten years (September 2012 - August 2021) institution-based multicenter retrospective cohort study was conducted from September 13 to September 30, 2021. we surveyed the cards of all patients having a diagnosis of bronchopleural fistula for the last 10 years. The document was reviewed using an extraction checklist. Descriptive statistics (mean, standard deviation, frequency, percentages) and crosstabulation were used to describe the outcome variable. RESULT: A total of 52(2%) patients were diagnosed to have bronchopleural fistula out of 2546 patients admitted to the cardiothoracic unit in three hospitals from September 2012 - August 2021 and 69% of study participants were male. The mean age of study participants was 33.42 years with SD = 12.5. Thirty-one (60%) of the cases spontaneously developed a bronchopleural fistula and 20 (38%) were post-surgical and 1(2%) was a post-traumatic fistula. Of the total of post-surgical bronchopleural fistula, 14 (26.9%) of them were lung resection, 4 (7.7%) were hydatid cystectomy and 1(1.9%) are decortications, and bullectomy respectively. of the total post-lung resection, 8 (57%) were pneumonectomies followed by 3 (21.5%) Lobectomy, 2 (14.5%) wedge resection and 1(7%) bilobectomy respectively. Fifty patients were managed surgically and two patients were managed conservatively. Bronchopleural fistula (BPF) was closed in 40 (85.4%) and there were two (3.9%) deaths, and the cause of death was sepsis secondary to pneumonia of the contralateral lung in one case. CONCLUSION: Having thoracic surgery is a risk factor for the development of bronchopleural fistula. Management of bronchopleural fistula needs to be individualized.

Ileal fecalomas causing small bowel obstruction: A case report.

INTRODUCTION: Fecaloma is an accumulation of feces that has formed a mass and has failed to be expelled spontaneously. Because fecal matter is harder and firmer in the left side of colon, and the diameter of the bowel is smaller compared to the right, fecalomas mostly form in recto-sigmoid area. Small bowel fecaloma formation is an extremely rare condition. CASE PRESENTATION: We report a 49 years old man who presented with small bowel obstruction due to ileal fecalomas for whom enterotomy and removal of fecaloma was done with good outcome. DISCUSSION: Fecal matter can accumulate in the intestinal lumen to form a mass separate from other intestinal contents which eventually becomes fecaloma. Formation is usually related to chronic constipation, conditions causing intestinal motility disorder, or in psychiatric patients who could have ingested extraordinary substances. Fecaloma can present as abdominal mass, stercoral colitis, urinary retention or intestinal obstruction. Treatment options include conservative management with bowel rest, laxatives, endoscopic removal, laparotomy and removal via enterotomy. CONCLUSION: Fecaloma can be considered in patients who present with small bowel obstruction without any risk factors. Initial noninvasive management should be considered. Failed conservative treatment can be followed by laparotomy and fecaloma removal.