Jejunal Ectopic Pancreatic Tissue Rest as Lead Point in Patients with Intussusception: A Rare Case Report and Review of Literature.

Background: Ectopic pancreas (EP), characterized by pancreatic tissue outside its usual location, poses diagnostic challenges due to its asymptomatic nature in most cases. Gastric lesions are often symptomatic, causing epigastric pain or gastric outlet obstruction. Rarely, jejunal lesions can lead to intestinal obstruction or intussusception. The elusive preoperative diagnosis lacks specific biochemical markers, relying on intraoperative biopsy and histopathology as gold standards. Case Presentation: We present a unique case of a 37-year-old female with 12-hour crampy abdominal pain, bilious vomiting, blood-mixed diarrhea, abdominal distension, and obstructive symptoms. Imaging revealed jejunojejunal intussusception with a jejunal mass as the lead point. Intraoperatively, also identified jejunal mass as lead point. Resection of mass and end-to-end jejunojejunal anastomosis were performed, resulting in a successful outcome. Histopathological examination identified a type I ectopic pancreas within the muscularis propria. Twelve months postoperatively, the patient exhibited no stricture or recurrence. Conclusion: Ectopic pancreas, with varied symptoms, poses diagnostic hurdles. Despite the diagnostic challenges, surgical excision remains the optimal treatment for symptomatic cases. This report contributes to the limited literature on ectopic pancreas, emphasizing the importance of considering this entity in the differential diagnosis of gastrointestinal pathology.

A rare case of descending colonic volvulus presenting as large bowel obstruction 19 years after sigmoidectomy and descending colorectal anastomosis.

Introduction and importance: Large bowel obstruction is a common surgical emergency worldwide. Large bowel obstruction secondary to descending colonic volvulus is an extremely rare condition with only few reported cases worldwide. Its extreme rarity is due to its retroperitoneal location and lack of mesentery. Case presentation: A 75-year-old male patient with a history of sigmoidectomy and end-to-end descending colorectal anastomosis 19 years previously, presented with failure to pass faeces and flatus of 1 day duration with associated colicky abdominal pain, distension and vomiting. The abdomen was distended but soft and non-tender. Digital rectal examination showed an empty and ballooned rectum. The intraoperative finding was of a 360° counter-clockwise rotated descending colon. Detorsion and extraperitonealization of the descending colon was performed and the patient was successfully discharged. Clinical discussion: Volvulus is a twisting of a segment of bowel along its own mesentery. Sigmoid volvulus and caecal volvulus accounts for up to 90% and less than 20% of cases, respectively. Descending colonic volvulus is described in very few case reports. Diagnosis is clinical and confirmed by imaging. Conclusion: Descending colonic volvulus is a surgical emergency and an extremely rare cause of large bowel obstruction. Surgical management options include extraperitonealization of the descending colon, diversion colostomy or resection and primary end-to-end anastomosis.

Health-Care Providers' Knowledge, Attitudes, and Practices Regarding Adult Cardiopulmonary Resuscitation at Debre Markos Referral Hospital, Gojjam, Northwest Ethiopia.

BACKGROUND: Cardiac arrest is one of the leading causes of death worldwide. Good knowledge, attitudes, and practices of health-care providers regarding cardiopulmonary resuscitation are vital to improve patient outcomes after cardiac arrest. This study aimed to assess knowledge, attitudes, and practices with regard to management of adult patients with cardiac arrest among health-care providers at Debre Markos Referral Hospital, Debre Markos, northwest Ethiopia in 2019. METHODS: A hospital-based cross-sectional study was conducted from January to February, 2019 at Debre Markos Referral Hospital. All health-care providers who fulfilled the inclusion criteria were enrolled in the study. A pretested structured questionnaire was used for data collection. Data were entered into EpiData 3.1 and transferred to SPSS 20 for analysis. RESULTS: Of the 352 health-care providers, 324 participated in the study for a response rate of 92%. Amajority (63%) were male. The age of male (80%) was 26-35 years old, with a mean of 29.28±4.8 years. A majority (77.8%) had inadequate knowledge about cardiopulmonary resuscitation. Almost all (97.8%) had no knowledge about cardiocerebral resuscitation. More than half (64.2%) had unfavorable attitudes toward CPR. Moreover, 288 (88.9%) had unsafe practices regarding cardiopulmonary resuscitation. The site and depth of chest compression was answered correctly by only 33 (10.2%) and 59 (18.2%) of participants, respectively. CONCLUSION: Health-care providers' knowledge, attitudes, and practices were inadequate, unfavorable, and unsafe regarding the management of cardiac arrest. Training on the assessment of critically ill patients, cardiopulmonary resuscitation, and cardiocerebral resuscitation should be provided for health-care providers. Additionally, resuscitation equipment like defibrillators and emergency drugs should be available in all wards and emergency rooms.