Poorly differentiated adenocarcinoma of the jejunum in a patient with Peutz-Jeghers syndrome: A case report.

INTRODUCTION AND IMPORTANCE: Despite being the longest and containing a greater proportion of the gastrointestinal tract's mucosal surface area, the small bowel is where <2 % to 5 % of gastrointestinal cancers can occur. Peutz-Jeghers syndrome is the rarest risk factor for the development of small intestinal cancers. Here we report a case of perforated poorly differentiated adenocarcinoma of the jejunum for which Peutz-Jeghers syndrome is identified. CASE PRESENTATION: A 25-year-old male patient presented to the emergency department with generalized peritonitis caused by a perforated jejunal mass. The patient underwent an emergency exploratory laparotomy. There was 800 ml of thin pus in the peritoneal cavity and 5 cm by 6 cm perforated mass over the jejunum which extends to the mesentery. Palpable intraluminal polyps with an inverted serosal surface for some of them were identified. The pus was sucked out, and the mass was resected with its mesenteric lymph nodes and segments containing polyps. Subsequently, end-to-end hand-sewn anastomosis was performed, and the abdomen was closed. The histopathology report showed poorly differentiated adenocarcinoma, stage IIIC (PT3, PN2), and Peutz-Jeghers polyps, suggesting Peutz-Jeghers syndrome. CLINICAL DISCUSSION: Even though small bowel malignancy is a rare entity, early detection is a challenging issue, especially when it happens below the ligaments of the trietz. Surgical resection offers the only potential cure for small bowel malignancy. CONCLUSION: We conclude that patients with long-term, nonspecific abdominal complaints are good candidates for evaluation and investigation without overlooking small bowel malignancy. Peutz-Jeghers syndrome was a potential risk factor in our case.

Incidence, types, and associated factors of external abdominal hernias among adult patients visiting the surgical outpatient department, eastern Ethiopia: a multicentre cross-sectional study.

Background: Abdominal hernia is the most common surgical alignment that affects all age groups and sexes. It is characterized by the protrusion of abdominal contents through the abdominal wall's muscles and fascia. In this study, the incidence, types, and associated factors of external abdominal hernias at Hiwotfana Comprehensive Specialized Hospital and Jugal Regional Hospital, eastern Ethiopia, were ascertained. Objective: To identify the incidence, types, and associated factors of external abdominal hernia among adult patients who visited the surgical outpatient department of Hiwotfana comprehensive specialized hospital and Jugal regional hospital from 20 October to 5 December 2022. Methods: A cross-sectional study was conducted from 20 October to 5 December 2022, on adult patients who visited the surgical outpatient department at the Hiwotfana Comprehensive Specialized Hospital and Jugal Regional Hospital in eastern Ethiopia. All adult patients who visited the surgical outpatient department of each hospital were enroled in the study using a stratified random sampling technique. Both descriptive and inferential statistics were conducted, and the results were presented in text, graphs, and tables. Odd ratios for the strength and directions of association were used with a 95% CI, and a P value of less than 0.05 was considered to declare statistical significance. Result: A total of 403 participants were included in this study from two different governmental hospitals in Harar town, with a 100% response rate. The incidence of the external abdominal wall hernia was 41 (10.2%). The epigastric hernia had the highest prevalence (41.5%, n=17). Constipation [adjusted odds ratio (AOR)=2.91, CI=1.119-7.579), prolonged cough (AOR=3.993, CI=1.358-11.741), history of abdominal surgery (AOR=5.764, CI=1.837-18.083) and heavy lifting (AOR=5.476, CI=2.505-11.969) had statistically significant association (P≤0.05). Conclusion: The incidence of external abdominal wall hernia in our area is similar to the other existing literature reported from different areas. Epigastric hernia is the most prevalent type of external abdominal hernia and is commonly encountered in female patients. Constipation, a prolonged cough, previous abdominal surgery, and heavy lifting are significantly associated with an external abdominal wall hernia.

Magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a tertiary hospital in Eastern Ethiopia: a cross- sectional study.

INTRODUCTION: Several studies conducted worldwide revealed the magnitude of early relaparotomy and its outcome among patients undergoing laparotomy. However, there was very little evidence on the magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in Ethiopia, especially in the study area. OBJECTIVE: this study aimed to the assess magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a Tertiary Hospital in Eastern Ethiopia. METHODS: A retrospective cross-sectional study was conducted. All patients who underwent laparotomy during the data retrieval period were included. Data were collected using a data abstraction checklist from patients' medical records. The collected data were entered, cleaned, and analyzed by using SPSS version 23. Descriptives statistics were generated where by continuous variables were summarized into means and standard deviation and categorical variables were summarized as the frequency with proportions. RESULT: The magnitude of relaparotomy was 6.8%. Among 82 patients included in the final analysis, 53 (64.6%) were males and the mean (± SD) age of patients was 33.32 ± 16.63 years. The major indications for relaparotomy were intra-abdominal collection (26.8%) and anastomotic leak (24.4%). Among 82 patients who underwent relaparotomy, 52(63.4%) were developed post relaparotomy complications, and 30(36.6%) patients died. CONCLUSION: The magnitude of early relaparotomy was 6.8%. The magnitude of in-hospital mortality was high in comparison to earlier study findings from developing countries. About three fourth of patients who underwent relaparotomy were developed postoperative complications.

Khat induced bezoar; a rare cause of small bowel obstruction:a case report.

INTRODUCTION: Bezoar-induced small bowel obstruction (sbo) is a rare entity that might be difficult to establish diagnosis preoperatively. There are a multitude of factors attributed to its occurrence in different literature. Khat chewing which is widely practiced in eastern African and Middle East countries might contribute directly or indirectly to bezoar formation. It has chemicals known to decrease bowel motility thereby, possibly leading to concretion of proximal gastrointestinal contents. The aim of this case report is to give emphasis on the effect of khat towards bezoar formation as a result of alteration in bowel motility. CASE PRESENTATION: This is the case of a 60 years old farmer presented to our Hospital complaining Periumbilical abdominal pain of 3 days duration. He had the cardinal symptoms of obstruction. Historically he used to have intermittent episodes of constipation, otherwise no similar attack before. His staple diet was porridge made of wheat flour mixed with cooked and crushed potato along with cabbage consumed twice a day. He regularly chews Khat, a green leaf which has different chemicals known to have stimulant effect and cause decreased bowel motility. DISCUSSION: There are diverse reasons behind bezoar formation that cause bowel obstruction; out of which a preoperative diagnosis is made for few. The attributing factors were known retrospectively for majority of the cases but others remain speculations with different scientific reasoning. In our case, almost the main risk factors incriminated in the causation of bezoar formation and bowel obstruction were assessed with no supportive evidence other than khat associated constipation which has normalized after chewing khat was stopped. Additionally, tannin, an extract of khat polymerizes in an acidic environment to form a glue-like coagulum which can affix to other materials in the stomach that predisposed to bezoar formation. CONCLUSION: In patients having features of small bowel obstruction, complaining chronic constipation and who has regular khat chewing habit has to be suspected to have a bezoar as a cause. Bowel motility improves upon stopping chewing khat which may help decrease the recurrence of bezoar formation.