Wandering spleen presenting in the form of right sided pelvic mass and pain in a patient with AD-PCKD: a case report and review of the literature.

BACKGROUND: Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not. CASE PRESENTATION: We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful. CONCLUSION: Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.

Trends in Retention and Decay of Basic Surgical Skills: Evidence from Addis Ababa University, Ethiopia: A Prospective Case-Control Cohort Study.

INTRODUCTION: While prior studies have evaluated surgical skills simulation and retention in highly resourced environments, there is paucity of data on the retention of surgical skills taught in simulation laboratory to undergraduate students, and virtually none from low-resource settings. We aimed to evaluate the trends in retention/decay of surgical skills among medical students in Ethiopia and determine whether regular intervention in the form of intermittent skills testing can aid retention. METHODS: Forty-four final year medical students were randomly divided into two cohorts of 22 students each. All 44 were trained in surgical instrument identification, simple interrupted suturing and one-handed knot tying. A previously validated, standardized assessment was performed before training, immediately after training, and then at 6 weeks, 3 months, 6 months and 1 year for cohort 1, and before training, immediately after training, and at 6 months and 1 year for cohort 2. All areas learned were tested for general decay. RESULTS: The baseline mean scores of surgical skills were 3.8/30 for instrument identification, 3.3/15 for one-handed knot tying, and 1.35/15 for suturing. At the end of the training, mean scores improved to 26.6/30, 11.2/15 and 11.1/15 (instrument identification +599% and +772%, knot tying +447% and +417%, suturing +237% and +260%, respectively, for Cohort I and II). At 6 months and 1 year, there was a significant drop in all the three areas tested, especially in knot tying and suturing. There was no statistically significant difference between the two cohorts. CONCLUSIONS: While our surgical skills course is an effective means to teach surgical skills to medical students, there is significant decay in abilities after 6 months. Conducting regular assessments does not appear to have any effect in helping students retain these skills. We recommend such surgical skills training be conducted at appropriate intervals, such as just before internship, to prepare student for active surgical practice.

A review of a five (5) years experience (Sept. 2004-Aug. 2009) with hepatic resections at Gondar University Hospital (GUH).

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide. Many patients with benign and malignant hepatobiliary disease have been referred to the surgical outpatient department (OPD) of GUH. Hepatic resection is appropriate treatment for a variety of benign or malignant primary or secondary liver tumors. However, hepatobiliary neoplasms present a surgical management challenge and experience in the effective surgical management of these conditions has been generally lacking in the country. Few patients have been offered resection for liver tumors at GUH. The resections reported here represent the first set of cases from GUH and probably from any other institution in Ethiopia. This review summarizes a five year experience in hepatic resection procedures at GUH. Patients' charts and operating room logbooks, as well as the follow up notes of the senior surgeons were reviewed. Nine tumor resections (major, minor and enucleations) were done. There were two deaths; one from sepsis and the other from an acute cardiopulmonary event. We believe that in carefully selected patients hepatic resection is possible in facilities such as GUH and generally offers the best opportunity for long-term palliation and survival. At laparotomy general abdominal examination is a crucial step and should be routinely undertaken prior to hepatic resection.