Colon Lipoma Causing Colo-Colic Intussusception in an Adult: A Case Report from Tanzania.

Intussusception is rarely seen in adulthood but is commonly seen in the pediatric age group. Causes of intussusception in adults are commonly due to tumors and inflammatory diseases. Intussusception in adults accounts for less than 5% of intestinal obstruction. Colonic lipomas are usually asymptomatic and are mostly managed surgically with promising outcomes as seen in our case.

A unique presentation of metaplastic breast carcinoma, NOS: A case report.

Key Clinical Message: A rare form of invasive breast carcinoma, NOS, also known as matrix-producing carcinoma made up of epithelial and mesenchymal components. Usually, they are triple negative and clinically aggressive and respond poorly to neoadjuvant systemic therapy. Abstract: Metaplastic breast carcinomas (MBCs) are ductal carcinomas that undergo metaplasia to form nonglandular growth patterns. They are extremely rare, constituting less than 1% of all invasive breast carcinomas. Matrix-producing carcinoma is an exceedingly rare form of MBC distinguished by a ductal carcinomatous component with direct transition to areas of cartilaginous or osseous differentiation without the presence of an intervening spindle cell element. MBCs are clinically aggressive, but matrix-producing subtypes have a relatively better prognosis. The tumors are usually triple negative. Therefore, surgery and chemotherapy are the main therapeutic approaches. Our report describes this unique form of MBC with prominent osseous differentiation in a 33-year-old female patient. Its distinct histological features and peculiar clinical behavior necessitate a thorough understanding of this one-of-a-kind disease entity.

Chest tube thoracostomy: A simple life-saving procedure with potential hazardous risks.

INTRODUCTION AND IMPORTANCE: Chest tube thoracostomy is a simple life-saving procedure with many benefits but comes with significant potential morbidity. Potentially all intra-thoracic organs are at risk of possible injury as well as peritoneal. CASE PRESENTATION: We present four patients who had chest tube thoracostomy with potential complications fortunately were managed promptly and recovered fully. CLINICAL DISCUSSION: Complications related to tube thoracostomy is reported up to 25 % especially when done under emergency conditions. While the procedure is reported safe, it's associated morbidity is not well described. Additionally, clinicians are urged to follow standard operating procedures and address the potential complications with consent to their patients. CONCLUSION: Chest tube thoracostomy is an invasive life-saving procedure performed across various clinical ranks and sub-specialties. It has potential life-threatening risks and complications therefore clinicians should be well trained to identify such complications and address accordingly.

Burr hole as a management for extra axial hematomas in a low-resource setting.

INTRODUCTION AND IMPORTANCE: In a low-resource setting, the availability of neurosurgeons and neurosurgical equipment for neurosurgery has proved to be a challenge for the management of extra-axial hematomas hence general surgeons perform burr hole surgeries for emergencies. CASE PRESENTATION: We share our experience with three patients who presented with extra-axial hematomas and managed successfully in our institute with craniostomy as the surgical approach. CLINICAL DISCUSSION: Traumatic brain injury is a major global health burden as it is a leading cause of death among the middle-aged population. Mortality associated with brain injury is highest in low- and middle-income countries. From our experience, we had good outcome in terms of improved Glasgow Coma Scale and overall clinical status in those who underwent burr hole surgery for extra axial hematoma. CONCLUSION: The need for neurosurgeons in sub-Saharan Africa is high but training comes at a cost hence general surgeons can perform life-saving emergency procedures with good outcomes.

Giant pedunculated lipofibroma of the thigh.

Pedunculated lipofibroma is a rare form of nevus lipomatous cutaneous superficialis. They are usually solitary lesions found around the thighs, buttocks and trunk; thought to have a predilection for pressure areas. There are two types of lipofibromas; sessile or pedunculated. They are mostly asymptomatic but can cause symptoms as they grow larger affecting daily activities. Treatment is not indicated in smaller lesions, except for cosmetic purposes. Herein we present this rare benign lesion with an unusually large size.

Pancreatic pseudocyst as a cause for gastric outlet obstruction.

The pancreatic pseudocyst contains pancreatic enzymes encapsulated by a non-epithelialized wall. They are rare in the pediatric population and are mostly a result of pancreatic trauma: extrinsic, or intrinsic. Management options include conservative or surgical, depending on the clinical signs and symptoms, and the size of the cyst.

Valentino's syndrome: a bizarre clinical presentation.

A perforated peptic or duodenal ulcer may cause an unusual expression of right lower quadrant pain. In Valentino's syndrome, the chemical fluid from the ulcer flows via the right paracolic gutter to the right iliac fossa, causing peritoneal irritation and chemical appendicitis which will mimic pain in the right lower quadrant. We report a case of a 23-year-old male patient who presented with cramping lower abdominal pain with fevers and vomiting. His pain was mostly in the right lower quadrant and radiated to his back. A perforation-related pneumoperitoneum was found on a computed tomography scan, along with an accumulation of fluid in the abdomen and thickening of the pyloric antrum. Valentino's syndrome's aberrant clinical picture mimicking acute appendicitis is a pathognomonic presentation of the disease. Right lower abdominal pain should also prompt the scrutiny of atypical differentials, such as perforated ulcers. Physicians need to manage these patients with a high index of suspicion.

Chylous ascites: Our experience from a resource-limited setting.

INTRODUCTION AND IMPORTANCE: Chyle is a lipid-rich, milky-appearing fluid originating from lymph tissues. Chylous ascites is the collection of chyle in the peritoneal cavity and is a rare pathology. CASE PRESENTATION: In this case report we share our experience of successfully managing chylous ascites conservatively from a resource-limited setting. CLINICAL DISCUSSION: There are numerous causes hence management includes treating the cause. Generally responds well to conservative management however some cases require surgical intervention. CONCLUSION: Ascitic tapping is an effective diagnostic and therapeutic tool is chylous ascites.

Aortic aneurysm: An uncommon cause of dysphagia.

Dysphagia is a serious symptom and requires urgent investigations and prompt diagnosis to initiate appropriate therapy. Dysphagia aortica is a rare entity described as difficulty in swallowing due to external compression by the aorta. The incidence of this entity is unknown. Herein we present a 90-year-old woman who presented with a progressive 3-month history of dysphagia, diagnosed with aortic aneurysm who then developed related complications and succumbed. Dysphagia aortica should be considered in the list of differential diagnoses in a patient with dysphagia although rare. Early diagnosis and management are vital to avoid poor outcomes.

Gallbladder perforation: An uncommon cause of peritonitis in a child.

INTRODUCTION AND IMPORTANCE: Gallbladder perforations are infrequently encountered in the pediatric group but can be a cause of peritonitis with significant morbidity and mortality if not diagnosed and managed promptly. CASE PRESENTATION: We present a case of a 10-year-old female who presented with peritonitis due to a perforated gallbladder diagnosed by CT-scan. She was managed surgically successfully. CLINICAL DISCUSSION: Gallbladder perforation due to cholecystitis is usually seen in the elderly population but is uncommon among the pediatric population. Mortality rate can be as high as 26 % hence early diagnosis is vital. Management is mostly surgical as seen in the index case. CONCLUSION: Clinicians should keep gallbladder perforation in mind as a differential diagnosis of acute abdomen in children although uncommon.

A large infected urachal mass in an adult: A case report in Tanzania.

INTRODUCTION AND IMPORTANCE: Urachal Mass results from a failure of obliteration of the urachal canal during fetal growth. The aetiology of urachal masses is ambiguous, being either of a cancerous or benign origin. Much literature is stipulated in children presenting with urachal-associated diseases but few in adult patients. This study aims at elucidating the existence of urachal mass with an abscess in a patient and the management modalities. PRESENTATION OF CASE: We present a case report of a 52-year-old female patient with a two months history of abdominal pain and discomfort associated with intermittent low-grade fevers, anorexia and marked weight loss throughout her illness. An abdominal ultrasound revealed the presence of an intra-abdominal mass. A CT scan showed a multilobulated urachal mass. She eventually had a successful operation and quick recovery postoperatively. DISCUSSION: In the adult population, most urachal-associated diseases are malignant, with few being of benign origin. With different presentations between the two aetiologies, the most benign urachal masses may lead to infection and inflammation that typically present with a lower abdominal mass and fever. Diagnosis is made by ultrasound or CT scan of the abdomen. Surgical drainage and excision of the mass are the mainstay treatment modalities. CONCLUSION: Urachal masses are rare in the adult population and are often missed in initial presentations. This will constitute poor management and outcome for patients. Physicians are to be alerted of the knowledge and make a clear assessment of patients perioperatively to avoid the delayed diagnosis, which may have consequent poor outcomes.