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Introduction: The aim of this study is to highlight our experience in the management of long segment corrosive esophageal stricture using the left colon bypassing the strictured segment of the esophagus thereby maintaining continuity and restoring normal swallowing. Subjects and Methods: This was a retrospective study of patients with long-segment corrosive esophageal stricture who were managed by left colon bypass surgery in our center over a 5-year period between January 2012 and December 2016. Hospital records were reviewed and relevant information such as age, sex, clinical presentations, and operative procedure were obtained. The left colon grafts were taken under the pedicle of left colic artery in all cases, and three anastomoses were made at colocolic, cologastric, and colo-esophageal points. Feeding gastrostomy was done for all patients for early feeding. Results: There were 12 males (60%) and 8 females (40%) and age ranging from 2 years to 42 years; among them, there were 13 children (65%) and 7 adults (35%); caustic soda was the most common corrosive substance in 14 cases (70%) and acid in 2 cases (10%); the exact nature of the substances in 4 (20%) was not clear. Accidental ingestion was found in 90% of the cases. Psychiatric illness was associated in 2 adults (10%). Conclusion: The treatment of long segment corrosive esophageal stricture with left colon bypass graft surgery under the pedicle of the left colic artery is very effective with minimal postoperative complications; we, therefore, recommend this technique for relief of dysphasia from this form of injury.

Permanent pacemaker implantation is a lifesaving procedure. Complete heart block is one of the most common indications in our environment. Diagnosis is often missed and treatment is not readily available. These reasons account for the low turnover of cases. Two cases were successfully conducted in our center using the VVIR type of pacemaker, and no significant complications were recorded afterword. All patients presented with typical symptoms of complete heart block and were symptoms free after the procedure.

Reports are few of chylothorax complicating stab wounds to the left suprascapular region. We report a case of traumatic chylothorax following a stab wound to the suprascapular region in a 14-year-old boy. He presented with progressive dyspnoea and signs of a pleural effusion. This was confirmed by radiology and thoracocentesis to be a hemothorax. The hemothorax was drained by tube thoracostomy. He developed chylothorax on the third day after inserting the chest tube. Biochemical analysis confirmed chylothorax, which was managed conservatively. The chest tube was removed after it stopped draining. We discuss the pathogenesis of this form of chylothorax and the management options. Keywords: Chylothorax, Poirier’s triangle, Stab, Trauma

Highlights • Dedifferentiated Liposarcoma (DDLPS) occur rarely in the chest. • Response to chemotherapy is believed to be minimal. • Neoadjuvant chemotherapy plays a role in stopping refractory bleeding from a chest wall DDLPS. • Palliative resection may be used to improve quality of life even in the face of incurable disease., Introduction Dedifferentiated liposarcoma (DDLPS) is a heterogenous neoplasm of variable histological grade. DDLPS uncommonly arises from the chest wall. There are limited data available about the tumor’s response to chemotherapy and accessible reports indicate minimal benefits. Surgery is thus the cornerstone of management. Here, we demonstrate an uncommon situation where chemotherapy was used to arrest bleeding from a giant DDLPS that was refractory to all available hemostatic agents. This case also presents an uncommon indication for palliative chest wall resection and reconstruction (CWRR). Presentation of case A 55-year old woman presented with refractory bleeding from an ulcerated and foul-smelling mass on the anterior chest wall, confirmed histologically to be DDLPS. Chemotherapy with Doxorubicin and Ifosfamide was used to control the bleeding. She subsequently had CWRR to improve her quality of life. The patient made an uneventful recovery but later died from pulmonary embolism. Discussion The dedifferentiated component of DDLPS is vascular and may account for why we were able to exhibit a hemostatic response to chemotherapy. CWRR was then employed to improve the quality of life in an advanced, ulcerated and infected tumor of the chest wall. Conclusion We were able to demonstrate a hemostatic response of DDLPS to neoadjuvant chemotherapy and anticipate that this report may serve as a reference for further studies. Furthermore, we believe that palliative resection may be carried out to improve a patient’s quality of life even in the face of advanced disease.

Background: Patent ductus arteriosus (PDA) is quite a common acyanotic congenital heart disease (CHD). Its ligation in Sub-Saharan Africa is challenging due to lack of adequate cardiothoracic surgeons. We, therefore, present our experience and our challenges in our center with limited resources. Objectives: To determine the challenges and outcome of surgical ligation of PDA in our center. Methods: This was a retrospective review of all PDA ligations done from January 2012 to December 2017. Data were extracted from the operation theater register and patients files. Information such as age, sex, symptoms at presentation, intraoperative findings, and outcome of surgery were analyzed. Discordances between echocardiography and intraoperative finding of PDA were noticed in only two cases, and these were excluded from the study because PDA was not seen intraoperatively and they were referred for further evaluation. Statistical Package for the Social Sciences version 16 was used for data entry and analysis. Results: Twenty-five patients had PDA ligation during the study period; the subjects comprised 17 females and 8 males with a male-to-female ratio of 1:2. Two adult cases were recorded. Three cases had other associated CHD. All surgeries were carried out successfully and only a single case of complication was reported (4%, chylothorax). Conclusion: PDA ligation is relatively safe if properly done with successful outcome.

Few cases of true superior gluteal artery (SGA) aneurysms have been described in the English-language literature. This is the twenty-second reported case. SGA aneurysms can pose diagnostic problems, specifically when they are non-pulsatile and also therapeutic challenges when they are large. Although more aneurysms are being subjected to endovascular therapies, SGA aneurysmectomy or aneurysmorrhaphy still remain valid therapeutic options, especially in resource-poor settings. Surgery provides quick symptom resolution and still is the only means by which tissue for definitive histological diagnosis can be obtained.

Background: Peripheral vascular injuries (PVIs) are infrequent but their management could be hampered by delayed presentation and fraught with untoward morbidity or death. Herein, we describe the factors contributing to the morbidity and mortality of PVIs in this environment. Materials and Methods: Data relating to patients with PVIs between March, 2012 and March, 2018 were retrospectively collected from case folders and analyzed. Results: The records of 16 patients were analyzed. There were 13 (76.9%) males and 3 (23.1%) females. The male/female ratio was 4.3:1. The median age was 30 years (range, 10–52). The median duration between injury and presentation was 2.5 days. Nine (56.3%) PVIs were secondary to stab wounds; two (12.5%) occurred in intravenous drug abusers while the others were each of different etiologies. The superficial femoral artery was the most frequently injured vessel (six cases; 37.6%). Fourteen (87.5%) patients required surgery ranging from patch arterioplasty to reversed saphenous vein interposition graft. Two (12.5%) patients were managed conservatively. The mean length of stay for the overall patient population was 11.7 days. Ten patients (62.5%) had surgical site infections (SSIs) causing prolonged hospital admission. There were three deaths (18.8%), all occurring in patients with co-morbidities like chronic kidney disease (CKD) and sepsis. Conclusion: PVIs were infrequent in this environment and presentation is delayed. Reasonable limb salvage rates are possible depending on the severity of ischemia. SSIs may suggest prolonged hospital stay. Mortality appears to be heightened if there are underlying co-morbidities. More patients would however be required to statistically correlate these findings.