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Mulugeta Taeme G/tsion,1 Aschalew Tibebu Shumargaw2 1Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 2Department of Surgery, Dessie Comprehensive Specialized Hospital, Dessie, EthiopiaCorrespondence: Mulugeta Taeme G/tsion, Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia, Email mullerab1988@gmail.comIntroduction: Toxic multinodular goiter (TMNG) usually occurs in older individuals, who often have a lengthy history of nontoxic multinodular goiter. The cases of giant multinodular goiter are rare clinical conditions nowadays. Thyroidectomy is generally the preferred treatment option because it resolves both toxic and compressive symptoms.Case Report: We present here a case of giant toxic multinodular goiter successfully treated at Dessie comprehensive specialized hospital. A 60-year-old female presented with anterior neck swelling of 30 years and toxic symptoms of 3 years duration. She had breathing difficulty in a supine position. On physical examination, there was a huge anterior neck mass measuring 27× 24 cm in the largest dimensions. Based on TFT, FNAC, and ultrasound, she was diagnosed with a giant toxic multinodular goiter. After medical treatment with antithyroid drugs, a total thyroidectomy was performed and the gland was dissected successfully.Discussion: The most effective treatment of giant toxic multinodular goiter is total thyroidectomy which avoids recurrence and subsequent complication rates with repeat surgery.Conclusion: Due to difficulty during intubation, the presence of altered anatomy, and adhesions to the surrounding structures associated with giant toxic MNG, it will be a challenge to do a thyroidectomy.Keywords: case report, giant goiter, thyroid-stimulating hormone, toxic multinodular goiter, total thyroidectomy

Introduction: Toxic multinodular goiter (TMNG) usually occurs in older individuals, who often have a lengthy history of nontoxic multinodular goiter. The cases of giant multinodular goiter are rare clinical conditions nowadays. Thyroidectomy is generally the preferred treatment option because it resolves both toxic and compressive symptoms. Case Report: We present here a case of giant toxic multinodular goiter successfully treated at Dessie comprehensive specialized hospital. A 60-year-old female presented with anterior neck swelling of 30 years and toxic symptoms of 3 years duration. She had breathing difficulty in a supine position. On physical examination, there was a huge anterior neck mass measuring 27× 24 cm in the largest dimensions. Based on TFT, FNAC, and ultrasound, she was diagnosed with a giant toxic multinodular goiter. After medical treatment with antithyroid drugs, a total thyroidectomy was performed and the gland was dissected successfully. Discussion: The most effective treatment of giant toxic multinodular goiter is total thyroidectomy which avoids recurrence and subsequent complication rates with repeat surgery. Conclusion: Due to difficulty during intubation, the presence of altered anatomy, and adhesions to the surrounding structures associated with giant toxic MNG, it will be a challenge to do a thyroidectomy. [ABSTRACT FROM AUTHOR]

Spleno-sigmoid knotting is the twisting of the spleen around the sigmoid colon, causing obstruction of the sigmoid colon. It is an uncommon cause of intestinal obstruction. To our knowledge, there has been no previous case report of spleno-sigmoid knotting before our case. Here, we present the case of an 18-year-old female patient who visited the surgical emergency outpatient department with diffuse and progressive abdominal pain lasting for one and a half days. She also experienced obstipation and frequent episodes of vomiting of ingested matter. Upon initial evaluation, she exhibited tachycardia and tachypnea, and her abdomen was grossly distended with diffuse direct and rebound tenderness. Further investigation revealed significant leukocytosis with neutrophil predominance. Emergency laparotomy was performed with a possible diagnosis of generalized peritonitis secondary to gangrenous sigmoid volvulus, which revealed gangrenous spleno-sigmoid knotting. Various types of intestinal knots have been reported, with ileo-sigmoid knots being the most common and ileo-ileal knots being the rarest. Wandering spleen is a rare congenital anomaly with a variable clinical presentation ranging from asymptomatic to mild abdominal pain or acute abdomen due to torsion or acute pancreatitis. It can also cause intestinal obstruction, which may be the initial presentation. In patients presenting with acute abdominal pain and features of bowel obstruction, the possibility of spleno-sigmoid knotting should be considered, and early intervention should be instituted to prevent gangrenous progression and sepsis. [ABSTRACT FROM AUTHOR]