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Introduction and Importance: Giant lipomas, particularly in pediatric patients and unusual locations like the gluteal region, are rare. These benign tumors can mimic other conditions, making diagnosis challenging. This case highlights the importance of considering giant lipomas in differential diagnoses and the challenges posed by delayed treatment., Case Presentation: A 14-year-old female presented with a large, firm mass in the gluteal region, which had grown over time. MRI showed a well-circumscribed mass without spinal involvement. The mass was surgically excised, and histopathology confirmed a benign lipoma., Clinical Discussion: This case demonstrates the diagnostic challenges of giant lipomas, especially when atypical in appearance. MRI was crucial for diagnosis and surgical planning. Early surgical excision is vital to prevent complications. The case also highlights the need for timely medical intervention, particularly in low-resource settings., Conclusion: Early diagnosis and prompt surgical management are essential in cases of giant lipomas to prevent complications. Improved healthcare access and awareness in low-resource settings are necessary to ensure timely treatment., Competing Interests: Declaration of competing interest The authors declare they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Lipomas are common benign tumors, typically affecting subcutaneous tissues in the head, neck, trunk, and upper limbs, particularly in individuals over 40 years old. However, visceral involvement, such as mesenteric lipomas, is exceedingly rare, with fewer than 50 pediatric cases reported in the English literature. Mesenteric lipomas are generally asymptomatic but may present with non-specific symptoms like abdominal distension or signs of partial or complete intestinal obstruction. Imaging modalities such as abdominal ultrasound and CT scan often reveal a well-differentiated fatty tumor, but histological confirmation is essential for diagnosis and management. We present a case of a 3-year-old female who experienced progressive abdominal distension over the course of a year. Imaging identified a large lipomatous tumor, which was surgically excised. Histopathological examination confirmed the diagnosis of a mesenteric lipoma., Competing Interests: The authors declare they have no competing interests., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Adnexal masses are uncommon in children but are increasingly recognized due to advancements in diagnostic facilities. Such masses in the pediatric population often raise concerns about malignancy. Typically, these masses are small and can resolve spontaneously; however, larger ones can pose a diagnostic dilemma due to their signs and symptoms, requiring clinicians to be particularly vigilant. Simple ovarian cysts are seen in 1 in 2500 live births. They are commonly diagnosed prenatally as intra-abdominal masses by ultrasonography. While there are no established guidelines for management, larger cysts are generally managed surgically (either open or laparoscopic) with the aim of protecting the ovaries and ensuring future fertility. Herein, we present a case of an unusually large congenital ovarian cyst in a newborn that mimicked an abdominal mass, leading to respiratory compromise., (© The Author(s) 2024.)

Objectives: Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes., Methods: Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre.Last minute cancellation: a cancellation occurring within the last 24 hours from the planned operation. Cancellation categories: process-related and patient-related.The short-term and long-term outcomes of patients who experienced a last-minute cancellation were analysed., Results: 197 patients of 1587 (12%) had a last-minute cancellation: 156 (79%) were process-related and 41 (21%) were patient-related.3% (5/156) of patients cancelled for process reasons did not receive surgery vs 39% (16/41) of those cancelled for patient-related reasons, p < 0.0001.The 90-day mortality rates of cancelled and non-cancelled patients were similar (4.6% vs 4.7%, p = 1).Five-year overall survival of patients with cancellation was 58% (95% CI 49-66) vs 69% (95% CI 66-71) of those without cancellations, p = 0.022.Among those who had a cancellation, the 5-year OS of those with process-related cancellations was 61% (52-60) vs 35% (14-58) of those with patient-related cancellations (adjusted p value for multiple comparisons = 0.14).Cox regression analysis showed that surgery cancellations within the last 24 hours for patient-related (HR 1.87, 95% CI 1.02-3.42, p = 0.043) reasons remained a factor associated with poorer overall survival after adjusting for clinical stage, type of operation and patient related variables., Conclusions: Implementing the patient's preoperative clinical evaluation to reduce the occurrence of related last-minute cancellations might mitigate its negative impact on survival., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Extragonadal germ cell tumors (GCTs) are rare, accounting for 1% to 5% of all GCTs, with malignant sacrococcygeal yolk sac tumors (SCYSTs) being part of this uncommon subset. These tumors primarily occur in children and young adults and are known for their aggressive behavior, necessitating early diagnosis and prompt treatment. In this case report, we present the case of an 8-month-old female who presented with mild abdominal distension and a 3-week history of difficulty passing urine. Imaging revealed a pelvic mass originating from the coccyx, compressing the urinary bladder. The mass was surgically excised, and histopathological analysis confirmed a malignant yolk sac tumor with positive margins. The patient received adjuvant chemotherapy postsurgery. Despite treatment, follow-up scans showed residual tumor tissue, leading to a second tumor resection. Surveillance was continued using Alpha Fetoprotein (AFP) levels as a marker, which revealed a relapse of the tumor. Subsequent imaging confirmed a growing tumor, and the patient was scheduled for second-line chemotherapy. Management of SCYSTs is complex and requires a multidisciplinary approach, including surgeons, oncologists, radiologists, and pathologists. While relapse is rare, it poses a significant challenge for treatment, underscoring the need for clear and updated guidelines for managing relapsed cases., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction and Importance: Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly in the elderly. A rare variant, calcified chronic subdural hematoma, occurs more frequently in children and young adults. The calcification mechanism involves poor circulation, absorption issues, intravascular thrombosis, and prolonged hematoma existence. Clinical symptoms resemble non calcified CSDH. Surgery is generally recommended, especially for infants, young patients, or those with progressive neurological deficit. Calcified subdural hematoma is a rare cause of epilepsy., Case Presentation: Rare case of a 49-year-old male with chronic calcified subdural hematoma (CCSDH) and increased seizures. Despite a history of epilepsy, his symptoms were poorly controlled with medication. Surgical intervention, involving craniotomy and careful removal of the calcified hematoma, led to significant improvement in symptoms and restored neurological function., Clinical Discussion: Subdural hematoma (SDH) is a blood collection between the arachnoid and dura membranes, often following minor head trauma. Chronic subdural hematoma (CSDH) can occur without recalled injury, especially in individuals with conditions like epilepsy. Our patient, with a 23-year history of poorly controlled seizures, likely had undiagnosed CSDH that calcified over time. Calcified chronic subdural hematoma (CCSDH) is typically due to regressive changes and often requires surgical intervention in young or symptomatic patients to prevent further brain damage. Our patient's postoperative recovery highlights the effectiveness of surgery for symptomatic CCSDH., Conclusion: The case highlights the importance of considering surgical treatment for symptomatic CCSDH, especially in cases with clinical deterioration. The successful outcome aligns with existing literature, emphasizing the efficacy of surgical intervention for this uncommon condition., Competing Interests: Conflict of interest statement None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Late presentation of congenital diaphragmatic hernia (CDH) presents usually after the neonatal period and often misdiagnosed for other respiratory pathologies. It is crucial to differentiate late presentation of CDH from other potential causes of respiratory distress and gastrointestinal symptoms. Herein, we present 2 cases of delayed presentation of congenital diaphragmatic hernia in infants. Initially, both cases were managed as respiratory conditions in outpatient settings, with no significant improvement. The correct diagnosis was eventually made through radiological evaluation at our tertiary centre, leading to successful surgical management. Delayed presentation of CDH beyond the neonatal period is rare, owing to the wide spectrum of clinical manifestations. Early diagnosis and surgical management are crucial to reduce morbidity and mortality, making a high index of suspicion essential for timely intervention., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Primary breast lymphoma (PBL) is a rare malignant lymphoid neoplasm limited to the breast, accounting for about 0.15% of all malignant breast tumors and 1.7% to 2.2% of extra-nodal lymphomas. PBL must be distinguished from conventional breast carcinomas due to different therapeutic approaches. A 25-year-old female presented with a left breast mass. Histopathology and immunohistochemical tests confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). She had no similar lesions elsewhere in the body. She received 1 cycle of R-CHOP chemotherapy but absconded from the treatment and succumbed afterward while at home. Recent developments in DLBCL treatment have greatly improved patient outcomes by incorporating targeted medicines like rituximab, increased chemotherapy regimens, new drugs, and individualized treatment techniques. PBL appears to have a worse prognosis; thus, delay or abscondment from treatment is of serious concern when it comes to improving the prognosis of patients with PBL., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: Gastroschisis is associated with over 90% mortality in many sub-Saharan African countries. The introduction of the Gastroschisis Care Bundle at Muhimbili National Hospital (MNH) increased survival up to 60%. We aim to explain the impact of using implementation science methods to decentralize the care of babies with gastroschisis to other parts of Tanzania., Methods: We used a Step-Wedge Implementation Science design to scale up gastroschisis care through training of providers, dissemination and current revision of evidence-based care protocols, advocacy, and engagement with stakeholders. We used mixed methods for data collection. Anonymous patient and provider evaluation data were collected using a nationwide Gastroschisis Database via REDCap. We evaluated the implementation and effectiveness of the care bundle in different hospitals in Tanzania., Results: Decentralizing care nationally was feasible, acceptable, and adaptable. A total of nine trainings have been conducted training 420 providers (14 Master Trainers) reaching seven regions of Tanzania. The three advocacy national campaigns have ensured community reach and patient engagement. A countrywide gastroschisis database was developed to collect data on patients with gastroschisis, hosted locally at MNH with 332 patients' data entered in 1 year. The majority (90.2%) were treated using preformed silo bags with an overall survival of 28.5% in all centers. Late presentation and infection remain to be the main challenge., Conclusion: To achieve quality and sustainable surgical care, there is a need to design, implement, evaluate, and continuously improve context-relevant strategies to achieve and sustain the survival of neonates with congenital anomalies. Decentralization enables clear connectedness of hospitals, bringing care closer to patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Enterocutaneous fistula is a dreaded complication by most surgeons especially after emergency abdominal surgery. It can also occur spontaneously from an underlying disease. The pathology is demanding both mentally and physically and causes medical and nursing problems for the affected individual. In this case report we present a timeline of a young 4-year-old boy who sustained penetrating abdominal-perineal injury from a fall and later presented with peritonitis. His condition progressed to complicate into enterocutaneous fistula and succumbed unfortunately due to multifactorial reasons. This shows the impact and burden of the disease pathology not only on patients but also on the medical system as a whole., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Intussusception is a common and well-known surgical pathology. Intussusception in adults is rare, accounting for only 5% of all intussusceptions. Gastrointestinal stromal tumors (GIST) are common mesenchymal tumors of the stomach that can act as a pathological lead point for intussusception. Herein, we present an uncommon case of gastroduodenal intussusception in an elderly female patient due to gastric GIST which was successfully managed surgically by partial gastric resection. This case report creates awareness that clinicians should have gastric intussusception as their differential diagnosis for gastric outlet obstruct and highlights the importance of further radiological investigations., Competing Interests: The authors declare no competing interests., (Copyright: Mujaheed Suleman et al.)

Key Clinical Message: Jejunalileal atresia is a cause of intestinal obstruction in the newborn, hence a surgical emergency. Prenatal diagnosis can be made by simple obstetric ultrasound and postnatal by plain abdominal x-ray to plan a multidisciplinary approach to reduce morbidity and neonatal mortality., Abstract: Atresia can occur anywhere along the intestines and is a common cause of intestinal obstruction in neonates. Jejunoileal atresia (JIA) is a rare disease occurring in 2.1 per 10,000 live births. Type 3b jejunoileal atresia occurs in 11% of all small bowel atresia. We present three cases of type 3b jejunoileal atresia. They were all missed by prenatal ultrasonography, and presented with features of intestinal obstruction. The diagnosis was confirmed by plain abdominal x-rays and ultrasound, followed by laparotomy. Postoperative care was given in the neonatal unit according to local protocols. One recovered, however, two succumbed from neonatal infection. Jejunoileal atresia requires surgery and long postoperative care, with outcomes associated with numerous prognostic factors including multidisciplinary care and neonatal intensive care. Jejunoileal atresia is less commonly associated with other congenital anomalies, unlike duodenal atresia. Efforts are needed to scale up prenatal diagnosis of jejunoileal atresia, and therefore to plan for appropriate care after delivery. Also, further studies are needed to understand neonatal sepsis in the postoperative period and ways to improve outcomes., Competing Interests: The authors declare they have no competing interests., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Introduction and Importance: Sacrococcygeal teratoma is a rare extragonadal germ cell tumor occurring at the lower end of the back. It is congenital, and can be diagnosed in utero or just after birth. These tumors are sporadic in nature, more common in females than in males. They can be solid, cystic or a mixture of the two in consistency. Authors present this case to share their experience because these congenital tumors are rare and a lapse in appropriate management can be devastating because of chances of recurrence and the possibility of a malignant nature of the disease., Case Presentation: Authors in this case present a baby that was referred to their center 5 days post vaginal delivery with a huge mass on the sacrococcygeal region. MRI revealed sacrococcygeal teratoma type II. Wide local excision was done. Tumor margins were microscopically negative. The patient recovered well and was discharged. The patient did not require adjuvant treatment., Clinical Discussion: Routine obstetric ultrasound can diagnose sacrococcygeal teratoma with 100 % sensitivity. Fetuses with tumors <5 cm in size can be delivered vaginally. Tumors larger than that should be delivered at term through cesarean section. High risk sacrococcygeal teratomas can be delivered at 28 weeks of gestation by cesarean section followed by ex-utero intrapartum therapy. MRI is useful to assess the intrapelvic extent of the tumor and to plan management. Surgical intervention should be done after delivery., Conclusion: Intrauterine diagnosis is not an indication for termination of pregnancy. Surgical resection with negative margins provides a cure. Histological examination of the tumor is mandatory. For malignant sacrococcygeal teratomas, adjuvant chemotherapy is necessary for positive tumor margin after surgical resection. Positive margins may require chemotherapy. Neoadjuvant chemotherapy may be used for tumor debulking prior to surgery if the tumor infiltrates neighboring structures or is metastatic., Competing Interests: Declaration of competing interest The authors declare they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Colocolic intussusception occur in less than 5 % of all cases of intussusception. Median age at presentation is 4.4 years. Usually presents with features of intestinal obstruction. Common causes include pathological lead points like juvenile polyps, Meckel's diverticulum and lymphoma. However, rarely occurs without an organic cause as presented in the index case., Case Presentation: We present a case of colocolic intussusception in a 5-year-old boy with clinical evidence of blood-stained mucoid stools, abdominal distention and post prandial vomiting. CT-scan confirmed the clinical diagnosis. Surgical exploration revealed left-sided colocolic intussusception without a pathological lead point., Clinical Discussion: Most cases of colonic intussusception have a pathological lead point. Clinical features are unspecific but mostly present with intestinal obstruction, hence, a CT-scan aids in establishing the diagnosis., Conclusion: Colocolic intussusception is a rare subtype of intussusception in the paediatric age group especially in the absence of a pathological lead point. This case report presents a rare case of colocolic intussusception without pathological lead point, highlighting the importance of advanced imaging modalities like CT-scan in establishing the diagnosis and guiding management., Competing Interests: Conflict of interest statement Authors declare no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate the oncologic outcome of patients with hypermetabolic tumors resected by segmentectomy or lobectomy., Methods: This was a retrospective analysis of all consecutive patients with peripheral clinical stage IA1-2 non-small cell lung cancer (January 2017-June 2023) who underwent resection by segmentectomy or lobectomy in a single center. A hypermetabolic tumor was defined as a tumor with a positron emission tomography (PET) maximum standardized uptake value >2.5. Propensity score case-matching analysis was used to generate 2 balanced groups of patients with hypermetabolic tumors operated by segmentectomy or lobectomy. Four-year overall survival (OS), event-free survival (EFS), and cancer-specific survival were compared between the matched groups., Results: A total of 164 segmentectomies and 234 lobectomies were analyzed. There were 91 (55%) hypermetabolic tumors in the segmentectomy group versus 178 in the lobectomy group (76%), P  < .001. The comparison of the matched groups with hypermetabolic tumors showed a better 4-year OS after lobectomy compared with segmentectomy (lobectomy 87%; 95% confidence interval [CI], 76-93; segmentectomy, 67%; 95% CI, 49-80; P  = .029). The 4-year EFS appeared to have a better trend after lobectomy (77%; 95% CI, 65-85) compared with segmentectomy (58%; 95% CI, 39-72), P  = .088. The 4-year cancer-specific survival, however, was similar between the matched groups (lobectomy, 95%; 95% CI, 86-98 vs segmentectomy, 94%; 95% CI, 78-99, P  = .79)., Conclusions: Early-stage peripheral hypermetabolic tumors are associated with poorer oncologic outcomes compared with less PET-avid tumors. Despite poorer OS and EFS after segmentectomy likely caused by cancer-unrelated deaths, cancer-specific survival in this high-risk group was similar after lobectomy or segmentectomy. In well-selected patients, a high PET maximum standardized uptake value should not be considered a contraindication to segmentectomy., Competing Interests: Dr Brunelli received consultancy fees for speaker honoraria and advisory board roles with Astra Zeneca, BMS, Ethicon, MSD, and Roche. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2024 The Author(s).)

Objectives: The aim of this study was to assess the self-reported current dyspnoea and perioperative changes of dyspnoea in long-term survivors after minimally invasive segmentectomy or lobectomy for early-stage lung cancer., Methods: Cross-sectional telephonic survey of patients alive and disease-free as of March 2023, with pathologic stage IA1-2, non-small-cell lung cancer, assessed 1-5 years after minimally invasive segmentectomy or lobectomy (performed from January 2018 to January 2022). Current dyspnoea level: Baseline Dyspnoea Index score <10. Perioperative changes of dyspnoea were assessed using the Transition Dyspnoea Index. A negative Transition Dyspnoea Index focal score indicates perioperative deterioration in dyspnoea. Mixed effect models were used to examine demographic, medical and health-related correlates of current dyspnoea and changes in dyspnoea level., Results: A total of 152 of 236 eligible patients consented or were available to respond to the telephonic interview(67% response rate): 90 lobectomies and 62 segmentectomies. The Baseline Dyspnoea Index score was lower (greater dyspnoea) in lobectomy patients (median 7, interquartile range 6-10) compared to segmentectomy (median 9, interquartile range 6-11), P = 0.034. 70% of lobectomy patients declared to have a current dyspnoea vs 53% after segmentectomy, P = 0.035. 82% of patients after lobectomy reported a perioperative deterioration in their dyspnoea compared to 57% after segmentectomy, P = 0.002. Mixed effect logistic regression analysis adjusting for patient-related factors and time elapsed from operation showed that segmentectomy was associated with a reduced risk of perioperative dyspnoea deterioration (as opposed to lobectomy) (Odds ratio (OR) 0.31, P = 0.004)., Conclusions: Our findings may be valuable to inform the shared decision-making process by complementing objective data on perioperative changes of pulmonary function., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background/need: Pleural empyemas carry a high morbidity and mortality. Some can be managed with medical treatment but most require some form of surgery with the goals to remove the infected material from the pleural space and to help re-expand the collapsed lung. Keyhole surgery by Video Assisted Thoracoscopy Surgery (VATS) is rapidly becoming a common approach to deal with early stage empyemas to avoid larger, more painful thoracotomies that hinder recovery. However, the ability to achieve those aforementioned goals is often hindered by VATS surgery due to the instruments available., Methodology and Device Description: We have developed a simple instrument called the "VATS Pleural Debrider" to achieve those goals in empyema surgery that can be used in keyhole surgery., Preliminary Results: We have used this device in over 90 patients with no peri-operative mortality and a low re-operation rate., Current Status: Used in routine urgent/emergency pleural empyema surgery across 2 cardiothoracic surgery centres.

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., Competing Interests: Declaration of competing interest The authors declare they have no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms., Case Presentation: We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis., Conclusion: Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management., (© 2023. The Author(s).)

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., Competing Interests: Competing interest The authors declare they have no competing interests., (Copyright © 2023. Published by Elsevier Ltd.)

Managing major thoracic trauma begins with identifying and anticipating injuries associated with the mechanism of injury. The key aims are to reduce early mortality and the impact of associated complications to expedite recovery and restore the patient to their pre-injury state. While imaging is imperative to identify the extent of thoracic trauma, some pathology may require immediate treatment. The majority can be managed with adequate pleural drainage, but respiratory failure and poor gas exchange may require either non-invasive or invasive ventilation. Ventilation strategies to protect from complications such as barotrauma, volutrauma and ventilator-induced lung injury are important to consider. The management of pain is vital in reducing respiratory complications. A multimodal strategy using local, regional and systemic analgesia may mitigate respiratory side effects of opioid use. With optimal pain management, physiotherapy can be fully utilised to reduce respiratory complications and enhance early recovery. Thoracic surgeons should be consulted early for consideration of surgical management of specific injuries. With a greater understanding of the mechanisms of injury and the appropriate use of available resources, favourable outcomes can be reached in this cohort of patients. Overall, a multidisciplinary and holistic approach results in the best patient outcomes., (© 2022 Association of Anaesthetists.)

Introduction and Importance: Soft tissue sarcoma is an uncommon form of cancer with poor prognosis. Early diagnosis and treatment are vital for improving the treatment outcomes., Case Presentation: We report a series of high-grade soft tissue sarcomas of the lower extremity with delayed diagnosis to gain insight into the presentation, treatments and outcomes for this rare disease and to determine whether limb-salvage surgery yields reasonable outcomes., Clinical Discussion: Timely health seeking has an impact on the outcome of the treatment of any particular disease. Patient delays are usually socio-economic factors. Soft tissues sarcomas are uncommon malignant tumors that even managed adequately have a poor 5-year survival. Limb salvage becomes questionable especially when patients present late with adverse symptoms., Conclusion: In this series, we found that patients presented late and this led to unfavorable oncological outcomes, also limb salvage was not an option due to delayed presentation. Thus, early diagnosis is recommended so as to improve treatment outcome., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: The superficial circumflex iliac artery perforator flap is a widely used and acceptable option of free tissue transfer for small and large defects due to its ease of dissection and adjustable pedicle length., Case Presentation: Herein we present our experience with two similar cases of hand ulcers with differing aetiologies that were managed successfully at our tertiary centre by general surgeons to cover the defects in order to salvage the hand., Clinical Discussion: The pedicle groin flap was first described in 1972 and still indicated and used widely in hand resurfacing. It has shown to be reliable with minimal peri-operative complications., Conclusion: Groin flap donor skin provides adequate skin for coverage with versatile skin, but come at a cost of specialize expertise, resources and risks., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Congenital stenosis of the esophagus is often overlooked in children with feeding difficulties leading to delayed diagnosis and treatment. This can have detrimental effects on the child's growth and general health, ranging from malnutrition to life-threatening complications such as aspiration pneumonia., Case Presentation: We present a case diagnosed at the age of 3 years when the child already had developed moderate malnutrition and offer the diagnostic and surgical findings in the hope of helping others suspect and clench the diagnosis early., Clinical Discussion: With an incidence of up to 1 in 25,000, congenital stenosis of the esophagus is definitely a congenital malformation worth knowing about, particularly since misdiagnosis often leads to delayed intervention as was in our case. History of feeding difficulty and failure to thrive are often the triggers to seeking medical attention. The confirmation can be easily made with contrast imaging opening up the possibility for surgical and non-surgical management., Conclusion: With a high index of suspicion, diagnosis can be made relatively easily, allowing for early intervention, which can prove to be lifesaving., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Ano-genital warts are rare presentation in children. The main route of transmission is by sexual intercourse however horizontal transmission, self-inoculation and vertical transmission are also documented. Establishing the route of transmission when there is no evidence of sexual abuse may be difficult in pediatric and female virgins such as in our case report. Surgical excision remains one of the best options for treatment of large warts in pediatrics. To the best of our knowledge, this is the first report of novel case of large genital warts in pediatrics in Tanzania., Case Presentation: We present a case of female child of one year and 10 months old with large ano-genital cauli-flower masses admitted at Kilimanjaro Christian Medical Centre. The child's hymen was intact and with no evidence of sexual abuse identified. The masses were excised under general anesthesia and histology confirmed Condyloma acuminata., Clinical Discussion: Ano-genital warts are rare presentation in pediatrics and female virgins. Sexual abuse should be ruled out in pediatrics patients. Self-inoculation is described as a possible route of transmission in pediatrics and in female virgins. Horizontal and vertical transmissions are also possible route of transmission of HPV. It might be difficult to establish the route of transmission as in our case report. The warts were successful treated by surgical excision and cauterization., Conclusion: Condyloma acuminata are rare in pediatrics and establishing the route of transmission may be difficult. Sexual abuse should be ruled out in pediatrics., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)