Conventional open thyroid surgery has been the gold standard surgical approach for over a century. The evolution of surgical experience and surgical technology has improved cosmetic results and postoperative recovery. Minimally invasive surgery has been proposed recently for the management of thyroid disorders. New amazing minimally invasive approaches such as robotic surgery and natural orifice transluminal endoscopic surgery (NOTES) are currently described in thyroid surgery setting. With this article, we summarize the current information about minimally invasive thyroidectomy procedures with an effort to provide also a critical appraisal of these novel promising techniques.

Background: Anastomotic leak is a known and severe complication following esophagectomy. This study evaluates different interventions for treating this complication. Material and Methods: Anastomotic leak patients treated between January 1, 2016 and December 31, 2018 were retrospectively analyzed from an institutional database of patients undergoing esophagectomy. The primary out-comes for the assessed interventions were success-rate of intervention and length-of-stay (LOS). Results: The study population consisted of 223 patients, 28 (12.6%) of whom were diagnosed with anastomotic leak. Eighteen of the 28 anastomotic leaks were diagnosed by oral contrast CT scan and 10 endoscopically. Thirteen leaks were type I (no change in therapy), 12 were type II (interventional, but not surgical treatment) and 3 were type III (surgical treatment). The median post- operative day of leak diagnosis was day 5 (range 1 – 11 days). The median LOS for patients with type I leak was 9 days (range 3- 51 days). Endoscopic vacuum assisted closure therapy (E-VAC) (n=8) had a success-rate of 75 %, esophageal stents (n=4) 25 %, surgically placed drains (n=3) 100 % (not significant). Median LOS for E-VAC was 38 days (range 18-74 days), for stent 56 days (range 15-66 days) and for surgical drains 34 days (range 32-45 days) (not significant). Conclusion: There was no statistical significant difference in success rate between the different treatment modalities in the treatment of anastomotic leaks following esophagectomy. In patients with small leaks and few systemic complications, conservative treatment is often possible

Background: Surgical site infection (SSI) is reported to increase postoperative length of stay (LoS) and hospitalization costs in non-African settings. The impact of SSI on postoperative LoS and hospitalization costs in an African country such as South Africa (SA) is unknown. The aim of this research was to address this gap in the knowledge. Patients and Methods: This was a sub-analysis of data from a pre-existing laparotomy patient registry, collected at a quaternary SA hospital over a 5-year period. Demographic information, comorbidity, surgery-related variables, SSI, and other inpatient complications were collected for each patient during a retrospective chart review. Postoperative LoS was the primary study outcome. Quantile regression was used to investigate the impact of SSI across percentiles of postoperative LoS. Crude estimates of hospitalization costs attributed to SSI were also determined. Results: SSI was associated with an additional 1.06 days of hospitalization at the 25th percentile of postoperative LoS. The additional cost attributed to SSI at this percentile of postoperative LoS was ZAR8900/ $1180. SSI had no significant impact at other percentiles of postoperative LoS. Conclusion: SSI had implications for healthcare resource utilization and hospitalization costs in our setting, but only in patients who had shorter postoperative stays in hospital.

Background: The surgical patient is often at risk of malnutrition, especially when he is affected by gastrointestinal pathology. When such risk is confirmed its common to intervene with an additional nutritional support. Whenever possible, the enteric route should be privileged, once it is the most physiological, it maintains the structural and functional integrity of the intestinal barrier and it helps to stimulate the secretion of intestinal hormones, preventing the atrophy of the intestinal mucosa. Objective: To access the benefits and the safety of early enteral nutrition in the postoperative of gastrointestinal surgery. Method: Review of the literature that used the PICO methodology to compile the research question. The research was performed in CINAHL Complete, Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews and Pubmed databases to identify studies published between 2015 and 2019. Nine randomized clinical trials and six systematic reviews were selected. Results: Most of the articles included in this review point to the benefits of early enteral in people undergoing gastrointestinal surgery, namely the rapid recovery of intestinal function and reduction in hospital stay, which in turn reduces hospital costs. Only two articles considered this nutritional approach not viable/safe due to the increase in postoperative complications in its participants. Conclusion: This review reveals that early enteral nutrition is a beneficial and safe intervention in the postoperative of gastrointestinal surgery. However, due to some limitations of the studies analyzed and given the wide range of scenarios and surgical interventions, further studies are suggested.

Background: The incidence of lymphedema ranges from 9 to 41 percent in breast cancer patients who had axillary dissections. Despite some efforts to prevent lymphedema, such as sentinel lymph node biopsy (SLNB) to overcome axillary dissection, the lymphedema still occurs in 4 – 10% of patients. Prior researches reported positive outcomes of lymphedema treated with tissue flap transfer procedures. Hence, the goal of this study is to investigate the potential association between tissue flap transfer following lymph node dissection and the lymphatic flow in the dissection area. Methods: Identification of inguinal lymphatic flow was done by blue dye injection to Sprague-Dawley rats. Inguinal lymph node dissections were conducted to 32 subjects. The first group, consisted of 16 rats, were only given inguinal dissection without flap. The second group, consisted of 16 rats received inguinal dissection with tissue flap transfer. After two months, the comparison of lymphatic flow on both groups was carried out by identifying any inguinal blue dye flow or the colored lymph node presence. Results: Only 12.5% of subjects that only received inguinal dissections showed lymphatic flows. In contrast, 81.2% of subjects in the group that received inguinal dissections with tissue flap transfers showed lymphatic flows. Tissue flap transfer procedure was significantly associated with restored lymphatic flow (Relative risk [RR] = 6.50, 95%, confidence interval [CI] = 1.74 - 24.27, p 0.001) Conclusion: The implementation of the tissue flap transfer following lymph node dissection is potential to restore the lymphatic flow.

Objective: The aim of this study was to compare the post-operative groin pain and other postoperative complications of self-gripping mesh with conventional sutured mesh in open inguinal hernioplasty. Methods: The present study was a prospective comparative study between self-gripping mesh (polyester mesh with polylactic acid grips) and sutured mesh (polypropylene) in open inguinal hernioplasty under spinal anesthesia. This study was conducted from 1st November 2018 to 31st March 2020 in ABVIMS & Dr. R.M.L. Hospital, New Delhi. The potential candidates for the study were patients of 18 years age and above, presenting with a unilateral uncomplicated inguinal hernia that underwent open inguinal hernioplasty under spinal anesthesia. Sixty patients were alternatively allotted to group A (self-gripping mesh) and group B (sutured mesh) for comparison. Results: The mean age of patients under study was 44.42±6.8 years with cases ranging from 18 to 83 years. In group-A mean age was 47.03±2.3 years and in group-B mean age was 41.80±3.1 years. In group-A time taken for mesh placement of self-gripping mesh ranged from 42-74 seconds with a mean time of 58.73 ± 7.529 seconds while in group-B, it was ranged from 287-589 seconds with the mean time of 404.10 ± 70.371 seconds. Post-operative pain in both the groups in post-operative day 1, at 1 week, at 1 month & at 3 months was studied which was assessed using VAS (visual analogue scale) score. Pain in post-operative day 1 and at 1 week was less in self-gripping mesh since the P-value for both was 0.05, which was statistically significant. However, it was not statistically significant for post-operative pain at 1 month and 3 months (P-value for post-operative day at 1 month was 0.175 & for 3 months was 0.544). Chronic groin pain was also statistically not significant in comparison to both the groups. Conclusion: The self-gripping mesh can be recommended for the repair of uncomplicated inguinal hernia due to less operative time, faster recovery and less post-operative pain but with additional cost.

Background: Identifying a marker that can predict diagnosis of acute appendicitis (AA) and can differentiate uncomplicated and perforated appendicitis with good sensitivity and specificity is still a subject of interest among many researchers. Aim of this study was to compare some simple laboratory markers for the diagnosis of AA and distinguish patients with perforated appendicitis. Material and Methods: We retrospectively evaluated laboratory data from 2359 children with AA that admitted two hospitals in Lviv and Zhytomyr during January 2016 and March 2020. Simple appendicitis was noted in 1741 (73.8%) and perforated – in 618 (26.2%) patients. The control group complain 146 children with suspected diagnosis of AA. Laboratory data were collected including white blood cell (WBC) count, neutrophil value, neutrophils to lymphocytes ratio (NLR), and sodium plasma level. Receiver operating characteristic (ROC) curve, specificity, sensitivity, positive prognostic value (PPV), negative prognostic value (NPV), and likelihood ratio (LR) were determined for all laboratory markers. Results: The sensitivity, specificity, PPV, and NPV of NLR and neutrophil count for diagnosis of AA were 84.9% and 70.3%, 67.1% and 72.2%, 17% and 32.1%, 98.2% and 92.9%, respectively; whereas the sensitivity, specificity, PPV, and NPV of NLR and sodium plasma level for differentiating complicated and simple appendicitis were 90.3% and 82.5%, 89.9% and 84%, 98.9% and 98.5%, 46.4% and 27.5%, respectively. Conclusion: Among markers of complete blood count, the best prognostic value for the diagnosis of AA, have NLR and neutrophils count. NLR and sodium plasma level permit with the high degree of reliability preoperatively select patients with suspected appendix perforation. Moreover, these markers is not expensive to measure, is easily available, and the short time required for analysis is valuable in the emergency department.

Background: Laparoscopic appendectomy can decrease the incidence of surgical site infection, especially if there is no contact between the appendix specimen and the wound site, the main disadvantage of the retrieval bags is their high cost and relatively the bigger incision they need, the extraction of the appendix through any of the ports directly is limited to the thin non complicated appendix, in this study we tried to evaluate the use of a cuff of a surgical glove tailored as a retrieval bag. Patients and methods: 103 patients undergoing laparoscopic appendectomy were randomized into two groups; group I, 52 patients where surgical glove were used as retrieval bag for extraction of the appendix. Group II, 51 patients where the appendix was extracted directly through the suprapubic port. Preoperative, operative and follow up data were analyzed for comparison between both groups. Results: The demographic and preoperative data are almost comparable between both groups, but operative data shows a significant difference between both groups regarding post-operative intraperitoneal collection higher in the second group (p=0.038) also the rate of the SSI is higher in the second group but statistically insignificant. Conclusion: The use of surgical glove cuff as a retrieval bag during laparoscopic appendectomy is a cheap efficient alternative to the readymade expensive retrieval bags in reduction of intraabdominal and surgical site infections.

Introduction: many investigations emerged in the last decades and contribute towards a diagnosis of unsure appendicitis; they are valuable to the emergency general surgeons. This study aims to assess the role of laboratory markers (bilirubin and phospholipase A2) individually or combined with Computed Tomography (CT) for the diagnosis of grey zone appendicitis (Alvarado Score 5-6). Methods: This prospective Randomized controlled trial included all 310 patients admitted with right iliac fossa (RIF) pain who had Alvarado Score 5-6 (intermediate risk of appendicitis). All underwent full laboratory investigations including serum total bilirubin and phospholipase A2. All are underwent CT scan and classified into group A with normal CT but with persistent right iliac fossa pain and group B with proved acute appendicitis by CT. All cases underwent a laparoscopic or open appendectomy. Other causes of hyperbilirubine¬mia are excluded among the patients. Results: Among the 310 patients, a laparoscopic appendectomy was performed in 300 cases (97%), and an open ap¬pendectomy was performed in 10 cases (3%). Bilirubin had equal specificity and sensitivity with phospholipase A2(26.47% &40.94% respectively) ,but when combined together, the sensitivity and specificity rise(38.40 %&32.35%).the accuracy of diagnosis of early appendicitis with serum bilirubin and phospholipase A2 assessment is 39.35%.both serum bilirubin and phospholipase A2 has a strong positive predictive value for early appendicitis. Conclusion: high bilirubin and phospholipase A2 are a statistically significant diagnostic markers for early acute appendicitis and should be combined with CT in diagnosis of unsure cases of acute appendicitis.

Background: Hemorrhage is one of the most serious complications of esophageal varices. Sclerotherapy and ligation are the two endoscopic methods that are widely used to manage variceal hemorrhage; however, their efficacy is debatable. Objective: To compare endoscopic sclerotherapy and variceal ligation for the treatment of esophageal variceal hemorrhage. Methods: This prospective study was conducted over an 18-month period on 110 patients admitted with acute esophageal variceal hemorrhage in a tertiary healthcare facility. Equal number of patients were managed with either sclerotherapy or variceal ligation followed by evaluation of treatment outcome in terms of efficacy, complications, and survival. Clinical outcomes were compared using SPSS software and analyzed with Chi-square test. Results: Our results showed that 78% of the patients treated with ligation effectively recovered from bleeding compared to 54% of the patients treated with sclerotherapy (p0.05). Variceal ligation resulted in lower rates of re-bleeding compared to sclerotherapy (16% vs 34%). Sclerotherapy was associated with a higher mortality rate than variceal ligation (11% vs 5%). Conclusion: Overall, variceal ligation is a superior method for managing patients with acute esophageal variceal hemorrhage and should be considered as the primary method of choice by medical practitioners.

Aim: Aim of our study was to evaluate incidence and causative factors for acute kidney injury in gastrointestinal and hepatobiliary surgeries. Material and methods: All the gastrointestinal surgeries performed between April 2018 to March 2020, in our institution have been analysed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi square test and continuous variables by Mann Whitney U test. Statistical analysis was done using SPSS version 23. P 0.05 was considered significant Results: We performed 331 gastrointestinal and hepatobiliary surgery from April 2018 to March 2020. After exclusion 317 patients were included in study population.14 patients (4.4%) were defined as having acute kidney injury according to acute kidney injury network classifications. On univariate analysis acute kidney injury was associated with open surgery (p= 0.002, Intra operative hypotension (p=0.006), CDC grade of surgery (p0.001), increased used to blood products (p=0.004), higher ASA grade (p0.0001), increased operative time(p0.0001). On multivariate logistic regression analysis higher ASA grade (p=0.001) and increased operative time (0.015) independently predicted acute kidney injury. Acute kidney injury was also significantly associated with 90 days mortality. ( p= 0.0001) Conclusion: Post-operative acute kidney injury was associated with significant mortality in gastrointestinal and hepatobiliary surgery. Open surgery, higher CDC grade surgery, more blood products, higher ASA grades, increase operative time predicted acute kidney injury in post operative periods. Higher ASA grades and increased operative time predicted acute kidney injury.

Background: Granulomatous mastitis is a chronic inflammatory condition of the breast with uncertain cause that may be confused with cancer breast. The optimal managing strategy of such condition is still unknown due to its uncertain cause, low incidence, uncertain diagnosis and high recurrence rate. There are many previous studies which compared between both surgical and medical management strategies, but their results are not accurate due to their limited number. The aim of our study was to compare between both surgical and medical management strategies of idiopathic granulomatous mastitis to determine the most beneficial and effective approach of management. Patients and Methods: We carried out that study on 150 granulomatous mastitis patients. We divided patients into two groups; Group 1 underwent surgical management strategy Group 2 underwent conservative medical management strategy in addition to systemic steroids. We record all included patients outcomes and follow-up data. Results: We have found no statistically significant differences between both included groups of patients regarding etiological and demographic factors. Average recovery period for the 75 surgically managed patients was 1.5 (1–4) months, but it was 7 (2–14) months for the 75 medically managed patients who administered steroids (p = 0.002). There are no recurrences in patients in Group 1 while there are recurrences in group 2 (p = 0.005). Conclusions: Wide local excision with safety negative margin is the recommended strategy for treatment of idiopathic granulomatous mastitis mimic breast cancer. It provides rapid recovery and less recurrence than medical treatment.

Background: Breast cancer remains the leading health concern among females in Malaysia. This study aims to compare the survival time between triple negative breast cancer (TNBC) and non-triple negative breast cancer (NTNBC) ,its proportion and prognostic factor of mortality among TNBC patient. Methods: This is a retrospective cohort study of patients with breast cancer treated at Hospital Raja Perempuan Zainab II (HRPZ II) from 1st January 2007 till 31st December 2013. Kaplan Meier survival analysis was used to compare median survival time between TNBC and NTNBC. Univariate and multivariate analysis were performed to determine prognostic factor of mortality for TNBC including: age, tumor size, lymph node ratio, histological tumor grade, lymphovascular invasion and type of treatment. Results: Out of one hundred fifty one (151) breast cancer patients, thirty two (32) of them were TNBC. The proportion of TNBC and NTNBC incidences made up 21.2% and 78.8% respectively. Overall median survival time of TNBC and NTNBC patients cannot be determined as death occurred in less than 50% of patients (47.7%). However estimated mean and median survival time of TNBC were much lower than NTNBC, which were 29.7 months (95% CI: 21.41, 38.05) versus 34.3 months (95% CI: 28.18, 40.46) and 23.0 months (95% CI: 16.28, 29.78) versus 30.8 months (95% CI: 21.43, 40.14) respectively. There were no significant prognostic factors among TNBC patients whereby the univariate analysis showed that tumor size and lymph node ratio were the significant factors of mortality among all breast cancer patients. Conclusion: Our study concluded that regardless of breast cancer subtypes, the factors that affect overall median survival time were tumor size and lymph node ratio.

Introduction: The Aim of the study was to evaluate relationship between non surgical procedure related complication and 30 days mortality. Material and Methods: All gastrointestinal and hepatobiliary procedures performed in last 3 years have been evaluated retrospectively. Non surgical procedure related postoperative complications were defined as perioperative complications non related to surgical procedures or techniques and related to patients’ physiological health or comorbidities (e.g acute kidney injury, ARDS, acute respiratory failure, pre existing sepsis , etc.), Surgical related complications were defined as perioperative complications related to surgical procedures or techniques (e.g. bleeding, leaks, sepsis due to leaks etc.). Factors affecting 30 days mortality and morbidity were analysed using univariate and multivariate analysis. Chi square test was used for categorical values, Mann Whitney U test was used for numerical values. Multivariate logistic regression analysis was used for multivariate analysis. Statistical analysis was used suing SPSS version 21. Results: Total 325 major hepatobiliary and pancreatic surgery was done in our institute in last 2 years. 30 days overall mortality rate was 6.4%. In univariate analysis mortality was significantly associated with nonsurgical procedure related complications. (p 0.0001). Surgical complications were not associated with mortality. On univariate analysis other factors associated with mortality were emergency surgeries, high CDC grade of surgery, higher ASA grades, increase operative duration, increased blood product requirements. However on multivariate analysis only nonsurgical procedure related postoperative complications independently predicted mortality. (p=0.001). Conclusions: Non surgical procedure related post operative complications (Physiological) is strongly associated with 30 days mortality, suggesting improved perioperative care can help to reduce post operative mortality.

Introduction: A rectovaginal fistula (RVF) is an epithelium-lined abnormal tract between the rectum and the vagina .It is often a challenging problem for both the patients and to the surgeons. In literature, there is still debate regarding the best treatment options for rectovaginal fistulas. To assess the results of the treatment of rectovaginal fistulas with incontinence and impaired anal tonus using fistulectomy, sphincteroplasty with or without bulbocavernosus muscle (Martius) flap. Patients and Methods: A total of 22 consecutive patients with simple RVFs were included and assigned to transperineal repair. The patients were divided into two groups, group1: with Martius flap; group2: without Martius flap .Postoperatively, patients were followed up for one year. Results: All of the simple rectovaginal fistula cases are best treated with fistulectomy, sphincteroplasty. Martius flap has no effect in prevention of fistula recurrence with no statistically significant difference between group using Martius flap and group not using Martius flap. Conclusion: Repair of rectovaginal fistula with fistulectomy, sphincteroplasty without diversion is ideal for treatment of simple rectovaginal fistula. Treating the fistula without Martius flap does not affect outcome and may be treated without.

Background: The relationship between the postoperative use of patient-controlled analgesia (PCA) and surgical site infection (SSI) in primary hip arthroplasty patients has not been established. This information has implications for postoperative pain management in this surgical population. The current study sought to address this gap in the knowledge. Materials and Methods: This was an exploratory, matched-cohort study of data from a pre-existing registry of adult primary hip arthroplasty patients who had their procedures performed at a South African hospital over a 22-month period. Data collected as part of pre-existing registry included patient demographics, comorbidities, pre-operative laboratory test results, surgical information, antimicrobial prophylaxis, SSI, and PCA pump use. The National Nosocomial Infections Surveillance (NNIS) score was also calculated for each patient. Patients who used PCA pumps postoperatively were matched in a 1:1 ratio with patients who did not use PCA pumps postoperatively based on all the aforementioned variables, with the exception of SSI. Data were analyzed using the McNemar test for categorical variables and the paired t-test for continuous variables. Results: The final matched cohort consisted of 76 patients (38 patients who used PCA pumps and 38 patients who did not use PCA pumps). SSI incidence between patients who used PCA pumps and those patients who did not use PCA pumps was statistically similar (10.5% versus 2.6%, p=0.375). Conclusion: The postoperative use of PCA pumps does not appear to be a risk factor for SSI in primary hip arthroplasty patients.

Aim: The aim of this study was to review the current literature on Tuberculosis (TB) of the knee and the surgical management of end- stage tubercular arthritis. Methods: A collective review of the literature was undertaken utilizing applicable databases. Research criteria were the following: (1) Developing and developed country studies; (2) level II, III, IV and V studies; (3) human subjects only; (4) period of study from 1999 to 2019; (5) English text only. The identified publications were assessed for their relevance and methodology and 19 articles were selected. Results: The overall evaluation of the results demonstrates that total knee arthroplasty results in excellent functional outcomes. However, reactivation of TB arthritis is always a risk. Surgical management should be combined with anti-TB chemotherapy, preoperatively and postoperatively to minimize the risk of reactivation. Knee arthrodesis is a good alternative in younger patients from low socioeconomic backgrounds, where TKA is not the ideal choice.

Background: Gluteal compartment syndrome (GCS) is a rare entity, while the nonspecific clinical manifestations can lead to misdiagnosis and delay of treatment, compromising the morbidity and mortality rate. GCS impairs large muscles and this can rapidly result in severe rhabdomyolysis, renal failure, multiple organ failure and even death. Case Presentation: A 47-year-old female patient was admitted to our emergency department on bad general condition due to neurologic deterioration of her right leg. After medical history record, laboratory and imaging testing diagnosis of GCS was settled. Although, there was remarkable delay from the onset of symptoms till to the diagnosis confirmation for several reasons. The delay, the hemodynamic instability, the acute renal failure, the important comorbidities and the skin condition led us to treat this patient conservatively. The patient underwent hemodialysis, while we discontinued her previous medication, which may have worsened rhabdomyolysis. One year after admission, she could ambulate without any support with minor complaints. Conclusion: Gluteal compartment syndrome is a rare entity and high degree of suspicion is needed for timely diagnosis and treatment. Fasciotomy is the gold standard treatment and surgeons should be able to perform this intervention in urgent setting. Medical history is paramount of importance for timely diagnosis. Surgeons should be aware that patient’s mal positioning during surgery can lead to this devastating complication. Deep vein thrombosis should be excluded and low molecular weight heparin should not be initiated without confirmation of the diagnosis. Drug induced rhabdomyolysis should be taken into consideration in cases of intoxication with specific medicines. In cases with delayed presentation there is no consensus for the appropriate treatment. Decision should be based on patient’s general condition, the condition of the skin, the patient’s comorbidities and trauma center facilities.

Schwannomas are nerve cell tumors, mainly encountered on the peripheral nerves and rarely seen in the gastrointestinal (GI) tract. GI-schwannoma manifestations are mostly encountered in the stomach. We present a rare case of a transverse colon Schwannoma in a 65-year-old male patient with a classic clinical presentation of possible colon cancer, that was eventually treated with open excision of the transverse colon.

The coexistence of primary hyperparathyroidism (PHPT) and non-medullary differentiated thyroid carcinoma (NMTC) is rare but it does happen. The possibility of thyroid cancer should be considered in cases of primary hyperparathyroidism with coexistent thyroid nodules. The clinical diagnosis and treatment is quite challenging when sestamibi scan is negative that will lead to second surgery and exposing the patients to morbidity. There are multiple opinions regarding the role of investigating thyroid lesions in primary hyperparathyroidism patients. Multiple imaging modalities are used for preoperative localization of parathyroid lesion, including ultrasonography (USG), sestamibi scintigraphy SPECT/CT, and four-dimensional computed tomography (4D-CT) with different sensitivity and specificity. These various imaging techniques are meant for localization of nodular parathyroid lesions to reduce the need for unnecessary exploration by targeting the focal lesion approach. Sestamibi scintigraphy SPECT/CT is usually recommended as an investigation of choice. However, ultrasound acts as the perfect diagnostic tool to detect concomitant thyroid and parathyroid nodules because it is an inexpensive and non-invasive technique.

Background: Myositis ossificans is a benign, tumor-like lesion in which there is heterotopic ossification outside of the skeletal muscle structure. It is localized, usually involves large muscle groups and is commonly precipitated by trauma. To our knowledge, the occurrence of large Myositis ossificans at the plantar of the foot in a non-traumatic patient has never been reported. Case presentation: We report a case of a middle-aged man with a giant plantar soft tissue mass diagnosed with a myositis ossificans confirmed by the histopathological examination. Conclusion: Myositis ossificans can present at an atypical site and mimicked soft tissue malignancy. Early excision is advocated for histopathological diagnosis and optimal clinical outcome.

Pleuropulmonary blastoma (PPB) is an uncommon, very aggressive and highly malignant intrathoracic tumour of embryonal origin. It commonly occurs in infant and children aged below 4 years with three types of histology: cystic (type I), mixed solid- cystic (type II) and solid (type III). Type I generally carries a good prognosis but usually progress to type II and III over time. Type II and III carries grave prognosis even after multimodal approach. We hereby report a 2 years old boy presented with fever, rapid breathing, lethargy and poor oral intake, was diagnosed with type II pleuropulmonary blastoma after initial misdiagnosis of benign congenital pulmonary airway malformation, subsequently treated with surgical resection followed by adjuvant chemotherapy. This case highlights the subtle clinical features to differentiate congenital pulmonary airway malformation and pleuropulmonary blastoma, so prompt action can be taken in suspected cases of pleuropulmonary blastoma.

Gallstone disease is a common entity worldwide, differs in types according to the dietary, hereditary factors and geographical predispositions. Common sequelae of the disease are cholecystitis, pancreatitis and symptomatic cholelithiasis. However, mechanical bowel obstruction secondary to impacted gallstone as a result from cholecysto-enteral fistula is rare. The diagnosis of gallstone ileus is based upon clinical suspicion of acute bowel obstruction with recent biliary symptoms. The confirmation was presence of pneumobilia, and detection of ectopic gallstone on computed tomography. The operative approaches of either enterolithotomy alone followed by elective fistula closure with cholecystectomy or a single-staged approach performing all the described above at the same setting remained controversial. We presented a case 67 years old lady presented with gallstone ileus, managed successfully with a two-staged surgery approach. The management of either non-operative, single-staged or two- staged surgery relies upon the patient’s general comorbidity and the availability of surgical expertise at presentation.