Thyroidectomy, though a commonly performed and generally safe procedure, carries the risk of various postoperative complications that can significantly affect patient outcomes. Among the most notable complications is recurrent laryngeal nerve (RLN) injury, which can result in vocal cord paralysis and voice alterations. Hypocalcemia, stemming from inadvertent parathyroid gland damage or removal, is another frequent complication, leading to a spectrum of symptoms from mild paresthesia to severe tetany. Postoperative bleeding (PB) is a critical concern, with the potential for airway compression and life-threatening hematomas. Injury to the external branch of the superior laryngeal nerve (EBSLN) may cause voice pitch changes, particularly in patients who rely on their voice professionally. Additional complications include thoracic duct injury, which may result in a chylous fistula, tracheal injury, leading to airway compromise, and esophageal injury, which can cause dysphagia or infection. The occurrence of these complications necessitates vigilant surgical technique, careful anatomical identification, and prompt postoperative management to minimize risks and optimize patient recovery. This paper discusses the key postoperative complications of thyroidectomy and highlights the importance of prevention, early recognition, and appropriate treatment strategies. This transparency empowers patients with knowledge of what to expect and the available treatment options. Ultimately, fostering open communication between surgeon and patient optimizes the potential negative impact that complications may have on a patient’s quality of life, fostering a collaborative approach to achieving the best possible outcomes.

Background: Anticipating the cause/risk factors for development of clinically relevant postoperative pancreatic fistula (CR-POPF) –which remains the major cause of morbidity after pancreaticoduodenectomy (PD)– can help surgeon to adopt a more personalized approach in perioperative management. Thus, we investigated the clinical, laboratory, surgical and pathological factors that can predict the development of CR-POPF. Methods: This is a retrospective cohort study which included all patients who underwent PD, in the period from 2017 to 2022 at Surgical Oncology department, South Egypt Cancer Institute, Assiut University. Logistic Regression analysis was calculated for prediction of CR-POPF after PD among the studied cases. Results: A total of 64 pancreatic cancer cases were included, out of which 24 cases (37.5%) developed CR-POPF. The predictive ability of drain amylase level for prediction of POPF by using the ROC curve analysis revealed that at a cutoff value of ≥685 IU/L; the areas under the ROC curves was 99.2% (95%CI: 0.977-1.0, P 0.001) with a sensitivity of 95.8%, specificity of 95.0%, and accuracy of 99.2%. Patients complicated by CR-POPF suffered from higher rate of wound infection, longer hospital stay and higher mortality rate. Obesity, lower serum albumin level, higher drain amylase ≥685 IU/L, soft pancreatic consistency, and small pancreatic duct are independent risk factors for development of CR-POPF. Conclusion: Identifying risk factors for POPF is very crucial. POPF is associated with poorer outcome and higher death rate and leads to prolonged hospital stay with potential increased healthcare costs.

Introduction: From a pathogenetic point of view, the most common theory for the formation of liver hemangiomas is a severe disturbance in the embryogenesis of the vascular system of the liver. It has been suggested that treatment with estrogens and steroids, as well as pregnancy, can lead to an increase in the size of an already existing hemangioma, but not to its appearance. Aim: To compare the prevalence and growth rate of hemangioma among different age groups and sexes. Materials and methods: The study included 101 patients with cavernous hemangioma who underwent radical surgery in the Department of Surgery of the Military Medical Academy for the period 2010-2023. Approximately half of the patients were followed prospectively (n = 52), and the rest (n = 49) retrospectively. Gender: 37% male (n = 37), 63% female (n = 64), mean age 54. Results: Men are older than women (p = 0.001), with the largest number of patients in the 55-64 age group. Tumors larger than 10 cm occur in every age group, with the highest incidence in the 35-44 age range, while those larger than 20 cm occur in the 35-65 age range. In both sexes, the largest size of tumors is in the age range of 45-54 years. Discussion. No statistically significant difference was found in the size of hemangiomas in the different age groups in men and women, although the size of the hemangioma was larger in women – 39 of the hemangiomas over 10 cm were in women, while in men 16 of the tumors were over 10 cm. In patients >50 years of age, hepatic hemangiomas may grow slowly or stop growing, and surgical treatment may be unnecessary if no complications are caused by the tumor. However, for younger patients, growth potential may be considered in decision making. Conclusion: Although the results of our study were not statistically significant, age and gender seem to be important factors influencing tumor growth.

Introduction: Treatment of gastric cancer is a multimodal approach. The surgical options vary in their extent, tools, targets, and complications. Patients and methods: Patients with stomach cancer diagnosed between January 2016 and December 2021 were investigated for the evaluation of surgery-related complications as well as cancer epidemiology, prognosis, and follow-up. Results: This study involved 125 patients divided into three groups: Group I: 60 patients (48%) have operated gastric adenocarcinoma, Group II: 42 patients (33.6%) have operated GIST, Group III: 23 patients (18.4%) have gastric adenocarcinoma proven inoperable after surgical evaluation. There were no statistically significant differences in clinical and demographic variables between the three groups. Meanwhile, there was a statistically significant difference in tumor characteristics between the three groups except for pathological. In addition, there was a statistically significant difference in surgical approach, type of surgery, NPO duration, and postoperative hospital stay between the three groups. The overall complication rate was 27.2%. Severe complications defined as grades III to V according to Clavien-Dindo classification occurred in 14.4% of cases. The difference in severe complications was not significant between the three groups. Conclusion: Choosing the appropriate surgical procedures and approaches can help to reduce the incidence of complications in gastric cancer surgery. Surgeons need to follow enhanced recovery protocols and recent treatment guidelines.

Background: Alternative surgery devices have become popular to conventional hemostasis in thyroid surgery. These devices reduce operative time and post-operative complication. The aim of this work was to compare between diathermy and ligasure in hemostasis in thyroidectomy and to determine the best and most effective method for hemostasis. Methods: This prospective randomized controlled trial study was carried out on 350 thyroidectomy patients aged from 18 years old or more, both sexes. Patients were randomly allocated using computer generated randomization tables into two groups: Group A (n = 150): Ligasure and group B (n = 200): Diathermy group underwent thyroidectomy. All patients were subjected to inspection, palpation, and investigations was done for all the patients. Results: There were significant increase in group A compared to group B regarding operative time, blood loss, and pain score (P ≤ 0.001), while no significant difference was observed between both groups regarding type (Hemi-thyroidectomy, subtotal thyroidectomy, lobectomy, near total thyroidectomy, total thyroidectomy, selective neck dissection, and retrosternal goitre), hospital stay, all complications except bleeding, and seroma were significantly different (P 0.001) for group A (Ligasure) better than group B (diathermy). Conclusions: Our study’s findings make it clear that, in comparison to the diathermy technique, ligasure is not only a safe way to achieve hemostasis during thyroid surgery, but it also facilitates the operation’s notable expeditiousness. Additionally, the Ligasure can reduce intraoperative blood loss while significantly altering the postoperative course in terms of the intensity of pain following surgery and allowing for an earlier return to regular activities and employment.

Aim: Thyroid disorders are commonly encountered in daily general and oncological surgical practice. However, some rare and unexpected pathologies are encountered now and then. Herein, we report our experience regarding the presentation, diagnosis, and management of rare thyroid disorders. Materials and methods: We retrospectively reviewed the data of 25 patients who were diagnosed with rare thyroid disorders in our tertiary care center. Results: Granulomatous thyroiditis and amyloid goiter are difficult to diagnose with FNAC and usually a difficult thyroidectomy is both diagnostic and therapeutic. Isolated MALT lymphoma in thyroid may be cured by thyroidectomy, while the value of thyroidectomy in disseminated disease is questionable unless to relieve airway obstruction. In our series, one third of poorly differentiated carcinoma patients were metastatic and 16.5% recurred after treatment. Follicular tumour and well-differentiated tumor with uncertain malignant potential are now WHO classified as low risk neoplasm thus hemithyroidectomy as done in one of our patients is curative and RAI may be an overtreatment. Mucoid adenocarcinoma of pulmonary origin was encountered; however, its diagnosis was a dilemma as thyroid cancer do also spread to lungs, as such immunohistochemistry was used to confirm origin. Of the uncommon thyroid cancer variants, oncocytic and columnar subtypes recurred, while patients with Warthin-like, tall cell, and solid papillary thyroid carcinomas were disease free. Conclusion: Rare entities should be kept in the list of differential diagnoses during the assessment of patients with thyroid diseases.

Background: Laparoscopic cholecystectomy is a commonly performed surgery worldwide. Despite being minimally invasive, postoperative pain is a major concern that hinders early hospital discharge. Several regimens were suggested for proper control of postoperative pain including fascial plane blocks. EOIPB is a fascial plane block that provides somatic coverage from T6-T10. These dermatomes cover the sites of trocars insertion in LC, representing the greatest contribution to postoperative cholecystectomy pain. Methods: 38 ASA I-II patients aged 18-70 years were split into 2 groups (E and C). Each group had 19 patients. Both groups received U/S-guided EOIPB. The E group received: 30 ml of 0.25% bupivacaine. The C group received 30 ml of normal saline. In both groups the following was recorded; perioperative opioid consumption, NRS at different points, time of discharge from the PACU, early mobilization time, and time of first analgesic requirement. Results: the total doses of postoperative morphine and intraoperative fentanyl doses were significantly reduced in the E group. Furthermore, the time to the first analgesic requirement was significantly prolonged in the E group, and the number of patients who required analgesics in the first 15 minutes after discharge to the PACU was considerably lower in the E group. Conclusion: The current study showed that EOIPB is a simple, superficial, convenient, effective, and opioid‐sparing regional anesthetic technique for postoperative pain management of laparoscopic cholecystectomy. The bupivacaine regimen used with a concentration (0.2%) and volume (30 ml) showed no complications in either group.

Background/Aim: A preoperative scoring system can predict difficulty. L.C. Surgeons can plan operations based on predicted difficulty. This study aims to verify a risk score for predicting difficult laparoscopic cholecystectomy based on the preoperative characteristics. Patients and methods: This study was conducted at Al Ahrar Zagazig Teaching Hospitals, General Surgery Department. This study included 300 symptomatic GSD patients who were all given L.C. after being admitted for cholecystectomy. Results: There is a significant difference between the two groups regarding age, duration of operation, duration of symptoms, and BMI. Also, a significant correlation exists between difficult laparoscopic and BMI, age, duration of symptoms, and Operation duration. Conclusion: Gender, age, obesity, past hospitalization for acute cholecystitis, past ERCP, past surgery, hepatomegaly, and/or cirrhotic liver U.S. findings were factors associated with the surgical difficulty of L.C., with obesity being identified as one of the predictors of difficult L.C. in our study.

Background: Obesity is a global pandemic affecting organs, quality of life, and male fertility. Preventative measures include diet, exercise, anti-estrogens, and aromatase inhibitors, while bariatric surgery is a viable option for morbidly obese men. Patients and methods: In this prospective case series study, 45 morbidly obese patients who had undergone bariatric surgery for weight loss at Kasr Alaini hospital, Cairo University, between December 2020 and December 2023 were included. These patients had a history of delayed conception, either primary or secondary, for at least a year. Following surgery, every patient underwent a comprehensive and focused history and physical examination at every three months, six months, and yearly appointments. Serum hormone profiles (Testosterone and E2) were assessed for every patient three, six, and twelve months following the procedure in order to determine the impact of bariatric surgeries on infertility. Results: Our study revealed a statistically significant improvement in the parameters of semen analysis, including motility, progressive motility, vitality, and aberrant forms, with a P value of less than 0.001. Our investigation revealed statistically significant increases in testosterone (T) and decreases in estradiol (E2) in relation to changes in sex hormones. P-value (0.001). Conclusion: The choice of bariatric procedure should be tailored to patients’ needs, in collaboration with a multi-disciplinary team and based on the discussion of risks, benefits and side effects.

Introduction: Laparoscopic drainage of liver abscess (LA) remains uncommon in Africa. We undertook this study with the aim of reporting our experience on this procedure in our limited setting. Methods: We conducted 10-years retrospective analysis of the medical records of patients who had a laparoscopic drainage of LA, in two surgery departments of Yaoundé (Cameroon) Results: Laparoscopic drainage of LA represented 2.02% of all the laparoscopic procedures conducted during the study period, with a total of 17 patients. The mean age of patients was 39.2 years (range: 19-66 years) and 11 (64.7%) were male. They were symptomatic for an average of 21 days before the diagnosis of liver abscess was made. The abscess was most often located in the right lobe (n = 12, 70.59%), single (n = 11, 64.7%) with an average diameter of 8.4cm (range: 7.2-17.3 cm). Amoebic etiology was identified in six patients (35.3%), the others being pyogenic. Among the pyogenic LA, five (45.45%) was cryptogenic with no underlying disease identified. The mean operating time was 52.5 min (range: 30-92 min) and we drained an average of 1,300 mL of pus (range: 600-4,200 mL). No case of conversion was recorded or death in the 30 days following the surgery. The morbidity rate was 11.76% and one case of recurrence (5.88%) was noted, requiring a new laparoscopic drainage. Conclusion: If surgical drainage of a LA is indicated, we emphasize the use of laparoscopy even in a low income setting like our own.

Background: Acute pancreatitis (AP) is a severe inflammatory condition with substantial morbidity and mortality, accounting for a notable proportion of hospital admissions and causes significant burden on healthcare systems globally. Timely nutritional support is vital in managing AP, with early enteral feeding (EEF) showing promise in reducing complications and mortality. The objective of this study was to evaluate the clinical outcomes of EEF compared to conventional feeding (CF) in patients with mild to moderate AP. Material and methods: This prospective observational study was carried out at tertiary care hospital in Northern India from November 2015 to October 2017. Patients aged 18 to 60 years with mild to moderate AP were randomly assigned to Group A(CF) and Group B(EEF). Clinical parameters such as time to initiate feeding, feeding intolerance, infections, length of hospital stay and mortality were evaluated and compared between the groups. Results: A total of 50 patients were enrolled and randomized equally in each group with similar baseline characteristics. No significant differences were observed between the groups in the incidence of infections, necrotizing pancreatitis, and mortality. However, the duration of hospital stay was significantly shorter in the EEF group (6.58 ± 1.74 days) compared to the CF group (11.21 ± 2.96 days) (p 0.0001). Conclusions: EEF can be safely given in mild to moderate AP patients and has been associated with decreased length of hospital stay, reduced hospital care costs with comparable mortality rates compared to CF. This approach proves to be cost-effective and also offers convenience for both patients and healthcare resources.

Aim of the study: For cases of sacrococcygeal pilonidal sinus disease (SPD) the application of minimally invasive treatments such as crystallised phenol and silver nitrate has increased in recent years. The aim of this study was to compare the efficacy of crystallised phenol and silver nitrate in SPD treatment. Materials and methods: The study included a total of 77 patients; 38 applied with silver nitrate, 39 with crystallised phenol. Clinical data were recorded from patient files, patient satisfaction was evaluated with a Likert satisfaction scale, and the severity of postoperative pain with a Visual analog Scale (VAS). Results: The patients comprised 62 (80.5%) males and 15 (19.5%) females with a mean age of 27.2 ± 8.7 years. Treatments were applied of silver nitrate to 38 patients and crystallised phenol to 39. In the crystallised phenol group, the mean operating time was statistically significantly longer, the mean VAS values at postoperative 1 and 24 hours were higher, and the rate of acute complications was higher than in the siver nitrate group. At 6 months postoperatively, no statistically significant difference was observed between the groups in respect of recurrence rates and patient satisfaction. The relapse rate was lower in the crystallised phenol group than in the silver nitrate group (12.8% vs. 28.9%) but the difference was not statistically significant (p = 0.081). Conclusion: Compared to crystallised phenol, silver nitrate for the treatment of sacrococcygeal pilonoidal sinus has less postoperative pain, fewer acute complications and shorter operation time, but higher disease recurrence.

Background and aims: Rectal prolapse (RP) is a debilitating condition and can cause manifestations of fecal incontinence, obstructed defecation, incomplete evacuation of the rectum, and pain. Recently, there has been increasing evidence that prolapse is strongly associated with pelvic hiatus (GH) size (normal 4.5 ± 0.7). Many surgical studies have suggested that an enlarged pelvic hiatus may be associated with prolapse recurrence. The main aim of this study is to assess the incidence of dyspareunia and improvement of symptoms in patients that were treated from rectal prolapse with wide pelvic hiatus. Patients and methods: Our study is a cohort study which included seventeen patients with rectal prolapse with wide pelvic hiatus. Those patients underwent rectal prolapse repair with levatorplasty. Results: Adding Levatorplasty with rectal prolapse repair showed improvement in Wexner score, recurrence rate with less postoperative pain and Dyspareunia. Conclusion: Rectal prolapse repair combined with levatorpasty in patients complaining of rectal prolapse with wide pelvic hiatus showed improvement in Wexner score, recurrence rate with less postoperative pain and dyspareunia.

Background: Obstructed defecation syndrome (ODS) is a type of constipation characterized by fragmented stools, need for straining at defecation, sense of incomplete evacuation, tenesmus, urgency, pelvic heaviness and self-digitation. Anorectal manometry has gained wide acceptance as a helpful method to objectively assess the apparatus of defecation provided by the anorectal sphincter. The standard manometric evaluation enables measurement of resting and squeeze pressures, as well as of the length of the functional anal canal high pressure zone [HPZ]. Purpose: the aim of this study is to access the rectosigmoid pressure together with the anal and rectal pressures in constipated patients in relation to their symptoms. Methods: our study is a case control study which included 30 patients with obstructed defecation underwent assessment of the rectosigmoid pressure by using anorectal manometry. Results: Evaluating the rectosigmoid junction pressure in 30 patients with obstructed defecation revealed statistically significant positive correlation with the severity of symptoms according to Cleveland clinic constipation score. Conclusion: high pressure in the recto sigmoid junction can be one of the causes of obstructed defecation, eliminating this high-pressure zone by sigmoidectomy can lead to improvement of symptoms.

Background: Anal fistula is an abnormal tract or cavity communicating skin with the rectum or anal canal. Anal fistula has always been a challenge to surgeons and patients. Although patients have bad experience about fistula, they will have worse experience if the surgery complicated with stool incontinence that will affect their quality of life. Fascia lata biological plug (FBP) is a sphincter-sparing procedure that uses auto graft to close an anorectal fistula. Purpose: The objective of this study is to assess the effectiveness of FBP as anal fistula plug to treat different types of uncomplicated anal fistulae regarding healing, anal continence, operative time, post-operative pain and post-operative discharge. Methods: Our study is a case series study which includes 40 consecutive patients who presented at Kasr Al Ainy colorectal outpatient clinic with anal fistulae, assessed clinically and radiologically to ensure that it meets our inclusion criteria. Results: fistula healing rate reached 75% after 6 months of follow up the patients on weekly basis in outpatient clinic with minimal post-operative complication in 8 patients in the form of simple wound infection 4 of them has also donor site wound infection, no impairment of continence state of all patients enrolled in our study. Conclusion: We suggest using FBP for the surgical management of patients with anal fistula who are at high risk of developing anal incontinence. Further studies with larger sample size are required to properly assess the long-term efficacy of FBP in management of anal fistula.

Burn wounds present a significant challenges to healing, often leading to prolonged recovery and increased vulnerability to infections. Untreated burns can result in severe complications, including infections, scarring, and long-term physical and psychological impacts. The physiological wound healing process involves four stages: hemostasis, inflammation, proliferation, and remodeling, driven by complex cellular and molecular processes. Factors such as infection, inadequate blood supply, and impaired immune responses can hinder this process. Recent therapeutic strategies aim to enhance burn wound healing and mitigate related complications. This review explores two promising interventions: stem cell-derived microvesicles (MVs) and silver nanoparticles (AgNPs). Stem cell-derived MVs, rich in bioactive molecules, show potential in promoting tissue regeneration and modulating inflammatory responses. AgNPs are noted for their antimicrobial properties and ability to accelerate wound closure. The review details the normal biological phases of wound healing and examines how factors like bacterial infection and underlying health conditions can impair healing. It critically evaluates the therapeutic potential of stem cell-derived MVs and AgNPs in the context of burn wound healing, highlighting future research and clinical application areas.

In obstetrics and gynecology, the microorganisms that commonly cause SSIs are a mixture of aerobic and anaerobic bacteria predominantly originating from the vaginal tract rather than the skin. Objective: To identify potential risk variables associated with developing SSI. Methods: This study, carried out at Minia Maternity University Hospital, Egypt, tertiary referral center- over five years (January 2017 to December 2021), involved 25,725 obstetrics and gynecological surgery patients. SSI cases were matched to a control group based on surgery date. The research explored SSI risk factors, categorizing them into demographic and peri-operative aspects, using data from medical records and univariate and multivariate analyses. The study included a detailed analysis of patients’ pre-existing medical conditions, including diabetes- Type 1 or Type 2 known to influence the risk of surgical site infections. Data on diabetes type were collected from medical records. Results: During the study, 2,725 obstetric and gynecologic patients developed SSIs, a 5.5% incidence. CS had a 6.2% SSI rate (1,095 cases), and gynecological surgeries had a 4.1% rate (330 cases). Age, residence, and parity showed no significant differences between SSI and control groups. The SSI group had a higher average BMI (29.9 vs. 25.0, p 0.001) (OR = 5.13) and a higher diabetes prevalence (71.6% vs. 37.9%, p ≤ 0.001, odds ratios 4.1). Findings: The study identified modifiable risk factors for SSIs in obstetrics and gynecology surgeries at a rural Egyptian hospital, aiding in prioritizing interventions in low-middle-income countries.

Background. Large enhancing renal tumours are always a dilemma. Malignancy and benign renal tumours are not easily differentiated from CT scan imaging. Enhancing renal tumours should be treated as malignant. Mainstay of treatment with radical surgical resection should be the main option unless proven otherwise. We report successful removal of the large Adult Cystic Nephroma weighing at 5.7 kilogram by Thoracoabdominal incision. A 40 years old man presented with a 4 years history of right abdominal mass but defaulted throughout the years leaving the mass to grow largely. We discuss the diagnostic dilemma.

Primary Renal Synovial Sarcoma is an extremely rare, agressive with poor prognosis tumour. Only fewer than 50 cases have been reported. Imaging modalities shows no specific findings and can only be diagnosed by immunohistochemistry. We present a case of 37 years old lady with a complex perirenal collection, increasing collection despite percutaneous drainage. She successfully underwent Laparoscopic Radical Nephrectomy with adjuvant chemotherapy. Due to rarity of this disease and difficulty in diagnosis, it is best managed with a Multidisciplinary approach.

Background: Acute mesenteric ischaemia (AMI) is uncommon post blunt abdominal trauma (BAT) and is divided into occlusive and non-occlusive (NOMI). Case presentation: We present a case of healthy 18-year-old man who developed NOMI post BAT due to a motor vehicle accident. He presented with breathing difficulty, abdominal and chest pain. He was tachypnoeic while abdomen was tender over left hypochondrium with bilateral positive pelvic spring. A pan computed tomography (CT) revealed ruptured left diaphragmatic hernia, mesenteric hematoma and open book fracture. Laparotomy was done, mesenteric tears and left diaphragmatic tear were repaired while symphysis pubis diastasis was reduced and fixed. Patient deteriorated Day 2 post-surgery. Although CT Angiography showed no bowel ischaemia, relaparotomy revealed extensive bowel gangrene. Patient succumbed on Day 4 post-surgery. Conclusion: Diagnosis of AMI is often challenging. Hence, high index of suspicion and early intervention is necessary in treating AMI post trauma to reduce mortality.

Backround: The concept of a single anastomosis gastric bypass, in its original configuration, was first described in 1967 by Mason and Ito. One anastomosis gastric bypass (OAGB) is a variation of the original technique and has emerged as one of the primary methods of metabolic surgery. Marginal ulcer (MU) is a serious complication of this technique with various incidence and multiple management strategies. Case report: We report the case of a 24-year-old woman, with a OAGB surgery 6 years ago without properly following a PPIs treatment post-op, who presented at the emergency department with a history of severe abdominal pain gradually worsening within the last 3 days, fever and vomiting. Initial clinical examination revealed abdominal distension with diffuse tenderness and positive guarding and blumberg sign. Abdomen x-ray and computed tomography (CT) scan were suggestive of gastrointestinal perforation. Emergency laparotomy revealed a perforated marginal ulcer (MU) and primary repair with omentopexy was performed after thorough irrigation of the abdominal cavity. She was discharged on 7th post-operative day sufficiently recovered. Conclusions: MU rupture is a severe complication of OAGB and primary closure with omental patch (Graham’s patch) is a considerable treatment option.

Pancreatic arteriovenous malformation (PAVM) is relatively rare condition. It represents about 5% of all arteriovenous malformations found in the gastrointestinal tract. Pancreatic AVM may present with variety of presentations. Surgery remain mainstay of treatment, however other modality can be offered as temporary measures

Background: Extranodal lymphoma in the gastrointestinal tract is a rare malignancy, mainly non-Hodgkins diffuse B cell type. In the small intestine, the ileum is the most common site. The presentation and diagnostic modalities can mimic other gastrointestinal diseases and pose great diagnostic challenges. With the notable clinicopathological and molecular heterogeneity of DBLCL identifying the immunostaining positivity is now important to know the cell of origin. Case presentation: A 69-year-old male presenting with abdominal pain and obstruction. Computed tomography (CT) was instrumental in identifying the small bowel tumor, and metastatic disease. He underwent surgical resection and anastomosis for the tumor and was subsequently diagnosed with stage IV diffuse large B-cell lymphoma (DLBCL) with metastasis to the lung and bones. Immunohistochemistry analysis included CD3: scattered T lymphocyte stain Positive, CD20+, Immunopositive for CD 45+, BCL6+, CD10+, C-myc (>40%). The proliferative index with Ki67 is up to 90% revealing a germinal center B-cell-like (GCB-DLBCL) subtype. He was treated with an R-CHOP chemotherapy regimen. His post-chemotherapy fludeoxyglucose (FDG) positron emission tomography (PET) (FDG PET) scan showed background FDG avid right lung mass of indeterminate significance only and no FDG abnormality at any of the bony lesion. Conclusion: This case underscores the importance of accurate histopathological and immunohistochemical characterization for optimal management and prognosis. Early diagnosis, aggressive treatment, and close follow-up are crucial for improving outcomes in patients with intestinal lymphoma.

Background: Subclavian arterial injury during central venous catheter central venous catheter insertion poses a formidable challenge. Dual vascular injury involving the internal jugular vein internal jugular vein and subclavian artery is uncommon. Due to its rarity, surgical approach for repair of this uncommon dual vascular injuries has not been reported or discussed. Case presentation: We present the case of a 54-year-old frail female with end-stage renal failure undergoing central venous catheter insertion into the right internal jugular vein. Ultrasound-guided placement was attempted, but inadvertent cannulation of the right subclavian artery occurred. Confirmatory imaging revealed through-and-through passage of the catheter into the right subclavian artery. Urgent consultation with the cardiothoracic team led to an exploratory surgical removal. A vertical cervical incision along the sternal head of the right sternocleidomastoid muscle facilitated repair of the right internal jugular vein and the punctured site of the proximal right subclavian artery, whilst avoiding a sternotomy. Postoperatively, the patient was monitored in the Intensive Care Unit and continued renal replacement therapy via a femoral central venous catheter. Conclusion: This case reports a rare complication of a common procedure managed by a novel surgical approach via the ipsilateral vertical supraclavicular incision, avoiding a morbid sternotomy. It also underscores the importance of prompt recognition, with aid of imaging for surgical planning tailored to the specific arterial involvement encountered during central venous catheter complications.