Rare Occurrence of Mix Stromal Tumours: A Case Report Of Gastrointestinal and Extra-Intestinal Stromal Tumour on the Jejunum And Omentum of a Nine Year Old Girl From Adamawa State, Nigeria

Background: Stromal tumors of the jejunum (GIST) and omentum (EGIST) are uncommon and dearth of information still exists on their occurrence concurrently.Case details: Here, we report a nine year old girl that presented with tender abdominal mass measuring 14 x 8 cm associated with features of gastric outlet obstruction and hyponatremia of 115mmol/L. A diagnosis of hyponatremia in a child with gastric outlet obstruction secondary to intraabdominal mass was made for which exploratory laparotomy was carried out. Histology of the tumour revealed stromal spindle epithelioid as well as myxoid cells. Complete resection of the tumour and correction for hyponatremia was done in addition to antibiotics therapy with remarkable improvement.Conclusion: Index case is that of mixed stromal tumours that presented with features of gastric outlet obstruction, and the patient did well after surgery.Keywords: Gastrointestinal/extraintestinal stromal tumors, Jejunum,  Omentum, Paediatrics, Adamawa state, Nigeria

Microeconomics of managing Diabetic Ketoacidosis in a rural Nigerian child of low socioeconomic class: a case report

Health care delivery is a concurrent responsibility of the various levels of government in Nigeria where most of the populace earn less than one dollar a day. The total expenditure on Nigerian health care as a percentage of gross domestic product, and the percentage of federal government expenditure on health care is far below the World Health Organization recommended standard. Thus, caregivers pay out of their pockets to settle health care expenses of their children thereby creating a negative microeconomic impact on parents, households and health workers. Herein, we report the case management of newly diagnosed Diabetic Ketoacidosis (DKA) in an eight-year-old boy from a low socioeconomic class (SEC), and the costs implication of the child’s hospital care. After forgoing indirect costs like opportunity cost which is difficult to determine, the direct total cost involved in patient’s hospital care for DKA was forty eight thousand eight hundred naira only (N48, 800.00) equivalent to three hundred and ten United States Dollars and eighty three cents (310.83 USD). Based on the high cost of managing DKA observed in the study case, there is a need to convince health system administrators and policy makers to strengthen health insurance so as to enable patients, especially those from low SEC, to pay their hospital bills promptly.Keywords: Diabetic ketoacidosis; Microeconomics; Costs; Low socioeconomic class; Child; Yola; Nigeri