Perforated Appendix in a Neonate: A Review of Literature and a Case Report from Northern Tanzania

Acute perforated appendicitis is rare in neonates and is associated with high morbidity and mortality. This is mainly because the rarity of the pathology and the abnormal clinical features cause delays in diagnosis and definitive management. We report a case of a  premature neonate who presented with sudden onset of abdominal distension associated with an inability to pass stools. The initial abdominal X-ray showed free air under the right hemi-diaphragm. An emergency laparotomy was performed revealing a perforation at the appendicular tip. An appendectomy was done, and the neonate recovered well with a mild surgical site infection during the course of recovery. Neonatal perforated appendicitis is rare, and clinicians need to consider it as a differential diagnosis due to the atypicalpresentations. This preterm neonate presented with clinical features of intestinal obstruction and was found at laparotomy to have a perforated appendix at the tip due to neonatal appendicitis. Keywords: Neonate, Neonatal appendicitis, Neonatal perforated appendiciti

Diagnostic dilemma in a rare case of nonfunctional parathyroid carcinoma at a referral facility in Northern Tanzania

Key Clinical Message Rare cancer originating from parathyroid parenchymal cells. Preoperative diagnosis is often difficult. Presents with normal serum levels of calcium and parathyroid hormone. Treated by en bloc resection. Benefits of adjuvant therapy are unclear. Abstract Parathyroid carcinoma is an uncommon endocrine tumor. Its typical presentation is that of primary hyperparathyroidism with elevated serum calcium and parathormone levels. Nonfunctioning carcinoma of the parathyroid gland with normal serum calcium levels is extremely rare. This paper describes a case of nonfunctioning parathyroid carcinoma and brief literature review thereof

A Report of a Large Axillary Cystic Hygroma (a.k.a Lymphangioma) in a Newborn from a Tertiary Hospital in Northern Tanzania

Introduction. Cystic hygroma is a rare condition of the lymphatic system that occurs mainly in children. They are found around the neck, axilla, inguinal, or thoracic regions. Case Presentation. A newborn female baby with a right-sided axillary mass since birth was admitted to our center. She was otherwise a healthy baby with noncontributory prenatal history. The mass was 12 cm in diameter and cystic. Wide excision of the mass was done, and histology confirmed cystic hygroma. Postoperatively, the baby did well clinically and was discharged. Conclusion. Due to its rare incidence, reports and literature on management of cystic hygroma are few. A multidisciplinary approach is vital to yield the best prognosis for this rare condition

Tailgut cyst mimicking second anal opening in an infant

Tailgut cysts are rare tumors of embryonic remnant located in the retrorectal space. They are mostly asymptomatic hence diagnosis is incidental. They at times present with unspecific symptoms therefore are often misdiagnosed. Radiological imaging aids with the diagnosis and plan the surgical management. Surgeons should be well conversant to avoid complications. Herein we present an infant with a fistulating tailgut cyst who was successfully managed surgically

Juvenile Polyposis Syndrome in a Young Girl from Northern Tanzania

Introduction. Juvenile polyposis syndrome is a rare autosomal dominant disorder in children characterized by multiple polyps in the gastrointestinal tract. A variety of clinical features manifest, including prolapse of a polyp or entire rectum, gastrointestinal bleeding, anaemia, and intussusception. This condition if left unmanaged promptly leads to fatal complications including the development of cancer of the bowel. Case Presentation. A 13-year-old girl with a history of mass protrusion per anus associated with bloody diarrhea. Colonoscopy showed multiple polyps in her large bowel. She underwent total colectomy with ileorectal anastomosis and did clinically well post surgery with no complications. Conclusion. Juvenile polyposis syndrome is an inherited condition with significant morbidity and a high risk of colon malignancy. It is important for early screening and diagnosis and hence management in its early stages as there are no specific standard guidelines for children

Placental pathology and maternal factors associated with stillbirth: An institutional based case-control study in Northern Tanzania.

ObjectiveTo determine the placental pathologies and maternal factors associated with stillbirth at Kilimanjaro Christian Medical Centre, a tertiary referral hospital in Northern Tanzania.MethodsA 1:2 unmatched case-control study was carried out among deliveries over an 8-month period. Stillbirths were a case group and live births were the control group. Respective placentas of the newborns from both groups were histopathologically analyzed. Maternal information was collected via chart review. Mean and standard deviation were used to summarize the numerical variables while frequency and percentage were used to summarize categorical variables. Crude and adjusted logistic regressions were done to test the association between each variable and the risk of stillbirth.ResultsA total of 2305 women delivered during the study period. Their mean age was 30 ± 5.9 years. Of all deliveries, 2207 (95.8%) were live births while 98 (4.2%) were stillbirths. Of these, 96 stillbirths (cases) and 192 live births (controls) were enrolled. The average gestational age for the enrolled cases was 33.8 ±3.2 weeks while that of the controls was 36.3±3.6 weeks, (p-value 0.244). Of all stillbirths, nearly two thirds 61(63.5%) were males while the females were 35(36.5%). Of the stillbirth, 41were fresh stillbirths while 55 were macerated. The risk of stillbirth was significantly associated with lower maternal education [aOR (95% CI): 5.22(2.01-13.58)], history of stillbirth [aOR (95%CI): 3.17(1.20-8.36)], lower number of antenatal visits [aOR (95%CI): 6.68(2.71-16.48), pre/eclampsia [aOR (95%CI): 4.06(2.03-8.13)], and ante partum haemorrhage [OR (95%CI): 2.39(1.04-5.53)]. Placental pathology associated with stillbirth included utero-placental vascular pathology and acute chorioamnionitis.ConclusionsEducating the mothers on the importance of regular antenatal clinic attendance, monitoring and managing maternal conditions during antenatal periods should be emphasized. Placentas from stillbirths should be histo-pathologically evaluated to better understand the possible aetiology of stillbirths

Ventricular silent rupture leading to sudden death: Navigating diagnostic challenges in a resource‐constraint setting

Key Clinical Message Ventricular myocardial rupture is a rare complication of myocardial infarction. It occurs within hours to weeks after an infarction. Mortality is high. Antemortem diagnosis is a challenge in low‐resource settings, leading to potential misdiagnosis. Abstract Left ventricular myocardial rupture is a potentially fatal yet common complication in acute myocardial infarction patients. Rupture can occur as early as hours after an infarction. However, rupture may also occur later in the first week in the setting of myocardial necrosis and neutrophilic infiltration. Patients may survive several days to weeks before rupture occurs, and cardiac tamponade may present subacutely with a slow or repetitive clinical course. Sudden death can be attributed to ventricular rupture, more commonly during this time frame. Myocardial rupture can also occur as a result of trauma, infections, or cancer. Mortality is exceedingly high if surgical intervention is delayed. In most patients, myocardial rupture manifests as a catastrophic event within days of a first, small, uncomplicated acute myocardial infarction. Acute onset of shortness of breath, chest pain, shock, diaphoresis, unexplained emesis, cool and clammy skin, and syncope may herald the onset of ventricular septal rupture after acute myocardial infarction. Sudden death from myocardial rupture during acute myocardial infarction in patients with no apparent previous symptoms of myocardial ischemia represents a challenge for medical examiners, law enforcement officers, and society as a whole. An autopsy is critical for establishing the cause of death. We present the case of a 54‐year‐old male whose body was found beside the road after a trivial quarrel a day before. Further medical information about the deceased was not available. The preliminary cause of death was presumed to be traumatic. No evidence of trauma was seen during the autopsy. Massive pericardial blood collection compressing the heart and concealed left ventricular myocardial rupture were noted. Histopathological examination of the heart demonstrated myocardial infarction with a tear associated with bleeding that was contained in the pericardial sac. We ruled cardiac tamponade as the cause of death due to an infarcted myocardial rupture. Antemortem diagnosis of myocardial rupture can be challenging in low‐resource settings, leading to potential misdiagnosis and negative impacts such as community conflicts

Colorectal cancer in a patient with intestinal schistosomiasis: a case report from Kilimanjaro Christian Medical Center Northern Zone Tanzania

Abstract Background Colorectal cancer associated with chronic intestinal schistosomiasis has been linked with the chronic inflammation as a result of schistosomal ova deposition in the submucosal layer of the intestine. Among all species Schistosoma japonicum has been more linked to development of colorectal cancer as compared to Schistosoma mansoni due to absence of population-based studies to support the association. Despite the weak evidence, some cases have been reported associating S. mansoni with development of colorectal cancer. Case Presentation We report a patient who presented to us as a case of intestinal obstruction and found to have a constrictive lesion at the sigmoid colon at laparotomy, then later found to have colorectal cancer with deposited S. mansoni ova at histology. Conclusion Given the known late complications of schistosomiasis, and as S. mansoni is endemic in some parts of Tanzania, epidemiological studies are recommended to shed more light on its association with colorectal cancer

Prevalence and associated risk factors for Kaposi's sarcoma among HIV-positive patients in a referral hospital in Northern Tanzania: a retrospective hospital-based study

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