Zakarie Abdijamal Abdulle,1 Mohamed Abdirahman Mohamud,1 Muhindo Kavuyiro Alpha,1 Mohamed Ibrahim Mohamed,1 Abdikarim Ahmed Warsame,1 Abdullahi Ahmed Abdulle,1 Akora Job,1 Abdirizak Hussein Sheikdon,1 Leila Mohamed Hassan,1 Abdikafi Mohamed Farah,1 Odongo Kenneth Obita2 1Department of Otorhinolaryngology, Kampala International University Teaching Hospital, Ishaka, Bushenyi, Uganda; 2Department of Ear, Nose and Throat, Lira Regional Referral Hospital, Lira, UgandaCorrespondence: Zakarie Abdijamal Abdulle, Email zakarieabdijamal@gmail.comAbstract: Choanal atresia is a rare congenital cause of nasal obstruction. Complete obstruction is termed atresia, whereas partial narrowing is more accurately described as choanal stenosis. We report a 4-year-old girl with lifelong bilateral nasal obstruction, persistent mouth breathing, snoring, poor sleep, easy tiredness, intermittent rhinorrhoea, breastfeeding difficulty during infancy, and recurrent respiratory tract infections. Clinical assessment showed absent right-sided and markedly reduced left-sided nasal airflow. Bedside testing demonstrated no right-sided cotton-wisp movement or misting and minimal movement and misting on the left; a size 8F suction catheter could not be advanced beyond 3.5 cm on the right and met posterior resistance on the left. Preoperative flexible nasal endoscopy was not obtained because financial constraints limited access to the procedure. Computed tomography demonstrated complete right-sided choanal atresia with incomplete left-sided congenital choanal stenosis. The child underwent transnasal repair under general anesthesia using direct visualization with a Killian nasal speculum and headlight, puncture and serial dilatation of the posterior choanal obstruction, and temporary bilateral stenting. The stents were removed after six weeks. During four weeks of follow-up after stent removal, the child had improved nasal breathing and clinically patent bilateral nasal airways. This case highlights delayed recognition of asymmetric bilateral congenital choanal obstruction and the practical diagnostic and operative adaptations required in a resource-limited setting. The outcome should be interpreted as favorable in the short term because objective postoperative endoscopic confirmation and long-term follow-up were not available.Keywords: congenital choanal obstruction, choanal atresia, choanal stenosis, pediatric nasal obstruction, transnasal repair, temporary stenting, resource-limited setting
Julius Goodwill Nteziyaremye,1,2 Derrick Akandwanaho,3 Linda Lutada Adong41Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda; 2Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital, Mbale, Uganda; 3Department of Pathology, Mbale Surgical Centre, Mbale, Uganda; 4Department of Pathology, Uganda Cancer Institute, Kampala, UgandaCorrespondence: Julius Goodwill Nteziyaremye, Email jntezi@gmail.comBackground: Cervical cancer (CC) is the leading Gynaecological cancer in Uganda with an estimated 6959 women diagnosed, and 4607 annual deaths. About 60– 80% of CC patients present with advanced stage disease with either local spread or with distant metastases. For those with distant metastases, the most common sites of spread are the lungs and supraclavicular lymph nodes. Breast and integumentary system metastases are very rare. We present a case with such metastases managed in eastern Uganda.Case Presentation: A 72 years old, Ugandan black African female, came in with a 13 months history of intermittent postmenopausal bleeding and associated abnormal vaginal discharge. She had repeatedly been managed from the nearest health facility for recurrent urinary tract infection and sexually transmitted diseases with no improvement. On examination at Mbale Regional Referral Hospital, she had poor performance status, cachexic, with bilateral pitting, tender poedal oedema, left breast masses and cutaneous nodules on the anterior aspect of the left thigh. Abdominal exam revealed a bulky uterus. On vagina examination, a large easily bleeding cervical tumour measuring about 8 cm × 7 cm and involving the upper 1/3 of the vagina was found. Bimanual pelvic exam revealed bilateral parametria involvement and bilateral pelvic side wall extension. Biopsies of the cervical, breast and the cutaneous masses were positive for high grade adenocarcinoma. Immunohistochemistry (IHC) for breast and cutaneous biopsies was positive for 16-kilodalton protein (P16), and negative for Oestrogen receptors (ER) and Progesterone receptors (PR). A diagnosis of cervical adenocarcinoma stage IVB (with breast and integument system metastases), with obstructive uropathy and probable deep venous thrombosis was made. She was offered total palliation and unfortunately succumbed on day 3 of admission.Conclusion: Cervical adenocarcinoma stage IVB with breast and integumentary metastases portends poor prognosis. Gynaecologic Oncologists and other service providers need to do thorough exam and investigations to rule out metastases to rare sites. This will aid appropriate counselling during care.Keywords: cervical cancer, metastases to integumentary system, metastases to the breast, Uganda
Sharmarke Hassan Ali,1 Mohamed Mukhtar Mohamed,2,3 Mustafe Bile Ismail,1 Abdikani Ali Salad11Department of Thoracic Surgery, Mogadishu Somalia Turkiye Training and Research Hospital, Mogadishu, Somalia; 2Department of Emergency Medicine, Mogadishu Somalia Turkiye Training and Research Hospital, Mogadishu, Somalia; 3Faculty of Medicine and Health Sciences, Hormuud University, Mogadishu, SomaliaCorrespondence: Sharmarke Hassan Ali, Department of Thoracic Surgery, Mogadishu Somalia Turkiye Training and Research Hospital, Digfer Road, Hodan, Mogadishu, Somalia, Email sharmarkehassan99@gmail.comBackground: Anterior chest wall tuberculosis is an uncommon form of extrapulmonary tuberculosis that can mimic a chronic pyogenic abscess or chest wall mass. Its indolent presentation and absence of constitutional symptoms may delay diagnosis, particularly in resource-limited settings.Case Presentation: A 22-year-old previously healthy male soldier presented with a progressively enlarging parasternal–xiphoid swelling and intermittent seropurulent discharge, without respiratory or constitutional symptoms. Examination revealed a minimally tender 5 × 2 cm fluctuant swelling with a draining sinus and localized skin changes. Thoracic computed tomography showed a 57 × 18 mm subcutaneous collection at the xiphoid level without demonstrated pleural or osseous involvement, alongside centrilobular nodules and a tree-in-bud pattern suggestive of pulmonary infection. Incision, drainage, and debridement were performed. Xpert MTB/RIF Ultra testing of a fluid specimen detected Mycobacterium tuberculosis complex at a low bacillary load, without rifampicin resistance detected. Histopathological examination was reported to show caseating granulomatous inflammation with multinucleated giant cells. Sputum testing was also positive for M. tuberculosis, supporting concomitant pulmonary tuberculosis. First-line antituberculous therapy was initiated. The wound was closed at the 14-day postoperative assessment. Following six months of treatment, the patient remained asymptomatic; follow-up computed tomography demonstrated resolution of the chest wall collection and regression of pulmonary abnormalities.Conclusion: Chest wall tuberculosis should be considered in patients with persistent parasternal swelling or a draining sinus, even without constitutional or respiratory symptoms. Tissue sampling, molecular and histopathological evaluation, and assessment for concomitant pulmonary disease support timely diagnosis and appropriate treatment.Keywords: anterior chest wall tuberculosis, cold abscess, parasternal sinus, extrapulmonary tuberculosis, xpert MTB/RIF ultra, pulmonary tuberculosis, resource-limited setting, case report
Francisco Javier López-González,1 Estefany Gilberty Mendoza Verdin,1 Jose Armando Díaz-Martínez,2 Regina Rodríguez-Arias,3 Lorelay Livier Gutiérrez Oliva,4 Arturo Javier Navarro Gómez,1 Dominick Manzo Frias51Department of Neurosurgery, Hospital Civil de Guadalajara "Fray Antonio Alcalde”, Guadalajara, Jalisco, Mexico; 2Department of Neurosurgery, Hospital Universitario "Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; 3Department of Anesthesiology, Hospital Civil De Guadalajara "Fray Antonio Alcalde”, Guadalajara, Jalisco, Mexico; 4Pediatric Neurosurgery Service, Department of Neurosurgery, Hospital Civil De Guadalajara "Fray Antonio Alcalde”, Guadalajara, Jalisco, Mexico; 5Faculty of Medicine, Universidad Siglo XXI, Pachuca de Soto, Hidalgo, MexicoCorrespondence: Estefany Gilberty Mendoza Verdin, Department of Neurosurgery, Hospital Civil de Guadalajara "Fray Antonio Alcalde”, Calle Hospital 278, Colonia El Retiro, Guadalajara, Jalisco, C.P. 44340, Mexico, Tel +52 33 2619 4851, Email estefany.mendozaverdin@gmail.comBackground: Single-stage bilateral microsurgical treatment of multiple anterior circulation aneurysms is uncommon and increases operative complexity. Rapid ventricular pacing (RVP) produces brief, reversible, and titratable systemic hypotension that can facilitate clip reconstruction when prolonged temporary occlusion is undesirable or insufficient.Case Description: A 54-year-old woman with untreated hypertension and active smoking presented with a pupil-involving left oculomotor nerve palsy and was found to have five unruptured anterior circulation aneurysms: on the left, a paraclinoid internal carotid artery (ICA) aneurysm (Barami type IIIa) and a posterior communicating artery (PCoA) aneurysm; on the right, an ICA C6 blood blister–like lesion, a PCoA aneurysm, and a middle cerebral artery (MCA) M1 pre-bifurcation aneurysm. She underwent sequential left and right mini-pterional craniotomies in a single operative session with bilateral extradural and intradural anterior clinoidectomies. The paraclinoid aneurysm was reconstructed with a 90° fenestrated clip reinforced with a microclip, both PCoA aneurysms were clipped, the blister-like lesion was treated with focal bipolar coagulation under temporary ICA occlusion, and the MCA aneurysm was reconstructed with a straight clip plus a semicurved microclip. RVP was applied in 12 episodes (19 s to 1 min 40 s; 180 bpm) during key reconstruction steps, without arrhythmia requiring intervention or postoperative troponin elevation. Immediate and approximately 2-month postoperative computed tomography angiography (CTA) demonstrated complete aneurysm occlusion. The preoperative left oculomotor nerve palsy persisted, and the modified Rankin Scale (mRS) score was 2 at discharge and at 2-month follow-up.Conclusion: In this carefully selected patient, single-stage bilateral microsurgery supported by repeated RVP was feasible for the definitive treatment of five complex aneurysms, although persistent cranial neuropathy was observed. The advantages of a single session must be weighed against longer operative time and the morbidity of bilateral craniotomies, and the evidence supporting RVP remains limited to small, noncomparative series.Keywords: rapid ventricular pacing, microsurgical clipping, unruptured intracranial aneurysm, multiple intracranial aneurysms, blood blister–like aneurysm
Seyede Fateme Mahmoudi Hashemi,1 Fahime Soleimani,1 Sayed Mortaza Fayez21Otorhinolaryngology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 2Internal Medicine Department, Faculty of Medicine, Kabul University of Medical Sciences Abu Ali Ibn Sina, Kabul, AfghanistanCorrespondence: Sayed Mortaza Fayez, Internal Medicine Department, Faculty of Medicine, Kabul University of Medical Sciences Abu Ali Ibn Sina, Kabul, Afghanistan, Email sayedmortazafayez455@gmail.comBackground: Neurofibroma is a benign peripheral nerve sheath tumor composed of Schwann cells and fibroblasts. It may occur sporadically or as part of neurofibromatosis type 1 (NF1). Solitary neurofibroma arising in the submental region of an adolescent is extremely rare. We report a case of a solitary submental neurofibroma in a 15-year-old male and highlight its diagnostic and management implications.Case Presentation: A 15-year-old adolescent boy presented with a chronic, painless right submental swelling that had been present for one year and had enlarged over the preceding three months. Clinical examination revealed a rubbery, nontender, approximately 3× 3× 4 cm mass without skin changes or systemic symptoms. There was no personal or family history suggestive of NF1, neural tumors, or pheochromocytoma. Ultrasound and CT imaging showed a well-defined soft-tissue mass consistent with a benign neurogenic tumor. The mass was completely excised via a submental incision. Histopathological examination confirmed a solitary neurofibroma with Schwann cell and fibroblast proliferation within a collagen matrix, Antoni A and B patterns, and positive S-100 immunostaining, with no evidence of malignancy. The postoperative course was uneventful, and tongue and floor-of-mouth function were preserved.Conclusions: Solitary submental neurofibroma should be considered in the differential diagnosis of submental masses in adolescents, even in the absence of NF1 features. Complete surgical excision is the treatment of choice and allows definitive histopathological diagnosis. A thorough evaluation for NF1 is recommended to guide long-term management and follow-up.Keywords: adolescent, head and neck, neurofibroma, solitary neurofibroma, submental mass
