Introduction Peritonitis remains a significant cause of morbidity and mortality among surgical patients. Understanding its aetiology and antimicrobial susceptibility is essential for effective treatment. This study investigates the causative organisms, antimicrobial agents used, and sensitivity patterns among patients with peritonitis who underwent surgery at Kilimanjaro Christian Medical Centre in northern Tanzania. Methods A prospective hospital-based cross-sectional study was conducted at Kilimanjaro Christian Medical Centre (KCMC) from October 2015 to March 2016 on admitted patients. Peritoneal fluid (5-10) mls and aerobic culture using standard microbiological techniques was taken during the operation. Antibiotic sensitivity testing was conducted against locally available antibiotics using the disk diffusion method. Results A total of 60 patients with a median age of 22.5 and an interquartile range (IQR) of 12.0-44.5 were enrolled in this study, and the majority (65.0%) of them were males. Secondary peritonitis was the leading cause of peritonitis by 81.7%, mainly due to ruptured appendix (41.6%), gastric perforation (10.0%), jejunum perforation (10.0%), and ileal perforation (8.3%). Gram-negative bacteria were the most frequently isolated bacteria. Escherichia coli (38.2%) was the most frequently isolated bacterium, followed by coliform species (14.8%) and another Streptococcus pyogenes, Staphylococcus aureus, and Klebsiella pneumoniae, all of which were isolated by 11.8%. Most of the gram-negative bacteria were sensitive to Amikacin (100.0%), Gentamycin (72.7), and Ceftriaxone (54.5%). Gram-positive bacteria were sensitive of 100.0% of Vancomycin, clindamycin, and Ciprofloxacin. All bacteria isolated and tested for ampicillin were resistant. Conclusion The most common causes of secondary peritonitis at Kilimanjaro Christian Medical Centre (KCMC) are perforated appendix, gastroduodenal, and jejunal perforations. Gram-negative bacteria were isolated the most, and E. coli was the commonest. Effective antibiotics for gram-negative bacteria were Amikacin, Gentamycin, and Ceftriaxone, and for gram-positive bacteria were Vancomycin, Clindamycin, and Ciprofloxacin. All bacteria were resistant to Ampicillin.

Thyroidectomy is a safe procedure when performed by competent well-trained surgeon in ideal settings. However not all centers have settings that adhere to recommended standard preoperative, intraoperative, and postoperative well laid guidelines. Surgeons in such settings must improvise ingenious methods to try to comply with recommended guidelines. Patients in resource limited settings present late with huge benign or malignant multinodular goiters with limited preoperative investigative modalities due to financial constraints. These settings create logistical challenges for the attending surgeons in such settings. Thyroidectomy also carries a high legal ramification potential due to its high complication potential index from its anatomical proximity of potential lethal or life changing complications by iatrogenic injury to adjacent structures such as Recurrent Laryngeal Nerve, parathyroid glands, or the large caliber blood vessels. It is the author’s intention to highlight these logistical challenges and not recommend or advocate the practice in such settings to be adopted as the standard of care.

Background: Thyroid diseases are common and serious diseases in the world and because of this fact, early diagnosis is necessary. Clinicians in our settings rely on clinical presentation, physical examination and biochemical findings in diagnosing patients with thyroid mass and sometimes this leads to misdiagnosis or late diagnosis of cancerous lesions. Abnormal lymph node sometimes can be mistaken for a thyroid nodule. Clinical examination or biochemical findings become difficult differentiatingdifficult differentiating the two conditions. The global consensus is to employ FNAC as standard baseline test to pick out thyroid lesions with malignancy potential. The inherent pitfalls and unique presentation in developing countries have proven a challenge in using FNAC as a stand-alone tool for preoperative assessment Objective: To determine the diagnostic accuracy of fine needle aspiration cytology for thyroid tumours at a tertiary hospital in Northern Tanzania from January 2019 to June 2023. Methodology: A retrospective cross sectionalcross-sectional hospital-based study that was conducted from January 2019 to June 2023 in patients who had thyroidectomy done during the study period at KCMC. Structured Questionnaires were used to collect key information from case notes, descriptive data were summarized by median and interquartile range and proportions in percentage and analyzed by SPSS version 25. Results: A total of 207 patients who underwent thyroidectomy across the period of study were eligible. Females were 89.37% and% and males 10.63% with a Female: Male ratio 8.4:1. The age of participants ranged from 8 to 81 years, median (IQR) 49 (37-56) years. Malignant lesions 47.83% were papillary carcinoma, 30.43% follicular carcinoma and the rest were squamous cell carcinoma 8.7%,follicular%, follicular variant of papillary thyroid carcinoma 8.7% and 4.35% papillary carcinoma follicular variant. The study had a sensitivity of 36.36%, specificity 91.89%, positive predictive value of 34.78% negative predictive value 92.39% false positive rate 8.10%, false negative rate 63.64% and an overall accuracy of 85.99%. Conclusion: This study reveals high specificity, a low sensitivity, and a within range diagnostic accuracy for FNAC at detecting malignancy in thyroid nodules. The findings are a baseline data on performance of FNAC in thyroid tumours at our facility, there is a consistent trend toward papillary thyroid carcinoma (PTC) than follicular thyroid carcinoma (FTC) across regions.

INTRODUCTION AND IMPORTANCE:Low-grade fibromyxoid sarcoma is a rare, indolent soft tissue tumor with a deceptively benign histological appearance, high recurrence rates, and potential for late metastasis. It typically arises in the deep soft tissues of the extremities or trunk in young adults, but reports of unusual locations exist. CASE PRESENTATION:We report a 43-year-old African male with a 2-year history of a progressively enlarging left thigh mass. Initial attempts at traditional remedies delayed medical intervention. Examination revealed a large ulcerated mass, and imaging showed a well-circumscribed soft tissue tumor without bone involvement. The biopsy confirmed Low-grade fibromyxoid sarcoma, and the patient underwent hip disarticulation surgery. Histopathology showed typical Low-grade fibromyxoid sarcoma features with no lymph node involvement. Postoperative recovery was satisfactory, and the patient is undergoing rehabilitation. CLINICAL DISCUSSION:Low-grade fibromyxoid sarcoma diagnosis is challenging due to its morphological heterogeneity. Ancillary studies, including MUC4 immunostaining, are critical but often unavailable in resource-limited settings. Wide surgical excision remains the primary treatment, as the tumor is less responsive to chemotherapy and radiotherapy. This case underscores the need for early medical intervention, clinician-led community education, and long-term follow-up. CONCLUSION:This report highlights the rarity of Low-grade fibromyxoid sarcoma and its challenges in resource-limited settings. Future efforts should focus on establishing standardized management protocols and identifying prognostic biomarkers to improve patient outcomes.

INTRODUCTION AND IMPORTANCE:Traditional bone setting (TBS) is commonly practiced in many communities worldwide, especially in developing countries in Asia, South America, and Africa, where healthcare resources are less developed. It plays an important role in healthcare delivery systems and remains a widely used alternative to modern medical care for limb fractures. This practice involves using wooden straps and casts to immobilize and stretch the injured limb, often leading to complications such as non-union, malunion, infections, compartment syndrome, and even limb amputations. CASE PRESENTATION:We discuss a case of a 30-year-old male patient who arrived at our facility with infected and gangrenous forearm with compartment syndrome following a week after traditional bone-setting intervention. The patient required an urgent fasciotomy and extensive surgical debridement of necrotized tissues. Due to extensive tissue loss, ischemia, gangrene, and persistent limb hypoesthesia and paresis, a forearm amputation was ultimately performed. CLINICAL DISCUSSION:The traditional bone setter is a lay practitioner of joint manipulation, often lacking formal medical training. Despite the availability of modern healthcare systems, traditional bone setting continues to be widely used in many communities, leading to severe complications when improperly performed. In rural areas, traditional healers may not have the necessary knowledge to manage limb fractures appropriately, resulting in inflammation, infections, and delayed treatment. Strengthening healthcare delivery requires additional training for traditional healers and increasing public awareness about trauma care and early hospital referrals. CONCLUSION:While traditional bone setting holds cultural significance, it poses serious risks, including infection, gangrene, and limb amputation, as demonstrated in this case. This report highlights the urgent need for community education, improved trauma awareness, and enhanced integration of safe, evidence-based fracture management in rural settings to prevent such complications and improve patient outcomes.

BACKGROUND:Retroperitoneal cysts are rare, accounting for less than 1% of retroperitoneal tumors. Idiopathic giant unilocular retroperitoneal cysts are even more uncommon, with very few reported cases. Their diagnosis and management are particularly challenging in resource-limited settings due to restricted access to advanced imaging and surgical techniques. CASE PRESENTATION:A 38-year-old female presented with progressive abdominal distension. Imaging revealed a giant retroperitoneal cyst. Due to limited resources, an open laparotomy was performed, and a 33 cm cyst containing 8 l of clear fluid was completely excised. Histopathology confirmed a giant idiopathic retroperitoneal cyst. DISCUSSION:This case is unique due to the cyst's idiopathic nature, massive size, and successful surgical management despite resource constraints. Complete surgical excision remains the definitive management to prevent recurrence and complications. CONCLUSION:This case highlights the importance of surgical intervention in managing giant retroperitoneal cysts in resource-constrained settings, ensuring favorable outcomes despite diagnostic limitations.

Urinary bladder diverticula can be either primary (congenital) or secondary (acquired) and are more commonly observed in males, sometimes in association with syndromes. The condition presents with a wide range of symptoms, while some cases may remain asymptomatic. Management options include conservative treatment, endoscopic intervention, or surgery, depending on patient factors, clinician expertise, and available resources. In this case report, we present a 5-month-old female infant with progressive abdominal distension and reduced urine output. She was managed surgically and recovered well postoperatively. This case underscores the diverse presentation of surgical pathologies in children, emphasizing the need for individualized management strategies, the use of advanced radiological investigations to confirm diagnosis, and a multidisciplinary approach in a tertiary care setting.

Introduction:Popliteal artery injuries are frequently seen with fractures and dislocations. In the setting of trauma is a rare but highly comorbid condition associated with significant long-term disability, limb loss, and even mortality. Literature suggests that vascular damage occurring with injury of the lower extremity is rare and uncommon. Case presentation:We present a case of 37 years old male patient who had popliteal injury on the left knee joint with undisplaced and non-dislocated tibiofemoral joint 8 h after an injury. He underwent surgery at our facility and intraoperatively was found to have a transected popliteal artery. The mechanism of injury was unclear. Surgical debridement was done, systemic heparinization followed by an end to end popliteal artery anastomosis that resulted into well perfusion of the distal limb. Discussion:Popliteal artery injuries remain a challenging entity that carries the greatest risk of morbidity. Surgical management of popliteal vascular injury continues to be of great needs. This follows after an early and accurate clinical and radiological diagnosis of vascular injury. The computed tomography angiography with intravascular contrast injection and arterial venous ultrasound are the ideal modalities for diagnosing vascular injuries. Popliteal artery anastomosis and systemic heparinization add more value in managing a transected popliteal artery. Postoperative use of heparin is advocated after a successfully primary anastomosis. Conclusion:Despite major efforts in establishing protocols and guidelines in the management of vascular trauma, optimal strategies of traumatic popliteal artery injuries are still under investigated. Clinical evaluation of popliteal artery injury can readily overlook other associated injuries. An early repair and restoration of blood perfusion as well as liberal use of heparin play important role to achieve acceptable outcomes.

Pancreatic cancer is a common and deadly cancer, ranking as the 14th most common cancer worldwide and the 7th leading cause of cancer-related deaths. Advanced pancreatic malignancy frequently presents with biliary and gastric outlet obstruction and palliative open interventions are often required, especially in low-income countries where endoscopic surgical bypass methods are often unavailable. This study aimed to describe the demographic and clinical characteristics of patients undergoing biliodigestive bypass for pancreatic malignancy. This was a hospital-based retrospective observational study at the tertiary hospital in northern Tanzania. We included 53 patients who underwent double or triple bypass surgery for pancreatic malignancy between January 2019 to December 2022 at Kilimanjaro Christian Medical Centre (KCMC), Tanzania. Data was collected from medical records, analyzing demographics, comorbidities, pre-surgery and surgery details, and post-surgery outcomes. Descriptive statistics were used to summarize continuous variables as mean with standard deviation and categorical variables as percentages. 53 patients were analyzed, with a mean age of 63.2 years and a male to female ratio of 1.03:1. Jaundice was the most common presentation (77.4

Background: Malignancies of the head of the pancreas pose a significant global challenge due to their late presentation and the disease's aggressive nature. Modifiable risk factors, such as obesity, cigarette smoking, and alcohol consumption, are expected to increase, leading to a higher incidence of pancreatic cancer. Although the incidence of pancreatic cancer in Africa is expected to increase, data on pancreatic head malignancies in the region are abysmal. This study aimed to assess the current status of pancreatic cancer diagnosis and treatment options in Northern Tanzania. Methods: We conducted a retrospective hospital-based study from January 2016 to December 2023 at a tertiary hospital in northern Tanzania. We aimed to investigate clinical presentation, management outcomes, and survival analysis. We retrieved data on patients diagnosed with pancreatic head tumours from the cancer registry. Data on demographics, clinical features, diagnostics, treatment, and outcomes were extracted from the cancer registry and hospital records. Descriptive statistics are presented as means with standard deviations (SD) or medians with interquartile ranges (IQR) for continuous variables, and frequencies with percentages for categorical variables. The chi-square (χ²) test assessed the association between categorical variables, while the grouped sample t-test or one-way ANOVA evaluated continuous outcomes at a 95% confidence interval. Significance was set at P < 0.05. Survival was analysed using the Kaplan–Meier method and log-rank tests, with Cox regression used to identify independent predictors of mortality. Ethical approval was obtained from the institutional review board, with consent waived due to the study’s retrospective nature. Results: A total of 132 patients were included in this study, with a mean age of 61 years and a slight male predominance of 56.1%. Despite the low rate of chemotherapy administration (15.9%), treatment was associated with improved 30-day overall survival (OS 77.7% for recipients vs. 60.4% for non-recipients). Chronic pancreatitis was significantly associated with increased mortality (HR 5.92, p=0.019). Conclusion: Our study reveals a high rate of late-stage presentations, limited diagnostic and treatment options, and markedly poor survival outcomes for patients with tumours of the head of the pancreas in northern Tanzania. The findings underscore the necessity for enhanced diagnostic and treatment strategies for pancreaticobiliary malignancies, given the significant mortality risks linked to certain factors and the limited use of invasive treatments. Further research is essential to develop more cost-effective interventions and enhance patient outcomes.

Background Peritonitis is a life-threatening surgical emergency and a major cause of morbidity and mortality worldwide. Appropriate antibiotic therapy is critical, yet misuse of antimicrobial agents contributes to the rise of resistant strains, especially in developing countries. Resistance leads to treatment failure and imposes financial burdens on both patients and healthcare systems. This study aimed to assess intra-abdominal pathogens and their antimicrobial susceptibility patterns among patients with peritonitis. Methods This was a hospital-based descriptive cross-sectional study conducted at Kilimanjaro Christian Medical Centre, northern Tanzania, between October 2019 and April 2020. All patients with peritonitis admitted to the surgical department were enrolled. Intraoperative peritoneal swabs were collected and cultured. Antimicrobial susceptibility testing was performed using the Kirby-Bauer method on Müller-Hinton agar and interpreted according to Clinical and Laboratory Standards Institute guidelines. Data were summarized using descriptive statistics and supplemented with information from patients’ clinical notes. Results A total of 39 patients were identified, of whom Thirty-five patients met eligibility criteria. The median age was 32 years (IQR: 20–48), and 51.4% were male. The most common isolates were Escherichia coli (42.4%) and Klebsiella pneumoniae (21.2%). Both were highly susceptible to amikacin and meropenem (100%), but showed low susceptibility to ceftriaxone (22% and 20%, respectively). Conclusion and recommendations High levels of resistance to commonly used empirical antibiotics were observed, highlighting the need to revise empirical therapy for peritonitis in this setting. Rational use of antibiotics, alongside close monitoring of treatment responses, is essential to reduce morbidity, mortality, and the spread of antimicrobial resistance.

Introduction: Although it is primarily a pulmonary disease, extra-pulmonary TB has been reported in 15 % of TB patients and it can affect any body system including the pleura. Pleural tuberculosis can result into empyema thoracis which can further complicate if left untreated to empyema necessitans. This requires high index of suspicious for prompt medical and surgical management. Case presentation: A 41-year-old immunocompetent male presented with a two-month history of chest wall swellings. The swellings were associated with intermittent fevers and night sweats. Clinical examination revealed anterior and posterior left chest swellings, tender, and fluctuant. Chest X-ray showed left hemithorax opacification with right sided mediastinal shift. A chest tube was inserted and pus was drained and it was positive for Mycobacterium Tuberculosis. He was continued with anti-tuberculous therapy for 7 more months with good outcome. Discussion: Empyema necessitans is a rare complication of tuberculous thoracis in which the pus invades the chest wall resulting into pus collection under the skin. Areas of the chest wall likely to be affected are those with relative lung adherence to the chest wall which are anterior superior and posterior inferior chest wall. The inflammatory process can result into classic signs of inflammation including swelling, warmth, erythema, pain, but in other patients it just presents as a swelling under the skin. Management involves pus drainage through chest tube and anti-tuberculous therapy. Conclusion: Healthcare providers must keep high index of suspicion for empyema necessitans in patients presenting with chest wall masses especially when they have history of tuberculosis.

INTRODUCTION AND IMPORTANCE:Spontaneous trans-mesenteric hernia is a rare entity in adults. Its pre-operative diagnosis is challenging even with Computed Tomography Scanning. Most cases are diagnosed as incidental findings during laparotomy or postmortem. This case report highlights that even in geriatric patients without prior laparotomies, peritonitis or abdominal trauma which predispose to trans-mesenteric herniation, a differential diagnosis of a spontaneous trans-mesenteric hernia is of paramount importance as delay in diagnosis leads to death. CASE PRESENTATION:We report a case of a geriatric lady who presented with features of intestinal obstruction. Intra-operative findings revealed strangulated gangrenous small bowels extending from 170 cm from ligament of Treitz to the ileal caecal junction through a trans-mesenteric defect of about 12 cm in diameter. She underwent resection of the gangrenous small bowel with right hemi colectomy and jejunal-transverse colon end to side anastomosis. However, she succumbed two days post operatively. CLINICAL DISCUSSION:Spontaneous trans-mesenteric hernia is a rare cause of small bowel obstruction in adults, difficult to clinically and radiologically diagnose pre-operatively and mostly presents with bowel ischaemia due to strangulation. Early diagnosis is paramount in reducing morbidity and mortality rates in these cases. CONCLUSION:Delay in diagnosis of trans-mesenteric hernia leads to strangulation, gangrene of bowels and eventual death. A high index of suspicion is needed from both surgeons and radiologists even in cases of intestinal obstruction without prior histories of laparotomy, peritonitis or abdominal trauma.

Background: The mainstay treatment for patients with hydrocephalus is surgical, with ventriculoperitoneal shunt (VPS) placement being a routine practice in hospitals with limited resources and workforce. Nonetheless, avoidable complications following VPS placements are still evident, compounding significant patient morbidity and mortality. We review an analysis of the causes and outcomes of the shunt revisions. Methods: A cross-sectional study was carried out at a tertiary hospital between March 2020 and March 2023. It included 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for 3 months, at which time their characteristics in relation to shunt complications were evaluated. SPSS, version 26, was utilized to analyze the data that had been gathered. Results: VPS revisions were performed on 90 of 263 patients, a prevalence of 34.2%. Of the revisions, the majority (92.2%) were pediatric patients. Females made up 52.2% of the patients. The most common reason for revisions was shunt infection (50%), followed by malposition (27.8%), blockage (15.6%), and shunt dislocation (6.7%). Surgical site infection increased the likelihood of shunt revision by 29.8%. Shunt revision was 31% more likely in operations lasting longer than 45 min. Intraoperative involvement of a junior surgical trainee raised the possibility of revision by 25%, and a revised VPS system is 13.2 times more likely to fail, integrating into longer hospital stays. Conclusion: The emphasis on lengthy surgeries and a surgeon’s skill as risk factors for revisions demonstrates a need for change in surgical practice to enhance surgical outcomes. Given the high likelihood of re-revisions after VPS revisions, it is suggested that the surgical practice of the index operation be enhanced to reduce complications. These findings serve as an initial guide for developing interventional techniques to enhance good surgical outcomes.

Background: Traumatic brain injury is a leading cause of mortality and morbidity in Africa. Craniotomy is the surgical standard for acute extra-axial hematomas that is not realistic in LMIC due to deficient human and operative resources. Burr hole surgery may be an alternative in resource-limited settings. This study aimed at determining outcomes and factors associated with burr hole surgery as definitive management of traumatic extra-axial hematomas. Methods: Hospital-based cross-sectional study of patients with acute traumatic extra-axial hematomas who underwent burr hole surgery. Data were extracted from the patient's medical records after confirmation of the surgery and CT scan findings. The data were entered to SPSS 25 for analysis where a bivariate analysis was done. Results: 156 participants were enrolled; 149 (95.5 %) were males. The mean age of the participants was 35.33 (SD 15.37) years. The mean arrival GCS was 11.76 ± 3.59. Most participants had mild, followed by severe then moderate (55.8 %, 24.4 %, and 19.9 % respectively) TBI. 118 (75.6 %) participants had good outcomes and the overall in-hospital mortality was 18.6 %. 109 (69.9 %) had epidural hematomas mostly (21 %) in the parietal lobe. 30 (19.2 %) had brain herniation syndromes. Poor outcomes were associated with age above 50 years, severe TBI, motor response <4, abnormal pupil size, other injuries, ICU admission, SDH, midline shift >10 mm, cerebral edema, and brain herniation syndromes. Surgical site infection and hemostasis by packing were associated with a long length of hospital stay. Conclusion: Burr hole surgery is still a safe, effective, and simple life-saving procedure in patients with acute hematomas in resource-constrained areas.

Background: Despite technological advancements in clinical medicine, the diagnosis of acute appendicitis remains a challenge owing to its divergent presentation. For years, the Alvarado score has been the mainstay for the clinical diagnosis of appendicitis; however, it has led to a high negative appendectomy rate (NAR) with post-appendectomy consequences. This study aimed to establish a NAR to further improve the diagnosis and management of appendicitis. This study aimed to determine the NAR by evaluating the clinical diagnosis versus histological correlations in post-appendectomy patients in northern Tanzania. Materials and Methods: This hospital-based cross-sectional study was conducted between March 2020 and March 2023 at a referral hospital in northern Tanzania. Data were extracted from patient records to assess the clinical Alvarado score and were compared to histological findings to determine the NAR. Results: A total of 99 participants were enrolled in the study, with mean age of 33.2 years (+/- 18 years), and the NAR was 12.5%, highest in females (8%) compared to males (4.5%). Histology confirmed appendicitis in 85 patients (85.9%). Conclusion: NAR remains a burden globally, with an acceptable value of 20%. This study showed a reduction in NAR at our institute using various diagnostic modalities. NAR should be incorporated as a quality metric to judge institutional performance and reduce morbidity and mortality.

INTRODUCTION AND IMPORTANCE:Cystic echinococcosis (CE) is a chronic illness caused by the tapeworm Echinococcus granulosus. It is classified as a neglected disease and is a priority according to the World Health Organization. CE is prevalent in populations engaged in specific livestock practices and is associated with poor living conditions.CASE PRESENTATION:41-year-old female Maasai patient who presented with symptoms of cough, dyspnea, fever, and weight loss. Physical examination and CT scans confirmed the presence of cystic masses in the lungs and liver. The patient underwent a thoracotomy procedure to address complications from a hepato-pleural fistula.CLINICAL DISCUSSION:Echinococcus is a tropical disease that affects over a million people worldwide annually. It primarily affects communities engaged in animal husbandry and causes the development of hydatid cysts. Diagnosis can be challenging due to prolonged asymptomatic periods. In rare cases, cysts can rupture into the pleura and bronchial tree, causing respiratory symptoms. Surgical treatment involves the systematic evacuation of cysts and visceral cyst excision, with concurrent laparotomy and thoracotomy being the optimum approach.CONCLUSION:Hydatid cysts remain a significant health problem, particularly when large pleural cysts occur with subphrenic liver cysts. Surgical intervention, specifically a single-stage thoracotomy, is the preferred first-line treatment. This approach allows for both cysts to be addressed in a single procedure, providing effective and efficient treatment to patients.

Background: Despite its postoperative risks, the insertion of a ventriculoperitoneal shunt (VPS) is a very routine surgery in patients with hydrocephalus. Nonetheless, lengthy surgeries and the surgeon's experience have been shown to have a considerable effect on surgical outcomes. We present a review of these characteristics in hydrocephalus patients with shunt complications. Methods: This study was carried out at a single-centered facility between March 2020 and March 2023 that involved 315 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-ups for 3 months, at which time their characteristics in relation to shunt complications were evaluated. The SPSS version 25 was utilized for analyzing the data. Results: Following up, 119 patients (37.8%) out of the 315 patients who were included had shunt complications. Shunt infection was the most prevalent complication (50%), and the majority of patients (64; 20.3%) were female. Communicating hydrocephalus contributed to 61.3% of the complications. A junior surgical trainee's involvement was responsible for 48.7% of the complications and had a 20% chance of resulting in postoperative shunt complications. Lengthy surgery durations of more than 45 minutes were 3.3 times more likely to result in VP shunt complications. Conclusion: The study found that 37.8% of shunt complications are linked to lengthy surgeries and low surgeon experience, impacting routine surgical practice and hydrocephalus patients' care, especially in low-resource settings. The findings suggest a need for a second look at current surgical practices and further research to develop innovative strategies to improve patient outcomes and improve surgical outcomes.

BackgroundIn 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach.MethodsParticipatory Action Research workshops were held in the 3 countries in July-October 2017 and in October 2018-July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants' perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres.ResultsAll groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site.ConclusionThe inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams.

Introduction and importance: Penetrating neck injuries (PNIs) are common and are associated with arterial injuries in 10-25 % of the cases, with carotid artery twice as frequent as to vertebral arteries. Carotid artery injury constitutes about 22 % of all cervical vascular injuries.Case presentation: We present a case of a 44-year-old male who sustained penetrating neck injury in a motor traffic crash. He presented with monoplegia of his right upper limb and an open wound on the left side of his neck which was not actively bleeding hence surgical debridement was done and sutured. CT angiography and CT-scan brain concluded of left common carotid thrombosis secondary to penetrating neck trauma with ischemic brain injury. Patient was successfully managed conservatively.Clinical discussion: The general mortality rate in PNI with associated cervical vascular injury is approximately 66 %. Artery dissection occurs when the intima tears causing intramural hematoma leading to narrowing or occlusion. CT angiography is the best and fastest modality to assess these injuries and management depends on the clinical bases of the patient.Conclusion: Neck is vulnerable to external trauma because it is not protected by the skeleton. The neck contains vital structures such as the trachea, esophagus, blood vessels and nervous system organs. Vascular injuries can be life-threatening owing to its prompt clinical assessment and investigation.