South African Journal of Surgery最新文献

Breast tuberculosis (TB) is a rare form of extrapulmonary tuberculosis, accounting for 0.1% of all breast conditions globally, with a higher incidence in endemic regions such as India, East Asia, and sub-Saharan Africa. It can mimic breast carcinoma, complicating timely diagnosis. Early recognition and proper treatment are crucial for favourable outcomes in breast TB. This review offers a detailed examination of breast TB, and presents a diagnostic pathway designed to improve the diagnosis and management of the disease. This literature review considers the epidemiology, pathophysiology, clinical features, and diagnostic approaches, highlighting the need for a high level of clinical suspicion, particularly in TB-endemic areas. By providing a structured diagnostic framework, this paper aims to improve prompt and accurate diagnosis of breast TB, enhancing patient care and outcomes.

Background: Minimal access surgery (MAS) has been on the rise internationally; however, there seems to be limited information regarding research and training in the general and paediatric surgical (GPS) disciplines in South Africa (SA). We performed a scoping review to identify knowledge gaps that will assist us in developing strategies to improve the delivery and training of MAS within the GPS disciplines in SA.

Methods: The method of the review - 2020 JBI guide and PRISMA for scoping reviews. We searched online databases and websites for publications from 1990 to 2022. Interviews were conducted with senior MAS trainers from training sites.

Results: Full texts of 194 articles were reviewed. Most publications were related to trauma, followed by laparoscopic appendicectomy and laparoscopic cholecystectomy. Paediatric MAS comprised 11.9% (21), and training was the focus in 4.5% (7) of all the publications. Published limitations regarding MAS included access to training and equipment.

Conclusion: This scoping review has summarised the current MAS research and training within the GPS disciplines in SA. We have highlighted the limitations that exist, which can direct the focus of research and training to improve the delivery of MAS within the GPS disciplines.

Summary: A 40-year-old male, known to be positive with the human immunodeficiency virus (HIV), presented with a large perianal mass and faecal obstruction. His CD4 count was 121 cells/mm3 suggesting advanced HIV disease, and he was started on second-line antiretroviral therapy. Magnetic resonance imaging (MRI) confirmed a large mass involving the anorectal junction. A biopsy of the tumor revealed a plasmablastic lymphoma (PBL). A diverting colostomy was performed for faecal obstruction. While awaiting chemotherapy treatment, the tumour rapidly decreased in size with complete clinical resolution. PBL is rare and has a dismal prognosis. Spontaneous regression of PBL has been reported but regression on second-line antiretroval therapy has not been previously described.

Background: Burn injuries are a global public health crisis and a significant cause of morbidity and mortality in low- to middle-income countries (LMICs). Sub-Saharan Africa carries an extraordinary burden of burn injuries amongst children under 18 years of age. The purpose of this study was to assess burn wound outcomes, and parental health-seeking behaviour of children managed as outpatient burns.

Methods: A retrospective audit was performed of children presenting with burns to the emergency centre at Red Cross War Memorial Children's Hospital during two seasonal periods. Standard demographics, wound management and outcome were reviewed. Adherence to provincial burn referral was also assessed. Descriptive statistics were performed on information gathered using a standardised questionnaire.

Results: One thousand one hundred and ninety-one (1 191) children with burns were attended to in the study period, 57 (5%) were excluded due to incomplete records. There was a relative increase in the number of patients (158, 32%) in winter/spring compared to summer/autumn. Two hundred and eighty-nine (24%) patients did not warrant admission, and this subgroup cohort was the study's focus of enquiry. Most of these, 157 (54%), were male, and the average age was 32.5 (R 2-153) months. The average TBSA was 2.5% (R 1-8%) and scalds predominated, 252 (87%). Many patients (148, 51%) defaulted follow-up appointments due to transport difficulties and financial constraints.

Conclusion: This study demonstrated similar demographics, burn injury patterns and seasonal variability compared to international literature. Referral criteria were strictly adhered to by referral facilities. Fiscal constraints determine the ability to attend follow-up appointments. Telemedicine programmes have been instituted as a solution.

Acute appendicitis has afflicted humankind throughout our existence but has been a surgical disease for little over one hundred and fifty years. Leonardo da Vinci first drew the appendix in 1508, and several anatomists described it over the next two centuries. These included Berengarius in 1522, Andreas Vesalius in 1543 and Giovanni Battista Morgagni in 1719.¹ Several pathologists began to define and elucidate the pathophysiology of acute appendicitis and a number of authors from the enlightenment onwards began to describe what was termed typhlitis until Fitz, described a large series of acute appendicitis in 1886. The first recorded operation for acute appendicitis was by the expatriate French surgeon Amyand in London in 1753.

Summary: This report describes a rare case of a gastric trichobezoar complicated by gastric perforation in a 14-year-old female. The patient presented with severe abdominal pain and vomiting. Computer tomography (CT) scan showed a pneumoperitoneum with a large trichobezoar in the stomach and free intra-abdominal fluid. The patient underwent an emergency laparotomy, where a perforation on the lesser curve of the stomach was detected and a large trichobezoar that was occupying the entire stomach was removed. Histology confirmed a benign gastric ulcer most likely resulting from pressure necrosis due to the bezoar.

A 55-year-old female presented with a 6-year history of a scalp mass. Clinical assessment revealed a non-toxic right thyroid nodule and 18 x 17 cm scalp mass with facial varicosities (Figure 1). A skull X-ray (Figure 2a) and brain computerised tomography (CT) scan (Figure 2b) revealed extensive erosion of the parieto-occipital bones and a lobulated mass extending within the right parietal lobe. Ultrasoundguided core biopsy of the scalp mass confirmed the clinical suspicion of metastatic follicular thyroid carcinoma. A staging CT scan demonstrated lung metastases, but no other bone metastases.

Summary: Trans-stomal herniation, where abdominal contents protrude through the stomal aperture and lie between the two intestinal walls of the stom a is a very rare complication of stomas and can resemble a stomal prolapse. We describe a unique case of a stomal prolapse and concurrent trans-stomal small bowel herniation, which required emergency stoma refashioning for incarceration.

Background: Tracheobronchial tree injuries (TBTI) represent a type of trauma that is rare among all trauma patients, with a paucity of literature available in Africa. These may result from blunt or penetrating trauma to the neck and thorax (chest). The purpose of this study was to document the spectrum of injury and the experience with surgical and nonsurgical management and outcome of TBTI in the KwaZulu-Natal setting.

Methods: This was a single-centre retrospective analysis of all patients with TBTI referred to Inkosi Albert Luthuli Central Hospital (IALCH) over 21 years. Data collection extended from 1 January 2003 to 31 December 2023.

Results: Penetrating trauma was the most common cause of injury, with a total of 32 patients (86%), while blunt injuries were seen in five patients (14%). Anatomically, there were 20 cervical tracheal injuries, eight thoracic tracheal injuries, six bronchial injuries and three multiple site injuries. A total of 27 (73%) patients underwent surgery, while 10 (27%) patients were managed conservatively. Overall mortality was seen in four patients and one patient survived with long-term disease sequelae. The overall median duration hospital stay was 6 days (IQR 4-10).

Conclusion: TBTI remains a rare injury. Sepsis was one of the main causes of death in both surgical and conservative management. Conservative management in selected cases is just as effective as definitive surgical management. Overall, there was good outcome with TBTI in this centre.

Summary: We present a rare case of a massive gastrointestinal bleed from a gastrointestinal stromal tumour (GIST) originating from the jejunum. GISTs make up only 0.1-3% of all gastrointestinal neoplasms and typically present as an occult or chronic gastrointestinal bleeding. Acute gastrointestinal bleeding from the small bowel is uncommon and can be a challenging diagnosis to make.