A Rare Case of Dysphagia Secondary to a Large Oesophageal Lipoma

Dysphagia is considered a warning symptom that requires exclusion of significant pathology such as oesophageal cancer, especially in elderly patients. Benign neoplasms of the oesophagus are rare. We report the case of a 69-year-old lady who presented with a five years history of infrequent intermittent dysphagia that had rapidly progressed over one month. This was associated with globus sensation, weight loss, intermittent episodes of stridor and aspiration pneumonia. Investigations revealed a large oesophageal lipoma in the proximal oesophagus extending down to the lower oesophagus. This was successfully resected via a left cervical approach. She remained well two years after the surgery.

Routine chest drainage after patent ductus arteriosis ligation is not necessary

Introduction Chest drain insertion after surgical patent ductus arteriosus (PDA) ligation creates significant morbidity in terms of pain, pleural space infection, reduced mobility as well as prolonged hospital stay. We investigated the safety and efficacy of performing drainless thoracotomy closure following PDA ligation in a paediatric population. Materials and Methods Retrospective analysis of data collected from 13 paediatric patients undergoing PDA ligation at RIPAS hospital by a single surgeon over a period of five years (2001 to 2006) was performed. All continuous data were presented as mean ± standard deviation. Results PDA ligation was performed via a left thoracotomy in 13 paediatric patients with a mean age of 2.24 ± 2.03 years (ten females and three males). Mean duration of the procedures was 67 ± 12 minutes. There was minimal blood loss and no transfusions were required. Postoperatively, ten patients required only oral paracetamol for pain relief. Two patients required additional non steroidal anti-inflammatory drugs (NSAIDs). One patient had one dose of pethidine immediately post-operatively. Post-operative chest radiographs confirmed full expansion of the left lung except in one patient who had a small apical pneumothorax. Two other patients developed mild surgical emphysema despite full expansion of the left lung. All three complications resolved spontaneously after a day. Median post-operative stay was two days. There were no cases of left recurrent nerve injury and no mortality. Conclusion Routine chest drainage is not necessary following uncomplicated surgical PDA ligation and patients recovered more quickly and were discharged earlier.