Transhiatal esophagectomy for distal esophageal cancer during pregnancy: A rare and challenging case report.

INTRODUCTION: Esophageal cancer during pregnancy is extremely very rare. The diagnosis of esophageal cancer during pregnancy is not easy because of overlapping clinical presentation of the disease and pregnancy related symptoms. The management of esophageal cancer during pregnancy is also very challenging. This is because of the absence of standard treatment guidelines and all treatment options have significant risk both on the mother and fetus. CASE PRESENTATION: We present a 35 years old multipara women presented with difficulty of swallowing solid meal initially and later both to solid and liquid diet of 3 months duration and significant weight loss of same duration at gestational age of 27 weeks whom successfully treated with trans hiatal esophagectomy and discharged from the hospital uneventfully. DISCUSSION: Proper patient evaluation and high index of suspicion is very important in order to detect esophageal at its early stage. Multidisciplinary and individualized patient approach should be advised to manage esophageal cancer during pregnancy as there is no standard treatment guideline. For resectable esophageal cancer during pregnancy, esophagectomy can be a treatment option as free margin tumor resection with lymph node clearance is the only curative treatment option for esophageal cancer. CONCLUSION: Esophagectomy can be one of the option of treatment for pregnant women diagnosed with resectable esophageal cancer without causing major risk both on the patient and pregnancy.

Right side traumatic diaphragmatic hernia presented after 20 years with shortness of breath; a rare case presentation, and literature review.

INTRODUCTION: A right side diaphragmatic injury was linked to serious trauma to the abdomen, pelvis, and chest. The most significant type of injury was blunt abdominal trauma sustained in a car collision. The left side was more likely than the right to experience herniation. The stomach and colon were the most often herniated abdominal viscera. In the same location as the diaphragm rupture, there were rib fractures, hemothorax, and liver damage. Delayed diaphragmatic rupture with diaphragmatic hernia is rare and has a mysterious nature. CASE PRESENTATION: A 68 years old female patient who has repeated history of shortness of breath, for which she treated as lung infection presented with sudden exacerbation of shortness of breath, she witnessed history of blunt trauma 20 years back and up on investigation bowel herniation to the chest cavity diagnosed. Posteriolateral thoracotomy done, the herniated bowel reduced and the diaphragmatic defect repaired. The patient significantly improved and discharged from the hospital smoothly on 4th postoperative day. DISCUSSION: Careful recording of past history and physical examination are the best approaches in diagnosing delayed presentation of traumatic diaphragmatic rupture. CT scan with reconstruction of the diaphragm is helpful in both diagnosis and differential diagnosis. Surgical therapy after diagnosis is the best treatment. CONCLUSION: Delayed right side diaphragmatic hernia is a rare entity resulting in grave consequences, In a patient with history of trauma there should be a high index of suspension and patients should undergo imaging and surgical management is the best treatment.

Effectiveness of Single Chest Tube vs Double Chest Tube Application Postdecortication: Prospective Randomized Controlled Study.

BACKGROUND: Draining the chest cavity with 2 tubes is a common practice among thoracic surgeons. This research was conducted in Addis Ababa from March 2021 to May 2022. A total of 62 patients were included. STUDY DESIGN: This study was conducted to investigate the superiority of either single or double tube insertion after decortication. Patients were randomized in a ratio of 1:1. In group A, 2 tubes were inserted; in group B, single 32F tubes were inserted. Statistical analyses were performed using Statistical Package for Social Sciences version 27.0, Student's t test and Pearson chi-square test. RESULTS: The age range of patients was 18 to 70 years, with a mean of 44 ± 14.4434 years; the male to female ratio was 2.9:1. The dominant underlying pathologies were tuberculosis and trauma (45.2% vs 35.5%); the right side was more involved (62.3%). Drain output was 1,465 ± 1,887.9751 mL in group A vs 1,018 ± 802.5662 mL in group B (p value = 0.00001); the duration of drains was 7.5498 ± 11.3137 days in group A vs 3.8730 ± 1.4142 days in group B (p value = 0.000042). The degree of pain was 2.6458 ± 4.2426 vs 2.000 ± 2.1213 in group A and group B, respectively (p value = 0.326757). The length of hospital stay was 21.5818 ± 11.9791 days in group A vs 13.6091 ± 6.2048 days in group B (p value = 0.00001). Group A had air leak of 90.3% vs 74.2% in group B; subcutaneous emphysema was 9.7% in group A and 12.9% in group B. There was no fluid recollection, and no patients required tube reinsertion. CONCLUSIONS: The placement of a single tube after decortication is effective in reducing drain output, time of drain, and hospital stay. There was no association with pain, and there was no effect on other endpoints.