Isolated cerebellar tuberculoma mimicking a malignant posterior cranial fossa tumor in a healthy child: A rare case report from Tanzania.

INTRODUCTION: Tuberculosis (TB) is one of the leading causes of mortality and morbidity in the world, especially in developing countries that account for 98 % deaths among TB cases. Although TB is primarily a disease of the lungs, extrapulmonary manifestations have been reported. Although CNS tuberculoma mostly affects immunocompromised people, it also affects healthy people at extremes of age. Imaging of intracranial tuberculoma may look like neurocysticercosis, and other ring-enhancing lesions hence imposing a diagnosis dilemma. CASE PRESENTATION: A 13-year-old female presented with headache, convulsions, blurry vision, and gait disturbance for six months. Brain imaging showed a left cerebellar lesion with obstructive hydrocephalus. She underwent ventriculoperitoneal shunting on admission, then sub-occipital craniotomy with tumor resection one week later. Histology confirmed a diagnosis of tuberculoma. She was given anti-tuberculosis medications and she was discharged home healthy without any of the symptoms she had on admission. DISCUSSION: Although only about 1 % of active tuberculosis cases presents as CNS TB, 5-10 % of intracranial space-occupying lesions in developing countries are tuberculomas. Provisional diagnosis of tuberculoma can be made through clinical history, examination, and neuroimaging. However, it is challenging because neurocysticercosis also appears as a ring-enhancing lesion in the brain and has almost similar prevalence in low-income settings. Being immunocompetent with no history of tuberculosis or constitutional symptoms, a diagnosis of tuberculoma was only confirmed by histology. CONCLUSION: A high index of suspicion for CNS tuberculomas in TB endemic areas should be kept in patients presenting with features of intracranial space-occupying lesions regardless of the absence of risk factors.

Burr hole as a management for extra axial hematomas in a low-resource setting.

INTRODUCTION AND IMPORTANCE: In a low-resource setting, the availability of neurosurgeons and neurosurgical equipment for neurosurgery has proved to be a challenge for the management of extra-axial hematomas hence general surgeons perform burr hole surgeries for emergencies. CASE PRESENTATION: We share our experience with three patients who presented with extra-axial hematomas and managed successfully in our institute with craniostomy as the surgical approach. CLINICAL DISCUSSION: Traumatic brain injury is a major global health burden as it is a leading cause of death among the middle-aged population. Mortality associated with brain injury is highest in low- and middle-income countries. From our experience, we had good outcome in terms of improved Glasgow Coma Scale and overall clinical status in those who underwent burr hole surgery for extra axial hematoma. CONCLUSION: The need for neurosurgeons in sub-Saharan Africa is high but training comes at a cost hence general surgeons can perform life-saving emergency procedures with good outcomes.

Chylous ascites: Our experience from a resource-limited setting.

INTRODUCTION AND IMPORTANCE: Chyle is a lipid-rich, milky-appearing fluid originating from lymph tissues. Chylous ascites is the collection of chyle in the peritoneal cavity and is a rare pathology. CASE PRESENTATION: In this case report we share our experience of successfully managing chylous ascites conservatively from a resource-limited setting. CLINICAL DISCUSSION: There are numerous causes hence management includes treating the cause. Generally responds well to conservative management however some cases require surgical intervention. CONCLUSION: Ascitic tapping is an effective diagnostic and therapeutic tool is chylous ascites.

Case series of high-grade soft tissue sarcoma of the lower limb with delayed diagnosis: Experience at a tertiary hospital in northern Tanzania.

INTRODUCTION AND IMPORTANCE: Soft tissue sarcoma is an uncommon form of cancer with poor prognosis. Early diagnosis and treatment are vital for improving the treatment outcomes. CASE PRESENTATION: We report a series of high-grade soft tissue sarcomas of the lower extremity with delayed diagnosis to gain insight into the presentation, treatments and outcomes for this rare disease and to determine whether limb-salvage surgery yields reasonable outcomes. CLINICAL DISCUSSION: Timely health seeking has an impact on the outcome of the treatment of any particular disease. Patient delays are usually socio-economic factors. Soft tissues sarcomas are uncommon malignant tumors that even managed adequately have a poor 5-year survival. Limb salvage becomes questionable especially when patients present late with adverse symptoms. CONCLUSION: In this series, we found that patients presented late and this led to unfavorable oncological outcomes, also limb salvage was not an option due to delayed presentation. Thus, early diagnosis is recommended so as to improve treatment outcome.

A stubborn nasogastric tube: self-knotting of a nasogastric tube.

Nasogastric tubes (NGT) are widely used and generally harmless as such, complications are uncommon. NGT knotting is one such complication. We report a 45-month-old female with spontaneously knotted NGT that was identified and safely removed without complications. NGT knotting detection needs a high index of suspicion; if not detected and managed in a proper way, it may lead to severe complications. We discuss this case to raise awareness of this complication and how to minimize the likelihood of it happening and improve patient outcome.

Esophageal stenosis: A case of delayed dysphagia in an infant from northern Tanzania.

INTRODUCTION AND IMPORTANCE: Congenital stenosis of the esophagus is often overlooked in children with feeding difficulties leading to delayed diagnosis and treatment. This can have detrimental effects on the child's growth and general health, ranging from malnutrition to life-threatening complications such as aspiration pneumonia. CASE PRESENTATION: We present a case diagnosed at the age of 3 years when the child already had developed moderate malnutrition and offer the diagnostic and surgical findings in the hope of helping others suspect and clench the diagnosis early. CLINICAL DISCUSSION: With an incidence of up to 1 in 25,000, congenital stenosis of the esophagus is definitely a congenital malformation worth knowing about, particularly since misdiagnosis often leads to delayed intervention as was in our case. History of feeding difficulty and failure to thrive are often the triggers to seeking medical attention. The confirmation can be easily made with contrast imaging opening up the possibility for surgical and non-surgical management. CONCLUSION: With a high index of suspicion, diagnosis can be made relatively easily, allowing for early intervention, which can prove to be lifesaving.

Sigmoid volvulus in pregnancy: a case report.

INTRODUCTION: Sigmoid volvulus in pregnancy is a rare cause of intestinal obstruction with high maternal and fetal morbidity and mortality if not diagnosed and managed early. CASE PRESENTATION: A 29-year-old female (Chagga by tribe) presented with clinical features of intestinal obstruction 24 weeks into her second pregnancy. She had symptoms for one week. An emergency laparotomy was performed whereby gangrenous sigmoid volvulus was found; thus, it was resected and Hartmann's colostomy was raised. Unfortunately, she experienced intrauterine fetal death post-operatively. She was discharged clinically stable. CONCLUSION: Early diagnosis and management can prevent adverse effects such as bowel ischemia and preterm labor. Because classic clinical and radiological features may not be evident, high degree of suspicion is warranted.