Sternal tail: A new entity; A case report.

INTRODUCTION AND IMPORTANCE: Supernumerary ribs are very rare. They may occur at any level of the spine. We present here a case of an unusual localization of an extra rib that has not been previously described in the literature. CASE PRESENTATION: A 4-year-old girl, with no medical history, presented with a congenital deformity in the sternal region mimicking a tail. The tail-like structure had a bony axis and was covered by normal skin and hairs. A computed tomography of the chest demonstrated that this structure was an abnormal bone articulated with the the sternum. For cosmetic purposes, we have decided to resect the malformation. On histopathological examination, it was a supernumerary rib. CLINICAL DISCUSSION: A review of the literature reveals a global incidence of cervical ribs ranging from 0.04 % up to 4.5 %, intrathoracic ribs in about 50 cases to date and very few reports on supernumerary ribs in the lumbar and sacral region. We were unable to find any similar cases of supernumerary ribs in the sternum. CONCLUSION: Supernumerary ribs are rare and benign congenital anomalies. This case report describes an unusual localization of an extra rib in the sternum mimicking a tail.

Enhanced recovery after thoracic surgery in low- and middle-income countries: Feasibility and outcomes.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) applies multimodal, perioperative, and evidence-based practices to decrease postoperative morbi-mortality, the length of hospital stay, and hospitalization costs. Implementing enhanced recovery after thoracic surgery (ERATS) in low- and middle-income countries (LMIC) is problematic. This randomized controlled trial evaluated the feasibility and effectiveness of an ERATS protocol adapted to LMIC conditions in Tunisia. MATERIALS AND METHODS: We conducted this randomized controlled trial between December 2015 and August 2017 in the Thoracic and Cardiovascular Surgery Department at Habib Bourguiba University Hospital of Sfax, Tunisia. RESULTS: One hundred patients undergoing thoracic surgery were randomly allocated to the ERATS group or Control group. During the postoperative phase, 13 patients (13%) were excluded secondary. These complication rates were lower in the ERATS group: lack of reexpansion (14.63% vs 16.10%: p = 0.72), pleural effusion (0% vs 10.86%, p = 0.05), and prolonged air leak (17.07% vs 30.43%, p = 0.14). The pain level decreased significantly in the ERATS group from postoperative H3 (p = 0.006). This difference was significant at H6 (p = 0.001), H24 (p = 0.05), H48 (p = 0.01), discharge (p = 0.002), and after 15 days (p = 0.01), with a decreased analgesic consumption. The length of hospital stay was shorter in the ERAS group (median six days vs seven days, p = 0.17). CONCLUSION: This study provides an adapted ERATS protocol, applicable regardless of the surgical approach or the type of resection and suitable for LMIC hospital's conditions. This protocol can improve the postoperative outcomes of thoracic surgery.