DISTAL ILEAL STENOSING SUBSEROSAL LIPOMA: A CASE REPORT.

Lipoma is the commonest soft tissue tumour and ubiquitous in distribution. The gastrointestinal tract is a rare site for this neoplasm. This 38 years old patient presented to the surgical emergency unit of the Jos University Teaching Hospital with features of intestinal obstruction which was confirmed by plain abdominal X-ray. Patient was resuscitated and had exploratory laparotomy. At surgery, a dilated, oedematous, and pale segment of ileum was seen measuring 56 cm in length and 10 cm short of the ileo-caecal junction, where an obstruction had occurred.The distal segment was collapsed. A limited right hemi-colectomy was done with ileocolic anastomosis. Specimen received atthe Histopathology Laboratory consisted of 45 cm of the ileum, the caecum, appendix, and proximal 25 cm of the colon in continuity. There was stenosis affecting the distal 30 cm of the ileum. The wall of the stenosed part of ileum had intramural fat at the sub-serosal locale. Histology confirmed the presence of sheets of matured adipocytes between the muscularispropria and serosa. Patient condition improved and was discharged seven days after surgery. This case is reported five months after surgery. We recommend that lipoma be at all times considered in the differential diagnosis of intestinal obstruction.

Role of pathology in improving health care in poor resource environments.

BACKGROUND: The task of a Pathologist is to provide an accurate specific and sufficiently comprehensive diagnosis to enable the clinician to develop an optimal plan for patient treatment and to a large extent possible, estimate prognosis. Modern Pathology practice is closely linked with all clinical departments and it serves as a bridge between the beginning of disease and how the disease ends. It is obvious that Pathology practice is central to patient care and it is the science behind the cure. However the paucity of pathologist in resource poor countries has posed a challenge to effective health care delivery. METHODOLOGY: This is a review article aimed at reviewing the challenges of Pathology practice in poor resource environment. The author reviewed literature in Medline and other journal on challenges facing health care in developing countries of sub-Saharan region of Africa. Solutions to some of these challenges were also provided and the way forward for the practice of Pathology in Africa. RESULT: Literature review showed that there were negative factors that affected the effective practice of pathology. These factors are:-Lack of political will of most Governments to appropriately provide resources, according to United Nation standard. Absence of National Health Insurance Policy, population control, and infrastructural support. Poor funding, training and, lack of motivation which is prevalent in most resource poor countries. CONCLUSION: Private Partnership with public health institution, donor agencies and non-government agencies is believed to be the only solution to good clinical practice including pathology practice.