East and Central African Journal of Surgery

Standing on the Shoulders of Giants, We Move Forward: Honoring Professor Ignatius Kakande

Abebe Bekele — 2024-11-27

In this issue of The East and Central African Journal of Surgery (ECAJS), we reflect on the remarkable contributions of Professor Ignatius Kakande, our second editor-in-chief and a guiding force behind the journal’s conception, birth and growth. Professor Kakande’s legacy is deeply woven into the fabric of ECAJS and COSECSA, where his influence as a senior professor in surgery, a mentor, and fatherly figure has left an indelible mark on countless colleagues and students alike. His commitment to building a platform for African surgical voices has transformed ECAJS into a respected journal, showcasing the innovations, challenges, and triumphs of surgical practice across the continent.

Abstracts of the 16th ECSACONM Biennial Scientific Conference: 11th - 13rd September 2024

2024-11-28

Bilateral Retinoblastoma with Lumbar Spine and Forearm Metastasis, Six Years after the Initial Presentation: A Rare Case Report

Bezawit Teferi — 2024-11-22

Retinoblastoma is one of the most common childhood intraocular tumours. Extra-ocular extension is rare, but the risk of systemic metastasis increases with late diagnosis. We report a case of retinoblastoma metastasis to the forearm six years after the first diagnosis was made and treated. It is believed to add to our understanding of retinoblastoma metastasis, and this relatively uncommon disease course.

Advanced Mucinous Colorectal Carcinoma in a Teenager: A Case Report of a Changing Age Paradigm

Jay Lodhia — 2024-11-19

Colorectal cancer (CRC) is predominantly a disease of older adults, but its incidence among younger populations has been rising significantly. While the overall global incidence and mortality of CRC have declined due to population-based screening programs, the rate of early-onset colorectal cancer (EOCRC) in individuals under 50 has increased sharply. The reasons behind this alarming trend remain unclear. Although hereditary cancer syndromes can predispose individuals to EOCRC, the majority of these cases are sporadic, and known lifestyle risk factors such as diet, smoking, and alcohol alone do not fully explain the rise. This phenomenon is global and affects both males and females. A low clinical index of suspicion in young adults often leads to delayed diagnosis, resulting in the detection of CRC at advanced stages, which contributes to poorer outcomes, particularly in younger patients. In this case report, we describe a 19-year-old male who presented with acute abdominal distention and bloody diarrhea. Imaging revealed an obstructive colorectal tumor with extensive metastasis to the mesentery, omentum, liver, stomach, and anterior abdominal wall. An emergency colostomy was performed to relieve the obstruction, but the patient ultimately succumbed to the aggressive nature of the disease nine days later. This case underscores the importance of recognizing colorectal cancer in young patients and raises awareness of the need for early diagnosis and intervention. By increasing vigilance for EOCRC in both primary and tertiary care settings, healthcare providers can improve patient outcomes through timely referrals and treatment.

Presentation and Challenges Associated with Management Of Children with Craniofacial Anomalies at Kiruddu Regional Referral Hospital: A Case Series Reflecting On Current Service Provision.

Adelaida Elisamehe Mghase — 2024-11-19

Craniofacial anomalies encompass a wide range of congenital malformations affecting the head and face, creating substantial medical, social, and psychological challenges for children and their families. In low-resource settings like Uganda, managing these conditions is especially difficult due to limited access to multidisciplinary specialized care. The shortage of Craniofacial Surgeons and inadequately equipped healthcare facilities further complicate the delivery of proper treatment. This study presents three cases of children with craniofacial anomalies attended at Kiruddu Regional Referral Hospital in Uganda, highlighting the significant gaps in care and the pressing need for enhanced medical resources in East Africa.

Understanding the Impact of COVID-19 on Zambia’s FlySpec Program in Delivering Specialized Surgical Care to Rural Populations

Tensae Assefa — 2024-11-19

Background: Orthopedic injuries are very common among the global burden of surgical disease. The Department of Orthopedic Surgery at the University of Zambia is home to FlySpec, a medical charity that facilitates surgical care delivery to the most remote Zambian communities. We studied the impact of the COVID-19 pandemic on the FlySpec program. Methods: We analyzed yearly FlySpec reports from 2018 to 2022 to identify differences in various surgical care delivery metrics. Results: We found that there was a reduction in the number of hospital visits, patients seen, and operations performed Post-COVID-19 compared to Pre-COVID-19. There was no difference in the number of FlySpec car visits or air visits in relation to the COVID-19 pandemic. Conclusions: The COVID-19 pandemic significantly reduced the clinical activity of FlySPec.

Osteosarcoma diagnosis and treatment at a tertiary hospital in Blantyre, Malawi: A retrospective, descriptive study

Vincent Lewis Mkochi — 2024-11-19

Introduction

Osteosarcoma is a rare and aggressive bone malignancy that often affects children and young adults. In Malawi, osteosarcoma accounts for 2.2% of all registered bone tumors. However, little is known about the patterns of diagnosis and treatment of this disease in this setting. Delays in diagnosis and treatment may contribute to poor outcomes and survival. Therefore, this study aimed to describe the clinical features, diagnostic methods, and treatment modalities associated with osteosarcoma in Malawi. The study also investigated timelines between symptom onset, healthcare consultation, diagnosis, treatment, and outcomes.

Method

We conducted a retrospective review of medical records of 25 patients who were diagnosed with osteosarcoma at Queen Elizabeth Tertiary Hospital, in Blantyre- Malawi, between January 2011 and December 2016. We extracted data on patient demographics, presenting symptoms, diagnostic procedures, incisional biopsy histological findings, treatment options, and time intervals from symptom onset to first presentation at a tertiary hospital, and from diagnosis to treatment initiation. We obtained approval, to conduct study, from the College of Medicine Research and Ethics Center (COMREC) (P.02/18/2364).

Results

Out of 11,165 malignancies registered during the study period, 25 (0.22%) were osteosarcoma cases. The median age of the patients was 25.04 years (SD +/-11) with an equal sex distribution. The most common presenting symptoms were pain (100%) and swelling (92%). The median duration from symptom onset to first visit at tertiary hospital being 8.5 months and time of diagnosis to treatment with a median duration of 16.5 days. The diagnosis was confirmed by histology in 14 (56%) cases and by radiography in 11 (44%) cases. No tumor grade was recorded in the histology reports. The treatment carried out included amputation (48%), palliative care (symptom supportive care) (32%), limb salvage surgery (4%), and neoadjuvant chemotherapy (4%). Three patients (12%) refused amputation. No patient received adjuvant chemotherapy.

Conclusion

Osteosarcoma is a challenging disease to diagnose and treat in Malawi due to its rarity, nonspecific symptoms, lack of histological grading and staging, limited treatment options, and long delays in the care pathway. There is a need for increased awareness and suspicion among primary health care providers, improved access to diagnostic facilities and specialized care, and multidisciplinary collaboration to optimize the management and prognosis of osteosarcoma patients in this setting.

The practice and results of age-based coronary study among patients 40 years and above undergoing valve surgery due to rheumatic heart disease: A cross-sectional study

Lijalem Taye Garba — 2024-11-20

Background

Rheumatic valvular disease is the most common indication for open heart surgeries in developing countries. Western guidelines recommend preop coronary studies before valve surgery for patients above 40 years of age and that has also been the practice in patients with rheumatic valve disease. Co-existence of coronary disease among patients with rheumatic valve disease is not well studied before.

Objective

To evaluate the prevalence of Coronary artery disease among older adults (above 40 years of age) undergoing valve procedures due to rheumatic heart disease and asses the validity of age-based recommendation for preop screening among those patients.

Method

Retrospective chart review of patients with rheumatic valve disease who underwent valve surgeries between January 2017 to October 2023 at Tenwek Hospital,Kenya was done. All patients 40 years of age and above were included, patients with non rheumatic valvular diseases, patients with confirmed or symptomatic Coronary artery disease were excluded.

Results

A total of 108 patients were identified. Seventy-five (69%) patients were female, median age was 51 yrs and mitral valve replacement was the most common procedure. Ninety-eight percent had preop coronary screening study and only 2 cases of mild disease detected with the rest of them having no evidence of coronary disease.

Conclusions

This study showed that coronary artery disease is infrequent among patients with rheumatic valve disease and screening can possibly be considered only for patients with strong risk factors rather than age alone. Further study on the topic is recommended to establish strong practice guideline for this particular patient population.