No abstract

No abstract

BackgroundTuberculous (TB) oesophagitis is a rare manifestation of dysphagia occurring in 0.3% of all gastro-intestinal tract TB infections as well as 0.15% of all cases of dysphagia and often is misdiagnosed. This report presents a rare manifestation of TB as a cause of oesophageal stricture.Case presentationWe describe a rare presentation of a patient with grade IV dysphagia due to an oesophageal stricture. Oesophagoscopy revealed a pinhole stricture with evidence of high grade dysplasia on histology. Subsequently an Ivor-Lewis oesophagectomy was performed and histology revealed evidence of active oesophageal tuberculosis. The patient had an uneventful recovery and completed anti-TB medication.ConclusionsOesophageal TB is a rare but curable cause of dysphagia. It may mimic cancer of the oesophagus and it is usually missed as a possible cause of oesophageal strictures. There needs to be an increased index of suspicion among patients with dysphagia in TB endemic regions.

Background Aortic arch injuries account for about 8% of thoracic aortic injuries. Penetrating zone I neck injuries account for 18% of vascular injuries in the neck and have great potential to traverse to involve thoracic vascular structures as well. The hard and soft signs of vascular injury facilitate triage of patients on an individual basis. We present a case of a ball-point pen traversing through zone I of the neck and causing penetrating aortic arch injury with minimal mediastinal haemorrhage. Case presentation We present a polytrauma patient who was admitted with traumatic brain injury and a ball-point pen lodged above the sternal notch in zone I of the neck following a road traffic accident. He underwent mediastinal exploration via a median sternotomy. The ball-point pen was found penetrating the anterior wall of the aortic arch and resting in its lumen. The ball-point pen was successfully explanted and primary repair of the penetrating aortic arch injury was done. He had an uneventful recovery without any added secondary neurological complications. Conclusion Penetrating aortic arch injuries are rare compared to injuries of the ascending aorta and descending aorta. They require a high index of suspicion, rapid investigation and urgent intervention in view of their high associated fatality. The ball-point pen in this case assumed the shape of a plug which acted as a seal at the site of injury preventing catastrophic exsanguination.