Gastrointestinal stromal tumors (GIST) account for 1% to 3% of gastrointestinal tract tumors and are the most common of the mesenchymal tumors. Carcinogenesis of GIST arises in the interstitial cells of Cajal (ICC) and in the myenteric plexus of the gastrointestinal tract due to a mutation of the kinase receptor (KIT, also known as CD117) and the platelet-derived growth factor A (PDGFA) gene leading to activation of the tyrosine kinase receptor. The exact incidence and prevalence of GIST is not known. Symptoms of GIST are non-specific; they present with GI bleeding due to ulceration (50%), abdominal pain (20% to 50%), dysphagia (esophageal GIST) and GI obstruction (10% to 30%) (7,10). Signs include abdominal mass and fullness. A computerized tomographic (CT) scan is the preferred imaging to evaluate GIST. Diagnosis is confirmed by immunohistochemical (IHC) staining a of biopsy sample for medical treatment tyrosine kinase inhibitors (TKI). Surgical resection with negative microscopic margins is the gold standard treatment of GIST. TKI are required for tumor reduction to increase chances of respectability (neoadjuvant therapy) or to prevent recurrence and reduce the progression of advanced, resectable GIST.

Postoperative Perineal hernia (PerH) is a recognised rare complication of radical pelvic oncologic procedures for rectal cancer, with a reported prevalence of 0.6-7%. PerH is a swelling in the perineum caused by herniation of abdominal or pelvic viscera through a defect in the pelvic floor. The cause of postoperative PerH is not known, however, wide extent of dissection, wound infection, neoadjuvant radiotherapy, length of small bowel and wider female pelvis, have been identified as risk factors for development of postoperative PerH. Cause of PerH is not known. Universal case definition of PerH does not exist, except it is a bulge in the perineum. Patients who are fit for surgery, have no recurrency, and are bothered or have severe symptoms (perineal swelling, perineal skin necrosis, urinary problems and/or intestinal obstruction) are offered surgical treatment. The aim of surgical repair is to exclude recurrency, closure of the pelvic defect with reconstruction of a new pelvic floor and repair of hernia.

Malaria is a common parasitic disease with very high mortality in tropical countries including Zambia.Symmetrical Peripheral Gangrene(SPG) is a rare complication of Malaria associated with Plasmodium falciparum infection.Reported here is a case of SPG in a 2 year 3 month old Zambian Toddler and highlight the need for awareness and prompt diagnosis and treatment.

Soft Tissue Sarcomas (STS) are rare malignant tumors that: arise from mesenchyme, 80% arise in soft tissue while 20% in bone, and they comprise 1% adult tumors. Gluteus maximus STS is site with frequently diagnoses of high- and low-grade STS. Low-grade STS respond well to surgery alone while high-grade STS require preoperative chemoradiation therapy, followed by surgery, and then postoperative chemotherapy. Work-up includes: a core needle biopsy for histopathological diagnosis, MRI for imaging of local disease and Contrast enhanced CT scan for pulmonary metastasis. Recurrence is viewed as a sign of poor local treatment and a risk for distant metastasis. Reduction of local recurrence does not lead to improved survival, but lack of disease progression with pulmonary metastasis does. In our patient, laparoscopy allowed total mesorectal excision dissection and sparing of rectum, as there was no metastatic spread of tumor to the rectum. Despite excision of right levator ani muscle, our patient maintained her continence, as shown by Fucini et al. [1] that continence would be maintained despite dissection and separation of levator ani muscle from the anal complex unit (external and internal anal sphincter) followed by unilateral excision of levator ani muscle, while achieving good oncologic and anal function outcome. We present our management of a 55-year-old lady with recurrent gluteal STS with extension into the ischiorectal fossa managed at Tata Memorial Hospital, in Parel, Mumbai, India, in the Department of Colorectal Surgery.

Colorectal cancer is the third most common cancer, second most common cancer in women, and the fourth leading cause of death in the world. Radical surgical treatment with Total Mesorectal Excision (TME) is considered the best treatment for cancer found in the lower third of the rectum and has benefits of complete tumor removal to reduce risk of recurrence and to improve survival. Advances in preoperative chemoradiation therapy have increased chances of achieving a 1 cm distal margin and allowed successful sphincter-preserving surgery by intersphincteric resection (ISR) and Coloanal Anastomosis (CAA) that allows normal defecation. MRI is particularly useful in evaluating localization of the tumor, involvement of anal sphincter (internal and external sphincters), levator ani muscles, and adjacent structures to the anus, with an accuracy of 85%, sensitivity of 87%, and specificity of 75%. Performing ISR with TME oncologic principles achieves similar results to Low Anterior Resection (LAR), but depends on the presence of sufficient Distal Rectal Margin (DRM); if a sufficient DRM cannot be achieved, then patients are offered an Abdominoperineal Resection (APR) with permanent colostomy and poor quality-of-life results.