Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. Methods A prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90 mm Hg lasting more than 5 min, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables. Result A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 min. Intraoperative mean low SBP was 80 mmHg while the lowest record was 55 mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26–6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22–9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14–1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP < 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98–1.14; p = 0.16) Conclusion In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.

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Primary hyperparathyroidism is an endocrine disorder characterized by excessive and inappropriate release of Parathormone (PTH) from parathyroid glands resulting in diverse clinical manifestations involving the skeletal system in the form of bone and joint pains and pathological fractures, the gastrointestinal system in the form of dyspepsia from Peptic ulcer disease and pancreatitis, nephrolithiasis and other neuropsychiatric and nonspecific symptoms. There is nothing known about the epidemiology of this condition in our country and experience in Parathyroidectomy is very limited. In the biggest tertiary referral and teaching hospital in the country, only seven cases have been seen and treated over a period of seven years from 2007-2014 and only three had complete medical documents. We therefore present these three cases in detail and review the available literature in the management of primary hyperparathyroidism.

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Introduction and importance: Ileosigmoid knotting (ISK), also known as double volvulus or compound volvulus is a rare cause of intestinal obstruction in which small bowel or sigmoid colon wrap around each other, causing double loop obstruction and frequently leading to bowel strangulation. This study aimed to determine the characteristics, presentation, morbidity, and mortality associated with ISK at University Hospital. Methods A retrospective medical record review of all patients operated for ISK between January 2018 and January 2023. A data collection format that was tested on five patients was used to collect data on sociodemographic characteristics, clinical presentation, preoperative investigations, preoperative stabilization, intraoperative findings, type of surgical procedure performed, and patients’ treatment outcomes. Outcomes A total of 29 patients were operated on for ISK during the study period. Of these, the medical records of 25 patients were retrieved, reviewed, and analyzed. Males were commonly affected with a male-to-female ratio of 2:1(16:9). The peak age for ISK was between 30 and 50 years. The mean age of the patients was 42.6 years (SD ± 15.9) and ranged from 20 to 70 years. Only one of the patients had comorbidity (retroviral infection). The average duration of illness was 1.6 days (SD ± 0.65), and the majority (23, 92%) presented within 48 h. Four-fifth (20, 80%) of patients are from the rural areas and the majority of them (15 (75%)) presented later than 24 h, while 3 (25%) of patients from urban settings presented within 24 h. Abdominal pain was present in all patients followed by vomiting (24, 96%), abdominal distention (22, 88%), and failure to pass feces or flatus (15, 52%). Four (16%) of the patients were in shock at the presentation. The leading abdominal findings were guarding (25, 100%), tenderness (24, 96%), rebound tenderness (21, 84%), and hyper-tympanic abdomen (11, 44%). On digital rectal examination, a stool was found in more than half (17, 68%), followed by an empty rectum (7, 28%) and blood in 2 (8%) of the patients. Preoperative imaging (plain abdominal x-ray) was done in 13 patients with symptoms of obstruction and with no features of diffuse peritonitis. Conclusion The performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failures may contribute greatly to improving the survival rate of victims of this dreadful entity. Highlights

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Echinococcosis is a re-emerging public health issue in developing countries as most communities are homes to dogs and other domesticated animals while cattle raising is a major habit of most sub-Saharan countries. The usual presentations include liver and lung cysts. While few documentations and publications have been made on extra-pulmonary intrathoracic hydatid cysts in other parts of the world, there has been no published document on extra-pulmonary intrathoracic hydatid cysts consisting of eighty or more cystic masses in a single patient in Ethiopia. We present a case of right sided extra-pulmonary intrathoracic hydatid cysts in a 20-year old Ethiopian male patient with compressive respiratory symptoms and significant social history of cohabiting with dogs throughout childhood. The patient was treated by surgery via a posterolateral thoracotomy and had a smooth Post-operative course and discharged home on postoperative day 15 on albendazole and analgesics. Intraoperative findings included approximately 1500 ml of cystic fluid, eighty cystic masses and collapsed lung.