Background: Congenital diaphragmatic hernia (CDH) with late presentation beyond the neonatal period is rare and often misdiagnosed, with delayed treatment. We report the management of a series of patients that presented after the neonatal period. Patients and method: we reviewed our experience over 4 years (2015-2019) in a single institution to determine the factors for late presentation of congenital diaphragmatic hernia, associated anomalies, complications and its management. Results: We had six patients diagnosed as late presenting CDH and operated in our institution over 4 years . The patients ranged in age from one year to 10 years with males to females ratio 2:1. All the hernia defects were left sided. Except one patient all have abnormal gut rotation. The mode of presentations were ; one patient presented with gastric perforation due to misdiagnosis of pneumothorax and ICD placement. Another one had irreducible gut gangrene, 2 cases have left lobe of liver along with small bowel, colon and spleen and stomach, The other 2 patients had small bowel, colon and spleen and stomach as hernia content. All cases were managed by primary repair of defect with interrupted non absorbable suture through transabdominal approach. Two cases had post op pleural effusion and pneumothorax and required intercostal tube placement, and all the patient were kept in intensive care for 48 hours but without any ventilator support. Conclusions: There should be a high index of suspicion in every case presenting with persistent vomiting along with abdominal pain, recurrent pneumonia, chronic respiratory conditions or acute abdominal condition with doubtful x-ray chest.

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Desmoid tumor or desmoid-type fibromatosis is a benign but aggressive tumor that usually arises from the musculoaponeurotic structures in the body. It is very rare accounting for less than 3% of all soft-tissue tumors. Intra-abdominal and extra abdominal forms of this disease have been identified in the literature. Mandible, tongue, mastoid process, and maxilla are the most common subsites affected by the tumor in the head and neck region. Occurrence of desmoid tumors in the paranasal sinus is extremely rare, and only very few cases were reported in the literature especially in Nigeria. We present a case of desmoid tumor occurring in the maxillary sinus of a 29-year-old lady from Nigeria. The clinical presentation, diagnosis, and successful treatment of desmoid tumor are discussed. Desmoid-type fibromatosis is an aggressive benign tumor that rarely occurs in the maxilla. It can progressively increase in size, leading to facial disfigurement. Meticulous surgery is necessary to ensure adequate resection of the tumor and at the same time avoiding damage to vital surrounding structures.

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Heterotopic pancreas (HP), also known as ectopic or aberrant pancreas, is a congenital disorder with an occurrence rate of 0.5%–13% in the general population. In this report, a 26-year-old obese female patient with a body mass index of 39.49 kg/m2, with an unremarkable medical and surgical history, was admitted electively for laparoscopic sleeve gastrectomy (LSG). Abdominal ultrasound and esophagogastroduodenoscopy findings were normal. During the operation, a 3 cm subserosal mass was found on the greater curvature in the corpus of the stomach. Following complete exploration of the stomach and regional lymph nodes the surgical technique was not altered because the lesion would remain in the specimen during the procedure. HP can be seen atypically as submucosal tumor but in some instances; it can be found in the muscularis or serosa. Surgical resection is the mainstay treatment if the HP in symptomatic or when the lesion is found incidentally during surgery.

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Unilateral tubal twin pregnancy is rare with an incidence of 1: 125,000 spontaneous pregnancies. Majority of cases that occur follow ovulation induction and assisted reproductive technology. A 38-year-old single primipara with a 9-week history of amenorrhea, 2-week history of lower abdominal pain, and a 3-day history of vaginal bleeding. Previous history of ectopic gestation with surgery, as well as repeated elective abortions and pelvic infections, was elicited. She was hemodynamically unstable with features of an acute abdomen. Pelvic examination revealed features suggestive of ectopic gestation. Spot serum pregnancy test was positive and the pelvic ultrasound revealed left tubal twin ectopic gestation with the significant peritoneal fluid collection. An emergency laparotomy with left salpingectomy was performed, with an un-complicated post operation course. The diagnosis was confirmed with histology. A high index of suspicion is required in the diagnosis of ectopic gestation in order to reduce the morbidity associated with it. Unilateral twin tubal ectopic gestation, although rare, has been reported with higher frequencies, and as such, the occurrence should be carefully sought on ultrasound in order to reduce its potential morbidity and mortality.

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Breast cancer of mesenchymal origin is rare. Malignant peripheral nerve sheath tumors (MPNST) are believed to derived from peripheral nerves or demonstrate peripheral nerve differentiation. They represent only 5-10% of all malignant soft tissue sarcomas with an incidence of 4% in patients with neurofibromatosis type 1 syndrome and 0.001% in general population. We present a 40-year-old woman with Von Recklinghausen's disease diagnosed 10 years prior to presentation and complain of right breast lump of 3 months duration that rapidly increase to affect the whole breast. The overlying skin ulcerated spontaneously with preservation of the nipple areola complex. Examination revealed features of Neurofibromatosis type 1. The right breast contained a hard mass with an overlying ulcer. Axillary lymph nodes were not enlarged. Incisional biopsy of the ulcer revealed features of neurofibromatosis. A chest radiograph revealed pleural effusion while abdominal ultrasound revealed liver metastasis. A diagnosis of metastatic peripheral nerve sheath tumour was made. The challenges in the diagnosis and treatment of this patient are discussed.

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Amoebic liver abscess (ALA) is the most common inflammatory space occupying lesion of the liver in human. It is considered the third leading cause of death among the parasitic diseases, surpassed only by malaria and schistosomiasis. It has a highly variable presentation causing diagnostic difficulties. ALA if untreated, its complications could lead to high morbidity and mortality. We present a 1 year old child with abdominal pain and distension, persistent fever and weight loss. The abdomen was distended with tenderness on the epigastric and right hypochondrial regions. Hematological and biochemical profile were normal. Abdominal CT showed hepatomegaly, with a huge hypodense mass within the liver with enhancement of the liver parenchymal on contrast injection. There was breach of the hepatic capsule with localized intraperitoneal collection. A diagnosis of pyogenic liver abscess was made. Attempt to aspirate under US guide was unsuccessful. Patient underwent surgery and 500 ml of pus was drained.

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Background: Swellings of the head and neck region could present as lymphadenopathy. Lymphomas are among the diseases associated with lymphadenopathy and commonly affected lymph nodes are cervical nodes in the head and neck region. The present study aimed at analyzing the causes of head and neck swellings in a tertiary health facility specialized clinic. Patients and Method: An analysis of patients with head and neck swellings carried out retrospectively between 2006 and 2014 in a tertiary health clinic. Relevant data were retrieved on patients' biodata, clinical details, and definitive histopathological reports from the clinic and departmental records. Data were analyzed using SPSS version 23. Results: There were more males (65.6%) than female and the first decade of life was the most affected. The most common pathological site was the cervical nodes (44.8%) followed by the mandible. There were more neoplastic lesions with Burkitt's lymphoma been the commonest followed by diffuse large cell lymphoma. Conclusion: Swellings and lymphadenopathies of the head and neck do occur in our environment with lymphoma accounting for the majority of them.

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