H-type TEF is very rare and commonly presents with recurrent chest infection, chocking and coughing during feeds and cyanosis. Physicians caring for these patients should be aware of this and a high index of suspicion is of paramount importance to avoid delay in diagnosis with its associated morbidity. A contrast esophagogram is valuable in confirming the diagnosis. The study however may need to be repeated. Preoperative bronchoscopy is valuable to localize and cannulate the fistula for easier access during surgery. Surgical repair is the treatment of choice and this should be performed through a right cervical incision or thoracotomy for low fistulae. Thoracoscopic ligation and division of a low H-type fistula is an alternative and less invasive approach when compared to thoracotomy.

Objectives: To evaluate the impact of coronavirus-19 (COVID-19) pandemic and its consequences on general surgery residents. Methods: Cross-sectional, survey based study including surgical residents in Kingdom of Saudi Arabia and Kingdom of Bahrain. Results: Surgical trainees who participated in our survey (n=234) were young (mean age 28), single (53.8%), and males (65.8%). Approximately half (50.4%) have been deployed to cover the staff shortage in intensive care units (ICUs) or emergency departments (EDs). Half of our trainees (117) scored positive in the screening tool of generalized anxiety disorder (GAD). There was a significant association between experiencing anxiety and male gender ( p =0.055), level of training ( p =0.002), deployment to cover ICUs ( p =0.050), testing positive for COVID-19 ( p =0.054) and having an infected family member ( p =0.004). Conclusion: Coronavirus-19 pandemic has a serious effect on all healthcare workers and surgical residents have experienced a considerable amount of stress. Accordingly, this psychological burden should be appropriately addressed in organizations planning strategies. We suggest formulating guidelines to help surgical trainees to continue their learning process with least psychological burden.

Background: The satisfaction of surgical residents with their training programs is a key indicator for program effectiveness. This survey was conducted to assess the level of perceived satisfaction of surgical residents with the current training programs in Eastern Saudi Arabia. Materials and methods: Resident satisfaction was measured by questionnaire in 119 selected participants at 9 training centers in Eastern Saudi Arabia, as part of the general surgery residency program of Saudi Commission for Health Specialties. Results: The survey response rate was 69.7% (83/119) resident participants. A total of 37 (44.6%) residents expressed dissatisfaction with their current training programs. The residents were least satisfied with research opportunities (78.3%), followed by faculty didactic involvement (59%), mentorship (51.8%), and case volume (41%) offered in their programs. Conclusion: The general low level of satisfaction among surgical residents in Eastern Saudi Arabia warrants a national review of the current programs. Resident satisfaction should be considered as a potent factor while conferring accreditation to surgical training programs across the country. Highlights:

Pseudomyxoma peritonei is a rare progressive disease. Patients commonly present with a picture of acute appendicitis or with increasing abdominal girth. We present a case of a 71 year old man who presented with right iliac fossa pain, fever and vomiting. His abdominal examination revealed right iliac fossa mass which was confirmed radiologically. Diagnostic laparoscopy showed jelly like material along with a right iliac fossa mass. The aspirate was negative for malignancy initially. Due to persistance and progression of his disease he underwent right hemicolectomy. Histopathological diagnosis showed moderately differentiated adenocarcinoma of the cecum Duke’s C2.