Background: Pancreatic duct adenocarcinoma is increasing in incidence without appreciable decrease in overall survival despite decades of heightened research. Its mortality rate approaches its incidence rate. We report a case of carcinoma of the pancreas that had complete response from adjuvant chemotherapy. Case Presentation: A 39-year old male radiographer presented with a 3-month history of progressively worsening epigastric pain radiating to the back, associated with history of weight loss, anorexia, and jaundice. Abdominal CT scan showed a mass in the head of pancreas. A Whipple's operation was planned for the patient. However, intraoperatively, the head and body of the pancreas were found to have been taken over by the tumor, which encased the portal vein as well. Multiple core needle biopsies of the pancreas were taken. Cholecystojejunostomy, gastrojejunostomy, and jejunojejunostomy were then done. Histopathologic analysis of the specimen revealed a well-differentiated adenocarcinoma of the pancreas. He was commenced on 28-day cycle of gemcitabine 1000 mg/m2 on Days 1, 8, and 15 plus capecitabine 830 mg/m2 on Days 1–14. Repeat CT scan done after the 4th cycle showed no residual tumor in the pancreas. He has been in good health after 36 months follow-up, having received eight cycles of chemotherapy. He was counseled on resection of the pancreas, but he declined. Conclusion: Complete radiologic response may rarely occur after adjuvant chemotherapy for locally advanced adenocarcinoma of the pancreas. This does not, however, imply a cure of the disease.

Objectives: Percutaneous endoscopic gastrostomy (PEG) is a well-established endoscopic procedure that is used predominantly to create enteral access for feeding. Its use has not been widespread in Nigeria despite its efficacy. This study is done to review the early experiences in the use of PEG in Federal Medical Centre, Owerri and Carez Clinic, Owerri. Material and Methods: This is a 4-year retrospective cross-sectional study of patients who had PEG from January 2015 to December 2018. The indications, complications, and outcomes of the procedure were analyzed. Results: A total of 13 patients had pull-type gastrostomy during this period. Six (46.1%) patients had the procedure on account of neurologic disorders, 4 (30.8%) patients had esophageal tumors, while 3 (23.1%) patients had esophageal motility disorders. The overall success rate for PEG tube placement was 100%. The most common complication was superficial skin infection 30.8% (4/13). No mortality was attributable to the procedure. Conclusion: PEG is still not commonly done in our setting, but it is a relatively safe procedure. Physicians should be encouraged to offer it to our teeming patients with neurologic disorders who may benefit from it.

Nigeria lacks an equitable healthcare system. Low earnings characterize the income in rural areas where 55% of Nigerians who cannot afford basic medical care live. An organized rural medical and surgical outreach program can augment the formal healthcare system. Objective: To key into the International College of Surgeons Humanitarian Surgery Program by providing surgical specialists through collaboration to a sustainable free medical and surgical program.