No abstract

In all head and neck bullet injuries, treatment has to be individualized, as there is no universal protocol for all cases. Five important steps of management should be taken: securing airways, hemorrhage control, recognizing other injuries, foreign body removal when necessary, and repair of facial wounds. In this report, the case of a 28-year-old male patient will be presented and discussed. The patient was referred from a surgery clinic to an ear, nose and throat (ENT) outpatient clinic complaining of right neck pain, throat pain, and foreign body sensation in the throat for 2 months following a firearm injury to his face. The entry wound was observed on the left alar cartilage of his nose, which was almost healed and had left a scar. A sinus computed tomography scan showed a bullet in the right parapharyngeal space about 3 mm in front of the first vertebral body. The bullet was successfully removed using a trans-nasal endoscopic approach with the support of an image-guided navigational system and frequent fluoroscopy. These 2 methods help to replace the old traditional open approaches.

Gallstone disease was considered a rare disease in West African subregion, however with increasing urbanisation and lifestyle change, the incidence of the disease is rising. Laparoscopic cholecystectomy is the best treatment for gall stone disease. Initially, laparoscopic cholecystectomy required inpatient care after surgery, but for the past 30 years, there is a shift toward performing the procedure as a daycase. Day-case laparoscopic cholecystectomy was first reported in early 1990s, but in most countries of West Africa, cholecystectomy is still an inpatient procedure and this has been an additional strain to the health-care community as the number of personnel needed for postoperative care can be directed toward the care of other patients if the surgery is performed as a daycase. It has also been reported that increased use of day surgery would reduce waiting times and reduce last minute cancellations by the hospital. Although laparoscopic cholecystectomy was added to the basket of day-case procedures in the early 1990s, initial progress was slow because the procedure was not widely accepted as suitable for day case surgery. In sub-Saharan Africa, only Sudan, Nigeria, Tanzania, and South Africa have reported attempts at day-case laparoscopic cholecystectomy with good outcome.