th an increased risk of perioperative mortality within 7 days of surgical intervention.Tibebe Ghion Specialized Teaching Hospital should emphasis on evaluation and monitoring of outcome for reduction of mortality with the emergency surgeries younger than 18 years old. We also suggested doing this research work at larger sample sizes for more actual information.Mycobacterium tuberculosis (Mtb) senses and adapts to host immune cues as part of its pathogenesis. One environmental cue sensed by Mtb is the acidic pH of its host niche in the macrophage phagosome. Disrupting the ability of Mtb to sense and adapt to acidic pH has the potential to reduce survival of Mtb in macrophages. Previously, a high throughput screen of a ∼220 000 compound small molecule library was conducted to discover chemical probes that inhibit Mtb growth at acidic pH. The screen discovered chemical probes that kill Mtb at pH 5.7 but are inactive at pH 7.0. In this study, AC2P20 was prioritized for continued study to test the hypothesis that it was targeting Mtb pathways associated with pH-driven adaptation. RNAseq transcriptional profiling studies showed AC2P20 modulates expression of genes associated with redox homeostasis. Gene enrichment analysis revealed that the AC2P20 transcriptional profile had significant overlap with a previously characterized pH-selective inhibitor, AC2P36. Like AC2P36, we show that AC2P20 kills Mtb by selectively depleting free thiols at acidic pH. Mass spectrometry studies show the formation of a disulfide bond between AC2P20 and reduced glutathione, supporting a mechanism where AC2P20 is able to deplete intracellular thiols and dysregulate redox homeostasis. The observation of two independent molecules targeting free thiols to kill Mtb at acidic pH further supports that Mtb has restricted redox homeostasis and sensitivity to thiol-oxidative stress at acidic pH.Polyacrylamide hydrogel (PAAG) is a synthetic substance previously used as an injectable material for augmentation mammoplasty. Current literature has demonstrated that the average time from PAAG injection to the onset of complication ranges from 6 to 39 months. We present a unique case report describing the onset of complications 18 years after PAAG augmentation mammoplasty. To the best of our knowledge, the presentation of a healthy female who experienced unprovoked expansion of breast tissue >15 years after polyacrylamide injection has not been previously reported in surgical literature. This suggests that serious complications of PAAG injection may occur later than the literature has previously described. Importantly, this case is the first demonstration of the successful surgical removal of polyacrylamide 18 years after injection. Additionally, this case also provides a histopathological analysis of breast capsules which showed evidence of an extensive chronic inflammatory reaction to polyacrylamide, consistent with previous reports.A 53-year-old man with prior history of resection of liposarcoma in his leg presented with gallbladder mass. Computed tomography showed 4-cm tumor at gallbladder fundus with weak enhancement with IV contrast. Differential diagnoses included hemangioma and liposarcoma, and laparoscopic cholecystectomy was recommended. In the operating room, the tumor appeared without serosal and liver invasions and uncomplicated laparoscopic cholecystectomy was completed. Histopathological examination revealed the tumor as myxoid liposarcoma with round cells. Adjuvant chemotherapy was not given, and he was placed on imaging surveillance. At 16 months after the operation, he developed recurrence of liposarcoma in the left popliteal fossa.Crossed fused renal ectopia is a very rare congenital ectopia and poses great challenges when performing abdominal aortic surgery because of the accompanying abnormal vessels and urinary tracts. A 79-year-old woman with an abdominal aortic aneurysm and L-shaped crossed fused renal ectopia was referred to our facility. One of the large ectopic renal arteries arose from the right common iliac artery. The aneurysm was treated with an endovascular aortic repair. The reversed chimney graft technique was applied to preserve the ectopic renal artery while elongating the distal landing zone on the right side. The patient experienced no complications such as renal dysfunction or recurrence of the abdominal aortic aneurysm during the 6-month follow-up period.Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour of smooth muscle origin. It commonly presents with non-specific symptoms including abdominal pain, distention, and lower extremity edema. Surgical resection with macroscopically clear margins is the only potential curative treatment for the disease. Here we present the case of a previously healthy 38-year-old woman with a subacute one-month increase of a four-year slowly progressive right sided abdominal pain and back pain. Imaging revealed a 14.5x12x15cm mass in the right hepatic lobe causing mass effect on adjacent abdominal and retroperitoneal organs, and involving the retrohepatic IVC. En-bloc resection of the right hemi-liver, most of segment four, the caudate lobe, and approximately a 10 cm section of the retrohepatic IVC, along with IVC reconstruction, was performed. Histologic examination revealed the diagnosis of a high grade leiomyosarcoma.A young adult male presented with recurrent pancreatitis and a 2.2 cm mixed duct intraductal papillary mucinous neoplasm (IPMN) located in the pancreatic body. Our patient presented at age 21 with his second hospitalization for acute pancreatitis within a year. A mixed duct IPMN with main ductal dilation was identified, which prompted additional workup. Based upon the findings the patient was counseled regarding the risks and benefits of surveillance versus surgery. The patient elected to undergo a robotic-assisted laparoscopic distal pancreatectomy and splenectomy. Final pathology revealed an IPMN involving branch and main pancreatic ducts with low and focally high-grade dysplasia. IPMNs are increasingly being identified. Consensus guidelines generally propose surveillance, but management in young adults can be complex. Herein we present the second youngest reported case and highlight the continued need for consensus management guidelines.Xanthogranulomatous pyelonephritis may, rarely, occur as a renal cystic mass. We report a case report of a 50-year-old with a history of medically treated renal lithiasis, who consults for left low back pain. Imaging findings concluded to a Bosniak type-3 hemorrhagic cystic mass of the left kidney. The diagnosis of xanthogranumolatous pyelonephritis on its focal form was made histologically. The diagnosis of xanthogranulomatous pyelonephritis is often difficult even with surgical findings and frequently a histological surprise. This points out the importance of identifying it in pre-operative staging; the diagnosis may be suggested by the association of chronic pyelonephritis, renal stones and hypovascular renal tumor syndrome without specificity at sonography and CT.Chronic expanding hematoma (CEH) mimicking seroma following inguinal hernia surgery has not been reported previously. A 78-year-old man underwent laparoscopic repair of a left direct hernia via a totally extraperitoneal approach. He was discharged 2 days after surgery without any complications. Two weeks later, he complained of left inguinal bulging without pain. We considered seroma and decided to observe the patient for 1 month. However, the cyst did not change in size. Additional cyst aspiration and drainage attempts were unsuccessful. Three months after the initial surgery, we performed a second surgery (resection of the cyst) because conservative therapies were ineffective. The resected cyst was pathologically diagnosed as a CEH. The postoperative course was uneventful, and no recurrence was observed. Complete excision of a CEH is mandatory because aspiration and drainage cannot prevent recurrence.Cowden syndrome is a rare autosomal dominant disorder that is characterized by multiple hamartomatous neoplasms in a variety of tissues and is associated with germline mutations in the PTEN gene. Cowden syndrome does not have increased risk of gastric malignancy; however, complications of benign neoplasm can occur. The authors report a case of a patient with Cowden Syndrome and with gastric polyps that caused severe morbidity and a surgical approach was indicated. An antrectomy with troncular vagotomy was performed with a Billroth I reconstruction. In this case, this was of paramount importance so the duodenum can be revisited.Congenital lumbar hernia is a rare disease affecting mainly infants. Its association with lumbo-costo-vertebral syndrome (LCVS) is hardly seen in the literature. We present a case of LCVS in a 1-month-old female infant presenting with a soft bulge in left lumbar region. Abdominal X-ray revealed absence of multiple ribs with a mild lumbar scoliosis and defective ninth vertebra. Ultrasonography showed absence lateral abdominal wall muscles in left lumbar region and 2.5 cm diameter lumbar hernia. Primary repair of the adnominal wall defect was performed without meshplasty and no recurrence was reported. We hope to enhance the literature of this rare disease with our case.A 76-year-old woman with hereditary hemorrhagic telangiectasia presented to the emergency department with chest pain. Workup revealed multiple bilateral pulmonary arteriovenous malformations (PAVMs) with large aneurysmal venous outflow. A collaborative approach between interventional radiology and thoracic surgery was used in the treatment of these PAVMs.Esophageal gastric heterotopia (GH), the presence of differentiated gastric tissue in the esophagus, is estimated in up to 14% of populations worldwide and has always been reported on the surface of the esophagus, where it is also known as inlet patch. However, submucosal GH, in any tissue, is a rare finding. We report the case of a 50 year-old male presenting with chronic cough, heartburn and raspy vocalizations. Endoscopic examination showed a single 7 mm esophageal nodule, 20 cm from the incisors, interpreted as a submucosal mass. Pathologic examination of the endoscopically excised nodule showed well-differentiated gastric mucosa within the submucosa underneath the overlying squamous mucosa, consistent with submucosal GH. This case raises the awareness of an atypical presentation and location of GH seen as a submucosal mass on endoscopy.Acute acalculous cholecystitis remains an elusive clinical diagnosis possibly due to complex clinical setting in which this entity develops, lack of large prospective controlled trials that evaluate various diagnostic modalities, thus dependence on a small database for clinical decision making. Concealed gallbladder perforation is rare. Herein, we report an 82-year-old female who presented with a right upper quadrant pain and features of local peritonitis. Abdominal ultrasound was suggestive of cholecystitis while computed tomography (CT) scan reported a perforated gallbladder with pericholecystic fluid collection. The patient underwent successful cholecystectomy; and intra-operatively, similar findings as those reported on imaging were seen. Unfortunately, she succumbed shortly post-operatively due to pulmonary embolism. Our report highlights the importance CT scan in patients with vague abdominal symptoms followed by sudden resolution. It also reminds the importance of considering the diagnosis of concealed gallbladder perforation as a differential in patients with peritonitis, as it may be missed by routine radiological investigations.