Lennox–Gastaut syndrome (LGS) is a severe developmental epileptic encephalopathy that presents anesthetic challenges because of refractory epilepsy, multiple antiepileptic medications. We report the anesthetic management of a 7-year-old boy with LGS who underwent elective tracheostomy for progressive upper airway obstruction. Preoperative evaluation revealed micrognathia, retrognathia, and dynamic upper airway obstruction, suggesting a potentially difficult airway. Antiepileptic medications were continued throughout the perioperative period, and general anesthesia was induced after preoxygenation with a HFNC (high-flow nasal cannula). Tracheal intubation was successfully performed using a McGrath MAC video laryngoscope, and anesthesia was maintained uneventfully with sevoflurane and remifentanil without perioperative seizure-related or airway complications. The patient recovered without anesthetic complications. This case highlights the importance of careful perioperative planning, including appropriate seizure management and airway preparation, for the safe administration of general anesthesia in pediatric patients with LGS.

Background: Angiomyolipoma (AML) is a benign mesenchymal neoplasm belonging to the family of perivascular epithelioid cell tumors (PEComas). While most AMLs arise in the kidney, extra-renal occurrences are exceptionally rare. Fat-poor variants may pose significant diagnostic challenges because of their resemblance to malignant mesenchymal neoplasms. Case Presentation: We report the case of a 58-year-old woman presenting with progressive abdominal enlargement. Imaging revealed a giant retroperitoneal mass measuring approximately 40 cm, radiologically suggestive of sarcoma. Preoperative biopsies yielded discordant diagnoses, including dedifferentiated liposarcoma and spindle-cell neoplasm with smooth muscle differentiation. Complete surgical excision was performed. Histological examination demonstrated a predominantly smooth muscle proliferation lacking atypia, necrosis, or increased mitotic activity. Extensive sampling identified focal mature adipose tissue and dysmorphic blood vessels. Immunohistochemistry showed positivity for smooth muscle actin, desmin, HMB-45, and Melan-A, confirming the diagnosis of fat-poor extra-renal retroperitoneal angiomyolipoma. Conclusion: Extra-renal angiomyolipoma is an uncommon benign neoplasm that may mimic retroperitoneal sarcoma clinically, radiologically, and histologically. Adequate sampling and appropriate immunohistochemical investigations are essential for accurate diagnosis and prevention of overtreatment.

Acute appendicitis remains one of the most common surgical emergencies worldwide; however, its presentation, diagnosis, and management in elderly patients differ considerably from those in younger populations. Elderly individuals frequently exhibit atypical clinical manifestations, delayed presentation, multiple comorbidities, and reduced physiological reserve, all of which contribute to higher rates of perforation, postoperative complications, prolonged hospitalization, and mortality. Advances in diagnostic imaging, minimally invasive surgery, perioperative care, and risk stratification have significantly improved outcomes in this population. The role of non-operative management with antibiotics remains controversial, particularly given concerns regarding recurrence, missed neoplasms, and delayed definitive treatment. This review examines current evidence regarding the treatment options and outcomes of acute appendicitis in the elderly. Emphasis is placed on the role of non-operative treatment and appendectomy in the management of acute appendicitis in the elderly. We will also look at the role of laparoscopic appendectomy in the management of acute appendicitis in the elderly. Understanding the unique characteristics of appendicitis in elderly patients is essential for improving diagnostic accuracy, reducing complications, and optimizing clinical outcomes.