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Will We Tire of Case Reports?

Alex Okello Wamalwa

Kenyatta National Hospital, Nairobi, Kenya

Correspondences to: Alex Okello; email:
Received: 3 Jul 2023; Revised: 18 Jul 2023; Accepted: 18 Jul 2023: Available online: 19 Jul 2023

Key words: Case report, Evidence, Publication 

Ann Afr Surg. 2023; 20(3): 80-81


Conflicts of Interest: None

Funding: None

© 2023 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

The relevance of case reports in communications of surgical research has stood the test of time and should be encouraged despite its low level of evidence (1,2). The Annals of African Surgery has supported their publication evidenced by consistent allocation of not less than 30% of space in each issue, to case reports. The current issue should be a record with the majority of content portraying interesting cases.   Case reporting is a chance to convey a new and unique clinical presentation, management approach, and prognostic outcome (3). The case by Mohamed et. al. features an understated clinical presentation of lumbar hernia (4). They can also stir up theories that could be dispelled or otherwise, by interrogating larger populations (5). Dahir’s et. al.’s article should challenge readers to report on varied modalities of breast reconstruction akin to current trends (6). “Forgotten” historical techniques that result in similar outcomes to modern approaches are highlighted and described in-depth to re-educate, such as the approach taken by Hussein et. al. in managing tibialis posterior tendon dislocation (7). The management of truly rare diseases and circumstances, especially where it would be implausible or unethical to have cohorts, come to light in this manner, irrespective of their outcome. Finally, one can publish in a different specialty-based journal to simply inform on the available management options and hopefully stimulate cross-specialty referrals in instances where adequate expertise was previously unavailable.  
Case reports lack controls, blinding, and the numerical advantage to be considered as representative of the population. Thus, extrapolation of the end result to the public and, by extension, illustration of an association or causal relationship are both unbefitting. An author should strive to candidly report and critically appraise all aspects to limit biases (observation, recall, selection, measurement, and publication) and encourage objective interpretation (8). An exhaustive yet succinct demonstration of the scenario coupled with high-quality clinical photographs and discussion is a must, which requires quite the effort. Remember to undertake a thorough literature review and do stick to the journal and reporting guidelines (9). 
A well-written clinical report will consistently have a place in publication, otherwise why would high-impact journals have an exclusive space for them (10). Something to note is that a journal risks maintenance of low impact factor scores as reports are less referenced compared with higher level articles. Potential authors should take advantage of the Annals of African Surgery to enhance their research skills and have fun while at it, in spite of the daunting review comments! It is anticipated that the nature of submissions would shift toward being more postulative and thereby stimulating further research in our society. 

Conflict of interest
The author is an Associate Editor of the Annals of African Surgery.


​1.   Nissen T, Wynn R. The history of the case report: a selective review. JRSM Open. 2014;5(4):. doi:10.1177/2054270414523410
2.  Oxford Centre for Evidence-Based Medicine Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Oxford Centre for       Evidence-Based Medicine. Accessed 30th June,        2023.
3.  McKeon JM, King MA, McKeon PO. Clinical contributions to the available sources of evidence (CASE) reports: executive summary. J          Athl Train. 2016; 51(7):581-85. doi: 10.4085/1062-6050-51.9.07. 
4.  Mohamed MS, Abdalla RO. Spontaneous Lumbar Hernia: A Case Report. Ann. Afr. Surg. 2023 July; 20(3): 99-102.
5.  Nissen, T., Wynn, R. The clinical case report: a review of its merits and limitations. BMC Res Notes 7. 2014; 7: 264.                                  
6.  Dahir M, Ojuka D, Hungu E, Wamalwa A. Latissimus Dorsi Myocutaneous Flap Reconstruction Post Resection of a Giant Malignant            Phyllodes Tumor of the Breast: A Case Report. Ann. Afr. Surg. 2023 July; 20(3): 103-107.
7.   Hussein HI, Atinga M. A Case Report and Technique Guide for Stabilization of Tibialis Posterior Tendon Dislocation in an Athlete.                  Ann. Afr. Surg. 2023 July; 20(3): 94-98.
8.   Albrecht J, Werth VP, Bigby M. The role of case reports in evidence-based practice, with suggestions for improving their reporting. J             Am Acad Dermatol. 2009;60(3):412-18. doi: 10.1016/j.jaad.2008.10.023
9.   Riley DS, Barber MS, Kienle GS, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol.                 2017; 89:218-235. doi: 10.1016/j.jclinepi.2017.04.026. 
10. Calvache JA, Vera-Montoya M, Ordoñez D, Hernandez AV, Altman D, Moher D. Completeness of reporting of case reports in high-           impact medical journals. Eur J Clin Invest. 2020; 50(4):e13215. doi: 10.1111/eci.13215.

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