Mesosigmoid hernia presenting as irreducible inguinal hernia

We report a rare case of a sixty-year-old male who presented with an irreducible right inguinal hernia of 6-h duration, associated with vomiting and abdominal pain. Later in the course the hernia spontaneously reduced. After resuscitation and appropriate work-up, the patient was taken to operating room for a diagnostic laparoscopy. Consequent to finding hemorrhagic ascites and a loop of infracted bowel, a lower midline laparotomy was performed, which revealed a loop of intestine herniating through a tight defect in sigmoid mesocolon. Resection of the affected bowel with primary anastomosis was performed. Patient made an uneventful recovery and was discharged home on the 8th post-operative day. Patient was followed up at 2 and 4 weeks intervals in the surgical clinic and remained symptom-free

Impact of Antibiotics Prophylaxis in Elective Laparoscopic Cholecystectomy: a prospective randomized study

Objectives: To determine the necessity of a single dose prophylactic antibiotic in preventing the postoperative infective complications in patients undergoing elective laparoscopic cholecystectomy. Methods: All consecutive patients who underwent laparoscopic cholecystectomy [LC] at King Saud Medical City from 1 January 2010 to 1 May 2011 were considered for this prospective randomized controlled study. Patients who were included in this study were prospectively randomized into two groups: those receiving single dose of intravenous Cefuroxime 1.5 gm, 30 minute before surgery [group A] and those not receiving any preoperative antibiotic [group B]. Postoperative infective complications were recorded and compared for both groups.Results: One hundred and twelve patients received antibiotics [group A], and 109 patients did not received any antibiotics [group B]. In group A, 3 patients developed umbilical port site infection whereas in group B, 5 patients developed infection [four in the umbilical port site and one in the epigastric port site]. The differences in the infection rate between the two groups were not significant. Intraoperative gallbladder perforation and positive bile culture was not found to increase the rate of surgical site infection. Conclusion: The elimination of prophylactic antibiotics in patients undergoing elective LC increase the incidence of postoperative infective complications but not to a statistically significant degree.

Routine or selective interval appendectomy for non-surgically treated appendiceal mass

The purpose of this study was to evaluate the need for interval appendectomy after a successful conservative treatment of an appendiceal mass. This retrospective study was conducted on patients admitted with appendiceal mass at King Saud Medical City during between July-2004 to July-2009. Only patients who were successfully treated conservatively [non-surgical] were included in the study. Data on patient demography, clinical presentations, investigations1 follow up, relapse of symptoms and/or recurrent acute appendicitis were collected and analyzed. Seventy-three patients were successfully treated conservatively for appendiceal mass. After discharge from the hospital, all were followed up in an OPD clinic. Seven patients [9.6%] developed recurrent symptoms appendicitis and underwent appendectomy. Sixty six patients [90.4%] were discharged from the outpatient clinic as they remained asymptomatic. All were seen in OPD at least twice before discharge. At the time of data collection for this study, all of them were contacted and recalled for assessment in the outpatient department. Five patients [6.8%] had emergency appendectomy elsewhere after discharge from the OPD clinic. Overall, 12 patients [16.4%] needed appendectomy after a successful conservative treatment for appendiceal mass. Sixty one patients [83.6%] have remained asymptomatic since their discharge from the clinic. Routine interval appendectomy is unnecessary after a successful conservative treatment of an appendiceal mass. It should be recommended selectively to those who develop recurrent symptom or recurrent acute appendicitis

Alvarado score as an admission criterion for suspected appendicitis in adults

Background: Acute appendicitis is a common surgical problem

Aim of the Study: To assess Alvarado score as an admission criterion for adult patients with suspected appendicitis in order to decrease unnecessary admissions to surgical wards

Patients and Methods: A prospective study of consecutive patients attending the Emergency Department [ED] of Riyadh Medical Complex with suspected appendicitis. The patients were managed according to the algorithm of the study protocol and discharged after clinical improvement either from ED or from the ward. They were followed by telephone 2-3 days later. Alvarado score was obtained in the ED in all patients

Results: The study included 211 patients, 60 patients were observed in ED and discharged, 151 patients were admitted and 137 of them were operated with a negative rate of 12.5%. The remaining 14 patients were observed and discharged. No patients with a score of 4 or less had appendicitis

Conclusion: Though the diagnosis of acute appendicitis remains mainly clinical, Alvarado score can be recommended as a helpful tool for the admission criteria and further management in order to reduce unnecessary admissions and to reduce the morbidity and mortality of acute appendicitis