Colorectal cancer in young patients under 40 years of age Comparison with old patients in a well defined Jordanian population

To determine the incidence of colorectal cancer [CRC] in young Jordanians and to compare the clinical and pathological characteristics with those in older patients and with those in high risk populations. Clinical and pathological data of all the patients with CRC managed at Princess Basma Teaching Hospital, Irbid, Jordan over a 10 year period [January 1990 through December 1999] were recorded. The patients were divided according to age into group one [those <40 years] and group 2 [> 40 years]. The 2 groups were compared regarding sex, predisposing conditions, tumor stage at presentation, tumor differentiation, mucin secretion, tumor invasion, presentation with complications and tumor location. The data were compared with those of "high risk" Western populations and with the few reports coming from "low risk" populations, mainly from Kingdom of Saudi Arabia and Egypt. Out of 202 patients evaluated, 4 were excluded. Group1 constituted 20.2% of the patients, 17.5% of them have predisposing conditions. Comparison between group 1 and 2 revealed the following: female sex [65% versus 50.6%, p=0.104], advanced stages at presentation [65% versus 41%, p=0.005], rectal tumors [50% versus 39.2%] and right side tumors [15% versus 29.1%] [p=0.18]. Mucinous and signet ring tumors [30% versus 15.8%, p=0.04], poor tumor differentiation [20% versus 18.3%, p=0.78] and presentation with complications [21% versus 22.2%, p=0.96]. The incidence of CRC in young Jordanians was much higher than high risk populations. Half of the tumors were rectal. Young patients have more advanced stage and more mucin secreting tumors. The relative high frequency and frequency of predisposing conditions calls for family screening and surveillance in the presence of predisposing conditions

Torsion of abdominal appendages presenting with acute abdominal pain

Diseases of the abdominal appendages are rare causes of abdominal pain in all age groups. Patients and Nine patients with torsion and infarction of abdominal appendages were retrospectively reviewed. Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of part of the greater omentum, and one patient had torsion and infarction of the falciform ligament. The patient with the falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiploica represents the first reported case of vibration-induced appendix epiploica torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass, and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis. The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease, and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management. Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations

Splenic torsion: a complication of wandering spleen

Wandering spleen is a rare diagnosis. Three cases of wandering spleen are presented. Two patients presented with sudden appearance of abdominal mass secondary to splenic torsion and infarction and both were managed by splenectomy. The third patient was a child who had an accidentally felt upper abdominal mass. The diagnosis was made by ultrasound. The child was followed up for two years with no complications. The different modes of presentation are presented and the treatment modalities are discussed

Aids and the surgeon

As the number of patients infected with HIV virus continues to increase dramatically, surgical intervention and evaluation of such patients will be required more frequently. This review aims at throwing light on the different presentations of HIV infection that might need surgical intervention or simulate surgical problems. An understanding of this syndrome with it's different presentations and complications is mandatory for the surgeon to adequately evaluate and manage such patients