Management of liver trauma in Kuwait

The aim of this study was to introduce the concept of non-operative management [NOM] for blunt liver trauma by establishing a protocol and a prospective Liver Trauma Registry in Kuwait. A prospective Liver Trauma Registry was started in 4 hospitals and it included 117 patients who had sustained blunt liver trauma [94 men and 23 women]. Unstable patients were taken to surgery while stable patients were managed conservatively regardless of the grade of liver injury. High-grade [III-VI] liver injuries were managed in collaboration with the liver surgery specialist. The mean age of the 117 patients was 29.02 +/- 11.18 years [range 7-63]. NOM was successful in 94 [96%] patients and failed in 4 [4%] [these 4 then underwent successful surgery]. Nineteen [16.2%] were unstable and underwent surgery immediately; 15 [79%] of them survived [they had had grade III-V injuries] and 4 died [2 with grade V injuries and 2 with grade VI injuries]. Perihepatic packing was necessary in 8/19 [42%] patients. The overall mortality was 3.4% [4/117]. This study showed that NOM was successful in a majority of patients with blunt liver trauma. In addition, it confirmed that the magnitude of liver injury and haemoperitoneum did not preclude NOM as long as the patient was haemodynamically stable

Giant sigmoid diverticulum: a case report

To report an unusual presentation of a giant sigmoid diverticulum in the colon. Clinical Presentation and Intervention: The patient presented with an abdominal mass, altered bowel habits, and increasing weight. The provisional diagnosis was made by barium enema and CT scan. The patient underwent laparotomy, revealing a perforated giant sigmoid diverticulum that was excised using Hartmann's procedure. The perforation could have been precipitated by the barium enema study. The histopathology of the resected specimen revealed giant sigmoid diverticulum with no evidence of malignancy. CT scan was adequate for diagnosis of the suspected giant sigmoid diverticulum. Surgical intervention was successfully used to excise the diverticulum