Toe tourniquet syndrome

Toe tourniquet syndrome refers to external, mechanical, circumferential constriction of the toes. We report a series of 4 infants with toe tourniquet syndrome from Saudi Arabia who presented during wintertime with very similar symptoms [approximately 48 hours of inconsolable crying and irritability], similar involved region [toes], and similar constricting agent [hairs]. Immediate removal of the hair fibers was carried out in all patients, fortunately followed by fast healing with no signs of tissue necrosis. The prompt diagnosis and treatment of the condition were vital in attaining the good outcome and preventing ischemic complications

Medical and surgical management of fecal incontinence after repair of high imperforate anus anomalies

To report the medical and surgical management of fecal incontinence in children after repair of high imperforate anus. Thirty-seven children with fecal incontinence post repair of high imperforate anus were recruited between January 2000 and July 2007 at Aseer General Hospital, Abha, and Alhada Military Hospital, Taif, Kingdom of Saudi Arabia. The decision for surgery [dynamic graciloplasty] was based on the degree of incontinence and failure to respond to medical treatment. Five children were operated from the start according to the input of history, examination, and investigations [incontinence score of 15-20]. The remaining 32 patients were treated medically. Those cases that failed to respond to medical treatment had alternatively biofeedback therapy. Cases that failed to respond to biofeedback therapy underwent surgery. Response to medical treatment is favorable [71%]. Biofeedback showed discouraging results [22%] Dynamic graciloplasty showed excellent outcome [100% improvement in continence on long term follow up]. Based on history, examination, and investigations, recruited cases were primarily treated medically; those who had failed the medical treatment approach had dynamic graciloplasty, which demonstrated excellent results during the 1 -7 years follow-up period

Undescended testes: do we need to fix them earlier?

Patients with undescended testes [UDT] may present with acute testicular torsion or incarcerated hernia requiring immediate surgical intervention. The exact incidence of these two complications among cases of UDT is not known. The aim of this study was to investigate the frequency of such conditions in our series of undescended testes, and to evaluate whether early intervention in undescended testes could eliminate such problems. All the data of patients with undescended testes admitted for surgery in Aseer Central Hospital, Abha Saudi Arabia, over a 6-year period were reviewed. In two hundred and ninety patients, 18 presented acutely with torsion of the undescended testicle in the inguinal canal [n=11] or incarcerated inguinal hernias [n=7]. The data of these 18 patients were looked up for patient characteristics. Methods of diagnosis, preoperative preparation, operative findings, operative interventions, histopathological results and outcome were all analyzed. Ten out of 18 patients [55.5%] were less than six months. Nine out of eleven patients with testicular torsion required orchiectomy. The other two underwent orchiopexy, which ended up with atrophy. All patients with incarcerated hernia had simultaneous hernia repair and orchiopexy; of which, three atrophied. Acute testicular torsion and hernia incarceration in cases of cryptorchidism may be more prevalent than initially thought. Orchiopexy, as early as 3 months of age, may reduce the incidence of such problems. 'Therefore, earlier intervention in undescended testes [between 3-6 months] is recommended

Drainge of pancreatic pseudocysts. the importance of cyst wall biopsy in the recent era

While open internal drainage has been the standard treatment for pancreatic pseudocysts, less invasive techniques which pay little attention to cyst wall biopsy, are becoming popular. The aim of this study is to report on our experience in draining pancreatic pseudocysts and probe the necessity or otherwise of obtaining a wall biopsy at drainage. Operation theatre registry, operation log books and medical records at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia, were reviewed to retrieve the clinical details of patients with pancreatic pseudocyst who required a drainage procedure in a 13 years period from August 1989 to November 2002. Sixteen patients were identified. Cyst wall biopsy was obtained in 10 cases, in 8 of them the diagnosis was confirmed, while a true cyst was found in the remaining 2 excluding them from further analysis. In the remaining 14 cases [8 males, 6 females, mean age 38 years, range 4-60], pain was the main presenting feature. Open internal drainage was offered to 12 cases while one patient received external drainage under ultrasound guidance and the other received open external drainage. The type of operation was cystogastrostomy in 9 patients and cystojejunostomy in 3 patients. The recurrence rate after internal drainage was 16.7%, while after external drainage was 100%. There was no mortality in this series. A procedure-related complication occurred in 3 [21.4%] patients. The mortality, morbidity and recurrence rates in this series are compared favorably with other reports. The final diagnosis of a presumed pancreatic pseudocyst should rest on the histopathologic examination of the cyst wall

Abdominal twin foetuses-in-foetu in an infant: Case report and review of literature

We present a case of intra-abdominal twin foetuses-in-foetu in the left upper retroperitoneal space attached uniquely to the pancreas in a 5-month-old male infant. Antenatal ultrasonography demonstrated the presence of the mass. Although a bony component was present in the mass; the plain x-ray abdomen was not helpful in the diagnosis and abdominal computed tomography was the main diagnostic tool. Diagnosis was only confirmed at laparotomy