Recurrent intestinal perforations as a presentation of antiphospholipid syndrome

Antiphospholipid syndrome [APS] is a rare but important cause of thrombosis. It is suspected in patients who present with recurrent thrombosis or thrombosis in an unusual site. Gastrointestinal involvement is rare in this syndrome. Moreover, intestinal perforation in APS is very rare. We report a 19-year-old female patient who developed recurrent spontaneous intestinal perforations in which repeated laparotomies were undertaken and different diagnoses were entertained. The patient had received different treatments but without improvement. Antiphospholipid syndrome [APS] was suspected and diagnosed, and subsequently anticoagulant therapy was started. To our knowledge, this is a first report describing recurrent small intestinal perforation in a patient with APS

Abdominal tuberculosis: review of 78 cases

Seventy-eight patients with abdominal tuberculosis [TB] were admitted to the medical and surgical departments at two major teaching hospitals in Jeddah during the period from January 1991 to August 2001. They were young patients with average age of 31 years. They all belonged to low socio-economic class. The majority of patients presented with non-specific symptoms which included fever, weight loss, abdominal pain, vomiting and change of bowel habit. There was a predilection for a single organ involvement. The peritoneum being the commonest site [61.50%] followed by the liver [16. 60%], mesenteric lymph nodes [10.20%], small bowel [3.80%] and colon [2.60%]. The spleen, appendix, pancreas and perineum were involved a 1.3% [one case each]. Abnormal chest x-ray suggestive of active or old tuberculosis and positive Mantaux test were present in 41% and 14.60% of patients respectively. Laparoscopy was helpful in establishing the diagnosis of peritoneal tuberculosis in 43 patients. Seven patients [8.90%] required various surgical procedures. The outcome of treatment with anti-TB chemotherapy for 6 months was successful. One patient developed post-operative abdominal fistula and two patients died. The morbidity was 1.3% and the mortality was 2.56%

Thyroid and parathyroid surgery: drain or no drain

Routine wound drainage after thyroid and parathyroid surgery was and still used on no scientific basis. We aimed to confirm whether drains following thyroid and parathyroid surgery are of any benefit. Method: A retrospective analysis of 232 patients who underwent thyroid and parathyroid surgery were reviewed. A total number of 197 patients had thyroid surgery and 35 patients had parathyroid surgery. Drains were used in 117 patients [50.4%] [group A] and no drains were used in 115 patients [49.6%] [Group B]. There was no difference between the two groups in terms of major complications that require intervention. The average drainage in group A was 60 ml [range 0-320 ml]. All patients in group B developed flaps oedema and suprasternal fullness that resolved spontaneously without intervention and one patient developed wound infection. Routine wound drainage following thyroid and parathyroid surgery is unnecessary and should be used selectively