Validity of leukocyte count to predict the severity of acute appendicitis

To ascertain whether white blood cell [WBC] count with differential analysis may predict severity of disease in acute appendicitis. We conducted this retrospective study on appendectomy patients from 1996 to 2001, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. We reviewed patient's age, gender, duration of symptoms, temperature on admission, WBC count including differential and the histological diagnosis of the appendicular specimen. We further analyzed the data of those patients found to have acute, gangrenous and perforated appendicitis to determine the correlation between a high WBC count and a more advanced form of appendicitis. Out of an aggregate of 232 patients, 162 were males and 70 females with a mean age of 23.7 years [range, 12-70 years]. Mean duration of symptoms was 1.9 +/- 1.1 days, mean temperature 37.8 +/- 1.4 degree celcius, with reported elevated WBC count in 167 [71.9%] and normal in 65 [28.1%] cases. Mean WBC counts in acute were 14.5 +/- 7.3 x 109/L, gangrenous 17.1 +/- 3.9 x 109/L and perforated appendicitis 17.9 +/- 2.1 x 109/L. This reflected a persistently higher WBC count in the complex [gangrenous, perforated] appendicitis compared with acute appendicitis [p less than 0.05]. The differential analysis showed neutrophilia in 123 [53%] and lymphopenia in 112 [48%] cases and out of these, 116 [94%] with neutrophilia and 107 [95%] with lymphopenia were reported to have appendicitis. A high WBC with differential count is a reliable indicator of the severity of appendicitis and signifies a more advanced stage

Malignant duodenocolic fistula Various therapeutic surgical modalities

Malignant duodenocolic fistulas are the most rare and evolutive complication of colonic cancer due to their rapid nutritional disturbances and difficult surgical management. This case report details a 23-year-old female who presented with diarrhea, anorexia, weight loss, anemia and abdominal pain. A series of examinations showed a transverse colon carcinoma with a malignant duodenocolic fistula and direct infiltration of the right lobe of the liver. The patient underwent extended right hemicolectomy with wide local excision of the duodenum and segmental hepatic resection. Postoperative recovery was uneventful. The analysis of other similar cases from the literature treated with this procedure or less frequently, with right hemicolectomy and pancreaticoduodenectomy, allows us to discuss the indications and results of radical surgery. Whenever feasible, resection offers the best treatment as lesser techniques such as bypass and exclusion result only in minimal palliation. The benefit of exploration should almost always be offered, even in such secondary fistulas, as a better quality of life and long term survival are realistic goals and prognostically justifiable

Cholesterolosis: incidence, correlation with serum cholesterol level and the role of laparoscopic cholecystectomy

To report the incidence of cholesterolosis in the surgically removed gallbladders, its association with serum cholesterol level and to review the role of laparoscopic cholecystectomy in the treatment. This retrospective study included all patients who had consecutive cholecystectomies for various gallbladder disorders, performed by 2 consultants during a 5-year period from January 1997 through to December 2002, in the College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. The clinical records of those found to have cholesterolosis on histopathological examination were reviewed, and the data were analyzed for their age, sex, fasting serum cholesterol level and the final outcome of cholecystectomy. The study group was comprised of 549 patients and out of which, 74 [13.4%] had cholesterolosis of the gallbladder. There were 59 [79.9%] female and 15 [20.1%] male patients. Age ranged from 18-64-years with a mean of 35.7-years. Sixty-three [85.1%] cases were reported to have abnormally high fasting serum cholesterol levels [>=5.5 mmol/L], whereas 11 [14.9%] had normal serum cholesterol level. Cholesterolosis with coexistent gallstones was documented in 47 [63.3%] patients while 27 [36.5%] subjects showed acalculous cholesterolosis. Laparoscopic cholecystectomy was performed in 71 [95.9%] individuals, whereas 3 patients ended up with open cholecystectomy [conversion rate of 4.2%]. There were no postoperative complications. Cholesterolosis of the gallbladder is a distinct pathologic entity and carries a positive correlation with high serum cholesterol level. Laparoscopic cholecystectomy is effective, safe and a feasible treatment modality for cholesterolosis

Extra adrenal retroperitoneal paraganglioma

We herein report a case of a 45-year-old Saudi lady not diabetic nor hypertensive who presented to the emergency room with a one day history of severe central and lower abdominal pain. On examination, she was hemodynamically stable and abdominal examination showed tenderness in the lower abdomen. Her hematological and biochemical investigations were normal. Computed tomography of the abdomen showed an 8 x 7 cm retroperitoneal mass located at the aortic bifurcation. The patient had exploratory laparotomy and complete excision of the mass. The histopathological study showed a paraganglioma. The patient had an uneventful postoperative period and follow up

Symptomatic gallstones: a disease of young Saudi women

This is a study performed to identify the risk factors for gallstones in Saudis, taking the patient population of King Khalid University Hospital as a sample. Only Saudis with symptomatic gallstones were studied, the parameters being age, sex, weight, body mass index, fertility, age at menarche and age at marriage. The results showed that sex, weight, body mass index and fertility all appeared to be important factors in the development of gallstones and that the condition affects more Saudi females and at a younger age than reported in the literature, probably due to overweight and factors related to reproductivity. We conclude that gallstones are common in Saudi women and affect them at a younger age than western women, weight and fertility appear to be important risk factors

Hemorrhoids: don't call the surgeon yet

Two hundred and twenty-four consecutive patients seen for the first time with symptomatic hemorrhoids were given a high fiber diet supplemented by ispaghula husk, Patients were seen at I, 3, 6 and 12 months and showed improvement. The results suggest that conservative treatment using only a high fiber diet supplemented by Metamucil is highly effective in the symptomatic treatment of patients with piles

postcholecystectomy syndrome: a review

The objective is to study the Postcholecystectomy Syndrome [PCS]; its causes, different methods of diagnosis and different treatment options and their results in order to deduce from the above data the best method of prevention of its occurrence and the best method of treatment once it has occurred. Data sources include a medline search of articles covering this topic in the English literature and the abstracts of non-English articles from 1966-1994. The total number of articles of interest to the study being approximately 120. There are many causes of PCS, some related to improper preoperative diagnosis and some related to avoidable and unavoidable consequences of cholecystectomy. The different diagnostic modalities are dependent on the cause as are the different treatment options. The best treatment of this condition remains prevention whenever possible. Proper diagnosis of those patients who truly require cholecystectomy and care in performing the cholecystectomy will minimize the incidence of this syndrome

Pilonidal sinus: Primary closure with low recurrence

Inorder to assess the effectivity of simple primary excision and closure in the management of pilonidal sinuses, 75 patients were treated by this method. No antibiotics or drains were employed. The patients were mostly young males. Over an average follow-up period of 31 months, the recurrence rate was found to be 2.66%. Although the number of cases is small and the follow up period relatively short, we may speculate that a simple method of repair with conservative excision if done carefully can give good results