Ingestion of metallic shrapnel by a bomb?blast victim: a case report and literature review

This case report describes an unusual incidence of shrapnel ingestion by a bomb?blast victim with infliction of multiple, simultaneous, penetrating injuries.Consequently, the foreign body that appeared within the lumen of cecum on the computed tomography [CT] scan was thought to have entered through one of these penetrating injuries. A 31?year?old male, who was the victim of a bomb?blast, was brought to the emergency room with multiple, penetrating wounds. The CT scan of the abdomen showed a dense metallic body within the cecum but cecal perforation was not ruled out. Exploratory laparotomy revealed a metallic body within the lumen of the cecum with no gut perforation. The metallic foreign body, which was actually ingested shrapnel, subsequently passed out in the stools. Even with the use of high?tech investigations and diagnostic tools, the clinician was unable to reach a conclusive diagnosis. Therefore, the importance of a thorough and detailed clinical history and physical examination and their interpretation should not be underestimated, and physicians should be open to a wide variety of possible causes

Patterns of thyroid cancer in southwestern Saudi Arabia

To examine the pattern of thyroid cancer, assess the magnitude of the problem, and evolve a management plan for such malignancies. This is a retrospective cohort study of all thyroid cases operated at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia, between January 1998 and December 2007. Clinical presentations, management regimens, and recurrence were reviewed. Five hundred and sixteen patients were operated for different thyroid lesions. Ninety-two [17.8%] were malignant [20 males and 72 females]. Mean age for males was 41.35 +/- 15.52 years compared to 36.59 +/- 13.28 years for females. Papillary carcinoma constituted 50%, while follicular carcinoma formed only 4.3% of malignant cases. Lymphoma ranked third with only 1.1% of all malignant thyroid lesions. No cases of medullary carcinoma were found. Of 92 patients, 75 reported for follow-up. The recurrence rate for follow-up patients was 29 [31.5%]. High resolution neck ultrasonography and image-guided fine needle aspiration cytology should be considered as routine investigative tools in patients with suspicious thyroid swelling. Total thyroidectomy and removal of all lymph nodes in the central compartment of the neck seem to be the ideal management plan, until such trials emerge. Residual thyroid tissues, following surgery, should be ablated using radioiodine [I131] isotope