Comparison of Harmless Acute Pancreatitis Score with Ranson's Score in Predicting the Severity of Acute Pancreatitis.

OBJECTIVE: To determine the predictability of harmless acute pancreatitis score (HAPS) in determining the severity of acute pancreatitis (AP) and compare it with Ranson's score. STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2012 and December 2015. METHODOLOGY: All patients admitted with AP at King Saud Medical City, Riyadh, during 2012 - 2015 were studied prospectively. Patients were assessed by HAPS and Ranson's score. Predictability values of the two systems were analysed and compared. RESULTS: Out of 116 patients studied, 104 (89.6%) were HAPS positive and predicted to have mild disease. Pancreatitis was mild in 101 (87%) but severe in 3 (2.6%) patients who scored ≥ 3 Ranson's criteria. Among 12 HAPS negative patients, 10 scored ≥ 3 Ranson's criteria and developed severe pancreatitis while 2 (1.7%) with 2 positive Ranson's criteria developed mild pancreatitis. HAPS correctly predicted the disease severity in 101 (87%) patients, a sensitivity of 98% specificity of 77% and accuracy of 96%. Ranson's system predicted correctly in all but took 48 hours for assessment. Statistical analysis showed moderate agreement (Kappa = 0.776, p < 0.001), and positive relation (rs = 0.777, p < 0.001) between the two scores. CONCLUSION: HAPS is effective in rapid identification of patient who will run non-severe course of AP. Assessment can be completed within one hour from presentation. Ranson's score, although more accurate, takes 48 hours to complete.

Intraoperative Dilatation and Air-Tight Testing of the Hepaticojejunostomy: A New Technique.

OBJECTIVE: To evaluate the effect of creating an air-tight anastomosis and intraoperative dilatation of the hepaticojejunostomy (HJ) in reducing the early and long-term complications. STUDY DESIGN: Interventional study. PLACE AND DURATION OF STUDY: Department of Surgery, King Saud University, Riyadh, between March 2008 and January 2016. METHODOLOGY: After completion of HJ, the anastomosis was tested for air-tightness, and dilated with Kelly clamp in all patients undergoing the procedure. The anastomosis was reinforced with extra suture in cases of air leak. Comparison was performed between the patients who underwent HJ by the same surgeon, after and before the new technique. RESULTS: Sixty-seven patients underwent HJ during the study period. Air leaks from HJ were observed in 3 patients before anastomotic dilatation. The anastomosis was reinforced in these patients. No air leak was observed after dilatation of the anastomosis. There was no postoperative bile leak in any patient. However, during the follow-up 3 patients presented with recurrent cholangitis and stricture formation at the HJ site required surgical revision. The new technique had significantly reduced the rate of bile leak (p=0.029) and stricture (p=0.037) at the site of HJ when compared with patients who underwent HJ without the new technique. CONCLUSION: Creation of air-tight HJ anastomosis has completely eliminated the postoperative bile leak and reduced the rate of HJ stricture formation. The addition technique resulted in insignificant prolongation of operative time. There was no technique related complication.

Enteric duplication cyst as a leading point for ileoileal intussusception in an adult: A rare cause of complete small intestinal obstruction.

Duplication of alimentary tract (DAT) presenting as an ileoileal intussusception is a very rare clinical entity. Herein, a case of an ileoileal intussusception due to DAT is presented. A 32-year-old woman was hospitalized due to diffuse, intermittent abdominal pain, vomiting and constipation for 3 d associated with abdominal distention. Plain abdominal X-ray revealed dilated small bowel. Abdominal computed tomography showed grossly dilated small bowel with "sausage" and "doughnut" signs of small bowel intussusception. She underwent laparotomy, with findings of ileoileal intussusception due to a cystic lesion adjacent to the mesenteric side. Resection of the cystic lesion along with the affected segment of intestine, with an end to end anastomosis was performed. The histopathology was consistent with enteric duplication cyst. This case highlights the DAT, although, an uncommon cause of adult ileoileal intussusception should be considered in the differential diagnosis of intussusception in adults, particularly when the leading point is a cystic lesion.

Pseudomyxoma Retroperitonei: ARare Cause of Retroperitoneal Cystic Mass.

Pseudomyxoma retroperitonei is a rare condition, characterized by accumulation of mucinous material in the retroperitoneal space, originating predominantly from the appendiceal mucinous neoplasms. A72-year-old male patient presented with a history of progressive right side abdominal pain for 5 months with a palpable abdominal mass. Ultrasound, computerized tomography, and magnetic resonance imaging showed large right abdominal multiloculated cystic lesion with heterogeneous echoic contents. Colonoscopy revealed normal mucosa with extramural pressure on the right colon and cecum. He underwent complete excision of the mass along with right hemicolectomy. The cystic mass was containing gelatinous material. Histopathology revealed low grade mucinous neoplasm. Pseudomyxoma retroperitonei should be considered in the differential diagnosis of patient presenting with progressive right side abdominal pain and retroperitoneal cystic mass.

Alvarado score as an admission criterion for suspected appendicitis in adults.

BACKGROUND: Acute appendicitis is a common surgical problem. AIM OF THE STUDY: To assess Alvarado score as an admission criterion for adult patients with suspected appendicitis in order to decrease unnecessary admissions to surgical wards. PATIENTS AND METHODS: A prospective study of consecutive patients attending the Emergency Department (ED) of Riyadh Medical Complex with suspected appendicitis. The patients were managed according to the algorithm of the study protocol and discharged after clinical improvement either from ED or from the ward. They were followed by telephone 2-3 days later. Alvarado score was obtained in the ED in all patients. RESULTS: The study included 211 patients, 60 patients were observed in ED and discharged, 151 patients were admitted and 137 of them were operated with a negative rate of 12.5%. The remaining 14 patients were observed and discharged. No patients with a score of 4 or less had appendicitis. CONCLUSION: Though the diagnosis of acute appendicitis remains mainly clinical, Alvarado score can be recommended as a helpful tool for the admission criteria and further management in order to reduce unnecessary admissions and to reduce the morbidity and mortality of acute appendicitis.