Schistosomal appendicitis in Kuwait A5-year study.

BACKGROUND: Appendicular schistosomiasis is an unusual etiology of acute appendicitis, which has been reported in countries endemic in schistosomiasis, such as sub-saharan Africa and South America. Nowadays, due to globalization, this disease has been diagnosed in non-endemic countries. Kuwait is a country possessing a larger percentage of foreigners than national citizens. Therefore, several cases of schistosomal appendicitis were found. METHOD: The clinicopathological records of all patients that underwent appendectomy during January 2007 and December 2011 were recorded from the archives of Al-Adan Hospital in Kuwait. All cases of schistosomal appendicitis were retrieved and the histopathologic slides reconfirmed by the histopathologist. RESULTS: During the 5-year study period, 3012 appendectomies were performed and 8 schistosomal appendicitis were found. They were all Egyptian males that were admitted for a clinical suspicion of acute appendicitis. The age ranged between 24 and 42 years, with a mean age of 32.75 years. All cases showed histological features of acute or acute suppurative inflammation, with ova seen in the vasculature of all layers of appendicular wall. CONCLUSION: Although schistosomiasis is a rare causative agent of acute appendicitis, this however can't be confirmed until histological evaluation. Therefore, adequate follow up postoperatively is necessary to insure eradication of the disease and to prevent further serious consequences.

Diagnostic performance of gastric imprint smear for determination of Helicobacter pylori infection.

BACKGROUND: Despite the availability of several methods (invasive and noninvasive) for the diagnosis of Helicobacter pylori infection, no test is considered to be the 'gold standard'. Endoscopy-based tests are regarded as the reference method in most studies. OBJECTIVE: To evaluate the diagnostic performance of imprint cytology smears of antral biopsies compared with Gram-stained smears, the rapid urease test and culture methods, separately and in combination. METHODS: Antral biopsies were obtained from consecutive patients undergoing upper gastrointestinal endoscopy at a single centre. The biopsies were examined for the presence of H pylori by Gram-stained smear, the rapid urease test, culture methods and imprint cytology smear.  RESULTS: A total of 273 biopsies were studied. All tests were positive in 36% of the patients. Of 252 biopsies tested, 73% were positive using the imprint cytology technique. Using Gram-stained smear, the rapid urease test and culture methods individually, the sensitivity and specificity of imprint cytology smears for the detection of H pylori were found to be 92.7% and 50%; 92.7% and 49%; and 92.4% and 38.5%, respectively. Combining the three microbiological methods resulted in a sensitivity of 92.1%, a specificity of 51.0% and an efficiency of 71.7% for imprint cytology smears. CONCLUSIONS: Endoscopic examination provides useful clinical information. Imprint gastric cytology can be used as a rapid test to establish the diagnosis of H pylori infection at the time endoscopy is performed, enabling the endoscopist to start treatment with immediate effect.

Penetrating cardiac injury.

OBJECTIVES: To report a case of penetrating cardiac injury with patient's survival. CLINICAL PRESENTATION AND INTERVENTION: A 23-year-old man stabbed with a knife to the epigastric area just below the right costal margin was brought to the Emergency Room, Al-Adan Hospital, Kuwait, in a state of shock. Aggressive resuscitation was performed, chest X-ray showed no evidence of hemo- or pneumothorax. Exploratory laparotomy was performed revealing a severely congested liver, with no intraperitoneal hemorrhage to explain his being in a state of shock. Left thoracotomy revealed pericardial tamponade with perforation in the right ventricle and hemorrhage. A mattress suture was used to control bleeding from the right ventricle. Postoperative echography revealed a tear in the interventricular septum and papillary muscle. Open-heart surgery was performed to repair the injured tissues. The patient made an uneventful recovery. CONCLUSION: This report shows that patients with penetrating cardiac injuries and detectable vital signs on arrival at the hospital can be salvaged by prompt surgical intervention.

Rupture of splenic artery aneurysm during labor: a case report of maternal and fetal survival.

OBJECTIVE: To report a case of splenic artery aneurysm that ruptured during labor with both maternal and fetal survival. CLINICAL PRESENTATION AND INTERVENTION: A 33-year-old primigravida at 42 weeks of gestation was admitted to Adan Hospital for induction of labor. Three days after induction, the patient suddenly collapsed and was found to be hypotensive. Abruptio placentae was mistakenly diagnosed, despite the absence of vaginal bleeding, and the patient was immediately taken to the operating room for emergency cesarean section. A female infant was delivered without any evidence of abruptio placentae but with 2,000 ml blood noted in the abdominal cavity. A vertical midline incision was performed and a ruptured splenic artery aneurysm was found. Proximal ligation of the splenic artery was performed followed by splenectomy. Both mother and newborn did well and were discharged on the 7th postoperative day. CONCLUSION: This case illustrates the need to consider ruptured splenic artery aneurysm as part of differential diagnosis of hemoperitoneum in pregnant women. Immediate surgical intervention is needed to ensure survival of both mother and fetus.