Pattern of surgical and medical diseases among pilgrims attending Al-noor hospital makkah.

OBJECTIVE: Hajj usually presents a unique medical crisis especially for the Emergency Department. This study will identify the surgical and medical cases that presented at the Emergency Department during Hajj and percentage admitted. DESIGN: A prospective study of the pattern of surgical and medical cases that presented at the Emergency Department of the largest tertiary care hospital in Makkah city and holy lands during Hajj. METHODS: The study was conducted prospectively during the 1413 (1993) Hajj pilgrimage from 20.11.1413 to 20.12.1413. All Saudi and non-Saudi pilgrims presenting at the Emergency Department of Al-Noor Specialist Hospital were included. RESULTS: From the 7,676 patients who came to the Emergency Department, 1426 were admitted. The commonest cause for surgical admission was trauma, while the commonest cause for medical admission was pneumonia. CONCLUSION: More than 50% of cases could have been dealt with in the Outpatient Department or Primary Health Care Centers.

Minimal invasive surgery: a district hospital experience.

This was a prospective analysis of the first 162 patients who underwent biliary and nonbiliary minimally invasive (video laparoscopic) procedures in the Royal Commission Medical Centre (RCMC) over two periods separated by a one year interval (September 1993-September 1994)-(October 1995-February 1996). One hundred and fifty patients had video laparoscopic cholecystectomy (VLC). Thirty four males and 116 females with a mean age of 39.7 years (range 16-80). Forty two patients (28%) were admitted as emergency (37 acute cholecystitis, 5 acute pancreatitis). The indication for VLC was symptomatic gall stones. The VLC was accomplished successfully in 144 patients (96%). Six patients (2 electives and 4 emergency) required a conversion for various reasons, unfavourable anatomy being the commonest. Ten patients with preoperative evidence of a dilated common bile duct, with or without stones had an ERCP done in another hospital 200 km away. The median operative time was 100 minutes (range 30-270 minutes) There were three major complications (one CBD injury, one bleeding from gall bladder bed and one post operative acute pancreatitis) and 6 minor complications (urethral bleeding, atelectasis post-operative pyrexia, umbilical port cellulitis, prolonged ileus and acute anxiety state). The median hospital stay was 72 hours for successful VLC. Twenty five per cent of the patients did not require any narcotic analgesic. Twelve patients (7.4%) had one or another non-biliary video laparoscopic procedure. Our results suggest that VLC can be offered and performed safely in the majority of patients presenting with acute and/or chronic cholecystitis and that the results we achieved in a district hospital are comparable to other series. We conclude that VLC will continue to be demanded by patients and non-biliary video laparoscopic procedures which were slow to develop in our hospital will continue to need special training, interest and expertise before it can be adopted as a routine.

Splenic preservation after traumatic rupture. A remote hospital experience.

OBJECTIVE: The aim of this study is to describe the outcome of treatment modalities, the length of hospital stay and blood transfusion requirements of patients with traumatic splenic rupture. It also discusses the pros and cons of each treatment given, to determine its feasibility and pre-requisites in a set-up similar to this one. SET-UP: The Royal Commission Medical Centre is a 340-bed secondary care facility located in Yanbu Industrial City, in the western part of Saudi Arabia. It serves the population of the city (approximately 40,000) plus a catchment area of nearly 300,000. METHODS: A retrospective cross-sectional design was used in this study. The medical records were reviewed to abstract the required data. RESULTS: Twenty-one patients (15 males, 6 females) were included. The age ranged between 4 and 57 years, with a mean of 20.8 years and a SD of 13.3 years. A total of 14 spleens (66.6%) were preserved. Non-operative treatment (active conservative) was given to 12 patients while two spleens were preserved operatively by splenorraphy. Seven (33.3%) had operative treatment in the form of splenectomy. The blood transfusion requirement was significantly less in the non-operative treatment modality (p<0.005). The outcome of treatment was significantly better in the non-operative treatment modality (p<0.005). The length of hospital stay was not statistically significantly different. CONCLUSION: Active-conservative treatment is a viable and safe alternative in stable patients with splenic injury due to blunt trauma when intensive care and monitoring facilities are available and properly utilized.