Pilonidal sinus disease recurrence at a tertiary care center in Riyadh.

BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory disease of the sacrococcygeal area. Pilonidal sinus recurrence is a matter of concern to both patients and healthcare providers. OBJECTIVES: Estimate the rate of PSD recurrence in our center and identify any risk factors contributing to disease recurrence. DESIGN: Retrospective. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: All patients who underwent surgery for primary or recurrent pilonidal sinus between 1 January 2016 to 30 June 2019 were included to allow for at least 1-year of follow-up at the time of data collection. MAIN OUTCOME MEASURE: Recurrence rate of PSD and risk factors for recurrence. SAMPLE SIZE AND CHARACTERISTICS: 369 patients: 329 males (89.2%) and 40 (10.8%) females. Median (interquartile range) age was 21 (18-26) years. RESULTS: Of the 369 included patients, recurrence was identified in 84 (22.8%) cases [95% confidence interval (CI) 18.6-27.4], and the mean timing of recurrence was 1.8 (1.6) years after the primary surgery. In a multivariate logistic regression analysis, increased age and post-operative seroma fluid discharge were independent risk factors for recurrence. In contrast, preoperative antibiotic prophylaxis and postoperative hair removal were effective in reducing recurrence. Type of surgery closure had no effect on recurrence, yet primary closure was associated with early onset of recurrence compared to secondary closure (P=.02). CONCLUSION: Our findings on the factors associated with recurrence of PSD are consistent with many reports in the literature. Reported prevalence estimates vary widely. LIMITATION: Single center, small sample size, retrospective. CONFLICT OF INTEREST: None.

Laparoscopic exploration of the retroperitoneum in a gunshot victim: A case report.

INTRODUCTION: Non-operative management and minimally invasive surgery reduce the burden of negative laparotomies in patients with penetrating gunshot wounds (GSW). Careful patient selection is key. Although challenging, in experienced hands laparoscopic exploration of the retroperitoneal space can be carried out. CASE PRESENTATION: A 38year old man was brought to the emergency room after sustaining a GSW to his right groin. Due to evidence of intoxication, clinical picture was unreliable, although the patient was hemodynamically stable and there were no signs of peritonitis. Furthermore, the presence of retained bullet fragments created significant artifact on imaging. Clinical and radiological uncertainty urged us to proceed with laparoscopic exploration. Following mobilization, the ascending colon wall was fully inspected and no injury was identified. The pelvic fracture was managed non-operatively. After an uneventful hospital course, the patient was discharged home in stable condition and outpatient follow up was re-assuring. DISCUSSION: Avoiding morbidity from missed colonic injury is important, particularly in patients with unclear clinical and radiological findings, that were present in our case. Non-operative management by serial examination and minimally invasive surgical techniques are considered an alternative to the classical exploratory laparotomy approach. Furthermore, utilization of laparoscopy in retroperitoneal injury has gained much attention in the recent years particularly in well-established centers. CONCLUSION: Laparoscopic exploration is a safe and effective surgical approach in patients who have sustained GSW to the abdomen and to the retroperitoneal space. However, it requires careful patient selection and surgical expertise.

The prevalence of head and facial injuries among children in Saudi Arabia following road traffic crashes.

BACKGROUND: Motor vehicle crashes (MVCs) are the leading cause of death among children in Saudi Arabia. Childhood injuries can be prevented or minimized if safety measures, such as car seats, are implemented. The literature on the epidemiology of head and facial injury among children is limited, which affects the ability to understand the extent of the burden and hinders investment in public health prevention. OBJECTIVE: Describe the epidemiology of head and facial injuries among children admitted to the hospital following MVCs. DESIGN: Retrospective chart review. SETTING: Five hospitals in several regions. PATIENTS AND METHODS: We collected data on all patients ≤16 years old, who were admitted to the hospital following MVCs between 2016-2019. Differences in various characteristics like head injury status and age groups were compared. MAIN OUTCOME MEASURES: Head and facial injuries. SAMPLE SIZE: 253 patients. RESULTS: Of the injured population, 97 (38.3%) sustained a head injury, and 88 (34.8%) had a facial injury. Thirteen (9.1%) children were driving the car at the time of the crash. About half of the children were seated in the back (53.8%) without a seatbelt or safety seat. CONCLUSION: The prevalence of head and facial injuries is striking. In addition, the study revealed that driving among children is not uncommon, which warrants monitoring and implementing interventions. Improved documentation of restraint use and police enforcement of safety laws can play a significant role in reducing associated injuries. The study findings highlight the importance of combination or rear seating as well as age-appropriate restraint in order to reduce the likelihood of head or facial injuries among children. LIMITATIONS: Retrospective study using the electronic search system to identify patients, but may have missed cases that were not coded correctly. Large amount of missing data for some variables. Additionally, the analysis was limited to those admitted to the hospital. CONFLICT OF INTEREST: None.

Superior mesenteric vein injury in penetrating abdominal trauma: A case report.

INTRODUCTION: Injury to the superior mesenteric vein (SMV) is considerably rare amongst abdominal visceral vascular injuries. Multiple factors play a role in identifying such injuries, leading to the high morbidity and mortality associated. CASE PRESENTATION: We report a twenty-six-year-old male sustaining a SMV injury following a self-inflected gun shot. Initial assessment of the patient reveals hemodynamic instability and intraabdominal hemorrhage. Surgically approaching the patient was performed in two stages. Midline laparotomy was performed to control the active bleeding and stabilize the patient. Kocherizing the duodenum reveals that the source of retroperitoneal bleeding was from the SMV and one of the supra-renal tributaries of the Inferior Vena Cava (IVC). Several stitches were taken in a figure-of-eight manner to control the bleeding. Second-look operation was performed to rule out other injuries and permeant closure of the abdominal wall. Proper psychiatric care was ensured before transferal of the patient in good conditions to another healthcare facility specialized in mental health. DISCUSSION: High mortality rates reaching up to 65% are reported in similar cases. Multiple factors have contributed to the patient's favorable outcome, including rapid trauma response, absences of other associated injuries, and the patient's baseline healthy status. CONCLUSION: The principle of damage control surgery in trauma is an effective strategy to stabilize the patient and rule out other injuries which might not have been discernible initially.

Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia.

BACKGROUND: Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Because speed is a major risk factor for severe crash-related injuries, a camera ticketing system was implemented countrywide in mid-2010 by the traffic police in an effort to improve traffic safety. There are no published studies on the effects of the system in Saudi Arabia. OBJECTIVE: To examine injury severity and associated mortality at a large trauma center before and after the implementation of the ticketing system. DESIGN: Retrospective, analytical. SETTING: Trauma center of a tertiary care center in Riyadh. PATIENTS AND METHODS: The study included all trauma registry patients seen in the emergency department for a crash-related injury (automobile occupants, pedestrians, or motorcyclists) between January 2005 and December 2014. Associations with outcome measures were assessed by univariate and multivariate methods. MAIN OUTCOME MEASURE(S): Injury severity score (ISS), Glasgow coma scale (GCS) and mortality. RESULTS: The study included all trauma registry patients seen in the emergency department for a crash-related injury. All health outcomes improved in the period following implementation of the ticketing system. Following implementation, ISS scores decreased (-3.1, 95% CI -4.6, -1.6) and GCS increased (0.47, 95% CI 0.08, 0.87) after adjusting for other covariates. The odds of death were 46% lower following implementation than before implementation. When the data were log-transformed to account for skewed data distributions, the results remained statistically significant. CONCLUSIONS: This study suggests positive health implications following the implementation of the camera ticketing system. Further investment in public health interventions is warranted to reduce preventable RTIs. LIMITATIONS: The study findings represent a trauma center at a single hospital in Riyadh, which may not generalize to the Saudi population.