Surgical approach to coexistent inguinal endometriosis and inguinal hernial defect: a case report.

The presence of ectopic endometrial and myometrial tissue is referred to as endometriosis. The majority of cases of inguinal endometriosis are linked to prior uterine surgery. We present a 39-year-old female presented to the general surgery clinic in June 2013 with mild right inguinal pain and swelling. Enhanced computed tomography scan of the abdominal and pelvis revealed an elongated cystic mass in the right groin region. Diagnostic laparoscopy was performed and the uterus, both ovaries, and pouch of Douglas were examined. Two endometrial deposits were detected: on in the superoposteriar part of the uterus and another below the base of the right fallopian tube. In addition to the right inguinal hernia, a cystic lesion was noted on the surface of the round ligament. The entire round ligament, including the canal of Nuck, and cyst were dissected and excised completely. The right inguinal hernia was repaired.

An incidental intra-operative finding of sclerosing encapsulating peritonitis, "abdominal cocoon" in an emergency presentation of small bowel obstruction, a case report.

INTRODUCTION AND IMPORTANCE: Sclerosing encapsulating peritonitis (SEP) is a disease characterized by a chronic inflammatory process in which the small intestines are encased by a dense fibrocollagenous membrane. In this article, we report a 57 year old male who presented with bowel obstruction secondary to sclerosing encapsulating peritonitis with an initial imaging suggesting internal hernia. CASE PRESENTATION: A 57-year-old male, who presented to the emergency department at our center with a chronic persistent nausea and vomiting, associated with anorexia, constipation and weight loss, CT scan showed a transition zone seen at the duodeno-jejunal (DJ) junction and findings suggesting internal hernia, he was treated conservatively initially followed by a diagnostic laparoscopy that was converted to open with intraoperative findings of intra-abdominal cocoon rather than an internal hernia, managed with adhesolysis and discharged home in stable good condition. CLINICAL DISCUSSION: There are multiple factors that could attribute to PSEP including cytokines, fibroblasts, and angiogenic factors, such patients might be asymptomatic or presenting with GI obstruction symptoms. The diagnosis of PSEP varying from abdominal x rays to contrast enhanced CT scan. CONCLUSION: The management of PSEP depends on the presentation and should be individualized, weather conservative medical or surgical approach can be used.

The impact of preoperative total parenteral nutrition on the surgical complications of Crohn's disease: A retrospective cohort study.

Background: Crohn's disease (CD) is associated with malnutrition, an independent risk factor for surgical morbidity and mortality in more than 65% of patients, with a significant impact on disease outcomes. In this single-center retrospective cohort study, we aimed to investigate the impact of total parenteral nutrition (TPN) on the surgical outcomes of patients with CD. Methods: This study included patients with CD who underwent abdominal surgery. We compared patients who received preoperative total parenteral nutrition (TPN group) to those who did not (non-TPN group). Prolonged oral intolerance, albumin level <30 g/L, and body mass index <18.5 were the main indications for TPN. We evaluated postoperative surgical complications in both groups. Results: Between January 2010 and October 2018, 169 eligible patients underwent abdominal surgery. The TPN and non-TPN groups included 40 and 129 patients, respectively. The mean albumin level was significantly lower in the TPN group (P = 0.013). Laparoscopic surgery was performed in 76.9% of the patients, with a conversion rate of 11.6%. Infectious and non-infectious complications developed in 8.9% and 16% of patients, respectively. Surgical complications were comparable between the groups (P >0.05). Conclusions: Despite oral intake intolerance and severe disease in the TPN group, the surgical complications were comparable between the groups.

Multiple primary gastrointestinal tumors of gastric, pancreatic and rectal origin; a case report.

INTRODUCTION: The occurrence of multiple primary synchronous or metachronous malignancies is a described phenomenon. Such cases may have genetic predisposition or could be related to environmental risk factors but may also be sporadic. We are reporting a unique combination of triple primary synchronous malignancies in the same patient. CASE PRESENTATION: A 71 year old man presented with constipation and per rectal bleeding with a palpable mass 5-6 cm from the anal verge on physical examination. Colonoscopy with biopsy confirmed adenocarcinoma of rectal origin. After multi-disciplinary tumor board meeting, the patient received neoadjuvant chemoradiation therapy followed by single-stage surgery. Re-staging work up showed the presence of pancreatic lesion. Incidental finding of a gastric nodule upon surgical exploration which was confirmed to be a gastrointestinal stromal tumor. The patient had an uneventful postoperative course. DISCUSSION: Multiple primary malignancies of the gastrointestinal system has previously been reported in the literature; whether in the form of double, triple, quadruple or even quintuple primaries. Furthermore, gastrointestinal malignancies have been reported to be combined with extra-intestinal malignancies. However, this unique combination of pancreatic adenocarcinoma, rectal adenocarcinoma and gastric gastrointestinal stromal tumor has not been previously reported in the literature. Single-stage multiple resections was successful. CONCLUSION: We are reporting a unique case of three primary malignancies involving the rectum, pancreas and stomach. For such patients, there is no clear guidelines regarding management or surveillance, but rather should be individualized.

Benefits of conservative management of a retained appendicolith after laparoscopic appendectomy: A case series.

INTRODUCTION: Acute appendicitis is a disease with multifactorial etiology and frequently includes lumen obstruction. Appendicoliths can pose a challenge during the appendectomy procedure if not identified. METHODS: This is a prospective case series at our academic institution involving two medically free patients with intra-abdominal abscess formation secondary to an overlooked appendicolith who were treated conservatively with a follow up period of one year for each patient. RESULTS: Complications of a retained appendicolith are serious and include intra-abdominal abscess, perihepatic abscess, and delayed wound healing through fistula formation, most surgeons would undergo surgical removal with preoperative localization of the appendicolith using different modalities. In contrast, conservative management is an emerging approach to managing such conditions. The conservative approach involves percutaneous retrieval and the IR-guided draining of an intra-abdominal collection. In our cases, percutaneous drainage and intravenous antibiotics were a successful treatment, with no abscess recurrence in over a year. CONCLUSION: We suggest that patients with appendicoliths presenting with appendicitis should undergo appendicolith removal to prevent the risk of recurrent abscess formation. We also consider that the conservative management of patients with appendicoliths presenting with recurrent abdominal pain and abscesses after appendectomy is a better and safer approach than the surgical removal of a dropped appendicolith, as the risks of the surgical procedure complications can be avoided.

Impact of COVID-19 pandemic on patient satisfaction and surgical outcomes: A retrospective and cross sectional study.

OBJECTIVE: The objective of this study was to evaluate the impact of the COVID-19 pandemic on patient satisfaction and surgical outcomes at King Khalid University Hospital in Saudi Arabia. BACKGROUND: The COVID-19 pandemic has greatly affected health care systems across developing and developed countries. Therefore, it is important to understand its impact on various parameters of patient care as regards revised infrastructure and policies in hospitals during the pandemic. METHOD: It is a retrospective cross-sectional study was conducted from 13-3-2020 to 26-4-2020 at King Khalid University Hospital in Saudi Arabia. Patient satisfaction and surgical outcomes were the main outcome measures. RESULTS: 331 participants were included in the study (median age: 53 years; 70% female), and 223 completed the patient's satisfaction survey. 260 of the surgeries were non-oncolog cases (78.6%) compared to 71 oncology cases (21.4%). With respect to the surgical outcomes, 12% of the patients required admission to the ICU, and 10.9% developed postoperative complications, most of which were infectious complications. Only 1.8% (6 patients) were re-admitted to the hospital. Three patients died within 30 days post-op (0.9%), all had emergency surgery. Regarding patient satisfaction, 77.6% and 93% of the patients reported that nurses and doctors, respectively, treated them with courtesy and respect, listened to them carefully, and provided clear explanations to them. 90.3% were satisfied with the hospital sanitary measures. 64.1% stated that they got written instructions at the time of discharge. CONCLUSION: The satisfaction level of patients was high for all the studied domains, and there were a small number of complications with overall good surgical outcomes. That indicates that all the actions and policies that were implemented during the pandemic were proven beneficial for the patients. It is recommended to continue those measures until the COVID-19 pandemic is over.

Non operative management of proximal posterior gastric injury in a trauma patient: A case report.

INTRODUCTION: Proximal postierior gastric injuries are challenging and are often overlooked and diagnosed late. We present a case of traumatic proximal posterior gastric injury. PRESENTATION OF CASE: A 34-year-old male patient presented with traumatic proximal posterior gastric injury secondary to falling from a height. Nonoperative treatment was achieved by placing a gastric stent and wide drainage that resulted in complete healing of the perforation within a period of 8 weeks. DISCUSSION: There are no standard treatment guidelines for managing gastric leaks, except for surgical repair, in trauma patients. Management with a gastric stent has been proven effective in gastric leaks resulting from bariatric surgeries and surgical interventions for gastric cancer. This approach was followed in the management of our patient and showed promising results. CONCLUSION: Nonoperative management with an endoscopic stent can be considered a treatment option for leaks resulting from traumatic gastric injury.

Survival and outcomes after laparoscopic versus open curative resection for colon cancer.

BACKGROUND: Many studies have shown that open and laparoscopicsurgery for resection of colonic cancers produce similar short- and long-term results, but no data have been reported from Saudi Arabia. OBJECTIVE: Compare 3-year disease-free and overall survival after laparoscopic versus open curative resection for potentially curable colon cancer. DESIGN: Multicenter retrospective cohort study. SETTING: Tertiary academic hospital. PATIENTS AND METHODS: We analyzed data of patients who underwent curative resection for potentially curable colon cancer using the laparoscopic or open approach at three tertiary care centers during the period 2000-2015. MAIN OUTCOME MEASURES: Overall and disease-free 3-year survival were the primary endpoints. Secondary endpoints included conversion rate, duration of surgery, length of hospital stay, rate of wound infection, resumption of bowel function, number of lymph nodes retrieved, adequacy of resection and rate of recurrence. Risk factors for recurrence, including complete mesocolic excision, were assessed. SAMPLE SIZE: 721. RESULTS: Patient and tumor characteristics were similar in the two groups except for ASA class ( P<.01), weight ( P<.05) and tumor stage ( P<.05). Over a median follow-up of 46 months, the 3-year overall survival was 76.7% for open resection and 90.3% for laparoscopic colon resection ( P<.05). The 3-year disease-free survival was 55.3% for open colon resection and 64.9% for laparoscopic colon resection ( P=.0714). CONCLUSION: Overall and disease-free survival after the laparoscopic approach for curative resection of colon cancer is comparable to the open approach. LIMITATIONS: Retrospective design and the possibility of selection bias. CONFLICT OF INTEREST: None.

Patients reasons for obtaining psychotropic medications without a prescription at retail pharmacies in Central Saudi Arabia.

OBJECTIVE: To explore the possible causes behind adults seeking psychotropic medications without a prescription; identify the most commonly used psychotropic medications without a prescription; and determine the prevalence of depression and anxiety disorders among adults who used psychotropic medications without a prescription in Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted from November 2014 to August 2015. A convenience sample was taken by distributing a self-administered questionnaire among participants who had obtained psychotropic medications without a prescription from retail pharmacies during the 4 weeks prior to study intake in Riyadh, Kingdom of Saudi Arabia. In addition to the study questionnaire, the 9-item Patient Health Questionnaire was used to screen for major depressive disorder, and the 7-item Generalized Anxiety Disorder Scale was used to screen for general anxiety disorders. RESULTS: Of the 302 subjects, 42.4% attributed their use of psychotropic medications without a prescription to the non-seriousness of their symptoms and 28.5% to the high cost of psychiatric services. Escitalopram was the most commonly used medication (31.8%), and 3 atypical antipsychotics were used by more than one-fifth of the study participants. The prevalence for major depressive disorder was 46.0% and 41.7% for generalized anxiety disorder. CONCLUSION: Most of the participants were able to easily obtain psychotropic medications without a prescription. We recommend implementing strong policies to prevent retail pharmacies from dispensing psychotropic medications without a prescription.