Textiloma is a pseudotumor arising from a nonabsorbable retained cotton matrix, incidentally left behind during surgery, which has triggered an inflammatory reaction. This study describes a case of intra-abdominal textiloma, which mimicked a small bowel tumor on preoperative assessment. A 24-year-old asymptomatic female patient, who had undergone open appendectomy at the age of 20, presented to our institution with incidental finding of a large solid mass in the small bowel, covered by the omentum. Abdominal computed tomography showed an enhanced tumoral mass occupying the right intraperitoneum. During the laparoscopic exploration, the tumor was identified attached to the small bowel loop; small bowel en bloc resection was performed. Pathology results were compatible with a piece of gauze surrounded by reactive changes adherent to the small bowel (textiloma). The patient had a good recovery, and postoperative follow-ups were uneventful. The case offers a medicolegal perspective of this not uncommon, yet avoidable, problem and assesses the difficulties of assigning the responsibility for its occurrence to surgical team members and operating room staff.
{"title":"Textiloma mimicking an intra-abdominal tumor: A case report from a medicolegal point of view","authors":"Mohammed A Alharthi, Ibtihal O. Alghamdi, M. Aljiffry","doi":"10.4103/ssj.ssj_91_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_91_21","url":null,"abstract":"Textiloma is a pseudotumor arising from a nonabsorbable retained cotton matrix, incidentally left behind during surgery, which has triggered an inflammatory reaction. This study describes a case of intra-abdominal textiloma, which mimicked a small bowel tumor on preoperative assessment. A 24-year-old asymptomatic female patient, who had undergone open appendectomy at the age of 20, presented to our institution with incidental finding of a large solid mass in the small bowel, covered by the omentum. Abdominal computed tomography showed an enhanced tumoral mass occupying the right intraperitoneum. During the laparoscopic exploration, the tumor was identified attached to the small bowel loop; small bowel en bloc resection was performed. Pathology results were compatible with a piece of gauze surrounded by reactive changes adherent to the small bowel (textiloma). The patient had a good recovery, and postoperative follow-ups were uneventful. The case offers a medicolegal perspective of this not uncommon, yet avoidable, problem and assesses the difficulties of assigning the responsibility for its occurrence to surgical team members and operating room staff.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123349679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: This was a prospective observational study of 18-month duration. The purpose of this study is to compare preoperative serum calcium levels with postoperative serum calcium levels and to analyze postthyroid surgery hypocalcemia with regard to prevalence, clinical presentation, and severity and to treat hypocalcemia if it occurs. In addition, we analyzed the correlation of postoperative hypocalcemia with relation to the type of surgery, diagnosis, duration of surgery, and the quantity of blood loss. This study was conducted on consecutive patients who underwent thyroid surgery in the Department of General Surgery of a tertiary hospital in Puducherry for 18 months from November 2014 to April 2016. The median age of the patients was 40 years. The sex ratio was 17:2 in favor of females. Out of 38 patients, 18 patients were diagnosed with multinodular goiter, 8 were follicular carcinoma thyroid, 5 were papillary carcinoma thyroid, 2 were medullary carcinoma thyroid, 4 were adenomatoid nodule, and 1 patient was diagnosed to have thyroid abscess. In addition, 31 patients underwent total thyroidectomy, 6 patients underwent hemithyroidectomy when 1 patient underwent incision and drainage for thyroid abscess. Results: 39% (n = 15) of the patients developed hypocalcemia postoperatively. 87% (n = 11) of the patients were symptomatic and required calcium correction. Two patients had delayed presentation of hypocalcemia on postoperative day 5. One patient who underwent hemithyroidectomy developed hypocalcemia in the postoperative period. Trousseau's sign was the most typical clinical feature seen in hypocalcemia patients. In the present study, no significant association of hypocalcemia with the female gender was noted, and we did not find any association of hypocalcemia with advancing age. We did not find any association between hypocalcemia and prolonged surgery duration or increased blood loss in the present study. In addition, we did not see any increase in the incidence of hypocalcemia in patients who underwent thyroidectomy combined with lymph node clearance. Conclusion: The rate of postoperative hypocalcemia following thyroid surgery in this study was 39%. It coincides with the incidence reported elsewhere in the world. Although the risk of hypocalcemia was associated with increased blood loss, prolonged surgery, and extent of surgery, it was not statistically significant. If a similar study is conducted on a larger scale, including a broader spectrum of the population, important factors that influence postoperative hypocalcemia may be recognized.
{"title":"Hypocalcemia following thyroid surgery- A prospective study","authors":"S. Cherian","doi":"10.4103/ssj.ssj_95_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_95_21","url":null,"abstract":"Introduction: This was a prospective observational study of 18-month duration. The purpose of this study is to compare preoperative serum calcium levels with postoperative serum calcium levels and to analyze postthyroid surgery hypocalcemia with regard to prevalence, clinical presentation, and severity and to treat hypocalcemia if it occurs. In addition, we analyzed the correlation of postoperative hypocalcemia with relation to the type of surgery, diagnosis, duration of surgery, and the quantity of blood loss. This study was conducted on consecutive patients who underwent thyroid surgery in the Department of General Surgery of a tertiary hospital in Puducherry for 18 months from November 2014 to April 2016. The median age of the patients was 40 years. The sex ratio was 17:2 in favor of females. Out of 38 patients, 18 patients were diagnosed with multinodular goiter, 8 were follicular carcinoma thyroid, 5 were papillary carcinoma thyroid, 2 were medullary carcinoma thyroid, 4 were adenomatoid nodule, and 1 patient was diagnosed to have thyroid abscess. In addition, 31 patients underwent total thyroidectomy, 6 patients underwent hemithyroidectomy when 1 patient underwent incision and drainage for thyroid abscess. Results: 39% (n = 15) of the patients developed hypocalcemia postoperatively. 87% (n = 11) of the patients were symptomatic and required calcium correction. Two patients had delayed presentation of hypocalcemia on postoperative day 5. One patient who underwent hemithyroidectomy developed hypocalcemia in the postoperative period. Trousseau's sign was the most typical clinical feature seen in hypocalcemia patients. In the present study, no significant association of hypocalcemia with the female gender was noted, and we did not find any association of hypocalcemia with advancing age. We did not find any association between hypocalcemia and prolonged surgery duration or increased blood loss in the present study. In addition, we did not see any increase in the incidence of hypocalcemia in patients who underwent thyroidectomy combined with lymph node clearance. Conclusion: The rate of postoperative hypocalcemia following thyroid surgery in this study was 39%. It coincides with the incidence reported elsewhere in the world. Although the risk of hypocalcemia was associated with increased blood loss, prolonged surgery, and extent of surgery, it was not statistically significant. If a similar study is conducted on a larger scale, including a broader spectrum of the population, important factors that influence postoperative hypocalcemia may be recognized.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129838757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Robotic surgery is one of the rapidly expanding technologies in the field of medicine. It has been implemented since 2000; and its use has expanded over the past years. Da Vinci system was first introduced to the Middle East in 2003 by Saudi Arabia; then over the following 15 years it was utilized by other gulf countries. With the expanding knowledge of this technology and the effectiveness of its utilization; formal training programs were introduced by many hospitals. However; there are no established credentialing standards or well-structured curriculum to provide this training in the gulf region. Method: This we aim to understand the perception of general surgery residents toward robotic surgery training in tertiary care centers in Riyadh; Saudi Arabia. An anonymous web based survey was conducted on general surgery residents enrolled in Saudi Commission for health specialties approved residency training hospitals in Riyadh. Results: 50% of GS residents were involved in robotic assisted surgery which was significantly associated with the presence of robotic machines in their training centers (P0.025). Sixty Percent of residents who were involved in RAS did not receive a formal training prior to their participation, barely even a brief introduction. Conclusion: exposure and education about RAS at early training years showed that residents have better technical performance during their fellowship training. However, it should not the main focus of the training.
{"title":"Exposure and perception of general surgery residents' toward robotic-assisted surgeries in Riyadh, Saudi Arabia","authors":"Zeyad Yousef, Sarah Marie, S. Gheshayan","doi":"10.4103/ssj.ssj_96_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_96_21","url":null,"abstract":"Introduction: Robotic surgery is one of the rapidly expanding technologies in the field of medicine. It has been implemented since 2000; and its use has expanded over the past years. Da Vinci system was first introduced to the Middle East in 2003 by Saudi Arabia; then over the following 15 years it was utilized by other gulf countries. With the expanding knowledge of this technology and the effectiveness of its utilization; formal training programs were introduced by many hospitals. However; there are no established credentialing standards or well-structured curriculum to provide this training in the gulf region. Method: This we aim to understand the perception of general surgery residents toward robotic surgery training in tertiary care centers in Riyadh; Saudi Arabia. An anonymous web based survey was conducted on general surgery residents enrolled in Saudi Commission for health specialties approved residency training hospitals in Riyadh. Results: 50% of GS residents were involved in robotic assisted surgery which was significantly associated with the presence of robotic machines in their training centers (P0.025). Sixty Percent of residents who were involved in RAS did not receive a formal training prior to their participation, barely even a brief introduction. Conclusion: exposure and education about RAS at early training years showed that residents have better technical performance during their fellowship training. However, it should not the main focus of the training.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126687060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Applying American College of Surgeons Trauma Team Activation (TTA) criteria could improve trauma system outcomes and minimize both overtriage and undertriage of trauma patients. However, a percentage of trauma patients might slip through the system and become undertriaged. Objective: The objective of the study is to investigate factors related to undertriage of trauma patients at level 1 trauma center. Design: This was a retrospective cohort study. Setting and Subjects: We included all trauma patients at a level 1 trauma center from January 1, 2016, to December 31, 2019. Methods and Main Outcome Measures: We compared those who received TTA after 5 min of their arrival to emergency department (ED) (undertriaged cohort) to those who received no TTA (properly triaged cohort) in terms of demographic, anatomical, and physiological factors as well as injury severity assessment. Results: A total of 3740 trauma patients were included; 3330 (89%) were appropriately triaged and needed no TTA while 410 (10.9%) were undertriaged. In multivariate logistic regression model, the following factors were significantly associated with undertriage: arriving to ED in weekends (odd ratio, 1.417, confidence interval [CI] 95%, 1.047–1.916), motorcycle accidents (odds ratio, 3.709, 95% CI, 1.422–9.671), pedestrian victims (odds ratio, 7.477, 95% CI, 3.048–18.341), heart rate <60 (odds ratio, 2.657, 95% CI, 1.083–6.522), systolic blood pressure 76–89 (odds ratio, 4.235, 95% CI, 1.596–11.235), and Glasgow coma scale 9–12 (odds ratio, 4.365, 95% CI, 2.747–6.936). Conclusion: This study displayed different factors predictive of delayed TTA. Recognizing these factors could improve patient outcomes. Limitations: Poor prehospital documentation and communication from emergency medical services and a large number of missing data.
{"title":"Factors associated with undertriage of trauma patients at level 1 trauma center","authors":"Ibrahim Al Babtain, Mohammed Alnasser, Abrar Dohaim, Sahar H Alomar","doi":"10.4103/ssj.ssj_88_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_88_21","url":null,"abstract":"Background: Applying American College of Surgeons Trauma Team Activation (TTA) criteria could improve trauma system outcomes and minimize both overtriage and undertriage of trauma patients. However, a percentage of trauma patients might slip through the system and become undertriaged. Objective: The objective of the study is to investigate factors related to undertriage of trauma patients at level 1 trauma center. Design: This was a retrospective cohort study. Setting and Subjects: We included all trauma patients at a level 1 trauma center from January 1, 2016, to December 31, 2019. Methods and Main Outcome Measures: We compared those who received TTA after 5 min of their arrival to emergency department (ED) (undertriaged cohort) to those who received no TTA (properly triaged cohort) in terms of demographic, anatomical, and physiological factors as well as injury severity assessment. Results: A total of 3740 trauma patients were included; 3330 (89%) were appropriately triaged and needed no TTA while 410 (10.9%) were undertriaged. In multivariate logistic regression model, the following factors were significantly associated with undertriage: arriving to ED in weekends (odd ratio, 1.417, confidence interval [CI] 95%, 1.047–1.916), motorcycle accidents (odds ratio, 3.709, 95% CI, 1.422–9.671), pedestrian victims (odds ratio, 7.477, 95% CI, 3.048–18.341), heart rate <60 (odds ratio, 2.657, 95% CI, 1.083–6.522), systolic blood pressure 76–89 (odds ratio, 4.235, 95% CI, 1.596–11.235), and Glasgow coma scale 9–12 (odds ratio, 4.365, 95% CI, 2.747–6.936). Conclusion: This study displayed different factors predictive of delayed TTA. Recognizing these factors could improve patient outcomes. Limitations: Poor prehospital documentation and communication from emergency medical services and a large number of missing data.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115083261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Tobacco smoking has been proven to be a major risk factor for morbidity and mortality. The connections between smoking and postoperative adverse effects are very much recorded across surgical specialties. It has been established that smoking cessation has a major impact in optimizing the surgical outcomes of smokers. This study aims to obtain the perception of knowledge regarding surgery-related adverse effects of cigarette smoking among adult population of Al-Ahsa in Saudi Arabia. Methodology: To assess the knowledge of surgery-related adverse effects of cigarette smoking, an online survey was distributed randomly to all Al-Ahsa population in Saudi Arabia. The participants asked about their biographical data and questions regarding surgery-related adverse effects of cigarette smoking. Responses were analyzed as means and standard deviations for the quantitative variables, and percentages for qualitative categorical variables. The results shows that most of participants have agreed that smoking can increase the risk of future heart and lung problems (79%) and think it is necessary to stop smoking after surgery (69%), while more than a half of all participants did not know that smoking can increase pain (60.8%), infection after surgery (56.2), surgical complications with anaesthesia (51.3%). In this study, only 16.5% agreed that the ideal smoking cessation period before surgery is 4 to 6 weeks. Results: The results suggest that the awareness of smoking related postoperative adverse effects is poor. That is why we recommend starting and implanting a strong pre-operative smoking cessation program to provide the needed information and educational materials, advising smoker to quit and offering referral for behavioral change. Conclusion: The awareness of smoking-related postoperative adverse effects is poor. It is important for health-care providers to raise their patient's awareness and knowledge before the surgery.
{"title":"Perception of knowledge toward surgery-Related adverse effects of cigarette smoking among Al-Ahsa population, Saudi Arabia","authors":"M. AlQuaimi, Zainab A Alammar, Zahra Alghannam, F. Alabbad, A. Al Mulhim, Kawthar A Boumarah","doi":"10.4103/ssj.ssj_83_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_83_21","url":null,"abstract":"Introduction: Tobacco smoking has been proven to be a major risk factor for morbidity and mortality. The connections between smoking and postoperative adverse effects are very much recorded across surgical specialties. It has been established that smoking cessation has a major impact in optimizing the surgical outcomes of smokers. This study aims to obtain the perception of knowledge regarding surgery-related adverse effects of cigarette smoking among adult population of Al-Ahsa in Saudi Arabia. Methodology: To assess the knowledge of surgery-related adverse effects of cigarette smoking, an online survey was distributed randomly to all Al-Ahsa population in Saudi Arabia. The participants asked about their biographical data and questions regarding surgery-related adverse effects of cigarette smoking. Responses were analyzed as means and standard deviations for the quantitative variables, and percentages for qualitative categorical variables. The results shows that most of participants have agreed that smoking can increase the risk of future heart and lung problems (79%) and think it is necessary to stop smoking after surgery (69%), while more than a half of all participants did not know that smoking can increase pain (60.8%), infection after surgery (56.2), surgical complications with anaesthesia (51.3%). In this study, only 16.5% agreed that the ideal smoking cessation period before surgery is 4 to 6 weeks. Results: The results suggest that the awareness of smoking related postoperative adverse effects is poor. That is why we recommend starting and implanting a strong pre-operative smoking cessation program to provide the needed information and educational materials, advising smoker to quit and offering referral for behavioral change. Conclusion: The awareness of smoking-related postoperative adverse effects is poor. It is important for health-care providers to raise their patient's awareness and knowledge before the surgery.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"190 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117170322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized by progressive fibrosis, morphological changes, leading to exocrine and/or endocrine insufficiency. Tropical pancreatitis (TP) is seen mainly in the younger population with large ductal calculi and calcification. In this study, we evaluate the postoperative outcome and pain relief after Frey's and modified Puestow procedure (mPP) in patients of tropical and alcoholic pancreatitis. Materials and Methods: This is a retrospective review of prospectively collected data of surgically treated cases of CP. A total of 44 surgeries were performed with Frey's procedure in 36 (81.82%) patients; and mPP in 8 (18.18%) patients. The pain had been evaluated by the Visual analog scale in preoperatively and at 1 year follow-up. Results: The etiology of CP was related to chronic alcohol use in 16 patients (36.36%) and TP in 28 patients (63.63%). Abdominal pain relief was achieved in 86.36% of the patients. Postoperative pain relief was achieved in 91.66% and 62.5% of patients undergoing Frey's and mPP, respectively. Postoperative pain relief was better in TP (92.86%) as compared to alcoholic pancreatitis (75%) (P = 0.0968). Postoperative major complications over 30 days (Clavein Dindo Grade IIIa and above) were seen in 6.8%. Conclusion: Frey's procedure was associated with better abdominal pain relief as compared to mPP. Patients of tropical CP experience better postoperative pain relief than alcoholic CP.
{"title":"Outcome after surgical management of tropical and alcoholic chronic pancreatitis - A Indian tertiary centre experience","authors":"Maulik S. Bhadania, Hasmukh B. Vora, Premal R Desai, M. Bhavsar","doi":"10.4103/ssj.ssj_54_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_54_21","url":null,"abstract":"Background: Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized by progressive fibrosis, morphological changes, leading to exocrine and/or endocrine insufficiency. Tropical pancreatitis (TP) is seen mainly in the younger population with large ductal calculi and calcification. In this study, we evaluate the postoperative outcome and pain relief after Frey's and modified Puestow procedure (mPP) in patients of tropical and alcoholic pancreatitis. Materials and Methods: This is a retrospective review of prospectively collected data of surgically treated cases of CP. A total of 44 surgeries were performed with Frey's procedure in 36 (81.82%) patients; and mPP in 8 (18.18%) patients. The pain had been evaluated by the Visual analog scale in preoperatively and at 1 year follow-up. Results: The etiology of CP was related to chronic alcohol use in 16 patients (36.36%) and TP in 28 patients (63.63%). Abdominal pain relief was achieved in 86.36% of the patients. Postoperative pain relief was achieved in 91.66% and 62.5% of patients undergoing Frey's and mPP, respectively. Postoperative pain relief was better in TP (92.86%) as compared to alcoholic pancreatitis (75%) (P = 0.0968). Postoperative major complications over 30 days (Clavein Dindo Grade IIIa and above) were seen in 6.8%. Conclusion: Frey's procedure was associated with better abdominal pain relief as compared to mPP. Patients of tropical CP experience better postoperative pain relief than alcoholic CP.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115542718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To evaluate indication and result of open posterolateral thoracotomy done in the theatre for chest trauma (CT). Methods: During a 5-year period, our team performed thoracotomies in a total of 24 patients out of the 307 patients who had CT. The demographic data, type, mechanism, clinical diagnoses, operative finding, Injury Severity Score, case-fatality rate, and complication of the CT were computed with the descriptive statistics were presented in percentage and fraction. All the surgeries were performed by the same team. Results: Of the 307 patients who sustained CT, 24 patients (7.8%) had open posterolateral thoracotomy done in the theater. The mean age was 31.2 (standard deviation ± 13.10) years with a male-to-female ratio of 7:1. The cause of CT was gunshot injury 13 (54.2%) patients, motor vehicular accident in 5 (20.8%) patients, stab injury in 5 (20.8%) patients, and fall 1 (4.2%) patient. The diagnosis was made following the assessment of the quantity and quality of the output of inserted chest tube, auscultated bowel sounds in the chest, chest radiograph, and chest ultrasound. The operative finding was diaphragmatic injury in 13 patients (54.2%), lung laceration in 5 patients (20.8%), negative in two patients (8.3%), bullet in the pleural space in two patients (8.3%), and trachea-bronchial injury and bleeding internal mammary artery (4.2%) in a patient each. The case-fatality rate was 17.4%. Conclusion: Massive hemothorax remains the most common reason for the thoracotomy with diaphragmatic injury being the most common intraoperative finding. Diaphragmatic rupture should be ruled out before the insertion of chest tube for traumatic hemothorax or pneumothorax.
{"title":"Thoracotomy for chest trauma: Indication, operative finding, and outcome","authors":"K. Okonta, C. Amadi, P. Okoh, C. Ekwunife","doi":"10.4103/ssj.ssj_85_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_85_21","url":null,"abstract":"Background: To evaluate indication and result of open posterolateral thoracotomy done in the theatre for chest trauma (CT). Methods: During a 5-year period, our team performed thoracotomies in a total of 24 patients out of the 307 patients who had CT. The demographic data, type, mechanism, clinical diagnoses, operative finding, Injury Severity Score, case-fatality rate, and complication of the CT were computed with the descriptive statistics were presented in percentage and fraction. All the surgeries were performed by the same team. Results: Of the 307 patients who sustained CT, 24 patients (7.8%) had open posterolateral thoracotomy done in the theater. The mean age was 31.2 (standard deviation ± 13.10) years with a male-to-female ratio of 7:1. The cause of CT was gunshot injury 13 (54.2%) patients, motor vehicular accident in 5 (20.8%) patients, stab injury in 5 (20.8%) patients, and fall 1 (4.2%) patient. The diagnosis was made following the assessment of the quantity and quality of the output of inserted chest tube, auscultated bowel sounds in the chest, chest radiograph, and chest ultrasound. The operative finding was diaphragmatic injury in 13 patients (54.2%), lung laceration in 5 patients (20.8%), negative in two patients (8.3%), bullet in the pleural space in two patients (8.3%), and trachea-bronchial injury and bleeding internal mammary artery (4.2%) in a patient each. The case-fatality rate was 17.4%. Conclusion: Massive hemothorax remains the most common reason for the thoracotomy with diaphragmatic injury being the most common intraoperative finding. Diaphragmatic rupture should be ruled out before the insertion of chest tube for traumatic hemothorax or pneumothorax.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122227064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paraduodenal hernia (PDH), also called mesocolic hernia, is a rare congenital anomaly. However, it accounts for up to 53% of all internal hernias, but they cause only 0.2%–0.9% of all cases of intestinal obstruction. Clinical findings are often indetermined. Computerized tomography is usually diagnostic; however, the diagnosis is often made intraoperative. PDH carries the risk of morbidity and mortality due to incarceration, leading to bowel obstruction and strangulation if not treated, that is why the patient should be repaired surgically not conservatively when the diagnosis is made. Here, we present a case of left-sided PDH with low-grade partial bowel obstruction, who underwent laparoscopic exploration and reduction of small bowel content that founded to be healthy and viable.
{"title":"Paraduodenal hernia","authors":"Abeer Alshammari, Ziyad AlYousef, Faris Alwahhabi","doi":"10.4103/ssj.ssj_78_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_78_21","url":null,"abstract":"Paraduodenal hernia (PDH), also called mesocolic hernia, is a rare congenital anomaly. However, it accounts for up to 53% of all internal hernias, but they cause only 0.2%–0.9% of all cases of intestinal obstruction. Clinical findings are often indetermined. Computerized tomography is usually diagnostic; however, the diagnosis is often made intraoperative. PDH carries the risk of morbidity and mortality due to incarceration, leading to bowel obstruction and strangulation if not treated, that is why the patient should be repaired surgically not conservatively when the diagnosis is made. Here, we present a case of left-sided PDH with low-grade partial bowel obstruction, who underwent laparoscopic exploration and reduction of small bowel content that founded to be healthy and viable.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128793877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The aim of the present study was to find the utility of upper gastrointestinal (UGI) endoscopy in predicting the persistence of postoperative pain following laparoscopic cholecystectomy (LC) and to find the prevalence of other UGI pathologies before LC. Materials and Methods: Ninety patients ≥18 years of age who have gallbladder stones confirmed by ultrasonography were included in this prospective observational study. All patients were subjected to UGI endoscopy (UGIE) examination 1 day before operation. Postoperative follow-up was done on day 1, 14, and 30 for the symptoms. The primary outcome measure was the persistence of postoperative pain, whereas the secondary outcome measure was the prevalence of UGI pathology. The comparison of quantitative variables and qualitative variables was done using the unpaired Student's t-test and the Chi-square test/Fisher's exact test, respectively. Results: The majority of the patients (63.3%) had atypical symptoms. The incidence of the severity of postoperative pain at day 1, day 14, and day 30 did not differ significantly between typical symptoms group and atypical symptoms group. The postoperative pain at day 14 and day 30 was 62.9% versus 20.0% and 45.7% versus 5.5% in an abnormal UGIE group and normal UGIE group, respectively (P = 0.001 for both). In all 20 (22.2%), 9 (10.0%), 1 (1.1%), 2 (2.2%), and 3 (3.3%) had gastritis, deudenitis, gastric ulcer, deudenal ulcer, and gastrooesophageal reflux disease (GERD), respectively. Conclusions: Patients should undergo UGIE before LC to find the presence other UGI pathology.
{"title":"Diagnostic and prognostic role of upper gastrointestinal endoscopy in cholelithiasis patients with upper gastrointestinal symptoms","authors":"Azeem Nasaruddin, D. Jain, K. Patil, Deepak S. Phalgune","doi":"10.4103/ssj.ssj_84_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_84_21","url":null,"abstract":"Background: The aim of the present study was to find the utility of upper gastrointestinal (UGI) endoscopy in predicting the persistence of postoperative pain following laparoscopic cholecystectomy (LC) and to find the prevalence of other UGI pathologies before LC. Materials and Methods: Ninety patients ≥18 years of age who have gallbladder stones confirmed by ultrasonography were included in this prospective observational study. All patients were subjected to UGI endoscopy (UGIE) examination 1 day before operation. Postoperative follow-up was done on day 1, 14, and 30 for the symptoms. The primary outcome measure was the persistence of postoperative pain, whereas the secondary outcome measure was the prevalence of UGI pathology. The comparison of quantitative variables and qualitative variables was done using the unpaired Student's t-test and the Chi-square test/Fisher's exact test, respectively. Results: The majority of the patients (63.3%) had atypical symptoms. The incidence of the severity of postoperative pain at day 1, day 14, and day 30 did not differ significantly between typical symptoms group and atypical symptoms group. The postoperative pain at day 14 and day 30 was 62.9% versus 20.0% and 45.7% versus 5.5% in an abnormal UGIE group and normal UGIE group, respectively (P = 0.001 for both). In all 20 (22.2%), 9 (10.0%), 1 (1.1%), 2 (2.2%), and 3 (3.3%) had gastritis, deudenitis, gastric ulcer, deudenal ulcer, and gastrooesophageal reflux disease (GERD), respectively. Conclusions: Patients should undergo UGIE before LC to find the presence other UGI pathology.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123533571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heterotopic gastric mucosa of the proximal esophagus (HGMPE) also referred to as inlet patch is a salmon-colored patch located just distal to the upper esophageal sphincter. HGMPE is usually asymptomatic detected incidentally during endoscopy. Its clinical significance is mainly acid-related or neoplastic complications. Here, we present a case of a 58-year female presenting in the casualty with two episodes of upper gastrointestinal (UGI) bleeding. UGI Endoscopy revealed a large esophageal ulcer 1.5 cm × 1 cm just below the upper esophageal sphincter (UES). Biopsy from this area revealed a diagnosis of HGMPE. UGI bleed occurring as a complication of inlet patch has been very rarely reported. Only one case in literature is present making this case report the second one. This case highlights the importance of careful endoscopic evaluation of the UES region along with biopsy which may reveal heterotopic gastric mucosa in patients with unexplained UGI bleed.
食管近端异位胃黏膜(HGMPE)也称为入口贴片，是位于食管上括约肌远端的鲑鱼色贴片。HGMPE通常是在内镜检查中偶然发现的无症状。其临床意义主要是酸相关或肿瘤并发症。在这里，我们提出了一个58岁的女性在伤亡者提出了两个发作的上消化道(UGI)出血。UGI内窥镜显示食管上括约肌(UES)正下方1.5 cm × 1 cm的大食管溃疡。该区域活检诊断为HGMPE。UGI出血作为进气道贴片并发症的报道非常少。文献中仅有一例，使本病例成为第二例。本病例强调了在不明原因UGI出血患者中，内镜下对UES区域进行仔细评估以及活检的重要性，这可能会发现胃粘膜异位。
{"title":"Heterotopic gastric mucosa in the proximal esophagus manifesting as upper gastrointestinal bleeding: An uncommon presentation","authors":"Devyani Pendharkar, Sabina Khan, S. Hameed, Shubham Vatsya","doi":"10.4103/ssj.ssj_67_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_67_21","url":null,"abstract":"Heterotopic gastric mucosa of the proximal esophagus (HGMPE) also referred to as inlet patch is a salmon-colored patch located just distal to the upper esophageal sphincter. HGMPE is usually asymptomatic detected incidentally during endoscopy. Its clinical significance is mainly acid-related or neoplastic complications. Here, we present a case of a 58-year female presenting in the casualty with two episodes of upper gastrointestinal (UGI) bleeding. UGI Endoscopy revealed a large esophageal ulcer 1.5 cm × 1 cm just below the upper esophageal sphincter (UES). Biopsy from this area revealed a diagnosis of HGMPE. UGI bleed occurring as a complication of inlet patch has been very rarely reported. Only one case in literature is present making this case report the second one. This case highlights the importance of careful endoscopic evaluation of the UES region along with biopsy which may reveal heterotopic gastric mucosa in patients with unexplained UGI bleed.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115666494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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