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Alquraish FA, AlQattan AS, Al-Shammari T. Surgical site invasive aspergillosis in immunocompetent patient secondary to Kramericeae herb: Case report. Int J Surg Case Rep 2023; 105:108026. [PMID: 36996711 PMCID: PMC10070630 DOI: 10.1016/j.ijscr.2023.108026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgical site infection results in an increased morbidity and length of stay. This poses a great economic burden to society and remains a challenge in the surgical field surgery. In the recent years, there has been great attention in modalities to avert such complications. Primary cutaneous infection with aspergillosis is rare entity in immune competent patient. CASE PRESENTATION We report a rare cause of surgical site infection with invasive aspergillosis in immunocompetent patient secondary to Kramericeae herb. We describe the wound which was noted to be offensive with production of a tar like and golden green slough material, which lack clinical improvement despite aggressive surgical debridement and the use multiple broad-spectrum antibiotics. CLINICAL DISCUSSION Post-operative wound infection with aspergillosis has been reported in literature related to patient and environmental factors; immunocompromised patient and contamination of ventilation system. Poor response to conventional measures in treating wound complication should alert surgeons to anticipate unusual fungal wound infection. Mortality due to aspergillus infection wound is highest in patient with solid organ transplant. However, it is uncommon that it can lead to septic shock and death in immunocompetent patients. CONCLUSION Post-operative wound infection with fungi seems to be less anticipated cause in immunocompetent patient. To improve outcome better awareness of the wound characteristics and clinical course. Furthermore, a better control by local authorities of non-controlled "herbal medicines" sellers in terms of routines checks of their products to ensure their health safety.
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AlQatari AA, Fallatah RZ, AlQattan AS, Al Abdrabalnabi AA, Mashhour M, AlShahrni AA. Transduodenal resection of periampullary neuroendocrine tumor: A case report. Ann Med Surg (Lond) 2022; 73:103126. [PMID: 35070273 PMCID: PMC8767234 DOI: 10.1016/j.amsu.2021.103126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction and importance Periampullary tumors are characterized as tumors that emerge nearby to the major papilla in the duodenum. They are rare lesions with an incidence rate of 0.4–0.48 per 100,000. Neuroendocrine tumors (NETs) constitute only 3% of all duodenal tumors. Their proximity to the major and minor papillae along with the gastric outlet raises a surgical challenge. Case presentation Our patient is a 40-year-old, male, medically free. He presented with history of a testicular mass. A CT scan of the abdomen and pelvis was done and showed a large retroperitoneal lymph node. A biopsy of the epididymal mass showed no evidence of malignancy. Excision of the left para-aortic mass revealed a metastatic lymph node of a well-differentiated neuroendocrine tumor. Further evaluation by gallium-68 PET-CT scan showed a periampullary neuroendocrine tumor. The decision to operate was concluded in a multidisciplinary team meeting, and intraoperatively the duodenum showed a well-defined mass between the first and second part of the duodenum which was excised via a trans-duodenal submucosal approach. A frozen section confirmed a negative margin. The final histopathology report showed a grade 2 metastatic well-differentiated neuroendocrine tumor. The latest follow-up was 3 years post-op via fluorine-18 fluorodeoxyglucose PET-CT and it showed no FDG avid disease at the duodenum or pancreases with no FDG avid lymphadenopathy or distant metastasis. Conclusion Periampullary tumors that fall under certain parameters could be resected via transduodenal local resection. This procedure yields equivalent results to more invasive surgeries, such as a Whipple's procedure, with less morbidity. Ampullary neuroendocrine tumors (NETs) are rare in compare to duodenal NETs, as they are highly metastatic and aggressive regardless of the size. These tumors present a diagnostic challenge in addition to being a topic of contention regarding surgical resection options. The controversy resides in main surgical options; the first being a pancreaticoduodenectomy (PD), and the second is a transduodenal local resection. Certain conditions must be met to achieve a satisfactory outcome for transduodenal local resection in case of periampullary NETs. For patients who have met the criteria, transduodenal local resection is believed to be a less invasive, safe, and useful alternative for PD.
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AlQattan AS, Alqutub AA, Masoudi JH, Alassaf MAM, Mansi N. Splenic oligometastasis from cervical adenocarcinoma three years after disease free survival: A case report and a review of literature. Ann Med Surg (Lond) 2021; 72:103144. [PMID: 34934488 PMCID: PMC8654797 DOI: 10.1016/j.amsu.2021.103144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Cervical cancer is the fourth most common cancer among females. Squamous cell carcinoma is the most common subtype of cervical cancer, followed by adenocarcinoma. The most reported sites of metastasis are the lungs, bones, liver, and brain. One of the rarest sites of metastasis, particularly from the adenocarcinoma subtype, is the spleen, with only four reported cases in the literature. Case report A 54-year-old post-menopausal female was diagnosed with adenocarcinoma of the endocervix (FIGO stage IIIB) after she presented to the gynecologist complaining of post-coital vaginal bleeding. The patient received chemoradiotherapy followed by brachytherapy. After completion of treatment, she had a restaging work-up which revealed a complete radiological and pathological response. During her routine follow-up, she was found to have a new splenic lesion by surveillance abdominopelvic MRI three years after completion of treatment. Surgical resection was performed, and pathological analysis confirmed the diagnosis of metastatic cervical adenocarcinoma to spleen. Conclusion Cervical cancer metastasis to spleen is very rare, especially in the cervical adenocarcinoma subtype. A high index of suspicion is necessary during follow-up. Once there is a suspicion of splenic metastasis, surgical intervention should be considered for both curative and palliative intents. Solitary splenic metastasis of cervical adenocarcinoma is rare. A high index of suspicion is necessary during follow-up of cervical cancer. Splenectomy is the definitive treatment in cases of solitary splenic metastasis.
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Affiliation(s)
| | - Afnan Amro Alqutub
- King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jumana Husain Masoudi
- King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Nabeel Mansi
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Tabbal M, Alkhalifa AM, AlQattan AS, AlJawad M, Tawfeeq MA, Al Qahtani MS. Salvage liver transplantation after resection of colorectal cancer liver metastasis with favorable outcomes: a case report and review of the literature. BMC Gastroenterol 2021; 21:191. [PMID: 33906639 PMCID: PMC8077760 DOI: 10.1186/s12876-021-01778-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Approximately 50% of patients with colorectal cancer (CRC) develop metastases most commonly in the liver. Liver transplantation (LT) can be used in certain cases of primary liver malignancy or in metastatic diseases, such as Neuroendocrine tumors. However, there are controversies regarding LT as a treatment option for liver metastasis from CRC due to poor outcomes in previously reported cases. Case presentation We report a 37-year-old male who underwent resection of the left-sided colon due to cancer and was found to have synchronous liver metastasis for which he received chemotherapy. Later, he underwent a right hepatectomy, which was complicated by insufficient liver remnant function despite the preserved liver perfusion. Therefore, salvage liver transplantation was performed successfully with a good long-term outcome. Conclusions Many studies examined the survival and quality of life in patients undergoing liver transplantation for unresectable colorectal liver metastasis; these studies include the SECA Study (secondary cancer) and others with favorable outcomes. We reviewed the literature and compared the outcomes of some of these studies in this article. Our case emphasizes that liver transplantation could be an option for some colon cancer liver metastasis (CLM) patients, specifically, as a salvage procedure. Thus, more research is needed to develop selection criteria for patients who may benefit from liver transplantation.
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Affiliation(s)
- Mahmoud Tabbal
- Hepatobiliary and Transplant Surgery, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia.
| | | | - Abdullah Saleh AlQattan
- Hepatobiliary and Transplant Surgery, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia
| | - Mohammed AlJawad
- Hepatobiliary and Transplant Surgery, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia
| | - Mansour Ahmed Tawfeeq
- Hepatobiliary and Transplant Surgery, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia
| | - Mohammed Saad Al Qahtani
- Hepatobiliary and Transplant Surgery, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia
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Alzamil AM, AlQattan AS, Alanazi AA, Alshammari T, Tahtouh M. Ischiorectal fossa metastasis from colon cancer: Case report of a rare entity and review of literature. Int J Surg Case Rep 2021; 82:105912. [PMID: 33964711 PMCID: PMC8121690 DOI: 10.1016/j.ijscr.2021.105912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance Colorectal cancer is one of the most common cancers both nationally and internationally. It commonly metastases to local lymph nodes, liver and lungs, with few reported cases of rare sites of metastasis such as adrenal glands, breast and skin. Case presentation We report a 55-year-old-female admitted as case of large bowel obstruction and unintentional weight loss. Computed tomography scan of chest, abdomen and pelvis (CT CAP) showed sigmoid colon circumferential thickening with three lesions in the right hemi-liver. A laparoscopic diverting ileostomy followed by a colonoscopy showed a sigmoidal mass consistent with adenocarcinoma on histopathology. Hence, she received neoadjuvant chemotherapy followed by hepatectomy for the liver metastasis. Post-operatively CT CAP showed a newly developed right ischiorectal fossa (IRF) nodule along with newly developed porta hepatis lymph node. PET scan showed uptake in these two new lesions. Therefore, the patient underwent resection of the primary tumor, porta hepatis lymph node and right ischiorectal fossa nodule excision. The histopathology of the primary tumor came as moderately differentiated adenocarcinoma with both ischiorectal lesion and the porta hepatis nodule being positive for metastatic disease. Clinical discussion & conclusion Ischiorectal fossa tumors are extremely rare with the majority being benign in origin. Nevertheless, the possibility of metastasis is there with no clear explanation regarding the pathway of how the metastatic cells can reach the IRF. Pre-operative diagnosis is important to determine the appropriate approach particularly if the mass is thought to be malignant. Further larger studies are needed to understand the pathway of metastasis to IRF. Colorectal cancer is one of the most common malignancies worldwide. Colorectal cancer has a tendency to metastasize to certain locations like local lymph nodes, liver and lungs. However, the ischiorectal fossa is an extremely rare location for metastatic tumors with vast majority being benign tumors. The ischiorectal fossa hasn't been reported before to be one of the sites of colon cancer metastasis. The exact pathway of metastasis to the ischiorectal fossa remains unknown.
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Affiliation(s)
| | | | | | - Turki Alshammari
- Department of Surgery, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Mohammed Tahtouh
- Department of Surgery, King Fahad Specialist Hospital-Dammam, Saudi Arabia
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AlQattan AS, AlSulaiman NS, AlDossary MY, AlSomali M, Alshammari T. Metastatic Mixed Adeno-Neuroendocrine Carcinoma of the Colon to the Liver with Multiple Peritoneal Deposits: A Case Report. Am J Case Rep 2021; 22:e929099. [PMID: 33857061 PMCID: PMC8057652 DOI: 10.12659/ajcr.929099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 48-year-old Final Diagnosis: Poorly differentiated mixed adenoneuroendocrine tumor of the colon Symptoms: Abdominal pain • fatigue • weight loss Medication: Azathioprine Clinical Procedure: Colonscopy Specialty: Oncology • Pathology • Surgery
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Affiliation(s)
- Abdullah Saleh AlQattan
- Department of General Surgery, Colorectal Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Najd Saad AlSulaiman
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Yousef AlDossary
- Department of General Surgery, Colorectal Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed AlSomali
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Turki Alshammari
- Department of General Surgery, Colorectal Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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AlQattan AS, Ghulam WZ, Aldaoud N, Algheryafi L, Aleisa N, Aldulaijan FA. Breast fat necrosis secondary to warfarin-induced calciphylaxis, a rare mimicker of breast cancer: A case report and a review of literature. Breast J 2021; 27:258-263. [PMID: 33480097 DOI: 10.1111/tbj.14160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
Breast fat necrosis (BFN) is usually a benign inflammatory response to breast trauma. However, an extremely rare cause of fat necrosis is calciphylaxis, a calcification of small- and medium-sized arteries causing thrombosis and ischemia. It is classified into (A) uremic (B) nonuremic-induced calciphylaxis. Calciphylaxis has been reported to be encountered in different parts of the body. However, to the best of our knowledge there is only one case in the English literature of BFN 2ry to warfarin-induced calciphylaxis. We report a 65-year-old female, known case of atrial fibrillation on warfarin, presented with a left breast mass of 4-month duration. The mass was painful and progressively enlarging. Examination of the left breast showed 7 × 4 cm mass, spanning from 10-2 o'clock, free from surrounding structures, with preserved overlying skin. However, the mass was not visualized on mammogram. Ultrasound showed a left breast lobulated hypoechoic mass containing a hyperechoic component. Biopsy showed fat necrosis. After 1 month, she presented with ulceration of the overlying skin. After wide local excision, histopathology demonstrated a calciphylaxis-induced fat necrosis. Considering the patient's background, the diagnosis was BFN secondary to warfarin-induced calciphylaxis. Hence, the warfarin was shifted to Rivaroxaban, 6 months follow-up showed no evidence of recurrence. In conclusion, the rarity of nonuremic calciphylaxis is reflected on the delay of diagnosis in some of the reported cases and the lack of grading system used to guide the management of such difficult wounds. However, keeping a high index of suspicion is important whenever such wounds are encountered with presence of risk factors other than end-stage kidney disease.
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Affiliation(s)
- Abdullah Saleh AlQattan
- Department of Surgery, Breast and Endocrine Surgery Section, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Weaam Zohier Ghulam
- Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, Saudi Arabia
| | - Najla Aldaoud
- Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan.,Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Lama Algheryafi
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Nadia Aleisa
- Department of Radiology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Fozan A Aldulaijan
- Department of Surgery, Breast and Endocrine Surgery Section, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
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Alayyaf N, AlQatari AA, Altalib A, AlQattan AS, Alshahrani AA. Management of Very Late Pancreatic Metastasis of Renal Cell Carcinoma 8 Years After Radical Nephrectomy: A Report of a Rare Case. Am J Case Rep 2021; 22:e927921. [PMID: 33400693 PMCID: PMC7797602 DOI: 10.12659/ajcr.927921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Female, 63-year-old Final Diagnosis: Pancreatic metastasis of renal cell carcinoma Symptoms: Asymptomatic Medication:— Clinical Procedure: Distal pancreatectomy Specialty: Oncology • Surgery
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Affiliation(s)
- Norah Alayyaf
- Department of General Surgery, Hepatobiliary Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | - Amer Altalib
- Medical College, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Saleh AlQattan
- Department of General Surgery, Hepatobiliary Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Abdulwahab A Alshahrani
- Department of General Surgery, Hepatobiliary Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Medical College, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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AlQattan AS, Alshaqaq HM, Al Abdrabalnabi AA, Alnamlah M, Alanazi AA, Alqahtani MS. Huge solid pseudopapillary tumor of the pancreas 'Frantz tumor': a case report. J Gastrointest Oncol 2020; 11:1098-1104. [PMID: 33209501 DOI: 10.21037/jgo-20-180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solid pseudopapillary neoplasms (SPN) of the pancreas are rare neoplasms accounting for 1-2% of all pancreatic tumors and have a general female predominance. We report a case and intraoperative videos of SPN involving the whole pancreatic tail. A 19-year-old female patient initially presented to another healthcare facility complaining of abdominal pain, which was started 6 years ago. A contrast-enhanced Computed Tomography (CT) scan of the abdomen showed a large mass measuring 15.6 cm × 11.6 cm × 11 cm, arising from the pancreas with an enhancing cystic component. The patient underwent exploratory laparotomy, which revealed a huge mass occupying most of the abdominal cavity. Thus, we proceeded with a distal pancreatectomy and splenectomy. Intraoperatively, the frozen section showed that the mass had features of a solid pseudopapillary tumor of the pancreas with negative resection margins. The SPN diagnosis was confirmed by histopathology and immunohistochemistry. The pathophysiology behind the development of SPN and its cellular origin is still a matter of debate with multiple proposed hypotheses. SPNs are asymptomatic in almost 70% of all cases and usually discovered incidentally. The pre-operative diagnosis of SPNs remains a clinical challenge despite all the current advances in the diagnostic modalities. Surgical management with negative resection margins is the mainstay of treatment, even with metastasis and vascular invasion, surgical excision should be performed whenever feasible. The recurrence rate after surgical resection has been reported to be 3-9%. The prognosis of SPN limited to the pancreas is generally excellent with over 95% cure rate following complete surgical resection. SPN is a rare entity of a controversial origin but is considered as a low-grade malignancy. Surgical resection to achieve complete excision constitutes the mainstay of treatment, which mostly results in an excellent prognosis.
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Affiliation(s)
- Abdullah Saleh AlQattan
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Hassan M Alshaqaq
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Alaa A Al Abdrabalnabi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Muna Alnamlah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ahmed Abdulmajeed Alanazi
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Mohammed Saad Alqahtani
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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Maghraby NH, Alshaqaq HM, AlQattan AS, Alfaraj AF, Alghamdi OA, Alzawad MJ, Farcy DA. Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study. Open Access Emerg Med 2020; 12:305-313. [PMID: 33122955 PMCID: PMC7591101 DOI: 10.2147/oaem.s263754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients. Patients and Methods A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients. Results A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation <94% and GCS ≤8 were associated with positive CT scans. Conclusion Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.
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Affiliation(s)
- Nisreen H Maghraby
- Department of Emergency Medicine, King Fahd University Hospital-College of Medicine, Imam Abdulrahman Bin Faisal University, AlKhobar, Kingdom of Saudi Arabia
| | - Hassan M Alshaqaq
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Abdullah Saleh AlQattan
- Department of General Surgery, King Fahad Specialist Hospital-Dammam, Kingdom of Saudi Arabia
| | - Adnan Fawzi Alfaraj
- Department of Emergency Medicine, King Fahad Specialist Hospital-Dammam, Kingdom of Saudi Arabia
| | - Omar A Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Malak J Alzawad
- Department of Psychiatry, Ministry of Health, Dammam, Kingdom of Saudi Arabia
| | - David A Farcy
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida, USA
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Abstract
Patient: Male, 33-year-old Final Diagnosis: Hibernoma Symptoms: Mass in the thigh • increasing in size Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
| | - Alaa A Al Abdrabalnabi
- King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | | | - Tarek Ewies
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Miral Mashhour
- Department of Histopathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ahmed Abbas
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Alkhalifa AM, Aldossary MY, Abusultan AJ, AlQattan AS, Alsomali M, Alquraish F, Alkhaldi N, Alsaeed JY, Alwosaibei AM, Alqambar M, Alsaif OH. Lipomatous tumors of adrenal gland: A case series of 5 patients and review of the literature. Int J Surg Case Rep 2020; 67:54-61. [PMID: 32007865 PMCID: PMC7000441 DOI: 10.1016/j.ijscr.2020.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Lipomatous tumors of the adrenal glands are a diverse group of tumors characterized by the composition of adipose tissue. This group of tumors include myelolipomas, angiomyolipomas (AML), lipomas, and teratomas. They are usually benign, non-functioning tumors, and they account for 5% of all primary adrenal tumors. This study aimed to elucidate the management of the initial size of the adrenal mass and symptoms of presentation. We provide a succinct literature review regarding angiomyolipomas tumors of the adrenal glands. PRESENTATION OF CASES Here, we report 5 cases of lipomatous tumors of the adrenal glands. All 5 tumors were non-functioning. Four of them were myelolipoma, and one was AML. Two cases of myelolipoma presented with flank pain, while the rest of the 3 cases presented with hypochondrium pain. Three cases of myelolipoma were managed with laparoscopic adrenalectomy, one case of myelolipoma was converted from laparoscopic to open adrenalectomy because of abdominal adhesions, and the last case was AML and was managed with open adrenalectomy. All patients had an uneventful recovery with regular follow-up. DISCUSSION Myelolipoma, the most common lipomatous tumor of the adrenal gland, consists of a mixture of bone morrow element and adipose tissue. AML consists of a mixture of a thick-walled blood vessel, smooth muscle, and adipose tissue. They mimic many different benign and malignant tumors on radiography, and the histopathological examination is still needed to confirm the diagnosis. There is still controversy in the management of these tumors. Usually, the management is individualized on each case. Reporting of these tumors are increasing due the wide-spread use of modern imaging modalities. CONCLUSION Adrenal lipomatous tumors are uncommon but with the increase use of imaging modalities their detection has increased. Further studies are needed to establish guidelines in the management of these tumors, especially that they can mimic malignant conditions.
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Affiliation(s)
| | - Mohammed Yousef Aldossary
- Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia.
| | - Ammar Jamal Abusultan
- Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Al-Khobar, Dammam 31441, Saudi Arabia
| | - Abdullah Saleh AlQattan
- Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Mohammed Alsomali
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Fatimah Alquraish
- Department of General Surgery, King Abdulaziz Airbase Armed Forces Hospital, Dhahran, Saudi Arabia
| | - Njoud Alkhaldi
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Jamal Y Alsaeed
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Abdulaziz M Alwosaibei
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Mohammed Alqambar
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Osama Habib Alsaif
- Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
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Aldossary MY, AlQattan AS, Alghamdi YM, Alayed AA, Alquraish F, AlAnzi OA, Alabdulrahim N, Alateeq A, Alqahtani MS. Surgical outcomes of primary carcinosarcoma of the gallbladder after curative resection: A rare case series. Int J Surg Case Rep 2019; 65:32-39. [PMID: 31678697 PMCID: PMC6838533 DOI: 10.1016/j.ijscr.2019.10.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Primary carcinosarcoma is a rare neoplasm of the gallbladder, and is characterized by collision elements of the adenocarcinomatous and sarcomatous components. The tumours comprise both malignant epithelial and mesenchymal elements, and are usually very aggressive, conferring poor prognosis. Adenocarcinomas are the most common neoplasms of the gall bladder, while carcinosarcoma are extremely rare, with a global prevalence rate of less than 1%. The low incidence of carcinosarcoma greatly hinders the understanding of its aetiology. PRESENTATION OF CASE Here, we report the surgical outcome of 3 rare cases of gallbladder carcinosarcomas, two of which had a IVB stage disease and in one case the staging was II. Following surgery, the survival in the former was less than 1 year, while in the latter, it extended up to 7 years (86 months), and the patient is alive till date. This study aimed to elucidate the surgical outcomes and prognosis after curable resection for carcinosarcomas of the gallbladder. DISCUSSION The findings suggest that carcinosarcomas are associated with a poor prognosis and short survival, particularly in those with tumours of >5 cm. In the absence of effective adjuvant treatment, surgery remains the mainstay of treatment. CONCLUSION Complete surgical resection may improve prognosis and extend survival in patients with this rare and aggressive form of gallbladder cancer.
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Affiliation(s)
- Mohammed Yousef Aldossary
- Department of General Surgery, Hepatobiliary Surgery Unit, King Fahad Specialist Hospital-Dammam, Saudi Arabia.
| | - Abdullah Saleh AlQattan
- Department of General Surgery, Hepatobiliary Surgery Unit, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | | | - Amal A Alayed
- Department of General Surgery, Hepatobiliary Surgery Unit, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Fatimah Alquraish
- Department of General Surgery, King Abdulaziz Airbase Armed Forces Hospital, Dhahran, Saudi Arabia
| | - Omar Abdulaziz AlAnzi
- Department of General Surgery, Hepatobiliary Surgery Unit, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | | | | | - Mohammed Saad Alqahtani
- Department of General Surgery, Hepatobiliary Surgery Unit, King Fahad Specialist Hospital-Dammam, Saudi Arabia
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AlQattan AS, Alkuwaiti FA, Alghusnah ES, Bojal SA, Alqahtani MS. Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature. Int J Surg Case Rep 2019; 61:38-43. [PMID: 31306902 PMCID: PMC6626975 DOI: 10.1016/j.ijscr.2019.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient. CASE PRESENTATION We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation. CONCLUSION Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.
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Affiliation(s)
| | | | | | - Shoukat Ahmad Bojal
- Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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ELsaid AS, AlQattan AS, Elashaal E, AlSadery H, AlGhanmi I, Aldhafery BF. The ugly face of deep vein thrombosis: Phlegmasia Cerulea Dolens-Case report. Int J Surg Case Rep 2019; 59:107-110. [PMID: 31128546 PMCID: PMC6535643 DOI: 10.1016/j.ijscr.2019.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Phlegmasia Cerulea Dolens (PCD), a rare & life-threatening condition caused by a massive deep venous thrombosis that is associated with arterial occlusion caused by the subsequent compartment syndrome. CASE PRESENTATION A 56-year-old male was diagnosed as a case of extensive left femoral DVT & pulmonary embolism. Two days after being managed by systemic thrombolytics & heparin, his condition worsened as he developed cyanosis of the affected limb, compartment syndrome & foot drop so he was referred to our facility for further management. CT venogram showed a thrombosis of the left popliteal vein extending into the left common iliac vein confirming the diagnosis of PCD & May-Turner syndrome. We adopted a limb preserving approach using a pharmacomechanical catheter directed thrombolysis (PCDT). The patient recovered fully with a complete resolution of his foot drop. DISCUSSION Several treatment options have been suggested to improve the outcomes of PCD, but due to the rarity of this condition a gold standard treatment is still controversial. But regardless of the chosen approach, there is an urgent need to decrease the thrombus burden to prevent further adverse sequelae like amputation or even death which can be achieved by using PCDT as it was demonstrated in our case. CONCLUSION Our case shows that a rare entity of DVT as PCD could be a result of improper management of acute proximal DVT in the background of anatomical variabilities & that despite the late presentation of such a rare condition there still a role for a limb preserving approach with endovascular techniques.
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Affiliation(s)
- Ayman S ELsaid
- Department of General Surgery King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Abdullah Saleh AlQattan
- Medical Intern, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Ehab Elashaal
- Department of General Surgery King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Humood AlSadery
- Demonstrator, Department of General surgery - Division of Vascular Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Ibrahim AlGhanmi
- Department of Radiology King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Bander Fuhaid Aldhafery
- Department of Radiology King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Abstract
INTRODUCTION Bariatric surgeries are increasingly performed to treat obesity worldwide. The currently available literature on these surgeries mainly focuses on their abdominal complications, giving less attention to their thoracic ones. Hence, the present work aimed to highlight the thoracic complications associated with bariatric surgeries. METHODS A retrospective descriptive study was performed and involved the review of the medical charts of 390 patients who underwent different bariatric surgeries between January 2014 and January 2017 in our hospital or who were referred to us from other centers after their specific operations. The data of patients who developed thoracic complications and who required further intervention were identified and categorized by the modality of diagnosis, outcome, duration of hospital and ICU stays, and management. Patients with a history of a preexisting pulmonary disease were excluded. RESULTS Twenty-six patients were observed to have thoracic complications secondary to their bariatric surgeries. Twenty-two patients (84.6%) received post-laparoscopic sleeve gastrectomy (LASG). Nine patients (34.6%) required ICU stays. Twenty patients (76.9) had incidences of pleural effusion in the postoperative period. The mean duration of hospital and ICU stays were 4.4 ± 11.67 days and 15 ± 19.36 days, respectively. Other reported thoracic complications included esophageal perforations, thoracic empyema, septic pericardial effusion, and pancreaticopleural fistula. CONCLUSION Bariatric surgeries are safe procedures in selected patients. There is a significant amount of literature describing abdominal, nutritional, neurological, and even ophthalmic complications after bariatric surgeries. Being that they are relatively rare, thoracic complications are underreported in the literature. The management of thoracic complications after bariatric surgery requires awareness and a high index of suspicion to prevent further morbidities and mortalities.
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Affiliation(s)
- Yasser Aljehani
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Abdullah Saleh AlQattan
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Feras Ahmed Alkuwaiti
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Farah Alsaif
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibrahim Aldossari
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hatem Elbawab
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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