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El-Menyar A, Naqvi SGA, Al-Yahri O, Abusal AM, Al-Shaikhli A, Sajid S, Abdelrahman H, Kloub AG, Ibnas M, Latifi R, Toble YMR, Al-Thani H. Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases. World J Surg 2024. [PMID: 38558004 DOI: 10.1002/wjs.12161] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Syed G A Naqvi
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Omer Al-Yahri
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Sadia Sajid
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad G Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Muhamed Ibnas
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Kosova College of Surgeons, Prishtina, Kosova, and University of Arizona, Tucson, Arizona, USA
| | - Yasser M R Toble
- Department of Anesthesiology and Pain Management, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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Abdelrahman H, Atique S, Kloub AG, Hakim SY, Laughton J, Abdulrahman YS, El-Menyar A, Al-Thani H. Needle Decompression Causing Pericardial and Pulmonary Artery Injuries in Patients With Blunt Trauma: Two Case Reports and Literature Review. J Investig Med High Impact Case Rep 2023; 11:23247096231211063. [PMID: 37950344 PMCID: PMC10640802 DOI: 10.1177/23247096231211063] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023] Open
Abstract
Tension pneumothorax (TPX) is a severe chest complication of blunt or penetrating trauma. Immediate decompression is the lifesaving action in patients with TPX. Needle decompression (ND) is frequently used for this purpose, particularly in limited resources setting such as the prehospital arena. Despite the safe profile, the blind nature of the procedure can result in a serious range of complications, including injury to the vital intrathoracic structures such as the lungs, great vessels, and heart. Here, we reported 2 cases of blunt chest trauma resulting in TPX demanding immediate ND; however, nonintentional pericardial and pulmonary artery injuries occurred. The first case was a 42-year-old man with a needle-related pulmonary artery injury that required surgery. The second case was a 19-year-old man in whom a needle-related pneumopericardium occurred and was treated conservatively. In both cases, trained personnel performed the ND. Although ND in the field is a lifesaving intervention, it may further complicate the patient condition. Therefore, it should be performed in adherence to the universal guidelines.
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Affiliation(s)
| | - Sajid Atique
- Hamad Medical Corporation, Trauma Surgery, Doha, Qatar
| | | | | | - James Laughton
- Ambulance Service Group & Clinical Governance, Hamad Medical Corporation, Qatar
| | | | - Ayman El-Menyar
- Hamad Medical Corporation, Trauma Surgery, Doha, Qatar
- Weill Cornell Medical College, Clinical Medicine, Doha, Qatar
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