King Fahad Hospital Jeddah

Introduction and importance:Adult ileocolic intussusception due to a terminal ileal lipoma is rare but clinically significant. The value of this case lies in how a typically benign and well-characterized condition presented with malignant-like clinical, radiologic, and inflammatory features, necessitating atypically extensive operative management and emphasizing diagnostic vigilance when assessing adult ileocolic intussusception. Case presentation:We report the case of a 61-year-old male who presented with signs of subacute intestinal obstruction due to ileocolic intussusception secondary to a terminal ileal lipoma. Imaging via contrast-enhanced CT scan demonstrated an ileocolic intussusception with a well-defined, fat-density mass in the terminal ileum, indicating a benign submucosal lipoma serving as the lead point. This finding enabled an accurate preoperative diagnosis and facilitated surgical planning. An extended right hemicolectomy with primary anastomosis was performed, and histopathology confirmed a benign submucosal lipoma. Clinical discussion:Adult intussusception is rare and usually caused by a pathological lead point, most often a benign tumor such as a lipoma. Unlike pediatric cases, symptoms in adults are typically nonspecific and may mimic subacute or chronic bowel obstruction. Contrast-enhanced CT is the most sensitive tool for identifying the intussusception and its cause, allowing preoperative planning. Surgical resection remains the standard of care due to the high likelihood of an underlying lesion and the risk of ischemia or malignancy. Conclusion:This case emphasizes the unique clinical presentation and diagnostic complexity that differentiate benign lipoma-induced intussusceptions from typical cases. The lesion's extension up to the right colic flexure required an extended right hemicolectomy, underscoring the importance of individualized management.

Diabetic foot ulcers (DFUs) are substantially increasing in parallel with the rapidly rising prevalence of diabetes mellitus (DM) worldwide. The regional epidemiological data of infected diabetic foot ulcers and their antimicrobial resistance (AMR) patterns are essential for optimal management of these health challenges. This systematic review and meta-analysis aimed to determine the pooled prevalence of bacterial profiles and antimicrobial resistance patterns of infected DFUs in Gulf Cooperation Council (GCC) countries. A comprehensive search of the literature was conducted on PubMed/MEDLINE, Web of Science, Embase (via Ovid), and Google Scholar databases. Critical appraisal was performed using the Joanna Briggs Institute tool for prevalence studies. A single-arm meta-analysis was conducted using RStudio to estimate the pooled prevalence of bacterial pathogens and their AMR rates using a random-effects model. The I² statistic and Cochran's Q test were used to assess the heterogeneity. P-values less than 0.05 were considered statistically significant. Sixteen studies comprising 3260 participants were included; the mean number of bacterial isolates per study was 196.1 ± 265.9. The pooled prevalence of the most common bacterial isolates obtained from DFU were Staphylococcus aureus (29%, 95% CI: 20–40%), Pseudomonas aeruginosa (16%, 95% CI: 13–20%), and Escherichia coli (14%, 95% CI: 10–19%). The highest pooled antibiotic resistance rate was observed for ampicillin (67%), followed by tetracycline (59%), gentamicin (58%), and ciprofloxacin (52%). In contrast, resistance rates were relatively low for carbapenem antibiotics. Our findings provide evidence to help guide appropriate antibiotic selection and infection prevention strategies in the GCC region. Given the high microbial diversity and antimicrobial resistance observed, locally informed stewardship efforts and evidence-based alternative therapeutics may be warranted, particularly in light of the growing global antimicrobial resistance challenge.

Exploratory laparotomy (EL) is the standard approach for managing abdominal trauma; however, it is associated with significant morbidity and high rates of non-therapeutic interventions. While laparoscopy is utilized to mitigate these risks, its therapeutic role and comparative safety profile, particularly in blunt trauma, remain controversial. This systematic review and meta-analysis compared the clinical outcomes of laparoscopic versus open surgery in hemodynamically stable patients with penetrating and blunt abdominal trauma. A systematic search of MEDLINE, Embase, CENTRAL, CINAHL, and Scopus was conducted from January 1990 to February 2026, adhering to PRISMA 2020 guidelines (PROSPERO: CRD420261296724). Comparative studies (randomized controlled trials and observational cohorts) evaluating laparoscopy versus open laparotomy in adult and pediatric trauma patients were included. The primary outcomes were mortality and length of hospital stay (LOS); secondary outcomes included overall complications and conversion rates. Random-effects models with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustments were used for pooling. Subgroup analysis, meta-regression, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were performed. Fifteen studies comprising 22,242 patients (3,965 laparoscopic and 18,277 open) were included. The laparoscopic approach was associated with a significant reduction in hospital LOS (mean difference (MD) -3.55 days; 95% confidence interval (CI): -4.92 to -2.18; p < 0.001; GRADE: moderate). Patients undergoing laparoscopy demonstrated 52% lower odds of mortality (odds ratio (OR) 0.48; 95% CI: 0.18 to 1.30; p = 0.12; GRADE: low) and a 55% reduction in overall postoperative complications (OR 0.45; 95% CI: 0.34 to 0.60; p < 0.001; GRADE: low), although these findings were susceptible to selection bias. Subgroup analyses confirmed that the reduction in LOS remained significant across both penetrating and blunt injury mechanisms. The pooled conversion rate from laparoscopy to open surgery was 18.6%. Leave-one-out sensitivity analyses and cumulative meta-analysis demonstrated the robustness and temporal stability of the treatment effect. In appropriately selected, hemodynamically stable patients with abdominal trauma, laparoscopy is a safe and highly effective alternative to open laparotomy. It significantly reduces hospital LOS and postoperative morbidity without increasing mortality, proving efficacious for both penetrating and blunt injury mechanisms. These findings support the integration of a laparoscopic-first approach as a standard of care in modern trauma algorithms.

Partial anterior cruciate ligament (ACL) tears account for 10–27% of isolated ACL injuries and present diagnostic and therapeutic challenges due to their variable presentation and risk of progression. This narrative review aimed to synthesize evidence-based approaches to managing partial ACL tears through emerging biologic therapies and selective reconstruction techniques. A partial ACL tear diagnosis requires clinical tests, including Lachman’s test, pivot-shift tests, and the KT-1000 arthrometer, as well as imaging. The gold standard diagnostic tool is arthroscopy. Non-operative management using dynamic braces and rehabilitation suits low-demand patients, yet carries a high risk of progression to full ACL tears in active individuals. Biologic therapies, including platelet-rich plasma and mesenchymal stem cells, demonstrate promising results in preclinical studies but inconsistent outcomes in human trials. Managing partial ACL tears with minimally invasive approaches featured innovative options, including the healing response technique and scaffold-assisted repairs, such as bridge-enhanced ACL restoration. Selective bundle reconstruction repairs the partial tears, preserves remnant fibers, and improves proprioception and functional outcomes compared to complete ACL reconstruction. The management of partial ACL tears warrants case-specific approaches based on injury and patient factors. Although biologic and selective reconstruction techniques are promising, additional evidence from high-quality studies is needed to validate these approaches, refine them, and develop standardized protocols to optimize knee function.