Abstract Castleman’s disease (CD) is an uncommon disorder characterized by lymphoid tissue proliferation, presenting in either unicentric or multicentric forms. It is most commonly found in the mediastinum, with unicentric retroperitoneal involvement being rare. We present the case of a 51-year-old man presenting with intermittent epigastric pain over 2 years. Abdominal imaging revealed a well-defined retroperitoneal soft tissue mass with multiple central calcifications. Robotic surgery was performed to excise the mass entirely. Histopathological analysis confirmed CD, demonstrating a mixed type with features of hyaline vascular and plasma cell types. CD should be considered in the differential diagnosis of retroperitoneal masses, particularly in cases where the diagnosis is uncertain.
Abstract Background: Pancreatic cancer is a highly aggressive and fatal form of cancer, primarily due to its late-stage diagnosis. A computed tomography (CT) scan is crucial because it offers essential insights into factors such as the feasibility of tumor resection, the presence of lymph node metastasis, and vascular invasion. Aim: In this systematic review, we explored the role of CT in evaluating pancreatic cancer, specifically its accuracy in predicting surgical findings. Methodology: We conducted a literature search and uncovered eight relevant studies from 2001 to 2021. These studies included 843 patients with diverse demographics, various stages of cancer, and different types of pancreatic tumors. Results: Our results showed that CT scans can initially be depended on for early detection, assessment of the extent of lesions, and determination of the resection feasibility. Furthermore, the “K-sign,” indicative of constriction of the pancreatic parenchyma, was observed in 58.5% of the cases. This shows promise for the early detection of pancreatic ductal adenocarcinoma. Conclusion: Our findings have significant implications for clinical practice, potentially influencing guidelines and ultimately enhancing patient outcomes. However, this also indicates a deficiency in existing studies supporting whether CT can accurately predict surgical outcomes.
Abstract Background: Gender disparities in bariatric surgery utilization and outcomes remain underexplored despite growing evidence of sex-specific risk profiles. This study aimed to evaluate gender-based differences in preoperative characteristics and short-term postoperative outcomes among patients undergoing bariatric surgery in the National Surgical Quality Improvement Program (NSQIP) cohort. Methods: A retrospective analysis was performed on 157,201 patients who underwent bariatric surgery, utilizing data from the American College of Surgeons-NSQIP database. Demographic, clinical, laboratory, and operative variables were compared between male and female patients. Primary outcomes included 30-day mortality and major postoperative complications, encompassing cardiac, respiratory, urinary, thromboembolic, septic, and bleeding events. Statistical analyses were conducted using SAS software, version 9.4 (SAS Institute Inc., Cary, NC, USA). Results: Male patients comprised 20.48% of the cohort and presented with significantly higher body mass index, older age, and greater prevalence of diabetes, hypertension, chronic obstructive pulmonary disease, and renal dysfunction. Laboratory markers indicated more advanced hepatic and hematologic abnormalities in males. Postoperative outcomes revealed a threefold higher mortality rate in males (0.15% vs. 0.05%, P < 0.0001), along with significantly increased rates of cardiac (0.19% vs. 0.07%), respiratory (0.51% vs. 0.31%), urinary (0.32% vs. 0.09%), thromboembolic (0.46% vs. 0.36%), septic (0.47% vs. 0.33%), and bleeding complications (0.76% vs. 0.55%). Return to the operating room was also more frequent in males (1.37% vs. 0.99%, P < 0.0001). Conclusions: Male patients undergoing bariatric surgery exhibit a higher burden of comorbidities and significantly worse short-term outcomes, including mortality and major complications. These findings underscore the need for earlier referral, targeted preoperative optimization, and gender-sensitive perioperative strategies to improve safety and equity in bariatric care.
Abstract Objective: The present study was designed to investigate the correlation between hematological and biochemical markers in COVID-19 patients. Methods: A single-center retrospective observational study design was followed from April 2020 to December 2020 in a tertiary hospital in Jeddah, Saudi Arabia. Various hematological and biochemical markers were evaluated. Activated partial thromboplastin time (APTT) and prothrombin time (PT) tests were performed. Results: One hundred and eight patients were categorized as died ( n = 63) or discharged ( n = 45). Dead patients had lower hemoglobin (Hb) levels (11.71 ± 2.69 vs. 12.88 ± 2.45, P = 0.02), lymphocyte absolute count (1.11±0.38 vs 1.48 ± 0.748, P = 0.001), and platelets (195.35 ± 80.86 vs. 232.18 ± 89.01, P = 0.02) and higher white blood cell (WBC) levels (10.26 ± 5.89 vs. 7.82 ± 2.96, P = 0.01) and neutrophil absolute count (9.61 ± 5.61 vs. 6.07 ± 2.91, P < 0.001). Dead patients had significantly prolonged APTT ( P = 0.02) and PT ( P = 0.01) than discharged patients. Dead patients had significantly higher levels of bilirubin, D-dimer, creatinine, lactate dehydrogenase, and C-reactive protein (CRP), while a nonsignificant difference in alanine aminotransferase (ALT) ( P = 0.36), aspartate aminotransferase (AST) ( P = 0.46), and ferritin (0.43). A strong positive correlation was observed between AST and ALT ( r = 0.829), as well as between WBC and neutrophil absolute count ( r = 0.725). Moderate positive correlations were observed between ALT and bilirubin ( r = 0.414) and between AST and bilirubin ( r = 0.345). PT moderately correlated with CRP ( r = 0.288), and ferritin with triglycerides ( r = 0.336) and CRP ( r = 0.240). A negative correlation was observed between Hb and PT ( r = −0.301), and Hb with creatinine ( r = −0.230). Conclusion: These findings underscore the need for a multifactorial approach in evaluating COVID-19 patients, suggesting regular hematological and biochemical tests may offer valuable insights into disease prognosis.
Abstract Background: Pancreatic cancer is a highly aggressive disease with few treatment options, poor prognosis, and a low 5-year survival rate. Aim: This study aimed to analyze the predictive value of computed tomography (CT) in preoperative assessment and its relationship with histopathological findings among individuals with pancreatic cancer. Settings and Design: A retrospective study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from November 2023 to January 2024, including patients diagnosed with pancreatic cancer between 2012 and 2022 who underwent preoperative CT imaging. Patients and Methods: Medical records were reviewed to assess the relationship between CT results, histological features, and surgical outcomes. Statistical Analysis Used: Data were analyzed using SPSS version 26. The Chi-squared test was applied to qualitative data, while Mann–Whitney and Kruskal–Wallis tests were used for nonparametric quantitative data. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and Spearman’s correlation, with a significance level of P < 0.05. Results: Among 51 individuals with pancreatic cancer, 51% were males, and pancreatic head tumors were most common (52.9%). No celiac trunk or superior mesenteric artery invasion was found. Histological analysis revealed ductal adenocarcinoma as the predominant type (82.4%). A significant discrepancy was noted in lymphovascular invasion (LVI) diagnosis between CT (2%) and histopathology (29.4%). Conclusions: While CT plays a crucial role in preoperative assessment, its limitations in detecting LVI highlight the need for improvement. Our findings suggest that enhancing imaging techniques could lead to more accurate preoperative evaluations of pancreatic cancer.
Abstract Background and Objectives: Rib fractures are associated with considerable morbidity and healthcare costs and often require specialized care. This systematic review evaluated randomized controlled trials (RCTs) comparing intensive care unit (ICU) and non-ICU length of stay (LOS) and clinical outcomes to identify optimal management strategies for patients with rib fractures. Methods: A systematic search of PubMed/MEDLINE was conducted to identify RCTs published in English up to November 2024. Eligible studies included adult patients (≥18 years) with rib fractures and reported outcomes such as ICU and non-ICU LOS, complications, and mortality. Two independent reviewers conducted study selection, data extraction, and quality assessment, with discrepancies resolved by consensus. Due to heterogeneity in study design and outcomes, a narrative synthesis was performed. Results: The search identified 970 records, with an additional 43 from gray literature. After screening 260 full-text articles, 13 met the inclusion criteria. Patients had an average of 3–11 rib fractures, with common comorbidities including chronic obstructive pulmonary disease, hypertension, and diabetes. ICU stay was generally shorter than non-ICU stay, particularly among patients undergoing surgical or interventional management. Pulmonary complications, especially pneumonia, were common, although the overall mortality was low. No significant differences in long-term quality of life were observed between groups. Conclusion: This review highlights the need for evidence-based guidelines for rib fractures management. ICU care appears beneficial for improving monitoring and pain management, reducing complications, and supporting informed clinical decision-making, and resource allocation to enhance patient outcomes.
Abstract Objectives: To evaluate the characteristics and oncological outcomes of metastatic colorectal cancer (CRC) by comparing patients with synchronous metastasis (SM) and with metachronous metastasis (MM) to assess prognosis and treatment outcomes. Methods: A retrospective analysis was conducted on patients who underwent primary CRC resection between January 2013 and June 2020. They were classified into SM and MM groups. Clinical, pathological, and survival data were analyzed. Primary outcomes included overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). The secondary outcome was to evaluate the factors associated with poor survival. Results: One hundred seventeen patients (58 synchronous and 59 MM) were included. Those with SM had more severe systemic disease, lower preoperative serum albumin levels, and more right-sided colon cancers. Five-year OS was significantly lower in SM (17.7%) than in MM (35.1%), whereas DSS was similar. Three-year DFS was comparable between SM patients who underwent curative resection and MM patients (9.7% vs. 11.9%, P = 0.23). Three-year OS was significantly higher in SM patients who underwent resection of primary tumor and metastasis than in those who underwent primary tumor resection alone. Liver metastasis and node-positive disease were independent predictors of poor survival. Conclusion: SM is associated with worse OS than is MM. However, curative resection improves outcomes, highlighting the importance of multidisciplinary management in evaluating potential curative surgery.
Abstract Context: Patients with peripheral arterial disease (PAD), diabetes, and foot osteomyelitis are at risk of minor foot amputations, which are the most common surgical procedures. Every 30 s, a limb is lost worldwide due to diabetes. However, little is known about the risk factors associated with reamputation. Aims: The aim is to estimate the prevalence of reamputation and identify its risk factors in a tertiary hospital. Settings and Designs: This retrospective observational study was conducted at a tertiary care hospital. Subjects and Methods: Medical records of patients admitted to our institution with a history of lower-limb reamputations between 2012 and 2022 were reviewed. Statistical Analysis Used: Descriptive statistics and comparative analyses (Chi-square test and logistic regression) were employed to identify associations between clinical factors and risk of reamputation. Results: Among 432 patients with a history of foot amputation, there was a significant difference in the first toe amputation ( P < 0.05). Major reamputation was significantly more frequent in cases associated with ischemia (78%, 54.2%) or infection (39.6%, 22.9%) compared with minor reamputation. Conclusions: One-third of patients with a prior amputation underwent reamputation, with the rate of major reamputation significantly exceeding that of minor reamputation. The key risk factors were diabetes, hypertension, PAD, and ischemic heart disease. The highest risk period occurred within 90 days after the primary amputation. Major reamputation was significantly more common than minor reamputation and was associated with ischemia, whereas nonhealing wounds were relatively frequent in both minor and major foot reamputations. Patients who underwent toe amputation had a higher risk of major reamputation surgery.
Abstract Introduction: Rheumatic valvular heart disease is the prevalent etiology of valvular heart disease in the developing world. The bulk of the pathologies are restricted to the mitral and aortic valves. Infective endocarditis is another important cause of valvular heart disease, especially in patients with an already existing valvular pathology and in intravenous drug abusers. The goal of surgical management is to deter disease progression, alleviate symptoms and improve the overall QOL of the patient. Health-related QOL (HRQOL) is an essential component of the effectiveness of therapy alongside improvement in symptoms and functional status. As a result, the American Heart Association has now included HRQOL evaluation as a strategic treatment-impact goal for cardiovascular health. Objective: To evaluate the QOL of patients following heart valve replacement surgery. Patients and Methods: This is a cross-sectional study where the QOL of patients was evaluated after valve replacement surgery in all patients who had heart valve replacement at the study hospital in Ghana within a period of two years. The Short Form-36 questionnaire, consisting of 36 questions arranged in eight domains, was used to assess the QOL and compared to the population norm. Results: Thirty-nine participants were studied with a mean age ± standard deviation of 43.82 ± 15.37 years. The mean score of the patients in seven of the eight domains of the SF-36 health survey was above 70. The Role Limitation due to Physical Health domain has a mean score of 62.17 ± 42.87. The mean score for each of the eight domains of the SF-36 health survey was well above the US population norm of 50. Conclusion: The findings show that the HRQOL of patients following heart valve replacement surgery is comparable to that of the general population.
Obesity affects 650 million people worldwide and is associated with several obesity-related diseases, reducing life expectancy and quality of life (QoL). Individuals with a body mass index >35 or those in the 30–34.9 kg/m2 lower range but with one or more obesity-related disorders should consider undergoing bariatric surgery. This study aims to assess postbariatric compliance with supplements/fluid intake, dietary instructions, and QoL between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Cross-sectional study including patients who underwent SG and RYGB surgeries between 2019 and 2022. We adapted a self-reported validated questionnaire, the RAND 36-item Health Survey version 1.0 (RAND 36), which measures QoL across eight lifestyle scales. In addition, we documented adherence to commitments to postbariatric instruction. The data were analyzed using SPSS version 26. Among 100 participants, 39% were aged 30–39 years, and 67% were female. Furthermore, 46% of the patients had chronic diseases, of which hypertension (17%) and hypothyroidism (12%) were the most common. Fifty percent of the participants underwent SG. Patients who underwent SG had a significantly higher mean score for physical health, emotional problems, and social functioning (SF). No significant relationship was found between surgery type and compliance with medications, supplements, proteins, fluids, iron, the amount of fluid taken after the procedure, or weight loss. This study found high RAND-36 scores for SG and RYGB, and patients with SG showed better QoL in terms of physical health, emotional problems, and SF; however, no significant association was found.
Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become the standard of care for elective surgery for patients with ulcerative colitis (UC). However, there are different surgical techniques and several patient variations affecting their outcomes. The aim of this international multicenter study is to assess the approaches of colorectal surgeons toward IPAA procedures. Thirty colorectal surgeons practicing in Saudi Arabia, UAE, and Oman were asked to complete a questionnaire on their knowledge of indications, complications of IPAA, and practice in selecting stoma versus restorative IPAA for patients with UC. Around 83.3% (n = 25) of participants were affiliated with academic tertiary hospitals and 66.7% (n = 20) had an inflammatory bowel disease (IBD) multidisciplinary board at their center. Regarding colorectal surgery fellowship, Author 2: 63.3% (n = 19) of participants were trained abroad (USA, Canada, Korea, Belgium, France, Germany, and UK) and 36.6% (n = 11) were trained in Saudi Arabia.. Most surgeons performed IPAA independently in their practice (73.3%, n = 22), with an average of 10–20 IBD surgeries per year (50%, n = 15). All the participants agreed that IPAA is indicated in UC patients, while only 5.9% (n = 1) of participants said that they would perform IPAA for indeterminate colitis. Most of the cohort (70.6%, n = xx) routinely performed two-stage IPAA, while only 29.4% (n = xx) of participants would routinely perform three-stage IPAA. This survey demonstrates that IPAA is a popular option to improve the quality of life with patients who are required to have surgical treatment. However, there is a need for a multidisciplinary approach to create sustainable outcomes for every patient’s variation.
In recent decades, obesity emerged as a prominent health issue. Its treatments range from restrictive diet to invasive surgical procedures, the latter gaining popularity in patients with morbid obesity. However, outcomes between different procedures still range. This study was conducted to determine the extent of improvement in quality of life (QoL) in different areas following different types of bariatric operations. This observational cross-sectional study was done in August 2023. All patients who underwent bariatric procedures at a tertiary center were contacted through phone to complete a questionnaire assessing the QoL following bariatric surgery. QoL was assessed using an Arabic version of the RAND 36-item Health Survey, a standardized and validated questionnaire. This study included 219 patients; 60.7% were females, with a mean age of 35.20 ± 10.42 at surgery time. Gastric sleeve was the most reported operation (81.7%), followed by gastric bypass (12.3%). QoL scores were similar for patients undergoing bypass and sleeve. However, in the long term, those who have undergone gastric bypass have shown better outcomes. Patients who had gastric bypass following gastric sleeve reported the poorest score in all sections except for the emotional well-being. Personal factors such as smoking also impacted QoL. Smokers scored significantly less in physical functioning than nonsmokers (45.44 ± 39.42 vs. 55.09 ± 38.27, P = 0.024). Gastric bypass resulted in a better QoL compared to gastric sleeve, especially beyond 5 years postoperatively.
Chordoma is a rare bone cancer originating from the residual notochord and overexpressing the nuclear transcription factor, brachyury, for which a positive immunostaining is a diagnostic hallmark. Patients, most commonly adult males in the fifth to sixth decade of life, usually present with an axial mass in the sacral region. Common symptoms are reflective of the site of involvement, including back pain and neuropathy. Complete surgical resection is the mainstay of treatment of localized chordomas. However, these tumors can be highly aggressive and metastasize to visceral organs, lymph nodes, and the peritoneum, often harboring a poor prognosis. This case report discusses a 46-year-old male with a sacral chordoma that was initially treated with suboptimal resection and eventually metastasized to regional lymph nodes and peritoneum after 5 years. The subsequent management heavily relied on an oncologic multidisciplinary tumor board and involved complete resection of the primary tumor and regional lymph nodes with metastasectomy of the involved peritoneal deposits, providing a favorable patient outcome.
Appendiceal mucinous neoplasms (AMNs) represent rare epithelial tumors of the appendix. While some cases are initially diagnosed due to appendicitis, the most prevalent presentation leading to a low-grade AMN (LAMN) diagnosis involves pain in the right lower abdominal quadrant within the context of acute appendicitis. The case presented here pertains to an unusually large LAMN (measuring 16 cm × 5 cm) that was successfully removed using laparoscopically assisted resection. A 33-year-old female patient presented to the emergency department, complaining of abdominal pain and tenderness in the right lower quadrant and a palpable mass. A contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis revealed a tubular, well-circumscribed, low-attenuation cystic lesion in the right iliac fossa. The lesion (measuring approximately 10 cm × 5 cm × 11 cm) appeared to originate from the lower medial aspect of the cecum. Magnetic resonance imaging (MRI) revealed a large (of about 16 cm × 5 cm dimensions), blind-ended tubular structure originating from the cecum. As LAMN was suspected, an emergency laparoscopic right hemicolectomy was performed, along with an end-to-end ileocolic anastomosis and lymph node (LN) dissection. During the surgery, a large appendicular mucocele with an impending risk of perforation was discovered. The final pathological diagnosis confirmed LAMN at stage pT3 with no LN involvement. Although LAMN has an excellent prognosis, preoperative AMN diagnosis remains challenging. Thus, timely workup and management are crucial to prevent progression to pseudomyxoma peritonei (PMP) and metastasis. LAMN is usually diagnosed by examining CT scans, even though MRI is more effective in detecting peritoneal disease. While surgical resection is the only curative option for LAMN, surgical approach and LN dissection remains controversial due to the difficulty of preoperative malignancy diagnosis. Nonetheless, laparoscopic resection for LAMN can yield beneficial outcomes, but to prevent mucocele injury, surgeons should avoid direct tumor handling and ensure that clear margins had been attained, especially in invagination cases. Surveillance for recurrent disease and PMP after appendectomy is recommended, although there are no established guidelines regarding the surveillance frequency and duration. LAMN diagnosis is typically confirmed through surgical excision, whereby the choice of surgical approach depends on the stage of the disease and the surgeon’s experience. The standardization of postoperative follow-up and surveillance protocols for such cases is still in progress.
Methods that measure patient satisfaction are not completely applicable to specific populations, such as children, who have difficulties expressing their opinions precisely and are often unable to provide the required information. In these circumstances, the parental perspective becomes valuable. Previous studies have confirmed that parental satisfaction has the potential to enhance treatment compliance. In the present study, we assessed the level of satisfaction among parents of pediatric patients. We conducted a cross-sectional study for 3 months at a tertiary care center, including all patients who underwent general anesthesia in the day care, whose parents agreed to participate in the study. In total, 85 questionnaires were collected, 34 of which were completed by patients’ fathers (40%) and 51 by patients’ mothers (60%). In total, 94% of the parents were satisfied with the care they received. Most parents of pediatric patients admitted to tertiary care for an outpatient surgical or radiological procedure were satisfied with the care provided to their child before, after, and on the day of the procedure.
Abstract Blunt abdominal trauma resulting in injuries to hollow organs is uncommon, accounting for 1%–3% of cases. Diagnosing the condition remains challenging because of the absence of a standardized approach and the limitations of commonly used imaging techniques. We presented two cases of pneumoperitoneum resulting from blunt abdominal trauma. One was managed conservatively, and the other was managed with laparotomy. This article delves into the controversies surrounding the accuracy of computed tomography scans for hollow viscus injuries and advocates for a more nuanced diagnostic approach. The presence of free air alone should not prompt laparotomy, as demonstrated by our cases and supported by existing literature. We propose a cautious and conservative strategy in specific cases to minimize unnecessary laparotomies and their associated complications.
Abstract Background: Breast cancer is the most common malignancy among younger women in Saudi Arabia. Challenges in diagnosing these patients include delayed presentation, lumpy dense breasts, decreased level of suspicion by physicians, and missed radiological diagnosis. Methods: We retrospectively reviewed patients in this age group and their radiological presentation at our center ### between 2009 and 2020. Results: We identified 109 patients who met the inclusion criteria. Half (50.5%) had undergone a mammogram, 67 (61.5%) an ultrasound, and 74 (67.9%) magnetic resonant imaging (MRI). The Breast Imaging Report and Data System classification showed that 11% of patients had a category 2 (benign) finding in at least one imaging modality before tissue biopsy. Regarding locoregional staging, around 20% of patients had a locally advanced T stage, T3 or T4, and almost half had node-positive disease; 12.9% of the whole population had N2 or N3 disease. Other features of advanced disease present included skin, nipple, and chest wall involvement, a surrogate of late presentation with advanced disease. Conclusion: This study highlights the importance of improved diagnostic strategies, including the liberal use of MRI in this age group. Increased awareness among women and physicians regarding the importance of breast awareness and close follow-up in women with breast masses is essential to help detect abnormalities early on. A multidisciplinary approach with collaboration among physicians, researchers, genetic experts, and policymakers is needed.
Abstract Background: The use of corticosteroids (CSs) in managing coronavirus disease 2019 (COVID-19) is a significant concern for healthcare professionals. The aim of this is to evaluate the indications for, and implications of, CS use in severe acute respiratory syndrome coronavirus 2 patients. Methods: A single-centered, retrospective, and quantitative study conducted at a tertiary care hospital. All patients ( n = 107) were admitted to the intensive care units (ICU) between March 1 and December 31, 2020. Demographic and clinical profiles were obtained from health records. Mortality, mechanical ventilation (MV) days, procalcitonin (PCT), and C-reactive protein levels were compared between CS and non-CS groups. Descriptive statistics include frequency and percentages. Inferential statistics include odds ratio, correlation coefficients, regressions, and analysis of variance. Results: The mean age of patients (84 males, 23 females) was 57.2 + 12.92 years (standard deviation: 12.92). The number who received CSs ( n = 75, 70.1%) was higher than the non-CS group ( n = 32, 29.9%). Mean PCT was significantly higher in the CS group compared to non-CS (0.47 ± 0.71 vs. 0.14 ± 0.61 ng/mL, P < 0.001). The mean number of days on MV was significantly higher in CS than in non-CS patients (9.6 days vs. 5.4 days). The study shows that the mortality percentage in the steroid group, 50.6% (38/75), was significantly higher compared to those who did not receive steroids 18.75% (6/32) ( P = 0.01). Conclusions: This study indicates that CS use in ICU-admitted COVID-19 patients is associated with an increased incidence of mortality, and this was not correlated with baseline immune status. Furthermore, steroid administration is significantly associated with a longer duration of MV. The findings suggest that CSs should be used with specific indications rather than broadly administered to all COVID-19 patients requiring intensive care. In addition, steroid use did not significantly increase the risk of secondary bacterial infections. Further studies are recommended to refine the criteria for CS use in this patient population.
Abstract Background: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) represents a spectrum of relatively rare and complex congenital malformations in newborns. It carries a major challenge for the pediatric surgeon in terms of operative intervention and early identification and management of postoperative complications. The short-and long-term postoperative complications are frequently observed during the follow-up period. This study evaluated the results of 14 cases of EA-TEF to determine the outcome of operative repair. Methods: This retrospective cohort study included all newborns with EA-TEF who were operated on and followed up in two institutions, King Abdulaziz Medical City (KAMC) and King Faisal Hospital Research Center (KFSHRC) in Jeddah, during a 5-year period (2015–2019). Data include the patient’s age, gender, birth weight, degree of prematurity, type of tracheoesophageal anomaly, the presence of comorbidities, time of intervention, type of operative intervention, and postoperative complications observed during the follow-up period. Results: The participants included in this study were newborns delivered and operated on at KAMC and KFSHRC. The birth weight was normal >2500 g (64.3%), low birth weight (LBW 1500–2500 g) (28.6%), and extreme low birth weight <1000 g (7.1%). The variants of tracheoesophageal anomalies were Type C (42.9%), Type A (28.6%), and Type E (28.6%). Females were more than males and comorbidity was found in 7 cases. Depending on the type of EA-TEF, the timing of the intervention ranged from 2 to 240 days. Operative interventions were primary anastomosis (35.7%), staged procedure (35.7%), and fistula ligation of Type E (28.6%). Postoperative complications were stricture (50%), gastroesophageal reflux disease (GERD) (28.6%), recurrence (7.1%), tracheomalacia (7.1%), and leak (7.1%). One patient died. All patients with Type C underwent primary anastomosis, except one who underwent a staged operation along with Type A patients. Fistula ligation was achieved in four patients with Type E. The outcomes of patients who received primary anastomosis were stricture (60%), GERD (40%), and recurrence (20%). The patients who underwent staged operation developed strictures (80%), followed by GERD (40.0%), they underwent further fundoplication procedure (40%), tracheomalacia (20%), and leak (20%). GERD developed in 1 of 7 cases (14.3%) who did not have stricture and in 3 of 7 cases (42.9%) who had stricture. Conclusions: EA/TEF is a rare condition associated with various comorbidities. Postoperative complications include stricture, GERD, recurrence, tracheomalacia, and leak. Further studies analyzing and describing postoperative management in detail are required.
Abstract Stump appendicitis is a rare complication of appendectomy. It carries risks similar to those of a normal appendix, including the potential development of appendicular carcinoma in a remnant stump. Patients with appendicular stumps typically present with symptoms similar to acute appendicitis. We report a case of a female patient who presented with a low-grade appendicular mucinous neoplasm 12 years after her appendectomy.
