Lightning strike injuries are a relatively common natural phenomenon, but documented cases of lightning causing hollow visceral perforation are extremely rare. In our case, male patient a 50-year-old, suffered acute abdominal pain and burns on the abdominal skin after being struck by lightning. Subsequent tests confirmed a bowel injury, leading to the need for surgery to repair the perforation in the small bowel and evacuate a hematoma in the omentum. This highlights the importance of understanding and addressing the potential medical consequences of lightning strikes.
Abdullah Almunifi Department of Surgery, College of Medicine, Majmaah University, Al Majma’ah, 11952, Saudi ArabiaCorrespondence: Abdullah Almunifi, Email a.almunifi@mu.edu.saBackground: Artificial intelligence (AI) is emerging as a transformative force in healthcare, particularly in metabolic bariatric surgery (MBS) and minimally invasive surgery (MIS). This literature review explores AI’s applications, advantages, challenges, and future potential in these fields.Methods: A narrative review of 30 studies, including randomized controlled trials, observational studies, literature reviews, and meta-analyses, was conducted. Critical findings on AI’s impact on surgical precision, workflow efficiency, complications, and patient outcomes were synthesized.Results: AI-enabled techniques significantly improved surgical precision, reduced complication rates, and optimized workflows. AI applications in preoperative planning, intraoperative assistance, and postoperative monitoring demonstrated consistent advantages. However, ethical concerns, data privacy, and standardization issues persist.Conclusion: AI integration in MBS and MIS has the potential to revolutionize surgical outcomes, enhance precision, and improve efficiency. Addressing interoperability, data security, and regulatory barriers will be crucial for widespread adoption.Keywords: metabolic bariatric surgery, minimally invasive surgery, artificial intelligence, robotic surgery, precision medicine, surgical efficiency
Sintayehu Asrat Beyene,1 Nahom Tadesse Bogale,1 Binyam Mohammedbirhan Berhe,2 Demis Degu Teshome3 1General Surgery Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2Department of Pathology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 3Department of Obstetrics and Gynecology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, EthiopiaCorrespondence: Sintayehu Asrat Beyene; Nahom Tadesse Bogale, Email sintayehubeyene54@gmail.com; Tadnahi2@gmail.comIntroduction: Endometriosis is a disease condition characterized by the presence of endometrial glands and stroma outside the uterine cavity and musculature. It affects 7– 10% of women of reproductive age and usually involves pelvic organs. The common symptoms include dysmenorrhea, menorrhagia, pelvic pain, dyspareunia, and infertility. Umbilical endometriosis is the rarest form of extra-pelvic endometriosis.Case Presentation: A 32-year-old Para II mother presented with umbilical swelling and pain that worsened during the menses of 2 months. She had two caesarean scars, both transverse Pfannenstein incisions. There was a dark blue, firm to hard 2× 3 cm umbilical mass on physical examination. Laboratory results are normal. Ultrasound of the abdomen showed umbilical mass with homogeneous echotexture measuring 2 cm × 3 cm with an irregular border and hypoechoic texture. An excisional biopsy was performed and a biopsy showed umbilical endometriosis.Discussion: Primary umbilical endometriosis is a disorder first described by Villar in 1886, and among all cases of extra-genital involvement of endometriosis, primary umbilical endometriosis accounts for 0.5– 1%. The usual presentation of primary umbilical endometriosis is typically the presence of a discrete bluish-purple mass in the umbilicus, which becomes swollen, painful, and bleeds concomitantly with the menstrual cycle. Ultrasound and other imaging techniques help in making diagnoses, and the diagnosis is confirmed by cytological examination. The management of umbilical endometriosis involves surgical excision and reconstruction of the umbilicus.Conclusion: Umbilical endometriosis is an uncommon form of extra-pelvic endometriosis. There is a wide differential diagnosis for swellings of the abdominal wall; however, it should be suspected in any female patient of reproductive age with an umbilical lesion that becomes more painful and swollen during her menstrual period. Appropriate clinical examination and workup are helpful to make a diagnosis and do a surgical excision.Keywords: endometriosis, umbilical nodules, umbilical hernia, abdominal wall scar, caesareans section
Sarah K Lee,1 Kaushik Mukherjee2 1Department of Plastic Surgery, University of California Irvine Health, Irvine, CA, USA; 2Division of Acute Care Surgery, Loma Linda University Health, Loma Linda, CA, USACorrespondence: Kaushik Mukherjee, Division of Acute Care Surgery, Loma Linda University Health, 11175 Campus Street, CP, 21111, Loma Linda, CA, 92350, USA, Tel +001 909-558-4286, Fax +001 909-558-236, Email kmukherjee@llu.eduAbstract: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a promising intervention for hemorrhagic shock and traumatic injury management, offering a minimally invasive means of aortic occlusion compared to resuscitative thoracotomy. While REBOA’s origin dates back to the 1950s, recent advancements have made it more accessible and applicable in various clinical scenarios. REBOA has become increasingly utilized in not only the exsanguinating trauma patient but also in non-traumatic hemorrhage as a bridge to definitive hemostatic control. This article reviews the procedure and mechanism, clinical applications, and challenges associated with the REBOA. There are several challenges to consider when implementing the REBOA, particularly in procedural execution and patient selection. Determining the ideal candidates for REBOA remains inconclusive, with varying outcomes reported in different patient populations. Additionally, the potential for ischemic complications, such as visceral organ injury, end organ damage, and lower extremity ischemia, underscores the critical importance of procedural planning and ongoing monitoring. Partial and intermittent REBOA techniques have been introduced to mitigate ischemic complications associated with complete occlusion, but their efficacy and safety warrant further investigation. Beyond technical considerations, logistical and institutional factors pose as potential barriers to the effective utilization of REBOA, highlighting the importance of standardized training and a multidisciplinary approach when establishing a REBOA program. REBOA offers promising advancements in hemorrhage control, and the technology continues to evolve to address potential challenges and complications. Further research is imperative to delineate its optimal use and potential impact on patient outcomes.Keywords: traumatic hemorrhagic shock, REBOA, postpartum hemorrhage, partial REBOA, aortic occlusion, endovascular
Background: Rectovaginal fistulas (RVFs) present a significant surgical challenge, particularly those resulting from gynecologic procedures, which are often complex and associated with higher recurrence rates. The Martius Flap technique, which involves the use of a vascularized adipose tissue graft, is an established method for enhancing fistula repair, especially in cases involving large, recurrent, or radiation-induced fistulas. Materials and Methods: We conducted a prospective evaluation of 46 female patients with RVFs treated using the Martius Flap technique between December 2008 and December 2019. The study focused on patients with RVFs caused predominantly by gynecologic procedures, including surgeries for benign and malignant conditions, as well as those with a history of radiation therapy. Results: The average age of the patients was 38.7 years (range 18-75 years). Of the 46 RVFs treated, 65.2% were due to gynecologic surgery, 26.1% were associated with iatrogenic injury or radiation therapy, and 8.7% were post-coital. Successful fistula closure was achieved in 95.6% of cases, with a recurrence rate of 4.4%. The Martius Flap demonstrated high efficacy, particularly in large and complex fistulas, with most patients reporting significant satisfaction and improved continence post-operatively. Conclusion: The Martius Flap technique is a highly effective option for the surgical management of RVFs, particularly those secondary to gynecologic procedures. The technique's ability to introduce well-vascularized tissue into the repair site significantly reduces recurrence rates and enhances healing, making it a preferred method for treating complex and recurrent RVFs.
