An Unexpected GIST Causing Life-Threatening Bleeding after an Elective Hernia Repair.

Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the alimentary tract. They are usually manifested by GI bleeding. Case Presentation A 53-year-old male patient was admitted to the hospital for elective inguinal hernia repair. The patient did not have any history of GI symptoms in the past. A day after open inguinal hernia repair, the patient developed recurrent attacks of hematemesis resulting in hemodynamic instability and admission to the intensive care unit. An upper GI endoscopy identified a small bleeding gastric lesion. After multiple failed attempts to control the bleeding endoscopically, an emergency exploratory laparotomy was performed. An unexpected large fungating bleeding gastric mass was detected. The mass measured approximately 40 × 30 cm, and multiple peritoneal deposits were also discovered. A wedge resection of the anterior gastric wall along with the mass was performed. Histopathology revealed a high-grade (G2) GIST. Discussion GISTs appear in variable sizes and may lead to a variety of complications including abdominal pain, GI obstruction, and bleeding. This case highlights the unexpected presentation and sudden bleeding of a large GIST in a totally asymptomatic patient undergoing elective hernia surgery. It also illustrates that GIST can be asymptomatic and grow to large sizes before developing clinical manifestations. Conclusion The case report highlights a common complication of GIST with unexpected timing, immediately after routine hernia surgery.

Congenital absence of the cystic duct: Case report of a rare anomaly and review of the literature.

INTRODUCTION AND IMPORTANCE: Congenital absence of the cystic duct is one of the rare types of anomalies associated with the extrahepatic biliary tract (EHBT). It is often an incidental finding intraoperatively leading to significant implications during the perioperative period. CASE PRESENTATION: A 25-year-old lady was admitted for an elective laparoscopic cholecystectomy indicated for recurrent symptoms of right upper quadrant pain with evidence of cholelithiasis on ultrasound. During laparoscopy, the cystic duct could not be identified. After retrieval of the gallbladder, a blind ending orifice resembling an obliterated cystic duct was discovered. CLINICAL DISCUSSION: Absence of the cystic duct can result from a congenital or an acquired process. In both cases, they are difficult to diagnose pre-operatively even though magnetic resonance cholangiopancreatography (MRCP) has shown great potential in delineating the EHBT. It confers an increased risk of injury to the surrounding biliary tract during cholecystectomy. Therefore, the surgical approach depends on the surgeon's operative competency and knowledge related to EHBT anomalies. CONCLUSION: Definitive treatment for patients with symptomatic absent cystic duct is an open cholecystectomy, given its increased likelihood of iatrogenic morbidity. Nonetheless, it is important to highlight that laparoscopic cholecystectomy may be performed if the surgeon carries sufficient skills.

Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience.

Background: Idiopathic intracranial hypertension (IIH) affects predominantly obese females during their reproductive age period. The demographics of this condition has not been studied in Kuwait before. Objectives: To determine the demographics, clinical features, risk factors, and treatment modalities of IIH in the main neurology tertiary referral hospital in Kuwait and to compare our data with literature. Methods: A retrospective study was conducted to identify cases of IIH seen between January 1, 2018, and December 31, 2018. Patients were diagnosed in and referred from the neurology and neuro-ophthalmology clinics. Results: Our cohort consisted of 139 patients. We estimated a crude annual incidence rate of IIH of 3.28 per 100,000 population. Female-to-male ratio was 9.6:1. Mean age was 32.1 ± 10.8 years. Mean age of males was 31.46 ± 12.63 and that of females was 32.11 ± 10.67. The median of the duration from the first symptoms till diagnosis was 6 weeks (2-10 weeks). Headache was the most common symptom in 134 (96.4%) patients, followed by visual disturbances in 85 (61.2%) patients, transient visual obscurations (TVOs) in 84 (60.4%) patients, pulsatile tinnitus in 72 (51.8%) patients, diplopia in 22 (15.8%) patients, other symptoms (e.g., nausea, vomiting, radicular neck, and back pain) in 19 (13.7%) patients, and 1 (0.7%) patient had facial weakness. High body mass index (BMI) was seen in 89.9% of patients, either overweight or obese, and it was the most common risk factors in both males (46.2%) and females (61.1%). Anemia was found in 38.1%; 21.6% of patients used OCPs and 7.9% used vitamin A. Bilateral transverse sinus stenosis (BTSS) was detected in 47 (33.8%) patients. Only 2 (1.4%) patients developed "fulminant IIH" characterized by rapidly progressive disease. All the patients received medical treatment and only 12 (8.6%) needed surgical management. Conclusion: Incidence of IIH in Kuwait is similar to other regional studies but higher than Western studies. Demographics and clinical features of IIH in our study are comparable to international and regional figures. Most of our patients had a benign course. IIH is more prevalent in females and strongly associated with obesity.

Caries Experience and Oral Health-related Factors of Kuwaiti Preschool Children and their Mothers: A Pilot Study.

AIM: The objective of this study was to investigate the association between the caries experience and oral-health-related behavior of Kuwaiti preschool children and their mothers. MATERIALS AND METHODS: A convenience sample of 84 participants (42 child-mother pairs) was selected. Data regarding children's and mothers' demographics, oral hygiene practices, and dietary habits were obtained by questionnaires. Oral clinical examinations were carried out on the participant children and mothers to determine their caries experience (decayed, missing, and filled teeth index-dmft/DMFT). RESULTS: An estimated 19% of children were caries-free and 66% of mothers have untreated caries. The mean dmft index of the preschool children was 3.90 ± 2.9, and the mean DMFT index of their mothers was 12.38 ± 5.4. Mothers' untreated caries was significantly associated with their children's untreated caries (r = 0.183, p < 0.05). No correlation was found between the brushing frequencies of children and their mothers (p = 0.582). High consumption of sugary snacks and sugary beverages was detected among the children and mothers with a significant association (p < 0.05). The mean dmft of the children was found to be significantly lower among the young mothers, less than 30 years, (2.4 ± 2.1) compared to that among the mothers older than 30 years (4.3 ± 2.9, p < 0.05). CONCLUSION: There was a high prevalence of early childhood caries in the preschool children studied. A positive correlation was found between the dental caries experience and sugar consumption of the Kuwaiti preschool children and those of their mothers. CLINICAL SIGNIFICANCE: The oral health status and dietary habits of mothers are potentially significant risk factors for the development of early childhood caries in their children. Pediatric dentists need to identify the main caries risk factors in their community in order to implement appropriate preventive dental care and educational programs. HOW TO CITE THIS ARTICLE: Husain FAAM, Alanzi AN. Caries Experience and Oral Health-related Factors of Kuwaiti Preschool Children and their Mothers: A Pilot Study. Int J Clin Pediatr Dent 2019;12(4):283-287.