Zebrafish Model in Illuminating the Complexities of Post-Traumatic Stress Disorders: A Unique Research Tool.

Post-traumatic stress disorder (PTSD) is a debilitating psychological condition that may develop in certain individuals following exposure to life-threatening or traumatic events. Distressing symptoms, including flashbacks, are characterized by disrupted stress responses, fear, anxiety, avoidance tendencies, and disturbances in sleep patterns. The enduring effects of PTSD can profoundly impact personal and familial relationships, as well as social, medical, and financial stability. The prevalence of PTSD varies among different populations and is influenced by the nature of the traumatic event. Recently, zebrafish have emerged as a valuable model organism in studying various conditions and disorders. Zebrafish display robust behavioral patterns that can be effectively quantified using advanced video-tracking tools. Due to their relatively simple nervous system compared to humans, zebrafish are particularly well suited for behavioral investigations. These unique characteristics make zebrafish an appealing model for exploring the underlying molecular and genetic mechanisms that govern behavior, thus offering a powerful comparative platform for gaining deeper insights into PTSD. This review article aims to provide updates on the pathophysiology of PTSD and the genetic responses associated with psychological stress. Additionally, it highlights the significance of zebrafish behavior as a valuable tool for comprehending PTSD better. By leveraging zebrafish as a model organism, researchers can potentially uncover novel therapeutic interventions for the treatment of PTSD and contribute to a more comprehensive understanding of this complex condition.

Effects of Omega-3 Polyunsaturated Fatty Acids, Docosahexaenoic Acid and Eicosapentaenoic Acid, on Post-Surgical Complications in Surgical Trauma Patients: Mechanisms, Nutrition, and Challenges.

This paper aims to provide an in-depth review of the specific outcomes associated with omega-3 polyunsaturated fatty acids (PUFAs), focusing on their purported effects on post-surgical complications in trauma patients. A comprehensive investigation of omega-3 polyunsaturated fatty acids was conducted until February 2023 using the PubMed database. Surgical trauma is characterized by a disruption in immune response post surgery, known to induce systemic inflammation. Omega-3 PUFAs are believed to offer potential improvements in multiple post-surgical complications because of their anti-inflammatory and antioxidant properties. Inconsistent findings have emerged in the context of cardiac surgeries, with the route of administration playing a mediating role in these outcomes. The effects of omega-3 PUFAs on post-operative atrial fibrillation have exhibited variability across various studies. Omega-3 PUFAs have demonstrated positive effects in liver surgery outcomes and in patients with acute respiratory distress syndrome. Omega-3 is suggested to offer potential benefits, particularly in the perioperative care of patients undergoing traumatic procedures. Incorporating omega-3 in such cases is hypothesized to contribute to a reduction in certain surgical outcomes, such as hospitalization duration and length of stay in the intensive care unit. Therefore, comprehensive assessments of adverse effects can aid in identifying the presence of subtle or inconspicuous side effects associated with omega-3.

Efficacy and Clinical Outcomes of mRNA COVID-19 Vaccine in Pregnancy: A Systematic Review and Meta-Analysis.

BACKGROUND: The world has witnessed one of the largest pandemics, dubbed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of December 2020, the USA alone reported 98,948 cases of coronavirus disease 2019 (COVID-19) infection during pregnancy, with 109 related maternal deaths. Current evidence suggests that unvaccinated pregnant women infected with SARS-CoV-2 are at a higher risk of experiencing complications related to COVID-19 compared to nonpregnant women. This review aimed to provide healthcare workers and non-healthcare workers with a comprehensive overview of the available information regarding the efficacy of vaccines in pregnant women. SUMMARY: We performed a systematic review and meta-analysis following PRISMA guidelines. The search through the database for articles published between December 2019 and October 2021 was performed. A comprehensive search was performed in PubMed, Scopus, and EMBASE databases for research publications published between December 2019 and October 2021. We focused on original research, case reports, case series, and vaccination side effect by authoritative health institutions. Phrases used for the Medical Subject Heading [MeSH] search included ("COVID-19" [MeSH]) or ("Vaccine" [MeSH]) and ("mRNA" [MeSH]) and ("Pregnant" [MeSH]). Eleven studies were selected and included, with a total of 46,264 pregnancies that were vaccinated with mRNA-containing lipid nanoparticle vaccine from Pfizer/BioNTech and Moderna during pregnancy. There were no randomized trials, and all studies were observational (prospective, retrospective, and cross-sectional). The mean maternal age was 32.2 years, and 98.7% of pregnant women received the Pfizer COVID-19 vaccination. The local and systemic adverse effects of the vaccination in pregnant women were analyzed and reported. The local adverse effects of the vaccination (at least 1 dose) such as local pain, swelling, and redness were reported in 32%, 5%, and 1%, respectively. The systemic adverse effects such as fatigue, headaches, new onset or worsening of muscle pain, chills, fever, and joint pains were also reported in 25%, 19%, 18%, 12%, 11%, and 8%, respectively. The average birthweight was 3,452 g. Among these pregnancies, 0.03% were stillbirth and 3.68% preterm (<37 weeks) births. KEY MESSAGES: The systemic side effect profile after administering the COVID-19 mRNA vaccine to pregnant women was similar to that in nonpregnant women. Maternal and fetal morbidity and mortality were lowered with the administration of either one or both the doses of the mRNA COVID-19 vaccination.

Adult appendicitis score versus Alvarado score: A comparative study in the diagnosis of acute appendicitis.

Background: Acute Appendicitis (AA) is the most common abdominal surgical emergency. It requires proper management to decrease mortality and morbidity. Clinical scoring systems for diagnosing AA aimed to decrease the use of radiological scans and the rate of negative appendectomies (NA). We aim to assess the adult appendicitis score (AAS) in the diagnosis prediction of AA. Method: A retrospective study with 1303 cases of AA is performed. We compared the correlation of AAS and Alvarado scores to postoperative histopathology. Specificity, sensitivity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were assessed. ROC was used. Results: AAS risk stratification was applied to the study population. Group I for a low probability, and groups II and III for an intermediate and high probability of AA. We found that 159 patients were matched in group I, 505, and 639 were in groups II and III of AAS, respectively. The correlation between Alvarado and AAS with HP was significant. AAS ≥ 16 presented sensitivity and specificity of 50 % and 75.47 %, respectively, with PPV of 97.96 % and NPV of 6.02 %, with an accuracy of 51.04 %. Regarding AAS ≥ 11, the sensitivity was 88.96 %, specificity was 39.62 %, PPV was 97.2 %, NPV was 13.21 %, and accuracy was 86.95 %. Conclusion: AAS is relatively more accurate than Alvarado's score, especially in selecting a safe candidate for discharge from an emergency. In addition, AAS is found to decrease the need for radiological images and NA rate more than Alvarado.

"Is percutaneous extraction of gallstones safe and effective in high-risk patients? Evidence from a systematic review".

Gallstone disease in high-risk patients presents a management dilemma as cholecystectomy is often not performed due to their co-morbidities. Alternatively, such patients can be managed by percutaneous removal of gallstones. To date, there is paucity of high-quality evidence addressing the safety and efficacy of percutaneous cholecystolithotomy in high-risk patients. We aimed to conduct a systematic review on the feasibility of percutaneous gallstone removal in high-risk patients. METHODS: A literature review was conducted using the Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines without setting the time limits to assess the outcomes of percutaneous gallstone removal in high-risk patients. RESULTS: Twelve studies were identified. A total of 435 patients underwent percutaneous gallstone removal. Success rate was 91%. Overall complications (including minor and major) were 28%. The mean length of stay was 7 days (range, 1-80). Procedure related mortality was 0.7%. The recurrence rate was 7%. CONCLUSION: Percutaneous cholecystolithotomy is a safe and effective technique. Although, it cannot substitute the current standard treatment for gallstones i.e., laparoscopic cholecystectomy. However, it may be considered for the patients who cannot undergo laparoscopic cholecystectomy due to their comorbid conditions.

Uncommon presentation of complicated internal hernia through the appendices epiploicae ring of adhesion: a clinical case study.

Background: Internal hernias are infrequent, yet serious, medical conditions with potentially severe consequences. An internal hernia resulting from an Appendices epiploicae (AE) ring is an especially rare cause, with a mere nine documented instances worldwide. Case report: This report presents the case of a 58-year-old male who suffered from an internal hernia originating from an AE ring. The condition led to a gangrenous small bowel, which was treated by laparotomy and resection of the affected segment, followed by primary anastomosis. The post-operative recovery was favorable. Conclusion: Internal hernias, although rare, warrant immediate attention and early intervention to preclude detrimental outcomes, as illustrated in this particular case.

Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies.

Purpose: This research aims to study whether the time of day impacts the outcome of laparoscopic appendectomy. Peri/post-operative data including type of surgery, operating room time, length of stay, re-hospitalization rates, and short/long term morbidity and mortality were assembled and analyzed. Methods: A retrospective review of all patient's charts who underwent an appendectomy for acute appendicitis at the Acute Care Surgery division at Hamad Medical Corporation (HMC) from December 2017 to July 2020 was performed. Our institution implemented SAGES protocol to patients with laparoscopic appendectomy. Medical history, symptoms, duration of symptoms, type of treatment, complication, experience level of surgeons in different shift, morbidity, mortality, and length of hospital stay were extracted and analyzed. Results: Multivariate logistic regression analysis was used to identify the odds ratio (OR) and the correlation of variables with different surgical groups. A total of 1001 patients were included in this study and underwent laparoscopic appendectomy, 51.3% were operated during the daytime shifts and 48.7% during the nighttime shifts. The majority of surgeries were operated during the nighttime shift C (1:00 a.m. to 7:00 a.m.). Neither there was any difference in clinical outcomes nor day/night operation time with physicians. A statistically significant correlation was found between hospital-stay of patients with different surgical group (OR: 2.13, 95% CI: 0.75-0.93, P < 0.001). Conclusion: Appendectomy conducted at night is correlated with similar complications as appendectomy performed during the day, and that the varied shift hours had no effect on the complication rates or on the quality of care provided to patients at our hospital.

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population.

Background/objective Acute appendicitis (AA) is one of the most common surgical emergencies that require a proper diagnosis to avoid a negative outcome in the case of missed or delayed diagnosis. Our study aims to assess the diagnostic power of the Alvarado score and the prediction of the severity of acute appendicitis in correlation to intraoperative findings and the final histopathology (HP) result. Methods This retrospective study was applied to 1,303 patients with clinically proven acute appendicitis (AA) and available HP results. We correlated Alvarado score to the gold standard HP and intraoperative findings. We selected the cutoff point of Alvarado at 5 and 7 as they were the most frequent cutoff value mentioned in the literature and based on the ROC curve in this study to assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results The mean age of the study cohort is 33.3 ± 9.5 years, with a male predominance (75.8%). The negative appendectomy (NA) rate was 4%. The operative complication rate was 1.2%, and we recorded one mortality case (0.1%). The diagnostic evidence of AA was in 95.9% of cases. Alvarado score ≥ 7 presented sensitivity and specificity of 66.4% and 69.8%, respectively, with PPV of 98.1% and NPV of 8.1%, with an accuracy of 66.5%. For Alvarado score ≥ 5, the sensitivity was 91.2%, specificity was 22.6%, PPV was 96.5%, NPV was 9.8%, and accuracy was 88.4%. In addition, we demonstrated statistical significance between Alvarado risk stratification with HP and intraoperative grades (p = 0.001 each). Conclusion The Alvarado scoring system alone is not enough to diagnose AA with unsatisfactory sensitivity and specificity. However, it is a good indicator of the severity of AA that we can depend on to prioritize those patients waiting for surgery.

Clinical outcomes of Pfizer-BioNTech COVID-19 vaccine in children and adolescents: A systematic review.

Background & Aims: The BioNTech-Pfizer vaccine is the only vaccine offered to children among all available vaccines. However, limited evidence is available about the clinical outcomes of COVID-19 vaccines, especially among children and adolescents. This review offers a comprehensive and up-to-date overview of the BioNTech-Pfizer vaccine's current information on children and adolescents. Methods: The review was conducted following the PRISMA guidelines; a comprehensive search was performed in PubMed, Scopus, MEDLINE, and EMBASE databases for research publications COVID-19 published between December 2019 and October 2021. All studies reporting on the outcomes of vaccinating children in their respective institutes were included. Results: A total of 78 vaccinated children and adolescents from six studies were included. The majority of symptomatic vaccinated pediatrics were males (71%). The mean age was 15.6 years, and the BMI was 24.1. The most common clinical symptoms were found in chest pain (35%), fever (32%), and myalgia (17%). The most common cardiac symptom in the EKG results was ST elevation, and 35% of vaccinated pediatrics had elevated serum troponin. The hospitalization, including ICU admission, was lower than in unvaccinated groups. Statistically significant associations (p ≤ 0.05) were found in two symptoms (fever and headache) between the vaccinated and nonvaccinated pediatric groups. Conclusions: Although we found better outcomes in the vaccinated group versus the nonvaccinated pediatric group, more studies are still crucial to further understand the specific etiology underlying postvaccination, particularly myocarditis, psychological impact, and other cardiac clinical symptoms in children and adolescents after receiving the BioNTech-Pfizer vaccine.

Diagnostic Inflammation Biomarkers for Prediction of 30-Day Mortality Rate in Acute Cholangitis.

Background: Acute cholangitis (AC) is an acute inflammation and infection of the biliary tract, a potentially life-threatening infection, which is usually associated with biliary tree obstruction and impairment of bile flow from the liver to the duodenum. AC is classified by severity from mild, moderate to severe infection (grade I to III, respectively). Methods: This study recruited a retrospective cohort from Jan 2015 to July 2018. Overall, 294 patients of age ≥ 18 years with AC were enrolled. The study was conducted according to the World Medical Association Declaration of Helsinki. Demographic and laboratory data were collected for analysis. T-Bilirubin and other laboratory results were collected and analyzed using independent T-test and ANOVA for continuous values and multivariate COX regression for survival analysis for identifying independent factors for early mortality. The cut-off threshold of T-bilirubin was determined by calculating the area under the receiver operating characteristic (ROC) curve. Results: There were 213 male and 81 female patients and mean age ± SD of patients was 49.57 ± 16.1 and 56.12 ± 20.18 respectively. 31.9% patients were found older than 60 years of age and 35% patients were found between 30-45 years of age. T-bilirubin and length of hospital stay (LOS) were found statistically significant (P < 0.05) in relation to mortality in AC patients. The area under ROC curve for T-bilirubin level (P = 0.017, OR = 1.010) was 0.717 (95% CI, 6.25-168.9) and this is consistent with the Cut-off point for more than or equal to 38.6 µmol/L (2.26 mg/dL). Conclusions: In this study, T-bilirubin level is found to be significantly related to short-term mortality in AC. Further studies are still needed with larger cohorts to shed more light on these findings. Highlights: Herein, we report a retrospective observational study aiming to evaluate biomarkers contributing to mortality in AC and to determine the cut-off diagnostic levels that could be easily used in emergency setting. Overall, 294 patients of age ≥ 18 years with AC were enrolled. The study was conducted according to the World Medical Association Declaration of Helsinki and approved by Institutional Review Board (IRB) with approval: MRC-01-20-823 at Hamad Medical Corporation (HMC). Demographic and laboratory data were collected for analysis. Total-Bilirubin and other laboratory results were collected and analyzed using independent T-test and ANOVA for continuous values and multivariate COX regression for survival analysis for identifying independent factors for early mortality. The cut-off threshold of T-bilirubin was determined by calculating the area under the receiver operating characteristic (ROC) curve. There were 213 male and 81 female patients and mean age ± SD of patients was 49.57 ± 16.1 and 56.12 ± 20.18 respectively. 31.9% patients were found older than 60 years of age and 35% patients were found between 30-45 years of age. T-bilirubin and length of hospital stay (LOS) were found statistically significant (P < 0.05) in relation to mortality in AC patients. The area under ROC curve for T-bilirubin level (P = 0.037, OR = 1.010) was 0.717 (95% CI, 6.25-168.9) and this is consistent with the Cut-off point for more than or equal to 38.6 µmol/L (2.26 mg/dL).

A systematic review on the latest developments in testosterone therapy: Innovations, advances, and paradigm shifts.

OBJECTIVES: To review the latest innovations and advances in testosterone treatments including their advantages and disadvantages and to address important issues in testosterone therapy (TTh). METHODS: This review was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-analyses guidelines. The PubMed, MEDLINE, Scopus and Cochrane databases were searched using specifically related key words. The identified studies were screened for inclusion criteria that included studies discussing one of the four objectives of the systematic review: 1) cut-off references, 2) prevention/remission of type II diabetes mellitus (T2DM), 3) duration of treatment, and 4) prostate, lower urinary tract symptoms, prostate health, or cancer. The search was limited to the past 15 years. Any studies were not written in English were excluded. RESULTS: The initial literature search retrieved 393 studies. After screening four studies were removed due to duplication, 360 studies were further excluded after reviewing the title, abstract or the whole manuscript due to different exclusion criteria or being not focussed on the objective. Finally, 29 studies were included in the review. One study discussed the cut-off value, four studies discussed the effect of testosterone replacement therapy (TRT) on the control of T2DM, four studies on duration of TRT, and 20 studies discussed the effects of TRT on the prostate. CONCLUSIONS: Numerous studies have demonstrated the benefits of TTh in overtly hypogonadal men. There are several possible administration routes for testosterone treatment. Each approach has advantages and disadvantages, and the choice of the method of TRT will often be determined by patient preference or co-medication (no intramuscular injections in patients under coumarin or similar anticoagulants). Although new developments are promising, it seems that among the available treatments, only transdermal gel delivery and long-acting injectable testosterone undecanoate provide pharmacokinetic behaviour that gives a steady state level within a physiological range.

Preparation of Poly(ethylene glycol)@Polyurea Microcapsules Using Oil/Oil Emulsions and Their Application as Microreactors.

The development process of catalytic core/shell microreactors, possessing a poly(ethylene glycol) (PEG) core and a polyurea (PU) shell, by implementing an emulsion-templated non-aqueous encapsulation method, is presented. The microreactors' fabrication process begins with an emulsification process utilizing an oil-in-oil (o/o) emulsion of PEG-in-heptane, stabilized by a polymeric surfactant. Next, a reaction between a poly(ethylene imine) (PEI) and a toluene-2,4-diisocyanate (TDI) takes place at the boundary of the emulsion droplets, resulting in the creation of a PU shell through an interfacial polymerization (IFP) process. The microreactors were loaded with palladium nanoparticles (NPs) and were utilized for the hydrogenation of alkenes and alkynes. Importantly, it was found that PEG has a positive effect on the catalytic performance of the developed microreactors. Interestingly, besides being an efficient green reaction medium, PEG plays two crucial roles: first, it reduces the palladium ions to palladium NPs; thus, it avoids the unnecessary use of additional reducing agents. Second, it stabilizes the palladium NPs and prevents their aggregation, allowing the formation of highly reactive palladium NPs. Strikingly, in one sense, the suggested system affords highly reactive semi-homogeneous catalysis, whereas in another sense, it enables the facile, rapid, and inexpensive recovery of the catalytic microreactor by simple centrifugation. The durable microreactors exhibit excellent activity and were recycled nine times without any loss in their reactivity.

Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study.

BACKGROUND: Laparoscopic Adrenalectomy (LA) has rapidly become the gold standard in management of adrenal tumors as it has been found to be associated with better cosmoses, shorter hospital stay and rapid convalescence. OBJECTIVE: The aim of this study was to compare laparoscopic and open approach to adrenal glands in terms of operative time, hospital stay, indications and blood loss at a tertiary medical center in Jordan. METHODS: A retrospective comparative study which included all patients who underwent adrenalectomy (open or laparoscopic) from 2005 to 2015 at King Hussein Medical Center (KHMC). Patients' demographics ,outcomes and essential study variables were extracted from patients' files. Data analysis was performed using SPSS17 and Stata 10. RESULTS: One hundred and three patients (mean age 44.9 years) were included, 90.2% of them underwent laparoscopic adrenalectomy. The size of the tumors ranged from 2 to 17 cm (mean 6.6 cm).The operative time, blood loss and hospital stay were significantly less in the laparoscopic group (P value <0.001). Patients in Open group had a significantly higher risk of incomplete excision of the tumors (P value=0.020). CONCLUSION: Laparoscopic adrenalectomy is associated with decreased operative time, blood loss and hospital stay compared to open approach. Tumor size and its malignant potential should be no more regarded as an absolute contraindication to laparoscopic adrenal surgery.

Platelet to Lymphocyte Ratio Associated with Prolonged Hospital Length of Stay Postpeptic Ulcer Perforation Repair: An Observational Descriptive Analysis.

BACKGROUND: The predictive role of platelet to lymphocyte ratio (P/LR) in patients with perforated peptic ulcer (PPU) is not well-studied. We aimed to investigate the association between the P/LR ratio and the hospital length of stay (HLOS) for surgically treated PPU. METHOD: This is a retrospective observational study for surgically treated adult cases of PPU at Hamad Medical Corporation during the period from January 2012 to August 2017. Patients were categorized into two groups based on their HLOS (I week). The receiver operating characteristic (ROC) curve was plotted to determine the cutoff value for lymphocyte count, neutrophil to lymphocyte ratio, and P/LR ratio for predicting the prolonged hospitalization. RESULTS: One hundred and fifty-two patients were included in the study. The majority were young males. The mean age was 38.3 ± 12.7 years. Perforated duodenal ulcer (139 patients) exceeded perforated gastric ulcer (13 patients). The HLOS > 1 week was observed in 14.5% of cases. Older age (p = 0.01), higher preoperative WBC (p = 0.03), lower lymphocyte count (p = 0.01), and higher P/LR ratio (p = 0.005) were evident in the HLOS > 1 week group. The optimal cutoff value of P/LR was 311.2 with AUC 0.702 and negative predictive value of 93% for the prediction of prolonged hospitalization. Two patients died with a mean P/LR ratio of 640.8 ± 135.5 vs. 336.6 ± 258.9 in the survivors. CONCLUSION: High preoperative P/LR value predicts prolonged HLOS in patients with repaired perforated peptic ulcer. Further larger multicenter studies are needed to support the study findings.

Extensive Aeroportia, Operate or Not to Operate? A Report of a Challenging Case.

Aeroportia is the presence of gas in the portal vein. It is considered an ominous radiological sign with poor outcomes. Historically, it was associated with bowel necrosis, and surgery was mandated in all cases. Herein, we present a challenging case of portal venous gas and its management. An 87-year-old male patient, with multiple co-morbidities, presented with abdominal pain. The computerized tomography (CT) scan showed extensive portal venous gas without evidence of bowel ischemia. Initially, he was managed conservatively, but his clinical condition deteriorated. So, an exploratory laparotomy was performed which revealed multiple superficial splenic abscesses covering the surface of the spleen and a pale segment of jejunum with questionable viability. Splenectomy was performed and second-look laparotomy was planned to assess the small bowel viability. Second-look laparotomy revealed dusky discoloration of 30 cm jejunal segment. The affected segment was resected. The patient improved after surgery and was discharged home. In conclusion, aeroportia (portal venous gas) is a radiological entity. The clinical condition of the patient must be kept in consideration to manage the patients optimally. However, if the patient deteriorates, a high index of suspicion for mesenteric ischemia and early surgical intervention are the keys to save the patients' life.

Combination of Common Problem in a Rare Disease: Right Iliac Fossa Pain in a Chronic Myeloid Leukemia Patient.

Abdominal symptoms in patients with hematological malignancies can occur due to an array of pathologies. Two diagnoses with similar presentation albeit, generally opposite treatment modalities, are typhlitis (inflammation of cecum) and acute appendicitis. Both diagnoses have to be kept in mind in such a patient presenting with right lower quadrant (RLQ) pain. Sagacious clinical judgment along with the aid of radiological imaging may help in differentiating between the two conditions. We present a case of a young male with chronic myeloid leukemia (CML) on imatinib, diagnosed and started on therapy four years earlier, who presented with symptoms of RLQ pain not typical of acute appendicitis. The accurate diagnosis was made with the assistance of ultrasound (US) imaging and prompt surgical therapy was instituted followed by a smooth postoperative recovery.

Small Intestinal Diverticulosis: A Rare Cause of Intestinal Perforation Revisited.

Jejunoileal diverticulosis (JID) is a rare and nonspecific symptomatic disease. It is usually an acquired condition associated with false diverticula and integrated with colonic diverticulosis which can be diagnosed incidentally or later with complications. A sixty-nine-year-old male presented with sudden onset generalized abdominal pain. Computed tomography (CT) imaging was suggestive of ileal diverticulitis with localized perforation. The patient was treated conservatively with IV fluids and antibiotics and kept nil per orem for three days and discharged after symptoms subsided. The patient returned with a similar presentation but with a greater intensity. CT with oral contrast revealed evidence of distal ileal perforation. The terminal ileum was resected, and a double barrel ileostomy was created. Six months later, the stoma was reversed after resecting 50 cm of proximal terminal ileum which included all diverticula. The patient had a smooth postoperative recovery. Small bowel diverticulitis is generally managed conservatively unless the patient's clinical condition mandates urgent exploration. This report may add knowledge and lead to a change in clinical practice.

A Unique Case of Low-Grade Mucinous Neoplasm in Stump Appendectomy.

BACKGROUND: We describe a case of a young male with a history of appendectomy one year ago, who developed symptoms of stump appendicitis, and after removing this stump, histopathology showed low grade neoplasm. Summary. Stump appendicitis is an uncommon complication after appendectomy and may lead to serious complications. Management of low-grade appendiceal mucinous neoplasm (LAMN) is controversial, and we discuss the importance of the case. CONCLUSION: The case of young male post stump appendectomy with histopathology showing LAMN in the stump of the appendix, which to our knowledge, is the first in the medical literature and, discuss the stump appendicitis and incomplete appendectomy concerning malignancy, mucinous neoplasm, and adenocarcinoma.

Post-trauma transmesocolic hernia: a case report.

The prevalence of transmesocolic hernias, a subtype of internal hernias (IHs), is generally low. Its clinical consequences, including strangulation, ischemia and even death, however, necessitate awareness. IHs are classified as congenital or acquired as resulting from surgery, trauma or intraperitoneal inflammation. This is a case of a 37-year-old male victim of a motor vehicle collision 1 month prior to the index admission. The trauma-related injuries were managed conservatively and then discharged home. The patient was re-admitted with a 2-day history of epigastric pain, vomiting and abdominal distension. A diagnosis of small bowel obstruction due to a transmesocolic hernia was made on CT and emergency laparotomy performed. The post-operative course was unremarkable. It is vital to consider transmesocolic hernias in trauma patients presenting with a picture of bowel obstruction even in the absence of prior surgery.