Spontaneous cholecystocutaneous fistula secondary to xanthogranulomatous cholecystitis: a case report.

BACKGROUND: Xanthogranulomatous cholecystitis, a rare variant of cholecystitis, may infrequently be complicated by spontaneous cholecystocutaneous fistula. CASE PRESENTATION: We report the case of a 75-year-old Saudi Arabian man who presented with "a painful area of redness" (cellulitis) over his right upper abdomen. Abdominal computed tomography revealed multiple collections, which were drained surgically. A discharging sinus was identified, and a fistulogram revealed cholecystocutaneous fistula during his follow-up visit. The patient underwent laparoscopic management and recovered uneventfully. Final histopathological evaluation confirmed acute-on-chronic xanthogranulomatous cholecystitis . CONCLUSIONS: Although rare, surgeons should consider cholecystocutaneous fistula in the differential diagnosis of anterior abdominal wall abscesses, particularly in patients with concurrent or background symptoms of gallbladder disease. We report the first case of laparoscopic management for cholecystocutaneous fistula in Saudi Arabia.

Effect of bariatric surgery on cardiac function in obese patients: An echocardiographic assessment.

OBJECTIVES: To analyze the clinical and echocardiographic changes in individuals with morbid obesity who underwent bariatric surgery. METHODS: In total, 59 obese patients with body mass index >35 kg/m2 were prospectively enrolled. We assessed baseline pre-operative and a 6-month post-operative lipid profile, hemoglobin A1c, echocardiography, lifetime, and a 10-year risks of atherosclerotic disease for all patients. RESULTS: The mean patients' age was 37±12 years, with 40 (67.8%) women. We found that the pre-operative total cholesterol (4.2±1.1 vs. 4.4±1.1, p=0.014) and triglyceride levels (1.4±0.7 vs. 1.8±0.8, p<0.0001) were significantly lower than post-operative levels, while post-operative high-density lipoprotein levels were significantly higher (1.5±0.5 vs. 1.2±0.3, p<0.0001). The calculated 10-year risk of atherosclerotic cardiovascular disease was significantly lower post-operatively (1.1±1.6% vs. 1.6±1.8%, p<0.0001). Echocardiography follow-up revealed that diastolic dysfunction was more prevalent pre-operatively than that post-operatively (41% vs. 10%, p<0.0001). Post-operative left ventricular (LV) mass was significantly lesser than the pre-operative mass (168±252 g vs. 187±255 g, p=0.019), whereas the post-operative LV diastolic (46.5±7 mm vs. 38.5±18 mm, p=0.002) and systolic dimensions (31±5 mm vs. 25±11 mm, p=0.001) were significantly smaller. CONCLUSION: Bariatric surgery resulted in a significant amelioration in lipid profile, reduction in LV mass, and LV cavity dimensions.

Indications and rate of first cesarean delivery in central region's maternity and children hospital.

OBJECTIVES: To investigate the indications of first (non-repeated) cesarean deliveries, to categorize those indications into absolute and relative according to established guidelines of cesarean deliveries, and to compare the women with absolute and relative indications by demography and pregnancy-related attributes.  Methods: A cross-sectional analysis of delivery data between September and October 2018, at the Maternity and Children Hospital, Buraidah, Al-Qassim, Saudi Arabia. Indications for cesarean deliveries of 200 primary cases were abstracted and were categorized into 'absolute' and 'relative' according to the Association of the Scientific Medical Societies in Germany guidelines.  Results: The leading indications were fetal distress (27.5%), non-progression of labor (22.5%), breech presentation (18%), and failed initiation of labor (4.5%). Of the 200 cases, 26.5% had absolute indications, 50% had relative indications, and 23.5% had indications that were neither absolute nor relative. Women with absolute indications had lower mean gestational age and a higher proportion with greater than 3 gravida than women with relative indications (p less than 0.05). Conclusion: The most common indications for first time cesarean, in decreasing order of frequency, were fetal distress, non-progression of labor, and breech presentation.