Risk factors and outcomes in acute perforated gallbladder: A retrospective cohort study.

BACKGROUND: Acute gallbladder perforation is a rare complication of biliary diseases with an estimated incidence of 2% of all gallbladder diseases. It carries a higher risk of morbidity and mortality. This study examines the risk factors and outcome of patients admitted with acute and subacute gallbladder perforation (AGBP) to a tertiary hospital in the Eastern Province of Saudi Arabia. METHODS: A retrospective study was performed including all patients with biliary diseases who were operated on from Jan. 2016 until Dec. 2020. The patients were divided: the first group included patients with AGBP and the second group included patients with other biliary diagnoses. We excluded patients with chronic perforation, traumatic or malignant perforation. RESULTS: A total of 587 patients were eligible for this study. The incidence of AGBP was 2.7% and its morbidity was 6.3% with no mortality reported. AGBP was significantly associated with male gender, older age, in patients with two or more associated comorbidities; diabetes mellitus, hypertension and dyslipidemia. Ultrasonography was not diagnostic while AGBP was confirmed by computed tomography in 42.9%. AGBP was associated with a significant higher risk of conversion to open cholecystectomy and partial or subtotal cholecystectomy. The multivariate linear regression analysis revealed that the length of hospital stays increased by 70% in patients with AGBP. CONCLUSION: Acute perforated gallbladder is predominant in elderly male patients with multiple comorbidities, especially diabetes mellitus, hypertension, and dyslipidemia. CT has a higher sensitivity to detect or suspect AGBP. Laparoscopic cholecystectomy is a safe management approach.

Synchronous Malignant Peritoneal Mesothelioma and Sigmoid Adenocarcinoma: a Challenging Clinical Entity.

Background: Malignant peritoneal mesothelioma (MPM) represents a rare clinical entity. The synchronous existence of MPM with other malignancies as colonic adenocarcinoma have been rarely reported. Its diagnosis and management are challenging given its complexity and rarity. Objective: Herein, we report a case of epithelioid subtype of MPM occurring synchronously with sigmoid colonic adenocarcinoma, along with review of the literature. Case presentation: An elderly female patient was referred as case of rectosigmoid mass. She reported history of abdominal pain, per-rectal bleeding, anorexia, and significant weight loss. Her computed-tomography scan of the abdomen revealed a fistulizing sigmoid mass and multiple enlarged lymphnodes with omental nodulation. The colonoscopy revealed a large fungating mass and the endoscopic biopsies were reported as colonic adenocarcinoma. The patient was scheduled laparoscopic low anterior resection. However, the diagnostic laparoscopy revealed several nodules disseminated all over the peritoneum, suggestive of peritoneal mesothelioma. Therefore, the decision was changed to create transverse colostomy after examination obtaining multiple biopsies from the omental and peritoneal nodules. The histopathological revealed MPM and the final diagnosis was sigmoid adenocarcinoma with synchronous MPM. The patient was started on palliative chemotherapy (capecitabine) without active management of MPM because of her general condition. She was followed up with a good clinical course. Conclusion: MPM is an overlooked entity with vague clinical presentation. Synchronous MPM with colorectal cancer is rare with only few published case reports. Its diagnosis is challenging, and its management should be tailored according to the patient. This case is the first reported case in Saudi Arabia and the Middle East.

Blunt Abdominal Trauma Leading to an Incidental Finding of Duplicate Inferior Vena Cava (DIVC): A Case Report and Literature Review.

BACKGROUND With a prevalence of about 2% to 3%, duplication is the most common anomaly associated with the inferior vena cava (IVC). In general, systemic venous anomalies are being more frequently diagnosed in asymptomatic patients. We report the case of a young man with an incidental finding of an asymptomatic duplicated IVC, along with a literature review. CASE REPORT A 36-year-old man was brought to our Emergency Department (ED) following a high-speed motor vehicle collision (MVC), reporting right flank and hip pain. Upon examination, the "seatbelt sign" was noticed, along with abrasions over his right side. He sustained a small-bowel mesenteric injury, for which he was admitted and was treated conservatively. A CT scan incidentally revealed a duplicate IVC (DIVC). He later underwent a laparotomy with limited right hemi-colectomy and was discharged home in good condition. CONCLUSIONS Undiscovered and asymptomatic DIVCs pose a potential risk to patients during clinical interventions. Advancements in diagnostic imaging contribute greatly to the incidental discoveries of inferior vena cava duplication.