Intestinal obstruction in a Saudi Arabian population.

In a six-year period, fifty-six cases of intestinal obstruction seen and treated at Asir Central Hospital since its inception were analysed. Adhesions from previous laparotomy scar constituted the commonest cause of intestinal obstruction (57.1%). A distant second is faecal impaction (7.1%). Previously performed appendicectomy is the commonest cause of adhesions causing intestinal obstruction. The interval between surgery and intestinal obstruction varies from one month to three years. The pattern of intestinal obstruction seen in this environment is more similar to those in the western World or advanced countries, than the pattern in the developing countries. This can be explained on the basis of the fact that, even though Saudi Arabia is a developing country, the health care delivery system is similar to those in developed countries. Fifty percent of intestinal obstruction due to adhesions were managed successfully by conservative treatment only. About 15% had a failed conservative treatment and had to undergo operation. In those cases that required exploration and lysis of adhesions, 43.8% also required bowel resection and re-anastomosis.

Spontaneous pneumothorax: A retrospective study of twenty-five patients and literature review.

We present a retrospective study of 25 patients with spontaneous pneumothorax (three current), comprising 16 Saudis (nine males and seven females) and nine non-Saudis (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of the patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan, and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient), and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma, and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only method of treatment in 20 out of the 25 patients, with three failures of closed thoracostomy tube drainage needing thoracotomy and resection of blebs/bullae. The only complication was empyema in two of the patients. Two patients were successfully treated conservatively with observation alone.

Analysis of 303 road traffic accident victims seen dead on arrival at emergency room-assir central hospital.

BACKGROUND: Although Rood Traffic Accident (RTA) is a noticeable common cause of death in Saudi Arabia, there is no published data showing the relative frequency of this disease as a cause of death. AIM OF THE STUDY: This study attempted to find out the relative frequency of RTA as a cause of death. Also, to identify age groups at risk as well as make some inferences from the different types of injuries seen. METHODOLOGY: In a period of over a four and half years, 574 patients were seen dead on arrival at the Emergency Department of Assir Central Hospital, Abha, Saudi Arabia. Of these, 303 (52.8%) were victims of RTA. RESULTS: The 303 victims revealed a male to female ratio of 14:1, Saudi nationals of 69% and age range of 3 months - 85 years (mean = 34.25 years). The peak age group was between 21 and 49 years and the peak period of presentation at the Emergency Department was between 12:00 noon and 18:00 hours. The month of ten in Hegira Calendar represented the peak period; a significant (P<0.05) seasonal variations was also seen, summer being the highest. Clinical assessment of the victims revealed that head and neck injuries were the commonest followed by chest injuries. CONCLUSION: RTA is the primary cause of death among dead on arrival cases affecting the most active and productive age group. The study recommended the implementation of pre -hospital emergency medical system.

Acute appendicitis in females--a clinical study of 366 cases.

A study was carried out on 366 female patients admitted consecutively to Asir Central Hospital with clinical diagnosis of acute appendicitis during the period between 1988 through 1991. In this study, 271 patients had histopathologically proven appendicitis for a diagnostic accuracy of 74%. Ninety-five (26%) patients did not have appendicitis, however, 27 (7.4%) of them had other disorders indicating surgical intervention. Consequently, 18.6% of the patients studied had negative laparotomy. This study showed insignificant (P > 0.05) relation between age, site of pain and its duration, presence of urinary symptoms, post-operative complications and hospitalization in one hand, and the final diagnosis on the other hand. The marital status, the presence of gynaecological symptoms, white blood cells count, neutrophils and lymphocytes percentages were, however, significantly related to the final diagnosis (P < 0.05). A conservative approach with in-hospital observation and repeated clinical examination of the doubted appendicitis cases are recommended so as to reduce the rate of the negative laparotomy with its considerable complications.