Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency and up to our knowledge no previous studies have been conducted in Saudi Arabia particularly at Qassim region and this study aimed to determine a total and direct bilirubin as a predictor of acute complicated appendicitis. METHODS: Observational retrospective study that included patients admitted under the general surgery department with a diagnosis of acute appendicitis at King Saud Hospital, Unaizah, Saudi Arabia. Data on age, gender, BMI, diabetes mellitus, total and direct bilirubin, AST, ALT, sodium, and WBCs levels were obtained. RESULT: Among the overall study population of 158 patients, the age median [IQR] was 24.5 [19-31], males were 99 (62.7%), and complicated appendicitis was 33 (20.9%). The multivariable analysis revealed that both elevated total and direct bilirubin are associated with complicated appendicitis (aOR = 3.79, 95% CI: 1.67-8.48, P = 0.001) and (aOR = 4.74, 95% CI: 2.07-10.86, P < 0.001) respectively. A receiver operating characteristic curve showed the best cutoff value of total and direct bilirubin as ≥ 15 µmol/L and ≥ 5 µmol/L respectively, with a sensitivity of 57.6%, and specificity of 73.6% for elevated total bilirubin, and a sensitivity of 54.6%, and specificity of 80% for elevated direct bilirubin. CONCLUSION: Elevated total and direct bilirubin are associated with acute complicated appendicitis in this setting. However, it should be supportive factor for acute complicated appendicitis and not considered as standalone diagnostic test.

Clinical Characteristics of Celiac Disease Patients in Qassim Region.

Objective: It is well known that celiac disease has a negative influence on patients' health and quality of life. It has a wide range of presentation from symptomless to multiple organ dysfunction but mainly gastrointestinal symptoms. Consequently, it is considered a main cause of mortality, morbidity, and health burden. We aim to evaluate the quality of life affected in gluten-free diet and to identify the serological characteristics of celiac disease patients in the Qassim Region of Saudi Arabia and King Fahad Specialist Hospital. Methods: This is a cross-sectional-based study conducted in King Fahad Specialist Hospital, Saudi Arabia, composed of 58 patients with celiac disease for 9 years between August 2011 and August 2020. Results: Fifty-eight patents were included (79.3% females and 65.5% married), who were divided according to their ages into five groups. Abdominal pain, diarrhea, and/or weight loss were the major patient complaints. A total of 64% of the patients had a +ve (tTG) IgA test at the time of diagnosis, while 17% were -ve. Of the studied patients, 78% reported that they had undergone a duodenal biopsy sampling. No other significant abnormalities were detected between females and males or among the five diagnosed age groups. Conclusion: Patients with celiac disease reported poor health-related quality of life across the board. However, social interaction, emotional role functioning, and emotional well-being were the most important factors.

Mild Abdominal Trauma Complicated With Bowel Perforation in Patient With Crohn's Disease: Clinical and Intraoperative Findings.

Crohn's disease (CD) is a chronic inflammatory disease and is an autoimmune disorder. Due to its remission and relapse cycle, the integrity of the intestinal wall becomes compromised in patients with inflammatory bowel disease. This increases susceptibility to bowel perforation following mechanical injury, especially in patients using immunosuppressive therapy. However, few reports discuss the severity of injury after abdominal trauma in Crohn's patients and how much mild abdominal blunt trauma in such patients can be different in the presentation clinically in correlation with the severity of the intraoperative findings. We report a case of ascending colon perforation secondary to mild abdominal blunt trauma in a patient with CD.