Publications by authors named "Abdullah Saleh AlQattan"

15 Publications

  • Page 1 of 1

Salvage liver transplantation after resection of colorectal cancer liver metastasis with favorable outcomes: a case report and review of the literature.

BMC Gastroenterol 2021 Apr 27;21(1):191. Epub 2021 Apr 27.

Hepatobiliary and Transplant Surgery, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia.

Background: Approximately 50% of patients with colorectal cancer (CRC) develop metastases most commonly in the liver. Liver transplantation (LT) can be used in certain cases of primary liver malignancy or in metastatic diseases, such as Neuroendocrine tumors. However, there are controversies regarding LT as a treatment option for liver metastasis from CRC due to poor outcomes in previously reported cases.

Case Presentation: We report a 37-year-old male who underwent resection of the left-sided colon due to cancer and was found to have synchronous liver metastasis for which he received chemotherapy. Later, he underwent a right hepatectomy, which was complicated by insufficient liver remnant function despite the preserved liver perfusion. Therefore, salvage liver transplantation was performed successfully with a good long-term outcome.

Conclusions: Many studies examined the survival and quality of life in patients undergoing liver transplantation for unresectable colorectal liver metastasis; these studies include the SECA Study (secondary cancer) and others with favorable outcomes. We reviewed the literature and compared the outcomes of some of these studies in this article. Our case emphasizes that liver transplantation could be an option for some colon cancer liver metastasis (CLM) patients, specifically, as a salvage procedure. Thus, more research is needed to develop selection criteria for patients who may benefit from liver transplantation.
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http://dx.doi.org/10.1186/s12876-021-01778-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077760PMC
April 2021

Metastatic Mixed Adeno-Neuroendocrine Carcinoma of the Colon to the Liver with Multiple Peritoneal Deposits: A Case Report.

Am J Case Rep 2021 Apr 15;22:e929099. Epub 2021 Apr 15.

Department of General Surgery, Colorectal Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

BACKGROUND Metastatic mixed adeno-neuroendocrine carcinoma (MANEC) is a rare malignancy. It is characterized by the presence of both neuroendocrine and epithelial components, each of which constitute at least 30% of the lesion to establish the diagnosis. CASE REPORT A 48-year-old man presented with a 1-month history of right upper-quadrant pain and unintentional weight loss of 18 kg. He was also complaining of constipation and fatigue for 6 days. The initial diagnosis from a referring hospital was colon cancer with liver metastasis based on a computed tomography (CT) scan of the chest, abdomen and pelvis. After re-evaluation at our hospital, the scan revealed multiple peritoneal deposits in addition to the previously reported findings. A colonoscopy and biopsy were performed, after which the histopathological examination demonstrated a mixed poorly differentiated large cell neuroendocrine carcinoma and adenocarcinoma. Based on the imaging and histopathology reports, he was diagnosed with a poorly differentiated MANEC of the colon with liver metastasis and multiple peritoneal deposits. His lesions were deemed unresectable, and he was referred to the oncology department for palliative care. There he received a total of 9 cycles of cisplatin and etoposide for 8 months. His CT scan showed a regression of the primary tumor indicating a good response to chemotherapy. The patient is still following up with his medical oncologist. CONCLUSIONS Although it is rare, MANEC is a complex neoplasm that requires a high index of suspicion to diagnose due to its nonspecific presentation. It is confirmed through histopathology and immunohistochemistry of the tumor biopsy. Imaging is performed for staging, with most patients presenting at advanced stages with metastases. The only curative option is complete surgical resection of both the primary and metastatic lesion. Many cases, however, are regarded as unresectable and are referred for palliative treatment.
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http://dx.doi.org/10.12659/AJCR.929099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057652PMC
April 2021

Gallbladder cancer of two histological origins: A case report and review of literature.

Int J Surg Case Rep 2021 Apr 4;81:105704. Epub 2021 Mar 4.

Department of General Surgery, Hepatobiliary Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia; College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Electronic address:

Introduction And Importance: Carcinosarcoma is an extremely rare subtype of gallbladder cancer with a worldwide prevalence of less than 1%. Carcinosarcomas are composed of a mixture of epithelial and mesenchymal components. Preoperative diagnosis of carcinosarcoma is challenging considering the non-specific clinical presentation and radiological findings.

Case Presentation: A 63 years old female presented with right hypochondrium abdominal pain for 6 months. CA 19.9 level was high. Computed tomography of abdomen showed gallstones with enhancing wall thickening, along with enlarged portacaval lymph node. Endoscopic ultrasound-guided biopsy of porta hepatis lymph node was done which showed moderately differentiated adenocarcinoma. Hence, she underwent extended cholecystectomy with extended porta hepatis lymph node dissection. Final histopathological result showed carcinosarcoma (pT2a, pN1 M0). Unfortunately, she passed away 7 months post-operatively.

Clinical Discussion: The majority of patients with carcinosarcomas are asymptomatic but can develop unspecific symptoms in advanced stages. The diagnosis is usually made incidentally on histopathological examination. Surgical resection is the mainstay treatment and longer survival can be achieved if combined with chemotherapy and radiation therapy. BILCAP trial suggested that capecitabine can improve survival in patients with gallbladder cancer. Unfortunately, even with these treatment modalities prognosis remains poor with a survival rate ranging from 2.9 to 6 months.

Conclusion: Gallbladder carcinosarcoma is a rare tumor with a poor prognosis. However, some cases reported a good survival rate after surgery. Further research is needed to understand the behavior of these tumors well and identify the role of chemotherapy and radiotherapy and which patients would benefit the most from surgery.
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http://dx.doi.org/10.1016/j.ijscr.2021.105704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073199PMC
April 2021

Breast fat necrosis secondary to warfarin-induced calciphylaxis, a rare mimicker of breast cancer: A case report and a review of literature.

Breast J 2021 Mar 21;27(3):258-263. Epub 2021 Jan 21.

Department of Surgery, Breast and Endocrine Surgery Section, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.

Breast fat necrosis (BFN) is usually a benign inflammatory response to breast trauma. However, an extremely rare cause of fat necrosis is calciphylaxis, a calcification of small- and medium-sized arteries causing thrombosis and ischemia. It is classified into (A) uremic (B) nonuremic-induced calciphylaxis. Calciphylaxis has been reported to be encountered in different parts of the body. However, to the best of our knowledge there is only one case in the English literature of BFN 2ry to warfarin-induced calciphylaxis. We report a 65-year-old female, known case of atrial fibrillation on warfarin, presented with a left breast mass of 4-month duration. The mass was painful and progressively enlarging. Examination of the left breast showed 7 × 4 cm mass, spanning from 10-2 o'clock, free from surrounding structures, with preserved overlying skin. However, the mass was not visualized on mammogram. Ultrasound showed a left breast lobulated hypoechoic mass containing a hyperechoic component. Biopsy showed fat necrosis. After 1 month, she presented with ulceration of the overlying skin. After wide local excision, histopathology demonstrated a calciphylaxis-induced fat necrosis. Considering the patient's background, the diagnosis was BFN secondary to warfarin-induced calciphylaxis. Hence, the warfarin was shifted to Rivaroxaban, 6 months follow-up showed no evidence of recurrence. In conclusion, the rarity of nonuremic calciphylaxis is reflected on the delay of diagnosis in some of the reported cases and the lack of grading system used to guide the management of such difficult wounds. However, keeping a high index of suspicion is important whenever such wounds are encountered with presence of risk factors other than end-stage kidney disease.
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http://dx.doi.org/10.1111/tbj.14160DOI Listing
March 2021

Management of Very Late Pancreatic Metastasis of Renal Cell Carcinoma 8 Years After Radical Nephrectomy: A Report of a Rare Case.

Am J Case Rep 2021 Jan 5;22:e927921. Epub 2021 Jan 5.

Department of General Surgery, Hepatobiliary Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

BACKGROUND The most common primary malignant neoplasm of the kidneys in adults is renal cell carcinoma (RCC), which originates inside the renal cortex and accounts for 80-85% of all primary renal neoplasms. RCCs can spread to many organs, including the liver, lungs, bones, and brain. Disease is quiescent until the late stages of disease in the vast majority of patients. CASE REPORT We report a case of 63-year-old woman who presented to her surveillance check-up after a right radical nephrectomy 8 years ago. Computed tomography of the chest, abdomen, and pelvis (CT-CAP) revealed a hypervascular mass in the body of the pancreas measuring 1 cm, consistent with metastatic appearance. Therefore, the tumor board decision was to proceed with spleen-preserving distal pancreatectomy. The final histopathology result showed metastatic clear cell renal cell carcinoma (CCRCC) with negative resection margins. The patient currently is under regular follow-up. The latest CT-CAP was done at 1 year postoperatively, which showed no evidence of recurrence or metastasis. CONCLUSIONS Patients with RCCs can develop asymptomatic metastatic lesions years after complete oncological resection of the primary tumor. Furthermore, metastatic RCCs can be misdiagnosed as other primary tumors. Hence, a meticulous long-term follow-up is essential to ensure that recurrence or a new distant metastasis is not missed. RCCs are known for their poor response to chemotherapy and radiation therapy. However, the new targeted therapies have shown a good response rate. Nevertheless, complete oncological resection of the pancreatic metastasis remains the best treatment modality and is associated with a 5-year survival rate of 75%.
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http://dx.doi.org/10.12659/AJCR.927921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797602PMC
January 2021

Huge solid pseudopapillary tumor of the pancreas 'Frantz tumor': a case report.

J Gastrointest Oncol 2020 Oct;11(5):1098-1104

Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia.

Solid pseudopapillary neoplasms (SPN) of the pancreas are rare neoplasms accounting for 1-2% of all pancreatic tumors and have a general female predominance. We report a case and intraoperative videos of SPN involving the whole pancreatic tail. A 19-year-old female patient initially presented to another healthcare facility complaining of abdominal pain, which was started 6 years ago. A contrast-enhanced Computed Tomography (CT) scan of the abdomen showed a large mass measuring 15.6 cm × 11.6 cm × 11 cm, arising from the pancreas with an enhancing cystic component. The patient underwent exploratory laparotomy, which revealed a huge mass occupying most of the abdominal cavity. Thus, we proceeded with a distal pancreatectomy and splenectomy. Intraoperatively, the frozen section showed that the mass had features of a solid pseudopapillary tumor of the pancreas with negative resection margins. The SPN diagnosis was confirmed by histopathology and immunohistochemistry. The pathophysiology behind the development of SPN and its cellular origin is still a matter of debate with multiple proposed hypotheses. SPNs are asymptomatic in almost 70% of all cases and usually discovered incidentally. The pre-operative diagnosis of SPNs remains a clinical challenge despite all the current advances in the diagnostic modalities. Surgical management with negative resection margins is the mainstay of treatment, even with metastasis and vascular invasion, surgical excision should be performed whenever feasible. The recurrence rate after surgical resection has been reported to be 3-9%. The prognosis of SPN limited to the pancreas is generally excellent with over 95% cure rate following complete surgical resection. SPN is a rare entity of a controversial origin but is considered as a low-grade malignancy. Surgical resection to achieve complete excision constitutes the mainstay of treatment, which mostly results in an excellent prognosis.
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http://dx.doi.org/10.21037/jgo-20-180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657821PMC
October 2020

Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study.

Open Access Emerg Med 2020 23;12:305-313. Epub 2020 Oct 23.

Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida, USA.

Background: Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients.

Patients And Methods: A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients.

Results: A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation <94% and GCS ≤8 were associated with positive CT scans.

Conclusion: Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.
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http://dx.doi.org/10.2147/OAEM.S263754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591101PMC
October 2020

A Diagnostic Dilemma of a Subcutaneous Hibernoma: Case Report.

Am J Case Rep 2020 Apr 25;21:e921447. Epub 2020 Apr 25.

Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

BACKGROUND Subcutaneous lipomatous lesions are commonly encountered in clinical practice. Hibernoma is a rare subtype of the benign lipomatous tumor, representing 1% of all types. It poses a challenge due to the difficulty of differentiating it from atypical lipomatous lesions and liposarcomas, which may lead to possible inappropriate diagnosis and management. CASE REPORT We report a case of a 33-year-old male who presented with a right upper thigh swelling noticed some time prior to presentation that had started increasing in size prior to his presentation. The magnetic resonance imaging (MRI) was unable to rule out atypical lipomatous tumor and liposarcoma. An ultrasound-guided biopsy gave a diagnosis of hibernoma. The patient underwent a wide local excision, which confirmed the diagnosis of hibernoma. At the 3-year follow-up, there was no evidence of local recurrence. CONCLUSIONS Hibernoma has been reported in the literature to be discovered incidentally by radiological imaging done for other causes. However, hibernomas raise a diagnostic challenge because in most imaging modalities they are indistinguishable from other malignant tumors. A wide local excision with negative margins is key to resolving the diagnostic dilemma that a hibernoma presents, as it will provide a definitive diagnosis differentiating it from other lipomatous lesions and prevent any future recurrence. Caution is advised when dealing with lipomatous lesions, as they often overlap with malignancy. Furthermore, an MRI should be done for any subcutaneous lesion that is larger than 5 cm or shows recent growth. A biopsy can resolve the diagnostic dilemma with caution to the hypervascularity of such tumors.
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http://dx.doi.org/10.12659/AJCR.921447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200092PMC
April 2020

Lipomatous tumors of adrenal gland: A case series of 5 patients and review of the literature.

Int J Surg Case Rep 2020 26;67:54-61. Epub 2020 Jan 26.

Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia.

Introduction: Lipomatous tumors of the adrenal glands are a diverse group of tumors characterized by the composition of adipose tissue. This group of tumors include myelolipomas, angiomyolipomas (AML), lipomas, and teratomas. They are usually benign, non-functioning tumors, and they account for 5% of all primary adrenal tumors. This study aimed to elucidate the management of the initial size of the adrenal mass and symptoms of presentation. We provide a succinct literature review regarding angiomyolipomas tumors of the adrenal glands.

Presentation Of Cases: Here, we report 5 cases of lipomatous tumors of the adrenal glands. All 5 tumors were non-functioning. Four of them were myelolipoma, and one was AML. Two cases of myelolipoma presented with flank pain, while the rest of the 3 cases presented with hypochondrium pain. Three cases of myelolipoma were managed with laparoscopic adrenalectomy, one case of myelolipoma was converted from laparoscopic to open adrenalectomy because of abdominal adhesions, and the last case was AML and was managed with open adrenalectomy. All patients had an uneventful recovery with regular follow-up.

Discussion: Myelolipoma, the most common lipomatous tumor of the adrenal gland, consists of a mixture of bone morrow element and adipose tissue. AML consists of a mixture of a thick-walled blood vessel, smooth muscle, and adipose tissue. They mimic many different benign and malignant tumors on radiography, and the histopathological examination is still needed to confirm the diagnosis. There is still controversy in the management of these tumors. Usually, the management is individualized on each case. Reporting of these tumors are increasing due the wide-spread use of modern imaging modalities.

Conclusion: Adrenal lipomatous tumors are uncommon but with the increase use of imaging modalities their detection has increased. Further studies are needed to establish guidelines in the management of these tumors, especially that they can mimic malignant conditions.
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http://dx.doi.org/10.1016/j.ijscr.2020.01.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000441PMC
January 2020

Surgical outcomes of primary carcinosarcoma of the gallbladder after curative resection: A rare case series.

Int J Surg Case Rep 2019 29;65:32-39. Epub 2019 Oct 29.

Department of General Surgery, Hepatobiliary Surgery Unit, King Fahad Specialist Hospital-Dammam, Saudi Arabia.

Introduction: Primary carcinosarcoma is a rare neoplasm of the gallbladder, and is characterized by collision elements of the adenocarcinomatous and sarcomatous components. The tumours comprise both malignant epithelial and mesenchymal elements, and are usually very aggressive, conferring poor prognosis. Adenocarcinomas are the most common neoplasms of the gall bladder, while carcinosarcoma are extremely rare, with a global prevalence rate of less than 1%. The low incidence of carcinosarcoma greatly hinders the understanding of its aetiology.

Presentation Of Case: Here, we report the surgical outcome of 3 rare cases of gallbladder carcinosarcomas, two of which had a IVB stage disease and in one case the staging was II. Following surgery, the survival in the former was less than 1 year, while in the latter, it extended up to 7 years (86 months), and the patient is alive till date. This study aimed to elucidate the surgical outcomes and prognosis after curable resection for carcinosarcomas of the gallbladder.

Discussion: The findings suggest that carcinosarcomas are associated with a poor prognosis and short survival, particularly in those with tumours of >5 cm. In the absence of effective adjuvant treatment, surgery remains the mainstay of treatment.

Conclusion: Complete surgical resection may improve prognosis and extend survival in patients with this rare and aggressive form of gallbladder cancer.
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http://dx.doi.org/10.1016/j.ijscr.2019.10.056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838533PMC
October 2019

Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature.

Int J Surg Case Rep 2019 26;61:38-43. Epub 2019 Jun 26.

Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Introduction: Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient.

Case Presentation: We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation.

Conclusion: Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.
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http://dx.doi.org/10.1016/j.ijscr.2019.06.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626975PMC
June 2019

The challenges of diagnosing idiopathic ovarian vein thrombosis: Case report.

Int J Surg Case Rep 2019 3;60:63-65. Epub 2019 May 3.

Imam Abdulrahman bin Faisal University, Department of General Surgery, King Fahad University Hospital, Saudi Arabia.

Introduction: Abdominal pain is a common clinical challenge presenting to the emergency department. The challenge lies in the wide differentials particularly in females due to the addition of potential gynecological conditions. Ovarian vein thrombosis (OVT) is one of the uncommon differentials requiring rapid recognition & treatment to avoid serious complications or even death.

Case Presentation: We report a 42-year-old healthy female, post normal vaginal delivery 1- year prior to presentation. She presented with left iliac fossa and periumbilical pain for 1-day with no other symptoms. She was vitally stable. Abdominal & pelvic examinations revealed left lower tenderness with guarding. Laboratory investigations were within normal. Abdominal Doppler showed a dilated left ovarian vein with absent flow and Computed tomography (CT) scan confirmed the presence of a thrombus. Therefore, the diagnosis of OVT was made and she was started on anticoagulation.

Discussion: OVT is a rare, life-threatening condition occurring mainly during the post-partum period (0.18% post vaginal delivery). Diagnosing ovarian vein thrombosis can be challenging because of the overlapping presentation with other differentials. A high index of suspicion should be kept in females presenting with abdominal pain. Standard guidelines for managing OVT are lacking. However, lower limb DVT guidelines have been suggested in the literature to be applicable.

Conclusion: The initial modality of diagnosing OVT is Doppler ultrasound. However, CT and MRA confirm the diagnosis in case of uncertainty. The mainstay of treatment is the conservative approach while the surgical approach is reserved for persistent OVT despite appropriate conservative therapy.
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http://dx.doi.org/10.1016/j.ijscr.2019.04.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580323PMC
May 2019

The ugly face of deep vein thrombosis: Phlegmasia Cerulea Dolens-Case report.

Int J Surg Case Rep 2019 11;59:107-110. Epub 2019 May 11.

Department of Radiology King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia.

Introduction: Phlegmasia Cerulea Dolens (PCD), a rare & life-threatening condition caused by a massive deep venous thrombosis that is associated with arterial occlusion caused by the subsequent compartment syndrome.

Case Presentation: A 56-year-old male was diagnosed as a case of extensive left femoral DVT & pulmonary embolism. Two days after being managed by systemic thrombolytics & heparin, his condition worsened as he developed cyanosis of the affected limb, compartment syndrome & foot drop so he was referred to our facility for further management. CT venogram showed a thrombosis of the left popliteal vein extending into the left common iliac vein confirming the diagnosis of PCD & May-Turner syndrome. We adopted a limb preserving approach using a pharmacomechanical catheter directed thrombolysis (PCDT). The patient recovered fully with a complete resolution of his foot drop.

Discussion: Several treatment options have been suggested to improve the outcomes of PCD, but due to the rarity of this condition a gold standard treatment is still controversial. But regardless of the chosen approach, there is an urgent need to decrease the thrombus burden to prevent further adverse sequelae like amputation or even death which can be achieved by using PCDT as it was demonstrated in our case.

Conclusion: Our case shows that a rare entity of DVT as PCD could be a result of improper management of acute proximal DVT in the background of anatomical variabilities & that despite the late presentation of such a rare condition there still a role for a limb preserving approach with endovascular techniques.
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http://dx.doi.org/10.1016/j.ijscr.2019.05.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535643PMC
May 2019

Thoracic Complications of Bariatric Surgeries: Overlooked Entities.

Obes Surg 2019 08;29(8):2485-2491

Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Introduction: Bariatric surgeries are increasingly performed to treat obesity worldwide. The currently available literature on these surgeries mainly focuses on their abdominal complications, giving less attention to their thoracic ones. Hence, the present work aimed to highlight the thoracic complications associated with bariatric surgeries.

Methods: A retrospective descriptive study was performed and involved the review of the medical charts of 390 patients who underwent different bariatric surgeries between January 2014 and January 2017 in our hospital or who were referred to us from other centers after their specific operations. The data of patients who developed thoracic complications and who required further intervention were identified and categorized by the modality of diagnosis, outcome, duration of hospital and ICU stays, and management. Patients with a history of a preexisting pulmonary disease were excluded.

Results: Twenty-six patients were observed to have thoracic complications secondary to their bariatric surgeries. Twenty-two patients (84.6%) received post-laparoscopic sleeve gastrectomy (LASG). Nine patients (34.6%) required ICU stays. Twenty patients (76.9) had incidences of pleural effusion in the postoperative period. The mean duration of hospital and ICU stays were 4.4 ± 11.67 days and 15 ± 19.36 days, respectively. Other reported thoracic complications included esophageal perforations, thoracic empyema, septic pericardial effusion, and pancreaticopleural fistula.

Conclusion: Bariatric surgeries are safe procedures in selected patients. There is a significant amount of literature describing abdominal, nutritional, neurological, and even ophthalmic complications after bariatric surgeries. Being that they are relatively rare, thoracic complications are underreported in the literature. The management of thoracic complications after bariatric surgery requires awareness and a high index of suspicion to prevent further morbidities and mortalities.
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http://dx.doi.org/10.1007/s11695-019-03868-7DOI Listing
August 2019

Brain metastasis and herniation in a patient with ampullary adenocarcinoma presenting with jaundice and memory loss: case report.

J Gastrointest Oncol 2018 Oct;9(5):871-874

Multiple Organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Periampullary carcinoma includes neoplasms arising from head of pancreas, distal common bile duct, duodenum and ampulla of Vater. We report a case of a 41-year-old male, medically free who presented to our hospital as a case of obstructive jaundice, weight loss, headache and blurred vision. Clinical evaluation revealed memory loss and ataxia. Endoscopic retrograde cholangiopancreatography (ERCP) was carried out and showed a mass in the ampullary area, histopathology showed ampullary adenocarcinoma. Metastatic work up was carried out which revealed two brain metastatic lesions and multiple intra-abdominal metastasis. We are reporting the third case of brain metastasis from ampullary adenocarcinoma. It metastasizes commonly intra-abdominally, but extra-abdominal metastases are rare yet it should be included in the differential diagnosis of patients with a history of ampullary carcinoma who present with neurological symptoms. There are no current specific management guidelines for brain metastasis secondary to ampullary adenocarcinoma, so general brain metastasis management is applicable.
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http://dx.doi.org/10.21037/jgo.2018.05.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219980PMC
October 2018