Publications by authors named "Ifrat Bakirov"

3 Publications

  • Page 1 of 1

Surgical Treatment of Wilkie's Syndrome by Vascular Transposition.

Cureus 2022 Apr 18;14(4):e24251. Epub 2022 Apr 18.

General Surgery Department, Imam Abdulrahman Alfaisal Hospital, Riyadh, SAU.

Introduction Superior mesenteric artery syndrome (SMAS), also called mesenteric duodenal compression syndrome, Wilkie's syndrome, chronic duodenal ileus or cast syndrome, is a rare clinical condition defined as a compression of the third portion of the duodenum in between the SMA and abdominal aorta (AA), due to narrowing of the space between them. SMAS is primarily attributed to loss of the intervening mesenteric fat pad, leading to partial or complete duodenal obstruction. Its manifestations are complex and non-specific, including postprandial epigastric pain, nausea, vomiting, early satiety, weight loss and anorexia. SMAS may present as an acute syndrome, or it may have an insidious onset with chronic symptoms. SMAS mainly affects females between 10 and 40 years of age. This study aims to discuss the safety and efficacy of vascular decompression of the duodenum by infrarenal transposition of SMA. Methods This single-centre prospective clinical study analysed 37 patients with Wilkie's syndrome who underwent infrarenal transposition of the SMA between January 2012 and December 2021. The indications for the surgery were severe weight loss, uncontrolled upper abdominal pain, vomiting and other gastrointestinal (GI) symptoms that were severely debilitating to patients' daily lives, along with radiological findings such as aortomesenteric angle < 25°, aortomesenteric distance <8 mm and distention of proximal part of the duodenum and the stomach. Ten patients (27%) concurrently had Nutcracker syndrome and seven patients (18.9%) had Dunbar syndrome (median arcuate ligament syndrome). Three female patients (8.1%) had all three above-mentioned vascular compression syndromes, which were treated in the same surgery. One male patient (2.7%) was after a laparoscopic duodenojejunostomy with symptoms that relapsed three months postoperatively, which was cured after the infrarenal transposition of SMA. Results Technical operative and clinical success were achieved in all patients. There were no cases of anastomotic failure, SMA thrombosis or intestinal ischemia. All of the patients are currently living symptom-free. One patient (2.7%), four days postoperatively, had a lymphocele formed in the retroperitoneum, which was successfully drained by a CT-guided percutaneous pigtail catheter. Another patient (2.7%) after three months of surgery needed a re-laparotomy for adhesive obstruction of the second part of the duodenum and was treated by adhesiolysis and omentoplasty. One patient (2.7%), 2-year postoperatively, had a proximal SMA stenosis up to 60% where drug-eluting balloon percutaneous transluminal angioplasty (DEB PTA) was performed successfully. Finally, the upper GI symptoms were resolved in all 37 patients (100%). Conclusion Wilkie's syndrome, although rare, is frequently late-diagnosed or underdiagnosed. In cases of failure of conservative therapy, infrarenal transposition of the SMA can be considered a safe and feasible surgical option with more physiologically favourable outcomes comparable to gastrointestinal bypasses, especially in patients concurrently suffering from Nutcracker syndrome. Simultaneously, it also restores physiologic duodenal passage of gastroduodenal content without the need of creating a digestive tract anastomosis. To our best knowledge, we have the highest number of SMA transposition surgeries performed in a single centre for the treatment of Wilkie's syndrome.
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April 2022

Symptomatic Carotid Artery Thrombosis in a Patient Recently Recovered From a COVID-19 Infection.

Cureus 2021 Oct 9;13(10):e18626. Epub 2021 Oct 9.

General Surgery, Al Imam Abdulrahman Alfaisal Hospital, Riyadh, SAU.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), was initially discovered in December 2019 in China and rapidly spread all over the world to become a pandemic. The most common symptoms of a disease are fever, cough, generalized body ache, weakness, dyspnoea, nausea, vomiting, and diarrhea. Among vascular complications of COVID-19, the venous thrombotic complications, like pulmonary embolism and lower limb deep veins thrombosis, are not uncommon. But data about arterial thrombotic complications of COVID-19, especially carotid thrombosis, are still limited. We are describing a case of stroke due to thrombosis of the right carotid arteries, in a patient who had recovered from asymptomatic COVID-19. A 66-year-old male with arterial hypertension presented to the emergency department with a history of repeated collapse, dysarthria, weakness in the left extremities, and a drop in the left angle of his mouth (National Institutes of Health Stroke Scale [NIHSS]-4). The patient was swabbed for COVID-19 which was negative. A computed tomography angiography (CTA) was obtained which showed thrombosis in the branching point of the brachiocephalic trunk (BCT) continuing into the right subclavian artery (SA) and also into the right common carotid artery (CCA), with a subtotal occlusion of the right CCA, extending into the internal carotid artery (ICA) as well. From the apical lung tissue caught during the CT scan, bilateral, irregular widespread ground-glass opacifications, as well as consolidations and small reticular changes were seen in the lungs, which is typical for COVID-19 infection. A quantitative antibody test for COVID-19 infection was performed with the results showing a strong positivity for IgG antibodies, indicating previous COVID-19 infection. The patient was indicated for a standard carotid thrombectomy, which was performed without complications. It seems that one of the important factors that led to the formation of the thrombus in the carotid arteries was COVID-19 infection-induced inflammation in the atherosclerotic carotid vessels and generalized hypercoagulability as well as hyperviscosity. COVID-19 infection is an independent and important risk factor for the formation of an arterial thrombus during the acute illness and in the early post-COVID-19 period also, regardless of the severity of its course. Prophylactic anticoagulation is needed not only at the time of acute illness but also at the early post-COVID-19 time.
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October 2021

Left inferior epigastric artery injury in COVID-19 patient. Case report and literature review.

Int J Surg Case Rep 2020 4;76:415-420. Epub 2020 Oct 4.

Imam Abdulrahman Alfaisal Hospital, Riyadh, Saudi Arabia. Electronic address:

Introduction: Management of COVID-19 pneumonia cases is a medical challenge. However, the situation becomes worse if the patient has coexisting morbidities or newly developed complications. The study is about managing rectus sheath haematoma (RSH) in a patient with COVID-19 pneumonia.

Presentation Of Case: The patient was a 75-year-old male, presenting with bilateral COVID-19 pneumonia, with pulmonary embolism complications. Therapeutic anticoagulation by subcutaneous Clexane injection was administered. A left rectus haematoma was observed, and the patient fell and underwent haemorrhagic shock. Laparotomy was done for the evacuation of the haematoma.

Discussion: Contrast-enhanced computed tomography (CECT) is an essential tool for diagnosing RSH, identifying the source of bleeding, type of haematoma, and compression of the urinary system.

Conclusion: Surgical management of RSH in COVID-19 patients is superior to interventional radiology during the rush pandemic period.
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October 2020