Publications by authors named "Thamer Bin Traiki"

18 Publications

  • Page 1 of 1

Colorectal Schistosomiasis Infection After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Metastatic Colon Adenocarcinoma: A Case Report.

Am J Case Rep 2021 May 11;22:e930439. Epub 2021 May 11.

Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

BACKGROUND Colorectal cancer is one of the most common cancers in men and women worldwide. There are several studies showing an association between chronic schistosomiasis infection and colorectal cancer. CASE REPORT A 53-year-old woman presented with recurrent metastatic colon cancer involving the peritoneum and bilateral adnexa. The patient then underwent exploratory laparotomy that involved abdominal wall deposit resection, omentectomy, redo left hemicolectomy, peritonectomy, diaphragmatic stripping, and total abdominal hysterectomy with bilateral salpingectomy-oophorectomy, as well as hyperthermic intraperitoneal chemotherapy (HIPEC). She also underwent adjuvant chemotherapy, but on her 6th cycle, the patient suffered intolerable anal pain, diarrhea, and rectal bleeding. Her colonoscopy showed extended circumferential inflammation with loses of vascular pattern and a few rectal ulcers going up to the anastomosis site. Biopsy revealed Schistosoma mansoni eggs and marked ischemic changes. She was then managed with a single dose of Praziquantel. CONCLUSIONS Colorectal schistosomiasis infection is a rare cause of such common presentations especially in postoperative settings in a patient with recurrent metastatic colon cancer. The use of multimodality investigations and high clinical suspicion were needed for the diagnosis and to exclude other common etiologies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/AJCR.930439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126586PMC
May 2021

Association of the microbiome with colorectal cancer development (Review).

Int J Oncol 2021 05 24;58(5). Epub 2021 Mar 24.

Department of Biosciences, Manipal University Jaipur, Jaipur, Rajasthan 303007, India.

Colorectal cancer (CRC) is the second most common malignancy causing cancer‑related mortality globally. It is the third most common type of cancer detected worldwide. The recent concept of the human body supporting a diverse community of microbes has revealed the important role these microbes play synergistically in maintaining normal homeostasis. The balance between the microbiomes and epithelial cells of the human body is essential for normal physiology. Evidence from meta‑genome analysis indicates that an imbalance in the microbiome is prominent in the guts of patients with CRC. Several studies have suggested that the gut microbiota can secrete metabolites [short‑chain fatty acids (SCFAs), vitamins, polyphenols and polyamines] that modulate the susceptibility of the colon and rectum by altering inflammation and DNA damage. The state of microbiome imbalance (dysbiosis) has been reported in patients with CRC, with an increasing population of 'bad' microbes and a decrease in 'good' microbes. The 'good' microbes, also known as commensal microbes, produce butyrate; however, 'bad' microbes cause a pro‑inflammatory state. The complex association between pathological microbial communities leading to cancer progression is not yet fully understood. An altered microbial metabolite profile plays a direct role in CRC metabolism. Furthermore, diet plays an essential role in the risk of gastrointestinal cancer development. High‑fiber diets regulate the gut microbiome and reduce the risk of CRC development, and may be fruitful in the better management of therapeutics. In the present review, the current status of the microbiome in CRC development is discussed.12.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3892/ijo.2021.5197DOI Listing
May 2021

Urolithin A induces cell cycle arrest and apoptosis by inhibiting Bcl-2, increasing p53-p21 proteins and reactive oxygen species production in colorectal cancer cells.

Cell Stress Chaperones 2021 May 5;26(3):473-493. Epub 2021 Mar 5.

Colorectal Research Chair, Department of Surgery, College of Medicine, King Saud University, PO Box 7805 (37), Riyadh, 11472, Kingdom of Saudi Arabia.

Colorectal cancer (CRC) is the second most common gastrointestinal cancer globally. Prevention of tumor cell proliferation and metastasis is vital for prolonging patient survival. Polyphenols provide a wide range of health benefits and prevention from cancer. In the gut, urolithins are the major metabolites of polyphenols. The objective of our study was to elucidate the molecular mechanism of the anticancer effect of urolithin A (UA) on colorectal cancer cells. UA was found to inhibit the cell proliferation of CRC cell lines in a dose-dependent and time-dependent manner in HT29, SW480, and SW620 cells. Exposure to UA resulted in cell cycle arrest in a dose-dependent manner along with alteration in the expression of cell cycle-related protein. Treatment of CRC cell lines with UA resulted in the induction of apoptosis. Treatment of HT29, SW480, and SW620 with UA resulted in increased expression of the pro-apoptotic proteins, p53 and p21. Similarly, UA treatment inhibited the anti-apoptotic protein expression of Bcl-2. Moreover, exposure of UA induced cytochrome c release and caspase activation. Furthermore, UA was found to generate reactive oxygen species (ROS) production in CRC cells. These findings indicate that UA possesses anticancer potential and may be used therapeutically for the treatment of CRC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12192-020-01189-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065090PMC
May 2021

Correction to: A novel coordination complex of platinum (PT) induces cell death in colorectal cancer by altering redox balance and modulating MAPK pathway.

BMC Cancer 2020 Sep 1;20(1):834. Epub 2020 Sep 1.

Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, PO Box 7805 (37), 11472, Riyadh, Saudi Arabia.

An amendment to this paper has been published and can be accessed via the original article.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12885-020-07245-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466422PMC
September 2020

Impact of COVID-19 pandemic on patient satisfaction and surgical outcomes: A retrospective and cross sectional study.

Ann Med Surg (Lond) 2020 Oct 21;58:14-19. Epub 2020 Aug 21.

Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11461, Saudi Arabia.

Objective: The objective of this study was to evaluate the impact of the COVID-19 pandemic on patient satisfaction and surgical outcomes at King Khalid University Hospital in Saudi Arabia.

Background: The COVID-19 pandemic has greatly affected health care systems across developing and developed countries. Therefore, it is important to understand its impact on various parameters of patient care as regards revised infrastructure and policies in hospitals during the pandemic.

Method: It is a retrospective cross-sectional study was conducted from 13-3-2020 to 26-4-2020 at King Khalid University Hospital in Saudi Arabia. Patient satisfaction and surgical outcomes were the main outcome measures.

Results: 331 participants were included in the study (median age: 53 years; 70% female), and 223 completed the patient's satisfaction survey. 260 of the surgeries were non-oncolog cases (78.6%) compared to 71 oncology cases (21.4%). With respect to the surgical outcomes, 12% of the patients required admission to the ICU, and 10.9% developed postoperative complications, most of which were infectious complications. Only 1.8% (6 patients) were re-admitted to the hospital. Three patients died within 30 days post-op (0.9%), all had emergency surgery. Regarding patient satisfaction, 77.6% and 93% of the patients reported that nurses and doctors, respectively, treated them with courtesy and respect, listened to them carefully, and provided clear explanations to them. 90.3% were satisfied with the hospital sanitary measures. 64.1% stated that they got written instructions at the time of discharge.

Conclusion: The satisfaction level of patients was high for all the studied domains, and there were a small number of complications with overall good surgical outcomes. That indicates that all the actions and policies that were implemented during the pandemic were proven beneficial for the patients. It is recommended to continue those measures until the COVID-19 pandemic is over.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amsu.2020.08.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442049PMC
October 2020

A novel coordination complex of platinum (PT) induces cell death in colorectal cancer by altering redox balance and modulating MAPK pathway.

BMC Cancer 2020 Jul 23;20(1):685. Epub 2020 Jul 23.

Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, PO Box 7805 (37), Riyadh, 11472, Saudi Arabia.

Background: Colorectal cancer (CRC) is a heterogeneous tumor having various genetic alterations. The current treatment options had limited impact on disease free survival due to therapeutic resistance. Novel anticancer agents are needed to treat CRC specifically metastatic colorectal cancer. A novel coordination complex of platinum, (salicylaldiminato)Pt(II) complex with dimethylpropylene linkage (PT) exhibited potential anti-cancer activity. In this study, we explored the molecular mechanism of PT-induced cell death in colorectal cancer.

Methods: Colony formation was evaluated using the clonogenic assay. Apoptosis, cell cycle analysis, reactive oxygen species, mitochondrial membrane potential and caspase-3/- 7 were assessed by flow cytometry. Glutathione level was detected by colorimetric assay. PT-induced alteration in pro-apoptotic/ anti-apoptotic proteins and other signaling pathways were investigated using western blotting. P38 downregulation was performed using siRNA.

Results: In the present study, we explored the molecular mechanism of PT-mediated inhibition of cell proliferation in colorectal cancer cells. PT significantly inhibited the colony formation in human colorectal cancer cell lines (HT-29, SW480 and SW620) by inducing apoptosis and necrosis. This platinum complex was shown to significantly increase the reactive oxygen species (ROS) generation, depletion of glutathione and reduced mitochondrial membrane potential in colorectal cancer cells. Exposure to PT resulted in the downregulation of anti-apoptotic proteins (Bcl2, BclxL, XIAP) and alteration in Cyclins expression. Furthermore, PT increased cytochrome c release into cytosol and enhanced PARP cleavage leading to activation of intrinsic apoptotic pathway. Moreover, pre-treatment with ROS scavenger N-acetylcysteine (NAC) attenuated apoptosis suggesting that PT-induced apoptosis was driven by oxidative stress. Additionally, we show that PT-induced apoptosis was mediated by activating p38 MAPK and inhibiting AKT pathways. This was demonstrated by using chemical inhibitor and siRNA against p38 kinase which blocked the cytochrome c release and apoptosis in colorectal cancer cells.

Conclusion: Collectively, our data demonstrates that the platinum complex (PT) exerts its anti-proliferative effect on CRC by ROS-mediated apoptosis and activating p38 MAPK pathway. Thus, our findings reveal a novel mechanism of action for PT on colorectal cancer cells and may have therapeutic implication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12885-020-07165-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376665PMC
July 2020

Two Histologically Different Primary Malignancies: Synchronous Obstructive Descending Colon Adenocarcinoma and Appendicular Carcinoid Tumor.

Am J Case Rep 2020 06 19;21:e921810. Epub 2020 Jun 19.

Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

BACKGROUND Synchronous primary tumors are defined as 2 or more different histological tumors discovered in one patient at the same time or within a period of 6 months. Colorectal cancer is one of the most common cancers in the United States. Inversely, synchronous colorectal cancer and carcinoid tumors are rare. Carcinoid tumors can be classified into functioning and non-functioning tumors. Carcinoid tumors are steadily increasing in incidence. There is only 1 case reported in the literature as synchronous colorectal cancer and appendicular carcinoid. The difficulty is to manage 2 different types of malignancies at the same time. An optimal medical or chemotherapy strategy is needed. CASE REPORT A 29-year-old woman presented to the emergency room carrying with her computerized tomography (CT) abdomen and pelvic images showing bowel obstruction. Investigations confirmed an obstructing descending colon mass. She underwent colonoscopic stenting as emergency treatment with multiple biopsies. The pathology report came back positive for adenocarcinoma, and we planned to proceed with surgery. Intraoperatively, she was found to have an appendicular mass. The surgical team decided to proceed with laparoscopic-assisted subtotal colectomy. The postoperative course was uneventful, with no complications. The patient was discharged on postoperative day 6 in stable condition. CONCLUSIONS Synchronous colorectal cancer and carcinoid tumors are rare malignancies. The challenge is to find an optimal medical or chemotherapy strategy to manage both malignancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/AJCR.921810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322214PMC
June 2020

Single-Port Laparoscopic Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.

Am J Case Rep 2019 11 9;20:1648-1651. Epub 2019 Nov 9.

Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is one of the treatment options in low-grade appendiceal mucinous neoplasm with peritoneal dissemination. The minimal invasive surgery approach was introduced to the field after years of traditional open technique. Multi-port laparoscopic and robotic techniques were reported with good short-term outcomes in very selected patients with low PCI scores. We describe here the first single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. CASE REPORT We present a case of low-grade appendiceal mucinous neoplasm with peritoneal dissemination, in which single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy was completed through a 5.5-cm incision. A 35-year-old man with no medical illness underwent laparoscopic appendectomy for acute appendicitis 3 months earlier. Postoperative surgical pathology reported a low-grade appendiceal mucinous neoplasm with positive margin. After complete assessment and Tumor Board discussion, the patient was scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A single gel port access was inserted through a 5.5-cm peri-umbilical incision. The Peritoneal Cancer Index score was 4, and the decision was made to proceed with partial cecectomy, omentectomy, peritonectomy, and hyperthermic intraperitoneal chemotherapy with the Sugarbaker mitomycin C-based regimen. Postoperative care was carried out following the Enhanced Recovery After Surgery protocol. The patient was discharged on day 3 without any complications. CONCLUSIONS A single-port laparoscopic approach in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is safe and feasible in very selected patients, and has the advantage of direct visualization and palpation through the incision to determine more accurate Peritoneal Cancer Index assessment in comparison to other MIS approaches. Nevertheless, additional prospective studies are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/AJCR.918064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859933PMC
November 2019

A Perforated Colonic Neuroendocrine Tumor with Liver Metastasis: A Case Report and Literature Review.

Am J Case Rep 2019 Jun 28;20:920-925. Epub 2019 Jun 28.

Department of General Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.

BACKGROUND Neuroendocrine neoplasms (NENs) originate from cells of the endocrine and nervous systems, and they are rarely encountered in colorectal cases with no specific symptoms. The incidence and prevalence of NENs of the large bowel are increasing. Malignant colonic types are known to have poor diagnosis. The mean age of colonic NENs is the seventh decade, and the risk of NENs is increased 4-fold with affected first-degree family members. CASE REPORT A 57-year-old male patient presented to our Emergency Department with a 5-day history of severe generalized abdominal pain associated with worsening abdominal distension, history of night sweats, and weight loss. A CT scan of the abdomen and pelvis demonstrated a large heterogeneously enhancing neoplastic mass lesion involving the splenic flexure of the colon surrounded by fat stranding with a small contained leak, in addition to multiple metastatic hypodense focal hepatic lesions. Multiple lymph nodes under 1 cm in size were also noted. The patient underwent exploratory laparotomy, subtotal colectomy, ileostomy creation, and washout. The histopathological exam revealed high-grade invasive colonic neuroendocrine carcinoma, which was pT4N2bM1c, while the peritoneal lesion was metastatic carcinoma. The patient was then referred to the multidisciplinary tumor board. CONCLUSIONS Unusual presentation of neuroendocrine tumors is shown to be expected. Since colorectal NECs are rare, highly aggressive diseases and usually discovered very late, individualization of management, as well as additional research, is required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/AJCR.916288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613493PMC
June 2019

Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique.

Int J Surg Case Rep 2019 11;60:224-229. Epub 2019 May 11.

Department of General Surgery, King Khalid University Hospital and College of Medicine, King Saud University, Saudi Arabia; Colorectal Research Chair, Department of General Surgery, King Khalid University Hospital and College of Medicine, King Saud University, Saudi Arabia. Electronic address:

Introduction: Pseudomyxoma peritonei (PMP) is a feared complication of appendicular mucocele perforation. Although a rare disease, its major sequel mandates recognition and early intervention. Intestinal malrotation is mostly asymptomatic in adults. Its significance arises when it complicates another coinciding condition by confusing the presentation, leading to delay in diagnosis and treatment. PMP and incidental finding of gut malrotation in adults are two rare events, and the chance of both occurring in the same patient is very slim. This can complicate the clinical picture and lead to devastating outcomes.

Presentation Of The Case: We present a case of PMP in a patient with gut malrotation, managed with cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC).

Discussion: Management with CRS/HIPEC has been found to improve outcomes for patients with PMP. However, the extensive disease and abnormal anatomy of the patient in our report proposed unique intraoperative challenges. Preserving part of the colon was possible with an improvised surgical technique that we used which proved to be safe and effective.

Conclusion: Early recognition and consideration of uncommon but serious surgical conditions are essential for improved patient outcomes. To our knowledge, this is the first report in the English literature that describes the use of CRS/HIPEC for PMP in a case of intestinal malrotation. This improvised surgical technique was found to be safe and can provide a surgical solution for preserving part of the colon in selected patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2019.05.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598601PMC
May 2019

Survival and outcomes after laparoscopic versus open curative resection for colon cancer.

Ann Saudi Med 2019 May-Jun;39(3):137-142. Epub 2019 May 30.

From the Department of Surgery, College of Medicine, Princess Nourah bint Abdulrahman, Riyadh, Saudi Arabia.

Background: Many studies have shown that open and laparoscopicsurgery for resection of colonic cancers produce similar short- and long-term results, but no data have been reported from Saudi Arabia.

Objective: Compare 3-year disease-free and overall survival after laparoscopic versus open curative resection for potentially curable colon cancer.

Design: Multicenter retrospective cohort study.

Setting: Tertiary academic hospital.

Patients And Methods: We analyzed data of patients who underwent curative resection for potentially curable colon cancer using the laparoscopic or open approach at three tertiary care centers during the period 2000-2015.

Main Outcome Measures: Overall and disease-free 3-year survival were the primary endpoints. Secondary endpoints included conversion rate, duration of surgery, length of hospital stay, rate of wound infection, resumption of bowel function, number of lymph nodes retrieved, adequacy of resection and rate of recurrence. Risk factors for recurrence, including complete mesocolic excision, were assessed.

Sample Size: 721.

Results: Patient and tumor characteristics were similar in the two groups except for ASA class ( P<.01), weight ( P<.05) and tumor stage ( P<.05). Over a median follow-up of 46 months, the 3-year overall survival was 76.7% for open resection and 90.3% for laparoscopic colon resection ( P<.05). The 3-year disease-free survival was 55.3% for open colon resection and 64.9% for laparoscopic colon resection ( P=.0714).

Conclusion: Overall and disease-free survival after the laparoscopic approach for curative resection of colon cancer is comparable to the open approach.

Limitations: Retrospective design and the possibility of selection bias.

Conflict Of Interest: None.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5144/0256-4947.2019.137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832338PMC
December 2019

The Current Status of Peritoneal Surface Oncology in Saudi Arabia.

Indian J Surg Oncol 2019 Feb 15;10(Suppl 1):33-36. Epub 2019 Jan 15.

7Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia.

Peritoneal carcinomatosis (PC) is a common evolution of abdominal cancers. It may arise from the peritoneum itself (primary) or originate from another type of cancer especially those of gastrointestinal or gynecological origin (secondary). Without aggressive multimodal therapeutic approaches, PC is associated with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been used to treat PC since 1990. In Saudi Arabia, the first CRS and HIPEC were done in 2008. In 2018, Saudi Arabia population is 32 millions of people and the demand for such procedures has grown up. This article gives outlines of the current status of peritoneal surface oncology in Saudi Arabia and the future perspective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13193-019-00876-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397117PMC
February 2019

IL-17 and colorectal cancer risk in the Middle East: gene polymorphisms and expression.

Cancer Manag Res 2018 5;10:2653-2661. Epub 2018 Sep 5.

Colorectal Research Chair, Department of Surgery, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia,

Background: IL-17 expressed by Th17 cells play a crucial role in tissue inflammation by induction of proinflammatory and neutrophil mobilizing cytokines, and IL-17 polymorphisms are associated with colorectal cancer (CRC).

Objective: We investigated the expression of IL-17 and the association of IL-17 gene polymorphisms with CRC susceptibility in a Middle East population.

Materials And Methods: The study included 117 diagnosed CRC patients and 100 age- and gender-matched healthy controls. IL-17A rs2275913 (G197A) and IL-17F rs763780 (T7488C) single nucleotide polymorphisms, mRNA, and protein levels of IL-17A were assessed.

Results: We observed significant association between rs2275913 in IL-17A and susceptibility to CRC ( = 0.016228). The AG and AA genotypes conferred 2-fold and 2.8-fold, respectively, higher risk of developing CRC compared with individuals having GG genotype. Stratification of the data based on gender and age revealed very strong association of CRC with IL17A rs2275913 only in males and "AG" genotype in patients ≤57 years of age at the time of disease diagnosis. The rs763780 in IL-17F was not linked with CRCs in our cohort. Furthermore, IL-17A mRNA expression in CRCs was significantly elevated compared to adjacent normal tissues, particularly in early stages of disease ( = 0.0005). Strong immunoreactivity to IL-17A protein was observed in 70% of early stage relative to 30% of late-stage tumors.

Conclusion: The IL-17A G197A variant may be utilized as a genetic screening marker in assessing CRC risk, and its expression can be used as a biomarker for early detection of CRC in the Saudi population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/CMAR.S161248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6130533PMC
September 2018

Inguinal lymph node metastases from rectal adenocarcinoma.

ANZ J Surg 2019 Apr 6;89(4):431-433. Epub 2017 Jul 6.

St George Hospital Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.14091DOI Listing
April 2019

Enterocutaneous fistula in patients with peritoneal malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Incidence, management and outcomes.

Surg Oncol 2016 Sep 24;25(3):315-20. Epub 2016 May 24.

UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia. Electronic address:

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for peritoneal carcinomatosis (PC) from multiple origins, however is associated with increased complications compared to conventional gastrointestinal surgery. The aetiology of enterocutaneous fistulas (ECF) in most cases is a result of various contributing factors and therefore remains a major clinical problem, occurring in 4-34% of patients post-CRS. The aim of this study was to analyze the incidence and outcome of ECF following CRS/HIPEC.

Method: From April 1999 to September 2015, 53 patients of 918 CRS/HIPEC procedures developed an ECF. Patient, operative and postoperative data were retrospectively analyzed to determine aetiology, classification outcome and possible contributing factors were reviewed on univariate and multivariate analysis.

Results: We report a 5.8% ECF rate, diagnosed at a median of 13 days. The mortality rate was 5.7% and other morbidity was significantly increased (p = 0.0001). Twenty-five (47.2%), 8 (15.1%) and 20 patients (37.7%) had low, moderate and high output ECF respectively. Patients that had a CC2 cytoreduction, abdominal VAC or smoked had a higher risk of fistula (p = 0.004, p < 0.0001, p = 0.008). Spontaneous closure was achieved in 49.2% with conservative treatment (median 29 days) and 33.9% underwent surgical intervention. Preoperative serum albumin <35 g/L (p = 0.04), PCI>17 (p = 0.025) and operation >8.6 h s (p = 0.001) were independent risk factors on multivariate analysis. Overall and 5-year survival was significantly reduced (p < 0.0001,p = 0.016).

Conclusion: CRS/HIPEC remains an effective treatment modality for PC in selected patients with a comparable ECF incidence to reported elective gastrointestinal surgery rates. This study identifies multiple risk factors that should be considered in patients undergoing CRS/HIPEC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.suronc.2016.05.025DOI Listing
September 2016

Microwave ablation of liver metastasis complicated by Clostridium perfringens gas-forming pyogenic liver abscess (GPLA) in a patient with past gastrectomy.

Int J Surg Case Rep 2016 11;27:32-35. Epub 2016 Aug 11.

Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia. Electronic address:

Introduction: Gas-forming pyogenic liver abscess (GPLA) caused by C. perfringens is rare but fatal. Patients with past gastrectomy may be prone to such infection post-ablation.

Presentation Of Case: An 84-year-old male patient with past gastrectomy had MW ablation of his liver tumors complicated by GPLA. Computerised tomography scan showed gas-containing abscess in the liver and he was managed successfully with antibiotic and percutaneous drainage of the abscess.

Discussion: C. perfringens GPLA secondary to MW ablation in a patient with previous gastrectomy has not been reported in the literature. Gastrectomy may predispose to such infection. Even in high-risk patients, empirical antibiotic before ablation is not a standard of practice. Therefore following the procedure, close observation of patients' conditions is necessary to allow early diagnosis and intervention that will prevent progression of infection.

Conclusion: Potential complication of liver abscess following MW ablation can never be overlooked. The risk may be enhanced in patients with previous gastrectomy. Early diagnosis and management may minimise mortality and morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2016.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987502PMC
August 2016

Hemobilia post laparoscopic cholecystectomy.

J Surg Case Rep 2015 Feb 8;2015(2). Epub 2015 Feb 8.

Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Hepatic artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. A high index of suspicion and early identification and therapy are important points needed to prevent rupture. We report a case of complex biliary and vascular injuries 4 weeks after a laparoscopic cholecystectomy. The patient had recurrent bleeding from a hepatic artery pseudoaneurysm that has been treated successfully with angiographic stenting and embolization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jscr/rju159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321044PMC
February 2015

Fatal air embolism during sigmoidoscopy performed under spinal anesthesia.

Anesth Essays Res 2012 Jul-Dec;6(2):210-2

Department of Surgery, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Air embolism is an uncommon but potentially catastrophic event that occurs when air enters the vasculature. Because of a scared and friable colorectal mucosa, patients with anastomotic stricture are at an increased risk of complications associated with sigmoidoscopy such as bowel perforation and bleeding. This is a report of fatal air embolism confirmed on an immediate postmortem chest radiograph in a patient with a high colorectal anastomotic stricture undergoing sigmoidoscopy under spinal anesthesia is reported. The literature on air embolism in patients undergoing sigmoidoscopy/colonoscopy is reviewed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0259-1162.108336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173453PMC
April 2015