Objectives: To calculate the incidence of acute peripancreatic fluid collection (APFC) in patients with acute pancreatitis. The secondary objective is to determine the underlying etiologies of acute pancreatitis in the Saudi population.

Introduction & importance Carpal tunnel syndrome (CTS) is the most common neuropathy in the world and is caused by compression of the median nerve. It has many known risk factors, including hemodialysis and a persistent median artery (PMA), which can be an incidental finding during carpal tunnel release (CTR). Case presentation A 65-year-old woman with end-stage renal disease (ESRD) on dialysis for seven months presented with typical signs and symptoms of carpal tunnel syndrome. Nerve conduction studies (NCS) displayed severe neuropathy. Upon carpal tunnel release (CTR) a rare superficial non-calcified persistent median artery critical to the circulation of the hand was found. The patient's symptoms resolved completely within four weeks of the operation. Clinical discussion The PMA is a relatively common anomaly and could cause carpal tunnel syndrome by: directly pressing the median nerve, thrombosing, or in the setting of an aneurysm. Although usually found deep to the flexor retinaculum, the PMA could also be found superficially. It can be critical to the blood supply of the hand and should therefore be dealt with carefully. Conclusion Surgeons should be aware of the possibility of finding a PMA when performing CTR. The PMA could be deep or superficial to the transverse carpal ligament. Where possible, the PMA should be preserved. Especially if its contributions to the blood supply of the hand are undetermined.

Objectives: The primary objective of this study is to describe the most common radiological findings found on abdominal X-rays of patients with Crohn’s disease (CD) presenting with acute abdominal pain. Methods: A cross-sectional study was conducted at a tertiary care hospital in Riyadh. Data from CD patients who presented with acute abdominal pain between December 2016 and December 2021 was analyzed. A total of 144 abdominal X-rays met the inclusion and exclusion criteria and were included in the study. The medical records of patients who had the X-rays were subsequently reviewed for the presence or absence of follow-up imaging studies. Results: Of the 144 abdominal X-ray studies, 54 (37.5%) had positive findings, while 90 (62.5%) were unremarkable. The most common category of findings was small bowel findings (32.6%), acute complications (32.6%), followed by extraintestinal findings (2.7%), and colonic findings (1.35%). About 29.2% of the abdominal X-rays had subsequent follow-up imaging done. The multivariate logistic binary regression analysis demonstrated that males had an odds ratio of 2.25 of undergoing follow-up imaging compared to females (p = 0.049). Conclusion: The non-specific findings found on the majority of the abdominal X-rays may indicate that it is of limited diagnostic value in this patient population. However, they play an integral role in ruling out acute complications in CD patients presenting with abdominal pain and exhibiting disease activity.

The lingual frenulum (LF) is a fold of tissue that connects the tongue to the oral cavity's floor. Abnormal frenula are associated with speech alterations. The absence of the LF is associated with Ehler's Danlos syndrome (EDS). In this case report, we present a premature infant incidentally found to have an absent lingual frenulum, with recurrent desaturations during feeding. The desaturations were believed to be due to the absent lingual frenulum, but they resolved after one month without treatment and were then attributed to apnea of prematurity. Whole exome sequence showed no genetic disorders. The infant is now doing well with no interventions. An absent lingual frenulum warrants molecular genetic testing for EDS. However, it does not warrant any treatment; special considerations are only required during intubation.