Introduction and importance Gastric volvulus is the abnormal gastric rotation upon itself. It carries a considerable risk for gastric strangulation which may lead to gangrene and perforation, which can be fatal. It commonly presents with non-specific and vague abdominal symptoms making prompt diagnosis and management imperative. This is a case report describing a case of acute organo-axial gastric volvulus. Case presentation A 74-year-old female, with no comorbidities, presented to our department with non-specific abdominal symptoms. Gastric outlet obstruction was suspected. The patient was reviewed by the gastroenterologist and was offered an urgent upper endoscopy. The upper endoscopy findings described a gastric volvulus, and a Computed Tomography (CT) scan was done to confirm the diagnosis. The patient underwent exploratory/diagnostic laparoscopy and successful reduction and fixation followed. There was no evidence of tissue compromise or ischemia. The patient was discharged on post-operative day 4 following an unremarkable postoperative course. Clinical discussion Acute gastric volvulus is a surgical emergency which can be associated with a high morbidity and mortality, if complications occur. The most important factor in diagnosing acute volvulus of the stomach is a high index of suspicion of the clinical symptoms and should be confirmed by imaging. Contrast enhanced computed tomography (CT) scan is the preferred imaging modality. Urgent surgical intervention is needed to prevent potentially fatal complications. Conclusion Acute Gastric Volvulus is rare and carries the risk of significant morbidity and mortality. Prompt recognition and treatment is required to prevent complications.
Introduction: The onset of the COVID-19 pandemic resulted in governments implementing new regulations to divert healthcare resources, which in return led to the postponement of elective and semi-elective surgical procedures. Henceforth, many surgeons and surgeons in training reported feeling redundant, which ultimately resulted in psychological distress. This study aims to assess the psychological impact resulting from the COVID-19 pandemic and outline the effect it had on surgical training. Methods: The following study is a cross-sectional study conducted in Kuwait. Data was collected by distributing a questionnaire to surgeons and surgeons in training electronically. The survey included questions aimed at assessing both the effect of the pandemic on surgical training and the psychological impact it had on surgeons, assessing the latter using the DASS-21 screening tool. Results: The response rate for the following study was 52%, with the majority being junior male surgeons. The majority of surgeons in training reported postponement of their scheduled academic teaching sessions and pre-assigned surgical rotations, 78.9% and 65.8% respectively. In terms of the psychological impact of the pandemic, the majority of the participants reported an element of depression and stress, 61.2% and 55%, respectively, while approximately half, 48.1%, had symptoms associated with anxiety. Conclusion: The COVID-19 pandemic had a negative effect on the psychological well-being of a significant proportion of surgeons and associated surgical training programs.
Introduction and importance: Carotid body tumors (CBT) are neoplasms that originate from chemoreceptors of the carotid body. They are neuroendocrine tumors that are usually benign but may have malignant potential. Malignancy is diagnosed with evidence of lymph node metastasis, distant metastasis, or disease recurrence. Multiple imaging modalities are used to diagnose CBTs and the treatment of choice is surgical excision. Radiotherapy is used for unresectable tumors. In this case, series we describe two cases of malignant paragangliomas that were diagnosed and operated on at a tertiary hospital in Kuwait, by the vascular team. Malignant CBTs are rare, documentation of the cases encountered and the subsequent management and outcome is important to give us a better understanding of the disease. Case presentation: Case one– A 23-year-old woman presented with a right-sided neck mass. History, physical examination, and appropriate imaging suggested malignant paraganglioma with evidence of lymph node, vertebral, and lung metastases. Surgical excision of the tumor and regional lymph nodes was done. Histopathological assessment of the retrieved specimens confirmed the diagnosis. Case two – A 29-year-old woman presented with a left submandibular swelling. She was appropriately investigated, and the diagnosis of a malignant carotid body tumor was made with evidence of lymph node metastasis. Surgical resection of the tumor with clear margins was done and histopathological analysis of the resected specimen confirmed the diagnosis. Clinical discussion: CBT’s are the most common tumors of the head and neck. Most are nonfunctioning, slow growing, and benign. They typically present in the fifth decade of life but can occur at a younger age in individuals who carry certain genetic mutations. Both cases of malignant CBT’s that we encountered occurred in young women. Furthermore, the 4-year and 7-year history in case number one and two, respectively, supports the fact that CBTs are slow growing tumors. In our case series, the tumors were surgically resected. Both cases were discussed in multidisciplinary meetings and were referred for hereditary testing and radiation oncology for further management. Conclusion: Malignant carotid body tumors are rare. Prompt diagnosis and treatment is important to improve patient outcomes.
Introduction: Single incision extra-corporeal appendectomy (SIEA) has emerged as an alternative to the conventional three port appendectomy (CLA). In this study we aim to demonstrate that single incision extracorporeal appendectomy (SIEA) is noninferior to conventional laparoscopic appendectomy (CLA) and more cost effective. Methods and procedures: The following study is a retrospective case-control study of patients who underwent either SIEA or CLA. Data obtained from both groups was analyzed in terms of demographics, comorbidities, symptoms, laboratory findings, Alvarado score, imaging findings, American society of Anesthesia (ASA) score, operative time, intraoperative findings, case performance by surgeon level, and outcomes as well as cost. Wilcoxon test was used to compare continuous data. Fischer’s exact test compared proportions. Significance was defined as p-value < 0.05. Results A total of 156 patients (27 SIEA vs. 129 CLA) were reviewed. SIEA and CLA were similar in mean age, gender, comorbidities, laboratory investigations, Alvarado score, image positivity, ASA score, and intraoperative findings (p > 0.05 for all). Outcomes were similar between the two groups with regards time to advancement of diet (median time 6 hours vs 6 hours), post-operative complications (wound infection, deep seated infections 3.7% vs 4.7%), and readmission rates (3.7% vs 2.3%) (p > 0.05 for all). Length of stay was slightly shorter in the SIEA than the CLA group, despite approaching statistical significance it was not clinically significant (mean 1.7 days vs 2 days p = 0.05). Operative time in SIEA was shorter than CLA (median time 50 min vs 75 min, (p < 0.001). When considering equipment cost, SIEA had a lower cost compared to CLA (mean cost 236 USD vs 632 USD). Conclusion SIEA is noninferior to CLA in terms of outcomes, however it is associated with at least 63% reduction in cost.
Background We present our experience with the first five thyroidectomies and parathyroidectomy in Kuwait performed via the transoral endoscopic vestibular approach. Methods Retrospective data collection for all trans-oral endoscopic vestibular approach endocrine surgeries performed at a single institution in Kuwait between November 2019 and February 2021. Information on patient demographics, perioperative management and complications were collected and reviewed. Outcomes All 5 cases were completed successfully; the intended specimen was extracted successfully via the trans-oral endoscopic vestibular approach and conversion to traditional trans-cervical approach (TCA) was not required. Operative time for the parathyroidectomy case was 225 min and the average operative time for the remaining 4 cases, thyroidectomies, was 151 min. Blood loss was minimal, and length of hospital stay was between 24 and 48 h. One patient had a transient mental nerve injury, and one patient experienced a postoperative seroma which required aspiration. One case required completion thyroidectomy as histopathology revealed papillary thyroid carcinoma. Conclusion Transoral vestibular approach is a scar free and safe approach to thyroidectomies and parathyroidectomies. Careful patient selection and counselling with regards to risk versus benefit is required. It is an excellent alternative to the traditional transcervical approach and offers great cosmetic results.
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