BackgroundBlunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare.Case PresentationWe present a case of a young male who sustained a blunt thoracic trauma in a motor vehicle collision, that resulted in rupture of the left anterior descending (LAD) coronary artery and subsequent cardiac tamponade. Prompt surgical intervention with pericardiotomy and ligation of the artery has resulted in survival of the patient.ConclusionsIn cases of traumatic coronary artery rupture, early surgical intervention is crucial to avoid mortality. Ligation of the injured coronary is a viable option in selected cases, and can be the most expeditious option in patients in extremis.

Small bowel feces sign (SBFS) is a computed tomography (CT) finding that appears as fecal like material in dilated small bowel loops. This sign is usually seen in association with gradually progressive small bowel obstruction. We present a case of occlusive mesenteric ischemia in which the SBFS appeared on CT scan early on in the course of the disease. We put forward a suggested alternative mechanism to the appearance of this sign in association with mesenteric ischemia. The SBFS might have the potential to serve as an early sign of mesenteric ischemia on CT scan.

Objective We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers. Background The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12–14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines. Methods A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8–10 mmHg) vs. standard-pressure (12–14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022). Results one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons. Conclusion low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care.

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Introduction Obesity is a major cause of metabolic and health disorders like diabetes mellitus (DM) and gastro esophageal reflux disease (GERD). Patients usually offered a professional preoperative consultation and objective information regarding the bariatric surgery type and the advantages and disadvantages of each type for best outcome and satisfaction. Purpose To study the patient response to preoperative advice and recommendation and the patient's decision to undergo the recommended bariatric surgery. Objective To determine the statistical significance of preoperative recommendation and the patient personal choice of the type of bariatric surgery. Materials and methods This original article is a cross-sectional survey of 188 patients underwent bariatric surgery between February 2015 and December 2018 in the General Surgery Departments – Bariatric Surgery Clinics in Jordan University Hospital affiliated to the College of Medicine in the University of Jordan and Al Karak Governmental Hospital affiliated to the College of Medicine in Mutah University. 144 patients underwent longitudinal sleeve gastrectomy (LSG) and 44 patients underwent Roux en-Y gastric bypass (RYGB) as the recommended type of surgery for the selected comorbidities diabetes, gastroesophageal reflux disease, or both. Results Of 188 patients data collected, 54 patients who should had undergone RYGB as the recommended type of surgery, preoperative counseling did not have a significant effect on their decision to undergo the appropriate type of bariatric surgery. The number of patients who had pre-operative recommendation = 37 (68.5%). Out of these, only 15 patients choose the surgical team recommended surgery; p -value 0.183, odds ratio 2.22, (95% confidence interval (CI) = 0.6–8.12). Conclusion Preoperative surgical procedure type advice did not have a significant effect on patients’ choice of the recommended bariatric procedure.