Colorectal cancer (CRC) is considered one of the most common tumors worldwide (Ferlay et al., 2010). At a global level, CRC is regarded as the third most common cancer in males representing 10% of all cancers and second in females (9.2%) (Ferlay et al., 2010). In Saudi Arabia, overall, CRC is the second most common reported malignancy. (Mosli and Al-Ahwal, 2012; Zubaidi et al., 2015) It comes first in rank in males and second in females after breast cancer (Saudi Cancer Registry, 2016). The estimated incidence of CRC cases in the East Mediterranean region (EMRO) is 246,000 with estimated 112,000 deaths per year. (World health orgnisation, 2012) Furthermore, the 5-year prevalence during 2012 was 705,000. (World health orgnisation, 2012) Regarding the Age-standardized death rates in the EMRO region,

Introduction: Pneumothorax is a potentially dangerous condition that, if not properly recognized and treated, can have fatal consequences. Chest discomfort or difficulty breathing is common presenting symptoms. We present an atypical presentation for pneumothorax. Case Report: A 26-year-old male patient presented to the emergency department (ED) with complaints of pain in the right iliac fossa with localized rebound tenderness. The treating physician ordered a computed tomography (CT) abdomen to assess for acute appendicitis. From the abdominal CT scan, the radiologist reported a significant right-sided pneumothorax. The patient was treated with a chest thoracostomy and had an unremarkable recovery. Conclusion: All alternative diagnoses are considered in light of the patient’s complaint and clinical presentation. This case reminds physicians of possible atypical clinical presentations of common and serious diseases.

Background: Venipuncture is a common procedure in the emergency department, and in some patients the procedure may cause pain, anxiety, and fear. There are different studies in the literature looking for ways to reduce the pain, either pharmacologically or non-pharmacologically. Most of the studies were done in pediatrics but a few were in adult patients. We conducted this study to determine whether an ice pack application reduces venipuncture pain among emergency department adult patients compared to the conventional way. Methods: We conducted this randomized controlled clinical trial on adult patients in the Security Forces Hospital, Riyadh, Saudi Arabia, from 1 March 2021 to 30 June 2021. Computer randomization was done to randomize subjects to either control or intervention. The 22-gauge needle catheter was inserted in the antecubital fossa in all participants. Results: We included 281 patients aged 18 to 60 years, who were randomized to the control or intervention group. There were 140 patients in the control group and 141 in the intervention group. The mean average pain score in the control group was 2.19 and 1.66 in the intervention group, with a statistically significant difference (p-value: 0.016). Conclusion: The ice pack application reduces venipuncture pain in adult emergency department patients and was associated with a better first attempt success rate.

Introduction: Rhabdomyolysis is a muscle breakdown caused by a variety of factors. Based on a review of the literature, we are unaware of any case reports that discuss these complications of rhabdomyolysis with acalculous cholecystitis and ascites. Case Report: This patient is a 24-year-old man who had never had a chronic illness before. He was a nonsmoker and did not consume alcoholic beverages. He went to the emergency room (ER) because he was having upper abdominal pain and aches throughout his body. He was just started a rigorous physical activity-based training regimen. A total creatine kinase (CK) level more than 5 times higher than the upper normal value confirmed the diagnosis. For the upper abdominal pain, an ultrasound was performed. It reveals ascites and a thick-walled gallbladder. With a decrease in repeated total CK and clinical improvements, the patient was discharged home after aggressive hydration. The patient was asymptomatic at the follow-up appointment, and the ultrasound showed no ascites or gallbladder wall thickness. Conclusion: These are a rare complication of rhabdomyolysis. It implies that acalculous cholecystitis and ascites should be interpreted in light of the clinical scenario and presentation. The workup for ascites and acalculous differential diagnosis was uneventful. In a young patient with rhabdomyolysis, acalculous cholecystitis and ascites is an unusual occurrence.