Biomedical subjects

Abdulrahman A Al-Bassam

Publications and source records attributed to Abdulrahman A Al-Bassam.

3 recordsLinked to original sources

PubMed2006

Primary omental torsion in children. The pre-disposing factors and role of laparoscopy in diagnosis and treatment.

OBJECTIVE: To determine the predisposing factors and to evaluate the role of laparoscopy in the diagnosis and management of primary omental torsion in children. METHODS: We retrospectively reviewed the clinical records of all children treated for primary omental torsion from August 1999 to December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. Demographic data, clinical presentation, diagnostic and therapeutic modalities were evaluated. Follow-up was also obtained. RESULTS: Six children were included in the study. Their age ranging between 9-12 years (average 10.4 years). All of them presented with right lower quadrant (RLQ) pain mimicking appendicitis. The duration of symptoms varied from 3-5 days prior to presentation. Localized RLQ tenderness with guarding was demonstrated in all patients. All children were noted to be obese. Only one patient had low grade fever and nausea. None of the patients had an elevated white blood cell count. Laparoscopic exploration was carried out in all cases for possible appendicitis. Appendix was found to be normal and torted omentum was clearly seen in all cases. The infarcted omentum was removed laparoscopically; all patients had uneventful recovery and were discharged on second postoperative day. Pathological examination showed necrotic infarcted omentum with no other abnormalities. Follow-up documented complete resolution of the patient's symptoms. CONCLUSION: Clinical presentation of primary omental torsion mimics that of acute appendicitis. Its diagnosis is usually difficult and almost impossible pre-operatively. Obesity, paucity of gastrointestinal symptoms and relatively long duration of symptoms should increase the index of suspicion. We believe that the laparoscopic approach is an excellent tool for the diagnosis and treatment for the primary omental torsion.

Appendicitis↗

PubMed2005

Laparoscopic appendectomy in children.

OBJECTIVES: Laparoscopic appendectomy (LA) is rapidly becoming an alternative to open appendectomy for the treatment of appendicitis in children. We examined the efficacy, safety and complications of performing LA in children. METHODS: This is a critical review of the children who underwent LA between January 1999 and May 2003 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Demographic data, operative procedures, severity of appendicitis, histopathology, operative time, hospital stay, analgesia and complications were carefully analyzed. RESULTS: Laparoscopic appendectomy was attempted in 113 children. It was successfully completed in only 100 patients, 85 had uncomplicated appendicitis and 15 had complicated appendicitis. In 13 (11.5%) conversion to open appendectomy had to be carried out for complicated appendicitis. Their ages ranged between 2-12 years (average 8 years); 52 were males and 48 were females. Symptom duration average was 30 hours in uncomplicated appendicitis and 56 hours in complicated appendicitis. Operative time ranged between 35-80 minutes (average 53 minutes). Four patients with complicated appendicitis developed postoperative complications, 2 had wound infections and the other 2 had intra-abdominal collections. No intra-operative complications were encountered. The average hospital stay was 2 days for uncomplicated appendicitis and 6 days for complicated ones. Histopathological examination revealed 75 acutely inflamed appendices, 15 were perforated appendicitis with or without mass formation and 10 appendices reported to be normal. All patients were followed up for 6-12 months. CONCLUSION: Laparoscopic appendectomy is both a safe and effective method in managing children with acute uncomplicated appendicitis. In children with complicated appendicitis, LA should be carried out with caution and only by an experienced surgeon, as it is associated with a higher rate of conversion to open technique and more postoperative infectious complications.

Appendectomy↗

PubMed2002

Non operative management of blunt bile duct injuries in children.

Bile duct injuries after blunt abdominal trauma are rare in children. This report describes 2 cases of blunt bile duct injuries in children, which were managed non-operatively. One patient sustained partial tear in the right hepatic duct, which was managed successfully by passing a stent into the injured duct during endoscopic retrograde cholangio pancreatography. The 2nd patient had intrahepatic bile duct injury associated with liver trauma and was managed with a drain placed in the sub-hepatic area percutaneously. This non-operative management in our patients allowed healing of bile duct injuries without any stricture, at 2 years follow-up. Both children are symptom free with normal liver function tests and normal liver ultrasound. With the advancement in radiological and endoscopic techniques, some of the bile duct injuries can be managed conservatively. Conservative treatment must be individualized according to the site and extent of injury.

Bile Ducts, Intrahepatic↗