Background: Pharyngoesophageal stricture with laryngeal involvement due to corrosive ingestion is rare, and limited literature is available regarding management. Outcome is unpredictable due to progressive scaring of anastomosis and associated respiratory complications. Here, we share our experience of managing this challenging entity. Materials and Methods: Of 57 corrosive ingestion patients, we reviewed 15 patients of isolated pharyngoesophageal stricture managed in our unit of a tertiary care center between 2008 and 2016. The medical records, initial management, operative data, postoperative course, and follow-up data of these 15 patients were reviewed. These 15 patients divided into Group A of endless string insertion and dilatation and Group B of five patients who underwent additional colonic interposition. Results: Of 15 patients, 10 patients belonged to Group A of endless string insertion and dilatation and five patients belonged to Group B with additional coloplasty. All the 10 patients were successfully dilated with endless string insertion, whereas in coloplasty group, four patients out of five are taking normal diet, and one patient succumbed due to nonoperative cause. All 15 patients had no respiratory complication postoperatively, and five patients who were on tracheostomy before surgery are weaned off completely. All 14 patients have no dysphagia, have no respiratory complications, and have gained weight. Conclusion: Severe upper aerodigestive injury is rare and its management is herculean task, but satisfactory functional reconstruction can be achieved in the majority of patients without the need for permanent tracheostomy or feeding jejunostomy by our technique giving good quality of life.

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Introduction: The use of electrocautery in incising the skin was hypothesized to be questionable. It is believed to cause deep burns, excessive scarring and poor wound healing. However, many of the recent studies show that the electrosurgery has advantages of faster dissection, quicker hemostasis, reduced blood loss, and reduced operative time. Most of these studies included a homogeneous group of surgeries. Hence, a study was conducted to assess whether the electrosurgery can be used to incise skin. Materials and Methods: A prospective nonrandomized study was conducted in a tertiary center from December 2009 to May 2011. Patients were divided into electrosurgery and skin scalpel groups. Moreover, these were compared regard to duration of the incision, blood loss, operative and postoperative complications, and postoperative pain using visual analog scale. Results: A total of 60 patients were studied. Electrosurgery group and steel scalpel group both had 30 patients (50%) each in their group. The electrosurgery group had a significantly low blood loss (18.1 g ± 16.1 g vs. 35.8 g ± 16.9 g; t = 4.1; P = 0.0001) and lesser incision time (4.7 min ± 1.9 min vs. 6.6 min ± 3.1 min; t = 2.8; P = 0.006; Student's t-test) compared to steel scalpel group. Electrosurgery group also had a significantly lesser postoperative pain score at 6 h, 12 h, and 24 h. There was no statistical significance found between the groups regard to wound infection (P = 1; Fischer's exact test). Conclusion: Electrosurgery was superior to steel scalpel for incising skin, hence, can be used a primary choice to incise the skin.

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Aim: The aim of this study is to demonstrate the relation between tonsillectomy and weight gain in children, we hypothesize tonsillectomy may cause increase body weight in children. Methods and Materials: It is a comparative prospective study conducted in King Abdul Aziz Specialist Hospital, Taif, Saudia Arabia, between January 2013 and December 2015 between study group (tonsillectomy with or without adenoidectomy) and control (grommets insertion, adenoidectomy, turbinate reduction, evaluation under anesthesia nasal cavity). Patients were randomly selected, weight before and after the procedure, and reviewed 6-week postoperatively. Incomplete data, failure to follow up, and more than 60-days follow-up were excluded from the study. Results: A total of 96 patients were involved in the study, of whom 14 not fulfilling the criteria, were excluded. test group were 54 (65.8%) (male 44 [81.5%] and 18 females [22.7%]) and control group 28 (34.15%). Minimal and maximum ages were 1.11 and 12.4 years, respectively. The minimum and maximum follow-ups were 16 and 58 days, respectively, an average of 43.8 days. Weight gain calculated (< 0.5 kg, 0.5 – 1 kg, >1 kg) in study group was 14,4%, 24.3%, and 24.3% while the control group 7.6%, 12.7%, and 12.7%, respectively. The total accumulated Weight gain in the test group was 49.6 kg, Whereas in control group 33.4 kg. There was no difference noted between the two, however, both gained weight above the norm. Conclusion: Weight gain post tonsillectomy cannot be proven to be a sequence in children; however, both groups gained weight above the normal, further studies are require to exclude other factors.

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Perthe's syndrome (traumatic asphyxia) is rare, which is caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face and should always be kept in mind as a possible complication of injuries of the chest and abdomen. Crush asphyxia is different from positional asphyxia, as respiratory compromise in the latter is caused by splinting of the chest and/or diaphragm, thus preventing normal chest expansion. There are only a few cases or small case series of crush asphyxia in literature, reporting usually poor outcomes. We reported a case of a 29-year-old male who sustained a severe crush injury to the chest due to fall of a heavy object.

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Aim: Gastrointestinal (GI) perforation repair is a commonly performed surgery worldwide. Postoperative septic conditions are frequently accompanied by cholestasis and postoperative jaundice. Our study was conducted to evaluate the risk factors and outcome of postoperative hyperbilirubinemia in patients with perforation peritonitis. Materials and Methods: A prospective observational study of 100 patients was conducted between January 2013 and December 2014; they underwent surgery for generalized peritonitis caused by GI perforations in the Department of Surgery of JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India. Postoperative hyperbilirubinemia is defined as serum total bilirubin level of ≥5 mg/dl within 1 month after surgery. In all the patients with postoperative hyperbilirubinemia, risk factors and outcome were assessed. Data analyses done with Fisher's exact test, Mann–Whitney test, Chi-square test, Student's t test, and repeated-measures analysis of variance were used for statistical comparisons. Results: In our study of 100 patients, M:F ratio was 2.12. Sixteen percent of the total patients belonged to hyperbilirubinemia group and 84% belonged to no hyperbilirubinemia group. In the hyperbilirubinemia group, anemia was seen in 37.5%, poor nutrition in 44%, and shock in 62.5%, and these patients also had increased total leukocyte count counts, bilirubin level, aspartate aminotransferase level, and decreased platelet count, whereas in the no hyperbilirubinemia patients anemia was seen in 11%, poor nutrition in 15%, and shock in 15% cases and all of them had normal blood investigations. Postoperatively, in the hyperbilirubinemia group, cardiac and respiratory support was needed in 62% and 72% cases, respectively, renal insufficiency in 56% cases, prolonged paralytic ileus in 72%, and mortality in 62% cases. Infection-related complications developed in 20 patients (12 patients of hyperbilirubinemia group and 8 patients of no hyperbilirubinemia group). Conclusion: In our study, we concluded that in cases of perforation peritonitis, hyperbilirubinemia was associated with advanced age, poor nutritional status, and prolonged time until surgical intervention, and these patients with postoperative hyperbilirubinemia showed higher morbidity and mortality after surgery.

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Breast cancer has the greatest prevalence among females worldwide and most common leading cause for mortality overall. It usually metastasizes to lung, liver, lymph nodes, bones, and skin but rarely spread to other sites, such as urinary bladder and retroperitoneum. Survival of metastatic breast carcinoma to the bladder is poor as compared with metastasis to other organs (liver, lung, and lymph nodes). We present here what we believe is the first rare case in Saudi Arabia of breast carcinoma metastasis to the urinary bladder in a 58-year-old female.

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Leiomyosarcoma (LMS) overall comprises 5%–10% of all soft-tissue sarcoma. Subcutaneous LMS accounts only for 1%–2% of all superficial soft-tissue sarcoma. Usually, subcutaneous LMS occur in lower extremity; however, it may occur anywhere in the body. Its occurrence in the abdominal wall is extremely rare. Here, we report a case of recurrent LMS of anterior abdominal wall in a 25-year-old female.

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Introduction: Nontraumatic perforation peritonitis is the most common emergency in Saudi Arabia. The spectrum of etiology of perforation in Saudi Arabia continues to be different from the western countries. The objective of this study is to highlight the spectrum of etiology of nontraumatic perforation peritonitis and the predictor factors for increasing mortality in those patients. Patients and Methods: This is a prospective study (case series); all patients admitted with nontraumatic perforation peritonitis were included in the study from January 2005 to December 2010 and followed up in the outpatient department for 6 months up to 2 years. One hundred and thirty patients of nontraumatic perforation peritonitis were included in the study and their clinical presentation, operative findings, and postoperative course were recorded in Al Noor Specialist Hospital in Makkah (Holy city), Saudi Arabia. Results: The most common cause of perforation in our series was perforated duodenal ulcer (56 cases), followed by appendicitis (44 cases), perforated gastric ulcer (11 cases), typhoid fever (8 cases), and perforated gastrointestinal cancers (8 cases). Twenty-eight cases (22%) developed complication and three patients died (2.3%). Conclusion: This study shows that the upper gastrointestinal tract perforation due to nontrauma causes constitutes the majority of cases in Holy city, Makkah, in contrast to the western countries where lower gastrointestinal tract perforation is more common. Our study also highlights the outcome of nontraumatic perforation peritonitis.

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