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Obesity is an important public health concern worldwide. In Saudi Arabia, the overall prevalence of obesity has increased in both men and women in recent decades. The laparoscopic approach to bariatric surgery was first reported in the 1990s, with laparoscopic adjustable gastric banding (LAGB) developed soon after. The performance of bariatric procedures has increased rapidly in recent years, with safety and efficacy data available for the surgical treatment of obesity and related metabolic disorders. Herein, we report a challenging condition of a female patient who underwent LAGB insertion in 2013. The patient presented with a complaint of a foreign body passing through her rectum during defecation that was manually pushed back by the patient. Radiological imaging and upper/lower endoscopy confirmed the diagnosis of complete gastric band erosion into the stomach, and the reservoir with the remaining tube was observed inside the colon near the splenic flexure. This case was complicated by complete band erosion and gastrointestinal (GI) fistula formation following the delivery of her second child in January 2022. Colonic band erosion is a rare complication of LAGB. Most patients with gastric band erosion are asymptomatic or exhibit nonspecific symptoms. The definitive management of gastric band erosion involves band removal. Several approaches are commonly used in clinical practice. In our case, the band was removed using a combined laparoscopic and endoscopic retrieval approach, which is the first such report in the literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Binjaloud et al.)

Background Appendicitis is a common reason for hospitalization. Rarely do people with acute appendicitis have an appendiceal mass called an abscesses or inflamed phlegmon. The goal of this study was to determine the prevalence of different appendiceal tumors including neuroendocrine tumors, adenocarcinoma, carcinoid, and mucinous and evaluate patient demographic data (e.g., age and gender) at a major tertiary care center in Riyadh, Saudi Arabia. Materials and methods We conducted a cross-sectional analytical review of patient records of 1513 patients who received an appendectomy and were diagnosed with acute appendicitis from 2015 to 2020 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. We used nonprobability sampling to collect the sample. The study included patients older than 14 years. We also recorded patient demographic information, including age, gender, history, and final pathology. Results The mean age of our study population was 27.9 years (standard deviation [SD], 12.3 years). Our study had 958 male patients and 555 female patients. One thousand four hundred fifty-eight patients (96.3%) had right lower quadrant (RLQ) tenderness, and 228 patients had fever (15.0%). One thousand one hundred thirteen patients (73.5%) had rebound tenderness, 1,178 had nausea (77.8%), and 1,100 had high white blood cell (WBC) counts (72.7%). One thousand four hundred eighty-six patients received laparoscopic surgery (98.2%). Most patients (95.3%; n=1,443) had no postoperative complications. Appendicitis pathology was present in 1,381 patients (91.3%). Only 15 patients (1%) had tumor-related pathology, and these patients were significantly older than patients with nontumor-related pathology (p<.001) and had less RLQ pain, rebound tenderness, and pain migration but higher WBC counts. Pain migration was significantly inversely correlated with age: as age increased, pain migration was reported less often (odds ratio, 0.99, 95% confidence interval, 0.98 to 0.99; p=0.001). Conclusion This study aimed to determine the prevalence and types of appendiceal tumors in cases of acute appendicitis and the corresponding patient demographic data at a major tertiary care center in Riyadh, Saudi Arabia. According to our results, patients with appendicitis present with fever, rebound tenderness, nausea, and high WBC count. Appendiceal masses mainly occur in a later age group with less migration of pain and high WBC count. However, migration of pain is inversely related to age. Physicians treating patients with acute appendicitis should bear these data in mind and consider the presence of appendiceal tumors in appropriate patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alamoudi et al.)

Rheumatoid arthritis is a relatively common chronic inflammatory disorder affecting the synovial joints. Extra-articular manifestations of rheumatoid arthritis are not uncommon and include a wide range of cardiovascular, pulmonary, and neurological complications. Gastrointestinal involvement in rheumatoid arthritis is rare, but it can be impactful on the quality of life of patients. We present the case of a 45-year-old woman, with rheumatoid arthritis on methotrexate, who presented with a one-week history of abdominal pain. The patient visited the outpatient clinic earlier and was diagnosed with indigestion and was offered symptomatic treatment which failed to provide any improvement. Abdominal examination revealed a distended abdomen with generalized tenderness and rebound. However, the abdomen was soft with no palpable masses. Initial laboratory examination, including inflammatory parameters, was normal. The patient underwent a computed tomography scan of the abdomen with intravenous contrast which demonstrated inhomogeneous hyperdense mesenteric fat giving a mass-like lesion with a displacement of adjacent bowel loops. Such findings conferred the diagnosis of mesenteric panniculitis. The patient was started on corticosteroid therapy with oral prednisolone 40 mg daily with close follow-up. She developed gradual improvement in her condition and the pain resolved completely after six days. The patient was re-evaluated after six months from discharge and she had no recurrence. The case highlighted a rare association of mesenteric panniculitis and rheumatoid arthritis. Physicians should keep this mesenteric panniculitis in mind when they encounter patients with the autoimmune disorders who presented with abdominal symptoms., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Alzahrani et al.)

Background: Surgeons are at high risk of contracting infectious viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through exposure to patients' blood. The purpose of this study was to assess the surgeons' awareness of contracting bloodborne viruses.  Methods: A cross-sectional study with a questionnaire distributed to 241 surgeons at King Abdulaziz Medical City - Riyadh (KAMC-R) during the period June 2017 through January 2018. Descriptive statistics were used to analyze data collected using Stata®, v14 (StataCorp LLC, College Station, Texas, USA). Categorical variables were analyzed using Pearson chi-square test. P-value of < 0.05 was considered significant., Results: A total of 241 surgeons answered the questionnaire, 179 (74.3%) surgeons were male and 62 (25.7%) were female. The mean age ± standard deviation (SD) of male surgeons was 35.8 ± 11.0 years while for females was 33.3 ± 9.1 years. The majority of our cohort were vaccinated for HBV (96% in males and 97% in females). Two-thirds of the study cohort did not know the conversion rate post-needlestick injury by HIV, HBV, and HCV. Two-thirds of the study cohort think there is a need for HIV screening before surgery. Mixed answers were received from the cohort when asked about their concern regarding contracting HIV infection from their patients; only one-third of the surgeons were extremely concerned. When asked about the risk of needlestick injury during treating patients positive for HBV, the majority of the surgeons said no. However, a significant difference between the female and male surgeons was found in which 12 of the 62 female surgeons answered yes (19.4%) compared to 11 of the 179 male surgeons (6.1%) (p = 0.002)., Conclusion: The majority of our surgeons are vaccinated for HBV. However, female surgeons appear to be at higher risk of needlestick injury from HBV patients. This requires further investigation into the reasons for such high incidents. More education is needed about bloodborne viruses., Competing Interests: The authors have declared that no competing interests exist.