Browsing by Author "Dhuha Nahar Naser Boumarah"

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COVID-19 and Malignancy: What is the Association? A Case Report and Review of the Literature
(2023) Dhuha Nahar Naser Boumarah; Alkhafaji, D. M.; AlShammari, L. T.; AlArgan, R.; Alwaheed, A.; Boumarah, D. N.
BACKGROUND: After more than two years since Coronavirus disease 2019 (COVID-19) was first identified as a global pandemic, we still observe a variety of clinical presentations. From asymptomatic carriers to severely ill patients. Most patients infected with COVID-19 present with respiratory symptoms. OBJECTIVE: However, case reports of different presentations were published, none of them highlighted the potential of COVID-19 to facilitate the manifestation of hidden malignancy, particularly, gallbladder carcinoma. CASE PRESENTATION: In this report, we present a case of a 77-year-old Saudi lady with multiple comorbidities, presented with an acute confusional state after one month of having asymptomatic COVID-19 infection. Significantly, she was completely functional prior to her presentation and did not manifest any symptoms such as weight loss or fever. Her clinical assessment demonstrated severe abdominal tenderness and guarding on palpation. Computed tomography scans of the abdomen showed perforated gallbladder cancer. CONCLUSION: Among multiple clinical presentations related to COVID-19 infection, gastrointestinal manifestations are the most common extrapulmonary symptoms, ranging from mild to more severe symptoms. Acute abdomen with perforated viscus should be kept in mind as a differential diagnosis when dealing with COVID-19 infected patients who present with severe abdominal pain. The current case report highlights one of unusual presentations of COVID-19 infection.
Dilemma of Blunt Abdominal Trauma in Patients with Crohn's Disease, Can Intestinal Perforation be Missed?
(2023) Dhuha Nahar Naser Boumarah; Ali Hasan Ali Al Saffar; Mohammed Said Ahmed Mohammed Foula; AlQahtani, M.; Alsaffar, A. H.; Nabri, M.; Alshomimi, S.
BACKGROUND: Isolated intestinal injury after blunt abdominal trauma is a rare challenging clinical entity. Patients with Crohn's disease (CD) are considered more prone to spontaneous intestinal perforation rather than normal population However, spontaneous intestinal perforation remains rare. In the literature, there are few cases reports discussing intestinal perforation after blunt abdominal trauma in CD patients. OBJECTIVE: Herein, we report a young male patient with CD who had missed traumatic intestinal perforation along with literature review of similar cases. CASE PRESENTATION: A young male patient, known to have CD, was brought to the emergency department after a road traffic accident. He had mild tenderness over his right iliac fossa with no signs of peritonitis. His chest X-rays revealed right-sided pneumothorax. His pan-computed tomography revealed thickened terminal ileum and minimal collection between the intestinal loops that were interpreted as interval regression of his Crohn's disease. On the second day, he remained hemodynamically-stable with no signs of peritonitis but his chest X-rays showed air under diaphragm. A repeated CT showed pneumoperitoneum, air foci around the terminal ileum and mild free fluid. An ileal perforation was found around 25 cm from the ileo-cecal valve. The involved ileal segment was completely resected with double-barrel ileostomy. CONCLUSION: Traumatic intestinal injury in patients with Crohn's disease represent both diagnostic and management dilemma. Inaccurate interpretation of radiological signs may lead to a delayed or missed diagnosis and surgical intervention. Abdominal CT scan should be routinely repeated, within 24 hours, for such patients, regardless absence of symptoms or signs suggestive of intestinal perforation.
Reconstruction of Infected Mediastinal Wound with an Omental Flap Harvested Laparoscopically After Cardiac Surgery: Report of Two Cases and Literature Review
(2023) Alshammasi, Z. H.; Saeed Jaafar AlShomimi; AlAbbad, A.; Alkhalifa, A. A.; Sahwan, A.; Alshomimi, S.
BACKGROUND: Deep sternal wound infection and dehiscence are two serious complications after open cardiac surgery. Omental flap harvesting is recognized as one of the management options, with traditionally non-favorable outcomes due to laparotomy stress on patients. OBJECTIVE: Herein, however, we report our experience with two patients who have developed a mediastinal wound infection following coronary artery bypass grafting and were reconstructed with omental flaps harvested laparoscopically. CASE PRESENTATION: Two 74-year-old females, who were known to have multiple comorbidities, developed a sternal wound infection after coronary artery bypass graft. Several operative trials and non-operative measures have been attempted to manage the infections and/or reconstruct the wound but failed. Both patients then underwent laparoscopic omental flap harvesting for reconstruction and exhibited significant clinical improvement postoperatively. DISCUSSION: Omental flap is considered a feasible option for reconstruction of sternal wound dehiscence developing after open cardiac surgery because it is usually well-vascularized, contains a large number of immunologically active cells and has the ability to absorb wound secretions. The traditional method of harvesting is conventional laparotomy, but it carries high rates of morbidity. Therefore, laparoscopic harvesting can be utilized as an alternative with better outcomes. CONCLUSION: Laparoscopic omental flap harvesting is considered a feasible and safe procedure to manage sternal wound dehiscence after open cardiac surgery, with satisfactory surgical outcomes.