Najd Saeed Alzahrani

Inguinal hernias are common, with a lifetime risk of 25% in men. Approximately 10% become incarcerated, risking complications like strangulation and bowel obstruction. Herniation of the transverse colon (TC) is rare, especially when causing a closed-loop obstruction. A 67-year-old male with poorly controlled type II diabetes and hypertension presented with a symptomatic right inguinoscrotal hernia, showing nausea, vomiting, and partial bowel obstruction. A computed tomography (CT) scan revealed a herniated TC causing a closed-loop obstruction. Emergency open hernia repair with a modified Shouldice technique and mesh was performed. Viable TC and omentum were reduced. The patient recovered without complications and was discharged on the fourth postoperative day. This case involved a rare TC herniation causing a closed-loop obstruction, confirmed by CT imaging. The open approach was selected due to the risk of ischemia and anticipated adhesions. A modified Shouldice repair with mesh reinforced the inguinal canal, reducing recurrence risk. The patient’s postoperative course was uneventful. This case highlights the rarity of TC herniation causing closed-loop obstruction. CT scans were crucial for diagnosis, enabling prompt surgical intervention, which is key to preventing serious complications.

Background and Objectives: A difficult gallbladder anatomy augments the risk of bile duct injuries (BDIs) and other complications during a laparoscopic cholecystectomy. This study compares the outcomes of a laparoscopic subtotal cholecystectomy (LSTC) and open total cholecystectomy (OTC) for difficult cholecystectomies. Materials and Methods: This retrospective analysis of gallbladder procedures (LSTC or OTC) from 2016 to 2023 examined patient demographics, surgical details, and postoperative results. The primary outcome was the incidence of a BDI. Secondary outcomes included operative duration, blood loss, and postoperative complications. Results: Seventy-one patients were included in the study. Of them, 59.2% (n = 42) underwent an LSTC and 44.6% (n = 29) underwent an OTC. The LSTC cohort was more likely to have a day-surgery case with a same-day discharge (33.3% vs. 0%, p = 0.009), less blood loss (71.4 ± 82.26 vs. 184.8 ± 234.86, p = 0.009), and a shorter operative duration (187.86 ± 68.74 vs. 258.62 ± 134.52 min, p = 0.008). Furthermore, BDI was significantly lower in the LSTC group (2.4% vs. 17.2%, p = 0.045). However, there were no significant differences between the two groups concerning intraoperative drain placement, peri-cholecystic fluid collection, bile leak, and other complications (p > 0.05). Conclusions: LSTC is a safe and effective alternative to OTC for challenging gallbladder cases. Further studies with larger sample sizes and longer follow-up periods as well as different study designs are warranted.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, most healthcare workers (HCWs) were required to wear face masks for long periods of time. Since then, it has been shown that face masks have the potential to cause several physical adverse effects. This study aimed to estimate the prevalence of face mask-related complications among HCWs during the COVID-19 pandemic in Saudi Arabia. Furthermore, we compared the relationship between face mask usage with other variables, including the type of mask used and gender. Methodology: A cross-sectional study was conducted using convenience sampling, with a targeted sample of 517 participants (35% nonresponse). Data was collected via an electronic survey, the link for which was distributed through social media sites, such as WhatsApp and Twitter, to reach HCWs across Saudi Arabia. Data was analyzed using the SPSS software. Results: Overall, 438 HCWs who wore N95 or surgical masks for 4 hours or more per day on average were recruited. Skin-related complications in the nasal area had the highest prevalence (342, 78.1%), followed by behind the ear area (333, 76.0%), cheeks (307, 70.1%), and chin (248, 56.6%). Other complications included headaches (226, 51.6%), and eye-related complications (211, 48.2%). All face mask-related complications, except for behind the ear skin complications, were more associated with female gender. Conclusions: Mask usage was significantly associated with the development of headaches, and eye, and skin-related complications. Female HCWs were more predisposed to these complications. Preventative measures and awareness activities should be considered to help reduce mask use related complications.