Abdul-Wahed Meshikhes | Jayesh - Academia.edu (original) (raw)

Papers by Abdul-Wahed Meshikhes

PubMed, Dec 1, 2000

Objectives: To establish awareness and attitude of patients attending the general surgical clinic... more Objectives: To establish awareness and attitude of patients attending the general surgical clinic in Dammam Central Hospital, Dammam, Eastern Province towards a day surgery unit. Also, to establish the reasons for their preference to have surgery performed as inpatients or in the day surgery unit. Methods: Some 100 consecutive patients attending the surgical clinic of a single consultant surgeon at Dammam Central Hospital were surveyed. Patients who can neither read nor write were excluded. They were asked to answer a simple questionnaire on day surgery and their preference to have their minor operations under general anesthesia performed as a day surgery procedure or as an inpatient. Results: There were 64 males and 36 females of various professions. Ninety-four patients aged 15-45 years. Thirty-two patients gave the correct definition of day surgery while 38 patients did not know, and had never heard of the term and 30 patients gave wrong definitions. Only 30 patients preferred their surgery to be conducted as day surgery. Forty-five of 70 patients (64%) who preferred inpatient care felt they would be receiving better care in hospital and 16 (23%) felt happier to be looked after by their surgeon in the first few postoperative days to avoid complications. Nine females of the 70 patients who preferred inpatient surgery (13%) felt that hospital is a better place for rest after surgery and to get a way from husband, children and housework. Conclusion: The majority of our patients are unaware of the safety and services provided by a day surgical unit. Major work is needed to educate patients attending our clinics about the advantages of day surgery with the aim of improving their attitude towards it.

PubMed, Nov 1, 2004

astric leiomyoma is the most common benign smooth muscle tumor affecting the stomach. It is well-... more astric leiomyoma is the most common benign smooth muscle tumor affecting the stomach. It is well-circumscribed but nonencapsulated connective tissue lesion that may arise from any smooth muscle component of the muscular layer of the stomach wall and projects into the lumen.1 It may erode the covering mucosa producing a punched-out ulcer that may produce very brisk bleeding. Leiomyoma can also cause symptoms by obstruction, ulceration, and chronic blood loss or by compressing adjacent organs.1 Endoscopically, it appears as a large submucosal lesion, and invariably endoscopic biopsies are not deep enough to be of any diagnostic value. As leiomyoma lacks a capsule, enucleation is seldom adequate and often leaves tumor cells behind, which may lead to future recurrence. Hence, the recommended treatment is wide local excision of the surrounding stomach wall. We report 3 cases of gastric leiomyomas that were encountered and treated over 5 years of surgical practice from 1993 to 1997 at Dammam Central Hospital, Dammam, Kingdom of Saudi Arabia and raised the question of a possible association with Helicobacter pylori (H. pylori). Summary of the 3 cases is listed in Table 1. The first case was that of a 25-year-old Saudi male who presented to another hospital with 5-month history of dizziness, fatigue, palpitation and melena. There was no history of epigastric pain or weight loss. He denied any history of smoking, alcohol consumption or ingestion of any non-steroidal anti inflammatory drugs. On examination, he looked pale, well nourished, not jaundiced with normal vital signs and unremarkable abdominal examination. Blood investigations revealed iron-deficiency anemia with hemoglobin of 6g/dl. Gastroscopy revealed 2x3cm smooth-surfaced circular mass at the junction of the body and antrum. Biopsy showed mild gastritis of H. pylori. Ultrasonography showed a 3cm round solid mass to the left of the epigastric area. Diagnosis of gastric leiomyoma was suspected and hence a limited resection of the mass was performed. Histopathology confirmed presence of a gastric leiomyoma with ulceration and inflammation of covering epithelium. He was discharged 6 days later and remained well with no recurrence at 4-year follow-up. The second was a 50-year-old Saudi male presented with a history of 2 episodes of hematemesis that was associated with dizziness, palpitation and melena but no history of epigastric pain, anorexia or weight loss. He was known to have insulin-dependent diabetes and ischemic heart disease and was waiting to undergo cardiac catheterization and balloon-dilatation for a single M male, F female, H. pylori Helicobacter pylori, FU follow-up Table 1 Summary of the 3 gastric leiomyoma cases.

PubMed, Feb 1, 2008

We report a case of a 35-year-old lady who presented in the third trimester of her pregnancy with... more We report a case of a 35-year-old lady who presented in the third trimester of her pregnancy with signs, symptoms, and radiological features of acute cholecystitis. She was initially treated conservatively, but failed to respond well. Hence, laparoscopic cholecystectomy LC was performed successfully with good materno-fetal outcome. This article discusses the feasibility and safety of LC in the third trimester of pregnancy and the special precautions that are needed to guarantee the safety of materno-fetal well-being.

World Journal of Gastroenterology, 2011

The need for interval appendicectomy (I.A) after successful conservative management of appendicea... more The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned. Furthermore, emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis. There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted, there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms. On the other hand, the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate. It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology. Moreover, it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration. If emergency LA is to become the standard of care for appendiceal mass, I.A will certainly become 'something' of the past.

Saudi Medical Journal, 2007

Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mo... more Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mortality. In recent years, a marked improvement in the safety of surgery and anesthesia in this high-risk group of patients has been witnessed; owing to the improvements in surgical and anesthetic care, greater awareness of pathophysiology of the disease, proper perioperative preparation, and attention to factors predisposing to vasoocclusive crises. However, this is not paralleled by similar improvement in countries where the disease is not prevalent. Greater population mobility in recent years makes recognition of surgical manifestations of the disease, and awareness of perioperative management of sickle cell patients undergoing surgical interventions of paramount importance. This article aims to summarize steps towards safer surgery in patients with SCD.

Saudi Medical Journal, Dec 1, 2004

Saudi Medical Journal, Feb 1, 2008

BMJ case reports, 2013

Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic... more Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic procedures. Some concerns are raised regarding its long-term complications such as incisional hernia and adhesive small bowel obstruction. A woman was admitted with colicky central abdominal pain, distension and vomiting. She had a hand-assisted laparoscopic sigmoid colectomy for cancer 6 years earlier. Clinical examination revealed a well-healed periumbilical scar with no evidence of incisional hernia. The abdomen was distended with exaggerated bowel sounds. A CT scan showed dilated loops of small bowel with a transitional zone and distally collapsed bowel. A diagnostic laparoscopy revealed a twisted segment of small bowel that was adherent to the anterior abdominal wall at the hand-port closure site. This segment was released laparoscopically without the need for a resection. Adhesive small bowel obstruction to the hand-port site closure may occur years after HALS and can simply be re...

American Journal of Case Reports, 2013

Objective: Diagnostic/therapeutic accidents Background: Iatrogenic entero-atmospheric fistula is ... more Objective: Diagnostic/therapeutic accidents Background: Iatrogenic entero-atmospheric fistula is devastating and its management is extremely difficult because it is often associated with fluid and electrolyte disturbances, nutritional problems, and life-threatening sepsis. Case Report: A 60-year-old woman underwent laparoscopic repair of a recurrent incisional hernia that was complicated by iatrogenic cecal injury necessitating a limited ileocecal resection and onlay prosthetic mesh repair of the hernia. Postoperatively, sloughing of the overlying skin led to mesh exposure. An attempted rotational flap coverage was complicated by small bowel injury, which was recognized and repaired. However, an entero-atmospheric fistula developed after the removal of contaminated mesh. The fistula was initially treated by vacuum-assisted closure dressing and later was converted to a 'stoma'. Six months later, the small bowel segment bearing the fistula was excised and bowel continuity was restored. Conclusions: In selected cases, the conversion of entero-atmospheric fistula to a 'stoma' allows the patient to be discharged home early and maintain good nutritional status while awaiting the definitive surgical intervention.

Case Reports in Gastroenterology, 2010

Early bleeding after stapled haemorrhoidectomy (SH) is not uncommon. Late and persistent bleeding... more Early bleeding after stapled haemorrhoidectomy (SH) is not uncommon. Late and persistent bleeding occurring weeks or months after SH, however, is rare; it has only been described in more than 10% of cases. It is attributed to the development of inflammatory polyps at the staple line. Occurrence of rectal bleeding in the presence of palpable polypoid lesions at the stapled anastomotic line can cause diagnostic confusions, and it is not uncommon that such lesions are initially confused with rectal carcinoma. We report a case of a 38-year-old male who presented with persistent rectal bleeding some 6 months after SH performed in another hospital. Rectal and colonoscopic examinations revealed polypoid lesions at the anastomotic line. The biopsy failed to confirm malignancy, but identified cytomegalovirus (CMV) infection. The development of multiple inflammatory polypoid lesions in conjunction with CMV infection at the stapled anastomotic line has caused a diagnostic confusion, but-after exclusion of cancer-this complication was efficiently treated by CMV infection eradication combined with surgical excision of the remaining polyps due to persistence of bleeding. This case is reported to highlight late bleeding due to inflammatory polyps after SH and to increase the awareness of surgeons and gastroenterologists of this benign but somewhat common complication.

Surgical Endoscopy, 2010

Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium... more Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium for abdominal tuberculosis (TB). However, the laparoscopic view may be deceiving even to the most experienced eyes, and it is not uncommon for TB to be diagnosed erroneously before the final histologic confirmation is received. A retrospective review of 20 diagnostic laparoscopies was conducted. The cases erroneously diagnosed at laparoscopy were collected and analyzed. Five cases (20%) were identified. For two patients, the laparoscopic findings were thought to be those of carcinomatosis, but histology showed TB. For the other three patients, TB was suspected laparoscopically, but the final diagnoses were carcinomatosis, spontaneous bacterial peritonitis, and panniculitis. Two patients died: one due to delayed diagnosis and treatment of abdominal TB and the other due to carcinomatosis. For a percentage of patients, the laparoscopic features of abdominal TB at diagnostic laparoscopy may be mistaken for other pathologies. Caution should be exercised before disclosure of the provisional diagnosis to the patient based on laparoscopy alone without histologic confirmation.

International Journal of Surgery Case Reports, 2012

INTRODUCTION: The clinical manifestations of abdominal 'cocoon' are non-specific and hence its di... more INTRODUCTION: The clinical manifestations of abdominal 'cocoon' are non-specific and hence its diagnosis is rarely made preoperatively and the management is often delayed. Surgery remains the main stay of treatment with satisfactory outcome and comprises excision of the fibrous membrane, meticulous adhesionolysis and release of the entrapped small bowel. PRESENTATION OF CASE: A 45-year-old male patient presented with 6-month history of progressive subacute small bowel obstruction. After initial radiological investigations, he underwent diagnostic laparoscopy and was misdiagnosed as abdominal tuberculosis. He was started on anti-tuberculous therapy, but exploratory laparotomy was carried out after failure to respond to anti-tuberculous therapy. At laparotomy, the abdominal 'cocoon' which was encapsulating the entire small bowel was excised, and the adhesions were carefully lysed. The patient remained well and without recurrence at 1-year follow-up. DISCUSSION: Abdominal 'cocoon' is a rare cause of subacute, acute and chronic small bowel obstruction. Its diagnosis is rarely made preoperatively. CONCLUSION: Abdominal 'cocoon' should be thought of as a rare cause of small bowel obstruction. It may be mistaken with abdominal tuberculosis. Surgery remains the mainstay of curative treatment.

International Journal of Colorectal Disease, 2012

Dear Editor: I have read with great interest the article “Colon ischaemia following surgery for s... more Dear Editor: I have read with great interest the article “Colon ischaemia following surgery for sigmoid colon and rectal cancer: a study of 10 cases and review of the literature. Int J Colorectal Dis 2012; 27:671–5” by Park et al. I would like to share my experience of two similar cases of colon ischaemia that I have encountered after minimally invasive colorectal cancer surgery (one after hand-assisted laparoscopic colectomy (HALC) and another after laparoscopic anterior resection).

Journal of the Pancreas, Nov 10, 2004

Solid-pseudopapillary tumors are exceedingly rare in males. They are almost exclusively encounter... more Solid-pseudopapillary tumors are exceedingly rare in males. They are almost exclusively encountered in young females (mean age 26 years) and have a female predominance. It is most commonly detected incidentally, but may occasionally present with sudden pain or symptoms related to compression of adjacent organs. We report the case of a 12-year-old boy having a solid-pseudopapillary tumor of the pancreas presenting with a tender upper abdominal mass following a slight trauma. Radiological investigation showed the lesion to be a cystic mass arising from the body and the tail of the pancreas. The child underwent emergency distal pancreatectomy and has remained free of recurrence for 3 years. In the pediatric age group, solid-pseudopapillary tumors may present acutely with a tender abdominal mass following a slight trauma. Awareness of this fact will allow appropriate and prompt management to be undertaken.

Canadian journal of surgery. Journal canadien de chirurgie, 2006

I read with interest the article on the incidence of portal vein thrombosis (PVT) after laparosco... more I read with interest the article on the incidence of portal vein thrombosis (PVT) after laparoscopic splenectomy (Can J Surg 2005;48:352-4).1 I agree with the authors' assumption that the frequency of PVT after laparoscopic splenectomy is just as high as that after open splenectomy. I believe that the laparoscopic procedure per se has no bearing on the occurrence of PVT, which is found mainly in patients who undergo splenectomy for benign and malignant hematologic conditions. I also believe that PVT is more likely to occur after splenectomy if the postsplenectomy platelet count is greater than 1000 × 109/L, although it may occur at lower counts as the authors have indicated. In a review of 55 patients who underwent open splenectomy for various indications in our unit, only 2 (3.6%) had PVT; both had portal hypertension, and splenectomy was performed as part of an emergency devascularization procedure for bleeding esophageal varices.2 PVT should be suspected in any patient who is...

Journal of Surgical Case Reports

Diaphragmatic hernia in the absence of trauma in adults is very rare. It occurs as a result of un... more Diaphragmatic hernia in the absence of trauma in adults is very rare. It occurs as a result of unilateral diaphragmatic agenesis. The diagnosis of this rare condition is typically made in early infancy. However, in asymptomatic patients, the diagnosis is often delayed for months and even years. We present a case of a 27-year-old female, who was referred 48-hours after Caesarean section with suspected pulmonary embolism. Computed tomography scan revealed herniation of the liver as well as bowel loops into the right hemi-thorax. Exploration through a right thoracotomy revealed right diaphragmatic agenesis. The contents were reduced into the abdomen, and the defect was repaired using a mesh. The patient had an uneventful postoperative recovery and was discharged home 10 days later. This case highlights the acute late presentation of right diaphragmatic eventration with abdominal visceral herniation in adulthood. The condition may be triggered by the increasing size of gravid uterus.