Description

The Saudi Journal of Gastroenterology is published every four months by the Saudi Gastroenterology Association (SGA). The journal publishes peer-reviewed articles covering all the aspects of digestive diseases, including the prevention, diagnosis and management and related genetics, pathophysiology, and epidemiology as relevant to gastrointestinal and hepatobiliary disorders. The Saudi Gastroenterology Association acknowledges the contribution of Dallah Hospital to the publication of this journal.

Publisher details

Medknow Publications

Publications in this journal

• Helicobacter pylori infection in children.

  Authors: Shaman Rajindrajith, Niranga M Devanarayana, Hithanadura Janaka de Silva

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):86-94.

  Helicobacter pylori infection is a common problem in pediatric practice, and its acquisition is related with poor socioeconomic conditions. Although the organism is thought to be responsible for manyHelicobacter pylori infection is a common problem in pediatric practice, and its acquisition is related with poor socioeconomic conditions. Although the organism is thought to be responsible for many diseases, only a handful of them have a direct causal relationship. At present, only a small number of children with well-defined clinical syndromes are benefited from testing and treatment. The treatment should include at least two antibiotics with a proton pump inhibitor.

• Helicobacter pylori: prevalence and relationship with abdominal pain in school children in makkah city, Western saudi arabia.

  Authors: Abdulwahab M A Telmesani

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):100-3.

  BACKGROUND/AIM: The published data on Helicobacter pylori (H. pylori) prevalence and its relationship with abdominal pain in Saudi Arabia is scarce. This study was carried out to determine theBACKGROUND/AIM: The published data on Helicobacter pylori (H. pylori) prevalence and its relationship with abdominal pain in Saudi Arabia is scarce. This study was carried out to determine the prevalence of H. pylori and its relationship with chronic recurrent abdominal pain (RAP) among school students in Makkah City, Saudi Arabia. MATERIALS AND METHODS: Three hundred and fourteen school students, 103 at the intermediate level (grades 7-9) aged 12-15 years and 211 at the secondary level (grades 10-12) aged 15-18 years were tested for H. pylori. Urea breath test (UBT) was used for this purpose. Children with chronic RAP were identified as per the Apley criteria. RESULTS: Overall, the UBT was positive in 86/314 (27.4%) students. It was positive in 45/103 (43.7%) intermediate school students and 41/211 (19.4%) secondary students. Out of the 55 students with chronic RAP, 40 (73%) were positive for H. pylori. Further, 62.9% and 82.1% were positive among the intermediate and secondary school students with RAP, respectively. The overall and specific odds ratios of RAP were 12.35 [95% confidence interval (C.I.) 6.30-24.22] and 10.40 (95% C.I. 1.75-11.73) for the intermediate school students and 22.69 (95% C.I. 7.99-64.44) for the secondary school students. CONCLUSION: The prevalence of H. pylori among the school children in Makkah, Saudi Arabia, is relatively low compared with developing countries. The prevalence was found to be higher among the younger age group. Further, there was a significant relation between H. pylori infection and RAP among the school students.

• Crohn's Disease in a Saudi Outpatient Population: Is it Still Rare?

  Authors: Mohammad A Al-Mofarreh, Ibrahim A Al-Mofleh, Ibrahim N Al-Teimi, Abdulrahman M Al-Jebreen

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):111-6.

  BACKGROUND/AIM: To determine the epidemiology of Crohn's disease (CD) in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia andBACKGROUND/AIM: To determine the epidemiology of Crohn's disease (CD) in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia and outside. MATERIALS AND METHODS: The medical records of all patients with CD seen in the clinic in the period from January 1993 through December 2007 were reviewed. The demographic, clinical data and methods of diagnosis were retrieved. RESULTS: Over a period of 15 years, we saw 133 Saudi patients with CD. They were predominantly young, with a median age of 26.2 years and male preponderance (2.3:1). The final diagnosis was established within 1 week of presentation in 47% of the patients. The leading symptoms were abdominal pain (88%), diarrhea (70%), bloating (61%), rectal bleeding (50%), weight loss (33%), constipation (24%) and perianal disease (23%). The diagnosis was established by endoscopy and histopathology. Ileocecal involvement was encountered in 40% of the patients. CONCLUSION: From the current study, it is obviously possible to diagnose a large proportion of patients with CD in a gastroenterology outpatient clinic. The data revealed a strikingly increased incidence of CD in a mainly young Saudi population in the past few years.

• Biliary ascariasis in the Indian subcontinent: a study of 42 cases.

  Authors: Madhumita Mukhopadhyay

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):121-4.

  BACKGROUND/AIM: History of ascariasis is known to stretch back many centuries. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of theBACKGROUND/AIM: History of ascariasis is known to stretch back many centuries. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of the Indian subcontinent and the gangetic plain of West Bengal is one of them. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. MATERIALS AND METHODS: Forty-two cases of hepatobiliary ascariasis were studied over a period of 3 years. All the patients were adults aged between 20 and 50 years and all but two were admitted with acute upper abdominal pain. RESULTS: In this study, biliary ascariasis was found to be more common in females, 73.8% (31 patients). The most common presentation was upper abdominal pain in 95.2% of the patients (40 patients). Complications observed were obstructive jaundice in 28.56% (12 patients), cholangitis in 16.7% (seven patients), acute pancreatitis in 2.4% (one patient) and hepatic abscess in 2.4% (one patient). History of worm emesis was present in 38.1% (16 patients). History of previous cholecystectomy was present in 16.7% (seven patients) and endoscopic sphincterotomy in 4.8% (two patients). Ultrasound was the diagnostic tool of choice with 100% results. Conservative management was successful in 83.3% (35 patients). During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients). CONCLUSION: In endemic countries, ascariasis should be suspected in patients with biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Most of the patients respond to conservative management.

• Prevention of Bile Leak after Liver Surgery: A Fool-proof Method.

  Authors: Aswini K Pujahari

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):128-30.

  BACKGROUND/AIM: Bile leak is not uncommon after liver surgeries. There is no adequate method described to prevent this morbid complication. MATERIALS AND METHODS: At the end of the liver procedure,BACKGROUND/AIM: Bile leak is not uncommon after liver surgeries. There is no adequate method described to prevent this morbid complication. MATERIALS AND METHODS: At the end of the liver procedure, transcystic normal saline was injected under pressure with distal clamping. Leaking saline on the cut surface of the liver was sutured. The process was repeated till no leaking was observed. A suction drain was kept for any bile leak. RESULTS: Open liver resection and hydatid cyst surgery cases were included. There were 24 cases, with 13 males and 11 females. The age range was from 4 to 80 years, with a mean of 48 years (SD +/- 17.7). The number of leak sites that could be sutured were 0-4 (mean of 2.3 +/- 0.5). None had bile leak postoperatively. CONCLUSION: Transcystic injection under pressure with distal clamping demonstrates the leak sites. Suturing them prevents the postoperative bile leak.

• Wind sock deformity in rectal atresia.

  Authors: Sayed M V Hosseini, Farhad Ghahramani, Alireza Shamsaeefar, Tannaz Razmi, Mohammad Zarenezhad

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):133-4.

  Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectalRectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age.

• Male gender and laparoscopic cholecystectomy.

  Authors: Iqbal Saleem Mir

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):137.

• Hairdye-induced hepatitis: an unusal cause of acute hepatitis.

  Authors: Varadaraj P Gokak, Sasikala Mitnala, Ramji Cheemalkonda, Rupa Banarjee, Nagaraj Rao Padaki, D Nageshwar Reddy

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):138-9.

• Obstructive jaundice due to primary choroidal malignant melanoma metastasis: an unusual presentation.

  Authors: Gaurav Maheshwari, Nairuthya Shivathirthan, Premashish J Haldar, Dinesh Kamath

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):141.

• Twelve-years Old Girl with Retro-rectal Mass.

  Authors: Mounir Arroud, Chater Lamiae, Samir Atmani, Said Boujraf, My Abderrahmane Afifi, Moustapha Hida, Youssef Bouabdallah

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):145-6.

• Glimpse of the epidemiological research on helicobacter pylori in saudi arabia.

  Authors: Abdulaziz A Binsaeed

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):85.

• Gastrointestinal opportunistic infections in human immunodeficiency virus disease.

  Authors: Awadh R Al Anazi

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):95-9.

  Gastrointestinal (GI) opportunistic infections (OIs) are commonly encountered at various stages of human immunodeficiency virus (HIV) disease. In view of the suppressive nature of the virus and theGastrointestinal (GI) opportunistic infections (OIs) are commonly encountered at various stages of human immunodeficiency virus (HIV) disease. In view of the suppressive nature of the virus and the direct contact with the environment, the GI tract is readily accessible and is a common site for clinical expression of HIV. The subject is presented based on information obtained by electronic searches of peer-reviewed articles in medical journals, Cochrane reviews and PubMed sources. The spectrum of GI OIs ranges from oral lesions of Candidiasis, various lesions of viral infections, hepatobiliary lesions, pancreatitis and anorectal lesions. The manifestations of the disease depend on the level of immunosuppression, as determined by the CD4 counts. The advent of highly active antiretroviral therapy has altered the pattern of presentation, resorting mainly to features of antimicrobial-associated colitis and side effects of antiretroviral drugs. The diagnosis of GI OIs in HIV/ acquired immunodeficiency syndrome patients is usually straightforward. However, subtle presentations require that the physicians should have a high index of suspicion when given the setting of HIV infection.

• Role of Vitamin-E on Rat Liver-amiodarone: An Ultrastructural Study.

  Authors: Mohamed Samir A Zaki, Refaat A Eid

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):104-10.

  BACKGROUND/AIM: Amiodarone, a class III antiarrhythmic drug, has been found to be effective in the management of patients with life-threatening ventricular arrhythmias. The aim of this study was toBACKGROUND/AIM: Amiodarone, a class III antiarrhythmic drug, has been found to be effective in the management of patients with life-threatening ventricular arrhythmias. The aim of this study was to test whether the co administration of vitamin-E with amiodarone can reduce amiodarone-induced liver damage. MATERIALS AND METHODS: Twelve male albino rats were divided into three groups (ml vegetable oil/day by oral gavages daily for 2 weeks and were used as control group. The rats of the second group received 5.4 mg amiodarone/100 gm rat dissolved in vegetable oil daily by oral gavages for 2 weeks. In the third group, the rats received 5.4 mg amiodarone and 5 mg vitamin-E/100 gram rat dissolved in 2 ml vegetable oil by oral gavages daily for 2 weeks. Two weeks after treatment, the rats were sacrificed and liver specimens were immediately taken and processed for transmission electron microscopic examinations. RESULTS: Sections from the rat liver receiving amiodarone examined by electron microscopy showed disrupted hepatocytes with increased vacuolations. Degenerated organelles and disrupted nuclei were observed. The microvilli of bile canaliculi were disrupted and the hepatocytes showed increased lipid contents. Both endothelial cells and Kupffer cells were damaged. Phospholipids inside the mitochondria showed a loss of cristae. Sections from the liver of rats received amiodarone and vitamin-E showed lesser effects, especially in depositions of phospholipids in the mitochondria and the whole organelles and the nucleus showed minor damage in comparison to the previous group. CONCLUSION: Milder hepatotoxic effects are seen in rats administered amiodarone and vitamin E simultaneously suggesting that vitamin-E may play a role in amelioration of the effects of amiodarone.

• Total Leucocyte Count, C-reactive Protein and Neutrophil Count: Diagnostic Aid in Acute Appendicitis.

  Authors: Sheikh Muzamil Shafi, Misbha Afsheen, Farooq A Reshi

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):117-20.

  BACKGROUND/AIM: Acute appendicitis is one of the most common acute intraabdominal affections seen in surgical departments, which can be treated easily if an accurate diagnosis is made in time.BACKGROUND/AIM: Acute appendicitis is one of the most common acute intraabdominal affections seen in surgical departments, which can be treated easily if an accurate diagnosis is made in time. Otherwise, delay in diagnosis and treatment can lead to diffuse peritonitis. MATERIALS AND METHODS: A study was conducted on 110 patients who were operated for acute appendicitis to determine the role and predictive value of the total leucocyte count (TLC), C-reactive protein (CRP) and percentage of neutrophil count in the diagnosis of acute appendicitis. Preoperative TLC, CRP and percentage of neutrophil count were determined and were compared with the results of the histopathology of the removed appendix. RESULTS: Of all the patients studied, 92 had histopathologically positive appendicitis. The TLC was found to be significantly high in 90 patients who proved to have acute appendicitis, whereas CRP was high in only 88 patients and neutrophil percentage was raised in 91; four had a normal CRP level. Thus, TLC had a sensitivity, specificity and positive predictive value of 97.82%, 55.55% and 91.8%, respectively. CRP had a sensitivity, specificity and positive predictive value of 95.6%, 77.77% and 95.6% respectively. Percentage of neutrophil count had a sensitivity, specificity and positive predictive value of 98.9%, 38.88% and 89.21%, respectively. When used in combination, there was a marked improvement in the specificity and the positive predictive value to 88.04% and 98.7%, respectively. CONCLUSION: The inflammatory markers, i.e., TLC, CRP and neutrophil count can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value.

• A Study of Helicobacter Pylori-associated Gastritis Patterns in Iraq and Their Association with Strain Virulence.

  Authors: Nawfal R Hussein, Sarbar M Napaki, John C Atherton

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):125-7.

  BACKGROUND/AIM: Helicobacter pylori (H. pylori) infection causes peptic ulceration and gastric adenocarcinoma. In Iraq, gastric cancer is rare. We investigated whether infected adults had theBACKGROUND/AIM: Helicobacter pylori (H. pylori) infection causes peptic ulceration and gastric adenocarcinoma. In Iraq, gastric cancer is rare. We investigated whether infected adults had the antral-predominant pattern of H. pylori-associated gastritis, which does not predispose to cancer. MATERIALS AND METHODS: We evaluated histopathological changes by the Sydney scoring system in gastric biopsies taken from 30 H. pylori-infected adults and studied the correlation of these changes with the virulence factors. The Mann-Whitney test was used for the comparison of histopathological data. The presence or absence of each pathological index was evaluated with respect to the possession of virulence factors by the infecting H. pylori strain using the chi(2) test. RESULTS: Gastric lymphocyte infiltration was more prominent in the antrum (P = 0.01). Neutrophil infiltration was mild and gastric mucosal atrophy was rare. No relationship was found between virulence factors and histopathological changes. CONCLUSIONS: The mild pathology and antral-predominant gastritis help explain the low cancer rate in Iraq.

• Case of unusual foreign body in the rectum.

  Authors: Murtaza A Akhtar, Pooja K Arora

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):131-2.

  A 44-year-old male patient with a foreign body in rectum (beverage bottle), introduced as sexual perversion, is presented with literature review. The management emphasis is on transanal retrieval andA 44-year-old male patient with a foreign body in rectum (beverage bottle), introduced as sexual perversion, is presented with literature review. The management emphasis is on transanal retrieval and ruling out of the rectal and colonic perforation and the requirement for postremoval psychiatric treatment.

• Uncomplicated Spontaneous Rupture of the Pancreatic Pseudocyst into the Gut - CT Documentation: A Series of Two Cases.

  Authors: Mohammed F Mir, Feroze Shaheen, Tariq A Gojwari, Manjeet Singh, Pervez Nazir, Shafeeq Ahmad

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):135-6.

  Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention.Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present herein two cases of uncomplicated spontaneous rupture of a pancreatic pseudocyst into the stomach with complete resolution.

• Bony metastasis of gastric adenocarcinoma.

  Authors: Bhavesh Devkaran, R Jhobta, D K Verma

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):137-8.

• Intestinal spirochetosis: do we always treat it or is it a self-limiting disease?

  Authors: Apurva Sinha, Tony Mak, Shabina Petkar, Arthur Allan

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):139-41.

• Distinguishing tuberculosis and Crohn's disease in developing countries: how certain can you be of the diagnosis?

  Authors: Udayakumar Navaneethan, Jijo V Cherian, Rajesh Prabhu, Jayanthi Venkataraman

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(2):142-4.

  Distinguishing tuberculosis and Crohn's disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A largeDistinguishing tuberculosis and Crohn's disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A large number of patients with Crohn's disease are initially misclassified as having Intestinal tuberculosis in places where tuberculosis is endemic before they are treated for Crohn's disease. Although a variety of endoscopic, radiological and histological criteria have been recommended for the differentiation, it often proves difficult in routine clinical practice. Future prospective studies are required in patients with granulomatous colitis to prevent unnecessary inappropriate anti tuberculous therapy for patients with Crohn's disease and appropriate early treatment for a patient with tuberculosis.

• Pattern of corrosive ingestion in southwestern saudi arabia.

  Authors: Ali M Al-Binali, Mohammmed A Al-Shehri, Ismail Abdelmoneim, Ali S Shomrani, Suliman H Al-Fifi

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(1):15-7.

  BACKGROUND/AIMS: Ingested corrosive material is a major pediatric emergency all over the world. The corrosive material can cause damage to the digestive tract, ranging from minor injury toBACKGROUND/AIMS: Ingested corrosive material is a major pediatric emergency all over the world. The corrosive material can cause damage to the digestive tract, ranging from minor injury to strictures, and sometimes even death. We aimed to review the pattern of corrosive ingestion in children who had been admitted to Aseer Central Hospital in the Southwestern region of Saudi Arabia. METHODS: This is a retrospective study of all children who had been admitted with a history of corrosive ingestion to Aseer Central Hospital over a period of five years period from 1990 to 1995. The records of 72 patients (38 males and 34 females) were reviewed. The data included age, sex, time lapse till admission, action taken by parents, presenting symptoms, general management given to the child, barium study, endoscopy, and the postcorrosive ingestion outcome of the child. RESULTS: The mean age of the pediatric patients was 28 +/- 20 months. Different types of corrosives were encountered. The most common type was 5.25% hypochlorite in 36 patients (50%), kerosene in 12 patients (16.7%), caustic soda in nine patients (12.5%), hydrogen chloride and N-alkyl dimethyl benzyl ammonium chloride (HC and ADB) in eight patients (11.1%), and other material in seven patients (9.7%). Endoscopy was done in 30 patients (31.7%), 14 of whom were abnormal. Barium swallow was performed in 11 patients; five of them showed strictures that required frequent dilatation whereas one needed interposition surgery. CONCLUSION: Corrosive injury is still a major pediatric emergency among young children. It carries a major risk of complications (mainly stricture) and requires standardized management based on evidence-based medicine.

• Functional outcome of gastrointestinal tract and quality of life after esophageal reconstruction of esophagus cancer.

  Authors: Manochehr Aghajanzadeh, Feizollah Safarpour, M Reza Koohsari, Farborz M Ghanaei, Sadigheh M Bodaghi, Hadi Tozandehgani

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(1):24-8.

  BACKGROUND/AIM: Information about functional outcome and quality of life after esophagectomy and esophageal reconstruction (ER) for the treatment of esophageal cancer, as evaluated by the patientsBACKGROUND/AIM: Information about functional outcome and quality of life after esophagectomy and esophageal reconstruction (ER) for the treatment of esophageal cancer, as evaluated by the patients themselves is limited. We aimed to study the post-surgical outcome of such patients to detect for the development of any complications that may arise from the surgery as well as to evaluate their quality of life following the surgery. METHODS: From 1993 to 2003, 240 patients with stage I, II, or III esophageal carcinoma underwent esophagectomy at Razi Teaching Hospital located in the north of Iran. Of these, 192 patients filled out a questionnaire during a 2-year period (ranging from 12 to 48 months after surgical reconstruction). Among them, there were 134 men (69%) and 58 women (31%), and the mean age at the time of ER was 48 years (ranging from 22 to 75 years). Transhiatal esophagectomy, extended esophagectomy (three field operation), and Ivor-Lewis resection were done in 142 (73.95%), 30 (15.62%), and 20 patients (10.42%), respectively. Intestinal continuity after esophageal resection was established with stomach in 154 patients (80%), colon in 28 patients (14%), and small bowel in 10 patients (5.2%). Cervical anastomosis was established in 172 patients (89.6%), while intrathoracic anastomosis was performed in 20 patients (10.4%). RESULTS: After ER, 66 patients (34.4%) suffered from dysphagia to solids and 50 patients (26%) required at least one or three postoperative dilatations for alleviation of symptoms. Gastroesophageal reflux was seen in 32 patients (16.66%) and was more common in thoracic anastomosis patients than in cervical anastomosis patients. Heartburn was present in 33 cases (17%), 30 of whom required medication (37%). The number of meals per day was three to four in 116 patients (60%), more than four in 51 patients (29%), and less than three in 19 patients (9.82%). The number of bowel movement per day increased in 52 patients (27%), decreased in 60 cases (31%), and unchanged in 80 patients (41%). Weight gain was reported by 38 patients (19.8%), and weight loss was reported by 50 patients (26%). No change in weight occurred in 100 patients (52%). Overall satisfaction was excellent in 29 patients (15%). Overall quality of life (work, pain-relief, vitality, and emotional status) was lower than in general population. Age, sex, and stage of cancer did not affect the functional outcome but affected the quality of life. Also patients who received cervical anastomosis and ER with colon had significantly fewer reflux symptoms. Most of the patients with colon reconstruction gained weight. CONCLUSIONS: Self-assessment of postoperative ER by the patients after esophagectomy for malignant disease demonstrates that undesirable symptoms are frequently present at short- and long-term follow-ups. Short- and long-term functional outcome is affected by the type of reconstruction after esophagectomy. Results of this study suggest that colon graft in ER is significantly advantageous compared with other methods because of the ability of patients to gain weight and avoid developing postoperative reflux.

• Liver size in saudi children and adolescents.

  Authors: Mohammad I El Mouzan, Abdulla A Al Salloum, Abdulla S Al Herbish, Mansour M Qurachi, Ahmad A Al Omar

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(1):35-8.

  BACKGROUND/AIM: To examine the liver size in Saudi children and adolescents. METHODS: A large sample of children was selected from the general population by multistage random probability sampling forBACKGROUND/AIM: To examine the liver size in Saudi children and adolescents. METHODS: A large sample of children was selected from the general population by multistage random probability sampling for the assessment of physical growth. A random subsample of children-newborns to 18 years old-was taken from this larger sample for this study. Liver size below the costal margin and liver span along the midclavicular line were determined by physicians. Data were analyzed using SPSS software and medians and standard deviations were calculated. RESULTS: Between 2004 and 2005, 18 112 healthy children up to 18 years of age were examined. All were term and appropriate for gestational age. There were 9 130 boys and 8 982 girls, yielding a nearly 1:1 male to female ratio. The maximum palpable liver size below the costal margin was 2.4 cm. The median and + 2 SD liver span at birth were 4 and 6.9 cm, respectively. There was no difference in the liver span between boys and girls of up to 60 months of age. Thereafter, a difference could be seen increasing with age, with girls having smaller liver spans than boys. CONCLUSION: This manuscript reports the liver size in Saudi children and adolescents. The data should help physicians in the interpretation of liver size determined by physical examination of children and adolescents.

• Cholecystocolic fistula: a diagnostic enigma.

  Authors: Mervyn F S Correia, Dilip P Amonkar, Swati V Nayak, Jean-Louis A S Menezes

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(1):42-4.

  Cholecystocolic fistula is a rare biliary-enteric fistula with a variable clinical presentation. Despite modern diagnostic tools, a high degree of suspicion is required to diagnose it preoperatively.Cholecystocolic fistula is a rare biliary-enteric fistula with a variable clinical presentation. Despite modern diagnostic tools, a high degree of suspicion is required to diagnose it preoperatively. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10-20%), and the least common is the cholecystogastric fistula accounting for the remainder of cases. These fistulae are treated by open as well as laparoscopic surgery, with no difference in intraoperative and postoperative complications.We report here a case of obstructive jaundice, which was investigated with a plain film of the abdomen, abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography, but none of these gave us any clue to the presence of the fistula was discovered incidentally during an open surgery and was appropriately treated.

• Giant true celiac artery aneurysm.

  Authors: Badr Aljabri

  Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15(1):49-51.

  Celiac artery aneurysms are rare and usually asymptomatic. The management of these aneurysms is challenging, especially when they are large and involve the confluence of the trifurcation. We presentCeliac artery aneurysms are rare and usually asymptomatic. The management of these aneurysms is challenging, especially when they are large and involve the confluence of the trifurcation. We present here a case of a large celiac artery aneurysm involving its branches in a young woman. Preoperative investigations, intraoperative findings, and the operative procedure are also presented and discussed.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.