Background: Right-sided diverticulitis, particularly cecal diverticulitis, is a rare condition that can mimic other causes of acute abdomen and pose a diagnostic challenge.Case Presentation: A 57 year old male presented with acute tearing epigastric pain followed by lower abdominal pain. Examination revealed bilateral iliac fossa tenderness with guarding in the right iliac fossa and positive psoas and obturator signs. Laboratory testing showed elevated C reactive protein (70 mg/L) with otherwise unremarkable results. Because the initial tearing epigastric pain raised concern for serious conditions, including acute coronary syndrome, pancreatitis, and aortic pathology, cardiac enzymes, ECG, serum lipase, and contrast‑enhanced CT were obtained, which excluded these diagnoses. Abdominal ultrasound demonstrated focal bowel wall thickening in the right lumbar region. Contrast‑enhanced CT identified a cecal diverticulum with surrounding pericolic fat stranding and localized inflammatory changes without abscess or perforation, consistent with Hinchey stage Ia cecal diverticulitis. The patient was managed conservatively with intravenous ceftriaxone... Continue Reading

Introduction: The history of traumatic injury treatment is a progression from crude ancient practices to modern trauma systems, marked by significant developments in military medicine, surgery, and understanding of physiology. Key milestones include early documentation in ancient Egypt, the extensive but primitive record-keeping of the American Civil War, the introduction of antisepsis, the development of trauma centers, and advancements in casualty evacuation and the treatment of shock. There is a direct link between military and civilian trauma care that starts during the Civil War and continues until the current conflict in Ukraine. The wars of the last two decades have changed the nature of injuries seen on the battlefield, leading to further trauma management innovation. Trauma is a global burden of disease that is responsible for 5 million deaths around the world annually. Lessons learned in these hostile environments have guided many developments in trauma care in high-income countries, resulting... Continue Reading

Background: This systematic review synthesizes evidence on the prevalence, causes, and associated factors of non-urgent emergency department (ED) visits in Saudi Arabia, which contribute to overcrowding, increased costs, and delays in urgent care.Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched from inception to the search date. We included observational studies from Saudi Arabia reporting prevalence, reasons, or factors associated with non-urgent ED visits. Three reviewers screened titles/abstracts and assessed full texts. Two reviewers extracted data using a standardized form and assessed study quality using Joanna Briggs Institute critical appraisal tools. Because of heterogeneity across definitions and outcomes, we synthesized findings narratively.Results:Eleven studies published between 2002 and 2024 were included (total sample size 30,684). Non-urgent ED visit prevalence ranged from 20.7% to 82.4% (mean 49.75%). Most studies defined non-urgent visits using the... Continue Reading

This case report presents the effective management of a rare and life-threatening spontaneous hemothorax resulting from the rupture of an intercostal artery aneurysm in a patient with undiagnosed neurofibromatosis type 1 (NF-1). The patient exhibited acute chest pain and hemodynamic instability, requiring a multidisciplinary strategy that included permissive hypotension and interventional radiology (IR). Coil embolization successfully managed the hemorrhage, resulting in hemodynamic stabilization and positive patient outcomes. This case highlights the significance of promptly identifying spontaneous hemothorax in NF-1, the necessity of targeted resuscitation strategies, and the effectiveness of minimally invasive endovascular techniques in addressing vascular complications. This case study highlights the complexities involved in addressing an atypical presentation of an undiagnosed case of NF-1, which was further complicated by a sudden spontaneous hemothorax resulting from the abrupt rupture of an intercostal artery aneurysm. This underscores the essential importance of promptly identifying life-threatening bleeding and the necessity for a resuscitation... Continue Reading

IntroductionCalcium channel blocker (CCB) overdose is a leading cause of cardiovascular drug-related mortality, typically presenting with refractory hypotension, bradycardia, and metabolic acidosis . While initial therapy—including calcium, high-dose insulin euglycemia therapy (HIET), and vasopressors—remains the mainstay of management, extracorporeal membrane oxygenation (ECMO) serves as a salvage intervention in cases of refractory cardiogenic shock. A systematic review reported an 84.6% survival rate with ECMO in CCB overdose, reinforcing AHA recommendations to VA-ECMO in refractory shock unresponsive to maximal medical therapy . We report a case of amlodipine-induced vasoplegic shock successfully managed with VA-ECMO. Case Presentation:A 37-year-old woman with hypertension and hypothyroidism presented 15 hours after ingesting 220 mg of amlodipine and 6 g of paracetamol in a suicide attempt. She was hypotensive and acidotic despite early fluid resuscitation, High-dose insulin euglycemic therapy, vasopressors, glucagon, and intralipid. She then deteriorated to refractory vasoplegic shock with pulmonary edema requiring mechanical ventilation. A worsening... Continue Reading

Objective: This study aimed to assess aspirin formulation use for acute chest pain in emergency departments and primary care centers in Saudi Arabia, with a focus on Ministry of Health facilities. Methods: A cross-sectional, anonymous, convenience-based electronic survey was conducted among the healthcare professionals involved in the care of patients with acute chest pain in the Ministry of Health emergency departments and primary care centers. The survey assessed aspirin formulation, dose, and method of administration, as well as knowledge regarding enteric-coated aspirin absorption, availability of non-enteric aspirin, and willingness to change practice. Results: A total of 58 participants, most of whom worked in emergency departments (79.3%) and were emergency physicians (74.1%), were included. Enteric-coated aspirin was reported as the most commonly used formulation for acute chest pain (57%), most often administered by swallowing the tablet whole (58.6%), and 69.0% of participants were aware that enteric-coated aspirin has delayed absorption. Only... Continue Reading

Objective: This study aimed to evaluate the pain management practices for oncology patients in the emergency department (ED), focusing on pain assessment, analgesic use, and treatment effectiveness.Methods: This retrospective cohort study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia, from January 2020 to December 2023. A total of 341 oncology patients who presented to the ED with pain were included. As pain scores for most patients were missing, observed values were retained, and a transparent, conservative approach was used to estimate missing scores to enable inferential analyses. The primary outcome was effective pain relief (≥2-point reduction, 0–10 scale).Results: The mean age was 54 years, and 47% of participants were male. Pre-treatment pain scores were documented in 18% of patients; reassessment after analgesia was recorded in 28%. The mean pain score decreased from 7.4 pre-treatment to 1.6 post-treatment (p < 0.001). Opioid use was associated with greater odds... Continue Reading

Background: Emphysematous gastritis is a rare, life-threatening infection of the stomach wall caused by gas-forming bacteria. Fewer than 200 cases have been reported. The mortality rate has declined from 60% to 33% owing to earlier diagnosis and improved care. This report presents a case of emphysematous gastritis, highlighting the challenges with diagnosis and management.Case presentation: A 70-year-old woman with unresectable cholangiocarcinoma and hepatic metastases presented with fever, abdominal pain, and coffee-ground vomiting. Imaging revealed gas within the gastric wall consistent with emphysematous gastritis. She was managed conservatively with intravenous antibiotics, fluids, and proton-pump inhibitors. Despite treatment, her condition worsened and she was transitioned to palliative care. She died on hospital day 21.Conclusion: This case describes the difficulties in managing emphysematous gastritis in a patient with a complex medical history and advanced malignancy and the unfavorable outcome despite timely and appropriate treatment. It highlights the need for early recognition of emphysematous... Continue Reading