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BackgroundAcute appendicitis can occur at any age but is rare among people of extreme age; it is more common in teenagers and young adults. Traditionally diagnosis is made on clinical grounds. In recent times imaging techniques have been deployed to improve diagnosis and reduce negative appendicectomy rates. The aim of the study was to describe the common clinical features of acute appendicitis among our patients, highlight the role of medical imaging, and compare all these with the histological report of the excised appendix.MethodsA 24-months retrospective review of all patients who underwent appendicectomy (July 1, 2019-June 30, 2021) for suspected acute appendicitis was performed. Medical records numbers of patients who had appendicectomies were retrieved from the operating room register. These numbers were used to access the hospital's electronic medical records database for the patients' records. These records were reviewed for biodata, clinical features, laboratory, medical imaging findings, and histological reports.ResultIn this hospital, 354 appendicectomies were performed. Only 336 had complete data set suitable for further review. There were more males (N=257; 76.5%) than females (N=79, 23.5%), yielding a male to female ratio of 4:1. There were also more Saudi citizens (n=266, 79.2%), with the predominant age group being 11-30 years. Abdominal pain was the predominant symptom (100%) and was localized to the right iliac region in 331 (98.7%) of patients. Other symptoms recorded were anorexia (n=247, 73.5%), vomiting (n=190, 56.5%), and nausea (n=93, 27.7%). Atypical symptoms included diarrhoea (n=27, 8%) and constipation (n=12, 3.6%). Acute appendicitis, complicated appendicitis, and no appendicitis were the reported histological disposition in 174 (51.8%), 124 (36.9%), and 38 (11.3%) cases respectively. Abdominal CT scan had a higher sensitivity (98.6% vs 70.5%), higher diagnostic odd ratio (2.5 vs 1.4) and a lower miss (false negative) rate (1.4% vs 29.5%) compared to ultrasonography. However, the CT scan, from this study, has a rather low specificity (3.4%) and high false positive rates (96.5%). Open (n=205; 61%) and laparoscopic (n=131;39%) approaches were used for the appendicectomies. In our study, 44 patients were diagnosed with the decision to operate based on clinical grounds; and of this, 42 (95.4%; n=44) had confirmatory histology reports of appendicitis. Also, 38 patients had negative appendicectomy; giving a negative appendicectomy rate of 11.3%. This high rate may be due to the lower specificity and high false positive rate observed in this study. The post-operative complication rate was 21.4%, and this was solely due to surgical site infection, and this was more common with the open approach (p=0.001).ConclusionSuspected acute appendicitis was the sole indication for our appendicectomies. A computerized tomography scan was a more reliable diagnostic tool than ultrasonography. Despite the fact that acute appendicitis is majorly a clinical diagnosis, and good clinical acumen is an excellent skill in the management of patients, we observed an overreliance on medical imaging for diagnosis. Open appendicectomies were more common, and surgical site infection was the sole complication of surgery. There was a relatively high negative appendicectomy rate for an image-assisted diagnosis.

Introduction Seasonal variation is a common factor in the development of gastrointestinal conditions, including gallstone complications such as chronic cholecystitis, acute cholecystitis (AC), and acute biliary pancreatitis. The aim of this study is to evaluate the impact of seasonal temperature variation on the incidence of gallstone complications in adult patients admitted to King Fahad Specialist Hospital (KFSH) in Buraydah, Saudi Arabia. Methods This retrospective study analyzed 1,719 complete medical records of adult patients (>15 years) undergoing emergent or elective cholecystectomy at KFSH, Buraydah, Saudi Arabia, for gallstone-related indications (acute biliary pancreatitis, AC, common bile duct (CBD) or biliary obstruction, chronic cholecystitis, first-time diagnosed uncomplicated gallstones). Patients <15 years and those with incomplete records, non-gallstone, or rare gallstone complications (e.g., fistula, polyps, adenomyomatosis, Lemmel syndrome, Mirizzi syndrome, malignancy) were excluded. Diagnoses were standardized via validated ultrasound reports, and seasons were assigned based on the latest ultrasound diagnosis. Data were processed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States).  Results The study revealed that the summer season had the highest frequency of first-time diagnosed gallstones with and without complications (n=716, 41.7%). Overall, the prevalence of gallstone complications was found in 528 patients (30.7%). The most common gallstone complications were AC (49.2%, 260 cases), followed by CBD or biliary tree obstruction (31.4%, 166 cases). Additionally, age (adjusted OR (AOR)=2.092; 95%CI=1.214- 3.603; p=0.008) and gender (AOR=1.590; 95%CI=1.280- 1.976; p <0.001) were identified as significant independent predictors of gallstone complications, with male patients and those aged 65 years and above being more likely to develop gallstone complications Conclusion The study demonstrated a trend toward increased gallstone complications during the summer season among adult patients in Buraydah, Saudi Arabia; however, this seasonal variation was not statistically significant after multivariate analysis (p = 0.318). Male sex and age ≥65 years were identified as significant predictors. These findings support targeted awareness efforts focused on high-risk populations.

This cross-sectional descriptive study aimed to ascertain the prevalence of non-urgent cases, investigate gender and age preferences, and explore factors influencing individuals' selection of the emergency department (ED) for non-urgent cases in the Al-Qassim region of Saudi Arabia. From July 15, 2022, to December 31, 2022, a structured online questionnaire via a Google Docs survey collected data. The study sampled 425 patients from two prominent Al-Qassim healthcare institutions: Buraydah King Fahad Specialized Hospital and Buraydah Central Hospital. Encompassing patients aged 20 to 80 admitted to the ED between 8:00 and 16:00, concurrent with primary healthcare center availability, the study categorized participants by urgency using the Canadian Triage and Acuity Scale (CTAS) criteria. Data analysis employed descriptive statistics, chi-square tests, and probit regression in R version 4.3.3, with a significance level of < 0.05 for result interpretation. In Al-Qassim in 2022, 82.4% of ED visitors sought care for non-urgent cases, while 17.6% sought care for urgent cases. No statistically significant relationship was found between age and gender and urgent ED visits. Among those with non-urgent conditions, the top reasons for bypassing primary healthcare services were slow treatment (52.7%), lack of knowledge about primary healthcare (PHC) services (33.9%), and appointment unavailability (5.5%). Evaluation of awareness of the ED triage system showed a significant difference only among patients with excellent awareness. The investigation found a higher prevalence of non-urgent cases, especially among females. Challenges in appointment booking, accessibility, and the perception of urgency were key factors leading patients to choose the emergency department over PHC centers. The study emphasized the crucial role of ED triage system awareness and the impact of satisfaction with PHC services on healthcare-seeking behavior, with younger individuals less likely to visit the ED and males more inclined at specific satisfaction levels.