Background: Familial adenomatous polyposis (FAP) syndrome has a near-100% lifetime risk of colorectal cancer. Early surveillance and prophylactic surgery have been advocated to reduce this risk. However, the surveillance practices among FAP individuals in Saudi Arabia are unknown. We aimed to explore surveillance compliance in our population, as well as the disease impact on their quality of life (QoL). Methods: All patients with FAP who underwent surgical resection at King Saud University Medical City between 2016 and 2022 were included. Demographic data, clinical features, family history, and compliance with surveillance were collected and analyzed. QoL questionnaires: Short-form health survey (SF-36) and European Organization for Research and Treatment (EORTC) were conducted by phone interview. Results: A total of 14 patients were included with an average age of 25 years. Three patients (21.4%) were the first of their family members to develop FAP. Nine patients (64%) were untested for genetic mutation due to lack of referral to geneticists. The compliance rate toward both pre-operative colonoscopy and upper endoscopy were 78%. However, 38% and 27% compliance rates were observed toward initial and post-operative colonoscopy, respectively. The compliance rate was 14% toward thyroid ultrasound. QoL scores varied among patients, with a mean score above 60 across all SF-36 domains. Conclusion: An overall poor compliance was observed among our participants, particularly toward thyroid ultrasound. Increased health awareness and patient education are essential. In addition, the importance of surveillance and genetic counseling should be emphasized among physicians treating these patients.

Introduction: The occurrence of multiple primary synchronous or metachronous malignancies is a described phenomenon. Such cases may have genetic predisposition or could be related to environmental risk factors but may also be sporadic. We are reporting a unique combination of triple primary synchronous malignancies in the same patient. Case presentation: A 71 year old man presented with constipation and per rectal bleeding with a palpable mass 5–6 cm from the anal verge on physical examination. Colonoscopy with biopsy confirmed adenocarcinoma of rectal origin. After multi-disciplinary tumor board meeting, the patient received neoadjuvant chemoradiation therapy followed by single-stage surgery. Re-staging work up showed the presence of pancreatic lesion. Incidental finding of a gastric nodule upon surgical exploration which was confirmed to be a gastrointestinal stromal tumor. The patient had an uneventful postoperative course. Discussion: Multiple primary malignancies of the gastrointestinal system has previously been reported in the literature; whether in the form of double, triple, quadruple or even quintuple primaries. Furthermore, gastrointestinal malignancies have been reported to be combined with extra-intestinal malignancies. However, this unique combination of pancreatic adenocarcinoma, rectal adenocarcinoma and gastric gastrointestinal stromal tumor has not been previously reported in the literature. Single-stage multiple resections was successful. Conclusion: We are reporting a unique case of three primary malignancies involving the rectum, pancreas and stomach. For such patients, there is no clear guidelines regarding management or surveillance, but rather should be individualized. Highlights:

Malignant colonic obstruction (MCO) occurs in 10–18% of colorectal cancers. Traditionally, emergency surgery has been the standard treatment modality. However, it is associated with higher morbidity and mortality rates compared to patients undergoing elective surgery. With the advancement of endoscopic techniques, the self-expandable metal stent has been advocated as an alternative management that provides relief of obstructive symptoms, allowing the patient’s general condition to be restored and enabling elective surgery. Furthermore, the ability to complete staging allowed identification and avoidance of unnecessary surgery in patients with advanced disease who need palliative measures. However, various stent-related complications have been reported in the literature, including perforation, migration, and obstruction. In this study, we aimed to evaluate the success and complication rates of stent placement in MCO and compare short-term outcomes to those of upfront surgical management. We conducted a retrospective cohort study that included all patients with MCO between March 2015 and September 2021. Patients who had colon perforation at the time of the diagnosis, benign colonic obstruction, tumors of the rectum, or peritoneal metastasis that underwent cytoreductive surgery were all excluded. Patients were divided into groups according to the initial treatment, stent versus surgery, and the intent of therapy, curative versus palliative. Data was collected from medical records. Among 112 patients, 24 had stenting as a bridge to surgery (SBTS), and 16 underwent palliative stenting. The technical success rate was 95%, with failure in two patients due to complete obstruction and perforation in one patient each. Two patients (5%) who underwent stenting had clinical failure with persistent symptomatic obstruction beyond 48 h. The early complication rate following stent insertion was 8%, primarily due to perforation, obstruction from fecal impaction, and stent kinking. SBTS did not affect the laparoscopic approach or stoma creation rate among curative patients. However, it was associated with a more extended hospital stay. Half the patients who received stenting in the palliative group required re-stenting due to re-obstruction, with a mean stent patency time of 7 months. Management of MCO varies based on the patient’s clinical presentation, tumor site, and surgeon’s preference. Stent placement, whether as a bridge to surgery or as a palliative measure, is a safe, less invasive, and effective management option with success and low complication rates.

Concomitant surgery is an attractive option because of convenience. To our knowledge, this is the first study reporting concomitant laparoscopic sleeve gastrectomy (LSG) and laparoscopic right adrenalectomy. A retrospective review of three patients with obesity and a unilateral adrenal mass was conducted. The demographics, workup, surgical technique and outcome were presented. Patient 1 had a body mass index (BMI) of 41 kg/m², diabetes mellitus (DM), hypertension (HTN) and a right adrenal pheochromocytoma. Patient 2 had a BMI of 40 kg/m², insulin-dependent DM, uncontrolled HTN, chronic kidney disease, ischemic heart disease and an aldosterone secreting right adrenal adenoma. Patient 3 had a BMI of 41 kg/m², dyslipidemia, HTN and gout. All patients underwent concomitant LSG and laparoscopic adrenalectomy (LA). LSG and LA is a feasible and safe concomitant surgery when performed under specific measures with minimal morbidity and more convenience.

Key Clinical Message: Follicular variant of papillary thyroid cancer typically favors nodal spread. We report a case with hematogenous spread including multi‐organ involvement and describe our staged management approach. This is the first case to report follicular variant of papillary thyroid cancer with simultaneous adrenal and renal involvement.

Emergencies in endocrine surgery are rare. Acute neck hematoma may result from recent surgery or spontaneous as with ruptured thyroidal cyst, thyroidal vessel, or parathyroid adenoma. We are reporting a case of acute neck hematoma caused by a ruptured of parathyroid adenoma, which required urgent surgical intervention.