Awareness of colorectal cancer and screening uptake in Eastern KSA: Predictors and implications Saleh A. Busbait, Shadi A. Alshammary, Badour A. Alzahrani, Masoma A. Al-houri, Loay M. Bojbara, Humood A. Alsadery, Othman Y. AlFrayyan, Hassan A. Alsaleem Journal of Taibah University Medical Sciences, 2026 يُعد سرطان القولون والمستقيم من أكثر أنواع السرطان شيوعًا في المملكة العربية السعودية، حيث يحتل المرتبة الأولى بين الذكور والثالثة بين الإناث. وعلى الرغم من وجود برامج وطنية للفحص المبكر، إلا أن معدلات الوعي والمشاركة في الفحص لا تزال منخفضة، مما يعكس الحاجة لفهم مستوى المعرفة الحالي وتحديد العوامل المؤثرة على السلوك الصحي المتعلق بالفحص. هدفت هذه الدراسة إلى تقييم مستوى الوعي بسرطان القولون والمستقيم، بما في ذلك الأعراض وعوامل الخطورة، وكذلك مدى انتشار فحص الكشف المبكر، وتحليل العوامل الديموغرافية المرتبطة بهما بين البالغين في المنطقة الشرقية من المملكة. تم إجراء دراسة مقطعية شملت ٤١٢ مشاركًا من البالغين باستخدام استبيان إلكتروني موزع بين أبريل ويوليو ٢٠٢٤. تم تقييم الوعي بالأعراض وعوامل الخطورة والفحص، وتحليل العوامل المتنبئة بها. شملت البيانات الخصائص الديموغرافية، مستوى التعليم، وجود تاريخ عائلي للسرطان، والمكان الجغرافي. أظهرت النتائج أن ٥٧٪ من المشاركين لديهم وعي ضعيف بسرطان القولون والمستقيم. كانت الإناث أكثر وعيًا بالأعراض مقارنةً بالذكور، وسجلت الفئة العمرية من ١٨ إلى ٣٠ عامًا أعلى متوسط للوعي. وُجد ارتباط إيجابي بين التعليم العالي والوعي بعوامل الخطورة. بلغت نسبة من خضعوا للفحص المبكر للقولون ١١.٧٪ فقط، وارتفعت إلى ٢٤.٧٪ بين من تجاوزوا ٥٠ عامًا. من العوامل المتنبئة بالوعي الجيد: التعليم العالي، والتعرض المسبق لمعلومات حول السرطان، ووجود تاريخ عائلي. بينما كان العمر المتقدم، والإقامة في مناطق حضرية، ووجود تاريخ عائلي عوامل متنبئة بزيادة احتمالية الخضوع للفحص. تعكس الدراسة تدني مستويات الوعي والمشاركة في فحص سرطان القولون والمستقيم في المنطقة الشرقية، مما يستدعي تدخلات متعددة المستويات تشمل حملات توعوية موجهة، تعزيز دور الأطباء في التوصية بالفحص، وتفعيل أنظمة تذكير إلكترونية ضمن السجلات الطبية. تمثل هذه الخطوات ركائز لتعزيز الالتزام المجتمعي ببرامج الفحص وتقليل عبء المرض في المملكة. Colorectal cancer (CRC) is one of the most frequent cancers in KSA, ranking first among males and third among females. However, the uptake of the national screening programs is poor due to insufficient awareness and access barriers. Thus, this study evaluated the awareness of CRC and screening levels among adults in the Eastern Province of KSA, where recent data are limited. A cross-sectional study was conducted among 412 adults using a self-administered questionnaire between April 2024 and July 2024. Awareness of CRC signs, symptoms, risk factors, and screening was assessed. Logistic regression was used to determine the predictors of awareness and screening practice. In total, 57.0 % of the participants had low awareness of CRC. Females were more aware of the signs and symptoms of CRC than males ( p = 0.025). The lowest age group (18–30 years) had the highest mean awareness score ( p = 0.037). Higher level of education was positively related to knowledge of risk factors for CRC ( p < 0.001). Only 11.7 % had undergone CRC screening, which increased to 24.7 % among those aged 50 years and above. Positive predictors of awareness included higher education level ( p = 0.023) and prior knowledge of CRC ( p = 0.043). Age ( p < 0.001), living in main (central urban areas) areas ( p < 0.001), and family history ( p < 0.001) were predictors of undergoing screening. In the Eastern Province of KSA, awareness of CRC and screening rates are low. Thus, it is suggested that awareness campaigns, discussions with physicians, and electronic medical records-based reminder systems may help enhance compliance.
Recurrence rate and postoperative fistula formation: A retrospective analysis of surgically managed cases of anorectal abscess Saleh A. Busbait Qatar Medical Journal, 2025 Background: Anorectal abscesses are common surgical conditions associated with a high risk of recurrence or fistula formation. Although several studies have investigated the potential predictors, data from Saudi Arabia remain limited. This study aimed to assess the rate, timing, and predictors of recurrence or fistula formation following the primary surgical drainage of anorectal abscesses. Methods: We conducted a five-year retrospective cohort study at King Fahad Hospital of the University in Al Khobar, Saudi Arabia, including all patients who underwent surgical incision and drainage for a first-time anorectal abscess between January 2019 and December 2023. Demographic data, abscess characteristics, operative details, and follow-up outcomes were analyzed. Logistic regression and Cox proportional hazards models were used to identify the predictive factors. Results: Among 302 patients, 51.7% ( n = 156) developed either a recurrent abscess (12.9%, n = 39) or an index perianal fistula (38.7%, n = 117) during follow-up. The mean time to recurrence was 19.5 weeks. Complex abscesses, observed in 28.1% ( n = 85) of cases, were the only independent predictor of earlier recurrence (hazard ratios [HR]: 2.391, p < 0.001). Preoperative imaging was also associated with an increased risk in logistic regression analysis. Seton placement was rare (2.6%, n = 8), despite intraoperative fistula detection in 17.9% ( n = 54) of cases. Conclusion: Recurrence and fistula formation following drainage of first-time anorectal abscesses are common and tend to occur early. Abscess complexity is a key predictor of poor outcomes, highlighting the need for structured early follow-up and risk-based surgical planning.
Exploring barriers to colorectal cancer screening in Saudi Arabia: findings from a cross-sectional study Saleh Busbait Frontiers in Public Health, 2025 BackgroundColorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. Despite national screening recommendations, CRC screening uptake remains low in Saudi Arabia. This study aims to identify perceived barriers to CRC screening and examine their demographic variations.MethodsA cross-sectional study was conducted with 412 adults in the Eastern Province of Saudi Arabia. The study was conducted between April 2024 and July 2024 using a self-administered questionnaire. Perceived barriers to CRC were assessed using a questionnaire adapted from prior published studies. Statistical analyses included chi-square tests, exploratory factor analysis (EFA), and logistic regression to determine demographic predictors of screening barriers.ResultsThe most frequently reported barriers clustered into three domains: Personal Fears, Lack of Knowledge, and Healthcare System Barriers. “Absence of symptoms” (61.9%) and “fear of results” (28.9%) loaded under Personal Fears; “lack of awareness” (39.1%) under Lack of Knowledge; and “insufficient public awareness campaigns” (35.7%) under Healthcare Barriers. Women more commonly reported fear-related concerns, while younger participants cited knowledge gaps and financial limitations. The three factors explained 77.6% of the total variance. Logistic regression indicated that younger age and lack of prior screening experience were significant predictors of higher perceived barriers (p &lt; 0.05).ConclusionThe findings highlight the need for targeted interventions addressing psychological concerns, increasing public awareness, and improving healthcare provider engagement. Addressing these barriers through structured awareness campaigns, provider-driven screening initiatives, and improved access to non-invasive screening options could increase CRC screening rates and early detection in Saudi Arabia.
Early Closure of Diverting Ileostomy After Rectal Resection: Are We Ready to Make the Shift? Saleh Busbait Acta Informatica Medica, 2025 Background: Diverting ileostomy is widely used to mitigate the consequences of anastomotic leakage after low anterior resection for rectal cancer. While its protective role is well established, the optimal timing of ileostomy closure remains controversial, with traditional delayed reversal exposing patients to stoma-related morbidity and potential permanent diversion. Objective: The aim of this review is to synthesize randomized controlled trial (RCT) and meta-analysis evidence on early ileostomy closure, assess safety and outcomes, and evaluate whether a shift toward earlier reversal is justified in selected patients. Methods: A narrative review of the published literature was conducted, including randomized trials, prospective studies, and systematic reviews identified through PubMed, Scopus, and Google Scholar. Outcomes of interest included perioperative morbidity, stoma-related complications, quality of life, and functional results. Results and Discussion: Evidence from RCTs shows heterogeneity. Trials such as EASY, Kłęk, and Lasithiotakis support early closure, reporting comparable morbidity and reduced stoma-related complications, whereas Bausys, Elsner, and Fukudome caution against indiscriminate application due to increased septic and wound-related morbidity. Meta-analyses consistently indicate that early closure reduces stoma-related complications but increases wound infections, with overall morbidity largely comparable between groups. Patient selection, confirmation of anastomotic integrity, and oncologic treatment schedules are central to outcomes. Cost-effectiveness analyses and retrospective series further support potential system-level and quality-of-life benefits. Conclusion: Current evidence suggests that early ileostomy closure is feasible and safe in carefully selected patients, reducing the burden of stoma-related morbidity without compromising oncologic treatment. However, it should not yet be routine practice, as risks of septic complications persist in unselected populations. Future multicenter RCTs with standardized definitions, uniform imaging protocols, and long-term functional and cost-effectiveness endpoints are needed to guide practice.
Surgical Management of Perianal Crohn’s Disease: Current Evidence and Future Directions Saleh Busbait Acta Informatica Medica, 2024 Background: Perianal manifestations of Crohn’s disease (CD) are common, with fistulas being the most prevalent and challenging to manage. Objective: The aim of this articles was to describe and explain how Perianal fistulizing Crohn’s disease significantly impacts patients’ quality of life and poses a therapeutic challenge for clinicians. Methods: The author used published papers deposited in index databases PubMed Central, Scopus, HINARY etc. rergarding Surgical Management of Perianal Crohn’s Disease: Current Management requires a multidisciplinary and multimodal approach, integrating both medical and surgical interventions tailored to disease severity and fistula complexity. Results and Discussion: Despite advancements in therapy, the majority of patients require multiple interventions due to high rates of primary non-healing, surgical morbidity, and recurrence..Medical treatment primarily includes biologics, particularly anti-TNF agents such as infliximab and adalimumab, which have demonstrated efficacy in fistula closure and symptom control. Surgical approaches remain critical with various degrees of success. Conclusion: Despite the availability of multiple therapeutic options, Perianal fistulizing Crohn’s disease remains a complex condition with ongoing challenges in achieving sustained remission. Future research should focus on novel treatment strategies and optimizing individualized patient care.
Spigelian Hernia in Cirrhotic Patients: When and How to Repair? Nosibah Telmesani, Dhuha Boumarah, Naif Alkhaldi, Humood Alsadery, Saleh Busbait, Anas AlOthman, Faten Alaqeel Acta Informatica Medica, 2024 Background: Spigelian hernia, also known as spontaneous lateral ventral hernia, is defined as a protrusion of abdominal contents through an abdominal wall defect within the transversus aponeurosis. The entity was first reported in 1742 and named after Adrian van der Spieghel. It is recognized as a rare condition, accounting for 1 to 2% of all abdominal wall hernias. Cirrhotic patients, in particular, are more predisposed to hernias of all types. When Spigelian hernia is accompanied by hepatic cirrhosis, the decision to repair gets into a controversial aspect. Herein, we present the emergency management of an incarcerated spigelian hernia in a cirrhotic patient, highlighting the challenges in managing similar cases. Case Presentation: A 65-year-old lady, presented to our emergency department complaining of a left lower quadrant (LLQ) abdominal pain associated with a painful swelling for 9 hours duration. Upon assessment, the patient was jaundiced and haemodynamically stable. Abdominal examination revealed a soft and lax but distended abdomen, with irreducible tender swelling over the LLQ, measuring around 3x2 cm. Laboratory investigations showed anemia, hypoalbuminemia, hyperbilirubinemia, lactic acidosis and prolonged coagulation profile. A contrast-enhanced computed tomography (CT) scan of the abdomen showed evidence of incarcerated left spigelian hernia. Moreover, advanced cirrhosis of the liver was detected with hypertrophy of the caudate lobe, extensive ascites and splenomegaly. After establishing the diagnosis of incarcerated spigelian hernia, with a picture of advanced liver cirrhosis, Child-Pugh-Turcotte (CPT) score of C and a Model for End-Stage Liver Disease (MELD) score of 19 and Mayo score for post-operative mortality of 16% in 7 days and 53% in 30 days. Given the patient’s condition which necessitates urgent operative intervention beside the risk of decompensation of pre-existing liver disease and high mortality. Decision was made to proceed with laparoscopic hernia repair. Intraoperatively, ischemic small bowel segment was resected with creation of end ileostomy. Conventional anatomical repair of the hernia defect was performed. Postoperatively, the patient was managed and resuscitated in critical care unit and then discharged home in a satisfactory condition on post-operative day 15. She passed away prior to liver transplantation, thirty-two days post-operatively in a different institution. Conclusion: The surgical management of complicated hernias in an emergency setting comprise a notable number of cases encountered by surgeons. It always needs special attention. Moreover, cirrhotic patients with their predicted high morbidity and mortality require even further vigilance. Therefore, a patient-tailored approach is always recommended when managing similar cases to provide optimal outcomes.
Complex Presentation of Seatbelt Syndrome Naif Alkhaldi, Sadeem Aljaman, Rahaf Alghamdi, Faten Aqeel, Mamon Nabri, Ayman Nasr, Humood sadery, Saleh Busbait Medical Archives, 2024 Background: Seat belt usage can lead to injuries like the "Seat-belt sign," an abdominal bruising from compression forces. When coupled with internal or lumbar injuries, this forms "Seat Belt Syndrome Objective: This report details the case of a young male involved in a frontal collision, presenting with severe multiple complicated injuries including abdominal trauma with multiple damage control surgeries. Case presentation: The patient presented to the emergency department after road traffic accident with a seat belt sign, Exploratory laparotomy unveiled extensive injuries, including complete jejunal transaction, avulsion of the terminal ileum, sigmoid mesentery avulsion, and rectosigmoid junction degloving with left anterolateral muscle destruction forming a traumatic hernia. Surgical interventions included jejunal resection and anastomosis, ileocecal limited resection and anastomosis, lastly Hartmann procedure and left high colostomy creation. Subsequent procedures addressed complications, in form of anastomotic leakage managed with resection of the ileocolic anastomosis and ileostomy creation, Vacuum-Assisted Closure dressing, and biological mesh placement to manage abdominal wall infection and dehiscence. After one year the patient underwent surgery for ileostomy and colostomy reversal, along with abdominal wall reconstruction using biosynthetic mesh. Conclusion: Managing injuries involving the jejunum, ileum, and rectosigmoid requires careful surgical intervention, considering individual cases and surgeon judgment. Our experience highlights the need for a modification in the emergency room policies, advocating immediate computed tomography scans for patients with seat belt signs for early detection and improved outcomes.
Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): An extremely rare cause of small bowel obstruction—Two case reports and a review of literature Humood A. Alsadery, Saleh Busbait, Abdulrahman AlBlowi, Morshed Alsawidan, Hassan Mohammed AlBisher, Shadi Alshammary Frontiers in Medicine, 2022 IntroductionSclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction in which the bowel and internal abdominal organs are wrapped with a fibrocollagenous cocoon-like encapsulating membrane [1,2]. SEP is divided into two entities: abdominal cocoons (AC), also known as idiopathic or primary sclerosing encapsulating peritonitis, which is of extremely rare type, and secondary sclerosing encapsulating peritonitis, which is the more common type.Case presentationTwo male patients from India, a 26 year old and a 36 year old, presented to our hospital complaining about abdominal pain associated with nausea and vomiting without any history of previous surgical interventions; the patients' vitals were stable. Preoperative diagnosis of abdominal cocoon was established by abdominal computed tomography. It showed multiple dilated fluid-filled small bowel loops in the center of the abdominal cavity with thin soft tissue, non-enhancing capsules encasing the small bowel loops with mesenteric congestion involving small and large bowel loops. Both patients underwent complete surgical excision of the sac without intraoperative complications. Patients had a smooth postoperative hospital course and were discharged home in good conditions.ConclusionPatients with abdominal cocoons have a non-specific clinical presentation of intestinal obstruction. A high index of clinical suspicion in combination with the appropriate radiological investigation will increase the chance of preoperative detection of the abdominal cocoon. In patients with complete bowel obstruction, complete excision of the peritoneal sac is the standard of care.
Occult Invasive Lobular Carcinoma Presenting as an Axillary Skin Metastatic Lesion Underwent Neoadjuvant Endocrine Therapy and Surgical Resection: A Case Report and Review of Literature Saleh Busbait, Abdullah M Alkhalifa, Shahad Aljohani, Hiyam Alhaddad Breast Cancer Targets and Therapy, 2022 Introduction Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5–15% of all breast cancer cases. It usually presents with nonspecific signs and symptoms. Occult breast cancer presenting as an axillary mass is rare, with prevalence of 0.3–1%, less likely with isolated cutaneous breast metastasis as a first presentation. There are limited data in the literature on patients who underwent endocrine therapy and complete surgical resection. Case Presentation A 54-year-old woman with left axillary skin swelling that had been persisting for 6 years was diagnosed with ILC 18 months ago presenting with an ulcerated axillary skin lesion and was managed with letrozole in another facility as she was estrogen receptor (ER) and progesterone receptor (PR) positive. She received letrozole for 18 months and had a partial response in the form of healing of the ulcer with persistent subcutaneous nodules. Her breast mammogram, ultrasound, and magnetic resonance imaging findings were unremarkable; however, there were few prominent left axillary lymph nodes. A biopsy of the left axillary lymph node was positive for malignancy, consistent with ILC. A skin punch biopsy of the axillary skin lesion showed ILC extending to the dermis with no background breast tissue. The patient underwent left modified radical mastectomy with excision of the left axillary skin lesion. The breast specimen comprised 0.4 mm of ILC as the primary malignancy and nine positive axillary lymph node malignancies. The patient received adjuvant radiotherapy and continued to receive letrozole. There were no signs of complications or recurrence during the follow-up period. Conclusion Ulcerated skin lesions in the axilla should raise concerns regarding breast cancer metastasis. In cases of isolated cutaneous breast metastases, surgical excision can be considered in combination with endocrine therapy.
Primary Ectopic Breast Carcinoma in Man Mimicking Keloid Jamal Alqahtani, Nasser Alzoabi, Bader Algamdi, Saleh Busbait, Ghada Alakloby, Mohammed Hajla, Nouf Alharbi, Omar Alakloby Medical Archives, 2022 Background: Ectopic breast tissues (EBT) are developmental abnormality found in 1-6% of normal population. Like an orthotopic breast tissue, ectopic breast may have similar pathological changes including malignancy. Breast cancer as well as ectopic breast tissue in male are extremely rare. We present a case of ectopic breast carcinoma (EBC) in middle aged man mimicking keloid. Case report: A forty-two-year-old Indo-Aryan male referred from primary health care to the dermatology clinic with firm multi-nodular, non-tender, fleshy sessile mass on his right axilla measuring two by three cm in diameter. Excision of this lesion revealed moderately differentiated ductal carcinoma consistent with ectopic breast carcinoma. Conclusion: We report this case to shed light on such a rare condition and to keep in mind that ectopic breast carcinoma should be in differential diagnosis of any suspicious mass in axillae.
