Saint’s triad – Knowledge and References

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Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021

This patient is suffering from diverticular disease, which is defined as diverticula with symptoms. Diverticula are outpouchings of the colonic wall and they usually result from the herniation of the mucosa through the muscular layer due to the penetration of mesenteric vessels. They are most common in the sigmoid colon. Diverticulosis is the asymptomatic presence of diverticula; diverticulitis is the evidence of diverticular inflammation with or without localised symptoms or signs. Remember Saint’s triad of a hiatus hernia, diverticular disease and cholelithiasis, which is indicative of a Western lifestyle.

Hickam’s Dictum: Pseudoxanthoma elasticum and Usher syndrome in a single patient

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Published in Ophthalmic Genetics, 2020

Kevin Wang, Brittney Statler, Michael Ramos, Meghan J DeBenedictis, Amy Babiuch, Alex Yuan, Elias I. Traboulsi

Occam’s razor is the reductionist principle that “entities should not be multiplied without necessity”. In clinical practice, Occam’s razor is applied by choosing the simplest and most unifying diagnosis to explain a patient’s physical abnormalities. Contrary to this are Saint’s Triad and Hickam’s Dictum. South African surgeon Charles F.M. Saint observed that patients with atypical abdominal pain often had concurrent cholelithiasis, hiatal hernia, and diverticulosis without a unifying explanation. Saint used the triad to emphasize to medical students that more than one disease can explain a patient’s presenting signs and symptoms. Less elegantly, American physician John Hickam summarized this best by stating, “A man can have as many diseases as he damn well pleases”.

Saint's triad

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Hickam’s Dictum: Pseudoxanthoma elasticum and Usher syndrome in a single patient