Saint’s Triad

Saint’s Triad is the association of hiatal hernia, gallbladder disease, and diverticulosis in patients with atypical abdominal symptoms.

Termed by British surgeon Professor Charles Frederick Morris Saint who emphasized:

…the importance of considering the possibility of multiple separate diseases in a patient whenever his or her history and the results of the physical examination were atypical of any single condition.

Saint created this concept to caution medical students against misuse of Occam’s Razor ‘the simplest solution is usually the correct one’. Hilliard A. N Engl J Med. 2004.

The principle underlying Saint’s triad is also expressed as Hickam’s Dictum which asserts that at no stage should a particular diagnosis be excluded solely because it doesn’t appear to fit the principle of Occam’s razor.

Associated Person

• Charles Frederick Morris Saint (1886 – 1973)
• William of Occam (1287 – 1347)
• John Bamber Hickam (1914 – 1970)

Clinical Validation

Systematic research of 684 patients subjected to radiological examinations found 7 cases of Saint’s triad (1.02%) and 86 cases of bifocal associations; 59 cholelithiasis with diverticulosis, 17 cholelithiasis with hiatus hernia; 10 diverticulosis with hernia. Scaggion G.Minerva Med. 1987.

References

• Saint CFM. Saint’s triad.The origin and story of its recognition. Rev Surg. 1966; 23: 1-4.
• Burkitt DP, Walker AR. Saint’s triad: confirmation and explanation. S Afr Med J. 1976 Dec 18;50(54):2136-8.
• Hilliard AA, Weinberger SE, Tierney LM, Midthun DE, Saint S. Occam’s Razor versus Saint’s Triad. N Engl J Med 2004; 350: 599-603
• Scaggion G, Poletti G, Riggio S. Saint’s triad. Statistico-epidemiologic research and case contribution. Minerva Med. 1987