14 research outputs found
Factors associated with the recurrence of complicated diverticular disease
No full textColonic diverticula is observed in over 60% of the western population aged over 80 where up to 30% will eventually be symptomatic and may develop complications. The natural history and etiology of colonic diverticula have been well described. However, predictive indicators of complicated diverticular disease are not known thus preventing the prophylactic treatment of this subset of patients,. The aim of this study was to observe patients with complicated diverticular disease in order to identify common factors associated with recurrent complications. All hospital admissions from January 2005 to December 2008 for complications of diverticular disease were recruited. Using logistic regression, demographic data and factors such as clinical presentation, nature of complication, lifestyle, concomitant medical illness and medications that may be associated with recurrent episodes of complications were analyzed. A total of 121 patients were diagnosed with complicated diverticular disease during the study period with 24 patients having recurrent complications. Logistic regression analysis performed after controlling for confounders found active smoking (p=0.006) and alcohol consumption (p=0.036) along with underlying diabetes (p=0.031) and dyslipidemia (p=0.039) significantly associated with an increased risk of recurrent complications. We therefore concluded that smoking, alcohol consumption, diabetes mellitus and dyslipidemia are associated with recurrent complicated colonic diverticular disease. As these are modifiable risk factors, they should be sought for during the presentation of the first attack. Aggressive control of these factors will help in reducing the risk of recurrent complications
Uterine rupture mimicking Wunderlich’s syndrome in pregnancy: An unfortunate case
No full textIntroduction: Wunderlich’s syndrome (WS), characterized by non-traumatic renal haemorrhage into the subscapular and perinephric space is a rare entity in pregnancy. Aim: This article highlights the incidental discovery of a pregnant woman with WS that resulted in emergency nephrectomy. Case study: A 31-year-old gravida 4 para 3 female with 3 previous caesarean sections presented with acute abdomen and was in shock. The abdominal ultrasound revealed gross haemoperitoneum. With the preoperative diagnosis of a uterine rupture, surgical exploration was done showing an extensive right perinephric hematoma and active bleeding from the renal hilum. No renal tumor or pseudoaneurysm of the renal hilum was noted. Emergency nephrectomy was performed. Unfortunately, the foetus did not survive the ordeal. Results and discussion: WS occurs as a result of renal neoplasms, idiopathic causes, vascular diseases, infection, and miscellaneous. Ultrasonography can help to identify the perinephric hematoma, meanwhile, colour and/or spectral Doppler can aid in the detection of vascular pathologies. Contrast-enhanced computed tomography is still the imaging modality of choice. In pregnancy, a magnetic resonance imaging would be a better modality, avoiding radiation exposure to the foetus and consequent foetal malformations. Treatment includes arterial embolization and/or operative management such as nephrectomy. Conclusions: WS in pregnancy is a rare clinical entity requiring a high index of clinical suspicion for diagnosis. WS needs to be considered in pregnant patients presenting with shock with the presence of perinephric hematoma. A multidisciplinary approach is essential in providing optimum care
Mistaking primary hepatic tuberculosis for malignancy: Could surgery have been avoided?
No full textSummaryA 56-year-old woman presented with epigastric pain and loss of appetite and weight for the preceding 3 weeks. Clinically, she was jaundiced with upper quadrant abdominal tenderness. Initial blood tests and imaging scans suggested cholangiocarcinoma. Intraoperatively, no malignancy was observed. A frozen section biopsy suggested tuberculosis (TB). However, subsequent serological examination showed that the patient was nonreactive for human immunodeficiency virus, hepatitis B, hepatitis C, and acid-fast bacilli. A chest radiograph also showed no evidence of pulmonary TB. The patient was then placed on antitubercular therapy and her condition improved. Primary hepatic TB was not initially considered during diagnosis because of its low prevalence, but this led to performing an unnecessary surgery on this patient. We review the literature on this rare condition and discuss potential strategies for diagnosing and managing patients with primary hepatic TB
A rare presentation of low-grade appendiceal mucinous neoplasm within an amyand’s hernia: a case report
No full textAn Amyand’s hernia is characterised as the presence of the appendix in an inguinal hernial sac. During laparoscopic cholecystectomy for gallbladder polyps, an incidental Amyand’s hernia was discovered in a 75-year-old female patient. On examination, the hernia contained an appendiceal mucocele but no evidence of perforation. An open appendicectomy with tension-free mesh repair was performed for the hernia. The histopathological report of the appendix was a low-grade appendiceal mucinous neoplasm (LAMN), an entity that is just as rare as an Amyand’s hernia. The patient had the right inguinal swelling for over 10 years but it was thought to be an inguinal intramuscular cyst as reported on a previous abdominal ultrasound. Mucocele of the appendix may have a benign or malignant appendiceal progress, leading to individualised diagnosis and treatment. We review an Amyand’s hernia with LAMN and discuss the asymptomatic tendency yet malignant potential of appendiceal mucoceles along with treatment strategies
The great masquerader of pancreatic tuberculosis
No full textBackground: Pancreatic tuberculosis is a rare clinical entity. It represents a diagnostic challenge as the clinical presentation may mimic pancreatic malignancy. Case presentation: A 66-year-old gentleman presented with an incidental finding of a pancreatic tail mass on routine ultrasonography of the abdomen whilst working up on chronic kidney disease. He denied abdominal pain, fever, night sweats, constitutional symptoms or tuberculosis contact. On examination, there was no palpable mass per abdomen. The tumour marker of Ca 19-9 was normal. Ultrasonography revealed a lobulated heterogeneous hypovascular and hypoechoic mass at the tail of the pancreas. Contrast-enhanced computed tomography (CT) of the thorax and abdomen revealed a thickened right pleura, right pleural effusion with right lung collapsed consolidation and multiple mediastinal lymph nodes. There is an ill-defined hypodense mass seen in the tail and body of the pancreas measuring 3 × 7 × 3 cm with the presences of calcification within. The constellation of CT findings suggests a pancreatic malignancy with metastasis to the lungs. Endoscopic ultrasonography (EUS) assessment showed an irregular hypoechoic mass measuring 3.0 × 2.7 cm at the tail of the pancreas. Multiple rounded hypoechoic lesions were also seen scattered within the body of the pancreas with multiple enlarged para-aortic lymph nodes. A fine-needle aspiration biopsy of the lesion was consistent with granulomatous inflammation. The diagnosis of disseminated tuberculosis was made. The patient was subsequently started on antitubercular medication and recovered well. Conclusion: A high index of suspicion is needed to diagnose pancreatic tuberculosis, especially in patients whose radiological imaging shows a pancreatic mass with necrotic peripancreatic lymphadenopathy in endemic countries. EUS-guided fine-needle aspiration is the diagnostic modality of choice, and vigorous attempts should be made at obtaining a preoperative histological or bacteriological diagnosis to avoid unnecessary surgery
The indigenous young man with progressive abdominal distension
No full textThe incidence of pancreatic ascites is unusual. It is uncommon sequelae of chronic pancreatitis. Smith first discovered it in 1953 in the literature. The etiology includes chronic pancreatitis, pancreatic pseudocyst, pancreatic trauma and idiopathic in origin. Despite a rise in the incidence, it is scarcely reported. This is a case of a 20-year-old man presented with repeated acute pancreatitis episode complicated with gross ascites. Pancreatic duct stones were identified intra-operatively. Frey’s surgery was the procedure of choice. We discuss the presentation, choice of treatment and outcome
Symptomatic Benign Breast Cyst in a Young Male
No full textSimple breast cysts are benign lesions diagnosed in premenopausal women commonly presenting with a palpable breast lump. They are, however, extremely rare in males due to the absence of lobular tissue in the male breast. We report a case of a benign breast cyst in a 19-year-old male who presented with a left breast lump and nipple discharge. Clinical examination revealed a non-tender 2x2 cm mobile retro-areolar lump in the left breast with clear serous nipple discharge upon milking of the duct. Ultrasonography showed typical features suggestive of a simple breast cyst and fine needle aspiration cytology revealed epithelial cells of apocrine origin, thus confirming the diagnosis. We review the literature and discuss the approach to investigation of these uncommon lesions presented in males
A LESS INVASIVE METHOD OF REDUCING THE INCIDENCE OF POST-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS: INTRAVENOUS DICLOFENAC SODIUM VERSUS PLACEBO
No full textObjective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium.Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients\u27 demographic data were also observed.Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm and 63 into the placebo arm. There was an increase of 7.6% PEP rates in the placebo group (12.7% vs. 5.1% in the treatment arm). However, this was not statistically significant (p=0.142)Conclusion: This study shows that IV diclofenac sodium can decrease PEP but is not statistically significant
EtOH-LN cryoembedding workflow to minimize freezing artifact in frozen tissues: A pilot study in preparing tissues compatible with mass spectrometry-based spatial proteomics application
No full textCoolant-assisted liquid nitrogen (LN) flash freezing of frozen tissues has been widely adopted to preserve tissue morphology for histopathological annotations in mass spectrometry-based spatial proteomics techniques. However, existing coolants pose health risks upon inhalation and are expensive. To overcome this challenge, we present our pilot study by introducing the EtOH-LN workflow, which demonstrates the feasibility of using 95 % ethanol as a safer and easily accessible alternative to existing coolants for LN-based cryoembedding of frozen tissues. Our study reveals that both the EtOH-LN and LN-only cryoembedding workflows exhibit significantly reduced freezing artifacts compared to cryoembedding in cryostat (p < 0.005), while EtOH-LN (SD = 0.56) generates more consistent results compared to LN-only (SD = 1.29). We have modified a previously reported morphology restoration method to incorporate the EtOH-LN workflow, which successfully restored the tissue architecture from freezing artifacts (p < 0.05). Additional studies are required to validate the impact of the EtOH-LN workflow on the molecular profiles of tissues
