MyMedR

Rupture of the caecum due to invasive amoebiasis

Rohela M, Lee A, Khairul Anuar A, Zuminee MN, Johari S

JUMMEC, 2000;5:51-52.

This paper describes a case of invasive arnoebiasis in a 72 year old woman. About 1 week prior to admission she had right iliac fossa pain and physical examination suggested perforated appendix or carcinoma of caecum. Laparotomy revealed perforation of caecum. Histopathology of tissue removed showed abundant trophozoites of Entamoeba histolytica. After surgery treatment was instituted and patient had an uneventful recovery. KEYWORDS: Rupture of caecum, amoebiasis

Matched MeSH terms: Laparotomy

Fulltext Two different surgical approaches for strangulated obturator hernias

Sze Li S, Kenneth Kher Ti V

Malays J Med Sci, 2012 Jan;19(1):69-72.

PMID: 22977378 MyJurnal

Obturator hernia is a rare condition that may present in an acute or subacute setting in correlation with the degree of small-bowel obstruction. Pre-operative diagnosis is difficult, as symptoms are often non-specific. A high index of suspicion should be maintained for emaciated elderly women with small-bowel obstruction without a previous abdominal operation and a positive Howship-Romberg sign. When diagnosis is in doubt, computed tomography scan of the abdomen and the pelvis (if available) or laparotomy should be performed immediately, as high mortality rate is related to the perforation of gangrenous bowels. We present 2 cases of strangulated obturator hernia, managed differently with both open and laparoscopic approaches. The diagnostic accuracy of computed tomography scan is highlighted followed by a brief literature review with an emphasis placed on surgical management.

Matched MeSH terms: Laparotomy

Fulltext Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery

Wan Fadzlina WM, Wan Mohd Nazaruddin WH, Rhendra Hardy MZ

Malays J Med Sci, 2016 Mar;23(2):28-37.

PMID: 27547112 MyJurnal

Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB.

Matched MeSH terms: Laparotomy

Fulltext Adhesive small bowel obstruction (ASBO) in children--role of conservative management

Vijay K, Anindya C, Bhanu P, Mohan M, Rao PLNG

Med J Malaysia, 2005 Mar;60(1):81-4.

PMID: 16250285

Adhesive small bowel obstruction (ASBO) is an annoying postoperative complication. Though the diagnosis can be made easily, the role of conservative management in children is controversial. Hence a study was conducted to determine the role of conservative management, and to identify the factors that can predict / influence the outcome of conservative treatment in children with ASBO. Children admitted with ASBO from 1980 to 2002 (22 year period) formed the material for this study. The data was analyzed with respect to the influence of age at the time of presentation, primary disease for which original laparotomy was done, time interval between the primary surgery and the development of ASBO and the number of laparotomies prior to the development of ASBO on the outcome of conservative management. There were 74 episodes of ASBO in 69 children (Five children had two episodes). Out of 74 episodes, 5 episodes (6.75%) needed immediate laparotomy for suspected gangrene. All others were managed conservatively. Of the 69 episodes managed conservatively, 36 responded to conservative treatment (2-5 days) while 33 required subsequent surgical intervention, with 11 of them requiring bowel resection (two for gangrene and 9 for bowel damage during adhesiolysis) and in the rest 22 cases adhesiolysis. A substantial number of children with ASBO respond well to conservative treatment. Majority of the children developed ASBO within three months after the primary laparotomy. Children below the age of one year (at the time of presentation with ASBO) responded poorly to the conservative management. Children who had primary surgery for Hirschsprung's disease and intussusception also appeared to have responded poorly to conservative management, but statistically not significant. Time interval between the primary surgery and the number of laparotomies before the child developed ASBO did not influence the outcome of conservative management.

Matched MeSH terms: Laparotomy/adverse effects

Some aspects of the sterilization program in Malaysia

Arshat H, Ali J, Noor Laily Abu Bakar

Malays J Reprod Health, 1984 Jun;2(1):1-13.

PMID: 12267515

Matched MeSH terms: Laparotomy*

Establishing learning curve for Tenckhoff catheter insertion by interventional nephrologist using CUSUM analysis: how many procedures and in which situation?

Goh BL, Ganeshadeva Yudisthra M, Lim TO

Semin Dial, 2009 Mar-Apr;22(2):199-203.

PMID: 19426429 DOI: 10.1111/j.1525-139X.2008.00536.x

Peritoneal dialysis (PD) catheter insertion success rate is known to vary among different operators, and peritoneoscope PD catheter insertion demands mastery of a steep learning curve. Defining a learning curve using a continuous monitoring tool such as a Cumulative Summation (CUSUM) chart is useful for planning training programs. We aimed to analyze the learning curve of a trainee nephrologist in performing peritoneoscope PD catheter implantation with CUSUM chart. This was a descriptive single-center study using collected data from all PD patients who underwent peritoneoscope PD catheter insertion in our hospital. CUSUM model was used to evaluate the learning curve for peritoneoscope PD catheter insertion. Unacceptable primary failure rate (i.e., catheter malfunction within 1 month of insertion) was defined at >40% and acceptable performance was defined at <25%. CUSUM chart showed the learning curve of a trainee in acquiring new skill. As the trainee became more skillful with training, the CUSUM curve flattened. Technical proficiency of the trainee nephrologist in performing peritoneoscope Tenckhoff catheter insertion (<25% primary catheter malfunction) was attained after 23 procedures. We also noted earlier in our program that Tenckhoff catheters directed to the right iliac fossae had poorer survival as compared to catheters directed to the left iliac fossae. Survival of catheters directed to the left iliac fossae was 94.6% while the survival for catheters directed to the right iliac fossae was 48.6% (p < 0.01). We advocate that quality control of Tenckhoff catheter insertion is performed using CUSUM charting as described to monitor primary catheter dysfunction (i.e., failure of catheter function within 1 month of insertion), primary leak (i.e., within 1 month of catheter insertion), and primary peritonitis (i.e., within 2 weeks of catheter insertion).

Matched MeSH terms: Laparotomy/education; Laparotomy/methods

An evaluation of quality of life in women with endometriosis who underwent primary surgery: a 6-month follow up in Sabah Women & Children Hospital, Sabah, Malaysia

M F A, Narwani H, Shuhaila A

J Obstet Gynaecol, 2017 Oct;37(7):906-911.

PMID: 28617056 DOI: 10.1080/01443615.2017.1312302

Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p

Matched MeSH terms: Laparotomy/methods; Laparotomy/psychology

Fulltext Large tubular colonic duplication in an adult treated with a small midline incision

Yong YG, Jung KU, Cho YB, Yun SH, Kim HC, Lee WY, et al.

J Korean Surg Soc, 2012 Mar;82(3):190-4.

PMID: 22403754 DOI: 10.4174/jkss.2012.82.3.190

Tubular colonic duplication presenting in adults is rare and difficult to diagnose preoperatively. Only a few cases have been reported in the literature. We report a case of a 29-year-old lady presenting with a long history of chronic constipation, abdominal mass and repeated episodes of abdominal pain. The abdominal-pelvic computed tomography scan showed segmental bowel wall thickening thought to be small bowel, and dilatation with stasis of intraluminal content. The provisional diagnosis was small bowel duplication. She was scheduled for single port laparoscopic resection. However, a T-shaped tubular colonic duplication at sigmoid colon was found intraoperatively. Resection of the large T-shaped tubular colonic duplication containing multiple impacted large fecaloma and primary anastomosis was performed. There was no perioperative complication. We report, herein, the case of a T-shaped tubular colonic duplication at sigmoid colon in an adult who was successfully treated through mini-laparotomy assisted by single port laparoscopic surgery.

Matched MeSH terms: Laparotomy

Fulltext Superselective mesenteric arterial branch cannulation for intraoperative identification of bleeding intestinal mucosal lesions

Mahadeven M, Samad SA, Leong KS

Med J Malaysia, 1994 Jun;49(2):192-4.

PMID: 8090105

The intraoperative localisation of small intestinal bleeding lesions identified at pre-operative angiography has always been difficult, resulting in extensive resections in doubtful cases. We report two patients in whom, at angiography, a small intestinal lesion was noted to be the cause of gastrointestinal haemorrhage. They then underwent superselective mesenteric arterial cannulation at a second angiographic procedure and were operated upon with the angiographic catheter left within the branch responsible for the bleeding. This superselective catheter placement facilitates precise localisation of the bleeding site intraoperatively, enabling limited segmental resection of bowel. Both patients have had no recurrent bleeding episodes.

Matched MeSH terms: Laparotomy

Rare case of huge retroperitoneal liposarcoma presenting as a gynaecological problem

Kuppuvelumani P, Rachagan SP, Syed N, Kumar G, Cheah PL

Eur J Obstet Gynecol Reprod Biol, 1993 Mar;48(3):220-2.

PMID: 8335141

A large retroperitoneal liposarcoma presented clinically as an ovarian tumour in an infertile woman. The importance of computed tomography in the differential diagnosis and the appropriate management of retroperitoneal liposarcoma is presented with a review of the relevant literature.

Matched MeSH terms: Laparotomy

Fulltext Massive ovarian cysts--successful management of two cases

Ravindran J

Med J Malaysia, 1994 Sep;49(3):303-5.

PMID: 7845287

Massive ovarian cysts are not commonly encountered. They frequently present a challenge to the gynaecologist who is faced with them. Two cases of successful removal of massive ovarian cysts are presented. Successful management would involve recognition of complications which occur at various steps in the treatment.

Matched MeSH terms: Laparotomy

Fulltext Co-existing tubal ectopic pregnancy and appendicitis--a case report

Chia P, Jeyarajah A

Med J Malaysia, 1996 Dec;51(4):485-7.

PMID: 10968040

Appendicitis in pregnancy has a well documented high morbidity due to the difficulty in diagnosis. However, synchronous ectopic pregnancy and appendicitis is a rare event. This report describes the case of a 22-year-old lady of Bangladeshi origin who presented with both these conditions. The importance of prompt diagnosis and early surgical intervention, the inherent difficulties in diagnosis and the possible interrelated aetiological factors are discussed.

Matched MeSH terms: Laparotomy

Fulltext Perforated peptic ulcers in West Malaysia--a series of 73 cases treated by simple closure in a general hospital between 1972 and 1974

Said MY

Med J Malaysia, 1982 Sep;37(3):261-4.

PMID: 7177009

In a 3 year period 73 cases of perforated peptic ulcers were treated by simple closure. The overall mortality of 3.77 percent is acceptable when compared with other reports. There was a marked male preponderance (11 males: female 1). Biopsy results confirmed the operatiue findings that perforations were seven times more common in gastric peptic ulcers than duodenal ones. The disease affected young adults, the middle aged and elderly, the peak incidence occurring between the fifth and seventh decades oflife. Simple closure was an effective surgical procedure for our group of patients.

Matched MeSH terms: Laparotomy

Fulltext Gastric trichobezoar in an end-stage renal failure and mental health disorder presented with chronic epigastric pain: A case report

Ali AA, Gurung R, Fuad ZM, Moosa M, Ali I, Abdulla A, et al.

Ann Med Surg (Lond), 2020 Oct;58:76-79.

PMID: 32953103 DOI: 10.1016/j.amsu.2020.08.021

Background: Gastric trichobezoar happens when there is an indigestible substance or food found in the gastrointestinal tract. It is a rare presentation which is usually associated with trichotillomania and trichopagia. The presentation may not be specific and is usually related to dyspepsia-like symptoms. In the worst-case scenario, this may cause gastric outlet or intestinal obstruction which eventually requires surgery.

Case presentation: We present a 36-year-old lady with underlying end-stage renal failure (ESRF) and undiagnosed mental health issues who was treated for recurrent episodes of gastritis. Imaging modalities revealed intragastric foreign body ingestion which is consistent with gastric trichobezoar. She eventually underwent laparotomy and gastrotomy to remove the foreign body. Postoperatively, she was referred and followed-up by the psychiatric team.

Conclusion: Gastric trichobezoar has strong associations with psychiatric disorders. With the co-existence of an ESRF, uraemia might contribute to the aetiology of the trichotillomania and trichophagia. Open surgery is the choice of definitive management especially if bezoars are larger. Should the recurrence be remitted, a biopsychosocial modality and regular haemodialysis is the most sustainable approach to ensure the behaviour does not persist.

Matched MeSH terms: Laparotomy

Emergency Laparotomy in a COVID-19 patient with acute abdomen

Hassan R, Johari M, Nijhar JS, Sharifah BSA, Low LL, Amri N

Med J Malaysia, 2021 03;76(2):254-257.

PMID: 33742640

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.

Matched MeSH terms: Laparotomy

Fulltext The effects of nicotine on foetal loss, postnatal growth and plasma oestrogen and progesterone levels in rats

Siti Norashikin Mohd Tambeh, Sumitabha Ghosh, Mohd Hamim Rajikin

Journal of Clinical and Health Sciences, 2019;4(2):75-81.

MyJurnal

Introduction: The present study aims to investigate the effects of nicotine on foetal loss,
postnatal growth and corresponding levels of oestrogen and progesterone in pregnant rats.
Methods: Subcutaneous injection of nicotine tartrate (7.5 mg/kg/day) was administered to
groups of pregnant rats; with treatment scheduled from day 1 through day 5, day 5 through
day 9 or day 1 through day 9 of pregnancy. On day 10 of pregnancy, laparotomy was
performed to count the number of blastocyst implantation sites. During parturition, the
number of viable pups was recounted and statistically compared with the controls. One
group of rats which received nicotine from day 1 through day 9 of pregnancy was sacrificed
on day 16 of pregnancy, and circulating levels of oestrogen and progesterone were
measured. Upon delivery, the birth weight of the pups was measured, and their weights were
recorded until weaning. Results: There was a significant increase in foetal loss particularly in
rats which received nicotine from day 5 through day 9 and from day 1 through day 9 of
pregnancy. There was also significantly lower birth weight of pups in all groups; however,
this pattern did not continue until weaning. Plasma oestrogen level was significantly elevated
with a significant decrease in the plasma progesterone level. Conclusions: Nicotine
administration during pregnancy showed an increase in foetal loss with a corresponding
increase in oestrogen and decrease in progesterone levels. Although the birth weight of the
pups was low, there was catch-up growth in the pups.

Matched MeSH terms: Laparotomy

Fulltext The challenge in diagnosing and managing heterotopic interstitial pregnancy in natural conception

Noor Azura Noor Mohamad, Suzanna Daud, Sun Ta Thow, Darminder Singh Chopra, Bahiyah Abdullah

Journal of Clinical and Health Sciences, 2019;4(2):86-90.

MyJurnal

Heterotopic interstitial pregnancy in natural conception is very rare. Definitive diagnosis is
made by systematic pelvic ultrasound. Simultaneous viable conception observed in both intraand extra-uterine is pathognomonic of heterotopic interstitial pregnancy. We report a 34-yearold woman primigravida at 10 weeks’ amenorrhoea who underwent evacuation of retained
product of conception for missed miscarriage. Intraoperatively, minimal product of conception
was retrieved. Bedside pelvic ultrasound showed cystic mass at right superolateral part of
uterine fundus suspicious of interstitial pregnancy. Cornual resection was performed via
laparotomy. Histopathological examination showed presence of product of conception and
interstitial pregnancy. Serum β-human chorionic gonadotropin dropped from 10,027 IU/l on day
one post-ERPC to 210 IU/l at day three post-cornual resection. This case report highlighted
the challenge in diagnosing heterotopic interstitial pregnancy conceived naturally. Timely
diagnosis may avert dire consequences of massive haemorrhage from ruptured uterine cornua

Matched MeSH terms: Laparotomy

Fulltext Huge Retroperitoneal Cyst Masquerading as Ovarian Tumour: A Case Report

Johan S, Hassan MF, Hayati F, Azizan N, Payus AO, Edwin See UH

Front Surg, 2020;7:585411.

PMID: 33195391 DOI: 10.3389/fsurg.2020.585411

Retroperitoneal cystic mass is a rare surgical condition that is often misdiagnosed preoperatively. Here, we report a case of a 56-year-old woman who presented with abdominal swelling for a 1-year duration, which was associated with lower abdominal pain for 6 months. Her abdominal radiograph showed a huge radiopaque lesion, and contrast-enhanced computed tomography scan of the abdomen reported it as a left ovarian serous cystadenoma causing local mass effect to the left ureter leading to mild left hydronephrosis. She underwent exploratory laparotomy and noted there was a huge retroperitoneal cystic mass. The histopathological assessment finding was consistent with a benign retroperitoneal cyst. This case report aims to share the rare case of primary retroperitoneal lesions, which can cause a diagnostic challenge preoperatively to all clinicians despite advanced achievement in medical imaging.

Matched MeSH terms: Laparotomy

An unusual cause of acute abdomen and acute renal failure: Djenkolism

Sumitro K, Yong CS, Tan LT, Choo S, Lim CY, Shariman H, et al.

Malays Fam Physician, 2020;15(2):50-52.

PMID: 32843946

The djenkol bean (Archidendron pauciflorum) is a native delicacy in Southeast Asia, though consumption can sometimes lead to djenkolism. Clinical features of djenkolism include acute abdominal pain, hematuria, urinary retention, and acute kidney injury (AKI). The pain can be severe, which often leads to a misdiagnosis of acute abdomen. In this paper, we report the case of an Indonesian migrant with djenkolism. Due to the short history and severity of the abdominal pain, medical professionals suspected acute abdomen and proceeded with a negative exploratory laparotomy. However, djenkolism was suspected once relatives informed the professionals that the patient had consumed djenkol beans hours earlier. The patient recovered through aggressive hydration and urine alkalinization with bicarbonate infusion. We highlight the importance of being aware of this rare cause of AKI, especially in Southeast Asia, in order to provide early diagnoses and prompt treatments.

Matched MeSH terms: Laparotomy

Fulltext Abdominal Mass in the Puerperium: Challenges in Diagnosis

Muniandy, Sadesvaran, Teo, Yvonne Chiang Hoon, Suleman, Aehtoosham, Ramaiah, Prakash Doddaballapur

Borneo Journal of Medical Sciences, 2019;13(3):37-42.

MyJurnal

Ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia. Epithelial ovarian cancer accounts for 90% of all ovarian tumours. Herein, we present a rapidly growing ovarian tumour in a young female patient, following an uneventful vaginal delivery at home. We discuss on the challenges of making said diagnosis in a post-partum patient who presented with abdomen distension. A 19-yearold lady presented to the Emergency Department three days after spontaneous vaginal delivery at home. Her chief complaint was that of a rapidly progressive abdominal distension. Diagnostic and therapeutic emergency laparotomy were done, revealing a huge cystic ovarian mass. Histopathology reported a high grade, serous ovarian carcinoma. There are multiple causes for abdominal distension in post-partum women, however priority should be given into looking for gynaecological origin, given the changes in hormone. Sudden abdominal distension during post-partum period is rare and a systemic approach in its management is vital. There is, inarguably, a role of diagnostic and therapeutic laparotomy in this.

Matched MeSH terms: Laparotomy

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