Fistula-in-ano is a benign anorectal disease which always poses a big dilemma to the surgeons
because of their significant recurrent rate following surgery. Materials and Methods: A cross-sectional study
involving 42 patients undergoing core out fistulectomy in the Hospital Tengku Ampuan Afzan, Kuantan,
Pahang, Malaysia were included in this study. Demographic data of patients were assessed. Endoanal
ultrasound (EAUS) was done prior to the surgery to determine types of fistula and classified using Park’s
classification. Follow up was made post-operatively at 4th week, 2nd month, 3rd month, 4th month, 5th month
and 6th month to look for the duration of healing or recurrence. Results: 5 out of 42 patients were lost to
follow up leaving 37 patients available for the analysis. Mean age of the patient was 38.4 (13.8) years old.
Transphincteric and intersphincteric type of fistula accounted for 54.5% and 40.1%, respectively. 62.2%
(n=23) of patients achieved primary healing after the procedure. The mean for healing duration was 3.7
(3.1) months. Recurrence of the disease was seen only in 37.8% (n=14) of the patients. Conclusions: Even
though we managed to achieve significant success rate cumulatively, recurrence of fistula still impose a
significant challenge toward patient’s management. Therefore, further prospective study with a bigger
sample size is recommended to look into this method to reduce recurrence of fistula.
Colorectal cancer (CRC) is the second most common cancer in Malaysia. In general, patients aged > 65 years comprise the majority of the population with CRC. However, recent reports indicate its increasing incidence in younger populations. We describe 4 cases of early onset colorectal cancer in Kuantan. Materials and method: This is a descriptive study of a small series of patients. Data between 2018 and 2019 were obtained from medical charts. Results: We diagnosed four patients under the age of 50 with colon cancer (75% male), the median age was 36 (23-47), with no comorbidities. None of the patient had family history of colorectal cancer. The majority of our patients presented with complication of tumour (2 perforation, 1 obstruction) required emergency surgeries. Only one patient presented with with rectal bleeding and was found to have tumor of the rectosigmoid junction. Two patients had tumor at descending colon and one at the splenic flexure. From this case series, we found there were one patient for every stage of colorectal cancer. Carcinoembryonic (CEA) levels were elevated at baseline in only two patients. Conclusion: Incidence of colon cancer rises among young patients in Kuantan. Further studies are needed to clarify the clinical and biological characteristics of colon cancer, improve its treatment strategies, and promote better outcomes in young patients.
GIST are rare tumor and uncommon to occur in rectum where it accounts about 5% of all GIST [1] and rarer to develop simultaneously. Several surgical options are available, large tumours with aggressive features have been commonly treated with abdominoperineal resection.This is the first reported case of synchronous GIST of the rectum and jejunum. Case report: 66 year old man who presented with rectal bleeding and altered bowel habit. Colonoscopy revealed submucosal tumor on anterior wall of the rectum. Computerized Tomography (CT) of abdomen and Magnetic Resonance Imaging (MRI) of pelvis demonstrated a mass of approximately 88 AP x 88 W x 89mm CC in size on the anterior wall of the rectum at a distance of 2.3 cm from the anal verge, without any invasion to the prostate or evidence of metastasis, Histological examination of the biopsy sample via the rectum showed spindle cell neoplasm suggestive of GIST. An abdominoperineal resection was performed with wedge resection of small bowel lesion who discovered intraoperatively as yellow mass measuring 1.5 cm in its diameter involving the serosa. Histopathological examination of the sample confirmed the diagnosis of GIST of both rectal and small bowel specimen with positive CD117 on immunohistochemical assessment. Patient recovered post operatively. Discussion: Incidence of GIST as overall are about 1/100000 per year and commonly found in stomach (60-70%), small intestine (20-25%) but rarely occur in rectum (5%). Because of the low incidence of rectal GISTs, cases of simultaneous development of a GIST in rectum and jejunum are scarce. Simple coincidence could be the reasonable explanation in our case. For rectal GIST, surgical procedures may be considered, including abdomino-perineal resection. Conclusion: Simultaneous GISTs in the rectum and jejunum is extremely rare. Resection is the treatment of choice, suspicious lesions discovered during operation should be biopsied or removed as GIST could appear synchronously.