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Colo-appendico-duodenal fistula: Rare presentation of extrapulmonary tuberculosis

Gan DEY, Sibin R, Payus AO, Hayati F

Clin Case Rep, 2021 Oct;9(10):e04797.
PMID: 34631061 DOI: 10.1002/ccr3.4797

A colo-appendico-duodenal fistula is a rare occurrence that results from extrapulmonary tuberculosis (TB) complications, especially in the endemic region.
Malignant Subcutaneous Perivascular Epithelioid Cell Tumor of Anterior Abdominal Wall

Gan DEY, Choy RXY, Sellappan H, Hayati F, Azizan N

Oman Med J, 2021 Mar;36(2):e239.
PMID: 33768970 DOI: 10.5001/omj.2021.21

Perivascular epithelioid cell tumors (PEComas) are a family of rare mesenchymal tumors with discrete histological and immunohistochemical characteristics. Even rarer among them are cutaneous and subcutaneous PEComas. We describe a 34-year-old woman who presented with a large anterior abdominal subcutaneous lesion showing intact overlying skin and no obvious invasion of the abdominal musculature. A wide local excision was performed. Histopathology revealed a solitary tumor measuring 75 × 55 × 90 mm with epithelioid cells in nests with thin fibrovascular septa and spindle cells. Resection margins were clear with no invasion to the skin or rectus sheath. Tumor cells were positive for HMB-45 but negative for other markers. This is the largest subcutaneous PEComa reported to date.
Fulltext Choledochal cyst and aberrant biliary configuration along with situs inversus totalis: a case report

Gan DEY, Alagoo D, Chan KH, Choi RXY, Sellappan H, Sharif MS, et al.

Pan Afr Med J, 2021;38:398.
PMID: 34381542 DOI: 10.11604/pamj.2021.38.398.29228

Situs inversus totalis is the complete transpositioning of thoracoabdominal viscera into a mirror image of the normal configuration. Choledochal cyst is the congenital cystic dilation of the biliary tract. Both these conditions coexisting in a patient is extremely rare. We hereby present a case of type IC choledochal cyst in a patient with situs inversus totalis presenting with biliary sepsis secondary to choledocholithiasis. Also detailed are the management and operative strategies employed to deal with this rare entity.
Rectal Foreign Body: A Successful Removal at the Bedside and Detailing of a Stepwise Management

Gan DEY, Chan KH, Veerappan P, Sun KJ, Hayati F

Am J Case Rep, 2021 Jun 17;22:e930967.
PMID: 34135299 DOI: 10.12659/AJCR.930967

BACKGROUND A rectal foreign body (RFB) can be stigmatizing for patients and present a dilemma for the treating physician. Removal can be challenging owing to the variety of objects introduced. The goals of therapy are to safely remove the RFB and to minimize injury to the bowel. CASE REPORT A 22-year-old man was referred from a district hospital to our institution after being unable to remove a self-inflicted RFB after sexual gratification. He was hemodynamically stable with a soft and nontender abdomen. A mass was felt in the suprapubic region. Abdominal radiography revealed a well-defined radiolucent object in the pelvic region, which was consistent with a lubricant bottle. No sign of bowel obstruction or perforation was observed. The RFB was successfully retrieved by a combination of transrectal digital manipulation and directed gentle abdominal pressure, allowing for descent of the RFB and transanal traction at the bedside. Various approaches have been described for removal of a RFB, from simple bedside strategies to open surgery for complicated cases. Endoscopy and minimally invasive techniques have also demonstrated a role in formulating a tailored approach. CONCLUSIONS We describe a successful retrieval of an RFB at the bedside, avoiding unnecessary open surgery.
Performance and diagnostic accuracy of scoring systems in adult patients with suspected appendicitis

Gan DEY, Nik Mahmood NRK, Chuah JA, Hayati F

Langenbecks Arch Surg, 2023 Jul 06;408(1):267.
PMID: 37410251 DOI: 10.1007/s00423-023-02991-5

BACKGROUND: This study aims to determine the most accurate appendicitis scoring system and optimal cut-off points for each scoring system.
METHODS: This single-centred prospective cohort study was conducted from January-to-June 2021, involving all patients admitted on suspicion of appendicitis. All patients were scored according to the Alvarado score, Appendicitis Inflammatory Response (AIR) score, Raja Isteri Pengiran Anak Saleha (RIPASA) score and Adult Appendicitis score (AAS). The final diagnosis for each patient was recorded. Sensitivity and specificity were calculated for each system. Receiver operating characteristic (ROC) curve was constructed for each scoring system, and the area under the curve (AUC) was calculated. Optimal cut-off scores were calculated using Youden's Index.
RESULTS: A total of 245 patients were recruited with 198 (80.8%) patients underwent surgery. RIPASA score had higher sensitivity and specificity than other scoring systems without being statistically significant (sensitivity 72.7%, specificity 62.3%, optimal score 8.5, AUC 0.724), followed by the AAS (sensitivity 60.2%, specificity 75.4%, optimal score 14, AUC 0.719), AIR score (sensitivity 76.7%, specificity 52.2%, optimal score 5, AUC 0.688) and Alvarado score (sensitivity 69.9%, specificity 62.3%, optimal score 5, AUC 0.681). Multiple logistic regression revealed anorexia (p-value 0.018), right iliac fossa tenderness (p-value 0.005) and guarding (p-value 0.047) as significant clinical factors independently associated with appendicitis.
CONCLUSION: Appendicitis scoring systems have shown moderate sensitivity and specificity in our population. The RIPASA scoring system has shown to be the most sensitive, specific and easy-to-use scoring system in the Malaysian population whereas the AAS is most accurate in excluding low-risk patients.