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  1. Imaging appearances of hepatic tuberculosis: experience with 12 patients
    Ch'ng LS, Amzar H, Ghazali KC, Siam F
    Clin Radiol, 2018 03;73(3):321.e11-321.e16.
    PMID: 29174175 DOI: 10.1016/j.crad.2017.10.016
    AIM: To review computed tomography (CT), ultrasound (US), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiogram (PTC) appearances and their diagnostic value in hepatic tuberculosis.

    MATERIALS AND METHODS: The imaging studies for 12 patients with biopsy-proven hepatic tuberculosis from January 2012 till March 2014 were reviewed retrospectively. These cases were confirmed via ultrasound-guided biopsy.

    RESULTS: The patients were aged 24-72 years. Four patients had parenchymal tuberculosis only and eight patients had mixed parenchymal and biliary duct involvement. The parenchymal tuberculosis patients showed poorly enhancing, hypodense nodules on CT with central calcification and adjacent dilated intrahepatic ducts. Most patients had multiple lesions except for two patients with a single lesion. The size of the lesions ranged from 0.5 to 6 cm. Seven patients with biliary duct involvement showed a hilar strictures involving the intrahepatic ducts and common bile duct. Nine of the patients showed hilar stricture with atrophy of the ipsilateral lobe of the liver and compensatory hypertrophy of the contralateral lobe. Hepatolithiasis was seen in five patients. Tuberculous lung involvement was seen in seven patients.

    CONCLUSION: The presence of calcified and hypodense nodules with biliary duct dilatation associated with lobar atrophy were the most consistent features of hepatic tuberculosis, especially in the presence of active lung disease.

  2. Operative strategies and outcomes for patients with severe pulmonary artery hypertension and intestinal obstruction: case series from single institution-sharing lessons to improve surgical outcomes
    Ghazali KC, Mat AD, Yaacob H, Hamdan MUO, Sidek ASM
    J Surg Case Rep, 2024 Nov;2024(11):rjae711.
    PMID: 39564073 DOI: 10.1093/jscr/rjae711
    Pulmonary hypertension is a known perioperative risk factor that carries a high morbidity and mortality rate. Severe pulmonary hypertension is related to high morbidity after general anaesthesia. We are reporting three patients with underlying severe pulmonary hypertension, who presented with intestinal obstruction managed with different perioperative approaches. In case 1, a 38-year-old man with Eisenmenger syndrome and severe pulmonary hypertension underwent exploratory laparotomy, right hemicolectomy, and double barrel stoma for obstructed right-sided colonic tumour. He passed away on Day 6 post-operation. In case 2, a 52-year-old man with Eisenmenger syndrome and severe pulmonary hypertension presented with obstructed rectosigmoid tumour and jejunojejunal intussusception and underwent exploratory laparotomy and Hartmann's procedure. He succumbed after 33 days of fighting with cardiovascular and respiratory complications. In case 3, a 65-year-old woman, with strangulated paraumbilical hernia, underwent mini laparotomy, small bowel resection, primary anastomosis, and paraumbilical hernia repair under monitored sedation and local anaesthesia. She was discharged home after 7 days of hospitalization.
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