MyMedR

Fulltext Stomach trichobezoar (rapunzel syndrome) with iatrogenic intussusception

Yik YI, How AK

Med J Malaysia, 2016 04;71(2):74-6.

We present a rare case of stomach trichobezoar complicated with iatrogenic intussusception noted intra-operatively after failed attempt of endoscopic removal in a 13-year-old girl. At presentation, she had gastric outlet obstruction with anaemia. Endoscopy established the diagnosis of trichobezoar. Surgical removal was warranted after failed endoscopic removal. Her postoperative course was uneventful. Detailed history and careful examination disclosed trichotillomania and associated trichophagia. Psychiatric referral was sought with the intention to prevent future recurrence.

An unexpected encounter with jejunal web after foreign bodies entrapment in a toddler

Yik YI, How AK

Med J Malaysia, 2019 Jun;74(3):231-233.

PMID: 31256180

We present a very rare case of jejunal web discovered after a toddler presented with foreign bodies entrapment, following incidental ingestion. This is perhaps the first case reported in the English publication. Expectant management with spontaneous passage of foreign bodies failed. Serial abdominal radiographs failed to determine the site of the foreign bodies accurately. Endoscopic removal was unsuccessful. Surgical removal was warranted with unexpected intra-operative finding of a jejunal web with foreign body entrapment. Although rare, a congenital intestinal web must be considered in a child presents with failure of expectant management following foreign body ingestion as surgical intervention is necessary.

Fulltext A 'Hairy' problem: Trichotillomania, trichophagia and trichobezoars

Yik YI, How AK

Singapore Med J, 2016 Jul;57(7):411.

PMID: 27439704 DOI: 10.11622/smedj.2016125

High Incidence of Occult Atrial Fibrillation in Asian Patients with Cryptogenic Stroke

Seow SC, How AK, Chan SP, Teoh HL, Lim TW, Singh D, et al.

J Stroke Cerebrovasc Dis, 2018 Aug;27(8):2182-2186.

PMID: 29678635 DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.019

BACKGROUND: Occult atrial fibrillation (AF) is not uncommon in patients with stroke. In western cohorts, insertable loop recorders (ILRs) have been shown to be the gold-standard and are cost-effective for AF detection. Anticoagulation for secondary stroke prevention is indicated if AF is detected. The incidence of occult AF among Asian patients with cryptogenic stroke is unclear.

METHODS: Patients with cryptogenic stroke referred between August 2014 and February 2017 had ILRs implanted. Episodes of AF >2 minutes duration were recorded using proprietary algorithms within the ILRs, whereupon clinicians and patients were alerted via remote monitoring. All AF episodes were adjudicated using recorded electrograms. Once AF was detected, patients were counseled for anticoagulation.

RESULTS: Seventy-one patients with cryptogenic stroke, (age 61.9 ± 13.5 years, 77.5% male, mean CHA2DS2VASc score of 4.2 ± 1.3) had ILRs implanted. Time from stroke to the ILR implant was a median of 66 days. Duration of ILR monitoring was 345 ± 229 days. The primary endpoint of AF detection at 6 months was 12.9%; and at 12 months it was 15.2%. Median time to detection of AF was 50 days. The AF episodes were all asymptomatic and lasted a mean of 77 minutes (± 118.9). Anticoagulation was initiated in all but 1 patient found to have AF.

CONCLUSIONS: The incidence of occult AF is high in Asian patients with cryptogenic stroke and comparable to western cohorts. The combination of ILR and remote monitoring is a highly automated, technologically driven, and clinically effective technique to screen for AF.

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