Oesophageal perforation is a not uncommon condition, yet it carries a high mortality rate and has been observed as the most grievous trauma to the digestive tract. Common causes include iatrogenic instrumentation, foreign-body swallowing, and physical injury. This report highlighted a case of oesophageal perforation complicated by formation of proximal descending aorta pseudoaneurysm as a result of okra ingestion. The patient was successfully treated with conservative treatment. The possible mechanism of oesophageal rupture, diagnosis, treatment, and other complica- tion will be further discussed.
I would like to report the case of a Chinese boy of 5 years old who came to see me with a ball-bearing in one of his ears. Repeated attempts were made to extricate it under general anaesthesia by means of several kinds of aural apparatus, but they all failed. While about to give up hope and hand him over to a specialist, I managed to borrow a pair of magnetic forceps from a radio mechanic. The ball-bearing was immediately attracted to the point of the forceps and drawn out with ease. It would not be a bad idea to design a magnetic aural (or nasal) forceps based upon the above principles with a view to avoiding unnecessary pain and misery to the young victims.
The first endoscopic procedure done in Malaysia using the Caemaert-Abdullah method is reported and the followup results showed an excellent neurosurgical outcome. A 16-year-old girl with an aqueduct stenosis was operated on using a free-hand, computer-assisted endoscopic method where a third ventriculostomy was done. This was the first case being carried out in the Hospital Universiti Sains Malaysia. The next two cases were a suprasellar pituitary cyst in an elderly man and a child with an obstructive hydrocephalus who was previously shunted which became infected. Both endoscopic procedures, extirpation of the cyst using a Nd:Yag laser and a third ventriculostomy, respectively, were done under general anaesthesia in the supine position. Follow-up revealed a transient diabetes insipidus in all three cases up to 48 hours after the operation which resolved spontaneously. The fourth case involved an endoscopic removal of retained ventricular catheter after rectal migration of a shunt in an eight-year-old girl with congenital hydrocephalus. The fifth was a free-hand endoscopy with perforation of multiple brain septae in a ten-month-old baby with hydrocephalus secondary to meningitis. The final outcomes for all the cases were favourable hence we conclude that endoscopic neurosurgery is a safe procedure and hope that more neurosurgeons will continue to use this method, especially for the management of intraventricular cyst and hydrocephalus and especially in South East Asia.
Splinter or foreign body removal from the hand and foot is a common occurrence. Usually only the deep seated, broken or missed splinters are referred to the surgeon for removal. Unless the object is radio-opaque, plain radiograph will not give any useful information, hence removal can sometimes be very difficult and traumatic. We are reporting a case where a radiolucent splinter was removed with the aid of ultrasonography. This modality can help to localize a splinter at the pre and intra-operative period, minimizing amount of exploration and time of operation.
Foreign bodies in the laryngotracheobronchial tree are not uncommon. Their clinical presentations, the radiological and endoscopic findings in sixteen cases that presented to the Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia were reviewed. The technique of removal is also discussed.
Study site: Hospital Kuala Lumpur, Malaysia (UKM unit)
A 47-year-old healthy Indonesian gentleman, presented with blurring of vision on the left eye associated with pain
and redness after history of foreign body entering the eye. A general practitioner prescribed him some eye drops;
however, his symptoms worsened. A corneal laceration wound measuring 0.5 x 3.5mm with a large stromal abscess
measuring 9.0 x 5.0mm with flat anterior chamber was seen on the left eye. Emergency corneal T&S revealed a large
descemetocele and cyanoacrylate corneal glue was applied on the area. C&S showed Pseudomonas aeruginosa.
Patient was subsequently undergone penetrating keratoplasty as a definitive measure. This case highlights the rapid
progression of pseudomonas keratitis, presented with a large descemetocele, which can be mistaken as an infected
corneal laceration wound. Corneal cyanoacrylate glueing together with corneal suturing is a viable temporary method
for large descemetoceles awaiting definitive surgery.
A successful retrieval of a detached segment of a CVP catheter by percutaneous right transfemoral venous route, using a Dotter intravascular retriever basket, is reported. The procedure was monitored under fluoroscopy. Only local anaesthesia, which was infiltrated around the puncture site, was given to the patient. No significant complication was encountered. Successful retrieval of the detached catheter fragment by percutaneous means obviates the need for thoracotomy.
A 68-year-old female presented with a 1-month history of lower back pain with right-sided radiculopathy and numbness. She was diagnosed with lumbar spondylosis and treated conservatively with analgesia and physiotherapy. Imaging showed multiple susuk, a metal alloy, in the lower back region and other regions of the body. The patient had undergone traditional medicine consultation 10 years earlier when the susuk was inserted in the lower back as talisman. The practice of the insertion of susuk is popular in rural East Malaysia and Indonesia. These foreign bodies act as possible causes of chronic inflammation and granuloma formation. In addition, the localised heighten peril upon imaging. This report suggests that the insertion of multiple susuk as talisman carries risk to safety of patients when imaging, and this practice complicates the management of musculoskeletal disorders.
Tinnitus is not a disease per se but it is a symptom. It can be either subjective or objective type and the
underlying cause varies such as tumour, infection, vascular abnormality or Meniere’s disease. Foreign body in the external ear is a common presentation especially in children. However, foreign body in the middle ear manifested with only symptom of tinnitus is a rare and unexpected presentation. Foreign body in the middle ear are commonly due to iatrogenic cause such as complication of myringotomy and ventilation tube insertion surgery. There are reported cases of complications of myringotomy and ventilation tube insertion, and they typically presented with the ear infection manifestation, myringosclerosis or permanent perforation of tympanic membrane. Currently, there are only few reported cases in literatures of foreign body in the middle ear following complication of medial migration of ventilation tube into a middle ear with intact tympanic membrane.
Ocular fishhook injuries are rare, yet potentially vision threatening as complications such as corneal scarring, retinal detachment and endophthalmitis may result. The surgical management of these cases is challenging due to the construction of barbed fishhooks.
This is a case report of an 11-year old child who was suffering from rhinorrhoea for five years. As there was no history of foreign body insertion into the nose, the diagnosis of a nasal problem was not suspected. Furthermore, the initial presentation of unilateral rhinorrhoea (nasal discharge) masked the suspicion of other pathologies. The child was treated for allergic rhinitis until she presented herself to our attention whereby a rhinoscopy was performed, showing a rhinolith.
Superglue in the ear as a foreign body is an uncommon presentation. We report the case of a lady who accidentally instilled superglue directly onto her tympanic membrane and presented five days later. We successfully removed the glue with acetone and managed to preserve the integrity of the tympanic membrane.
Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.
Cases of retained surgical guaze are rarely reported because of medico-legal and professional implications. Retained gauze for a period of more than 10 years is even rarer. A case of retained surgical gauze for 11 years, an accidental finding from a plain radiograph of a patient who had sustained proximal femoral fracture, is reported. A review of other reported cases is presented.
CSF leak in penetrating skull base injury is relatively rare compared to close head injury involving skull base fracture. We report a 5-year-old boy presented with epistaxis and impacted pencil into the left nostril. The child was hemodynamically stable without any neurological deficit. Intraoperatively, there was a nasal septal defect posteriorly with anterior skull base fracture associated with CSF leak. The pencil was removed from the left nostril and the CSF leak was repaired using harvested abdominal fat under the same setting. Computed Tomography (CT) of the brain showed right cribriform plate fracture with small pneumocranium. Postoperatively, a prophylactic antibiotic was given for seven days and he was discharged well. Subsequent clinic visits up to one-year postoperative period showed no recurrence of the CSF leak. History taking, physical examination and CT imaging give valuable diagnostic values in managing the penetrating skull base injury. Early intervention for removal of the foreign body and repair of the CSF leak is advocated to prevent catastrophic complication.
Chronic discharging ear, mostly due to middle or external ear infection, is one of the leading causes for seeking healthcare among the paediatric population in a developing country. However, a long-standing forgotten middle ear foreign body forms a rare cause for such presentation demanding a high index of suspicion from the clinicians. Most of them are iatrogenic or accidental, and are removed by conventional permeatal approach; need for tympanotomy is rarely documented in the recent literature. We report the first case where a large stone was introduced into the middle ear through a pre-existing tympanic membrane perforation by the child himself, and only the second documentation of removal of a middle ear foreign body by tympanotomy in a child.
A rare complication of per rectal extrusion of a ventricule peritoneal shunt catheter occuring in a four-month old Chinese baby boy with hydrocephalus is described. Perforation of the bowel by the shunt occurred without any peritonitis or retrograde infection of the shunt system. Its pathogenesis and diagnosis are discussed.
An unusual case of proximal migration of a Hakim's valve intracranially into a porencephalic cyst two years after insertion of the ventriculo-peritoneal shunt in a neonate is reported. The underlying cause is discussed. It is recommended that all shunt should be anchored with nonabsorbable suture material properly on to the pericranium.