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Fulltext Malignant pancreatic carcinoid tumour

Zarina AL, Hamidah A, Zulkifli SZ, Zulfiqar MA, Jamal R

Singapore Med J, 2007 Dec;48(12):e320-2.
PMID: 18043827

Pancreatic carcinoid tumours are rare, particularly within the paediatric population. The clinical presentation is largely dependent on the functionality of the tumour. Although the tumour is generally slow-growing, surgical resection is still the mainstay of curative treatment. Morbidity is, however, significantly contributed by secretion of excess hormones; in view of this, biotherapy is an important treatment strategy. Octreotide, a somatostatin analogue, has been shown to be successful in both symptomatic control and stability of tumour progression. We report a 12-year-old girl, who presented with hypertensive crisis, and showed good response to a combination of chemotherapy and octreotide.

Matched MeSH terms: Laparotomy/methods
Fulltext Acute appendicitis in pregnancy: a diagnostic and management challenge

Zainur Rashid, Z., Sulaiha, S.A., Azmi, M.N.

International Medical Journal Malaysia, 2014;13(1):77-80.
MyJurnal

Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.

Matched MeSH terms: Laparotomy
Fulltext Gastrointestinal stromal tumors (GIST) in a patient with Neurofibromatosis: A case report

Zailani, M.H., Naqiyah, I., Rohaizak, M., Siti Aishah, M.A.

International Medical Journal Malaysia, 2007;6(1):1-5.
MyJurnal

Type 1 Neurofibromatosis (von Reckinghausen’s disease) has been associated with several gastrointestinal tumor complications, either benign or malignant. We report a case of a middle age man who had Type 1 Neurofibromatosis and presented with acute intestinal obstruction. Laparotomy revealed multiple nodular lesions along the small intestine with two larger nodules which were resected. Histopathological examination of the nodules confirmed it as gastrointestinal stromal tumors (GIST) with malignant potential. The association between neurofibromatosis and GIST is discussed.

Matched MeSH terms: Laparotomy
Fulltext Large tubular colonic duplication in an adult treated with a small midline incision

Yong YG, Jung KU, Cho YB, Yun SH, Kim HC, Lee WY, et al.

J Korean Surg Soc, 2012 Mar;82(3):190-4.
PMID: 22403754 DOI: 10.4174/jkss.2012.82.3.190

Tubular colonic duplication presenting in adults is rare and difficult to diagnose preoperatively. Only a few cases have been reported in the literature. We report a case of a 29-year-old lady presenting with a long history of chronic constipation, abdominal mass and repeated episodes of abdominal pain. The abdominal-pelvic computed tomography scan showed segmental bowel wall thickening thought to be small bowel, and dilatation with stasis of intraluminal content. The provisional diagnosis was small bowel duplication. She was scheduled for single port laparoscopic resection. However, a T-shaped tubular colonic duplication at sigmoid colon was found intraoperatively. Resection of the large T-shaped tubular colonic duplication containing multiple impacted large fecaloma and primary anastomosis was performed. There was no perioperative complication. We report, herein, the case of a T-shaped tubular colonic duplication at sigmoid colon in an adult who was successfully treated through mini-laparotomy assisted by single port laparoscopic surgery.

Matched MeSH terms: Laparotomy
Fulltext Congenital biliary anomaly with secondary cholangiohepatitis in a Siamese cross kitten

Yiew, X.T., Leong, Z.P., Rahman, N., Watanabe, M., Noordin, M.M., Khor, K.H.

Jurnal Veterinar Malaysia, 2016;28(1):7-11.
MyJurnal

A 5-month-old Siamese cross kitten was presented with jaundice and a palpable abdominal mass at the right cranial quadrant. The extra-hepatic biliary system was markedly distended upon abdominal ultrasonography. Complete bile duct obstruction was ruled out due to the presence of urobilinogen, light brown stool, and consistentlynormal alkaline phosphatase (ALP) levels. Head tremors developed on the second day of hospitalization. Tentative diagnoses of congenital biliary anomaly and hepatic encephalopathy werederived and exploratory laparotomy revealed a severely distended and tortuous bile duct indistinguishable from the gallbladder with negative duodenal filling. Modified cholechoduodenostomy was performed however the kitten did not recover from general anaesthesia. Secondary cholangiohepatitis and hepatic encephalopathy were confirmed upon histopathologic examination.Primary congenital biliary atresia or choledochal cyst with secondary cholangiohepatitis was suspected. Biliary anomalies are rare in cats with only two cases reported in the literature. These conditions are often challenging to diagnose and due to the limited treatment options, have a poor prognosis.

Matched MeSH terms: Laparotomy
Hemorrhagic extrahepatic recurrence of hepatocellular carcinoma: A case report

Yeow GPV, Yeow DGE, Sankaran P, Maiyauen T, Sharif MS

Ann Hepatobiliary Pancreat Surg, 2019 Feb;23(1):77-79.
PMID: 30863813 DOI: 10.14701/ahbps.2019.23.1.77

The recurrence of hepatocellular carcinoma (HCC) can mainly be divided into two phases or types: the intrahepatic recurrence (IHR) and the extrahepatic recurrence (EHR). Generally speaking, the EHR is usually referenced as being the less common of the two types or categories. In a post-hemihepatectomy patient with routine surveillance at 6 months, it was noted that the patient appeared to have an elevated alpha-fetoprotein, and also complained of vague lower abdominal pain. The accompanying computed tomography scan revealed a 6 cm-sized heterogeneous mass located at the pelvis region. Next, during a laparotomy for resection, the tumor was found to be bleeding from the omental deposition. In conclusion, a high index of suspicion and early surgical intervention can help in detecting possible bleeding extrahepatic recurrence in the background of a patient with history of HCC.

Matched MeSH terms: Laparotomy
Fulltext Cervical Cancer Surgery: Current State of Affairs

Yang FC, Huang W, Yang W, Liu J, Ai G, Luo N, et al.

Gynecol Minim Invasive Ther, 2021 04 30;10(2):75-83.
PMID: 34040965 DOI: 10.4103/GMIT.GMIT_81_20

Cervical cancer surgery has a history of more than 100-years whereby it has transitioned from the open approach to minimally invasive surgery (MIS). From the era of clinical exploration and practice, minimally invasive gynecologic surgeons have never ceased to explore new frontiers in the field of gynecologic surgery. MIS has fewer postoperative complications, including reduction of treatment-related morbidity and length of hospital stay than laparotomy; this forms the mainstay of treatment for early-stage cervical cancer. However, in November 2018, the New England Journal of Medicine had published two clinical studies on cervical cancer surgery (Laparoscopic Approach to Cervical Cancer [LACC]). Following these publications, laparoscopic surgery for early-stage cervical cancer has come under intense scrutiny and negative perceptions. Many studies began to explore the concept of standardized surgery for early-stage cervical cancer. In this article, we performed a review of the history of cervical cancer surgery, outlined the standardization of cervical cancer surgery, and analyzed the current state of affairs revolving around cervical cancer surgery in the post-LACC era.

Matched MeSH terms: Laparotomy
Fulltext Acute abdomen: unmasked the bleeding site in severe haemophilia A

Wan Suriana Wan Ab Rahman, Zefarina Zulkafli, Mohd Nazri Hassan, Wan Zaidah Abdullah, Azlan Husin, Anani Aila Mat Zain

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):345-347.
MyJurnal

Haemophilia A is an inherited bleeding disorder, commonly involve soft tissues and joints. Gastrointestinal tract
bleeding, are not uncommon but seldom highlighted. A 23-year-old male with underlying severe haemophilia A was
presented with a generalised abdominal pain for 2 days, abdominal distension, diarrhoea and vomiting. He did not
have any trauma to the abdomen. Abdominal examination revealed generalized tenderness with sign of guarding
on palpation. Laboratory investigations revealed isolated, prolonged activated partial thromboplastin time (APTT)
with normal total white blood cell count and haemoglobin level. In view of acute abdomen, which was not resolved
by conservative treatment, an emergency laparotomy was done with FVIII concentrate and recombinant factor VII
(rFVII) coverage. Intraoperative findings noted patchy gangrenous spots of about 30 cm in length in the small bowel.
Histopathology examination revealed an evidence of haemorrhage within the submucosal and intramuscularis layer
from the resected specimen. This case highlighted the possibility of gastrointestinal bleeding without prior trauma,
which can be presented as acute abdomen in severe haemophilia patient.

Matched MeSH terms: Laparotomy
Fulltext Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery

Wan Fadzlina WM, Wan Mohd Nazaruddin WH, Rhendra Hardy MZ

Malays J Med Sci, 2016 Mar;23(2):28-37.
PMID: 27547112 MyJurnal

Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB.

Matched MeSH terms: Laparotomy
Fulltext Antiphospholipid syndrome presenting as mesenteric vein thrombosis and gangrenous small bowel

Wan Ali WASR, Mohd Shahrir MS, Hussein H

International Medical Journal Malaysia, 2011;10(2):0-0.
MyJurnal

A 35-year-old Jordanian gentleman presented with worsening right iliac fossa pain of three-day durations with vomiting, loose stool and intermittent fever. He later underwent laparoscopic surgery, which was subsequently converted to open laparotomy. Intraoperatively, there was thickened bowel with multiple mesenteric lymph nodes, and also thrombosis of the small bowel vein supplying the affected bowel lesion, the diagnosis which was later conﬁ rmed with the histopathological report. Resection with end-to-end anastomosis was done during the surgery. Within one-week post laparotomy, he developed another progressive abdominal pain and distension, vomiting and no bowel opening. He was sent for another exploratory laparotomy. Intraoperatively, there was a gangrenous small bowel segment measuring 130 cm, with an intact large bowel and previous anastomotic site. Resection of 150 cm of the small bowel was subsequently done.

Matched MeSH terms: Laparotomy
Fulltext Multi-Target Approach to Metastatic Adrenal Cell Carcinoma

Wahab NA, Zainudin S, AbAziz A, Mustafa N, Sukor N, Kamaruddin NA

Arch Iran Med, 2016 Sep;19(9):671-3.
PMID: 27631184 DOI: 0161909/AIM.0012

Adrenal cell carcinoma is a rare tumor and more than 70% of patients present with advanced stages. Adrenal cell carcinoma is an aggressive tumor with a poor prognosis. Surgical intervention is the gold standard treatment and mitotane is the only drug approved for the treatment of adrenal cell carcinoma. Until recently in 2012, the etoposide, doxorubicin, cisplatin plus mitotane are approved as first-line therapy based on response rate and progression-free survival. This case illustrates a case of advanced adrenal cell carcinoma in a young girl who presented with huge adrenal mass with inferior vena cava thrombosis and pulmonary embolism. Multi-approach of therapy was used to control the tumor size and metastasis. Therefore, it may prolong her survival rate for up to 5 years and 4 months.

Matched MeSH terms: Laparotomy/methods
A case of ectopic triplets

Vine LE

Journal of the Malaya Branch of the British Medical Association, 1941;5:56-7.

Matched MeSH terms: Laparotomy
Fulltext Adhesive small bowel obstruction (ASBO) in children--role of conservative management

Vijay K, Anindya C, Bhanu P, Mohan M, Rao PLNG

Med J Malaysia, 2005 Mar;60(1):81-4.
PMID: 16250285

Adhesive small bowel obstruction (ASBO) is an annoying postoperative complication. Though the diagnosis can be made easily, the role of conservative management in children is controversial. Hence a study was conducted to determine the role of conservative management, and to identify the factors that can predict / influence the outcome of conservative treatment in children with ASBO. Children admitted with ASBO from 1980 to 2002 (22 year period) formed the material for this study. The data was analyzed with respect to the influence of age at the time of presentation, primary disease for which original laparotomy was done, time interval between the primary surgery and the development of ASBO and the number of laparotomies prior to the development of ASBO on the outcome of conservative management. There were 74 episodes of ASBO in 69 children (Five children had two episodes). Out of 74 episodes, 5 episodes (6.75%) needed immediate laparotomy for suspected gangrene. All others were managed conservatively. Of the 69 episodes managed conservatively, 36 responded to conservative treatment (2-5 days) while 33 required subsequent surgical intervention, with 11 of them requiring bowel resection (two for gangrene and 9 for bowel damage during adhesiolysis) and in the rest 22 cases adhesiolysis. A substantial number of children with ASBO respond well to conservative treatment. Majority of the children developed ASBO within three months after the primary laparotomy. Children below the age of one year (at the time of presentation with ASBO) responded poorly to the conservative management. Children who had primary surgery for Hirschsprung's disease and intussusception also appeared to have responded poorly to conservative management, but statistically not significant. Time interval between the primary surgery and the number of laparotomies before the child developed ASBO did not influence the outcome of conservative management.

Matched MeSH terms: Laparotomy/adverse effects
Fulltext Congenital trans-mesenteric herniation: a rare cause of small intestine strangulation in adults

Umaparan G, Nallusamy K, Abdul Wahab MH, Mohammad Nor AM, Mat Arif NA

J Surg Case Rep, 2012 Dec 04;2012(11).
PMID: 24968390 DOI: 10.1093/jscr/rjs003

Trans-mesenteric hernia is a form of internal hernia which is an extremely rare cause of intestinal obstruction in adults compared with the pediatric population. It often presents with complications such as acute intestinal obstruction and peritonitis requiring immediate surgical intervention. We report a case of a 21-year-old woman who presented to us with an acute abdomen and peritonitis that required an immediate exploratory laparotomy. She was found to have a small congenital mesenteric defect with strangulated segment of ileum. Gangrenous portion of the ileum was resected and the congenital defect was closed. The patient made an uneventful recovery. The occurrence of trans-mesenteric hernia in adults is rare and difficult to be diagnosed clinically; thus, the patient's clinical features may lead to early surgical intervention in order to reduce morbidity and mortality.

Matched MeSH terms: Laparotomy
Fulltext Urinary bladder rupture secondary to obstructive urolithiasis in a Jamnapari goat

Tan, Y.K., Hiew, M.W.H., Radzi, R., Khairuddin, N.H.

Jurnal Veterinar Malaysia, 2017;29(2):20-24.
MyJurnal

This report describes the complications of obstructive urolithiasis in the lower urinary tract causing urinary bladder rupture in a Jamnapari buck. A 3-year-old Jamnapari buck was presented with the complaint of stranguria, subsequent anuria and a progressively distended abdomen for the past three days. Upon physical examination, body temperature, pulse rate and respiration rate were increased. Uroliths could be felt within the urethra in the ventral abdomen region. A urolith was removed via amputationof the urethral process, but the patency of the urethra could not be established. Transabdominal ultrasound revealed anechoic areas around the bladder, and the bladder was relatively small for a urinary obstructed goat. The bladder wall was thickened and shadow of sludge was observed within the bladder. Abdominocentesis was done and fluid analysis revealed that it was a haemorrhagic effusion. Blood results revealed renal disease, liver disease, muscle injury and haemoconcentration. Retrograde cystourethrogram revealed no urolithswithinthe urethra but there was leakage of the contrast agent from the bladder into the peritoneal cavity. The final diagnosis was complete blockage of the lower urinary tract leading to bladder rupture. Exploratory laparotomy was done and emergency cystorraphy was planned. Due to the poor condition of the urinary bladder with presence of septic peritonitis, the goat was euthanised.

Matched MeSH terms: Laparotomy
Rare postpartum ruptured degenerated fibroid: a case report

Tan YL, Naidu A

J Obstet Gynaecol Res, 2014 May;40(5):1423-5.
PMID: 24689652 DOI: 10.1111/jog.12334

Spontaneous rupture of uterine fibroid is rarely encountered. We present a case of a 31-year-old who presented with acute abdominal pain at 9 weeks postpartum. On examination, the abdomen had diffuse tenderness, with rebound tenderness in the suprapubic area and in both iliac fossae. On ultrasonography, a 12.7 × 8.6 × 8.9-cm sized hyperechoic mass was visible on the posterior wall of the uterus. A large amount of fluid was visible in the paracolic gutters and the Pouch of Douglas (POD). The patient underwent an exploratory laparotomy. A ruptured, cystic degenerated uterine fibroid with active bleeding was found, as well as approximately half a liter of free, bloodstained peritoneal fluid and pus. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.

Matched MeSH terms: Laparotomy
Cytochrome P450 3A4 genetic polymorphisms and post-operative fentanyl requirements

Tan PC, Hassan SK, Mohamad NA, Gan SH

J Clin Pharm Ther, 2012 Feb;37(1):100-4.
PMID: 21128989 DOI: 10.1111/j.1365-2710.2010.01232.x

WHAT IS KNOWN AND OBJECTIVE: Interindividual variability in drug responses may be attributable to genetically determined alteration in enzyme activity. In this study, we investigated the association between cytochrome P450 3A4 (CYP3A4) genetic polymorphisms and post-operative fentanyl requirements.
METHODS: Patients (n = 94) scheduled for gynaecological laparotomy received i.v. fentanyl infusion (3 μg/kg/h) after induction of general anaesthesia. Post-operative fentanyl requirements were quantified by using a patient-controlled analgesia and the number of i.v. fentanyl rescue analgesia required were recorded. Pain control was assessed using visual analogue scores (VAS) and fentanyl's adverse effects were documented. CYP3A4*4, CYP3A4*5 and CYP3A4*18 alleles of cytochrome P450 3A4 were identified by polymerase chain reaction-restriction fragment length polymorphism. Differences in fentanyl requirements, VAS scores and adverse effects among the various genotypes were compared.
RESULTS AND DISCUSSION: No CYP3A4*4 and CYP3A4*5 alleles were detected. Eighty-nine patients (94·7%) were wild-type, five (5·3%) were heterozygous and none was homozygous. No significant difference was demonstrated between the genotype groups in terms of fentanyl consumption, pain control and adverse effects.
WHAT IS NEW AND CONCLUSION: CYP3A4*4 and CYP3A4*5 are rare in the Malaysian Malay population. Genetic polymorphism of CYP3A4*18 may not play an important role in influencing postoperative fentanyl requirements.

Matched MeSH terms: Laparotomy/methods
Fulltext Two different surgical approaches for strangulated obturator hernias

Sze Li S, Kenneth Kher Ti V

Malays J Med Sci, 2012 Jan;19(1):69-72.
PMID: 22977378 MyJurnal

Obturator hernia is a rare condition that may present in an acute or subacute setting in correlation with the degree of small-bowel obstruction. Pre-operative diagnosis is difficult, as symptoms are often non-specific. A high index of suspicion should be maintained for emaciated elderly women with small-bowel obstruction without a previous abdominal operation and a positive Howship-Romberg sign. When diagnosis is in doubt, computed tomography scan of the abdomen and the pelvis (if available) or laparotomy should be performed immediately, as high mortality rate is related to the perforation of gangrenous bowels. We present 2 cases of strangulated obturator hernia, managed differently with both open and laparoscopic approaches. The diagnostic accuracy of computed tomography scan is highlighted followed by a brief literature review with an emphasis placed on surgical management.

Matched MeSH terms: Laparotomy
Mycotic iliac artery aneurysm with appendicitis in a pediatric patient

Sunil SP, Aimanan K, Ismazizi Z

Med J Malaysia, 2021 03;76(2):270-272.
PMID: 33742645

Iliac aneurysms are rare in children, especially mycotic aneurysms. Re-vascularization is challenging given the infected field and concern on patency due to their growth potential and a longer life-span. We report a complex case of a mycotic iliac aneurysm in a child. A 12-years-old boy with a previous history of infective endocarditis was referred to us for a right common iliac mycotic aneurysm after presenting with pain. A balloon-expandable stent-graft was deployed across the aneurysm during the acute presentation. He improved post-operatively, but developed abdominal pain four weeks later. A repeat computed tomography (CT) imaging showed a new inflammation of the appendix which was adhered to the calcified wall of the aneurysm and an endoleak from the internal iliac artery. A laparotomy was performed and the right internal iliac artery ligated along with an appendicectomy and omental pedicle. Postoperatively the patient was well and discharged home. Six-month surveillance revealed a healthy child and imaging showed a patent stent-graft and no residual collection.

Matched MeSH terms: Laparotomy
An unusual cause of acute abdomen and acute renal failure: Djenkolism

Sumitro K, Yong CS, Tan LT, Choo S, Lim CY, Shariman H, et al.

Malays Fam Physician, 2020;15(2):50-52.
PMID: 32843946

The djenkol bean (Archidendron pauciflorum) is a native delicacy in Southeast Asia, though consumption can sometimes lead to djenkolism. Clinical features of djenkolism include acute abdominal pain, hematuria, urinary retention, and acute kidney injury (AKI). The pain can be severe, which often leads to a misdiagnosis of acute abdomen. In this paper, we report the case of an Indonesian migrant with djenkolism. Due to the short history and severity of the abdominal pain, medical professionals suspected acute abdomen and proceeded with a negative exploratory laparotomy. However, djenkolism was suspected once relatives informed the professionals that the patient had consumed djenkol beans hours earlier. The patient recovered through aggressive hydration and urine alkalinization with bicarbonate infusion. We highlight the importance of being aware of this rare cause of AKI, especially in Southeast Asia, in order to provide early diagnoses and prompt treatments.

Matched MeSH terms: Laparotomy

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