MyMedR

Perforated caecal mass: benign or malignant?

Chan KH, Muhamad A, Hayati F, Azizan N, Andee DZ

ANZ J Surg, 2021 Jul;91(7-8):1620-1622.

PMID: 33351236 DOI: 10.1111/ans.16508

Matched MeSH terms: Digestive System Abnormalities*

Effectiveness of table salt versus copper sulphate in treating umbilical granuloma: A pilot randomized controlled trial

Chung KJ, Chin YM, Wong MS, Sanmugam A, Singaravel S, Nah SA

J Pediatr Surg, 2022 Feb;57(2):261-265.

PMID: 34838305 DOI: 10.1016/j.jpedsurg.2021.10.032

BACKGROUND: Umbilical granuloma is a common infantile condition which usually responds to non operative management. Copper sulphate (CuSO4) is often used as chemical cauterization but can cause superficial skin burns. An alternative is table salt (NaCl), which osmotically dehydrates wet granulation tissue causing necrosis. We aimed to compare the effectiveness of NaCl versus CuSO4 in treating umbilical granuloma.

METHOD: We performed a multi centerrandomized controlled trial involving three regional pediatricsurgical units. We included children who presented with umbilical granuloma from December 2018 to May 2020. Children who received treatment prior to index visit were excluded. They were randomly allocated to receive NaCl (twice/day application for 5 days by caregiver) or CuSO4 (single application by clinician). Demographic data, compliance in the NaCl group by pill counting method, treatment outcomes, and complications were recorded. Treatment success was defined as complete lesion resolution. Partial or no response was considered treatment failure. Subsequent treatment then reverted to the respective center's routine management.

RESULT: We recruited 70 participants with 6 dropouts (2 defaulters, 1 vitellointestinal duct, 3 urachal remnants), leaving 64 subjects for final analysis: 31 NaCl, 33 CuSO4. Compliance rate of 77.4% was recorded for NaCl, with 6 (20%) 'poor compliance' participants stopping therapy before completion owing to complete resolution. NaCl group had a significantly higher complete resolution rate (90.4%) compared to CuSO4 (69.7%), p = 0.040. No NaCl participant developed complications versus 9% (n = 3) in CuSO4 (periumbilical superficial skin burn).

CONCLUSION: Table salt is an ideal treatment choice for umbilical granuloma as it is effective, safe, and readily available.

LEVEL OF EVIDENCE: II.

Matched MeSH terms: Digestive System Abnormalities*

Multiple Small Bowel Atresia: Resection or Conservation?

Govindarajan KK, Annamalai M

J Coll Physicians Surg Pak, 2021 Jun;30(6):740-742.

PMID: 34102795 DOI: 10.29271/jcpsp.2021.06.740

Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.

Matched MeSH terms: Digestive System Abnormalities*

An unexpected gangrenous duplication of ileum

Chiar CI, Elango T, Sivaneswaran L, Umasangar R, Mohan N

Med J Malaysia, 2017 02;72(1):83-84.

PMID: 28255153 MyJurnal

Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication. We discuss the preoperative diagnostic dilemma and management options in approaching this rare entity.

Matched MeSH terms: Digestive System Abnormalities

Fulltext Gastric duplication cyst in an infant presenting with non-bilious vomiting

G KK

Malays J Med Sci, 2012 Jan;19(1):76-8.

PMID: 22977380 MyJurnal

In an infant presenting with a mass in the abdomen and non-bilious vomiting, duplication cyst needs to be considered in the list of differential diagnoses. Gastric duplication cyst is an uncommon occurrence in children. Diagnosis is based on clinical findings and imaging features. Surgical excision is safe and offers a complete cure. The literature recommends excision even in asymptomatic cases due to isolated reports of malignancy arising in the duplication cyst in later life.

Matched MeSH terms: Digestive System Abnormalities

Fulltext Midgut malrotation with congenital peritoneal band: a rare cause of small bowel obstruction in adulthood

Low SF, Ngiu CS, Sridharan R, Lee YL

BMJ Case Rep, 2014;2014.

PMID: 24717859 DOI: 10.1136/bcr-2013-202690

Midgut malrotation commonly presents in the neonatal period, and rarely manifests its symptoms in adulthood with an estimated incidence of 0.2-0.5%. Nevertheless, the symptoms are non-specific with no strong pointers towards the clinical diagnosis. Consequently, the diagnosis is usually disclosed with imaging or surgery. We report a case of small bowel obstruction secondary to a congenital peritoneal band with underlying midgut malrotation in a 48-year-old man.

Matched MeSH terms: Digestive System Abnormalities/complications*

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: Digestive System Abnormalities

Fulltext Neonatal alimentary obstruction in Malaysia

Laidin AZ, Mohd Nor M, Abdul Wahab Y, Mahamooth Z

Med J Malaysia, 1982 Sep;37(3):281-9.

PMID: 7177013

Over the six-veer periodfrom. 1976 to 1981, there were 241 neonates referred to the U.K.M. Paediatric Surgical Unit, General Hospital, Kuala Lumpur for alimentary tract obstruction and 207 were operated on. The three commonest conditions were anorectal anomalies (91 cases), Hirschsprung's disease (31 cases) and oesophageal atresia (30 cases). Overall operatioe mortality was 28.0 percent. This was high when preoperative complications lihe gut perforation (88.9 percent) or pneumonia (61.9 percent) and associated severe anomalies (90.9 percent) or chromosomal abnormalities (66.7 percent) were present. Emphasis is placed on the establishment of early diagnosis and the significance of the green vomit and maternal hydramnios is highlighted, The need is felt for more specialised nurses and the creation of a separate neonatal ICU in this hospital.

Matched MeSH terms: Digestive System Abnormalities

The current practice of paediatric surgery in Malaysia

Somasundaram K

Aust N Z J Surg, 1978 Aug;48(4):356-9.

PMID: 282864

This 10-year review of surgical conditions in infants at the University Hospital, Kuala Lumpur, highlights some of the more common problems encountered and outlines their management. Anorectal agenesis and Hirschsprung's disease were seen relatively more frequently than other anomalies of the gastrointestinal tract. The management of these two conditions and the operation of colostomy and its complications are singled out and presented in some detail.

Matched MeSH terms: Digestive System Abnormalities

Fulltext Cholangiocarcioma in a cat

Lim, M.L., Watanabe, M.

Jurnal Veterinar Malaysia, 2016;28(1):16-19.

MyJurnal

A 7-year-old, intact female Domestic Shorthair cat was referred to University Veterinary Hospital (UVH), UPM for diagnostic workup of a hepatomegaly observed on abdominal radiographs. Physical examination revealed no significant findings except for a distended abdomen. Hematology and serum biochemistry findings included a regenerative anaemia, left shift neutrophilia and a 10-fold elevation in gamma-glutamyltranspeptidase (GGT). Abdominal ultrasound revealed heterechoic liver lobes with irregular margins and presence of nodular and cyst-like structures predominantly affecting the left lobes. A mild ascites was also noted. A fine needle aspiration of the liver was performed and cytology results confirmed a cholangiocarcinoma. Generally, the outcome for cholagiocarcinoma is poor and there is limited information regarding the prognosis for patients with cholangiocarcinoma following chemotherapy or surgery.

Matched MeSH terms: Digestive System Abnormalities

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