Gallbladder tuberculosis (GT) is an extremely rare condition. This is thought to be due to the protective property of bile against the infection. Clinical and radiological diagnosis of GT is difficult. We describe a case of GT who initially presented to us with jaundice, a right hypochondrial mass and computed tomographic findings suggestive of gallbladder empyema. Diagnosis was made from histopathological examination of the resected gallbladder which revealed epitheloid granulomas with caseating necrosis and presence of Langhan's giant cells. From a literature search and to the best of our knowledge, this is the first GT to be reported in South East Asia.
Scoring systems such as POSSUM and P-POSSUM have been developed to help predict mortality and morbidity in patients. The ratio of observed-to-predicted (O/P ratio) mortality and morbidity has been used as a performance indicator to compare different procedures, clinicians or hospitals. The aim of this study was to assess the predictive value of POSSUM compared with P-POSSUM in patients undergoing laparotomy in Queen Elizabeth Hospital, Sabah.
Synchronous cancers are defined as malignant tumours that occur simultaneously, each of which must be distinct with no possibility of one being the metastasis of the other. A 65 year old gentleman presented to us with two month history of epigastric pain associated with anaemia, loss of appetite and weight. He has no history of malignancy in his family. Colonoscopy revealed tumours at transverse colon and caecum. Intra-operatively, tumours were sited at caecum, transverse colon and jejunum. Tumours were diagnosed as synchronous adenocarcinoma histopathologically with loss of expression of MLH1 and MSH2. From literature search, this is the first reported triple synchronous tumours of the caecum, transverse colon and jejunum. We believe that this gentleman developed triple synchronous tumour through the sporadic MSI pathway.