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Fulltext Spontaneous closure of a persistent post-traumatic pancreatic fistula in a child: incidental therapeutic effect of ERCP

Thambidorai CR, Ismail S, Chan KY, Haron A, Zulfiqar A

Med J Malaysia, 2004 Mar;59(1):120-2.
PMID: 15535349

A child with a post-tramatic pancreatic pseuodocyst developed pancreatic fistula, following percutaneous drainage of the cyst. The fistula output was about 120ml/day and lasted for a month. A diagnostic ERCP revealed main pancreatic duct disruption. The fistula output ceased over the next two days following the ERCP. The patient has been well for the past four years. This patient's immediate recovery after ERCP could possibly be due to dislodgement of a mucus plug by the contrast injected during ERCP. Such a mechanism can explain the previous sporadic reports of spontaneous cure of persistent pancreatic fistulae in children.
Midgut volvulus: a rare cause of intestinal obstruction in adults

Koong JK, Vythialingam G, Rozalli FI, Thambidorai CR

ANZ J Surg, 2018 Apr;88(4):E348-E349.
PMID: 26464218 DOI: 10.1111/ans.13343
Fulltext Jaundice clearance and cholangitis in the first year following portoenterostomy for biliary atresia

Selvalingam S, Mahmud MN, Thambidorai CR, Zakaria Z, Mohan N, Isa, et al.

Med J Malaysia, 2002 Mar;57(1):92-6.
PMID: 14569724 MyJurnal

Sixty-one patients with biliary atresia, who underwent portoenterostomy (PE) between 1992 to 1998 in the Institute of Pediatrics, Kuala Lumpur and were followed for a period of one year, were studied to analyze the factors associated with jaundice clearance and cholangitis following PE. Sex distribution was equal. Majority of patients were Malays. Mean age in days at admission to the surgical ward was 66.90 +/- 23.36 and mean age at PE was 75.85 +/- 24.05. At the end of one-year follow-up, six patients (10%) had died, 35 (57%) developed one or more attacks of cholangitis, 35 (57%) had portal hypertension, eight (13%) liver failure and six patients had esophageal variceal bleeding. Thirty-three patients (54%) had jaundice clearance with a mean clearance time of 85 days after PE. The study shows that when the ductules in the porta hepatis were < 150 mu in size, persistence of jaundice after PE and the incidence of cholangitis in the first post-operative year were higher; patients with cholangitis in the first year had lower rate of jaundice clearance. Jaundice clearance was achieved in more patients when their postnatal age at the time of PE was lower but the relationship was not linear. Age at PE also did not have a linear temporal relationship to the incidence of cholangitis and the size of portal ductules. Prospective, multi-center based local studies on a bigger patient population are needed to identify other indicators of successful outcome following PE. This would help to define the indications for primary liver transplantation in the local population.
Amelanotic spitzoid melanoma in a prepubescent boy

Goh EH, Zarina AL, Thambidorai CR, Maizaton AA, Siti AM, Somasundram S

Pediatr Surg Int, 2008 Apr;24(4):447-9.
PMID: 17437116

The diagnosis of malignant melanoma (MM) in children is difficult due to its uncommon occurrence as well histological similarities to Spitz nevus. A case of MM of the foot in an 11-year-old boy is reported illustrating the histological overlap between Spitz nevus and MM. In our patient, both the primary foot lesion and the regional inguinal metastases were amelanotic, further increasing the diagnostic difficulty. The literature on MM in children is limited and the documentation of such unusual cases is necessary to improve the knowledge on this disease.
Recurrent gastric inflammatory myofibroblastic tumour in a 13-year-old male

Hamidah A, Khu SY, Thambidorai CR, Muhaizan WM, Zarina AL, Jamal R

Pediatr Surg Int, 2007 Jun;23(6):601-3.
PMID: 17063336

A 13-year-old boy who had epigastric pain and pallor for 2 months and found to have an ulcerative mass in the stomach and underwent partial gastrectomy. A diagnosis of inflammatory myofibroblastic tumour (IMT) of the stomach was made on histological examination. Three years later, recurrence in the stomach, with invasion into the pancreas and hilum of the spleen was noted and was managed by wide wedge resection of the stomach, distal pancreatectomy and splenectomy. The patient has been recurrence-free for the past 2 years. Gastric IMT is an uncommon tumour in children with unpredictable prognosis.
Fulltext Ultrasound measurement of corporeal (penile) length in newborns

Khairil OA, Zulfiqar A, Thambidorai CR, Nizam JM, Ahmad JT, Jamil MA

Med J Malaysia, 2005 Oct;60(4):469-74.
PMID: 16570709

In the initial clinical examination of a child with ambiguous genitalia an accurate measurement of the corporeal length is needed. Most often the corporeal length is measured with a ruler from the symphysis pubis to the tip of the glans of a stretched penis. More recently, ultrasound has been successfully used to measure corporeal length. This study aimed to (i) establish normal values for corporeal length in normal male newborns using ultrasound measurement, (ii) compare these measurements to stretched corporeal measurements, (iii) compare the corporeal length of newborns of different races, and (iv) determine the relationship between corporeal length and birth weight, birth length and head circumference. This was a prospective study of 141 newborns. Ultrasound imaging was done in an oblique parasagittal plane such that the corpus could be included in a single image and measured, Stretched corporeal length was measured with the penis stretched alongside a wooden spatula and the length from the pubic bone to the tip of the glans was marked on the spatula and measured. By ultrasound measurement the mean corporeal length of the normal newborn was 3.18 +/- 0.56cm. There was no significant difference in the mean corporeal length when determined by ultrasound and by stretched corporeal measurement. There was no significant difference in the mean corporeal length of the different races when the length was determined by either ultrasound or stretched corporeal measurement. There was a positive correlation between ultrasound length and birth weight and birth length. However, there was no correlation between ultrasound length and head circumference. There was no significant correlation between the stretched length and either birth weight, birth length or head circumference.
Cardiopulmonary bypass in surgery for complex-combined vascular malformation of the lower limb: case report

Ismail MS, Sharaf I, Thambidorai CR, Zainal A, Somasundaram S, Adeeb S, et al.

Pediatr Surg Int, 2005 May;21(5):392-5.
PMID: 15806424

A 16-year-old boy was referred with features of Parkes Weber syndrome (PWS) involving the right lower limb. He had presented at birth with cutaneous vascular malformations (VM) in the right thigh and at the age of 7 years developed congestive cardiac failure, which was controlled with drugs. He received alpha interferon and steroids during this period without any benefit. He defaulted follow-up and at 12 years of age presented with further enlargement of the VM in the right thigh and leg with skin and soft tissue thickening. At this stage, embolization and subsequent excision of the VM were tried, but the surgery was abandoned because of massive hemorrhage. Over the next 4 years, the boy became totally bedridden because of massive increase in the size of the limb, repeated hemorrhages, and secondary infection of the VM. Right hip disarticulation was considered the best option to improve his quality of life. To prevent uncontrollable hemorrhage during surgery, the disarticulation was done under cardiopulmonary bypass with low circulatory flow. Postoperatively, the patient required intensive care nursing for a week. He is presently ambulatory with crutches. Cardiopulmonary bypass with low flow has been used for treating posttraumatic arteriovenous malformations. However, its use in surgery for PWS has not been reported earlier.
Intra-abdominal hypertension in neonates following congenital diaphragmatic hernia repair: Correlation with early postoperative respiratory and gastrointestinal outcomes

Thambusamy E, Thambidorai CR, Nah SA, Gan CS, Wang J, Singaravel S, et al.

J Pediatr Surg, 2022 Feb;57(2):199-202.
PMID: 34857376 DOI: 10.1016/j.jpedsurg.2021.10.029

BACKGROUND: Increased intra-abdominal pressure (IAP) is seen in patients after congenital diaphragmatic hernia (CDH) repair owing to reduction of thoracic contents into the relatively smaller abdominal cavity. In infants, IAP ≥11 mmHg is considered intra-abdominal hypertension (IAH). We aim to determine the incidence of IAH and its relationship with duration of ventilatory support, and gastrointestinal function post CDH repair.
METHODS: We prospectively recruited all neonates who had CDH repair in four hospitals in Malaysia from June 2018 to October 2020. Intra vesical pressure was used as a proxy for IAP and was measured for 5 consecutive days post surgery. The daily median value was used for analysis. We categorized IAP as <11 mmHg (no IAH), 11-15 mmHg (IAH), and >15 mmHg (severe IAH). Incidence of IAH, its effects on the duration of ventilatory support, and gastrointestinal function were studied.
RESULTS: There were 24 neonates included in this study. They were operated between day 1 and 6 of life (median: 4 days old). IAH was detected within the first 3 days post surgery, with 83% occurring on day one. Those requiring ventilatory support for more than 3 days contributed the largest proportion of IAH (n = 17, 71%). There was strong correlation between days of IAH and duration of ventilation (p
Fulltext Acute pancreatitis in north-eastern peninsular Malaysia: an unusual demographic and aetiological pattern

Raj SM, Lopez D, Thambidorai CR, Kandasamy P, Toufeeq Khan TF, Mohamad H, et al.

Singapore Med J, 1995 Aug;36(4):371-4.
PMID: 8919148

A survey of 142 cases of acute pancreatitis was undertaken in two major hospitals serving the state of Kelantan in Malaysia. Females outnumbered males by a ratio of more than 3:1. The incidence among females peaked in the third decade of life. Twenty-one percent (23/109) of the females were pregnant. Ultrasonography revealed gallstones in only 9.4% (13/138). However, abnormalities of serum transaminases were found in 35% (35/100), suggesting that occult gallstones or microlithiasis may be the cause in a significant proportion of patients. Alcohol was virtually absent as an aetiological factor. There was a higher frequency of Ascaris infection in this group than a control hospital population (11/35 vs 33/242; p < 0.02) suggesting that ascariasis may be an important cause of acute pancreatitis in Kelantan. Only 8.4% fell into the category of severe pancreatitis. The overall mortality rate was 2.1%.