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Fulltext Huge Retroperitoneal Cyst Masquerading as Ovarian Tumour: A Case Report

Johan S, Hassan MF, Hayati F, Azizan N, Payus AO, Edwin See UH

Front Surg, 2020;7:585411.
PMID: 33195391 DOI: 10.3389/fsurg.2020.585411

Retroperitoneal cystic mass is a rare surgical condition that is often misdiagnosed preoperatively. Here, we report a case of a 56-year-old woman who presented with abdominal swelling for a 1-year duration, which was associated with lower abdominal pain for 6 months. Her abdominal radiograph showed a huge radiopaque lesion, and contrast-enhanced computed tomography scan of the abdomen reported it as a left ovarian serous cystadenoma causing local mass effect to the left ureter leading to mild left hydronephrosis. She underwent exploratory laparotomy and noted there was a huge retroperitoneal cystic mass. The histopathological assessment finding was consistent with a benign retroperitoneal cyst. This case report aims to share the rare case of primary retroperitoneal lesions, which can cause a diagnostic challenge preoperatively to all clinicians despite advanced achievement in medical imaging.

Matched MeSH terms: Abdominal Cavity
Fulltext Boesenbergia rotunda ethanolic extract inhibits compound action potentials via opioid receptors

Gopalsamy, Banulata, Chia, Jasmine Siew Min, Farihah Hanani Ghazali, Ammar Izzati Amir Ramadan, Wong, Siong Jun, Ahmad Akira Omar Farouk, et al.

Life Sciences, Medicine and Biomedicine, 2018;2(2):7-12.
MyJurnal

Boesenbergia rotunda, traditionally used to relieve stomach, abdomen, joint, muscle, and rheumatic pain was also reported for its antinociceptive effect on a mouse model. However, the possible pain relief effect of Boesenbergia rotunda ethanolic extract (BREE) via the inhibition to the neural pain pathway remains to be elucidated. This study investigated the inhibitory effect of BREE on compound action potentials (CAPs) and the possible involvement of the opioid receptors. The changes in the CAPs amplitudes of the frog’s sciatic nerves were evaluated following the exposure to three different dosages of BREE (1, 3 and 10 mg/ml and morphine (3 mg/ml). In another set of experiment, the nerves were pretreated with a non-selective opioid receptor antagonist, naloxone (0.1 mg/ml), before exposing the nerve to BREE (1 mg/ml) to investigate the involvement of opioid receptors in the CAPs inhibitory mechanism. The outcome showed a reduction in the CAPs amplitudes when treated with BREE (1, 3 and 10 mg/ml) whereby the effect was reversible. The CAPs inhibition by BREE was absent when the opioid receptors were blocked. Taken together, these findings suggest that BREE-induced CAPs amplitude reduction involves the activation of opioid receptors.

Matched MeSH terms: Abdominal Cavity
Fulltext Multiple renal arteries with an ascending upward renal Vein of the right kidney: a case report

Al-Shibli S.M.

International Medical Journal Malaysia, 2014;13(1):57-60.
MyJurnal

As it is known; the majority of the human subjects has two renal arteries arising from the abdominal aorta; each will supply one kidney but in 30% of individuals, certain variations can be found. Accessory renal arteries constitute the most common and clinically important of these variations. For our case report, we are presenting one of these different variations that can be found in the blood supply of the kidneys. During dissecting the abdomen of an approximately 65 years-old male cadaver, multiple variations were found. There were double right renal arteries with prehilar branching of the upper renal artery. We found also that the right renal vein ascended upwards obliquely before ending in the lateral aspect of the inferior vena cava. Variation in the renal vessels is relatively common, especially multiple renal arteries, and can go smoothly without any abnormalities with the function of the kidney, but in some situations like renal transplantations, vascular reconstructions, and various surgical and radiological diagnostic techniques, the study of the anatomy of these variations is of crucial importance to decrease the patient morbidity during surgical procedures.

Matched MeSH terms: Abdominal Cavity
Fulltext A case of lymphangioleiomyomatosis with multiple angiomyolipomas in the kidneys: a case report

How, S.H., Azlin, S., Pang, Y.K., Liam, C.K.

JUMMEC, 2006;9(2):35-38.
MyJurnal

Lymphangioleiomyomatosis (LAM) is a rare disease. The reported prevalence is around one per million in the West but the exact prevalence in Asia is unknown. It affects primarily young women of reproductive age, with a mean age of onset at 34 years. The disease is characterised by an abnormal proliferation of smooth muscle-like cells that grow over a course of time to obstruct airways, lymphatic and blood vessels. We report a case of LAM in a young woman who presented with a spontaneous pneumothorax. Computed tomography scan of the thorax and abdomen showed homogenous thin-walled cystic lesions with normal intervening lung parenchyma and multiple lesions in her kidneys with Hounsfield units similar to that of fat.

Matched MeSH terms: Abdominal Cavity
Inflamatory pseudotumor of the bladder: a histopathological diagnostic challenge from its malignant variant

Muhammad Akbar, Praveen, S., Christopher, H.C.K., Goh, E.H., Swaminathan, Zulkifli, M.Z.

Journal of Surgical Academia, 2012;2(1):46-49.
MyJurnal

Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology

Matched MeSH terms: Abdominal Cavity
Fulltext Issues in management of acute appendicitis in pregnancy

Nalliah, Sivalingam, Wijesuriya, Lionel, Venugopal, Subramani

International e-Journal of Science, Medicine & Education, 2011;5(1):2-9.
MyJurnal

Acute appendicitis is an infrequent yet the commonest surgical emergency in pregnancy occurring in about 1:1500 pregnancies. The classical abdominal pain in the right lower quadrant of the abdomen is the only reliable clinical sign. Delay in diagnosis is attributed to presence of symptoms commonly seen in pregnancy like nausea and vomiting and difficulty in localizing abdominal pain due to displacement of the appendix with advancing gestation. Perforated appendix and generalized peritonitis impacts adversely on pregnancy contributing to increases in miscarriage, pre-term delivery, fetal loss and even maternal mortality. Imaging studies like abdominal ultrasonogram, helical computerized tomography and magnetic imaging have been utilized to complement clinical suspicion and decrease ‘negative appendectomies’ but robust data on their routine use is awaited. Although the laparoscopic approach is a useful diagnostic and therapeutic tool in early pregnancy, its use as the primary approach for appendicectomy in pregnancy requires further evaluation as increases in the incidence of fetal loss of 5.6% has been reported compared to 3.1% in open access surgery

Matched MeSH terms: Abdominal Cavity
Fulltext Superior somatic pain relief and improved visceral pain control is achieved using pre-emptive analgesia for laparoscopic cholecystectomy: a randomized controlled trial

Koh, P.S., Cha, K.H., Lucy, C., Rampal, S., Yoong, B.K.

JUMMEC, 2012;15(2):1-7.
MyJurnal

BACKGROUND:
Laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. The use of local anaesthesia to relieve pain following this procedure is a common practice. However, it remains debatable whether a pre- or post-operative drug administration is more effective. Here, we investigated the role of preemptive local anaesthetic infiltration given pre- or post-incisional, in relieving the pain during laparoscopic surgery.

METHODOLOGY:
A randomized controlled trial was conducted with 96 patients receiving 0.5% Bupivacaine 100mg. Group A (n=48) received post-incisional skin infiltration whilst Group B (n=48) received pre-incisional infiltration. Incisional (somatic) and intra-abdominal (visceral) pain was assessed using Visual Analog Scale (VAS) at day 0, day 1 and day 7 post-operative days.

RESULT:
Baseline characteristics between the two groups were similar. Incisional pain was lower in Group B as compared to Group A at day 0 (P=0.03) and day 1 (P0.05).

CONCLUSION:
Administration of pre-incisional local anaesthesia offers better pre-emptive pain relief measure than post-incisional administration by reducing somatic and visceral pain in laparoscopic gall bladder surgery.

Matched MeSH terms: Abdominal Cavity
Fulltext Congenital peritoneal band causing bowel ischaemia post caesarean section: a rare occurrence

Phon, S.E., Ng, W.Y.L., Ng, B.K., Rahman, R.A., Zainuddin, A.A, Mahdy, Z.A.

Journal of Surgical Academia, 2017;7(2):28-31.
MyJurnal

Congenital peritoneal band is an extremely rare condition, but may induce small bowel obstruction (SBO) at any age, predominantly in childhood and rarely in adults. We report a case of extensive bowel ischaemia following caesarean section, due to trapping of an intestinal loop between a congenital peritoneal band and the mesentery. A 42-year-old, Gravida 2 Para 1, who has no history of prior abdominal surgery or trauma, presented in spontaneous labour and underwent an uncomplicated emergency lower segment caesarean section, for fetal distress. Postoperatively, she had worsening abdominal distension and pain, followed by vomiting. Computed Tomography Scan of the abdomen showed gross fluid retention with marked small bowel dilatation and fluid filled bowel loops. An emergency exploratory laparotomy was performed which revealed a congenital band, extending between the right fimbrial end and the small bowel mesentery, looping over the small bowel, causing extensive small bowel ischemia. Post-operative course was uneventful. In conclusion, congenital peritoneal band causing small bowel obstruction, although rare, should be considered in the differential, especially for patients with virgin abdomen.

Matched MeSH terms: Abdominal Cavity
Fulltext Infestation of parasitic rhizocephalan barnacles Sacculina beauforti (Cirripedia, Rhizocephala) in edible mud crab, Scylla olivacea

Waiho K, Fazhan H, Glenner H, Ikhwanuddin M

PeerJ, 2017;5:e3419.
PMID: 28674645 DOI: 10.7717/peerj.3419

Screening of mud crab genus Scylla was conducted in four locations (Marudu Bay, Lundu, Taiping, Setiu) representing Malaysia. Scylla olivacea with abnormal primary and secondary sexual characters were prevalent (approximately 42.27% of the local screened S. olivacea population) in Marudu Bay, Sabah. A total of six different types of abnormalities were described. Crabs with type 1 and type 3 were immature males, type 2 and type 4 were mature males, type 5 were immature females and type 6 were mature females. The abdomen of all crabs with abnormalities were dented on both sides along the abdomen's middle line. Abnormal crabs showed significant variation in their size, weight, abdomen width and/or gonopod or pleopod length compared to normal individuals. The mean body weight of abnormal crabs (type 1-5) were higher than normal crabs with smaller body size, while females with type 6 abnormality were always heavier than the normal counterparts at any given size. Sacculinid's externa were observed in the abdomen of crabs with type 4 and type 6 abnormalities. The presence of embryos within the externa and subsequent molecular analysis of partial mitochondrial COI region confirmed the rhizocephalan parasite as Sacculina beauforti. Future in-depth descriptions of the life cycle and characteristics of S. beauforti are recommended as it involves a commercially important edible crab species and the effect on human health from the consumption of crabs is of crucial concern.

Matched MeSH terms: Abdominal Cavity
Fulltext Dataset on the influence of relative humidity on the pathogenicity of Metarhizium anisopliae isolates from Thailand and Malaysia against red palm weevil (Rhynchophorus ferrugineus, Olivier) adult

Cheong JL, Azmi WA

Data Brief, 2020 Jun;30:105482.
PMID: 32368576 DOI: 10.1016/j.dib.2020.105482

Red palm weevil (RPW), Rhynchophorus ferrugineus, is a polyphagous insect that caused economic damage in various palm species, particularly coconut plantation in Malaysia. Therefore, entomopathogenic fungus Metarhizium anisopliae was being introduced in attempts to control biologically the RPW. The entomopathogenicity of an indigenous (Met-Gra4) and foreign (Met-TH) strains of M. anisopliae isolated from the soil of Malaysia and Thailand, were tested against RPW adults in laboratory bioassays at 50, 70, 90% relative humidity (RH). Bioassays indicate no significance differences in efficacy between both the conidia of M. anisopliae strains against RPW adults. Met-Gra4 showed the highest efficacy at 90% RH (LT50 = 6.17 days). However, LT50 only slightly differed from Met-TH (6.33 days; 90% RH). Scanning el ectron microscopy for the treated RPWs showed that Met-Gra4 (90% RH) was densely sporulated within the abdomen, while Met-TH can be found mainly across cuticular surface of RPW.

Matched MeSH terms: Abdominal Cavity
Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre's-Like Syndrome

Nguyen D, Yaacob Y, Hamid H, Muda S

Malays J Med Sci, 2013 Oct;20(5):70-8.
PMID: 24643401

Lemierre's syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.

Matched MeSH terms: Abdominal Cavity
Term Live Secondary Abdominal Pregnancy: A Case Report

Pannu D, Bharti R, Anand HP, Sharma M

Malays J Med Sci, 2016 Sep;23(5):96-99.
PMID: 27904431

Term, live abdominal pregnancy secondary to rupture of a uterine rudimentary horn is a rare condition. Pregnancies conceived in the rudimentary horn of the uterus usually rupture during early gestation and present as a catastrophic event. However, rarely, after rupture of the uterine horn the foetus may continue to grow in the abdominal cavity and reach term gestation. A primigravida with a term pregnancy was referred to our centre for caesarean section with ultrasonography findings of transverse lie and placenta previa. During surgery, a live baby was extracted from the abdominal cavity, revealing a bicornuate uterus with rupture of the rudimentary horn. The early peroperative diagnosis and prompt control of the bleeding with excision of the rudimentary horn and transfusion of multiple blood products saved the patient's life. The case is presented for its rarity and to highlight the importance of a high index of suspicion in cases presenting with abnormal foetal presentation.

Matched MeSH terms: Abdominal Cavity
Fulltext Encapsulating peritoneal sclerosis associated with Burkholderia pseudomallei peritonitis

Aulia Z, Wan Ali WASR, Shahar MA

Saudi J Kidney Dis Transpl, 2018 12 28;29(6):1484-1487.
PMID: 30588983 DOI: 10.4103/1319-2442.248318

Burkholderia pseudomallei is a known motile organism in soil. Its infection is usually described in immunocompromised patients. It inflicts serious infection with high mortality and morbidity rate. We report a rare case of an end-stage renal disease patient on regular continuous ambulatory peritoneal dialysis (PD) who developed melioidosis PD peritonitis. Within a short period of time, she developed encapsulating peritoneal sclerosis evidenced by the intraoperative findings of intraabdominal cocooning. Choice and duration of antibiotic are important for proper eradication of the organism. Early diagnosis and treatment of both conditions also may improve the prognoses.

Matched MeSH terms: Abdominal Cavity
Extranodal NK/T-cell lymphoma mimicking Crohn's colitis

Wan Ahmad Kammal WS, Mohd Rose I, Md Zin RR, Raja Ali RA, Masir N

Malays J Pathol, 2019 Aug;41(2):195-199.
PMID: 31427556

INTRODUCTION: Extranodal NK/T cell lymphoma is a rare tumour, typically involving the upper aerodigestive tract. Even rarer is primary extranasal disease involving the skin, testis, soft tissue and gastrointestinal tract.
CASE REPORT: We report a case of a 46-year-old Chinese male who presented with six months history of abdominal pain, weight loss and rectal bleeding. Diagnostic colonoscopy revealed multiple aphthous ulcers within the ileo-caecal region and distal transverse colon, separated by normal mucosa, mimicking skip lesions of Crohn's colitis. Computer topography (CT) scan of the abdomen showed multiple circumferential thickenings involving predominantly the right colon. A clinical diagnosis of colonic Crohn's disease with possible perforation was made. An extended right hemicolectomy was performed due to uncontrolled rectal bleeding. Histopathology examination of the colon showed infiltration by malignant lymphoid cells associated with necrosis, angiocentricity and angiodestruction. Immunohistochemical studies confirmed T-cell monoclonality, presence of cytotoxic granules and Epstein-Barr virus (EBV) infection. A diagnosis of extranodal NK/T cell lymphoma of the colon was made.
DISCUSSION: These findings highlight that colonic NK/T cell lymphoma may clinically mimic other benign inflammatory lesions and should be one of the differential diagnoses in patients presenting with gastrointestinal lesions. The final diagnosis is only possible with appropriate histological and immunohistochemical studies.

Matched MeSH terms: Abdominal Cavity
Fulltext Ultrasound Subcostal Approach Transversus Abdominis Plane Block in Morbidly Obese Patient

Nelbon Giloi, Liew, Constance Sat Lin, Payus, Alvin Oliver, Mac Guad, Rhanye, Murugaiah, Chandrika, Soe, May Zaw, et al.

Borneo Journal of Medical Sciences, 2019;13(3):43-47.
MyJurnal

As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.

Matched MeSH terms: Abdominal Cavity
Fulltext Reduction of tear-drop poikilocytes in a case of myelofibrosis following splenectomy

Chooi, Fun Leong, Soon, Keng Cheong

Medicine & Health, 2006;1(1):81-84.
MyJurnal

Myelofibrosis is a chronic myeloproliferative disorder characterised by splenomegaly, leukoerythroblastic anaemia, tear-drop poikilocytosis and marrow fibrosis. Splenectomy is indicated for patients requiring frequent transfusions or massive splenomegaly causing distressing symptoms and severe thrombocytopenia secondary to hypersplenism.A 56 year-old lady diagnosed to have primary myelofibrosis in year 2000 was referred to HUKM for further management of her increasing requirement of blood transfusion and massive splenomegaly. She has had two episodes of acute cholecytitis. Investigations done in our hospital showed that her hemoglobin level was 6.4g/dl, white cell count of 23.4x109/l, platelet count 163x109/l and peripheral blood showing leukoerythroblastic picture and tear-drop poikilocytosis. Leukocyte alkaline phosphatase score (NAP) was 184/100 neutrophils. Ultrasound of the abdomen showed massive splenomegaly with multiple gall stones. In view of the frequent transfusion requirements and symptomatic massive splenomegaly, splenectomy and cholecystectomy was performed. A review of her peripheral blood picture, post-splenectomy, showed marked reduction of the tear-drop poikilocytosis and leukoerythroblastosis. We believe that the spleen plays an important role in their formation, but the exact mechanism remains unclear.

Matched MeSH terms: Abdominal Cavity
Fulltext An epidemiological study of abdominal and pelvic injury trauma in post-mortem cases at Hospital Kuala Lumpur between the year of 2002-2003

Abdul Halim Mansar, Muhammad Aadeel T., Khairul Osman, Sharin Iskandar, A.W.

Jurnal Sains Kesihatan Malaysia, 2008;6(2):65-73.
MyJurnal

The abdominal pelvic cavity has always been regarded as one of the most vulnerable regions of the body. Injuries to this part have been known to be very serious. Based on this a retrospective study was performed on postmortem cases with abdominal and pelvic trauma from 1 October 2002 to 31 January 2003 at the Forensic Institute, Hospital Kuala Lumpur to determine the common pattern of abdomino-pelvic injuries, the injury’s relationship to epidemiological and socio-economic factors, risk organ within the abdominopelvic region and relationship between injuries and survival period. A total of 122 cases abdomino-pelvic were obtained stemming from medico legal postmortems procedures. Results indicated that those aged between 21 to 30 years (38.5%) had the highest incidence of this type of injury. Categorization based on gender showed that males (90.2%) dominated most of the cases. Prevalence based on socio-economic status showed that lower socioeconomy class (52.5%) had the highest incident. This was followed by the middle income (39.3%) and finally the higher income group. The most numerous type of trauma was non-penetrating trauma (94.3%). It was also found that victims with low injury severity score (ISS) had a longer survival period as compared to those with high ISS. It was also noted that victims with two or more region injuries either were spot dead or brought dead. The most common combination of injuries was abdomen, pelvic, chest and limb. In most blunt trauma cases majority of victims had one or two organ involvement while penetrating injuries were difficult to asses. The most common organ involved in this type of trauma was liver (72.1%), pelvic bone (47.5%) and spleen (43.4%). In conclusion, abdomino-pelvic injury is a serious condition and should not be overlooked. Proper attention towards their diagnosis and management is important and so any patient of head injury with coma must be considered as having intra-abdominal injury until proven otherwise.

Matched MeSH terms: Abdominal Cavity
Fulltext Melioidosis Prostatic Abscess: Clinical Presentation and Imaging Findings

Razali, M.R., Amran, A.R., How, S.H., Ng, T.H., Aminuddin, C.A., Jamalludin, A.R.

International Medical Journal Malaysia, 2008;7(1):0-0.
MyJurnal

Introduction: Melioidosis, an infection caused by Burkholderia pseudomallei is endemic in South East Asia and Northern Australia. It can affect many organs in the body such as lung, liver, spleen, bone, prostate, brain and soft tissues. Objective: This study aims to detect the presence of prostatic abscess in patients with a positive blood culture for Burkholderia pseudomallei with computed tomography (CT) of the abdomen and pelvis and to correlate it with the clinical presentation. Materials and Methods: This is a prospective observational study conducted in all melioidosis patients who had CT scan of the abdomen and pelvis. The location and size of any focal lesions seen on CT were recorded. Clinical data such as fever and urinary symptoms were also recorded. Results: 15 patients had CT scan of the abdomen and pelvis. Five patients were diagnosed to have prostatic abscess. Out of the five patients, only two had urinary symptoms. The other three had prolonged high grade fever without any urinary symptoms. Conclusions: Melioidosis prostatic abscess is not uncommon in patients with positive blood culture of Burkholderia Pseudomallei (33% in this series). Most patients do not present with any urinary symptoms.

Matched MeSH terms: Abdominal Cavity
Biliary ascariasis: a wandering worm

Lim, C.B., Munirah, A., Alias, M., Nandy, A.K., Thamby Dorai, C.R.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):68-71.
MyJurnal

Ascaris lumbricoides infection usually results in mild gastrointestinal symptoms. However, heavy worm load infections can cause major complications. In one-third of the latter cases, the worms enter the bile duct causing cholangitis, biliary colic and acute pancreatitis. We describe an eleven-year-old Indian boy who presented with high grade fever, vomiting of worms, jaundice and right hypochondria! pain. Examination revealed an ill, malnourished and jaundiced child. His abdomen was tender with positive Murphy's sign and hepatomegaly. Urgent ultrasound showed hepatomegaly with dilated intrahepatic and common bile ducts (CBD). There were tubular echogenic filling defects with central sonolucency along the long axis of the CBD. He was fasted, started on intravenous fluids and broad spectrum antibiotics. As there was no improvement after 24 hours, endoscopic retrograde cholangio-pancreaticography (ERCP) was performed: it showed worms in the CBD. A stent was inserted to decompress the bile ducts and to ensure biliary drainage. The patient improved, the fever settled, jaundice resolved, serum amylase and transaminase levels normalised. It was planned to remove the stent at a later date.

Matched MeSH terms: Abdominal Cavity
Fulltext Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

Ng BK, Yakob KA, Ng WYL, Lim PS, Abd Rahman R, Abdul Karim AK, et al.

Case Rep Med, 2017;2017:9016782.
PMID: 29259630 DOI: 10.1155/2017/9016782

Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10-20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

Matched MeSH terms: Abdominal Cavity

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