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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: Laparotomy
A case series of intestinal obstruction secondary to shiitake mushroom intake during Chinese New Year

Ng GH, Teoh LY, Teh MS, Jamaris S, See MH

J Surg Case Rep, 2020 Oct;2020(10):rjaa328.
PMID: 33093939 DOI: 10.1093/jscr/rjaa328

Shiitake mushroom is a common ingredient in East Asian cuisines. Food processing/preparation can cause the mushroom to be soft and slimy, leading to accidental swallowing. Due to its high insoluble fibre content, it remains the same size and shape in the intestinal tract. We present two cases of small bowel obstruction caused by shiitake mushroom requiring surgical intervention. Preoperative imaging showed dilated small bowel with a suspicious mass in the ileum. However, the exact cause was unclear. For both cases, exploratory laparotomy and enterotomy were then performed and undigested shiitake mushroom was found. Both patients recovered well from the surgery.

Matched MeSH terms: Laparotomy
Fulltext The challenge in diagnosing and managing heterotopic interstitial pregnancy in natural conception

Noor Azura Noor Mohamad, Suzanna Daud, Sun Ta Thow, Darminder Singh Chopra, Bahiyah Abdullah

Journal of Clinical and Health Sciences, 2019;4(2):86-90.
MyJurnal

Heterotopic interstitial pregnancy in natural conception is very rare. Definitive diagnosis is
made by systematic pelvic ultrasound. Simultaneous viable conception observed in both intraand extra-uterine is pathognomonic of heterotopic interstitial pregnancy. We report a 34-yearold woman primigravida at 10 weeks’ amenorrhoea who underwent evacuation of retained
product of conception for missed miscarriage. Intraoperatively, minimal product of conception
was retrieved. Bedside pelvic ultrasound showed cystic mass at right superolateral part of
uterine fundus suspicious of interstitial pregnancy. Cornual resection was performed via
laparotomy. Histopathological examination showed presence of product of conception and
interstitial pregnancy. Serum β-human chorionic gonadotropin dropped from 10,027 IU/l on day
one post-ERPC to 210 IU/l at day three post-cornual resection. This case report highlighted
the challenge in diagnosing heterotopic interstitial pregnancy conceived naturally. Timely
diagnosis may avert dire consequences of massive haemorrhage from ruptured uterine cornua

Matched MeSH terms: Laparotomy
Fulltext An Undiagnosed Non Functioning Retroperitoneum Paraganglioma, Complicating A Gynaecological Surgery; A Case Report

Noraziana, A.W., Hakim, B., Mokhtar, A., Alik, R.

International Medical Journal Malaysia, 2010;9(1):59-61.
MyJurnal

Paragangliomas are uncommon tumors arising from the neuroendocrine elements (chief cells) of the paraganglia and symmetrically distributed along the aorta in close association with the sympathetic chain. Although functional tumors are easier to diagnose due to the clinical fi ndings caused by excess secretion of catecholamines and an elevation of the urinary catecholamine levels, however the diagnosis of nonfunctioning paraganglioma of the retroperitoneum is diffi cult and only few cases have been made before exploratory laparotomy. Although our patient was initially planned and operated by our gynaecological team, the incidental findings had to involve the general surgeons. She is fortunate that the tumour did not show any features of malignancy nor metastasis, however a long time follow up is needed in case of any possible recurrence.

Matched MeSH terms: Laparotomy
Fulltext Diagnostic dilemma of a case of sigmoid volvulus complicating pregnancy

Nur Azurah, A.G., Ani Amelia, Z., Sagap, I.

Journal of Surgical Academia, 2011;1(1):46-48.
MyJurnal

We report the case of a 34-year-old Malay, admitted for constipation and abdominal pain at 35 weeks of gestation. Initially, she was diagnosed to have paralytic ileus and was managed conservatively. As her condition did not improve, emergency laparotomy was performed for suspected intestinal obstruction. She delivered a baby boy weighing 2.84kg with good Apgar score through a caesarean section. Intra-operatively, she was noted to have sigmoid volvulus and sigmoidopexy was performed. Post-partum, colonoscopy and bowel decompression was performed. She recovered well and was discharged on day 5. This case illustrates the need to diagnose or suspect volvulus in pregnant woman presenting with severe constipation as early surgical intervention can reduce morbidity to both mother and fetus.

Matched MeSH terms: Laparotomy
Fulltext Strangulated Morgagni hernia masquerading as an acute coronary syndrome

Ohn MH, Ng JR, Mehan TN, Luen NP

BMJ Case Rep, 2021 Jul 13;14(7).
PMID: 34257130 DOI: 10.1136/bcr-2021-244045

Morgagni hernia is the rarest type of congenital diaphragmatic hernia, which can present late in adulthood. Here, we report a case of Morgagni hernia in an elderly woman who presented as an acute coronary syndrome with raised troponin level. X-ray of the chest (CXR) showed air-fluid level in the right lower hemithorax with loss of right diaphragmatic outline and subsequently confirmed strangulated Morgagni hernia with CT. She was treated with emergency laparotomy to reduce the hernia content and surgical repair with mesh done. In conclusion, Troponin can be falsely positive in Morgagni hernia patients, possibly due to strain on the heart by herniated bowel contents. Basic imaging such as a (CXR) is useful in the case of chest pain to rule out the non-cardiac causes. Although 'time is the myocardium' in the setting of all cases of chest pain with raised troponin, CXR should be done before treatment that poses bleeding risk and unnecessary delay in laparotomy.

Matched MeSH terms: Laparotomy
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: Laparotomy
Ectopic pregnancies following mini-laparotomy Pomeroy female sterilization

Puraviappan A, Arshat H

Malays J Reprod Health, 1984 Jun;2(1):20-4.
PMID: 12267517
Matched MeSH terms: Laparotomy*
Fulltext Massive ovarian cysts--successful management of two cases

Ravindran J

Med J Malaysia, 1994 Sep;49(3):303-5.
PMID: 7845287

Massive ovarian cysts are not commonly encountered. They frequently present a challenge to the gynaecologist who is faced with them. Two cases of successful removal of massive ovarian cysts are presented. Successful management would involve recognition of complications which occur at various steps in the treatment.

Matched MeSH terms: Laparotomy
Rupture of the caecum due to invasive amoebiasis

Rohela M, Lee A, Khairul Anuar A, Zuminee MN, Johari S

JUMMEC, 2000;5:51-52.

This paper describes a case of invasive arnoebiasis in a 72 year old woman. About 1 week prior to admission she had right iliac fossa pain and physical examination suggested perforated appendix or carcinoma of caecum. Laparotomy revealed perforation of caecum. Histopathology of tissue removed showed abundant trophozoites of Entamoeba histolytica. After surgery treatment was instituted and patient had an uneventful recovery. KEYWORDS: Rupture of caecum, amoebiasis

Matched MeSH terms: Laparotomy
An unusual intra-vesicle foreign body following fall off a tropical fruit tree

S,Praveen, TW, Khor, L, James, GC, Teh, S, Febra

Journal of Surgical Academia, 2012;2(1):23-25.
MyJurnal

Penetrating injuries to bladder occur in 20 % of cases. Synchronous bladder and rectal perforation occur in 30-64 % of cases. The management of rectal and bladder injuries depend on whether it is an extra-peritoneal or intra-peritoneal injury. We hereby, report a case of penetrating trauma in a 13 year old boy who fell off a tropical fruit (Rambutan - Nephelium lappaceum) tree. He sustained an extra-peritoneal rectal injury with intra-peritoneal bladder injury. The rectal injury was repaired primarily via per anal route while the bladder injury needed an open repair following laparotomy. Upon removal of bladder clots, a leaf of the ‘Rambutan’ tree was found intra-vesically. It was removed and bladder repaired as per standard method. We review the literature on rare intra-vesicle foreign bodies and discuss the treatment of synchronous rectal and bladder injuries.

Matched MeSH terms: Laparotomy
Fulltext Perforated peptic ulcers in West Malaysia--a series of 73 cases treated by simple closure in a general hospital between 1972 and 1974

Said MY

Med J Malaysia, 1982 Sep;37(3):261-4.
PMID: 7177009

In a 3 year period 73 cases of perforated peptic ulcers were treated by simple closure. The overall mortality of 3.77 percent is acceptable when compared with other reports. There was a marked male preponderance (11 males: female 1). Biopsy results confirmed the operatiue findings that perforations were seven times more common in gastric peptic ulcers than duodenal ones. The disease affected young adults, the middle aged and elderly, the peak incidence occurring between the fifth and seventh decades oflife. Simple closure was an effective surgical procedure for our group of patients.

Matched MeSH terms: Laparotomy
Factors that influence pain intensity and fentanyl requirements after a gynecologic laparotomy

Seong Tan PC, Nik Mohamad NA, Gan SH

Pain Manag Nurs, 2013 Jun;14(2):102-9.
PMID: 23688364 DOI: 10.1016/j.pmn.2010.12.004

The association between pain intensity and its control by intravenous patient-controlled analgesia (IV-PCA) with fentanyl after a laparotomy for cystectomy/salphingoophorectomy, myomectomy, or hysterectomy was investigated. IV fentanyl infusion was administered to patients (n = 94) at 3 μg/kg/h to provide intraoperative analgesia after induction of general anesthesia. Postoperative fentanyl requirements were quantified via IV-PCA, and the amounts of rescue fentanyl required both during and after surgery were recorded. Mean values for PCA use as well as the visual analog scores (VAS) for pain were documented for up to 24 hours. The association between postoperative fentanyl requirements and VAS were then analyzed by using Mann-Whitney or Kruskal-Wallis tests. Patients with lower midline incisions had greater degrees of pain (p < .05) during the first 16 hours after surgery but did not consume more fentanyl compared with patients with Pfannenstiel incisions. Subjects who underwent operations lasting >4 hours required more rescue fentanyl during surgery (p < .05). However, this group consumed less fentanyl during the first 4 hours after surgery (p < .05). The demand at the fourth 4-hour period was lower among subjects undergoing myomectomy compared with cystectomy/salphingoophorectomy or hysterectomy (p = .045). Only a poor correlation was observed between pain intensity and analgesic usage. Postoperative pain intensity is influenced by the type of surgical incision but not the type of gynecologic surgery nor the duration of surgery. The relationship between subjective pain ratings with analgesic consumption is weak. Prolonged intraoperative administration of continuous IV fentanyl infusion may reduce fentanyl requirements in the immediate postoperative period.

Matched MeSH terms: Laparotomy/adverse effects
Fulltext Laparoscopic management of symptomatic urachal remnants in adulthood

Siow SL, Mahendran HA, Hardin M

Asian J Surg, 2015 Apr;38(2):85-90.
PMID: 24947766 DOI: 10.1016/j.asjsur.2014.04.009

The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. The aim of this study is to report our experience with laparoscopic urachus excision as a minimally invasive diagnostic and surgical technique.

Matched MeSH terms: Laparotomy
Fulltext The effects of nicotine on foetal loss, postnatal growth and plasma oestrogen and progesterone levels in rats

Siti Norashikin Mohd Tambeh, Sumitabha Ghosh, Mohd Hamim Rajikin

Journal of Clinical and Health Sciences, 2019;4(2):75-81.
MyJurnal

Introduction: The present study aims to investigate the effects of nicotine on foetal loss,
postnatal growth and corresponding levels of oestrogen and progesterone in pregnant rats.
Methods: Subcutaneous injection of nicotine tartrate (7.5 mg/kg/day) was administered to
groups of pregnant rats; with treatment scheduled from day 1 through day 5, day 5 through
day 9 or day 1 through day 9 of pregnancy. On day 10 of pregnancy, laparotomy was
performed to count the number of blastocyst implantation sites. During parturition, the
number of viable pups was recounted and statistically compared with the controls. One
group of rats which received nicotine from day 1 through day 9 of pregnancy was sacrificed
on day 16 of pregnancy, and circulating levels of oestrogen and progesterone were
measured. Upon delivery, the birth weight of the pups was measured, and their weights were
recorded until weaning. Results: There was a significant increase in foetal loss particularly in
rats which received nicotine from day 5 through day 9 and from day 1 through day 9 of
pregnancy. There was also significantly lower birth weight of pups in all groups; however,
this pattern did not continue until weaning. Plasma oestrogen level was significantly elevated
with a significant decrease in the plasma progesterone level. Conclusions: Nicotine
administration during pregnancy showed an increase in foetal loss with a corresponding
increase in oestrogen and decrease in progesterone levels. Although the birth weight of the
pups was low, there was catch-up growth in the pups.

Matched MeSH terms: Laparotomy
Atypical (symplastic) leiomyoma of the uterus--a case report

Siti-Aishah MA, Noriah O, Malini MN, Zainul-Rashid MR, Das S

Clin Ter, 2011;162(5):447-50.
PMID: 22041803

A 30-year-old, nulliparous woman presented with a history of subfertility. On examination she was found to have uterine fibroid of 28 weeks size of gravid uterus and subsequently laporatomy myomectomy was performed. Multilobulated masses, with diameters ranging from 22 mm to 160 mm were found. Cut sections of the lobulated masses showed whitish whorled cut surface. One of the multilobulated masses had a cystic cavity, measuring 60x50x35 mm(3). Light microscopic findings of the mass with the cystic cavity showed a well-circumscribed cellular tumour composed of cells exhibiting moderate nuclear atypia which were enlarged, nuclei with prominent chromatin clumping and were distributed in areas. Some tumour cells showed large nuclear pseudoinclusions, multinucleated or multilobated tumour giant cells, smudging and few enlarged nucleoli. Mitotic activity was 4 MFs per 10 HPFs. Occasional cells with intracytoplasmic inclusions resembling rhabdoid - like features were seen. There were no atypical mitoses or tumour necroses were noted. Diagnosis of atypical leiomyoma or symplastic leiomyoma was made. Atypical or symplastic leiomyomas are rare in the region of Malaysia and the present case discusses its incidence in younger age, its morphological features along with diagnosis and clinical outcome.

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
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
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
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

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