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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
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
Fulltext A puzzling case of biliary stricture with calcified liver nodules

Leow, V.M., Faizah, M.S., Yang, K.F., Hasnan, M.N., Manisekar, S.S.

International Medical Journal Malaysia, 2013;12(2):79-82.
MyJurnal

Tuberculous (TB) biliary stricture with calcified liver nodules rendering obstructive jaundice is a rare clinical phenomenon. Recently, we encountered a young patient with obstructive jaundice who was investigated in a general hospital. He was sent to our hospital for subsequent management after undergoing a series of investigations and biliary stenting. The radiological imagings performed revealed multiple calcified lesions in the liver with proximal bile duct strictures. Blood investigations, tumor markers and tuberculous work up were not remarkable. Subsequently, he underwent laparotomy and biliary reconstruction. Postoperatively, he was discharged well. Histopathological examination of the hepatoduodenal nodes showed chronic infections and granulomatous lymphadenitis, suspicious of a mycobacterium infection.

Matched MeSH terms: Laparotomy
Fulltext Congenital trans-mesenteric herniation: a rare cause of small intestine strangulation in adults

Umaparan G, Nallusamy K, Abdul Wahab MH, Mohammad Nor AM, Mat Arif NA

J Surg Case Rep, 2012 Dec 04;2012(11).
PMID: 24968390 DOI: 10.1093/jscr/rjs003

Trans-mesenteric hernia is a form of internal hernia which is an extremely rare cause of intestinal obstruction in adults compared with the pediatric population. It often presents with complications such as acute intestinal obstruction and peritonitis requiring immediate surgical intervention. We report a case of a 21-year-old woman who presented to us with an acute abdomen and peritonitis that required an immediate exploratory laparotomy. She was found to have a small congenital mesenteric defect with strangulated segment of ileum. Gangrenous portion of the ileum was resected and the congenital defect was closed. The patient made an uneventful recovery. The occurrence of trans-mesenteric hernia in adults is rare and difficult to be diagnosed clinically; thus, the patient's clinical features may lead to early surgical intervention in order to reduce morbidity and mortality.

Matched MeSH terms: Laparotomy
Prophylactic Onlay Mesh Repair (POMR) Versus Primary Suture Repair (PSR) for Prevention of Incisional Hernia (IH) After Abdominal Wall Surgery: A Systematic Review and Meta-analysis

Hassan MA, Yunus RM, Khan S, Memon MA

World J Surg, 2021 10;45(10):3080-3091.
PMID: 34279690 DOI: 10.1007/s00268-021-06238-6

BACKGROUND: With many different operative techniques in use to reduce the incidence of incisional hernias (IH) following a midline laparotomy, there is no consensus among the clinicians on the efficacy and safety of any particular repair technique. This meta-analysis compares the prophylactic onlay mesh repair (POMR) and primary suture repair (PSR) for the incidence of IH.
METHODS: A meta-analysis and systematic review of MEDLINE, PubMed Central (via PubMed), Embase (via Ovid), SCOPUS, ScienceDirect, Google Scholar, SCI and Cochrane Library databases were undertaken. Seven randomized controlled trials assessing the outcomes of PSR and POMR were analyzed in accordance with the PRISMA statement. The risk of bias was assessed using the Rob2 tool.
RESULTS: According to the pooled analysis, POMR significantly reduced the incidence of IH compared to the PSR (OR 5.82 [95% CI 2.69, 12.58] P

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
A rare case of intrauterine intussusception causing ileal atresia

Carine Sun CY, Ashok K, Mughni B

Med J Malaysia, 2020 05;75(3):304-306.
PMID: 32467551

Intrauterine intussusception is a rare but evident cause of intestinal atresia and is usually detected intraoperatively. We report on a term neonate who presented to the Department of Paediatric Surgery, Sabah Women and Children's Hospital, Malaysia with delayed passage of meconium and intestinal obstruction, wherein the lower contrast showed a claw sign. This was a good clue that this neonate had intrauterine intussusception and this suspicion was confirmed upon laparotomy. We found an ileo-ileal intussusception causing ileal atresia, requiring resection and primary anastomosis.

Matched MeSH terms: Laparotomy
Fulltext Hepatoblastoma in a low birth weight infant : a case report and review of the literature

Kaur G, Mutum SS

Malays J Med Sci, 2001 Jan;8(1):69-72.
PMID: 22973160

Hepatoblastoma is the most common primary liver tumour of childhood. This is a case report of a one-year-old boy who presented with a one-month history of progressive abdominal distension and weight loss. He was cachexic, anaemic, had gross hepatomegaly and ascites. He had been born prematurely with a birth weight of 1.23 kg, and his developmental milestones were delayed. Ultrasound and CT scan demonstrated a large solid tumour in the left lobe of the liver with a smaller superficial nodule in the right lobe. Serum alpha fetoprotein was significantly raised. A left lobe hepatectomy and complete excision of the right sided nodule was performed. There was no evidence of metastatic disease. Histopathological examination confirmed hepatoblastoma of the fetal type. The patient developed features of intestinal obstruction a few days after surgery and he succumbed ten days after re-laparotomy. The clinical presentation and investigation results in this case are characteristic. Recent reports have suggested a strong relationship between very low birth weight (< 1500gm)/prematurity and hepatoblastoma as is present in this case. Surgery is the mainstay of therapy in hepatoblastoma. A brief review of the literature on this tumour is presented.

Matched MeSH terms: Laparotomy
Surgical ascites

Nadarajah C

Journal of the Malaya Branch of the British Medical Association, 1940;3:423-4.

Matched MeSH terms: Laparotomy
Rare postpartum ruptured degenerated fibroid: a case report

Tan YL, Naidu A

J Obstet Gynaecol Res, 2014 May;40(5):1423-5.
PMID: 24689652 DOI: 10.1111/jog.12334

Spontaneous rupture of uterine fibroid is rarely encountered. We present a case of a 31-year-old who presented with acute abdominal pain at 9 weeks postpartum. On examination, the abdomen had diffuse tenderness, with rebound tenderness in the suprapubic area and in both iliac fossae. On ultrasonography, a 12.7 × 8.6 × 8.9-cm sized hyperechoic mass was visible on the posterior wall of the uterus. A large amount of fluid was visible in the paracolic gutters and the Pouch of Douglas (POD). The patient underwent an exploratory laparotomy. A ruptured, cystic degenerated uterine fibroid with active bleeding was found, as well as approximately half a liter of free, bloodstained peritoneal fluid and pus. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.

Matched MeSH terms: Laparotomy
Fulltext Tubal Ectopic Pregnancy: Do Our Women Benefit From Laparoscopic Surgery?

Lim, K.J., Omar, M.H., Jamil, M.A., Ng, S.P.

International Medical Journal Malaysia, 2006;5(2):1-8.
MyJurnal

Introduction: Operative laparoscopy is the gold standard approach for treatment of tubal pregnancy. Although benefits of this approach are well established, data on its uptake trend in Malaysia is largely unknown. Objective: This study aims to determine the operative laparoscopy uptake in management of tubal pregnancy at a busy tertiary hospital and whether the benefits associated with laparoscopic surgery was achieved. Materials and Methods: This prospective observational study was conducted on all women admitted for tubal pregnancy at Hospital Sultanah Aminah, Johor Bahru, a public tertiary hospital over a period of 12 months. The on-call team was responsible for the surgical approach. Patient’s clinical presentation, operative laparoscopic uptake, factors affecting the choice of approach and duration of hospitalization were analyzed. Results: The tubal pregnancy rate was 7.6 per 1000 deliveries. Twenty- seven of the 138 cases (20%) had hypovolemic shock, requiring urgent laparotomy and were excluded from study. The operative laparoscopy rate for stable tubal pregnancy was only 42.3% (47 of 111 cases). Women managed laparoscopically were associated with a significantly higher pre-operative hemoglobin level, mostly nullipara and had surgery performed during office hours. They waited longer for their surgery but were discharged earlier compared to the laparotomy group. There was no difference in the duration of hospitalization. Conclusions: Less than half of all hemodynamically stable tubal pregnancies in our hospital had operative laparoscopy. The current laparoscopy uptake rate can be further improved.

Matched MeSH terms: Laparotomy
Fulltext Post partum vulvo-vaginal haematomas and options of management

Lim, P.S., Muhammad Abdul Jamil, M.Y, Zainul, R.A.Z, Mohd Hashim O., Rozman, Z., Shafiee, M.N., et al.

Journal of Surgical Academia, 2011;1(1):52-55.
MyJurnal

Vulvo-vaginal haematomas are not an uncommon obstetric complication. Despite advances in obstetric care, practice and technique, vulvo-vaginal haematomas do occur especially in complicated vaginal deliveries. Various management options are available for vulvo-vaginal haematomas. We describe three cases of vulvo-vaginal haematomas with different severity and presentations which were managed in different manners i.e. local haemostasis control, laparotomy with hysterectomy, and transarterial embolisation. The choice of treatment options would mainly depend on the clinical presentations, availability of expertise as well as facilities. Early identification is crucial.

Matched MeSH terms: Laparotomy
Some aspects of the sterilization program in Malaysia

Arshat H, Ali J, Noor Laily Abu Bakar

Malays J Reprod Health, 1984 Jun;2(1):1-13.
PMID: 12267515
Matched MeSH terms: Laparotomy*
Fulltext Gastric trichobezoar in an end-stage renal failure and mental health disorder presented with chronic epigastric pain: A case report

Ali AA, Gurung R, Fuad ZM, Moosa M, Ali I, Abdulla A, et al.

Ann Med Surg (Lond), 2020 Oct;58:76-79.
PMID: 32953103 DOI: 10.1016/j.amsu.2020.08.021

Background: Gastric trichobezoar happens when there is an indigestible substance or food found in the gastrointestinal tract. It is a rare presentation which is usually associated with trichotillomania and trichopagia. The presentation may not be specific and is usually related to dyspepsia-like symptoms. In the worst-case scenario, this may cause gastric outlet or intestinal obstruction which eventually requires surgery.
Case presentation: We present a 36-year-old lady with underlying end-stage renal failure (ESRF) and undiagnosed mental health issues who was treated for recurrent episodes of gastritis. Imaging modalities revealed intragastric foreign body ingestion which is consistent with gastric trichobezoar. She eventually underwent laparotomy and gastrotomy to remove the foreign body. Postoperatively, she was referred and followed-up by the psychiatric team.
Conclusion: Gastric trichobezoar has strong associations with psychiatric disorders. With the co-existence of an ESRF, uraemia might contribute to the aetiology of the trichotillomania and trichophagia. Open surgery is the choice of definitive management especially if bezoars are larger. Should the recurrence be remitted, a biopsychosocial modality and regular haemodialysis is the most sustainable approach to ensure the behaviour does not persist.

Matched MeSH terms: Laparotomy
Fulltext Abdominal Mass in the Puerperium: Challenges in Diagnosis

Muniandy, Sadesvaran, Teo, Yvonne Chiang Hoon, Suleman, Aehtoosham, Ramaiah, Prakash Doddaballapur

Borneo Journal of Medical Sciences, 2019;13(3):37-42.
MyJurnal

Ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia. Epithelial ovarian cancer accounts for 90% of all ovarian tumours. Herein, we present a rapidly growing ovarian tumour in a young female patient, following an uneventful vaginal delivery at home. We discuss on the challenges of making said diagnosis in a post-partum patient who presented with abdomen distension. A 19-yearold lady presented to the Emergency Department three days after spontaneous vaginal delivery at home. Her chief complaint was that of a rapidly progressive abdominal distension. Diagnostic and therapeutic emergency laparotomy were done, revealing a huge cystic ovarian mass. Histopathology reported a high grade, serous ovarian carcinoma. There are multiple causes for abdominal distension in post-partum women, however priority should be given into looking for gynaecological origin, given the changes in hormone. Sudden abdominal distension during post-partum period is rare and a systemic approach in its management is vital. There is, inarguably, a role of diagnostic and therapeutic laparotomy in this.

Matched MeSH terms: Laparotomy
A rare complication of endoscopic cystgastrostomy

Lee J, Sachithanandan S, Raman K

Gastroenterology, 2011 Nov;141(5):e1-2.
PMID: 21946349 DOI: 10.1053/j.gastro.2010.07.062
Matched MeSH terms: Laparotomy
Fulltext An abdominal mass: a case of Jekyll and Hyde?

Gendeh, H.S., Kosai, N.R., Belani, L.K., Taher, M.M., Reynu, R., Ramzisham, A.R.

Medicine & Health, 2015;10(2):156-158.
MyJurnal

Right iliac fossa pain can often be misdiagnosed as something sinister or benevolent despite assistance with state of the art imaging techniques. This is particularly more challenging in the female gender whereby the error of managing a right iliac fossa pain may approach forty percent. A 66-year-old lady, ten years post-menopause, presented with a week history of progressively worsening right iliac fossa pain. Malignancy was suspected with a palpable abdominal mass. Computed tomography was suggestive of an abscess collection, but a needle aspirate produced brown faecal material suggestive of a diverticulitis. An exploratory appendisectomy revealed a non malignant appendicular abscess. In conclusion, when clinical and imaging assessments are inconclusive, an exploratory laparotomy for a surgical excision is warranted primarily if malignancy is suspected.

Matched MeSH terms: Laparotomy
Fulltext Adhesive small bowel obstruction (ASBO) in children--role of conservative management

Vijay K, Anindya C, Bhanu P, Mohan M, Rao PLNG

Med J Malaysia, 2005 Mar;60(1):81-4.
PMID: 16250285

Adhesive small bowel obstruction (ASBO) is an annoying postoperative complication. Though the diagnosis can be made easily, the role of conservative management in children is controversial. Hence a study was conducted to determine the role of conservative management, and to identify the factors that can predict / influence the outcome of conservative treatment in children with ASBO. Children admitted with ASBO from 1980 to 2002 (22 year period) formed the material for this study. The data was analyzed with respect to the influence of age at the time of presentation, primary disease for which original laparotomy was done, time interval between the primary surgery and the development of ASBO and the number of laparotomies prior to the development of ASBO on the outcome of conservative management. There were 74 episodes of ASBO in 69 children (Five children had two episodes). Out of 74 episodes, 5 episodes (6.75%) needed immediate laparotomy for suspected gangrene. All others were managed conservatively. Of the 69 episodes managed conservatively, 36 responded to conservative treatment (2-5 days) while 33 required subsequent surgical intervention, with 11 of them requiring bowel resection (two for gangrene and 9 for bowel damage during adhesiolysis) and in the rest 22 cases adhesiolysis. A substantial number of children with ASBO respond well to conservative treatment. Majority of the children developed ASBO within three months after the primary laparotomy. Children below the age of one year (at the time of presentation with ASBO) responded poorly to the conservative management. Children who had primary surgery for Hirschsprung's disease and intussusception also appeared to have responded poorly to conservative management, but statistically not significant. Time interval between the primary surgery and the number of laparotomies before the child developed ASBO did not influence the outcome of conservative management.

Matched MeSH terms: Laparotomy/adverse effects
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
Fulltext Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery

Wan Fadzlina WM, Wan Mohd Nazaruddin WH, Rhendra Hardy MZ

Malays J Med Sci, 2016 Mar;23(2):28-37.
PMID: 27547112 MyJurnal

Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB.

Matched MeSH terms: Laparotomy

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