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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 Acute appendicitis in pregnancy: a diagnostic and management challenge

Zainur Rashid, Z., Sulaiha, S.A., Azmi, M.N.

International Medical Journal Malaysia, 2014;13(1):77-80.
MyJurnal

Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.

Matched MeSH terms: Laparotomy
Fulltext Bleeding jejunal GIST: An uncommon cause of gastrointestinal bleeding

Mohanaraj T, Hanif H, Zainal AA

Med J Malaysia, 2015 Feb;70(1):31-2.
PMID: 26032526 MyJurnal

Gastrointestinal stromal tumours (GIST) are rare gastrointestinal tumours and are one of the causes of obscure gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding secondary to bleeding jejunal GIST in a 43 years old gentleman. Endoscopic intervention failed to identify the source of bleeding and CT Angiography (CTA) showed a jejunal mass and patient underwent laparotomy and resection of the bleeding jejunal GIST. This article highlights the rare cause of the massive GI bleeding and also emphasise the role of CTA in obscure GI bleeding.

Matched MeSH terms: Laparotomy
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 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 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
Fulltext Multi-Target Approach to Metastatic Adrenal Cell Carcinoma

Wahab NA, Zainudin S, AbAziz A, Mustafa N, Sukor N, Kamaruddin NA

Arch Iran Med, 2016 Sep;19(9):671-3.
PMID: 27631184 DOI: 0161909/AIM.0012

Adrenal cell carcinoma is a rare tumor and more than 70% of patients present with advanced stages. Adrenal cell carcinoma is an aggressive tumor with a poor prognosis. Surgical intervention is the gold standard treatment and mitotane is the only drug approved for the treatment of adrenal cell carcinoma. Until recently in 2012, the etoposide, doxorubicin, cisplatin plus mitotane are approved as first-line therapy based on response rate and progression-free survival. This case illustrates a case of advanced adrenal cell carcinoma in a young girl who presented with huge adrenal mass with inferior vena cava thrombosis and pulmonary embolism. Multi-approach of therapy was used to control the tumor size and metastasis. Therefore, it may prolong her survival rate for up to 5 years and 4 months.

Matched MeSH terms: Laparotomy/methods
Fulltext Congenital biliary anomaly with secondary cholangiohepatitis in a Siamese cross kitten

Yiew, X.T., Leong, Z.P., Rahman, N., Watanabe, M., Noordin, M.M., Khor, K.H.

Jurnal Veterinar Malaysia, 2016;28(1):7-11.
MyJurnal

A 5-month-old Siamese cross kitten was presented with jaundice and a palpable abdominal mass at the right cranial quadrant. The extra-hepatic biliary system was markedly distended upon abdominal ultrasonography. Complete bile duct obstruction was ruled out due to the presence of urobilinogen, light brown stool, and consistentlynormal alkaline phosphatase (ALP) levels. Head tremors developed on the second day of hospitalization. Tentative diagnoses of congenital biliary anomaly and hepatic encephalopathy werederived and exploratory laparotomy revealed a severely distended and tortuous bile duct indistinguishable from the gallbladder with negative duodenal filling. Modified cholechoduodenostomy was performed however the kitten did not recover from general anaesthesia. Secondary cholangiohepatitis and hepatic encephalopathy were confirmed upon histopathologic examination.Primary congenital biliary atresia or choledochal cyst with secondary cholangiohepatitis was suspected. Biliary anomalies are rare in cats with only two cases reported in the literature. These conditions are often challenging to diagnose and due to the limited treatment options, have a poor prognosis.

Matched MeSH terms: Laparotomy
An evaluation of quality of life in women with endometriosis who underwent primary surgery: a 6-month follow up in Sabah Women & Children Hospital, Sabah, Malaysia

M F A, Narwani H, Shuhaila A

J Obstet Gynaecol, 2017 Oct;37(7):906-911.
PMID: 28617056 DOI: 10.1080/01443615.2017.1312302

Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p

Matched MeSH terms: Laparotomy/methods; Laparotomy/psychology
Rare complication of appendix: small bowel gangrene caused by the appendicular knot

Mohana RT, Zainal AA

Med J Malaysia, 2017 12;72(6):370-371.
PMID: 29308777 MyJurnal

Intestinal knot formation was first described by Riverius in 16th century and later by Rokitansky in 1836. We report a very rare cause of small bowel gangrene caused by appendiceal knotting on to the ileum in a previously healthy mid aged lady. Patient underwent laparatomy and right hemicolectomy and primary anastomosis. The intra operative findings were the appendix was twisting (knotting) the small bowel about 40cm from the terminal ileum and causing gangrene to the segment of small bowel. Appendicitis is a common condition and management is usually straightforward. However we must be aware of rare complications which may arise that require a change from the standard treatment of acute appendicitis.

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 Urinary bladder rupture secondary to obstructive urolithiasis in a Jamnapari goat

Tan, Y.K., Hiew, M.W.H., Radzi, R., Khairuddin, N.H.

Jurnal Veterinar Malaysia, 2017;29(2):20-24.
MyJurnal

This report describes the complications of obstructive urolithiasis in the lower urinary tract causing urinary bladder rupture in a Jamnapari buck. A 3-year-old Jamnapari buck was presented with the complaint of stranguria, subsequent anuria and a progressively distended abdomen for the past three days. Upon physical examination, body temperature, pulse rate and respiration rate were increased. Uroliths could be felt within the urethra in the ventral abdomen region. A urolith was removed via amputationof the urethral process, but the patency of the urethra could not be established. Transabdominal ultrasound revealed anechoic areas around the bladder, and the bladder was relatively small for a urinary obstructed goat. The bladder wall was thickened and shadow of sludge was observed within the bladder. Abdominocentesis was done and fluid analysis revealed that it was a haemorrhagic effusion. Blood results revealed renal disease, liver disease, muscle injury and haemoconcentration. Retrograde cystourethrogram revealed no urolithswithinthe urethra but there was leakage of the contrast agent from the bladder into the peritoneal cavity. The final diagnosis was complete blockage of the lower urinary tract leading to bladder rupture. Exploratory laparotomy was done and emergency cystorraphy was planned. Due to the poor condition of the urinary bladder with presence of septic peritonitis, the goat was euthanised.

Matched MeSH terms: Laparotomy
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
Hemorrhagic extrahepatic recurrence of hepatocellular carcinoma: A case report

Yeow GPV, Yeow DGE, Sankaran P, Maiyauen T, Sharif MS

Ann Hepatobiliary Pancreat Surg, 2019 Feb;23(1):77-79.
PMID: 30863813 DOI: 10.14701/ahbps.2019.23.1.77

The recurrence of hepatocellular carcinoma (HCC) can mainly be divided into two phases or types: the intrahepatic recurrence (IHR) and the extrahepatic recurrence (EHR). Generally speaking, the EHR is usually referenced as being the less common of the two types or categories. In a post-hemihepatectomy patient with routine surveillance at 6 months, it was noted that the patient appeared to have an elevated alpha-fetoprotein, and also complained of vague lower abdominal pain. The accompanying computed tomography scan revealed a 6 cm-sized heterogeneous mass located at the pelvis region. Next, during a laparotomy for resection, the tumor was found to be bleeding from the omental deposition. In conclusion, a high index of suspicion and early surgical intervention can help in detecting possible bleeding extrahepatic recurrence in the background of a patient with history of HCC.

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
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 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
Fetal surgery and stem cell therapy for meningomyelocele

Hii LY, Sung CA, Shaw SW

Curr Opin Obstet Gynecol, 2020 04;32(2):147-151.
PMID: 32004173 DOI: 10.1097/GCO.0000000000000614

PURPOSE OF REVIEW: To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC).
RECENT FINDINGS: Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother.
SUMMARY: Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.

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 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

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