Caecal volvulus has been reported to be associated with various abdominal and pelvic pathologies. Its signs and symptoms are usually non-specific and maybe overlooked in favour of benign causes, such as constipation. A high degree of suspicion is required for prompt diagnosis. Herein, we report on an unusual case of caecal volvulus after a dental procedure that was managed initially as constipation.

Objective: the aim of this study was to determine the usefulness of Rockall score in predicting outcomes of 30 days rebleeding, mortality and need for surgical intervention of bleeding gastric and duodenal ulcers. Methods: this is a retrospective cohort study of all the emergency endoscopies performed in Hospital sultan Ismail from January 2009 to October 2014 for indications of upper gastrointestinal bleeding (UGIb). Data was extracted from hospital's electronic database and only non-variceal bleeds were included. Rockall score was calculated and outcomes of 30 days rebleeding, mortality and need for surgery was recorded. For each outcome, calibration was done using the Goodness-of-fit tests and discriminative ability was reflected by area under the receiver operating characteristic curve (AUROc). Results: A total of 1323 patients were included with a male preponderance of 64%. the overall rates of rebleeding were 11.2%, mortality rate of 8.7% and need for surgery was 2%. Low AUROc values for rebleeding (0.63), mortality (0.58) and surgery (0.67) showed poor discriminative ability of Rockall score. the Goodness-of-fit test also revealed that the scoring system was poorly calibrated in outcomes of rebleeding (p <0.001), mortality (p = 0.001) and surgery (p = 0.038) with p-value <0.05. Patients with high risk (scores ≥8) displayed highest rebleeding and mortality rates of 20% respectively in comparison to the moderate (score 3-7) and low (score ≤2) risk groups. conclusion: Rockall score has a poor discriminative ability and is poorly calibrated for rebleeding, mortality and need for surgery in upper gastrointestinal bleeding. However, it is the best tool we have now to stratify patients into risk groups.

The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass. Appropriate action should be taken when there is a suspicion of a pheochromocytoma or malignancy.
HIV ; Leiomyoma ; Acquired Immunodeficiency Syndrome

An Intrauterine contraceptive devices (IUCD) is commonly inserted by the primary health care physician. It can migrate into pelvic or abdominal organs. When a pregnancy occurs following an insertion of an IUCD, there should be a high suspicion of uterine perforation or possible migration. A radiograph can be done in the primary health care clinic to search for a missing IUCD. Early referral to the urology service is warranted when a patient presents with recurrent urinary tract infections. Removal of an intravesical IUCD can be managed with cystoscopy, laparoscopy or open surgery. Herein, we report a case of IUCD migration into the bladder. This case will highlight the importance of proper technique, careful insertion and the role of ultrasound.

Majority of Wilms tumour (WT) responds well to pre-operative chemotherapy. In Malaysia, incidence of WT is rare with only two cases reported per one million populations yearly. This case report is to highlight on the awareness of WT in an Asian population and highlight two cases and challenges faced after pre-operative chemotherapy. Case Report: In this case series, we report on two cases of WT which had poor response to pre-operative chemotherapy. Both cases underwent surgery after pre-operative chemotherapy and recovery was uneventful during a two-year follow-up. Discussion: Both patients had chemotherapy prior planned surgery, but had unfortunate poor tumour response. The tumour progressed in size which required a radical nephrectomy. The histology report for the first case had more than 60% blastemal cells remaining despite giving pre-operative chemotherapy with no focal anaplasia. This showed poor response to chemotherapy evidenced by the high number of blastemal cells. The second case was a stromal type WT which is known for poor response and may lead to enhancement of growth and maturation induced by chemotherapy. These were the possible reason of poor response of WT in these two cases.

suspicion is needed for immediate diagnosis and prompttreatment. In this case series, two rare cases oftracheobronchial injuries is described showing variableclinical presentations with different levels of injury. Our firstcase was seen in a 20 years old male whom had a directimpact on the neck and presented with upper tracheal injury.On arrival, this patient was in respiratory distress and hadbilateral pneumothorax. Bilateral chest tube was insertedwith subsequent neck exploration. During the neckexploration, anastomosis of the injured trachea wasperformed. The second case was represented by a 35 yearsold man with right main bronchial injury. Upon initialpresentation, this patient appeared well and wascomfortable under room air. However he graduallydeteriorated one week after the trauma requiring surgicalintervention. Eventually a thoracotomy with primaryanastomosis of the bronchial tear was performed. Details ofboth cases including clinical presentation, imaging andprocedures done will be discussed in this article.

Percutaneous nephrostomy is relatively safe for temporary urinary diversion. However, colonic perforation due to percutaneous nephrostomy can happen with an incidence of 0.2% as reported in the English literatures. To our knowledge, this is the first case being reported as a complication following treatment for traumatic renal injury. This paper is to share our treatment approach which differs from the usual approach according to existing literatures. We report on a young man who sustained grade IV renal injury due to blunt trauma and was managed conservatively. The treatment of traumatic renal injury via urinary diversion was complicated with an iatrogenic colonic perforation. The management and subsequent treatment of this patient is discussed in this case report.

Purpose: The purpose of this study was to demonstrate the feasibility and safety of laparoscopic-assisted anterior resection (LAAR) for colorectal cancer in a local Asian population. Methods: This is a retrospective review of all patients with colorectal cancer operated from November 2017 to October 2018. Main variables of interest were demography, type and surgery, length of stay (LOS), and the involvement of proximal and distal doughnut. Postoperative complications were analysed using chi-square or Fisher exact and Mann-Whitney tests. Results: There were 23 patients with a mean age of 62.5 ± 12.2 years. The mean time from diagnosis to surgery was 97.1 ± 154.84 days. There were 12 patients in the LAAR group and 11 in the open anterior resection (OAR) group. Duration of surgery was shorter in OAR (129.58 ± 51.38 minutes) compared to LAAR (147.91 ± 39.37 minutes). Mean LOS was shorter in the LAAR group with 5±1.5 days compared to the OAR group of 7.42 ± 4.25 days. However, there was no significant P-value for both duration of surgery (P = 0.322) or LOS (P = 0.87). A total of 3 complications were recorded after OAR and 2 after LAAR. Both groups had clear proximal and distal margins with 16 (12–18.5) harvested lymph nodes in LAAR and 18 (16–22) in OAR, which were equal (P = 0.155). Conclusion This study reports a shorter LOS in the minimally invasive group of 2 days with similar oncologic resection outcomes. This shows that LAAR is feasible in Malaysia and has potential outcome benefits.

Common or external iliac artery injury due to blunt trauma is unusual without an associated pelvic fracture. Here we report on a 62 years old man that sustained left external iliac artery thrombosis due to blunt trauma following fall from motorbike. There was no immediate circulatory compromise. Contrasted CT of abdomen revealed an associated left lower abdominal wall traumatic hernia. The iliac artery was intervened with an endovascular stent to restore luminal flow and the hernia was repaired electively. The entire clinical course and management dilemma are described in this article.

In Malaysia, incidence of Wilms’ Tumor (WT) is rare, with only 8 cases reported over four years according to the Malaysia Cancer Registry Report (2012-2016). Reports of spontaneous rupture of WT are scarce and the commonest presentation of this entity is a palpable mass in the abdomen. Herein, we report on the unusual presentation of an 11-year-old boy with typical symptoms of acute appendicitis. The child was subjected to an initial open appendicectomy and diagnosed intra-operatively with a right sided ruptured renal mass. Subsequent investigation leading to the diagnosis of a ruptured Wilms’ tumor and its treatment is discussed in this case presentation.
Child ; Kidney Neoplasms