Combined laparoscopic and endoscopic method for foreign body removal from descending colon: A case report

BACKGROUND

The majority of published reports on foreign bodies (FBs) involve the rectum and applied a transanal retrieval. Usually, patients with FB above the rectum are subjected to laparotomy for removal. Here, we illustrate the case of a man with an FB that had migrated into the descending colon, and its successful removal via a laparoscopic approach.

CASE SUMMARY

A 43-year-old man, who had the habit of FB insertion into his anus to aid defecation, presented upon experience of such an FB slipping through and migrating upward to the distal colon. Plain abdominal radiograph revealed a bottle-shaped FB, positioned in the left iliac fossa region. The FB was successfully removed via a laparoscopic-assisted procedure in which we combined diagnostic laparoscopic and endoscopic techniques during surgery. The patient was monitored for 2 d postoperatively and subsequently discharged home.

CONCLUSION

A minimally invasive approach should be adopted to aid extraction of colorectal FB as it is effective and safe.

Multiple gastrointestinal melanoma causing small bowel intussusception

A 61-year-old gentleman presented with small bowel intussusception from small bowel melanoma intussusceptum. He complains of intermittent abdominal distension but no history of intestinal obstruction. Apart from this, he was also symptomatic anemia which required repeated transfusion for the past few months. The contrast-enhanced computed tomography of the abdomen shows an omental mass with small bowel intussusception. He then underwent an exploratory laparotomy with segmental resection of the affected segment. Histopathological examination confirmed primary gastrointestinal melanoma. Multiple small bowel malignant melanoma is a rare disease. It remains a controversial diagnosis as it may be a primary or metastasis from an unidentified or regressed primary cutaneous melanoma. Prompt surgical intervention enables us to obtain tissue diagnosis, prevent complete intestinal obstruction and strategize the goals of treatment for the patient.

An Aubergine in My … Case of Rectal Foreign Body

A 24-year-old man presented to the casualty department with a history of left-sided, colicky abdominal pain for one day. It was associated with an inability to pass flatus or motion within the same duration. There was no history of vomiting. On examination, the vital signs were within normal limits, and he was afebrile. His abdomen was soft, but a hard mass was palpable on the left side of his abdomen. There was no peritonitis. The bowel sounds were sluggish.

Prospective diagnostic study on the use of narrow-band imaging on suspicious lesions during colonoscopy examination

INTRODUCTION

Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow-band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non-neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non-neoplastic colorectal lesions.

METHODS

This study enrolled 100 patients in a single-center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano's classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly.

RESULTS

The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver-operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non-disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P < 0.05).

CONCLUSION

The NBI system in colonoscopy was capable of distinguishing neoplastic from non-neoplastic colorectal lesions. It indicates an acceptable level of agreement with histopathology, the gold standard. However, the role of NBI in screening and surveillance in Malaysia still needs further evaluation and exploration.

Rare case of primary leiomyosarcoma of sigmoid mesocolon

We experienced a rare case of primary leiomyosarcoma of sigmoid mesentery. A 45-year-old woman was presented to us with left iliac fossa mass and discomfort for 4-month duration. CT scan of abdomen and pelvis revealed a huge mass 14 cm×14 cm×16 cm occupying left iliac fossa mimicked having a large left ovarian carcinoma. She was subsequently planned for elective total abdominal hysterectomy and bilateral salpingo-oophorectomy by gynaecology team. During laparotomy, a huge mass was revealed arising from sigmoid mesentery invaded to the left lower ureter. Curative resection was done and pathological findings show the tumour being leiomyosarcoma with immunohistochemistry tests on caldesmon, desmin, smooth muscle actin and CD34 reagent all positive. Clinicopathological and literature review of this rare primary leiomyosarcoma of mesocolon was discussed in our case presentation.

Peri-implant bone reactions to immediately loaded implants. An experimental study in monkeys

BACKGROUND

There are reports which demonstrate that immediately loaded splinted implants can be osseointegrated when they are placed in the anterior part of the lower jaw. The concept of immediate loading has not been well investigated in the posterior mandible. The aim of this study was to evaluate the bone reactions around immediately loaded implants placed in the posterior region of the lower jaw in the monkey model.

METHODS

Six adult Macaca fascicularis monkeys were used in this study. A total of 36 implants were placed after extraction of the second premolars, first and second molars, and complete healing of the sockets. Three control (C) group implants were placed in one quadrant of the lower jaw of each monkey. After a delay of 3 months to allow osseointegration to take place, the implants were loaded for 1 month using temporary resin bridges and later for 2 months using metal splinted crowns. In the contralateral region of the lower jaw, 3 test (T) group implants were placed and loaded immediately with the same sequence as carried out for the C implants. Specimens were examined and evaluated histologically after sacrifice.

RESULTS

All of the implants were osseointegrated. Compact, cortical bone in contact with the implant surface without any gaps or connective tissue formation was observed.

CONCLUSIONS

It was concluded that immediately loaded, splinted implants can be osseointegrated with a similar hard and soft tissue peri-implant response as delayed-loaded implants in the posterior mandible.

Third molars in the establishment of adult status--a case report

Teeth are the most durable structures in the human body. The timing and sequence of their development, as contained in dental development charts, have been used as valid criteria for age determination. The third molars however are the last teeth to erupt and are regarded as the most variable in the dentition. Age estimation in a legal context, using developing third molars must be carefully applied otherwise justice may miscarry. A case of wrongful use of the technique is presented here.

Racial characteristics of human teeth with special emphasis on the Mongoloid dentition

Determining the racial affinity of an unknown individual from dentition for identification is indeed a difficult endeavour. However, there are certain dental characteristics which are predominant in certain racial groups and these contribute important indicators in the identification process. Inherited dental characteristics are modified by prenatal and postnatal environmental and nutritional conditions. They can also become less discernible due to admixture of the various races.

Histiocytosis X: evidence for a genetic etiology

Histiocytosis X is a rare disorder with no particular predilection for race, age or sex. Since its discovery by Hand in 1893, the etiology has remained unknown, although viruses, bacteria and genetic factors have been implicated. Familial occurrence of this disease is very rare, and only a handful of such cases have been reported. The present study adds further evidence to support the influence of genetic factors in the etiology of histiocytosis X.

The radiographic appearance of ameloblastoma in Malaysians

The radiographs of fifteen Malaysian patients with presenting ameloblastoma aged between 20-55 years (average 35 years) were studied for any peculiar local features. The most common features were cortical plate expansion (80%), corticated scalloped margin (67%), multiloculation (87%), and resorption of tooth roots (47%). The latter two features are constantly found in advanced tumour stage. As pain was not a frequent complaint, many Malaysian patients seek treatment only at a very late stage after the tumours have reached large dimensions. Although ameloblastomas may be diagnosed often through radiographs, it should not be relied upon solely.