endoscopic-ultrasound-guided-biliary-drainage-endoscopic-ultrasound

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde ...

Universiti Malaya

University of Malaya

Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later, the patient developed massive lower gastrointestinal bleeding with hemorrhagic shock. Emergency total colectomy with end-ileostomy was performed. However, he deteriorated and died on the second postoperative day. Histopathological examination revealed multiple deep ulcers at the hepatic flexure where fungal bodies of mycelial and yeast forms were noted. Isolated lymph nodes showed abscess formation with fungal bodies. Infective fungal colitis with Histoplasma capsilatum was diagnosed. In vitro, amoebic parasites can increase virulence and pathogenicity of histoplasma which may account for the fulminant presentation in this patient. Although rare, this unusual dual infection should be considered in the differential diagnosis of infective colitis, as appropriate antimicrobial treatment may prevent progression to massive lower gastrointestinal bleeding, obviating the need for urgent surgical intervention.

Concurrent amoebic and histoplasma colitis: a rare cause of massive lower gastrointestinal bleeding.

Massive subcapsular air collection in the liver: a rare life-threatening complication following ERCP rendezvous procedure.

Hemobilia with jaundice as a result of cholestasis and bleeding from choledochal cyst is uncommon. Ascertaining the diagnosis is often challenging and delayed diagnosis can lead to significant consequences due to hemodynamic instability, particularly in elderly patients. Although surgery remains the definitive treatment modality, interventional radiology for hemostasis has been increasingly recognized as an option. In this manuscript, we described two Malaysian cases of jaundice and hemobilia associated with choledochal cysts and the challenges related with clinical diagnosis and management. 

Jaundice and life-threatening hemobilia: an uncommon presentation of choledochal cyst.

Education and imaging. Hepatobiliary and pancreatic: A huge liver paraganglioma.

Mediastinal hepatocellular carcinoma with unknown primary: an unusual and rare presentation.

Hepatocellular carcinoma (HCC) is an important cancer in Malaysia. This study aimed to determine the epidemiological characteristics and clinical presentations of patients in a multiracial population consisting of three major Asian races: Malays, Chinese and Indians.

Liver cancer in Malaysia: epidemiology and clinical presentation in a multiracial Asian population.

This study aims to assess if radiofrequency ablation (RFA) has any oncological superiority over transarterial chemoembolization(TACE) on post-hepatectomy recurrence.

Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis.

Adult-to-adult living donor liver transplantation (LDLT) is widely accepted today with good outcomes and safety reported worldwide for both donor and recipient. Nonetheless, it remained a highly demanding technical and complex surgery if undertaken. The last two decades have seen an increased in adult-to-adult LDLT following our first report of right lobe LDLT in overcoming graft size limitation in adults. In this article, we discussed the operative techniques and challenges of adult right lobe LDLT incorporating the middle hepatic vein, which is practiced in our center for the recipient operation. The various issues and challenges faced by the transplant surgeon in ensuring good recipient outcome are explored and discussed here as well. Hence, it is important to understand that a successful recipient operation is dependent of multifactorial events starting at the preoperative stage of planning, understanding the intraoperative technical challenges and the physiology of flow modulation that goes hand-in-hand with the operation. Therefore, one needs to arm oneself with all the possible knowledge in overcoming these technical challenges and the ability to be flexible and adaptable during LDLT by tailoring the needs of each patient individually.

Adult-to-adult living donor liver transplantation: Operative techniques to optimize the recipient's outcome.

Response to Wang et al. Re: How to choose and compare between radiofrequency ablation and transarterial chemoembolization for recurrent hepatocellular carcinoma?

Achieving critical view of safety (CVS) is vital during laparoscopic cholecystectomy (LC). There is no known study determining use of indocyanine green fluorescence cholangiography (ICGFC) in early identification of CVS during LC. This study aims to compare use of ICGFC in LC against conventional LC in early identification of CVS.

Early identification of the critical view of safety in laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: A randomised controlled study.

Acute suppurative thyroiditis account for <1% of thyroid diseases and is uncommon because of the gland's encapsulation, iodine-rich environment, good vascular supply and extensive lymphatic drainage. It has been reported in patients with underlying goiters, thyroid cancers and in immuno-compromised patients. The usual causative organisms are  and . Rarer organisms include . and . Due to its rarity (as there have been only 28 cases of  thyroid abscess being reported in the literature till 2020), only case reports are available to guide management. We report two cases of thyroid abscess due to  in our institution that may herald the re-emergence of this uncommon infection of the thyroid gland and to raise awareness for all clinicians. Both patients presented with neck swelling, dysphagia and sepsis. Surgical intervention was warranted in both patients due to the severity of the disease and failed medical therapy. Recovery was uneventful following adequate surgical intervention and antibiotic therapy according to the culture and sensitivity report of the pathogen. This case report highlights that both patients were immunocompromised, and they contracted  thyroid abscess without any gastrointestinal involvement. Thus, a high index of suspicion for  thyroid abscess in immunocompromised patients can expedite the diagnosis and appropriate management can be commenced such as antibiotic therapy, percutaneous aspiration and surgical drainage in the event of failed medical therapy.

 thyroid abscess-two case reports.

Obesity and non-alcoholic fatty liver disease (NAFLD) are rampant in South East Asia. There is paucity of data exploring its' impact on donor suitability for living donor liver transplantation (LDLT). We aimed to describe and examine the factors related to non-utilization of potential donors in our LDLT programme.

Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living-donor liver transplantation: A single-center experience.

Article	Year
Concurrent amoebic and histoplasma colitis: a rare cause of massive lower gastrointestinal bleeding. World journal of gastroenterology\| PubMed ID: 20222177	2010
Massive subcapsular air collection in the liver: a rare life-threatening complication following ERCP rendezvous procedure. Journal of digestive diseases\| PubMed ID: 23279747	2013
Jaundice and life-threatening hemobilia: an uncommon presentation of choledochal cyst. Journal of digestive diseases\| PubMed ID: 23324023	2013
Education and imaging. Hepatobiliary and pancreatic: A huge liver paraganglioma. Journal of gastroenterology and hepatology\| PubMed ID: 23782121	2013
Mediastinal hepatocellular carcinoma with unknown primary: an unusual and rare presentation. Journal of gastrointestinal cancer\| PubMed ID: 24045908	2014
Liver cancer in Malaysia: epidemiology and clinical presentation in a multiracial Asian population. Journal of digestive diseases\| PubMed ID: 25512092	2015
Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis. HPB : the official journal of the International Hepato Pancreato Biliary Association\| PubMed ID: 26473770	2015
Adult-to-adult living donor liver transplantation: Operative techniques to optimize the recipient's outcome. Journal of natural science, biology, and medicine\| PubMed ID: 28250667	2017
Response to Wang et al. Re: How to choose and compare between radiofrequency ablation and transarterial chemoembolization for recurrent hepatocellular carcinoma? HPB : the official journal of the International Hepato Pancreato Biliary Association\| PubMed ID: 28943394	2017
Early identification of the critical view of safety in laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: A randomised controlled study. Asian journal of surgery\| PubMed ID: 33223453	2021
thyroid abscess-two case reports. Gland surgery\| PubMed ID: 33447571	2020
Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living-donor liver transplantation: A single-center experience. Asian journal of surgery\| PubMed ID: 34384674	2022

Peng Soon Koh

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