Case report: Rectal perforation secondary to a toothbrush in an elderly man

Rectal foreign bodies often constitute an arduous diagnosis and perplexing management. A 72-year-old gentleman who is mentally sound was brought to the emergency department for severe epigastric pain of a 1-week duration. On examination, he was pyrexial and in sepsis. The abdomen was guarded. A digital rectal examination was normal. Erect chest radiography revealed air under the diaphragm and abdominal radiography showed neither dilated bowel nor foreign body. A diagnostic laparoscopy was performed which revealed a yellow hard rodshaped foreign body at the pelvis. Upon conversion to midline laparotomy, the foreign body was found to be a toothbrush with intraperitoneal rectal perforation of 1 cm in length. The brush was removed and the perforation was repaired primarily. A diverting transverse loop colostomy was created. Rectal foreign bodies may cause life-threatening rectal injuries including lacerations, bleeding, perforation, and obstruction. It is deemed crucial that any patient with rectal foreign body demands an orderly approach with the intention of diagnosis, management, and post-extraction evaluation

Multiple Endoscopic Biopsy Sites increase detection of Helicobacter Pylori infection: a multi-centre study

Background: Helicobacter pylori infection affects almost half of the population and remains clinically significant in chronic gastritis and gastric malignancy. However, its prevalence is found to be low in Pahang, Malaysia population where the practice of single antral biopsy during endoscopy has been advocated. Our aim for this research is to determine the role of multiple gastric biopsy sites during endoscopy (OGDS) to increase the detection of Helicobacter pylori infection. The recommended 5 biopsy sites in the Updated Sydney System in which includes antrum, incisura angularis and body of stomach. Methodology: This is a cross sectional study of 141 patients with clinical diagnosis of gastritis or dyspepsia who underwent OGDS in 2 tertiary hospital in Pahang, Malaysia from January 2016 to December 2016. Five biopsy sites have been obtained and tested with CLO test and send for histology. The positive result for Helicobacter pylori infection by CLO test and/ or histology together with sociodemographic data, endoscopic diagnosis and histology characteristics were recorded and analyzed using IBM SPSS Statistic version 23. Results: Total of 17 patients were diagnosed with Helicobacter pylori infection, making the prevalence of the infection to 12%. No significant difference seen in most of the parameters identified. However, we found out that single antral biopsy can missed the infection rate up to 35%. Conclusion: Multiple biopsy sites during endoscopy can increase detection of Helicobacter pylori infection