Ileocolonic mucormycosis in adult immunocompromised patients: A surgeon's perspective

We report three cases of ileocolic mucormycosis in adult immunocompromised patients presenting as acute abdomen. All patients underwent laparotomy but two of them died from multiorgan failure before the diagnoses were confirmed. The diagnosis of gastrointestinal mucormycosis is rarely suspected, and antemortem diagnosis is made in only 25%-50% of cases. These cases illustrate the difficulty encountered by surgeons in managing acute abdomen in neutropenic patients with hematological malignancy. The management of colonic mucormycosis in the published literature is also reviewed. © 2010 Baishideng. All rights reserved.published_or_final_versio

Robotic anterior resection in a patient with situs inversus: is it merely a mirror image of everything?

Situs inversus (SI) is a rare condition involving transposition of internal organs. In performing minimally invasive surgeries for these patients, exact mirror image of the usual technique may not be easily achieved, especially for right-handed surgeons. We describe a case of robotic anterior resection in a patient with rectal cancer and SI, illustrating the technique and how robotic system facilitates the procedure. A 59-year-old gentleman presented with altered bowel habit. Colonoscopy showed an obstructing tumour at 10 cm from the anal verge. Computed tomography did not show distant metastasis, but revealed the diagnosis of SI. Intraoperative laparoscopy revealed peritoneal metastasis. Total robotic, single docking, anterior resection was performed to palliate his obstructive symptoms. The operation lasted for 3 h and 24 min. Blood loss was 100 ml. There were no intraoperative or postoperative complications. The patient was discharged on day four. The final pathology was T3N2M1.postprin

The value of flexible sigmoidoscopy for patients with bright red rectal bleeding

Objective. To review the diagnostic yield of flexible sigmoidoscopy in patients presenting with bright red rectal bleeding. Design. Retrospective study. Setting. University teaching hospital, Hong Kong. Subjects and methods. Patients who underwent flexible sigmoidoscopy between January 1995 and April 1996 for investigation of bright red rectal bleeding were recruited. The extent of the endoscopic examination, complications, and endoscopic findings were recorded. Results. A total of 1052 patients were included in the study. The mean length of endoscopic examination was 55 cm. There were no complications attributed to the procedure. Thirteen (1.2%) patients aged from 41 to 87 years were found to have malignant tumours that were not palpable on digital examination. All the tumours were moderately differentiated adenocarcinoma. Two patients had synchronous liver metastasis at presentation. Adenomatous polyps were detected in 81 (7.7%) patients, of whom 76 were older than 40 years. The majority of polyps were tubular adenomas associated with mild or moderate dysplasia. Other endoscopic findings included hyperplastic and juvenile polyps, proctocolitis, diverticulosis, irradiation colitis, ischaemic colitis, rectal ulcers, and infective colitis. The overall diagnostic yield was 21.1%. No mucosal lesion was detected by flexible sigmoidoscopy in 78.9% of patients in whom the rectal bleeding was due to either haemorrhoids or anal fissure. Conclusions. Cancer was detected in 1.2% and adenomatous polyps in 7.7% of patients with bright red rectal bleeding using flexible sigmoidoscopy. All cancers and 94% of adenomatous polyps were detected in patients older than 40 years. Flexible sigmoidoscopy appears to be a valuable initial investigation for bright red rectal bleeding in patients older than 40 years.published_or_final_versio

Featured day surgery units: day surgery in Hong Kong

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香港的選擇性墮胎: 合法與否?

There is legal uncertainty as to whether selective foeticide is authorised under section 47A of the Offences Against the Person Ordinance (1967). Medical and legal issues surrounding a case of selective foeticide in a triplet pregnancy are reported.published_or_final_versio

Ambulatory stapled haemorrhoidectomy: A safe and feasible surgical technique

Objective. To compare outcomes following stapled haemorrhoidectomy as an in-patient versus day-surgery procedure. Design. Prospective non-randomised study. Setting. University affiliated hospitals, Hong Kong. Subjects and methods. Forty-eight consecutive patients who underwent stapled haemorrhoidectomy were included in the study. Twenty-four patients had the procedure in an ambulatory setting and the other 24 were treated as in-patients. The symptoms, operative details, postoperative complications, length of hospital stay, pain scores, analgesic requirements, and patient satisfaction scores were collected. Comparison was made between those patients undergoing ambulatory surgery and those treated as in-patients. Results. There were 25 women and 23 men in the study. The mean age was 46.6 years (standard deviation, 12.1 years). The mean operating time was 29.3 minutes (standard deviation, 9.9 minutes). An incomplete 'doughnut' after stapling was found in one patient. There were no other adverse intra-operative events or complications. Postoperative morbidities occurred in eight patients but none required further surgery. One patient in the day-surgery group could not be discharged because of urinary retention and three required re-admission to hospital because of secondary haemorrhage (n=1) or fever (n=2). There were no differences in the postoperative complications, pain scores, analgesic requirements, and patient satisfaction scores between the two groups. The total mean hospital stay was significantly shorter for those undergoing day-surgery stapled haemorrhoidectomy (0.46 versus 1.9 days, P<0.01). The mean follow-up period was 4.6 months (standard deviation, 4.0 months). All patients reported symptomatic improvement during this time and there was no incidence of faecal incontinence. One patient had a soft stricture, one had a fissure, and two had residual skin tags. All of these problems were conservatively managed, without the need for further surgical procedures. Conclusions. Stapled haemorrhoidectomy is a safe and effective operation for haemorrhoids. It is a feasible procedure to perform as day-surgery. The hospital stay can be significantly shortened, thus reducing the costs associated with in-patient care.published_or_final_versio

Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation

Aim: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed. Methods: Patients with adhesive small bowel obstruction were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 h had conservative treatment continued. Patients who showed no improvement in the initial 48 h were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 h were regarded as having partial obstruction and conservative treatment was continued. Patients in which the contrast failed to reach large bowel within 24 h were considered to have complete obstruction and laparotomy was performed. Results: Two hundred and twelve patients with 245 episodes of adhesive obstruction were included. Fifteen patients were operated on soon after admission due to fear of strangulation. One hundred and eighty-six episodes of obstruction showed improvement in the initial 48 h and conservative treatment was continued. Two patients had subsequent operations because of persistent obstruction. Forty-four episodes of obstruction showed no improvement within 48 h and gastrografin was administered. Seven patients underwent complete obstruction surgery. Partial obstruction was demonstrated in 37 other cases, obstruction resolved subsequently in all of them except one patient who required laparotomy because of persistent obstruction. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin. Conclusion: The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment is safe and reduces the need for surgical intervention. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Survival following laparoscopic versus open resection for colorectal cancer

published_or_final_versionSpringer Open Choice, 28 May 201

Risk factors for complications after colonic stent insertion for large bowel obstruction

This journal suppl. entitled: DDW 2014 ASGE Program and AbstractsBACKGROUND: Colonic stenting is proven to be an effective means in relieving malignant large bowel obstruction. However, severe complication such as perforation of bowel and subsequently fecal peritonitis can occur after successful of insertion of colonic stent. While colonic stenting is practiced more widely, concern also arises as a result of reports on increased complication rate from this procedure ...postprin

Total mesorectal excision for rectal cancer decreases local recurrence

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio