Incidental hepatic tuberculosis during planned resection of locally advanced ampullary carcinoma: a case report

Background: Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems. Case presentation: A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB. Conclusions: A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma

Trapped cystofix: Laparoscopic modality to untie

Suprapubic catheterization (SPC) is a temporary measure to relieve acute urinary retention (AUR). Despite being effective, it can lead to complications such as colon perforation, haematuria, and bladder wall spasm. We present a 52-year-old lady with cystofix for underlying urethral stricture presented with AUR. A new SPC was inserted to drain the urine. However, the SPC had looped and entangled with her cystofix, and laparoscopic removal of cystofix and insertion of a new SPC was done. In conclusion, trapped cystofix to the SPC tube is a potential complication during SPC insertion that can be avoided with appropriate care

Malignant ulcer: a great mimicker of gastric plasmablastic lymphoma

Plasmablastic lymphoma (PBL) is an uncommon human immunodeficiency virus (HIV)-associated lymphoma, with a predilection to develop in the oral cavity. It usually has a plasmablastic morphology with weak or no expression of B cell-associated markers. Among non-HIV patients, it tends to occur in the gastrointestinal (GI) tract, lymph nodes, and skin. We experience a 74-year-old male who presented with abdominal discomfort, altered bowel habit, loss of weight, and loss of appetite with a palpable abdominal mass. Upper endoscopy revealed multiple dish-like and raised nodular mass with a central ulcer in the stomach and duodenum. The histology was consistent with high-grade lymphoma of the plasmablastic type. The immunohistochemistry was positive for plasma cells marker of CD38 and CD138, but negative for the lymphocytic marker of CD45, as well as mature T and B cell marker of CD3 and CD20. Unfortunately, the patient succumbed due to sepsis without completion of his investigations and treatments

Spontaneous Omental Infarction: An Unusual Etiology of Abdominal Pain

A 49-year-old lady with previous scars complained of acute abdominal pain for two days. Her right hypochondrium was tender and guarding upon assessment. The laboratory investigations were unremarkable. Due to a diagnostic incongruity, computed tomography of the abdomen was performed showing a suspicious lesion at anterolateral aspect of the ascending colon. Surgical intervention was decided and intraoperative finding was consistent with spontaneous omental infarction. Omentectomy was undertaken and final histology was compatible with the intraoperative diagnosis. Although it is exceptional, omental infarction should be considered as part of the differential diagnoses of right-sided acute abdominal pain with normal laboratory investigations. This case highlights its unexpected discovery and we describe its literature reviews

Jejunojejunal intussusception secondary to inflammatory fibroid polyp: A rare cause of small bowel obstruction

Background: Adult intussusception is a relatively rare clinical entity. The majority of cases of intussusception in adults are due to a pathologic condition that serves as a lead point and requires surgery. Small bowel intussusception is usually caused by benign or malignant neoplasms appearing at the head of the invagination. Inflammatory fibroid polyp (IFP) of the small bowel is an unusual benign neoplastic lesion that has been rarely reported to cause intussusception, especially in the jejunum. Case presentation: We present a rare case of adult intussusception who presented with a triad of intestinal obstruction. Computed tomography revealed small bowel intussusception with bowel ischemia. Intraoperatively, she required resection of the small bowel and primary anastomosis. Macroscopic examination revealed a single pedunculated polyp, which is the lead point of intestinal obstruction and confirmed histologically. Conclusion: Inflammatory fibroid polyp should be considered as a cause of intussusception among adults with small bowel obstruction

Hooge Zwaluwe, Thijssenweg 12 (Gemeente Drimmelen). Een bureauondezoek en verkennend booronderzoek. ArGeoBoor rapport 1372

Op basis van de geologische ondergrond kunnen archeologische resten voorkomen, nadat de dekzand rug gevormd en vastgelegd is aan het eind van het Pleistoceen en begin van het Holoceen. De zandrug is in theorie bewoonbaar geweest tot deze bedekt is geraakt met veen. Wanneer dit gebeurd is en of er een veenlaag gevormd is op de dekzandrug, is niet bekend. Vervolgens is het gebied in gebruik genomen als bouwland in de Late Middeleeuwen. In het zuidoosten van het plangebied is in de 19e een het begin van de 20e eeuw een woonerf geweest. In de jaren ’80 van de 20e eeuw is het plangebied ingericht als bedrijventerrein. Vanuit het bureauonderzoek werden als oorspronkelijk bodemtype veldpodzolgronden verwacht in het plangebied. Dit bodemtype wordt gekenmerkt door een humeus dek dat dunner is dan 30 cm. Eventuele verstoringen aan de oppervlakte leiden dan ook relatief gemakkelijk tot verstoringen in de bodem en in de E-, B- en de top van de C-horizont. Omdat een groot deel van het plangebied verhard is werd daarom verwacht dat het bodemprofiel verstoord geraakt zou zijn. Tijdens het verkennende booronderzoek zijn in het hele plangebied 11 boringen gezet, waarvan vijf op de locaties van het nieuwe kantoorgebouw en de nieuwe bedrijfshal. Uit de boringen is naar voren gekomen dat de bodem in het plangebied sterk verstoord is. Waarschijnlijk is dit gebeurd tijdens de inrichting van het plangebied als bedrijventerrein. In het zuidoosten van het plangebied zijn geen resten gevonden van het erf wat hier in de 19e en 20e eeuw gelegen heeft. Eventuele archeologische waarden in de top van de oorspronkelijke bodem zullen hierbij verstoord zijn geraakt. ArGeoBoor adviseert om het plangebied vrij te geven voor de geplande bouwwerkzaamheden in de toekomst. Er kunnen echter nog archeologische resten in het plangebied aanwezig zijn, zoals losse vondsten. Als in het plangebied archeologische resten aangetroffen worden is het verplicht deze te melden bij het bevoegde overheid, zoals aangegeven in artikel 53 van de Monumentenwet