Treatment and outcome of lower gastrointestinal bleeding: an observational multicentre study in East Coast region of Peninsular Malaysia

OBJECTIVE The objective of this study is to determine the type of treatment and its patients’ outcome with new onset of LGIB in the East Coast of Peninsular Malaysia. METHOD This was a cross-sectional study conducted at hospitals in the East Coast region of Peninsular Malaysia. Observational data were collected from patients with a new onset of non-traumatic LGIB. The patient was observed from beginning of treatment until discharged from the hospital to study its outcome. This study commenced from September 2019 until September 2020. RESULT 54 patients with LGIB were recruited. Male was reported to be more common than female to have lower gastrointestinal bleeding (40.7% vs 59.3%). The incidence of LGIB is most common at the age of 65 years and above (35.2%). The most common cause of LGIB is haemorrhoid. 8 patients from the study came with massive bleeding. 27 patients underwent colonoscopy. 64% of the patients were treated conservatively. 47 patients (87%) were resolved upon the same admission and 7 patients (12.9%) had a recurrence. 2 patients died due to sepsis which was non-bleeding related. The amount of blood transfusion ranges from 0-18 pints of packed cells. The bivariate analysis revealed that there was no statistical significance in the findings. CONCLUSION LGIB is common among Malay, males aged more than 65 years old. The common cause of bleeding is haemorrhoid and most patients were treated conservatively. The majority of bleeding was resolved and rarely caused morbidit

Anal canal neuroendocrine tumour:: a rare case report

INTRODUCTION Neuroendocrine tumours of the anal canal are extremely uncommon, with only a few cases previously reported in the medical literature. OBJECTIVE We present a case of neuroendocrine tumour of the anal canal. CASE REPORT A 42-year-old man with no known medical conditions presented with left iliac fossa pain that had persisted for two weeks. The physical exam was unremarkable. Colonoscopy revealed a small whitish round tumour 9 mm in diameter just above the dentate line, as well as diverticular lesions in the descending, transverse, and ascending colon. The biopsy results are consistent with a well-differentiated neuroendocrine tumour. Under sedation, endoscopic mucosal resection was performed, and the HPE revealed a low-grade NET with a Ki-67 proliferative index of less than 2% and a margin clear but 1mm away. We planned on having a surveillance colonoscopy in a year. CONCLUSION Anal canal neuroendocrine carcinomas are extremely rare tumours, with only a few cases previously reported. Because no proper guidelines have been established, our case was treated in accordance with the colorectal NET guideline. More cases, however, are needed to identify prognostic factors, validate treatment modalities, and determine the best management strategy

Obstructed pedunculated jejunal gastrointestinal Stromal tumor disguise as pelvic mass - a case report

INTRODUCTION: Obstructed pedunculated jejunal gastrointestinal stromal tumours (GISTs) are very rare and can be misdiagnosed as gynaecological masses. OBJECTIVE: We are describing a rare case of small bowel obstruction caused by a jejunal GIST misdiagnosed as an ovarian mass. CASE REPORT A 70-year-old lady presented with abdominal pain, vomiting, and no bowel movement for three days prior. Clinical abdominal examination reveals a palpable mass at the level of the umbilicus, which was unable to feel the lower border of it. Contrasted CT Abdomen revealed a solid cystic mass in the pelvis, suspected to be ovarian in origin and associated with small bowel dilatation. The patient was subjected to exploratory laparotomy, which revealed a 12x13cm pedunculated mass from the jejunum 115cm from the duodenojejunal junction. The lesion was twisted and caused small bowel dilatation. The lesion was resected at the base of the peduncle using a linear stapler. Pathology was confirmed to be a high-risk GIST with a clear margin. The patient's postoperative course was uneventful, and she was discharged on the third postoperative day. The patient is currently receiving adjuvant imatinib therapy. CONCLUSION: Obstructed pedunculated jejunal GIST is a very rare disease and challenging to diagnose. It should be considered in patients with small bowel obstruction and pelvic mass. Resection at the peduncle base is safe and provides a clear oncological resection margin