Retroperitoneal cystic lymphangioma.
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Diagnosis, Differential↗
Biomedical subjects
H T Leong
Publications and source records attributed to H T Leong.
A fatal case of hepatic failure possibly induced by nitrosofenfluramine: a case report.
A 42-year-old female developed fulminant hepatic failure after having ingested an undetermined quantity of a herbal product over a period of approximately four months prior to the onset of her illness. Clinically, the cause of liver failure was assessed to be drug-induced and she eventually underwent total hepatectomy, with porto-caval shunting, in anticipation of a living-unrelated liver transplant. Unfortunately, her condition deteriorated and she died less than 48 hours post-operatively, approximately three weeks post-admission. An autopsy showed that the subject was deeply jaundiced and severely obese (BMI: 47.1 kg m(-2)), with evidence of diffuse haemorrhage, including the presence of 1.35 l of blood in the peritoneal cavity. The liver had been removed and was later recovered as a formalin-fixed specimen which was markedly contracted, comprising multiple micronodules interspersed with extensive areas of dense fibrotic tissue. Histologically, there was massive necrosis of the hepatic parenchyma, such that the residual hepatocytes were disposed as nodules displaying variable cellular regeneration and ballooning degeneration, attended by florid ductal proliferation and mixed inflammatory infiltrates. Infective, autoimmune, metabolic, vascular, neoplastic and most other natural causes of massive hepatocellular necrosis were effectively excluded. Analysis of the post-mortem blood samples yielded fluconazole, metronidazole, frusemide, lignocaine and tramadol, (therapeutic agents administered to the patient during her last illness). Subsequent analysis of the residual capsules revealed that they were adulterated by fenfluramine, N-nitrosofenfluramine (1.3-1.6 mg per capsule), nicotinamide (13.3-15.6 mg per capsule) and thyroid extract. None of the herbal ingredients is currently known to be hepatotoxic and much the same applies to fenfluramine, nicotinamide (except when taken in mega-doses) and thyroid extract. However, as nitrosamines are known to be variably hepatotoxic, it would be reasonable to surmise that, in the absence of a more plausible cause of liver damage, N-nitrosofenfluramine was the likely cause of massive hepatocellular necrosis in this instance.
Adult↗
Malignant rhabdoid tumour of the oesophagus: a case report.
Malignant extrarenal rhabdoid tumour (MERT) of the gastrointestinal tract is rarely reported in the literature. This report describes the clinical and pathological features of a malignant rhabdoid tumour of the oesophagus in a Chinese man. Ivor-Lewis oesophagectomy had been performed. The tumour behaved aggressively and the patient died from disseminated malignancy one year later. This is only the second case report of a malignant rhabdoid tumour affecting the oesophagus.
Esophageal Neoplasms↗
Laparoscopic repair of morgagni's hernia with percutaneous placement of suture.
Simultaneous laparoscopic repair of Morgagni's hernia and laparoscopic cholecystectomy in a 59-year-old lady is described. In contrast to most previous reported series, in which repairs were fashioned with direct intracorporeal suturing, stapling, or mesh placement, an alternative technique of suture placement with a percutaneously inserted needle was applied. The procedure was smooth, and there was no evidence of recurrent hernia 9 months after the operation.
Cholecystectomy, Laparoscopic↗
Spontaneous pneumomediastinum.
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Adolescent↗
Emergency laparoscopic orchidectomy for torsion of intra-abdominal testis: a case report.
Torsion of an intraabdominal testis is a rare cause of acute abdominal pain. With a history of undescended testis, it is difficult to establish the diagnosis and to exclude other emergency abdominal conditions without a laparotomy. The following case report illustrates the usefulness of laparoscopy as a diagnostic as well as a therapeutic tool in such a condition.
Adult↗
Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance.
The authors performed a prospective evaluation of 60 Hong Kong Chinese patients with symptomatic gallstones and gallbladder polyps undergoing outpatient laparoscopic cholecystectomy in a regional hospital in Hong Kong from March 1996 to May 1998 to determine the feasibility, satisfaction, and acceptance of this procedure among Chinese patients. Patients with American Society of Anesthesiologists grade I and II gallstones or polyps were selected. Exclusion criteria included 1) history of upper abdominal operations, attacks of acute cholecystitis, cholangitis, or pancreatitis; 2) abnormal liver function; and 3) ultrasonographic evidence of contracted gallbladder, thickened gallbladder wall, dilated common bile duct, or common bile duct stones. Patients discharged at 5:00 PM on the day of cholecystectomy were defined as having undergone outpatient procedure. Patients were asked about procedure acceptance, rated on a scale of 1 to 10 (best), using a standardized questionnaire 4 weeks after operation. The study included 21 men and 39 women with mean age of 40.5 years (range, 27-59). There were no conversions to open procedures in the series. There were 6 (10%) unanticipated postoperative hospital admissions; all patients were discharged on the first postoperative day. Another patient was readmitted 3 days after operation because of a common bile duct stone. Overall patient acceptance of outpatient laparoscopic cholecystectomy was good, with a mean score of 8.6 of 10. Thirteen patients (22%) expressed dissatisfaction with being discharged earlier than they had expected, and 9 (15%) would have preferred inpatient care. Forty-eight patients (80%) resumed full daily activities by the first postoperative day; the remaining 12 did so by the end of the first week. Among the 44 working patients, only 4 (9%) resumed full duty within the first postoperative week; 29 (66%) did so by the second week and the remaining 11 (25%) returned to work after the third week. By selecting appropriate subjects, outpatient laparoscopic cholecystectomy is feasible and highly accepted among Hong Kong Chinese patients. Approximately one quarter of the patients preferred a longer postoperative stay or inpatient care.
Adult↗
Diagnosis and current management of gastrojejunocolic fistula.
Gastrojejunocolic fistula is a late complication of gastroenterostomy and is associated with inadequate gastric resection and incomplete vagotomy. In the past, attempted primary repair had high mortality and staged operations were normally performed. We present two cases of gastrojejunocolic fistula and discuss the modern management of this condition. In both cases, improved nutritional support allowed successful one-stage surgical repair to be performed.
Adult↗
How useful is colonoscopy in locating colorectal lesions?
BACKGROUND: It is important to establish the precise location of a colorectal lesion preoperatively. We used a model based on colorectal cancer to assess the efficacy of colonoscopy in locating these lesions. METHODS: We retrospectively analyzed all consecutive new colorectal cancer cases at the Department of Surgery, United Christian Hospital, Hong Kong, in 1995. RESULTS: Of the 123 cases reviewed by us, 84 cases satisfied the analysis criteria. The overall accuracy was 81%. It was especially high in the rectosigmoid region (93%) and descending colon (100%). The overall predictive power was 83%. It was especially high in the right-sided colon (100%) and the rectosigmoid region (93%). CONCLUSIONS: We conclude that colonoscopy is an accurate means for locating lesions in the upper rectum and sigmoid colon. It is also very predictive of lesions in the upper rectum, sigmoid colon, and right-sided colon.
Adult↗
Laparoscopic gastropexy for chronic gastric volvulus.
Gastric volvulus is an infrequently encountered clinical entity characterized by abnormal rotation of the stomach around an axis made by its two fixed portions, the cardia and pylorus. Surgical treatment by anterior gastropexy is usually indicated for chronic gastric volvulus to prevent complications and treat the underlying pathology. We report a patient with chronic gastric volvulus who was treated with laparoscopic anterior and diaphragmatic gastropexy. Laparoscopy not only identifies underlying predisposing conditions but also allows effective fixation for gastric volvulus. Laparoscopic approach minimizes the access trauma and is superior for benign upper gastrointestinal lesions.
Adult↗
Laparoscopic intracavitary drainage of subphrenic abscess.
Percutaneous drainage is now the preferred initial treatment of subphrenic abscess. The result is best for simple, unilocular abscesses but less so for complex ones. Failure of drainage can lead to high morbidity and mortality. We describe a case in which a large multiloculated subphrenic abscess was successfully drained laparoscopically without contaminating the general peritoneal cavity.
Aged↗
Laparoscopic resection of bleeding gastric polyps.
Gastric polyps account for a small proportion of gastric neoplasms. Many of them presented with acute or chronic bleeding. Endoscopic polypectomy is the preferred treatment modality. However, endoscopic polypectomy is often incomplete and impossible for large polyps. Large and intramural polyps require laparotomy and excision. From June to October 1995, four patients with bleeding gastric polyps received laparoscopic resection in our unit. All were women, aged 40-78, with polyps 2-6 cm in diameter. One patient underwent emergency surgery for active bleeding. The others received elective operations. Operating time ranged from 90 to 120 min. There was no perioperative morbidity or mortality. Full diet was resumed by the 4th postoperative day. The average postoperative hospital stay was 5. 3 days (4-7). Laparoscopic resection of gastric polyp is a preferable treatment option when endoscopic treatment fails.
Aged↗
Single stitch laparoscopic omental patch repair of perforated peptic ulcer.
The standard treatment for perforated peptic ulcers in most institutions is omental patch repair and lavage. A laparoscopic approach is attractive because of the simplicity of the procedure. Most of the previously described laparoscopic methods required multiple working ports and multiple stitches. We employed three operating ports and applied a single stitch to close small peptic ulcer perforations. Prospective evaluations of the initial 33 cases of laparoscopic patch repair have confirmed its safety. There were five conversions, two for large perforations (> 10 mm), two for perforated gastric ulcers and the remaining one was converted because of bleeding. One patient early in the series with a 10-mm perforation suffered from radiological leakage after repair, which required secondary intervention. The mean operating time was 50 min. Patients, on average, require one dose of intramuscular pethidine (1 mg/kg body weight) for pain relief. The mean hospital stay was 6 days and 97% of them returned to their daily activities within 10 days of the operation. There was no mortality.
Adult↗
Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial.
BACKGROUND: Rebleeding following epinephrine injection of bleeding peptic ulcers occurs in 10% to 20% of all cases. The addition of a sclerosant has the theoretical advantage of inducing vessel thrombosis and permanent hemostasis. METHODS: A prospective randomized controlled trial was conducted to compare injections with epinephrine alone or epinephrine plus absolute alcohol in patients with actively bleeding ulcers at endoscopy. Repeat endoscopy was performed 24 hours later; treatment was repeated in the presence of endoscopic signs of rebleeding. Surgery was performed when arterial bleeding could not be controlled endoscopically, clinical rebleeding with hematemesis or shock occurred, or the transfusion total exceeded 8 units. RESULTS: One hundred sixty patients were enrolled (epinephrine alone, 81; epinephrine and absolute alcohol, 79). They were matched in age, sex, location of ulcers, hemoglobin on admission, shock, and severity of bleeding. Initial hemostasis was comparable: 79 of 81 with epinephrine alone (97.5%) versus 75 of 79 with epinephrine and absolute alcohol (94.9%). No difference was observed between the two with respect to either rebleeding (9 vs 6), need for emergency operation (12 vs 9), transfusion requirement (median, three units vs two units), hospital stay (median, 5 days vs 4 days), mortality (4 vs 7) and ulcer healing at 4 weeks (50 vs 46). CONCLUSIONS: The additional injection of absolute alcohol after endoscopic epinephrine injection confers no advantage.
Adolescent↗
Gasless laparoscopic excision of bleeding gastric polyp.
A case of bleeding gastric polyp in an elderly woman with compromised respiratory function was treated successfully as an emergency by the gasless laparoscopic technique after endoscopic means failed to control the bleeding. The application of laparoscopic mechanical stapling devices allows rapid gastrotomy and resection, with simultaneous hemostasis that is beneficial in acute bleeding condition. The use of gasless laparoscopy also allows continuous suction to be applied for identification of the bleeding pathology and it also reduces the risk of pneumoperitoneum in patients with poor cardiorespiratory reserve. The operative approach and technique are fully discussed.
Aged↗
Perforation after endoscopic injection sclerotherapy for bleeding gastric varices.
Bleeding from gastric varices is an uncommon condition for which hemostatic control is difficult and ill defined. Most clinicians tend to achieve hemostasis by endoscopic treatment because of the prevailing poor general condition of these patients. A case of fundal perforation following excessive injection sclerotherapy is reported and possible mechanism discussed.
Esophageal and Gastric Varices↗
Palliation of malignant oesophageal obstruction by endoscopic alcohol injection.
Thirty six-patients with inoperable cancers of the oesophagus or gastric tumour in the cardia were treated by endoscopic alcohol injection. After dilatation using Savary dilators, absolute alcohol was injected in 0.5-1 ml aliquots into protuberant parts using a sclerotherapy needle. The mean volume per session was 7.8 ml. The mean dysphagia score improved from 2.7 before treatment to 1.4 after treatment (p < 0.001). Complications included mediastinitis in one patient and tracheo-oesophageal fistulas in two patients. The mean duration of palliation before the development of recurrent dysphagia was 35 days. The mean survival was 82 days. Endoscopic alcohol injection is effective in relieving malignant dysphagia. This inexpensive and easily available technique merits comparative studies with more established forms of therapy, such as laser photocoagulation.
Adenocarcinoma↗
Proximal gastric vagotomy and anterior seromyotomy with posterior truncal vagotomy assessed by the endoscopic congo red test.
The completeness of vagotomy following proximal gastric vagotomy or anterior seromyotomy with posterior truncal vagotomy was assessed prospectively in 48 patients using the intraoperative congo red test. Pentagastrin (6 micrograms/kg) was given subcutaneously before the assessment. An endoscope was passed into the stomach and 180 ml congo red solution washed over the gastric mucosa. Continuing acid production was indicated by the appearance of a black colour (pH < 3) 2 min after introduction of the dye. A grading system was adopted where grades I and II showed little black discoloration and grades III and IV showed increasing areas of discoloration indicating that further denervation was required. All 20 patients undergoing anterior seromyotomy with posterior vagotomy were classified as grade I. Fifteen of an initial 23 patients receiving proximal gastric vagotomy were grade III or IV. Following division of either the right gastroepiploic nerve or the posterior vagal trunk, 22 patients improved to grade I (16) or II (six). In the subsequent five proximal vagotomies, modification of the dissection produced grade I results. Anterior seromyotomy with posterior truncal vagotomy gave consistently complete vagotomy. The congo red test highlighted major differences in the adequacy of vagotomy achieved using various dissection techniques during proximal gastric vagotomy. The test is a useful, reproducible and simple intraoperative method for assessing the completeness of denervation.
Adolescent↗