Porcelain gallbladder: The rare end of the spectrum of chronic cholecystitis

Porcelain gallbladder is an uncommon manifestation of chronic cholecystitis. The wall of the gallbladder becomes hard, calcified and brittle with a bluish-white tinge which resembles a porcelain ceramic. This condition is associated with increased risk of malignancy. We report two cases, both female patients (both 56 years old) who were diagnosed with porcelain gallbladder. One presented with a pyogenic liver abscess and the other was diagnosed to have gallbladder carcinoma on the background of porcelain gallbladder with metastases in liver.

Spectrum of endoscopic findings among patients referred for colonoscopy in RIPAS Hospital

Introduction: Colonoscopy is an investigation for the evaluation of lower gastrointestinal symptoms. Just like any other conditions, it is important to be aware of the spectrum of findings so that appropriate referral and decisions can be made. Materials and Methods: Patients (mean age 52.3 ± 15.3 years old with almost equal proportion of genders) referred for colonoscopy in RIPAS Hospital over a five year period (January 2003 to December 2007) were retrospectively identified and studied. Results: The most common indication for colonoscopy was bleeding per rectum (22.9%), followed by evaluation of abdominal pain (18.6%), anaemia (11.7%), colorectal cancer screening (11.7%), evaluation of constipation (5.9%) and altered bowel habits (3.8%). A large proportion (58.4%) colonoscopy was normal. The most common positive finding was haemorrhoids (30.3%), majority of which were categorised as grade I. This was followed by colonic polyps (17.6%), diverticular disease (12.1%), non-specific colitis (4.0%), colorectal cancers (4.0%) and ulcers (3.6%), melanosis coli (0.4%) and telangiectasia (0.1%). Colorectal cancer was most common among the Malays (4.4%), followed by the Chinese (4.0%), the indigenous (2.8%) and the others (1.2%). Conclusions: Our study showed that the most common indication was for the evaluation of bleeding per rectum. Majority had normal colonoscopy and the most common positive finding was haemorrhoids. Importantly colorectal neoplasms accounted for one fifth of procedures with colorectal cancers accounting for four percent.

Spectrum of hepatic disorders encountered in the Hepatology Clinics of RIPAS Hospital

Introduction: In the Southeast Asian region where chronic hepatitis B virus (HBV) infection remains prevalent, HBV related disorders comprise a significant proportion of cases managed by the Hepatology clinics. Additionally, non-alcoholic fatty liver disease (NAFLD) is becoming an increasingly common condition referred to Hepatology clinics for management. We prospectively assessed the spectrum of hepatic disorders managed by the Hepatology clinics in RIPAS hospital, the only tertiary referral centre in Brunei Darussalam. Materials and Methods: All patients seen for hepatic disorders (new referral or follow-up) during a 32 working days period were included in this study. Patients attending for non-hepatic disorders were excluded. Results: During this period, hepatic disorders accounted for 32.2% of the cases managed. The mean age of patients with hepatic disorders was 43.3 ± 12.2 years old with more male patients (65.7%). New referrals accounted for 10%. Overall, 49.6% were positive for HBV, 12% for chronic hepatitis C virus (HCV) infection and 42.1% had evidence of NAFLD. There were overlaps of disorders in 15.5% (12.5% HBV/NAFLD, 2.1% HCV/NAFLD and 1.2% HBV/HCV). Nineteen cases (5.75) had cirrhosis, most commonly associated with HBV and HCV. A quarter were cryptogenic. Patients with NAFLD were significantly heavier than those with HBV, HCV/HBV and the ‘Others’ group. There was also a significant trend for elevated serum alanine aminotransferase among those with NAFLD. Conclusion: Chronic HBV infection is still the most common hepatic disorder encountered in our Hepatology clinics. However, NAFLD is becoming an increasingly more common condition.

Haemoperitoneum secondary to spontaneous rupture of liver tumour

Hepatocellular carcinoma (HCC) is the most common primary tumour of the liver. Cholangiohepatocellular carcinoma (CHC) is less common and is a variant of HCC. There are many similarities with HCC with the exception that CHC tend to be more aggressive. We report a case of a 50-year-old man who was diagnosed with CHC and suddenly deteriorated secondary to hepatic tumour rupture. Despite aggressive supportive care, his condition rapidly deteriorated and died. Autopsy showed ruptured CHC.

Chronic hepatitis C treatment response to combination therapy: Experience of RIPAS Hospital

Introduction: Chronic hepatitis C (CHC) infection is an important cause of chronic and end stage liver disease. Treatment response has improved with combination therapy. We review our experience with combination therapy in CHC patients. Materials and Methods: All patients who had completed at least one course of combination therapy (> 6 months) and had longer than 6 months of follow-up were retrospectively reviewed. Results: There were 28 (22 males, mean age 40.7 ± 9.9 years old) patients who completed one course of treatment. Intravenous drug use (IDU) accounted for 61% of the aetiology. The end of treatment biochemical response was 92.6%. The overall sustained viral response (SVR) was 64.3%. Comparing IDU to the others (non-IDU), there was no difference in treatment SVR (64.7% vs. 63.6%, p = 0.954). Responders had significantly higher pretreatment serum alanine aminotransferase (p = 0.018). Overall treatment side effects were observed in 64% (flu-like symptoms 58.3%, haematological 50% and depressive mood 8%). Conclusions: Our response rates are comparable to published data. There was no difference in treatment response rate between the IDU and non-IDU. CHC infected IDU should be offered treatment.