Wandering Spleen as a Cause of Acute Abdomen: A Surgical Conundrum from Acute Appendicitis to Splenic Torsion and Ischemic Small Bowel Volvulus

@#Wandering spleen is renowned as a surgical enigma due to its diverse presentations. Due to lack of its attaching ligaments which would usually place it at the left hypochondrium region, the spleen ‘wanders’ and may be located anywhere within the abdominal cavity. This condition has been associated with many complications such as splenic torsion, pancreatitis and portal hypertension. We report a case of a wandering spleen presenting as acute appendicitis in an 18-year-old young active sportsman. The patient developed post-operative ileus and later intestinal obstruction which necessitated exploratory laparatomy onto which the final diagnosis of splenic and small bowel infarct due to splenic torsion with small bowel volvulus was made. Splenectomy, small bowel resection and primary anastomosis were performed and the patient made a full recovery.

Prevalence And Risk Factors Of Premature Coronary Artery Disease: A Comparative Cross-Sectional Study Between Two Time Frames In Malaysia

Limited studies on prevalence and risk factors of Premature Coronary Artery Disease (PCAD) were done in Malaysia, primarily on lipid profile. This cross sectional study aims to identify any changing patterns in prevalence and risk factors of Premature CAD between 2000 and 2012. From 2000 to 2012 we included 21862 patients who underwent the first Percutaneous Coronary Intervention (PCI). Analysis of risk factors was done to 1660 and 2098 patients from year 2007 and 2012 respectively. Age of less than 45 years was taken as PCAD. Data was collected from PCI database of National Heart Institute (NHI), NHI TrakCare System, and patients’ medical records. PCAD significantly decreased from 18.8% (2000) to 11.6% (2012). Malay ethnicity showed increasing trend over the years from 55.1% to 66.9%. Multiple logistic regression analysis in 2007 showed that smoking had the higher risk (AOR=2.52), followed by male gender (AOR=2.06), family history of PCAD (AOR=1.96), Indian ethnicity, (AOR=1.65), triglycerides level (AOR=1.20) and BMI (AOR=1.06). In 2012, family history of PCAD had the highest risk (AOR=2.00) followed by smoking (AOR=1.91) and BMI (AOR=1.11). There are changes in risk factors patterns of premature CAD between 2007 and 2012. Most of them are preventable at earlier stage.