Malrotation in the adult, a forgotten Etiology of Partial Gut Obstruction: A report of two cases

@#Ninety percent of cases of malrotation have shown signs and symptoms of intestinal obstruction by the first year of life. It is thus an often-overlooked etiology in adult patients. Evidence-based recommendations are also limited because of the paucity of cases. This paper discusses the two cases of malrotation from diagnosis to surgical management at a tertiary academic hospital. Both are previously well adult male patients with virgin abdomen who presented with vomiting and signs of intestinal obstruction. During medical decompression, CT scan with triple contrast clinched the diagnosis of malrotation for which Ladd's procedure was done, with no operative complications. The authors' experience and previous literature support early decompression, imaging, and surgery for all cases of malrotation regardless of severity of symptoms.

Surgical Site Infection (SSI) Rate after Colorectal surgery at the Philippine General Hospital

OBJECTIVE@#Surgical site infection (SSI) is one of the most common healthcare-associated infections. This study aimed to determine SSI rate and the associated factors among colorectal surgery patients.@*METHODS@#This included adult patients who underwent surgery under the Division of Colorectal Surgery from January to May 2018. Clinico-demographic, operative, and SSI outcome data were reviewed. Occurrence of SSI during admission until discharge, and up to 30 days after the surgery was analyzed. @*RESULTS@#A total of 172 surgeries were performed. Majority were elective procedures (68.0%), and performed via open approach (67.4%). Most were malignant cases (62.6%). Sixty-three colorectal resections were done (41 colon and 22 rectal). SSI rate prior to discharge was 6.4%, and 15.7% at 30 days. Among colorectal resections, 18 (28.6%) patients had SSI at 30 days. SSI rates were significantly higher among patients who were ASA 2 or 3; received chemotherapy 12 weeks prior to surgery; had malignant pathology; underwent emergency surgery; received perioperative transfusion; had stapled skin closure; had low anterior resection for rectal cancer; and had multivisceral resection. @*CONCLUSION@#The Division of Colorectal Surgery at the Philippine General Hospital had a higher SSI rate as compared to literature. Although this could be partly explained by the differences in patient and surgeon population, improving on SSI rates will be the unit's goal. Continued SSI surveillance with more patient accrual may provide better insight to the associated risk factors.

Bleeding duodenal diverticula managed With surgical resection: A case report

@#The duodenum is the most common extra-colonic site of diverticulum. If present, it rarely manifests with symptoms or complications. A case is discussed involving a 78-year-old female who presented with massive upper gastrointestinal bleeding from duodenal diverticula. Due to hemodynamic instability, she eventually underwent duodenal resection, with a side-to-side duodenojejunostomy as a means of restoring intestinal continuity. The postoperative course was unremarkable. The patient was able to feed enterally and had no recurrence of bleeding.

Disseminated intravascular coagulation from Intraperitoneal Oxaliplatin for Appendiceal Carcinoma: A case report

@#This is a case of a 65-year-old female diagnosed with appendiceal carcinoma, who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Profuse bleeding through the peritoneal drains, with hemodynamic instability, warranted a re-exploration on the fourth postoperative day. Intraoperatively, there was 500 mL of blood clots mostly on the right upper quadrant, diffuse muscle oozing along the previously-stripped right hemidiaphragm and right paracolic gutter, and a non-expanding hematoma on the right anterior abdominal wall. Bleeding parameters were checked postoperatively, and derangements pointing to a disseminated intravascular coagulation were noted. The patient was managed with multiple blood transfusions of packed red blood cells, fresh frozen plasma, platelet concentrates, and cryoprecipitate. Dexamethasone and tranexamic acid were given intravenously. The patient was discharged well on postoperative day 14 after clinical resolution of the bleeding. Eight days after discharge, however, patient succumbed to myocardial infarction.

Outcomes of surgical management of buschke-lowenstein tumor in a Philippine tertiary hospital

Buschke-Lowenstein tumor (BLT) is a sexually transmitted infection (STI) caused by the human papillomavirus. This study investigated the profile, management, and outcomes of patients who underwent surgery for BLT from 2015 to 2019 at the Philippine General Hospital. Seven patients underwent surgery for BLT. All were male, with ages ranging from 21 to 41 years. Presenting symptoms were anal mass, foul-smelling discharge, pain, bleeding, and pruritus. All were positive for human immunodeficiency virus. All admitted to having engaged in both insertive and receptive anal intercourse, with multiple partners. All underwent excision with healing by secondary intention. Two had recurrence of warts. Four had an anal stricture. Of these, 3 underwent anal dilatation, while 1 had to undergo proximal bowel diversion. One had intraepithelial carcinoma without dermal invasion on histopathologic analysis. BLT is a rare STI characterized by local aggressiveness but with low malignant potential. Wide excision remains to be the mainstay of treatment.

Modifications to Treatment Plan of Rectal Cancer in Response to COVID-19 at the Philippine General Hospital

Purpose@#The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare resources worldwide. Despite the high number of cases, cancer management should remain one of the priorities of healthcare, as any delay would potentially cause disease progression. @*Methods@#This was an observational study that included nonmetastatic rectal cancer patients managed at the Philippine General Hospital from March 16 to May 31, 2020, coinciding with the lockdown. The treatment received and their outcomes were investigated. @*Results@#Of the 52 patients included, the majority were female (57.7%), belonging to the age group of 50 to 69 years (53.8%), and residing outside the capital (59.6%). On follow-up, 23.1% had no disease progression, 17.3% had local progression, 28.8% had metastatic progression, 19.2% have died, and 11.5% were lost to follow up. The initial plan for 47.6% patients was changed. Of the 21 patients with nonmetastatic disease, 2 underwent outright resection. The remaining 19 required neoadjuvant therapy. Eight have completed their neoadjuvant treatment, 8 are undergoing treatment, 2 had their treatment interrupted, and 1 has yet to begin treatment. Among the 9 patients who completed neoadjuvant therapy, only 1 was able to undergo resection on time. The rest were delayed, with a median time of 4 months. One has repeatedly failed to arrive for her surgery due to public transport limitations. There was 1 adjuvant chemotherapy-related mortality. @*Conclusion@#Delays in cancer management resulted in disease progression in several patients. Alternative neoadjuvant treatment options should be considered while taking into account oncologic outcomes, acceptable toxicity, and limitation of potential COVID-19 exposure.

Modifications to Treatment Plan of Rectal Cancer in Response to COVID-19 at the Philippine General Hospital

Purpose@#The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare resources worldwide. Despite the high number of cases, cancer management should remain one of the priorities of healthcare, as any delay would potentially cause disease progression. @*Methods@#This was an observational study that included nonmetastatic rectal cancer patients managed at the Philippine General Hospital from March 16 to May 31, 2020, coinciding with the lockdown. The treatment received and their outcomes were investigated. @*Results@#Of the 52 patients included, the majority were female (57.7%), belonging to the age group of 50 to 69 years (53.8%), and residing outside the capital (59.6%). On follow-up, 23.1% had no disease progression, 17.3% had local progression, 28.8% had metastatic progression, 19.2% have died, and 11.5% were lost to follow up. The initial plan for 47.6% patients was changed. Of the 21 patients with nonmetastatic disease, 2 underwent outright resection. The remaining 19 required neoadjuvant therapy. Eight have completed their neoadjuvant treatment, 8 are undergoing treatment, 2 had their treatment interrupted, and 1 has yet to begin treatment. Among the 9 patients who completed neoadjuvant therapy, only 1 was able to undergo resection on time. The rest were delayed, with a median time of 4 months. One has repeatedly failed to arrive for her surgery due to public transport limitations. There was 1 adjuvant chemotherapy-related mortality. @*Conclusion@#Delays in cancer management resulted in disease progression in several patients. Alternative neoadjuvant treatment options should be considered while taking into account oncologic outcomes, acceptable toxicity, and limitation of potential COVID-19 exposure.

Determination of the antimicrobial property of oregano (Plectranthus amboinicus (Lour.) Spreng.) crude aqueous leaf extract against throat pathogens using broth and checkerboard dilution methods

@#<p style="text-align: justify;"><strong>Objective:</strong> This study aimed to determine the antimicrobial property of oregano (Plectranthus amboinicus) crude leaf extract against pathogens that infect the throat, specifically Streptococcus pyogenes and Candida albicans using the broth and checkerboard dilution methods.</p><p style="text-align: justify;"><strong>Methods:</strong> This study employed an experimental study design using broth dilution method for the determination of the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) against Streptococcus pyogenes ATCC 19615, and minimum fungicidal concentration (MFC) against Candida albicans ATCC 14053 of P. amboinicus crude extract (PA extract). Checkerboard dilution method was then used for determination of the synergy between PA extract and the standard antimicrobials.</p><p style="text-align: justify;"><strong>Results:</strong> In vitro growth inhibition of S. pyogenes (MIC 0.13 g/mL) and C. albicans (MIC 0.03 g/mL) was exhibited by the PA extract. The highest concentration of PA extract used in this study was not sufficient to demonstrate bactericidal and fungicidal activity (MBC >0.25 g/mL, MFC >0.25 g/mL). Results of checkerboard dilution method revealed that PA extract when combined with either penicillin (for S. pyogenes) or nystatin (for C. albicans) demonstrated indifference.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The crude extract of Plectranthus amboinicus has the capability to inhibit the growth of both S. pyogenes and C. albicans. This demonstrates its potential use in the treatment of throat infections caused by these organisms.</p><p style="text-align: justify;"><strong>Key Words:</strong> Plectranthus amboinicus, oregano, antimicrobial, throat infections, herbal medicine</p>