Skin ulceration as a complication from unexpected extravasation injury: A case report.

BACKGROUND: Extravasation injury (EVI) is common, yet it is always underestimated and underreported. Severity varies ranging from thrombophlebitis up to disability. Unrecognised EVI is a potential medicolegal case in medicine. CASE PRESENTATION: We experience a 47-year-old lady who developed an unrecognised EVI after being admitted for sepsis. The EVI turned out to be a huge and sloughy skin ulcer. A series of wound debridement with vacuum dressing were conducted until the wound was able to be closed. DISCUSSION: The EVI can be categorised according to Amjad EVI grading and Loth and Eversmann's EVI classification. Adult EVI tends to be overlooked, especially during critical care because patients cannot complain upon sedation and ventilation. In order to prevent EVI, firstly prevention is better than cure. Secondly, if EVI is recognised early, infusion should be stopped immediately. Thirdly, analgesia is mandatory. Finally, the plastic team needs to be engaged if it is deemed required. CONCLUSION: Prevention and early intervention before the occurrence of progressive tissue damage is the key to treatment. Early radical wound debridement and immediate or delayed wound coverage with skin graft or skin flap are indicated in full thickness skin necrosis, persistent pain, and chronic ulcer.

Infected omental cyst complicated with subacute intestinal obstruction and ileal erosion in a 2-year-old boy: a case report.

An omental cyst is a rare intraabdominal pathology that can cause acute abdomen and intestinal obstruction among children. A 2-year-old boy presented with fever, bilious vomiting, abdomen distension and loose stool of acute onset. The chest and abdominal radiographs showed right pleural effusion and prominent small bowels with thickening walls respectively. Ultrasonography revealed a gastrointestinal duplication cyst. An exploratory laparotomy was done and found a 5x5 cm infected omental cyst, severely adhered to and eroded into the ileum causing a small perforation. Omental cyst excision and ileal primary repair were done. The final diagnosis was a benign omental cyst. Omental cyst is usually asymptomatic; however, symptomatic omental cyst should be cautious for bleeding, intestinal obstruction, infection, torsion and rupture.

Malrotated Subhepatic Caecum with Subhepatic Appendicitis: Diagnosis and Management.

Subhepatically located caecum and appendix is a very rare entity. It occurs due to the anomaly in fetal gut rotation that results in an incomplete rotation and fixation of the intestine. Appendicitis, which is a common surgical emergency, in combination with the abnormal subhepatic location, presents a great challenge in its diagnosis and management. Here, we describe a 42-year-old male with chronic dyspepsia who presented with sepsis and severe pain at his right hypochondriac and epigastric region. The final diagnosis was acute appendicitis of the subhepatic appendix. Our discussion focuses on the diagnostic approach and clinical and surgical management. We hope that our report will increase the awareness among the clinicians and hasten the management of such rare condition to avoid complications.

Wild Banana Seed Phytobezoar Rectal Impaction Causing Intestinal Obstruction.

Wild banana (Musa acuminata subsp. microcarpa) seed phytobezoar rectal impaction in adult is a rare entity. Here, we report a 75-year-old male with dementia who presented with lower abdominal pain, per-rectal bleeding and overflow faecal incontinence. Our investigation discovered a large wild banana seed phytobezoar impacted in the rectum causing intestinal obstruction, stercoral ulcer and faecal overflow incontinence. In this article, we discuss the patient's clinical findings, imaging and management. The culprit plant was identified and depicted. This may be the first report of its kind. Public consumption of these wild bananas should be curtailed. It is hoped that this report would increase the awareness of such condition and its identification.

Helicobacter pylori Infection Rates in Patients Undergoing Endoscopy in the Interior of Borneo.

INTRODUCTION: Very limited data are available on the Helicobacter pylori infection among the population of interior Borneo. We aimed to investigate the H. pylori infection rate among an endoscoped interior Borneo population and to report the differences between the infected and noninfected patients. METHODS: We retrospectively analyzed the data of the rapid urease test (RUT) records in Endoscopy Unit Hospital Keningau from January 2009 to May 2014. Student's t-test, chi-square test or Fisher's exact test were used accordingly. Multiple logistic regression analysis was used to identify independent risk factors for H. pylori infection. Birth cohort was analyzed against H. pylori infection rate with chi-square test. RESULTS: Overall, there were 215 of 774 (27.8%) positive RUTs. Patients with H. pylori infection were younger (47.66 ± 14.93 vs 50.50 ± 15.02 years, p = .019), more likely to be female (OR = 1.54, 95% CI 1.12-2.13, p = .008) and originated from the Pensiangan district (OR = 1.63, 95% CI 1.01-2.64, p = .047). Chinese patients were less likely infected with H. pylori (OR = 0.36, 95% CI 0.16-0.80, p = .013). Birth cohort was significantly associated with H. pylori infection rate (χ(2) (7) = 14.71, p = .040) with an increasing trend of H. pylori infection rate in patients born later (χ(2) (1) = 5.26, p = .022). CONCLUSION: The overall H. pylori infection rate in this population was unexpectedly low. Accordingly, it may be a recent arrival in this community. Gender, age, dietary practice, socioeconomic status, and ethnicity were among the factors associated with H. pylori infection.