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A colo-appendico-duodenal fistula is a rare occurrence that results from extrapulmonary tuberculosis (TB) complications, especially in the endemic region. [ABSTRACT FROM AUTHOR]

This segment of the bowel was mistakenly interpreted as an FB in the rectum on the radiograph. However, 10%-20% of cases require endoscopic intervention, while 1% or less require surgical procedures due to complications such as bowel perforation or obstruction.3 Medical history obtained from the patient is highly critical in the diagnosis of FB ingestion. (b) Repeat abdominal radiograph post sigmoidoscopy revealing residual foreign bodies in the GI tract. gl The laparotomy was performed with a midline incision. [Extracted from the article]

As an initial ultrasound of the abdomen showed no intra-abdominal collection, a contrast-enhanced computed tomography (CT) of the abdomen and pelvis was thus conducted. Bowel perforation, a common but life-threatening condition, often creates a surgical dilemma in terms of patient management and treatment. However, the caecal perforation was only identified intraoperatively with the cause of the perforation later confirmed via histopathological examination. [Extracted from the article]

References 1 Ma JLG, Jayasekera H, Pilgrim C. Three pathologies in one: band adhesion strangulating neuroendocrine tumour-containing Meckel's diverticulum. Re: Three pathologies in one: band adhesion strangulating neuroendocrine tumour-containing Meckel's diverticulum We read with great interest an article entitled 'Three pathologies in one: band adhesion strangulating neuroendocrine tumour-containing Meckel's diverticulum' by Ma et al.1 We would like to congratulate the authors for reporting such an unusual case. [Extracted from the article]

Pneumoperitoneum caused by tubo-ovarian abscess in an elderly patient. First of all, we congratulate the authors for the interesting case report.1 Tubo-ovarian abscess is not commonly seen in post-menopausal women despite few similar cases in the literature.2 There are certain pieces of information that can benefit the readers, especially on the sexual history, but these are lacking in the article. Based on the patient's age and extensive contamination, a total hysterectomy or subtotal hysterectomy with bilateral salpingo-oophorectomy should be the ideal treatment.2 We believe that the intraoperative finding of the uterus is crucial, but it was not reported. [Extracted from the article]

This is followed by excision of NF and surgical management of the source of NF. We read with great interest the article by Karam I et al i ., which is published online in your esteemed journal.1 The authors had described in detail about a 59-year-old male who presented with septic shock secondary to necrotizing fasciitis (NF) which turned up to be originated from perforated descending colon cancer. [Extracted from the article]

Endometriosis involving the bowel is a form of deep infiltrating endometriosis (DIE). The endometriotic lesions can infiltrate the bowel layers mimicking a malignancy. The majority of bowel involvement happens in the colon and rectum. We report our experience in surgically managing rectal endometriosis in two patients, one via a conservative approach and the other with a more radical approach and their associated short‐term and long‐term outcomes are observed. In principle, surgery remains the mainstay of treatment in managing rectal DIE with adjuvant hormonal therapy. The selection of surgical approach should be based on disease factors such as the size of the lesions and extent of the disease, patient factors including fitness for surgery and expectations as well as logistics and resource limitations. [ABSTRACT FROM AUTHOR]

First, we congratulate the authors for the interesting case report.1 Mechanical bowel obstruction due to un-involuted uterus after cesarean section is not commonly seen in postpartum women. An enlarged uterus can be due to the pre-existing leiomyoma instead of subinvoluted uterus.4 Intraoperative finding of the uterus was needed to be stated. However, there are few similar cases in the literature regarding acute colonic pseudo-obstruction and paralytic ileus after cesarean section.2 There are some information, such as the amount of bleeding per vagina during postpartum and the completeness of the placenta, which are lacking in the article. [Extracted from the article]

Introduction: Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow‐band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non‐neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non‐neoplastic colorectal lesions. Methods: This study enrolled 100 patients in a single‐center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano's classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non‐neoplastic lesions were analyzed accordingly. Results: The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver–operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non‐disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P < 0.05). Conclusion: The NBI system in colonoscopy was capable of distinguishing neoplastic from non‐neoplastic colorectal lesions. It indicates an acceptable level of agreement with histopathology, the gold standard. However, the role of NBI in screening and surveillance in Malaysia still needs further evaluation and exploration. [ABSTRACT FROM AUTHOR]

We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour. [ABSTRACT FROM AUTHOR]

Preputial calculus is a relative surgical rarity. It usually happens in elderly men with poor hygiene and uncircumcised penis complicated with phimosis. In the paediatric group, it is usually secondary to phimosis and other urologic and/or neurologic anomalies. Surgical treatment is the mainstay of treatment. Herein, we report a 27-year-old gentleman with preputial stone presented with obstructive uropathy and was successfully treated with surgical intervention. To the best of our knowledge, this is the first reported case of the largest preputial stone in Malaysia. [ABSTRACT FROM AUTHOR]

The recent literature review included in this journal gives the incidence of common bile duct (CBD) stones in acute cholecystitis.1 It also utilizes abnormal liver function tests and the size of the CBD as predictors of CBD stone occurrence. This predictor is the size of the patient's cystic duct (CD). [Extracted from the article]

We read with great interest the article by Tang et al., entitled 'Benign free air under the diaphragm: a case of pneumatosis cystoides coli (PCC)', which was recently published.1 It is a very interesting case, yet could be improved further if certain concerns can be addressed. Besides that, by specifying the prognostic assessment Child-Pugh score in this patient who had untreated hepatitis C with grossly distended abdomen would help in differentiating the cause of peritonitis. Supplementary details of the patient's computed tomography (CT) finding can assist in identifying the cause of pneumoperitoneum. [Extracted from the article]

We acknowledge the remarks and comments made by Wadhwani and Rajesh[1] on the article by Teng I et al i .[2] with great interest. 1 Wadhwani N, Rajesh A. Response from Dr Wadhwani and Dr Rajesh to Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum. [Extracted from the article]

Meckel's diverticulum (MD) is a true diverticulum, develops after persistent vitellointestinal duct during embryonic life. Prophylactic resection is performed in male patient, age less than 50 years old, long diverticulum, narrow base MD and palpable heterotopic mass.[6]. [Extracted from the article]

We value greatly the article by Han I et al i ., which was recently published.1 The report demonstrated an unusual case of a wandering spleen (WS) presenting at an advanced age with symptoms of partial large bowel obstruction. The clinical presentation of WS is highly variable, from being asymptomatic to a life-threatening acute abdomen secondary to torsion, infarction or rupture.2 We had discovered and reported a case of WS with concomitant acute appendicitis and small bowel obstruction which ended up with splenectomy and bowel resection.3 There are several issues that trigger us to wonder. Wandering spleen as a cause of acute abdomen: a surgical conundrum from acute appendicitis to splenic torsion and ischemic small bowel volvulus. [Extracted from the article]

Letter to: Local anaesthesia for haemorrhoidal rubber band ligation reduces immediate post-operative recovery time and use of opioid analgesia This letter is in response to the article by Behrenbruch I et al i . discussing the benefit of local analgesia (LA) prior to haemorrhoidal rubber band ligation (RBL).[1] RBL is a cost-effective, easily available and low learning curve procedure performed to treat first- to third-degree internal haemorrhoids.[2] A tight rubber band is applied via proctoscopy above the dentate line aiming to cause fibrosis, retraction and fixation of the hemorrhoidal cushions. References 1 Behrenbruch C, Kong J, Chen F. Local anaesthesia for haemorrhoidal rubber band ligation reduces immediate post-operative recovery time and use of opioid analgesia. [Extracted from the article]

We acknowledge the observations and comments by Yagnik and Yagnik[1] on the article by Teng I et al i .[2] with great interest. 1 Yagnik VD, Yagnik B. Response from Dr Yagnik and Dr Yagnik to Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum. [Extracted from the article]