Odysseys of George

A sad story to follow the picture above! But till then keep the brain cells active and give the closest answer, if you can!

A lady was admitted for accidentally swallowing her two-premolar tooth denture. According to her , the wire piece had broken before and presently only supported by a wire on a single side. She was using this now loose denture for quite some time till 3 days ago while washing her mouth it dislodge and was swallowed accidentally.

An chest Xray showed it to be lying within the lower oesophagus but within the thoracic cavity.

Do you see it?
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A closer look shows a W-shape wire piece sitting horizontally.

Removing it surgically was also not going to be easy and would have high possible complications due to its position. Removing it endoscopically would be the best option but had failed 2 previous attempts.

Today, we decided to rescope her before taking her to the operating theatre and attempt to remove the denture. She had 2 attempts done before and was reported to be embedded to the wall of the oesophagus. We somehow, skillfully managed to remove the denture! Yahooo!

Moral of the story:

Please, when something is defunct or loose, don’t use it. And as typical Malaysian, don’t wait till something occurs, or assume that nothing would happen as nothing had happen so far, as it may be a high price to pay or may even cost your life!

A young lady in her early 20s, who became paraplegic from her mid chest and below from a motor vehicle accident, was admitted for sudden colicky abdominal pain and a grossly distended abdomen. She had difficulty passing motion since her injury and opens her bowel almost once every week. This present episode has occurred before but not as severe as this present presentation. She noticed some changes in her bowel habit since 3 months ago. On examination, she had a grossly distended but soft abdomen and per rectal examination reveals a mass compressing the rectum from above. So, what is this mass?

Note: The importance of complete history taking and the falls of making assumptions. I have left out a few things in the history which you can ask? Happy Guessing!

A young boy presents with sudden abdominal pain for a duration of 2 days. He was also noted to have progressive abdominal distension and inability to open his bowel or pass flatus. The abdominal pain was progressively worsening and a day prior to admission he was noted to have vomitting. According to the mother he has always had difficulty in passing motion and would require frequent enemas and laxatives to help him open his bowels. He passes very hard stools and at a frequency of once every week. He has had previous episodes of colicky abdominal pain but resolves with laxatives or enemas. This is the first episode of such severe presentation. On examination, revealed a dehydrated, listless child. He had a lowish blood pressure and his plse rate was fast. His abdomen was grossly distended and tender but no evidence of peritonitis. It was resonant on percussion. Per rectal was of empty rectum. This are his abdominal Xray.

and his CT scan

Any takes?

As I walk around town, I am astonished to see the ever growing number of women or ladies puffing about like it was a fashion sense to do so. I wonder why? Why make yourselves look wrinkled and your lips darker then cover it over with thick lipcoat? Why let your skin dry and worn out? Why let yourselves age 10 or maybe 20 times older? Yes initially this changes are inconspicuous but as time, as normally it does last, then these effects become more pronounced and irreversible.

Then again, I don’t actually know why men smoke too but I do hope that the lame excuse of women trying to imitate their male counterpart is not one of them!

A young boy of 15years old presented with a 2 day history of abdominal pain starting at the upper abdomen(epigastrium) then later the pain was worse felt over the right lower flank. He was diagnosed to have appendicitis.

I got a call from my medical officer saying that he drained 400mls of dark haemoserous fluid from his Lanz incision made for appendectomy. We converted the case to perform a laparotomy and this is what we found.

After releasing the twist,

It is a case of mesenteric venous thrombosis secondary to volvulus of the mid-segment of the small bowel. Maybe also it could be a internal herniation from a congenital band.
After the resection, he is left with probably 90cm of small bowel from about 250 to 300cm of small bowel.

Related post:

What?! This ain’t no appendix