2009

Durai R, Ruhomauly SN, Wilson E, Hoque H
Correspondence: Mr Rajaraman Durai, dr_durai@yahoo.com

ABSTRACT
Metastatic malignancy in the breast is uncommon. A 68-year-old woman with a past medical history of breast cancer presented with a lump in the opposite breast. A mammogram suggested a possible benign lump. An ultrasonography-guided core needle biopsy was taken to complete the triple assessment. The histology on the breast core biopsy showed it to be a metastatic renal cell carcinoma. Subsequent computed tomography of the abdomen confirmed a renal primary tumour. The patient was referred to the renal oncologist for palliative treatment.

Keywords: breast mass, breast metastatic tumour, breast neoplasm, metastasis, renal cell carcinoma
Singapore Med J 2009; 50(8): e277-e279

Lee LS, Foo CS, Chen CM, Poh CC
Correspondence: Dr Lee Lip Seng, lipseng100@yahoo.com

ABSTRACT
Malignant gastrocolic fistula formation is a rare complication of gastric carcinoma. We report a cachectic 82-year-old woman who presented with upper abdominal pain, diarrhoea, loss of weight and loss of appetite. Further investigation of her symptoms revealed a gastrocolic fistula connecting the ulcerated tumour of the body of the stomach to the splenic flexure of the colon.

Keywords: gastric carcinoma, gastrocolic fistula
Singapore Med J 2009; 50(8): e274-e276

Fu WP, Quah HM, Eu KW
Correspondence: Dr Hak-Mien Quah, quah.hak.mien@sgh.com.sg

ABSTRACT
Necrotising fasciitis is a life-threatening soft tissue infection that is associated with high mortality and morbidity. It has been described in the form of Fournier’s gangrene following rectal perforations related to colorectal cancer. In these rare instances, spontaneous perforation of locally-advanced rectal carcinoma provides an entry point for bacterial seeding to the surrounding soft tissues, resulting in Gram-negative sepsis of the perineum. To our knowledge, necrotising fasciitis extending beyond the perineum due to rectal perforation has not been previously described. We report an unusual self-induced traumatic rectal perforation presenting with severe necrotising fasciitis of the lower limb in a 73-year-old Chinese man. Our patient was successfully treated with a multidisciplinary approach that involved a defunctioning colostomy as well as prompt and rigorous debridement of the affected limb. We also review the literature on the management of retroperitoneal rectal perforations and their sequalae, as well as discuss the various surgical options commonly applied and their outcomes.

Keywords: colonic irrigation complication, intestinal perforation, necrotising fasciitis, rectal perforation
Singapore Med J 2009; 50(8): e270-e273

Chee DWY, Peh WCG
Correspondence: Prof Wilfred CG Peh, wilfred.peh@gmail.com

ABSTRACT
A 82-year-old woman presented with left buttock pain radiating to the left anterior knee for four weeks. Magnetic resonance imaging of the lumbar spine showed a rim-enhancing mass in the spinal canal at the level of L3 vertebra suggestive of a sequestered disc, which was subsequently confirmed on decompression laminectomy. The clinical and magnetic resonance imaging features of a sequestered disc and its mimics are discussed.

Keywords: disc protrusion, sequestered disc, spine imaging
Singapore Med J 2009; 50(8): 834-840