2009

Chattopadhyay P, Bandyopadhyay A, Ghosh S, Kundu AJ
Correspondence: Dr Partha Chattopadhyay, drpartha73@gmail.com

ABSTRACT
Tuberculous osteomyelitis involving primarily the diaphysis without articular involvement is very rare. Pain and swelling are the common presenting symptoms. The nonspecific nature of the symptoms leads to a delay in the diagnosis. Radiographs may mimic pyogenic osteomyelitis, Brodie’s abscess, tumours or granulomatous lesions. Curettage of the lesion and the histopathological examination of the material obtained are necessary for confirmation of the diagnosis and offer a chance for early healing. We report the successful diagnosis and management of a rare case in a 28-year-old man of Indian origin afflicted with primary diaphyseal tuberculosis of the left tibia.

Keywords: Brodie’s abscess, diaphyseal tuberculosis, tuberculous osteomyelitis, skeletal tuberculosis
Singapore Med J 2009; 50(6): e226-e228

Abdul-Rahman NR, Mohammad KF, Ibrahim S
Correspondence: Dr Sharaf Ibrahim, sharaf@ppukm.ukm.my

ABSTRACT
The Klippel-Trenaunay syndrome is a combination of venous and capillary malformations associated with soft tissue and/or bony limb hypertrophy, with or without lymphatic malformations. Although persistent foetal veins are rare, the persistence of the lateral marginal vein is a common association in this syndrome. It results in venous hypertension, which gives rise to venous varicosities, which are commonly seen in this syndrome. This is a case report of a 28-year-old man with Klippel-Trenaunay syndrome, with persistence of the lateral marginal vein, affecting his right lower limb. He was treated with an above-knee amputation. The amputated limb was dissected to demonstrate the anatomy of the lateral marginal vein. To the best of the authors’ knowledge, the gross anatomy of the lateral marginal vein has not been previously reported.

Keywords: Klippel-Trenaunay syndrome, lateral marginal vein, venous malformation
Singapore Med J 2009; 50(6): e223-e225

Ng CKD, Cheung YSH, Wong CHJ, Li KWM
Correspondence: Dr Dennis Chung Kei Ng, dennis_ckng@yahoo.com.hk

ABSTRACT
Coloduodenal fistula is an uncommon disease entity. It can be caused by either a malignant or benign disease. We report the fifth case of coloduodenal fistula secondary to colonic diverticulosis. Our patient, a 60-year-old man, presented with severe diarrhoea and recurrent severe hypokalaemia. A partial colectomy with en bloc excision of the fistula was performed, and the duodenal defect was closed primarily. A literature review was carried out on the aetiology, presentation, diagnosis and management of coloduodenal fistula.

Keywords: diverticulum, coloduodenal fistula, colonic diverticulum, diverticulitis, enteric fistula, fistula
Singapore Med J 2009; 50(6): e220-e222

Lee KH, Shelat VG, Low HC, Ho KY, Diddapur RK
Correspondence: Dr Ravishankar K Diddapur, ravi_diddapur@hotmail.com

ABSTRACT
Ascaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides can occasionally cause biliary obstruction and result in obstructive jaundice or pancreatitis. We present a 34-year-old Bangladeshi woman with biliary ascariasis, resulting in recurrent pancreatitis. Her diagnosis was made with endoscopic retrograde cholangiopancreatography performed during an acute attack of pain.

Keywords: Ascaris lumbricoides, biliary ascariasis, biliary obstruction, parasitic infection, recurrent pancreatitis
Singapore Med J 2009; 50(6): e218-e219

Singh VK, Singh PK, Balakrishnan SK
Correspondence: Dr Vinay K Singh, we.publish@googlemail.com

ABSTRACT
The coracoclavicular joint (CCJ) is a rare anomalous joint. Symptomatic CCJ, being an exceptional rarity, makes it difficult to formulate a standard set of practice or guidelines. We report a 50-year-old Indian man, a machine operator by profession, who experienced bilateral shoulder pain and arm paraesthesia for two years, and was diagnosed with bilateral CCJ. The symptoms gradually increased, affecting his daily activities. Dynamic magnetic resonance imaging revealed the compression of the brachial plexus in extreme shoulder abduction. After a thorough search of the literature, we retrieved four similar cases, all of them treated with individualised protocols. None of the cases was bilateral. The lack of clear evidence in any particular direction and the patient’s medical condition prompted us to give a conservative trial, before embarking on more invasive methods. He showed rapid response to the conservative treatment with remission of all symptoms. To the best of our knowledge, this is the first reported case of bilateral symptomatic CCJ with bilateral thoracic outlet syndrome, that was managed conservatively.

Keywords: bilateral thoracic outlet syndrome, coracoclavicular joint, symptomatic coracoclavicular joint, thoracic outlet syndrome
Singapore Med J 2009; 50(6): e214-e217

Ng WT, Ng SSM
Correspondence: Dr Simon SM Ng, simonng@surgery.cuhk.edu.hk

ABSTRACT
Double inferior vena cava (IVC) is a congenital anomaly resulting from the persistence of the embryonic venous system. The majority of cases are clinically silent and diagnosed incidentally on imaging for other reasons. However, these venous anomalies may have significant clinical implications, especially during retroperitoneal surgery and in the treatment of thromboembolic diseases. We report three cases of double IVC and review the relevant literature. The clinical importance of recognising double IVC is discussed.

Keywords: computed tomography, double inferior vena cava, inferior vena cava, venous anomaly
Singapore Med J 2009; 50(6): e211-e213

Singh VK, Singh PK, Kalairajah Y
Correspondence: Mr Vinay K Singh, we.publish@googlemail.com

ABSTRACT
Double dislocations of the thumb at the metacarpophalangeal joint (MCPJ) and interphalangeal joint (IPJ) occurring at the same time are seldom seen in medical practice. The sporadic occurrence of this interesting injury makes it difficult to formulate a clear management protocol. We report an unusual combination of injury involving a right thumb of a 60-year-old man, where the IPJ was dislocated dorsally with a volar dislocation of the MCPJ. It was an open injury with avulsion of the ulnar collateral ligament of the MCPJ. The dislocation was treated successfully by closed reduction in the casualty department, under a ring block. The ulnar collateral ligament was repaired later in the operating theatre. At six months’ follow-up, the patient had a full painless range of movement in his thumb with no instability. To our knowledge, this is the first reported case of a thumb double dislocation where the injury was open at both joints. This is also the first case where a volar dislocation of the MCPJ was treated successfully by closed reduction, with an excellent functional outcome.

Keywords: double thumb dislocations, interphalangeal joint dislocation, metacarpophalangeal joint dislocation, thumb dislocations
Singapore Med J 2009; 50(6): e206-e210

Aksoy B, Ertürer E, Toker S, Seçkin F, Sener B
Correspondence: Dr Serdar Toker, tokerserdar@hotmail.com

ABSTRACT
Tenosynovial giant cell tumours originate from synovial tissues of the joints, tendon sheaths, mucosal bursas or fibrous tissues adjacent to tendons. Tenosynovial giant cell tumours are rarely intra-articular. We report a giant cell tumour of the tendon sheath arising from the posterior cruciate ligament diagnosed by magnetic resonance imaging and resected arthroscopically in a 54-year-old woman.

Keywords: arthroscopic resection, giant cell tumour of the tendon sheath, pigmented villonodular tenosynovitis, posterior cruciate ligament, tendon sheath lesion, tenosynovial giant cell tumour
Singapore Med J 2009; 50(6): e204-e205

Yap YL, So JBY
Correspondence: Dr Yap Yan Lin, yapyanlin@yahoo.com.sg

ABSTRACT
Patients with common variable immunodeficiency syndrome (CVID) have an increased risk of gastric adenocarcinoma. We describe a case of gastric adenocarcinoma in a 29-year-old man with CVID. He complained of dyspepsia and weight loss. Endoscopy showed an antral lesion. He underwent subtotal gastrectomy with postoperative adjuvant chemoradiation, and remained disease-free for three years. CVID is a predisposing factor for gastric adenocarcinoma. Gastric complaints are common among these patients and should be viewed seriously. Endoscopy is performed to detect any pathology. Premalignant conditions like chronic atrophic gastritis, intestinal metaplasia and dysplasia require regular endoscopic surveillance in these high-risk patients.

Keywords: B-cell deficiency, common variable immunodeficiency syndrome, gastric adenocarcinoma, hypogammaglobinaemia
Singapore Med J 2009; 50(6): e201-e203