Duminda Subasinghe

Faecal incontinence and health related quality of life in inflammatory bowel disease patients: Findings from a tertiary care center in South Asia.

AIM To analyze the frequency and severity of faecal incontinence (FI) and its effect on the quality of life (QOL) in inflammatory bowel disease (IBD) patients. METHODS All patients who attended surgical and medical gastroenterology outpatient clinics in a tertiary care center with an established diagnosis of either ulcerative colitis (UC) or Crohns disease (CD) over a period of 10 mo were included in this study. Before enrollment into the study, the patients were explained about the study and informed consent was obtained. The patients with unidentified colitis were excluded. The data on demographics, disease characteristics, FI (Vaizey score), and quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 21. RESULTS There were 184 patients (women = 101, 54.9%; UC = 153, 83.2%) with a female preponderance for UC (male/female ratio = 1:1.5) and a male preponderance for CD (male/female = 2:1). Forty-eight (26%) patients reported symptoms of FI. Among the patients with FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range, 20-78 years). Average age of onset of FI was 48.6 (range, 22-74) years. Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 56.2% (n = 27), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty-one percent (n = 10) complained of disruption of their physical and social activity. There was no association between FI and type of IBD. Significant associations were found between FI and age (P = 0.005) and gender (P < 0.001). QOL in our cohort of patients was significantly affected by FI. CONCLUSION In our study, nearly a quarter of patients reported FI. There was a significant correlation between FI and QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in this group of patients.

Pancreatic Desmoplastic Small Round Cell Tumour. A Rare Presentation of Painful Obstructive Jaundice

CONTEXT Pancreatic desmoplastic small round cell tumour (DSRCT) is an extremely rare malignancy of which very few reports exist. It follows an aggressive course and has a dismal prognosis. CASE REPORT A twenty-four-year-old male presented with a one-month history of rapidly progressive obstructive jaundice associated with abdominal pain suggestive of a biliary colic. Contrast-enhanced CT (CECT) of the abdomen revealed a pancreatic head mass. He underwent a pancreaticoduodenectomy and adjuvant chemotherapy and is disease free one year after surgery. CONCLUSION This is the first reported case of a pancreatic head DSRCT, discovered in a young male investigated for a short history of painful obstructive jaundice.

Neurofibroma invading into urinary bladder presenting with symptoms of obstructed defecation and a large perineal hernia

BackgroundPelvic floor hernias pose a diagnostic and a treatment challange. Neurofibromatosis is a rare systemic disease, and urinary tract involvement is rare.Case presentationHere we report a case of a 54-year-old female with multiple neurofibromatosis who presented with features of obstructed defecation and was found to have a large perineal hernia. At surgery, we found an unusual herniation of a large neuropathic bladder and rectum through a perineal defect. She underwent reduction cystoplasty and repair of the pelvic floor using a prolene mesh. Subsequent histopathological examination confirmed a large neurofibroma infiltrating the urinary bladder.ConclusionNeurofibromatosis of the bladder is rare it should be considered as a differential diagnosis in patients presenting with symptoms of obstructed defecation.

Gastrointestinal stromal tumour of the stomach mimicking a hepatic tumour: a case report

BackgroundGastrointestinal stromal tumours are the commonest mesenchymal tumours of the gastrointestinal tract. The stomach and small intestine are the favoured sites of occurrence. The symptoms of these depend on the site, size of the tumour and may include abdominal pain, gastrointestinal bleeding or signs of obstruction. We describe a woman with extra luminal gastrointestinal stromal tumour of the stomach that mimicked a left hepatic tumour presenting as an abdominal mass.Case presentationA 51-year-old woman presented with a history of increasing epigastric pain for two-months duration. Her contrast-enhanced computed tomography of the abdomen revealed a large mass in relation to left lobe of the liver. On laparoscopy there was a large tumour arising from the lesser curvature of the stomach. The tumour was resected and histology was suggestive of gastrointestinal stromal tumour.ConclusionThis case shows new evidence for the presentation of extra luminal gastric gastrointestinal stromal tumour that are very rare and can mimic hepatic tumour.

Haemosuccus pancreaticus due to aberrant vessels from the coeliac trunk: a rare cause of Gastrointestinal (GI) bleeding with diagnostic and therapeutic challenges

Haemosuccus pancreaticus (HP) is a rare life-threatening cause of intermittent upper Gastrointestinal bleeding. We report the first documented case of HP due to bleeding from aberrant vessels originating from the coeliac trunk feeding the head of the pancreas. Our patient underwent initial surgery and subsequent angio-embolization. This case report describes the challenges faced during the diagnosis and treatment.