Simultaneous Laparoscopic Cholecystectomy and Appendectomy

These are samples taken from the same patient during an operation. 

The most left is the removed Appendix. 

The middle is the removed Gallbladder. 

The most right is the soft gallstones removed from the gallbladder. 

This patient presented with one month history of right-sided abdominal pain in the middle. 

Typically, upper right-sided abdominal pain is caused by inflamed gallbladder(Acute Cholecystitis). 

Typically, lower right-sided abdominal pain is caused by inflamed appendix(Acute Appendicitis). 

So, the middle right abdominal pain give rise to the suspicion of simultaneously inflamed gallbladder and appendix(concomitant Acute Cholecystitis and Appendicitis). 

Since the gold standard operation to remove the gallbladder is by Laparoscopic Cholecystectomy, during the procedure, the appendix was also explored and confirmed to be inflamed. 

Laparoscopic Appendectomy was also attempted but due to adhesions and the retrocaecal location, dissection was hazardous and hence the procedure was converted to conventional Open Appendectomy.

Alternative Therapy in Colorectal Cancer

The picture above is a CT scan view of a pelvis in a patient with locally advanced rectal cancer. The red  circle indicates the lateral extent of the rectal tumour. It appears that almost the whole lumen has  been obliterated by the tumour.The remaining compressed lumen is reflected by only three black dots in the centre of the mass.

The patient was diagnosed one year earlier in another hospital when he presented with just painless bleeding in the stools.

After colonoscopy and histological confirmation of the diagnosis, the patient refused the standard surgical operation offered, but instead went for an "Alternative Therapy" in Gerik, Perak.

He came to my clinic asking for a CT scan to check on his disease. 

From the CT scan, he soon will suffer Intestinal Obstruction that will require an emergency surgery. 

I am yet to find a cancer patient successfully treated by an "Altetnative Therapy".