The Thai Journal of Surgery

Continuation Development Santichatngam’s Colonic Injury Prediction Score (SCOPES) for Decision Making in Colonic Injuries due to Trauma

Prinya Santichatngam — 2025-12-26

Background: Primary repair, a method involving direct repair of colonic injuries, has emerged as a preferred treatment option. The development of the SCOPES scoring system has significantly enhanced decision-making regarding primary repair versus diversion procedures. SCOPES version I effectively predicts optimal patients for primary repair, while version II accurately identifies those requiring diversion. By providing a more systematic approach, SCOPES has reduced variability in clinical decision-making. Given the lack of a gold standard for managing colonic injuries, this study seeks to assess the clinical utility of SCOPES versions I, II, and III in patients with colonic injuries.

Patients and Methods: A four-year retrospective study was conducted involving 34 patients with colonic injuries from Pranangklao Hospital and Maharat Nakhon Ratchasima Hospital. Medical records were reviewed from October 2020 to September 2024.

Results: The majority of patients were working-age males with an average age of 38 years. Motor vehicle accidents were the primary cause of injuries, resulting in blunt trauma more frequently than penetrating trauma. The right colon was the most common site of injury. A comparison of primary repair and diversion procedures revealed that primary repair was associated with better outcomes and fewer complications. The study found that SCOPES version I was effective in predicting patients suitable for primary repair, although it had certain limitations. SCOPES versions II and III were more effective in predicting patients who required diversion compared to SCOPES version I. These versions demonstrated 100% sensitivity, specificity, accuracy, positive and negative predictive values, and had a significant impact on positive and negative likelihood ratios, diagnostic odds ratios, and posttest odds.

Conclusion: SCOPES versions II and III, designed for diversion procedures, outperformed SCOPES version I, which was developed for primary repair. These versions exhibited significantly better predictive accuracy compared to relying solely on clinical judgment or surgical judgment.

Efficacy of Customized Pressure Device in Treating Lower Limb Lymphedema: An Observational Study

Shi Hun Tan — 2025-12-26

Objectives: Lymphedema is a chronic, progressive, debilitating disease characterized by the accumulation of protein-rich interstitial fluids in the subcutaneous tissue due to the failure of the lymphatic drainage system. This study sought to evaluate the efficacy of customized pressure devices in treating lower limb lymphedema.

Materials and Methods: 5 patients with lower limb lymphedema who are on customized pressure devices were recruited in this study. The severity of the lymphedema limb(s) was evaluated over 5 months based on both objective and subjective measures. An objective measure was evaluated using limb circumference at different levels measured from the heel, supplemented with the lower extremity lymphedema (LEL) index. Subjective measures were evaluated using the Lymphedema Functionality, Disability and Health Questionnaire for Lower Limb Lymphedema Reliability and Validity (Lymph-ICF-LL).

Results: The study group includes 4 male patients and 1 female between 40 and 55 years old. 2 patients have bilateral lower limb lymphedema, 2 patients have right lower limb lymphedema, and 1 patient has left lower limb lymphedema. Through the LEL index, all patients have significant improvement except 1 patient. Whereas utilizing the Lymph-ICF-LL questionnaire, clinically relevant improvements were observed in 1 patient in the mental function and mobility domain. Minor improvements were identified in others. No patient experiences reduced functionality. Most patients with lower limb lymphedema experienced a positive effect with the use of customized pressure devices.

Conclusion: Our study demonstrated the role of customized pressure devices in managing lower limb lymphedema. There is a significant decrease in LEL in 80% of our patients. Only 20% reported clinically significant improvement in their Lymph-ICF-LL score. Further evaluation is needed to determine the long-term outcomes of patients with lower limb lymphedema, especially regarding the long-term effects of customized pressure devices on LEL index and the ability to return to physical activities.

Efficacy of Total Neoadjuvant Therapy (TNT) Versus Concurrent Neoadjuvant Chemoradiotherapy (CCRT) Alone for Locally Advanced Rectal Cancer in Rajavithi Hospital: A Retrospective Study

Pakkawat Chanpoom — 2025-12-26

Background: Conventional therapy for locally advanced rectal cancer included concurrent chemoradiotherapy (CCRT) followed by surgery and adjuvant chemotherapy. An alternative strategy known as total neoadjuvant therapy (TNT) involves the administration of neoadjuvant chemotherapy plus CCRT before surgery. The studies before suggest that TNT is a promising strategy in locally advanced rectal cancer with a superior rate of PCR compared with conventional therapy. The purpose of this study is to compare the rate of PCR using these 2 approaches in patients at Rajavithi Hospital.

Objective: To determine the differences in rates of pathologic complete response (PCR), R0 resection, and 30-day mortality between patients receiving TNT vs conventional CCRT.

Materials and Methods: We performed a retrospective study of patients with clinical stage II/III rectal cancer within Rajavithi Hospital. All patients who received TNT and conventional CCRT were collected between 2019 and 2024, and the rates of pathological complete response (pCR) were compared between the two arms.

Results: Of the 135 patients in the cohort, 102 (76%) received conventional treatment and 33 (24%) received TNT. At baseline, patients in both groups were more likely to have clinical Stage 3 disease. There were 5 (15.2%) TNT patients who achieved pCR after surgery, compared to 8 (7.8%) conventional CCRT patients (P = 0.305), with no significant difference. There were no significant differences in the rate of positive margins after surgery (3% vs. 8.8%, P = 0.45). Only one patient in the standard arm has mortality within 30 days.

Conclusion: In the TNT group, PCR was found to be higher than the standard group (15.2% vs 7.8%, p = 0.305), although PCR was not significantly different, the real pCR rate was consistent with previous studies that suggest TNT is a promising strategy in locally advanced rectal cancer, with superior rates of PCR compared to standard CCRT.

Evaluation of Breast Cancer Screening Services Using Mammograms and Ultrasounds via Mobile Mammography Units

Danai Manorom — 2025-12-26

Objective: Breast cancer is a major public health concern in Thailand, ranking as the most common cancer among Thai women, with an annual incidence of 17,043 cases and 4,753 deaths. Proactive screening methods, such as breast self-examination (BSE), clinical breast examination (CBE), mammograms, and ultrasounds, are crucial in reducing mortality rates. However, access to these technologies remains limited, particularly in remote areas, due to insufficient mammography machines nationwide. This study aims to evaluate breast cancer screening outcomes among at-risk populations and improve access to medical services in underserved areas.

Materials and Methods: This retrospective study analyzed data from 525 women aged 14-82 who underwent mammograms and ultrasounds via mobile screening units between April and August 2024.

Results: The results showed that 121 participants (23.05%) presented abnormalities requiring follow-up, classified under BIRADS 3–5 risk categories. The estimated number of breast cancer cases from this study is higher than the national average incidence rate.

Conclusion: The findings highlight the effectiveness of mobile screening units in detecting abnormalities and increasing access to services in underserved areas. The incidence of breast cancer in the population studied was approximately 20.02-31.34 per 1,000 individuals. The research underscores the need to expand access to advanced screening technologies and consider extending mammogram and ultrasound benefits to high-risk populations. Further cost-effectiveness and long-term outcomes studies are recommended to support policy development and enhance national breast cancer screening strategies.

A Self-Insertion of 26 High-Strength Neodymium Magnetic Beads in the Bladder: A Case Report

Hemanathan Praemanathan — 2025-12-26

Background: The presence of a foreign object inside the urinary bladder is a rare occurrence in urological emergencies. These objects can enter the bladder through various routes, including medical procedures (iatrogenic causes), self-insertion for sexual stimulation, sexual abuse, physical assault, or migration from nearby organs. Gathering a thorough patient history can be particularly difficult when the insertion was done for sexual gratification. Commonly encountered foreign bodies include everyday items like electrical wires and pencils, medical devices such as intrauterine contraceptive devices (IUDs) and catheter components, or, as seen in this case, high-strength neodymium magnetic beads.

Case Presentation: We describe a rare occurrence where a 24-year-old man inserted 26 high-strength neodymium magnetic beads into his urethra for sexual gratification. The clinical presentation with management outline is discussed. The patient underwent two cystoscopic procedures for complete removal of the intravesical foreign body. During the initial intervention, seven neodymium magnetic beads were successfully extracted. A second cystoscopy was performed the following day, resulting in the complete retrieval of the remaining 19 beads. While treatment’s main objective is the removal of the foreign object, it is essential to take into account both immediate and long-term complications that may arise.

Conclusion: Bladder foreign bodies are rare, requiring individualized management. This case highlights the challenges of managing magnetic bead insertion, emphasizing the importance of prompt diagnosis and staged endoscopic removal.

Retroperitoneal Extraosseous Ewing’s Sarcoma in a Young Infant: A Case Report and Literature Review

Sasabong Tiyaamornwong — 2025-12-26

Ewing's sarcoma (ES) is a rare malignancy primarily affecting bone and soft tissue in children and adolescents. While often presenting with palpable masses and bone pain, extraskeletal Ewing's sarcoma (EES) can manifest with diverse symptoms depending on the location. Accurate diagnosis and prompt treatment of EES are crucial for minimizing recurrence and improving survival outcomes. This case report describes a young infant presenting with a palpable left-sided abdominal mass, ultimately diagnosed as retroperitoneal EES. An initial computed tomography (CT) scan of the abdomen revealed a necrotic mass on the left side, arising from the pancreatic body and tail, leading to a suspicion of pancreatoblastoma. An unexpected finding during surgical exploration revealed a large, well-circumscribed, yellowish, hypervascular retroperitoneal mass attached to the tail of the pancreas. Histopathological examination of the resected tumor confirmed the diagnosis of Ewing's sarcoma. The infant was subsequently treated with a combination of chemotherapy and radiation therapy due to a tumor attached to the tail of the pancreas. This report highlights the diagnostic challenges and management strategies for retroperitoneal EES in infants, contributing to the limited existing literature on this rare clinical entity.