Aim: Intra-abdominal collection or abscess (IAA) is a dreaded complication post open or laparoscopic appendectomy for perforated appendicitis. There have been many discussions on the role of laparoscopic irrigation during laparoscopic appendectomy for perforated appendix but not its role for patients who subsequently developed IAA post-surgery. Methods: All patients who developed clinical symptoms and radiological evidence of IAA of more than 5 cm � 5 cm post appendectomy from January 2014 to May 2016 were subjected to delayed laparoscopic suction (DLS) of the IAA. Days to resolution of fever and improvement of symptoms post the DLS were recorded. Complications during DLS like bowel injury, bleeding and conversion to open surgery were documented and analysed. Patients were followed up for 1 month to a year to look for potential adhesive intestinal obstruction. Results: Seven patients who met the criteria of large IAA were subjected to DLS at post-operative day 3 to day 5 post appendectomy. Six of the cases were post laparoscopic appendectomy and one case was post open appendectomy from another institution. Ports were inserted via the same sites as used during the first surgery. Turbid intraperitoneal fluid and abscesses were laparoscopically sucked without irrigation. There was no bowel injury, bleeding or conversion in any of the cases. All patients were afebrile within 24 h post procedure and their associated symptoms improved significantly. All patients were discharged within three days of DLS and have not returned with adhesive obstruction.

The Siriraj I Gγ(Aγδβ)0 -thalassaemia is a novel mutation involving a 118kb deletion of the β-globin gene cluster. It was first reported in 2012 in two unrelated families from the southern part of Thailand. The carriers in the heterozygous state are clinically asymptomatic. Nonetheless, its complex interaction with other β-thalassaemia could give rise to different clinical phenotypes, ranging from mild thalassaemia intermedia to thalassaemia major. We report here a case of a six-year-old Malay boy, presented with pallor, growth failure and hepatosplenomegaly. His haemoglobin at presentation was 9.2g/dL with a mean cell haemoglobin of 22.6pg and a mean cell volume of 69.9fl. His peripheral blood smear showed features of thalassaemia intermedia. Haemoglobin (Hb) analysis revealed markedly raised Hb F (83%), normal HbA2 levels and absent HbA. Deoxyribonucleic acid (DNA) analysis showed compound heterozygous IVS1-1 (G→T) β-globin gene mutation and Siriraj I Gγ(Aγδβ)0 -deletion (genotype βIVS1-1/ β Siriraj I deletion). Both his father and elder sister are carriers of Siriraj I Gγ(Aγδβ)0 -thalassaemia while his mother carries IVS1-1 (G→T) gene mutation. Clinically, the patient is transfusion dependent on six weekly regime. To the best of our knowledge, this is the first reported case in Malaysia involving unique Siriraj I Gγ(Aγδβ)0 -thalassaemia and IVS1-1 (G→T) in a compound heterozygous state. In summary, detection of Siriraj I Gγ(Aγδβ)0 -thalassaemia is essential as this deletion can lead to severe disease upon interaction with a β-thalassemia point mutation as demonstrated in our case. The establishment of effective carrier screening and genetic counselling is important to prevent its adverse consequences.