It was a high fever that refused to abate but Mr Kho Chuan Heng, 54, did not think much about it. An inflight supervisor with Singapore Airlines, he was enroute from Singapore to San Francisco, USA on 30 Nov 05 when his high fever started. When he landed in San Francisco, he bought medicine from a pharmacy and self medicated. He flew from San Francisco to Hong Kong and from Hong Kong back to Singapore but the fever did not go away. After seeing his company doctor on 5th, 6th and 7th Dec, his fever was still peaking at 40 degree celsius.

Finally, 9 days after the fever started, Mr Kho came to CGH A&E on 8 Dec 2005 at his wife’s insistence. Dengue was suspected as his blood platelet count was low but admitting doctor-on-call, Dr Chua Tju Siang, Consultant Gastroenterologist, suspected something else was afoot as Mr Kho had slight jaundice and low blood pressure. His doubts were confirmed when the dengue serology test came back negative. It was a critical time for Mr Kho when his systolic blood pressure dropped to low 80s and he was transferred to ICU. Mr Kho’s abdominal ultrasound was normal but Dr Chua suspected that he was suffering from septicaemia (blood infection) due to a gall stone lodged in the common bile duct.

To get a better view, Dr Chua carried out an emergency Endoscopic Ultrasound (EUS). An EUS is a procedure that allows a doctor to look inside the gastrointestinal tract using a flexible tube that has an ultrasound probe at the tip of the tube. With EUS, the doctor can place the ultrasound probe against the tissue or area and view the area more closely. EUS is good for viewing deep-seated organs that lie next to the digestive track eg.pancreas, spleen, gallbladder, bile ducts, liver. EUS  

which takes about 30 minutes is usually performed as a day operation with the patient sedated.

“We managed to increase his systolic blood pressure to 100 with medication. I had to do his EUS in just 5 minutes at the ICU itself because there was no time to waste and I did not want to risk having his blood pressure coming down again,” said Dr Chua.

Through EUS, Dr Chua found a gallbladder stone that was blocking Mr Kho’s bile duct and the stagnant bile had caused a liver abcess (pus). Dr Chua then performed a therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and placed a temporary stent (tubing) to drain the bile and started Mr Kho on strong antibiotics to clear the infection. Thankfully, Mr Kho responded to the antibiotics and was finally discharged on 5 January 2006.

As surgery could only be carried out after his infection was resolved on 3 May 2006, Mr Kho came back to have his stent and the bile duct stone removed. On the following day, Dr Salleh Ibrahim, Consultant Surgeon also operated on him and removed his gallbladder where the problem started using keyhole surgery so that his gall stones will not recur.

"After having stayed here for close to
1 month at CGH, I am glad I was under the
charge of Dr Chua Tju Siang and Dr Teo Eng Kiong who tried all means to treat me without giving me false
hopes. Dr Chua has excellent bedside manners and either he or Dr Teo will update me on my condition every morning. They were a team of fantastic players who show a lot of passion and dedication for the job. Now my problem is all resolved,”
said Mr Kho."