Penile amputation and successful reattachment and the role of winter shunt in postoperative viability: A case report and literature review

Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation. A 51-yearold patient with paranoid schizophrenia presented 2 hours following penile amputation. He had swallowed the excised portion, which was endoscopically retrieved from the stomach in the emergency department. Successful reattachment was achieved including microvascular repair of the dorsal penile arteries without cavernosal arterial anastamoses. A Winter’s shunt was performed to improve venous circulation. The patient has been followed for 3 years from the date of repair. He has adequate erection for intercourse and good urinary function, but has experienced sensory loss over the dorsal aspect and glans and urethral stricture dilation. This is the first report of replantation following ingestion of an amputated penis.

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Spectacularly Successful Microsurgical Penile Replantation in an Assaulted Patient: One Case Report

Case Reports in Urology ◽

10.1155/2011/865489 ◽

2011 ◽

Vol 2011 ◽

pp. 1-2

Author(s):

Mohammed Fadl Tazi ◽

Youness Ahallal ◽

Abdelhak Khallouk ◽

Mohammed Jamal Elfassi ◽

Moulay Hassan Farih

Keyword(s):

Emergency Department ◽

Wound Healing ◽

Case Report ◽

Erectile Function ◽

Rare Condition ◽

Urinary Function ◽

Penile Amputation ◽

Penile Replantation

Penile amputation is a rare condition for which immediate surgical replantation is warranted. We present herein one case of a 27-year-old male who presented to the Emergency Department after his wife cut his penis. The penis was replanted microsurgically. The deep dorsal penile veins and superficial veins were anastomosed. Although we could not reanastomose the arteries, wound healing occurred without any problem one week postoperatively and the patient regained erectile function 4 weeks after surgery. At 1-year follow-up examinations he reported on restored erectile function and a normal urinary function.

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Management of Pleural Effusions in the Emergency Department.

Reviews on Recent Clinical Trials ◽

10.2174/1574887115666200624194457 ◽

2020 ◽

Vol 15 ◽

Author(s):

MT Congedo ◽

GM Ferretti ◽

D Nachira ◽

MA Pennisi

Keyword(s):

Emergency Department ◽

Systematic Approach ◽

Acute Chest Pain ◽

Pleural Effusions ◽

Therapeutic Approaches ◽

Massive Pleural Effusion ◽

Emergency Department Setting ◽

Clinical Conditions ◽

Definitive Management

Background: In symptomatic patients, admitted in emergency department for acute chest pain and dyspnea, who require an urgent treatment, a rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving. The aim of this review was to summarize the current diagnostic and therapeutic approaches for the management of the main types of pleural effusions that physicians can have in an emergency department setting. Methods: Current literature about the topic was reviewed and critically reported, adding the experience of the authors in the management of pleural effusions in emergency settings. Results: The paper analyzed the main types of pleural effusions that physicians can have to treat. It illustrated the diagnostic steps by the principal radiological instruments, with a particular emphasis to the role of ultrasonography, in facilitating diagnosis and guiding invasive procedures. Then, the principal procedures, like thoracentesis and insertion of small and large bore chest drains, are indicated and illustrated according to the characteristics and the amount of the effusion and patient clinical conditions. Conclusion: The emergency physician must have a systematic approach that allows rapid recognition, clinical cause identification and definitive management of potential urgent pleural effusions.

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The role of pulse oximetry in the accident and emergency department.

Emergency Medicine Journal ◽

10.1136/emj.6.3.211 ◽

1989 ◽

Vol 6 (3) ◽

pp. 211-215 ◽

Cited By ~ 19

Author(s):

M A Lambert ◽

J Crinnion

Keyword(s):

Emergency Department ◽

Pulse Oximetry ◽

Accident And Emergency ◽

Accident And Emergency Department

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“The Coats That We Can Take Off and the Ones We Can’t”: The Role of Trauma-Informed Care on Race and Bias During Agitation in the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2020.11.021 ◽

2021 ◽

Author(s):

Isaac K. Agboola ◽

Edouard Coupet ◽

Ambrose H. Wong

Keyword(s):

Emergency Department ◽

Trauma Informed Care ◽

Trauma Informed

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A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit

Medicina ◽

10.3390/medicina57060514 ◽

2021 ◽

Vol 57 (6) ◽

pp. 514

Author(s):

Tarek Hatoum ◽

Robert S. Sheldon

Keyword(s):

Emergency Department ◽

Diagnostic Yield ◽

Clinical Decision ◽

Emergency Department Visits ◽

Decision Tools ◽

Short And Long Term ◽

Electrocardiogram Ecg ◽

Structured Approach

Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12–86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.

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The Role of Bias by Emergency Department Providers in Care for American Indian Children

Medical Care ◽

10.1097/mlr.0000000000000533 ◽

2016 ◽

Vol 54 (6) ◽

pp. 562-569 ◽

Cited By ~ 20

Author(s):

Susan E. Puumala ◽

Katherine M. Burgess ◽

Anupam B. Kharbanda ◽

Heather G. Zook ◽

Dorothy M. Castille ◽

...

Keyword(s):

Emergency Department ◽

American Indian ◽

Indian Children

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A Case of Imported Severe Plasmodium falciparum Malaria in the Emergency Department and the Current Role of Exchange Transfusion Treatment

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2012.02.051 ◽

2013 ◽

Vol 44 (2) ◽

pp. e211-e215 ◽

Cited By ~ 8

Author(s):

Hania Habeeb ◽

Jill R. Ripper ◽

Alice Cohen ◽

Patrick B. Hinfey

Keyword(s):

Emergency Department ◽

Plasmodium Falciparum ◽

Falciparum Malaria ◽

Exchange Transfusion ◽

Plasmodium Falciparum Malaria ◽

Current Role

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Iatrogenic bacterial meningitis: an unmasked threat

CJEM ◽

10.2310/8000.2011.110316 ◽

2012 ◽

Vol 14 (04) ◽

pp. 263-266 ◽

Cited By ~ 4

Author(s):

Robert Barnwell ◽

Vincent Ball

Keyword(s):

Emergency Department ◽

Bacterial Meningitis ◽

Spinal Anesthesia ◽

Lumbar Puncture ◽

Epidural Anesthesia ◽

Emergency Physician ◽

Rapid Diagnosis ◽

Treatment And Prevention ◽

Sterile Technique

ABSTRACT Iatrogenic bacterial meningitis (IBM) is a rare but serious complication of neuraxial procedures, such as spinal and epidural anesthesia or lumbar puncture. We report a case of a 46-year-old female who presented to the emergency department with bacterial meningitis after spinal anesthesia. We reviewthe existing literature outlining the pathogenesis, vector hypothesis, diagnosis, treatment, and prevention as they relate to IBM. We highlight the role of the emergency physician in the rapid diagnosis of this disease, and underscore the need for sterile technique when performing lumbar punctures.

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