Cas D’une Fausse Fracture De La Verge Par Rupture De La Veine Dorsale Profonde Au Centre Hospitalo-Universitaire Departemental -Oueme Plateau De Porto Novo, Benin

Introduction : Les traumatismes du pénis intéressant le réseau vasculaire sont rarement rapportés dans la littérature. La rupture de la veine profonde du pénis est une urgence urologique dont la clinique peut simuler une fracture de la verge.Nous rapportons un cas de rupture de la veine profonde du pénis survenue lors d’un faux pas de coït.Patient et Méthodes : Il s’est agi d’un patient âgé de 26 ans présentant une tuméfaction de tout le pénis précédée d’une douleur minime et d’une détumescence progressive survenue au décours d’un coït. L’exploration chirurgicale a mis en évidence une lésion incomplète de la veine dorsale profonde et qui a été réparée.Conclusion : La rupture de la veine dorsale profonde est rare et peut simuler une fracture des corps érectiles. . L’exploration chirurgicale reste un moyen diagnostique et thérapeutique accessible. Introduction: Penile trauma involving the vascular network is rarely reported in this paper. The rupture of the deep vein of the penis is a urological emergency which can simulate a fracture of the penis. A case of rupture of the deep vein of the penis is reported, which occurred during a false coitus.Patient and Methods: The case study was a 26-year-old patient with swelling of the entire penis. This was preceded by minimal pain and progressive detumescence during coitus. Surgical exploration revealed an incomplete lesion of the deep dorsal vein, which was repaired.Conclusion: Rupture of the deep dorsal vein is rare and may simulate a fracture of the erectile bodies. Surgical exploration remains an accessible diagnostic and therapeutic means.

Synovial chondromatosis of the foot: A case report with brief review

Synovial chondromatosis is a rare, benign disorder which commonly involves the large joints and is characterised by the proliferation of cartilaginous nodules beneath the synovial membrane. We report a case of an elderly male who presented with pain and swelling of the right foot since five years. Proper clinico- radiological and histological evaluation of this case led to the diagnosis of synovial chondromatosis which was managed surgically and patient’s symptoms were relieved. The rare occurrence of this entity in the small joints of hands and feet and the presence of several close differentials, warrants a thorough clinico-radiological and histological work-up to prevent unnecessary surgical exploration.

Success of Immediate Manual Detorsion of Testicular Torsion

Evidence shows that patients having testicular torsion usually present to the emergency department to apply immediate interventions. Immediate manual detorsion has been validated among different investigations as a productive technique for the initial management of testicular torsion. In the present literature review, we have elaborated on the success of manual detorsion for patients with torsion according to findings from previous relevant studies. Our findings indicate the favorable events that can be obtained after using manual detorsion. However, some studies reported that the success rate for the modality is not very high. In addition, it has been reported to reduce the time of ischemia as a temporary measure until surgery is prepared. Evidence also shows that the approach's efficacy is superior to that of surgical exploration and should be used since the time of diagnosis to prevent further deterioration of the affected case and enhance perfusion. However, the current evidence is based on a limited number of investigations that validated the efficacy of manual detorsion among a small population. Accordingly, we encourage further studies to be conducted in this context further to validate the current evidence with more adequate sample sizes.

Blunt Trauma to Brachiocephalic Artery: Presentation and Management

Isolated innominate artery injury is very rare and accounts for less than 3% of recognized arterial injuries. Surgical exploration of the artery, especially at the origin of the artery from the arch of the aorta, is surgically challenging. Due to its rarity, any 1 surgeon’s experience in dealing with innominate artery injury is bound to be limited. We report 2 cases of innominate artery injury post-blunt chest trauma. Both patients underwent thoracotomy and innominate artery Dacron graft repair and both had an uneventful postoperative course.

Successful Surgical Salvage for a Patient with Ruptured Coronary Sinus during Percutaneous Ablation for Atrial Fibrillation: A Case Report

Herein, we describe the rare anatomy of an abnormal shunt from the left atrium to the coronary sinus, which ruptured during a percutaneous ablation for atrial fibrillation. The iatrogenic lesion was successfully repaired after emergent extracorporeal membrane oxygenation set up followed by surgical exploration. The patient’s postoperative course was uneventful, and she was regularly followed up without any complications.

An unusual case of small bowel obstruction secondary to internal herniation of distal ileum through a rent between adhered inflamed vermiform appendix and appendices epiploicae

Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.

Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour

Background Transcatheter valve replacement (TAVR) is an important therapeutic intervention for patients with aortic valve stenosis. As TAVR has become available to a broader population, there has been an increase in the number of less common, yet potentially catastrophic, complications. TAVR related infective endocarditis (TAVR-IE) is a rare, but potentially fatal, complication. Case series We present here two patients that we encountered for TAVR associated infective endocarditis. Our first patient presented 5 weeks after his TAVR. His initial presentation was consistent with signs of sepsis. The patient then developed Mobitz type I block during hospital course. His TEE was negative for features of infective endocarditis. Due to high suspicion, patient was taken for surgical exploration and was found to have multiple foci of vegetation adhered to the stent frame. Our second patient presented with new onset pulmonary edema, worsening heart failure and systemic inflammatory response. A TEE was done for persistent MSSA bacteremia which showed stable prosthetic valve function with no signs of infective endocarditis. Patient was discharged with a prolonged course of intravenous antibiotics. Patient was re-admitted for worsening sepsis and blood cultures were positive for MSSA. Patient was taken for surgical exploration of his prosthetic aortic valve which showed purulent aortic root abscess. Conclusion Through these cases, we aim to raise awareness on TAVR-IE. Due to the atypical clinical presentation, the modified Duke criteria may not be sufficient to diagnose TAVR-IE. Transesophageal echocardiogram in TAVR-IE may be negative or indeterminate. Prosthetic valve shadow may obscure smaller vegetations and/or smaller abscesses. A negative transesophageal echocardiogram should not rule out TAVR-IE and further diagnostic imaging modalities should be considered. PET/CT after administration of 18F-FDG (fluorodeoxyglucose) is a useful diagnostic tool in the diagnosis of infective endocarditis where TEE has been negative or inconclusive. Multi-modal imaging, in addition to the modified Duke criteria, can facilitate early diagnosis and improved mortality outcomes.

Up-to-Date Clinical and Biochemical Workup of the Child and the Adolescent with a Suspected Disorder of Sex Development

Background: The suspicion of a disorder of sex development (DSD) often arises at birth, when the newborn presents with ambiguous genitalia, or even during prenatal ultrasound assessments. Less frequently, the aspect of the external genitalia is typically female or male, and the diagnosis of DSD may be delayed until a karyotype is performed for another health issue, or until pubertal age when a girl presents with absence of thelarche and/or menarche or a boy consults for gynaecomastia and/or small testes. Summary: In this review, we provide a practical, updated approach to clinical and hormonal laboratory workup of the newborn, the child, and the adolescent with a suspected DSD. We focus on how to specifically address the diagnostic approach according to the age and presentation. Key Message: We particularly highlight the importance of a detailed anatomic description of the external and internal genitalia, adequate imaging studies or surgical exploration, the assessment of reproductive hormone levels – especially testosterone, anti-Müllerian hormone, 17-hydroxyprogesterone, and gonadotropins – and karyotyping.