A Rare Case of Urinothorax as a Result of Penetrating Trauma

Urinothorax, defined as urine within the pleural space, is an uncommon finding in published trauma literature. To date, there are less than ten recorded cases of non-iatrogenic trauma-induced urinothorax, most resulting from blunt traumatic injuries from motor vehicle collisions. Given the rarity of the condition, the diagnosis is often missed or delayed. Once the diagnosis is suspected, the most reliable finding is a pleural fluid to serum creatinine ratio of >1. A confirmed diagnosis of urinothorax then requires drainage of pleural fluid and management of distal ureteral obstruction. Unfortunately, the added complexity of the poly-trauma patient obscures this difficult diagnosis often leading to a delay in treatment and prolonged hospital stay. No current published literature exists on penetrating trauma as a cause of urinothorax. Here, we describe a unique case of urinothorax in a 32-year-old male as a result of penetrating trauma.

Broken guidewire intramedullary: what to do now?

Instrument breakage during orthopaedic procedures is relatively uncommon, but it remains a challenging problem to orthopaedic surgeons. We report a case of a broken guidewire during intramedullary nail fixation of a proximal femur fracture with subtrochanteric extension. We also report a simple yet effective technique for removal of a broken guidewire from the medulla of the proximal femur without causing much iatrogenic trauma.

FIVE YEARS CHARACTERISTIC OF URETERAL TRAUMA IN TERTIARY HOSPITAL IN WEST JAVA FROM 2013-2017

Objective: This study aims to determine the characteristics of trauma patients, especially ureteral trauma in Hasan Sadikin General Hospital and expected to be used as data for trauma nationally. Material & Methods: This study was descriptive. Retrospective data collection is taken from medical records of ureteral trauma from 2013 until August 2017 at Hasan Sadikin General Hospital, Bandung. The data obtained are gender, mechanism of trauma, and management of ureteral trauma. Results: A total of 20489 cases of trauma handled in Hasan Sadikin General Hospital, 2.3% is a case of urogenital trauma and 40 of which are cases of ureteral trauma (0.19%). Most ureteral trauma patients are female (90%). Based on the trauma mechanism, 39 patients iatrogenic trauma (97.5%) and 1 patient gunshot wounds (2.5%). From iatrogenic ureteral trauma, 36 patients (90%) had iatrogenic trauma from the gynecological procedure, 5% as a result of the urological procedure, and 2.5% due to gastrointestinal procedure. Management of ureteral trauma is 47.5% ureteroureterostomy and 25% ureteroneocystostomy. Conclusion: Most cases of ureteral trauma are experienced by women, and most commonly due to iatrogenic trauma. Iatrogenic ureteral trauma caused by gynecology procedure is the most common.

FIVE YEARS CHARACTERISTIC OF URETHRAL TRAUMA IN TERTIARY HOSPITAL IN WEST JAVA FROM 2013-2017

Objective: In this study, we try to describe the characteristics of patients with urethral trauma in Hasan Sadikin Hospital Bandung from 2013 to 2017. Material & Methods: The data were taken retrospectively from medical records in the Department of Urology with the permission of the ethical committee. The patient characteristics were then classified according to their age, etiology of trauma, location of trauma, grade of trauma, associated trauma, and initial management. Results: The number of trauma cases in Hasan Sadikin Hospital during 2013-2017 was 20.489, 477 of which (2.33%) were urogenital trauma. Of the total urogenital trauma, there were 124 patients with urethral trauma, male patients were more common (84.67%), with an average age of 34.67 (1-82) years. Seventy two patients (58.06%) were iatrogenic trauma (catheter instrumentation 44.35%, circumcision 6.45%, and others 7.25%), and fifty two patients (41.94%) were non-iatrogenic trauma (traffic accident 31.45%, falls from a height 7.25%, and occupational accident 3.22%). In non-iatrogenic trauma group, 40 patients (76.92%) had posterior urethral trauma and 12 patients (23.08%) had anterior urethral trauma. We found 22 (42.31%) of 52 patients with non-iatrogenic trauma were AAST grade I-II and 30 patients (57.69%) were AAST grade III-V. In patients with posterior urethral trauma, 25 patients (62.5%) had pelvic fractures. There were 10 patients (19.23%) who underwent primary endoscopic realignment within the first 72 hours while 30 patients (57.69%) underwent delayed urethroplasty 3 months after trauma, and the rest (23.08%) were treated conservatively. Conclusion: Urethral trauma in males occurs more frequently than in females. with the most common cause were catheter instrumentation (iatrogenic) and traffic accidents (non iatrogenic). Posterior urethral traumas had higher incidence than anterior urethral traumas, which were commonly associated with pelvic fractures.

Minimally invasive treatment of iatrogenic ureter injury after gynecological surgery

Introduction. Iatrogenic trauma of the ureters accounts for 1-5.7% of all injuries to the organs of the genitourinary system, it is this that presents the greatest difficulty for diagnosis and the greatest danger in terms of the rate and frequency of development of severe, life-threatening complications (phlegmon of the retroperitoneal space, urinary peritonitis, sepsis. Description of the clinical case. Patient A., 47 years old. On June 17, 2019, laparoscopic uterine extirpation was performed for fibroids. 06/22/2019, iatrogenic injury of the lower third of the left ureter was diagnosed. Percutaneous puncture nephrostomy on the left was performed as the first stage for urine diversion. At the second stage, ureteroscopy on the left was performed, in which a burn zone was determined in the lower third of the left ureter, up to 0.5 cm in length with a defect of 1/3 of the ureteral circumference. Left kidney stenting was performed. After 2 months, the ureteral stent was replaced. At control computed tomography (4 months after surgery), the left ureter was contrasted along the entire length, no urodynamic disturbances were revealed. Discussion. Open surgical interventions for iatrogenic trauma of the ureter are long and traumatic, require a long rehabilitation period, accompanied by social maladjustment of patients, therefore the use of X-ray endoscopic methods of treatment is an effective and alternative method of treating this pathology. Conclusion. In this case, timely detection of iatrogenic damage to the ureter made it possible to perform an effective minimally invasive surgical treatment, which saved the patient from possible severe complications.

Laporan Kasus: Petekie pada Rongga Mulut Akibat Faktor Iatrogenik pada Pasien Anak

Petechiae are round red lesions with a diameter of less than 2 mm located in the subcutaneous tissue or submucosa. Locations that often occur are the buccal mucosa, cheeks, lips, lateral tongue, base of the tongue, palate, oropharynx. The etiologic factors of petechiae consist of two types, local factors and systemic factors. Local factors that cause petechiae such as trauma, injury, fellatio, iatrogenic trauma. Systemic factors that cause petechiae such as platelet abnormalities, blood clotting factor disorders, blood vessel damage. An 8-year-old woman with her parents came to RSGMP Unsoed with complaints of red spots on the floor of the mouth, the patient was not aware of the redness under the tongue before treatment on the right lower tooth, did not feel pain and did not feel disturbed by this condition, The patient stated that this had never happened before. The patient is undergoing dental pulpotomy. Petechiae caused by trauma can heal by eliminating the etiologic factor.

The Pathogenesis of Adenomyosis vis-à-vis Endometriosis

Adenomyosis is used to be called endometriosis interna, and deep endometriosis is now called adenomyosis externa. Thus, there is a question as to whether adenomyosis is simply endometriosis of the uterus, either from the perspective of pathogenesis or pathophysiology. In this manuscript, a comprehensive review was performed with a literature search using PubMed for all publications in English, related to adenomyosis and endometriosis, from inception to June 20, 2019. In addition, two prevailing theories, i.e., invagination—based on tissue injury and repair (TIAR) hypothesis—and metaplasia, on adenomyosis pathogenesis, are briefly overviewed and then critically scrutinized. Both theories have apparent limitations, i.e., difficulty in falsification, explaining existing data, and making useful predictions. Based on the current understanding of wound healing, a new hypothesis, called endometrial-myometrial interface disruption (EMID), is proposed to account for adenomyosis resulting from iatrogenic trauma to EMI. The EMID hypothesis not only highlights the more salient feature, i.e., hypoxia, at the wounding site, but also incorporates epithelial mesenchymal transition, recruitment of bone-marrow-derived stem cells, and enhanced survival and dissemination of endometrial cells dispersed and displaced due to iatrogenic procedures. More importantly, the EMID hypothesis predicts that the risk of adenomyosis can be reduced if certain perioperative interventions are performed. Consequently, from a pathogenic standpoint, adenomyosis is not simply endometriosis of the uterus, and, as such, may call for interventional procedures that are somewhat different from those for endometriosis to achieve the best results.