Idiopathic neonatal hemoperitoneum presented as scrotal hematoma: it’s a diagnostic challenge?

Background Idiopathic hemoperitoneum in the newborn is an entity very rarely encountered in clinical practice. Case presentation A case of scrotal hemorrhage (SH) associated with intrabdominal hemorrhaging and acute anemia is presented. Indications for early surgery included a massive scrotal hematoma, rapid onset of severe anemia, and unknown etiology. Conclusion Clinical and diagnostic approaches in a case of neonatal scrotal hematoma should be given careful consideration as abdominal in origin, and a pre-operative computed tomography (CT) scan or magnetic resonance image (MRI) in addition to an abdominal/scrotal ultrasound should be added as part of the diagnostic work-up.

Antegrade Scrotal Sclerotherapy of Internal Spermatic Veins for Varicocele Treatment: Results and Complications about 660 Cases

Introduction: Varicocele is one of the leading causes of male infertility. Anterograde scrotal sclerotherapy (ASS) is one of the most recent techniques. Our objective is to evaluate the results of ASS in the treatment of varicocele in adults. Methods: This is a descriptive and analytical study of 660 patients treated for varicocele causing either a picture of hypofertility and/or symptomatic during the period from January 2008 to December 2018. Preoperative, intraoperative and postoperative data were analysed. Results: The average age was 30. The average duration of the intervention was 16 minutes (13-50 mins) and the average length of hospitalization was 19 hours (9-36 hours). We noticed a statistically significant improvement in all characteristics on the postoperative spermogram. Oligospermia increased from 41% to 29% (p=0.01), asthenospermia increased from 52% to 33% (p=0.02) and teretospermia from 24% to 14% (p=0.006). The paternity rate among hypofertile men was 22%. The disappearance of varicocele in postoperative was objectified in 588 patients (84%), the disappearance of scrotal pain in 322 patients (48%). Complications were identified in 70 patients (10.6%) hydrocele (27 patients, 4%), scrotal hematoma (14 patients), chemical orchitis (20 patients) and testicular atrophy (9 patients). A recurrence was noted in 73 patients (11%) at 9 months. Conclusion: SSA appears to be a reliable and reproducible technique in the treatment of varicocele, with significantly less morbidity in comparison with other techniques. We recommend it as a first-line treatment.

Clinical effect of minimally invasive surgery for inguinal cryptorchidism

Background The purpose of this study was to investigate the clinical effect of minimally invasive surgery for inguinal cryptorchidism. Methods The patients were divided into the minimally invasive surgery group (n = 100) and the traditional surgery group (n = 58). In the minimally invasive surgery group, patients with low inguinal cryptorchidism (n = 54) underwent surgery with a transscrotal incision, and patients with high inguinal cryptorchidism (n = 46) underwent laparoscopic surgery. Results There was no difference in the hospital stay duration or cost between the minimally invasive surgery group and the traditional surgery group (P > 0.05). As for the operative time, minimally invasive surgery of low inguinal cryptorchidism was shorter than traditional surgery (P = 0.033), while minimally invasive surgery of high inguinal cryptorchidism was comparable to traditional surgery (P = 0.658). Additionally, there were no cases of testicular atrophy, testicular retraction, inguinal hernia or hydrocele in either group. There was no significant difference in the incidence of poor wound healing between the two groups (P > 0.05). Although there was no significant difference in the incidence of scrotal hematoma between the two groups (P > 0.05), the incidence in the minimally invasive surgery group was higher than that in the traditional surgery group. Conclusions Minimally invasive surgery including a transscrotal incision for low inguinal cryptorchidism and laparoscopic surgery for high inguinal cryptorchidism is as safe and effective as traditional surgery, and could also provide a good cosmetic effect for children.

Comparison of Totally Extraperitoneal versus Transabdominal Preperitoneal repair of inguinal hernias

Introduction: Laparoscopic inguinal hernia repair is a tension-free mesh repair that is based on pre-peritoneal approach of repair. It provides mechanical advantage to the surgeon, by being able to place a large piece of mesh and by using the natural force of the abdominal wall to disperse the intra-abdominal pressure over a large area to support the mesh. This retrospective study is aimed to study the demography of inguinal hernia and to compare operating time, complications and postoperative pain between patients undergoing Total Extrapritoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair.Methods: A retrospective comparative study was conducted in patients with inguinal hernia who underwent laparoscopic repair by either TEP or TAPP, between April 2019 to July 2020 at Nobel Medical Collage Teaching Hospital, Biratnagar, Morang. Age, sex, type of hernia, duration of operation, post-operative complications, severity of pain and duration hospital stay were analyzed between two groups of patients undergoingsurgery by either TEP or TAPP.Results: One hundred and five patients underwent either TEP or TAPP during study period. There were 96 males and 9 females. There were 50 patients with right, 40 with left and 6 patients with bilateral inguinal hernia. Four patients had left sided irreducible inguinal hernia, 2 patients had bilateral recurrent inguinal hernia, 2 patients had right sided recurrent inguinal hernia and 1 patient had left sided recurrent inguinal hernia.There was significant difference in duration of operation (TEP 64.43min) / (TAPP 84.46min), p<0. 001. Total duration of hospital stay and postoperative pain were not significant between patients operated with TEPor TAPP. Accidental pneumoperitoneum was noticed in 8 cases, 10 cases of subcutaneous emphysema, 5 cases of seroma and 1 case of scrotal hematoma in TEP group. In TAPP group scrotal hematoma occurred in 4 cases and seroma in 5 cases which was not significantly different from TEP group.Conclusion: TAPP had significantly longer operating time as compared to TEP. However, there was no significant difference in post-operative pain and hospital stay in both group.