perineal skin
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Cureus ◽  
2021 ◽  
Author(s):  
Hatan Mortada ◽  
Tareg Alhablany ◽  
Dahna Alkahtani ◽  
Mohammed Ehsan Rashidi ◽  
Abdulla Altamimi

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shun Onishi ◽  
Chihiro Kedoin ◽  
Masakazu Murakami ◽  
Nayuta Higa ◽  
Akihiro Yoshida ◽  
...  

Abstract Background Image-guided surgery with an open magnetic resonance imaging (MRI) system is applied for brain tumors in the neurosurgery field, but has rarely been reported in pediatric surgery. We report our initial experience of intraoperative confirmation of precision rectal pull-through during laparoscopically assisted anorectoplasty (LAARP) in an open MRI operating theater for pediatric patients with anorectal malformation (ARM). Case presentation A 3.0 kg term male neonate was delivered with anorectal malformation. An invertogram revealed the intermediate type. Transverse colostomy was made on the left upper abdomen. The recto-bulbar urethral fistula (RBUF) was diagnosed by a distal colostogram and voiding cystourethrogram. LAARP was planned at 6 months of age. Because this was the first procedure in which the pediatric abdomen had been scanned in an open MRI operating theater in our institution, we scanned his pelvic floor under sedation 3 weeks before the operation using the open MRI system in our operation room. We performed the operation with 4 trocars. The peritoneal reflection was carefully incised and the rectum was dissected. The RBUF was resected. The center of the muscle complex was detected at the perineal skin with an electrical nerve stimulator, and a 7-mm longitudinal skin incision was made on the perineal lesion for anoplasty. The muscle complex and the pubo-rectal sling were confirmed laparoscopically using a 3.5-mm bipolar forceps connected to the electrical nerve stimulator. Anoplasty was performed between the rectal stump and perineal skin. After anoplasty, the patient was scanned with open MRI under general anesthesia. We attached the quadrature-detection (QD) head coil around the patient’s pelvis and inserted him in the gantry. A 0.45-T open MRI clearly revealed that the pulled through rectum was located in the center of the muscle complex on T2-weighted images. The postoperative course was uneventful. Oral intake was started on post-operative day 1. Postoperative dynamic urography showed no complication (e.g., leakage or residual fistula). Conclusions We successfully performed LAARP for ARM, with intraoperative confirmation of precision rectal pull-through in an open MRI operating theater. Further cases are required to evaluate the application of open MRI systems in pediatric surgery.


2021 ◽  
pp. 1247-1258
Author(s):  
Alexandra Crick

Anorectal abdominoperineal excision, either as a primary procedure for rectal cancer or as a salvage procedure for residual or recurrent anal cancer following chemoradiotherapy, creates a defect of the pelvic floor, pelvic dead space, and a perineal skin defect and may include a defect of the posterior vaginal wall. The ideal reconstruction should address all components of this defect and aims to achieve primary uncomplicated healing while preserving and restoring function. Pedicled flaps from the abdomen, gluteal and thigh regions, and occasionally free flaps are available for this purpose. There is increasing evidence that flap reconstruction improves perineal healing especially where there is a history of radiotherapy.


2021 ◽  
pp. 1-4
Author(s):  
Avanish Saklani ◽  
Seke Manase Ephraim KAZUMA ◽  
Mufaddal Kazi ◽  
Vivek Sukumar ◽  
Avanish Saklani

Postoperative Perineal hernia (PerH) is a recognised rare complication of radical pelvic oncologic procedures for rectal cancer, with a reported prevalence of 0.6-7%. PerH is a swelling in the perineum caused by herniation of abdominal or pelvic viscera through a defect in the pelvic floor. The cause of postoperative PerH is not known, however, wide extent of dissection, wound infection, neoadjuvant radiotherapy, length of small bowel and wider female pelvis, have been identified as risk factors for development of postoperative PerH. Cause of PerH is not known. Universal case definition of PerH does not exist, except it is a bulge in the perineum. Patients who are fit for surgery, have no recurrency, and are bothered or have severe symptoms (perineal swelling, perineal skin necrosis, urinary problems and/or intestinal obstruction) are offered surgical treatment. The aim of surgical repair is to exclude recurrency, closure of the pelvic defect with reconstruction of a new pelvic floor and repair of hernia.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mohamed Mansy ◽  
Mostafa Kotb ◽  
Yasmine Abdelmeguid ◽  
Shaymaa Raafat ◽  
Marwa Abdelaziz

Abstract Background Hemiscrotal agenesis (HSA) is an exceedingly rare congenital anomaly in scrotal development. It is characterized by unilateral absence of scrotal skin with intact midline raphe. In the English literature, only seven patients were diagnosed with HSA. Herein, we report a 14-month-old boy with HSA, unilateral cryptorchidism and a perineal skin tag. Additionally, the patient had a monodactylous limb, unilateral cerebellar hypoplasia, and a cardiac septal defect. Case presentation A 14-month-old boy presented with right HSA and ectopic scrotal skin in the right perineal region. Extra-genital examination showed right monodactylous lower limb, without dysmorphic facial features or any other skeletal anomalies. His karyotype was 46, XY, while his hormonal profile showed prepubertal LH and FSH. Skeletal survey showed right monodactylous lower limb (with only a big toe which had 2 phalanges) and normal spine alignment. A previous echocardiography was done and showed a small muscular ventricular septal defect (VSD) that closed on follow-up. Magnetic resonance imaging of the brain showed posterior fossa malformation. The patient had his right testis fixed in the right scrotum. The pathological examination of the perineal lesion showed fibro-epithelial polyp (skin tag), with no testicular tissue or atypia. Conclusion We believe that this is the first case to be reported with hemiscrotal agenesis and ipsilateral cryptorchidism, associated with a perineal skin tag, unilateral monodactylous lower limb on the same side, unilateral cerebellar hypoplasia, and VSD. Interestingly, further genetic analysis is required to reach a final diagnosis. However, regrettably, advanced molecular diagnostic studies for this patient is not available in our country.


2020 ◽  
Vol 41 (S1) ◽  
pp. s199-s199
Author(s):  
Lindsey Rearigh ◽  
Mark Rupp ◽  
Trevor Craig Van Schooneveld ◽  
Gayle Gillett ◽  
Adrienne Sy ◽  
...  

Background: Catheter-associated urinary tract infections (CAUTIs) are a common hospital-acquired infection (HAI) resulting in excess morbidity, mortality, and cost. Urine management can be a challenging issue, particularly in women, due to limited options for control of urinary incontinence. Issues with urinary leakage and worry for subsequent skin break down often leads to indwelling catheter insertion. In the spring of 2018, our facility implemented a female external urine collection device (EUCD) in efforts to decrease catheter days and to limit CAUTIs. Methods: Retrospective, 32-month (January 2017–August 2019), quasi-experimental, before-and-after study. Catheter use and CAUTI were defined according to CDC NHSN criteria. Poisson regression was used to model the rate of CAUTI (per 1,000 patient days [PD] and per 1,000 catheter days [CD]) comparing the 14 months prior to EUCD introduction with the 14 months after introduction and allowing a 3-month introduction period. Results: The CAUTI rate did not change significantly. The overall CAUTI rate per 1,000 PD decreased slightly from 0.24 to 0.20 (P = 0.44; model risk, 0.86; 95% CI, 0.58–1.26) whereas the rate per 1,000 CD increased slightly 1.5 to 1.6 (P = 0.76; model risk, 1.06; 95% CI, 0.73-–1.56). The CAUTI rate for men increased from 0.09 to 0.11 per 1,000 PD (P = 0.42; model risk, 1.29) and from 0.99 to 1.55 per 1,000 CD (P = 0.17; model risk, 1.56). For women, the rate of CAUTI decreased from 0.15 to 0.09 per 1,000 PD (P = 0.10; model risk, 0.61) and from 2.12 to 1.65 per 1,000 CD (P = 0.38; model risk, 0.38). A significant decrease in catheter days (CD per 1,000 PD; P < .0001) was observed for all hospitalized patients (from 158.56 to 128.3; model risk, 0.81), for men (from 87.06 to 72.15; model risk, 0.83), and for women (from 71.49 to 56.15; model risk, 0.79). Of 2,347 adverse events, 5 (0.2%) involved perineal skin breakdown and redness. Three events were related to malposition of the ECUD or inappropriate level of suction and 1 event was related to latex allergy and EUCD use. Conclusions: The introduction of a EUCD for women was associated with a significant decrease in indwelling catheter usage. A trend toward a decrease in CAUTI per 1,000 PD for women was observed (P = .10). Additional studies on whether the EUCD is associated with changes in UTI rates (both CAUTIs and noncatheter UTIs) as well as cost implications of EUCD are warranted.Funding: NoneDisclosures: None


2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sue Rogers ◽  
Micaela Thomas ◽  
Belinda Chan ◽  
Spencer K. Hinckley ◽  
Carol Henderson

2020 ◽  
Vol 6 (3) ◽  
pp. 344-350
Author(s):  
NJ Nwashilli ◽  
AI Arekhandia

Perineal injury in children is uncommon. Injuries range from minor perineal skin laceration to severe injury to the genitourinary tract, anorectal region and the pelvic bone. The mechanisms of injury are usually attributed to blunt trauma, penetrating injuries like impalement injury, or sexual abuse. Perineal injury resulting from explosive blast in children is rare. The management depends on the time and mode of presentation and examination findings. Early presentation (a few hours after injury) with 1st or 2nd-degree perineal injury may benefit from debridement with primary repair of soft tissues and/or sphincters. Late presentation (days after injury) with 3rd or 4th-degree injury will require diverting colostomy or urinary diversion and wound drainage. This is a report of an unusual case of severe perineal injury in a child following explosive blast sustained while squatting close to packed explosives that got detonated. The perineal injury was initially managed with colostomy and wound drainage. The colostomy was closed after the wound had healed with good faecal continence achieved and without perineal soft tissue or anal sphincteric repair. It is concluded that severe isolated paediatric explosive blast perineal injury is rare but is amenable to surgical care.


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