BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic...BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.展开更多
Strangulation of the penis by a ring is a rare but quite common event in children and is potentially serious. We found it important to report this case in order to share our experience on the management of penis rings...Strangulation of the penis by a ring is a rare but quite common event in children and is potentially serious. We found it important to report this case in order to share our experience on the management of penis rings. It was a 9-year-old child, with no particular medical-surgical history, nor any notion of known family defect, brought to the emergency room by his parents for intense pain in the penis associated with incessant crying. In front of which a clinical examination made it possible to conclude with penile strangulation by a metal ring. Our course of action was the ablation of the ring with non-medical forceps associated with local and general care. No complications were observed during treatment. The immediate consequences were simple and the patient was followed for 4 months.展开更多
Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia...Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia in an elderly person without any preoperative history. An 84-year-old Korean female was admitted with midabdominal pain and distension for 1 d. On abdominal computed tomography, we diagnosed transmesocolic hernia with strangulated small bowel obstruction, and performed emergency surgery. The postoperative period was uneventful and she was discharged 11 d after surgery. Hence, it is important to consider the possibility of transmesocolic hernia in elderly patients with signs and symptoms of intestinal obstruction, even in cases with no previous surgery. 2013 Baishideng. All rights reserved.展开更多
BACKGROUND:Closed loop bowel obstruction is a specific type of mechanical obstruction with a high risk of strangulation and bowel infarction,especially in the small bowel.It is associated with a high mortality rate.He...BACKGROUND:Closed loop bowel obstruction is a specific type of mechanical obstruction with a high risk of strangulation and bowel infarction,especially in the small bowel.It is associated with a high mortality rate.Hence,it is important for emergency physicians to identify the presence of strangulation,while making the diagnosis of closed loop small bowel obstruction.METHODS:We reported three patients with strangulated closed loop small bowel obstruction associated with severe abdominal pain,who had been treated at the emergency department.Urgent computerized tomography was performed in the patients.RESULTS:Two patients were discharged with stable conditions,and one patient died after hemodialysis.CONCLUSION:Urgent computerized tomography of the abdomen serves as an important diagnostic tool in view of its ability to detect the site,level and cause of obstruction along with the distinctive CT appearance of closed loop small bowel obstruction and signs of ischemia.Early definitive diagnosis will guide subsequent management and improve outcomes.展开更多
Background We created and validated a computed tomography(CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction.This would...Background We created and validated a computed tomography(CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction.This would assist surgeons in accurately predicting intestinal ischemia and strangulation in patients with intestinal obstruction.Methods We recruited 289 patients with acute intestinal obstruction admitted in the Affiliated Hospital of Qingdao University from January 2019 to February 2022.The patients were allocated to a training(n=226)and validation cohort(n=63).Radiomic features were collected from CT images,and the radiomic signature was extracted and used to calculate a radiomic score(Rad-score).A nomogram was constructed using the clinical features and the Rad-score,and the performance of the clinical,radiomics,and nomogram models was assessed in the two cohorts.Results Six robust features were used to construct the radiomic signature.The nomogram incorporating hemoglobin levels,C-reactive protein levels,American Society of Anesthesiologists score,time of obstruction,CT image of mesenteric fluid(P<0.05),and the signature demonstrated good predictive ability for intestinal ischemia in patients with acute intestinal obstruction,with areas under the curve of 0.892(95%confidence interval,0.837–0.947)and 0.781(95%confidence interval,0.619–0.944)for the training and validation sets,respectively.The decision curve analysis showed that this model outperformed the clinical and radiomic signature models.Conclusion The radiomic nomogram may effectively predict intestinal ischemia in patients with acute intestinal disease and may assist clinical decision-making。展开更多
Violence against the neck can result in a range of macromorphological and micromorphological findings.However,the forensic relevance of the carotid sinus in cases of violence against the neck remains controversial.In ...Violence against the neck can result in a range of macromorphological and micromorphological findings.However,the forensic relevance of the carotid sinus in cases of violence against the neck remains controversial.In this follow-up study of 22 cases of suicidal and accidental strangulations,carotid bifurcations were examined histologically for morphological changes implying direct trauma,including haemorrhage and immunohistochemical expression of heat-shock proteins 27,60,and 70 and aquaporin-3.These cases were compared with a control group(82 cases)without neck compression or head trauma and with variable causes of death.No relevant histopathological findings implying direct trauma of the carotid bifurcation were found.No cases showed positive aquaporin-3 staining and only five cases showed positive heat-shock protein-27 staining,all of which were hangings.Without massive trauma of the carotid bifurcation,histological alterations cannot be expected.Without signs of rapid death,findings of acute circulatory failure,macromorphological and micromorphological findings of neck compression,and reliable markers indicating relevant impact on the carotid bifurcation the diagnosis of a lethal reflex cannot be verified.展开更多
For the medicolegal evaluation of victims of survived strangulation,a neck-magnetic resonance imaging(MRI)can be performed for assessing lesions in the inner soft tissues(fat,muscles or lymph nodes,for example).In our...For the medicolegal evaluation of victims of survived strangulation,a neck-magnetic resonance imaging(MRI)can be performed for assessing lesions in the inner soft tissues(fat,muscles or lymph nodes,for example).In our institute,such MRI examinations have been performed for a test period of 4 years with the aim of evaluating the use of this tool by forensic pathologists and identifying medicolegal indicators for the performance of neck-MRI in surviving victims of strangulation.We retrospectively reviewed medicolegal reports from all victims examined during the test period.We extracted objective lesions(e.g.petechiae,bruising and abrasions)and reported clinical symptoms(e.g.vision disorder,dysphasia)from the reports.These findings were compared to those reported from the neck-MRI.In total,112 victims were clinically examined after suspected strangulation.Eleven of these victims underwent an MRI examination of the neck.Eighty-four of the victims presented objective lesions during the clinical examination,with eight showing signs of both petechiae and bruising.Neck-MRI was performed in four of these eight victims and three of them showed lesions visible in MRI.Of 76 victims with bruising as the only objective finding,66 victims described clinical symptoms.Of those 66 victims,seven were examined by MRI and two demonstrated lesions in MRI.When MRI was performed,relevant findings were detected in 45%of the cases.This leads to the suspicion that many more findings could have been detected in the other victims,if an MRI had been performed in those cases.Our results lead us to the conclusion that an MRI examination of victims of suspected strangulation is useful,and strict indications for its application should be established.展开更多
Background: Abdominal parietal hernia, a temporary or permanent exit of viscera through an anatomically pre-existing zone of weakness, is a frequent pathology in surgery. So, the management of emergency hernias surger...Background: Abdominal parietal hernia, a temporary or permanent exit of viscera through an anatomically pre-existing zone of weakness, is a frequent pathology in surgery. So, the management of emergency hernias surgery should include some complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in adults in the surgical departments of Bujumbura hospitals. Methodology: This is a prospective study over a period of one year that included all hernias operated on in emergency from January 2022 to February 2023. Results: During the period, 251 patients were admitted to the operating room for abdominal parietal hernias, including 49 for emergency hernia surgery. There were 43 men (87.76%) and 6 women (12.24%), i.e. a sex ratio of 7.1. The average age was 49.6 years, with extremes of 18 and 84 years. The occupation of strength (farmer, labourer, mechanic, mason, mason’s helper) represented 75.51% of the cases. Inguino-scrotal hernia was preponderant (65.31%) followed by inguinal hernia (25.58%), umbilical hernia (4.08%);femoral hernia represented 4.08%. Hernial strangulation represented 89.80% and engorged hernia 10.20%. Morbidity was minor, 2.04% of complications (suppuration, hematoma, urinary retention). No deaths were found. Altemeir stage and occupation were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days postoperative (p = 0.0028 and p = 0.0284 respectively). Conclusion: Abdominal parietal hernias are frequent, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia cures.展开更多
Background: Management of emergency hernias surgery should include certain complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days ...Background: Management of emergency hernias surgery should include certain complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in children in the surgical departments of 8 Bujumbura hospitals. Patients and Methods: This is a prospective study over a period of one year which included all hernias operated on in emergency from January 1, 2022 to February 29, 2023. Results: During the period, 282 patients (children) were admitted to the operating theatre for abdominal parietal hernias, of which 46 were admitted for emergency hernia surgery. Males accounted for 86.96% (40), sex ratio 6.6. The average age was 3.4 years. The persistence of the peritoneo-vaginal canal represented 52.17% of cases. Inguino-scrotal hernia was prevalent (43.48%). The main complication was strangulation (80.43%). Morbidity accounted for 1.3% of complications (infection, residual pain, testicular atrophy, hernia recurrence). No deaths were found. Altemeier stage and gender were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days post-op (p = 0.0260 and p = 0.0212 respectively). Conclusion: Abdominal parietal hernias are common in children, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia repairs.展开更多
The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divide...The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divided into 2groups:SOH group (n=9)and non-SOH group (n=23). Patient demographics,clinical signs,preoperative examinations and intraoperative findings were compared between the two groups,and risk factors for SOH were tested using a binary logistic regression model.To explore whether greater ovary was more likely to be twisted,leading to SOH, all the patients were divided into ovary volume <5cm^3 and ≥5cm^3 groups and the association between ovarian volume and ovary torsion was assessed.Among a total of 32 female patients (<1year old)with incarcerated ovarian herniation,9 patients developed SOH.The single variate analysis revealed that times of manual reduction,ovarian volume,ovary with or without multiple cysts,ovary torsion or not and angle of ovary torsion were found to be significant factors associated with SOH.The multivariate analysis showed ovarian volume was evidenced as an independent risk factor for SOH.Furthermore,the incidence of ovary torsion was significantly higher in ovarian volume ≥5cm^3 group than in ovarian volume <5cm^3 group,indicating that larger ovary was more likely to result in ovary torsion,leading to SOH.Our study demonstrated that the odds of SOH increased with increasing ovarian volume in female patients (<1 year old)because the relatively greater ovary at this age was more likely to be incarcerated and twisted,leading to SOH.展开更多
AIM:To clarify the usefulness of arterial phase scans in contrast computed tomography (CT) imaging of stran-gulation ileus in order to make an early diagnosis. METHODS:A comparative examination was carried out with re...AIM:To clarify the usefulness of arterial phase scans in contrast computed tomography (CT) imaging of stran-gulation ileus in order to make an early diagnosis. METHODS:A comparative examination was carried out with respect to the CT value of the intestinal tract wall in each scanning phase, the CT value of the content in the intestinal tract, and the CT value of ascites fluid in the portal vein phase for a group in which ischemia was observed (Group Ⅰ) and a group in which ischemia was not observed (Group N) based on the pathological findings or intra-surgical findings. Moreover, a comparative examination was carried out in Group Ⅰ subjects for each scanning phase with respect to average differences in the CT values of the intestinal tract wall where ischemia was suspected and in the intestinal tract wall in non-ischemic areas. RESULTS:There were 15 subjects in Group Ⅰ and 30 subjects in Group N. The CT value of the intestinal tract wall was 41.8 ± 11.2 Hounsfield Unit (HU) in Group Ⅰ and 69.6 ± 18.4 HU in Group N in the arterial phase, with the CT value of the ischemic bowel wall being significantly lower in Group Ⅰ. In the portal vein phase, the CT value of the ischemic bowel wall was 60.6 ± 14.6 HU in Group Ⅰ and 80.7 ± 17.7 HU in Group N, with the CT value of the ischemic bowel wall being significantly lower in Group Ⅰ; however, no significant differences were observed in the equilibrium phase. The CT value of the solution in the intestine was 18.6 ± 9.5 HU in Group Ⅰ and 10.4 ± 5.1 HU in Group N, being signifi-cantly higher in Group Ⅰ. No significant differences were observed in the CT value of the accumulation of ascites fluid. The average difference in the CT values between the ischemic bowel wall and the non-ischemic bowel wall for each subject in Group Ⅰ was 33.7 ± 20.1 HU in the arterial phase, being significantly larger compared to the other two phases. CONCLUSION:This is a retrospective study using a small number of subjects; however, it suggests that there is a possibility that CT scanning in the arterial phase is useful for the early diagnosis of strangulation ileus.展开更多
Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP...Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10) and non-ischemia (n = 27) groups. Serum I-FABP levels were longitudinally analyzed in 21 patients who showed high (>2.0 ng/ml) serum I-FABP levels. The relationship between serum I-FABP level and length of damaged bowel was also analyzed. Results: Median serum I-FABP levels were 9.2 ng/ml in the ischemia group and 1.9 ng/ml in the non-ischemia group (p < 0.0001). The elevated I-FABP levels rapidly decreased after therapeutic intervention and normalized on the third day in all patients. Linear regression analysis revealed a positive correlation between I-FABP levels and lengths of surgically excised bowels (y = 2.527x - 7.660, r = 0.604, p = 0.0018). By setting the cutoff level at 7.2 ng/ml, the diagnostic ability of serum I-FABP was 70.0% in terms of sensitivity, 92.6% in terms of specificity, and 86.5% in terms of accuracy. Conclusion: Serum I-FABP sensitively reflects bowel damage in SBO patients and seems to be a potential biomarker for detecting small-bowel ischemia.展开更多
Placement of constricting devices around the penis and scrotum for autoerotic purposes or increasing sexual performance represents a well-known challenge for urologists and can result in serious complications.The remo...Placement of constricting devices around the penis and scrotum for autoerotic purposes or increasing sexual performance represents a well-known challenge for urologists and can result in serious complications.The removal of the constricting devices can be challenging and often requires resourcefulness and multidisciplinary approach.We report one case of successful removal of a penoscrotal constricting metal ring in a 49-year-old male using a handheld orthopaedic saw under ketamine and midazolam sedation in the emergency department.展开更多
Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-tr...Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.展开更多
BACKGROUND Penial incarceration(PI)is a rare situation.It is usually caused by a foreign object which strangulates at the base of the penis.PI may derive from pranks,sexual demand,mental disease,or intention to prohib...BACKGROUND Penial incarceration(PI)is a rare situation.It is usually caused by a foreign object which strangulates at the base of the penis.PI may derive from pranks,sexual demand,mental disease,or intention to prohibit urinary disease.Generally,these situations are emergent and immediate treatments are needed.Cases of chronic PI are less reported,and their treating methods are yet to be discussed.CASE SUMMARY We reported a case on treating a 73-year-old male who had PI with a metallic hoop for three months.After multidisciplinary consultation,the operation was performed successfully with the help of a fretsaw.Despite the chronic strangulation,the prognosis of the patient was satisfying.To the best of our knowledge,this case was rare and precious as it featured the longest strangulating time,which might enlighten the treating process of future PI cases.Also,we have reviewed and summarized major published cases to encapsulate appropriate approaches when facing diverse strangulation situations.CONCLUSION The selection of surgical tools depends on the material of the strangulating objects,the availability of equipment,and the severity of the penial damage.The urination function may not be affected after three months of incarceration as in our case,whilst prudent preoperative measures and multidisciplinary evaluations are always essential.Although using a fretsaw is comparatively slow,it is safe and feasible to treat metallic penial incarceration.展开更多
Transanal intestinal evisceration is an extremely rare and dramatic digestive surgical emergency. The cases reported in the literature are few and concern much more elderly patients. We report the case of a 3-year-old...Transanal intestinal evisceration is an extremely rare and dramatic digestive surgical emergency. The cases reported in the literature are few and concern much more elderly patients. We report the case of a 3-year-old boy admitted in very general poor condition to the emergency department, late for transanal evisceration complicating rectal prolapse that the parents tried to reduce. The fatal outcome of this case is probably related to strangulation and delay in consultation. We learn from this that parents should avoid inopportune prolapse reduction and early consultation.展开更多
Amyand’s hernia [AH] is a rare condition with presence of vermiform appendix in an inguinal hernia sac [1]. It is a rare entity with very difficult preoperative diagnosis that does not affect management. We herein re...Amyand’s hernia [AH] is a rare condition with presence of vermiform appendix in an inguinal hernia sac [1]. It is a rare entity with very difficult preoperative diagnosis that does not affect management. We herein report a neonatal gangrenous AH masking all features of underlying bowel gangrene. In neonates, a great masquerader can mask all the features of underlying bowel gangrene and delay in diagnosis can be detrimental in context of outcome. A high index of suspicion of Amyand’s hernia with gangrene should be kept even if child presents with irreducible hernia without features of strangulation to prevent avoidable increase in morbidity and mortality.展开更多
Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 Janua...Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 January 2016 to 31 December 2016 of 84 patients operated on for inguinal hernias in the general surgery unit of CSRéf CII. Results: Inguinal hernia accounted for 8% of surgical consultations and hernia repair accounted for 30.22% of surgical procedures. Hernia repair accounted for 30.22% of surgical procedures. The male sex was the most represented with a ratio of 7.40. The average age of our patients was 43.19 years. Recurrence occurred in 10% of cases. The right side was most affected in 71.43% of cases, 19.05% on the left side in;it was bilateral in 09.52%. Local anaesthesia was used in 67.86% of our patients, general anaesthesia in 13.09% of cases and locoregional anaesthesia in 19.05% of cases. The hernia was external oblique in 75% of cases. Shouldice’s technique was the most used with 88%;Bassini’s technique was used in 7% and Mac Vay’s in 5% of cases. The postoperative course was simple in 96.43% of cases, with an early postoperative morbidity rate of 3.57%, one case of wall abscess and two cases of parietal haematoma. No deaths were observed during our study. Conclusion: The new methods of tension-free cure should be used more and more by our users in our facilities.展开更多
Introduction: Laryngeal stenosis is partial or circumferential narrowing of the endolaryngeal airway from congenital or acquired causes. It can present with life threatening upper airway obstruction, and the goal of t...Introduction: Laryngeal stenosis is partial or circumferential narrowing of the endolaryngeal airway from congenital or acquired causes. It can present with life threatening upper airway obstruction, and the goal of treatment is restoration of good quality voice, respiration and laryngeal competence. We report a case of laryngeal stenosis following strangulation by a trapped overflowed head scarf, whilst being transported on a motor cycle and highlighted the treatment challenges. Methodology: A case of laryngeal stenosis studied, clinical findings, investigation results and treatment analysed. Results: A 70-year-old Nigerian elderly woman presented with three weeks’ history of hoarseness and progressive difficulty in breathing, following pulling of her long head scarf into the back wheel of the motor cycle taking her home. She had immediate loss of consciousness, which lasted for about 60 minutes. There was associated bout of cough while eating. Examination revealed life threatening upper airway obstruction. X-ray soft tissue neck showed soft tissue mass obliterating larygotracheal air column. Flexible nasopharyngolaryngoscopy showed grossly distorted laryngeal inlet with invisible vocal cords. CT scan of the larynx showed multiple and displaced fractures of the laryngeal cartilages. Microlaryngoscopy findings were pin-hole laryngeal lumen with firm collapsed mucosa. Emergency tracheostomy was done to relieve the upper airway obstruction. Attempts were made to excise the collapse mucosa and insert a stent proved difficult. Referral for endoscopic laser excision was caution because of the potential risk of aspiration. She was counselled and coping well with the tracheostomy.展开更多
External hernia is one of the commonest causes of intestinal obstruction. Femoral hernia is a relatively uncommon hernia. It has a very high complication rate due to delayed diagnosis caused by deceptive symptomatolog...External hernia is one of the commonest causes of intestinal obstruction. Femoral hernia is a relatively uncommon hernia. It has a very high complication rate due to delayed diagnosis caused by deceptive symptomatology and subtle signs. CT scan enables a prompt diagnosis. Rigorous resuscitation followed by prompt surgical intervention is the mainstay of treatment. A case of a strangulated femoral hernia in a patient with complicated co morbid medical disorders is presented to highlight the pitfalls in initial clinical assessment.展开更多
文摘BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.
文摘Strangulation of the penis by a ring is a rare but quite common event in children and is potentially serious. We found it important to report this case in order to share our experience on the management of penis rings. It was a 9-year-old child, with no particular medical-surgical history, nor any notion of known family defect, brought to the emergency room by his parents for intense pain in the penis associated with incessant crying. In front of which a clinical examination made it possible to conclude with penile strangulation by a metal ring. Our course of action was the ablation of the ring with non-medical forceps associated with local and general care. No complications were observed during treatment. The immediate consequences were simple and the patient was followed for 4 months.
文摘Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia in an elderly person without any preoperative history. An 84-year-old Korean female was admitted with midabdominal pain and distension for 1 d. On abdominal computed tomography, we diagnosed transmesocolic hernia with strangulated small bowel obstruction, and performed emergency surgery. The postoperative period was uneventful and she was discharged 11 d after surgery. Hence, it is important to consider the possibility of transmesocolic hernia in elderly patients with signs and symptoms of intestinal obstruction, even in cases with no previous surgery. 2013 Baishideng. All rights reserved.
文摘BACKGROUND:Closed loop bowel obstruction is a specific type of mechanical obstruction with a high risk of strangulation and bowel infarction,especially in the small bowel.It is associated with a high mortality rate.Hence,it is important for emergency physicians to identify the presence of strangulation,while making the diagnosis of closed loop small bowel obstruction.METHODS:We reported three patients with strangulated closed loop small bowel obstruction associated with severe abdominal pain,who had been treated at the emergency department.Urgent computerized tomography was performed in the patients.RESULTS:Two patients were discharged with stable conditions,and one patient died after hemodialysis.CONCLUSION:Urgent computerized tomography of the abdomen serves as an important diagnostic tool in view of its ability to detect the site,level and cause of obstruction along with the distinctive CT appearance of closed loop small bowel obstruction and signs of ischemia.Early definitive diagnosis will guide subsequent management and improve outcomes.
基金the National Natural Science Foundation of China(Grant No.82000482).
文摘Background We created and validated a computed tomography(CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction.This would assist surgeons in accurately predicting intestinal ischemia and strangulation in patients with intestinal obstruction.Methods We recruited 289 patients with acute intestinal obstruction admitted in the Affiliated Hospital of Qingdao University from January 2019 to February 2022.The patients were allocated to a training(n=226)and validation cohort(n=63).Radiomic features were collected from CT images,and the radiomic signature was extracted and used to calculate a radiomic score(Rad-score).A nomogram was constructed using the clinical features and the Rad-score,and the performance of the clinical,radiomics,and nomogram models was assessed in the two cohorts.Results Six robust features were used to construct the radiomic signature.The nomogram incorporating hemoglobin levels,C-reactive protein levels,American Society of Anesthesiologists score,time of obstruction,CT image of mesenteric fluid(P<0.05),and the signature demonstrated good predictive ability for intestinal ischemia in patients with acute intestinal obstruction,with areas under the curve of 0.892(95%confidence interval,0.837–0.947)and 0.781(95%confidence interval,0.619–0.944)for the training and validation sets,respectively.The decision curve analysis showed that this model outperformed the clinical and radiomic signature models.Conclusion The radiomic nomogram may effectively predict intestinal ischemia in patients with acute intestinal disease and may assist clinical decision-making。
文摘Violence against the neck can result in a range of macromorphological and micromorphological findings.However,the forensic relevance of the carotid sinus in cases of violence against the neck remains controversial.In this follow-up study of 22 cases of suicidal and accidental strangulations,carotid bifurcations were examined histologically for morphological changes implying direct trauma,including haemorrhage and immunohistochemical expression of heat-shock proteins 27,60,and 70 and aquaporin-3.These cases were compared with a control group(82 cases)without neck compression or head trauma and with variable causes of death.No relevant histopathological findings implying direct trauma of the carotid bifurcation were found.No cases showed positive aquaporin-3 staining and only five cases showed positive heat-shock protein-27 staining,all of which were hangings.Without massive trauma of the carotid bifurcation,histological alterations cannot be expected.Without signs of rapid death,findings of acute circulatory failure,macromorphological and micromorphological findings of neck compression,and reliable markers indicating relevant impact on the carotid bifurcation the diagnosis of a lethal reflex cannot be verified.
文摘For the medicolegal evaluation of victims of survived strangulation,a neck-magnetic resonance imaging(MRI)can be performed for assessing lesions in the inner soft tissues(fat,muscles or lymph nodes,for example).In our institute,such MRI examinations have been performed for a test period of 4 years with the aim of evaluating the use of this tool by forensic pathologists and identifying medicolegal indicators for the performance of neck-MRI in surviving victims of strangulation.We retrospectively reviewed medicolegal reports from all victims examined during the test period.We extracted objective lesions(e.g.petechiae,bruising and abrasions)and reported clinical symptoms(e.g.vision disorder,dysphasia)from the reports.These findings were compared to those reported from the neck-MRI.In total,112 victims were clinically examined after suspected strangulation.Eleven of these victims underwent an MRI examination of the neck.Eighty-four of the victims presented objective lesions during the clinical examination,with eight showing signs of both petechiae and bruising.Neck-MRI was performed in four of these eight victims and three of them showed lesions visible in MRI.Of 76 victims with bruising as the only objective finding,66 victims described clinical symptoms.Of those 66 victims,seven were examined by MRI and two demonstrated lesions in MRI.When MRI was performed,relevant findings were detected in 45%of the cases.This leads to the suspicion that many more findings could have been detected in the other victims,if an MRI had been performed in those cases.Our results lead us to the conclusion that an MRI examination of victims of suspected strangulation is useful,and strict indications for its application should be established.
文摘Background: Abdominal parietal hernia, a temporary or permanent exit of viscera through an anatomically pre-existing zone of weakness, is a frequent pathology in surgery. So, the management of emergency hernias surgery should include some complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in adults in the surgical departments of Bujumbura hospitals. Methodology: This is a prospective study over a period of one year that included all hernias operated on in emergency from January 2022 to February 2023. Results: During the period, 251 patients were admitted to the operating room for abdominal parietal hernias, including 49 for emergency hernia surgery. There were 43 men (87.76%) and 6 women (12.24%), i.e. a sex ratio of 7.1. The average age was 49.6 years, with extremes of 18 and 84 years. The occupation of strength (farmer, labourer, mechanic, mason, mason’s helper) represented 75.51% of the cases. Inguino-scrotal hernia was preponderant (65.31%) followed by inguinal hernia (25.58%), umbilical hernia (4.08%);femoral hernia represented 4.08%. Hernial strangulation represented 89.80% and engorged hernia 10.20%. Morbidity was minor, 2.04% of complications (suppuration, hematoma, urinary retention). No deaths were found. Altemeir stage and occupation were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days postoperative (p = 0.0028 and p = 0.0284 respectively). Conclusion: Abdominal parietal hernias are frequent, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia cures.
文摘Background: Management of emergency hernias surgery should include certain complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in children in the surgical departments of 8 Bujumbura hospitals. Patients and Methods: This is a prospective study over a period of one year which included all hernias operated on in emergency from January 1, 2022 to February 29, 2023. Results: During the period, 282 patients (children) were admitted to the operating theatre for abdominal parietal hernias, of which 46 were admitted for emergency hernia surgery. Males accounted for 86.96% (40), sex ratio 6.6. The average age was 3.4 years. The persistence of the peritoneo-vaginal canal represented 52.17% of cases. Inguino-scrotal hernia was prevalent (43.48%). The main complication was strangulation (80.43%). Morbidity accounted for 1.3% of complications (infection, residual pain, testicular atrophy, hernia recurrence). No deaths were found. Altemeier stage and gender were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days post-op (p = 0.0260 and p = 0.0212 respectively). Conclusion: Abdominal parietal hernias are common in children, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia repairs.
文摘The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divided into 2groups:SOH group (n=9)and non-SOH group (n=23). Patient demographics,clinical signs,preoperative examinations and intraoperative findings were compared between the two groups,and risk factors for SOH were tested using a binary logistic regression model.To explore whether greater ovary was more likely to be twisted,leading to SOH, all the patients were divided into ovary volume <5cm^3 and ≥5cm^3 groups and the association between ovarian volume and ovary torsion was assessed.Among a total of 32 female patients (<1year old)with incarcerated ovarian herniation,9 patients developed SOH.The single variate analysis revealed that times of manual reduction,ovarian volume,ovary with or without multiple cysts,ovary torsion or not and angle of ovary torsion were found to be significant factors associated with SOH.The multivariate analysis showed ovarian volume was evidenced as an independent risk factor for SOH.Furthermore,the incidence of ovary torsion was significantly higher in ovarian volume ≥5cm^3 group than in ovarian volume <5cm^3 group,indicating that larger ovary was more likely to result in ovary torsion,leading to SOH.Our study demonstrated that the odds of SOH increased with increasing ovarian volume in female patients (<1 year old)because the relatively greater ovary at this age was more likely to be incarcerated and twisted,leading to SOH.
文摘AIM:To clarify the usefulness of arterial phase scans in contrast computed tomography (CT) imaging of stran-gulation ileus in order to make an early diagnosis. METHODS:A comparative examination was carried out with respect to the CT value of the intestinal tract wall in each scanning phase, the CT value of the content in the intestinal tract, and the CT value of ascites fluid in the portal vein phase for a group in which ischemia was observed (Group Ⅰ) and a group in which ischemia was not observed (Group N) based on the pathological findings or intra-surgical findings. Moreover, a comparative examination was carried out in Group Ⅰ subjects for each scanning phase with respect to average differences in the CT values of the intestinal tract wall where ischemia was suspected and in the intestinal tract wall in non-ischemic areas. RESULTS:There were 15 subjects in Group Ⅰ and 30 subjects in Group N. The CT value of the intestinal tract wall was 41.8 ± 11.2 Hounsfield Unit (HU) in Group Ⅰ and 69.6 ± 18.4 HU in Group N in the arterial phase, with the CT value of the ischemic bowel wall being significantly lower in Group Ⅰ. In the portal vein phase, the CT value of the ischemic bowel wall was 60.6 ± 14.6 HU in Group Ⅰ and 80.7 ± 17.7 HU in Group N, with the CT value of the ischemic bowel wall being significantly lower in Group Ⅰ; however, no significant differences were observed in the equilibrium phase. The CT value of the solution in the intestine was 18.6 ± 9.5 HU in Group Ⅰ and 10.4 ± 5.1 HU in Group N, being signifi-cantly higher in Group Ⅰ. No significant differences were observed in the CT value of the accumulation of ascites fluid. The average difference in the CT values between the ischemic bowel wall and the non-ischemic bowel wall for each subject in Group Ⅰ was 33.7 ± 20.1 HU in the arterial phase, being significantly larger compared to the other two phases. CONCLUSION:This is a retrospective study using a small number of subjects; however, it suggests that there is a possibility that CT scanning in the arterial phase is useful for the early diagnosis of strangulation ileus.
文摘Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10) and non-ischemia (n = 27) groups. Serum I-FABP levels were longitudinally analyzed in 21 patients who showed high (>2.0 ng/ml) serum I-FABP levels. The relationship between serum I-FABP level and length of damaged bowel was also analyzed. Results: Median serum I-FABP levels were 9.2 ng/ml in the ischemia group and 1.9 ng/ml in the non-ischemia group (p < 0.0001). The elevated I-FABP levels rapidly decreased after therapeutic intervention and normalized on the third day in all patients. Linear regression analysis revealed a positive correlation between I-FABP levels and lengths of surgically excised bowels (y = 2.527x - 7.660, r = 0.604, p = 0.0018). By setting the cutoff level at 7.2 ng/ml, the diagnostic ability of serum I-FABP was 70.0% in terms of sensitivity, 92.6% in terms of specificity, and 86.5% in terms of accuracy. Conclusion: Serum I-FABP sensitively reflects bowel damage in SBO patients and seems to be a potential biomarker for detecting small-bowel ischemia.
文摘Placement of constricting devices around the penis and scrotum for autoerotic purposes or increasing sexual performance represents a well-known challenge for urologists and can result in serious complications.The removal of the constricting devices can be challenging and often requires resourcefulness and multidisciplinary approach.We report one case of successful removal of a penoscrotal constricting metal ring in a 49-year-old male using a handheld orthopaedic saw under ketamine and midazolam sedation in the emergency department.
文摘Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.
文摘BACKGROUND Penial incarceration(PI)is a rare situation.It is usually caused by a foreign object which strangulates at the base of the penis.PI may derive from pranks,sexual demand,mental disease,or intention to prohibit urinary disease.Generally,these situations are emergent and immediate treatments are needed.Cases of chronic PI are less reported,and their treating methods are yet to be discussed.CASE SUMMARY We reported a case on treating a 73-year-old male who had PI with a metallic hoop for three months.After multidisciplinary consultation,the operation was performed successfully with the help of a fretsaw.Despite the chronic strangulation,the prognosis of the patient was satisfying.To the best of our knowledge,this case was rare and precious as it featured the longest strangulating time,which might enlighten the treating process of future PI cases.Also,we have reviewed and summarized major published cases to encapsulate appropriate approaches when facing diverse strangulation situations.CONCLUSION The selection of surgical tools depends on the material of the strangulating objects,the availability of equipment,and the severity of the penial damage.The urination function may not be affected after three months of incarceration as in our case,whilst prudent preoperative measures and multidisciplinary evaluations are always essential.Although using a fretsaw is comparatively slow,it is safe and feasible to treat metallic penial incarceration.
文摘Transanal intestinal evisceration is an extremely rare and dramatic digestive surgical emergency. The cases reported in the literature are few and concern much more elderly patients. We report the case of a 3-year-old boy admitted in very general poor condition to the emergency department, late for transanal evisceration complicating rectal prolapse that the parents tried to reduce. The fatal outcome of this case is probably related to strangulation and delay in consultation. We learn from this that parents should avoid inopportune prolapse reduction and early consultation.
文摘Amyand’s hernia [AH] is a rare condition with presence of vermiform appendix in an inguinal hernia sac [1]. It is a rare entity with very difficult preoperative diagnosis that does not affect management. We herein report a neonatal gangrenous AH masking all features of underlying bowel gangrene. In neonates, a great masquerader can mask all the features of underlying bowel gangrene and delay in diagnosis can be detrimental in context of outcome. A high index of suspicion of Amyand’s hernia with gangrene should be kept even if child presents with irreducible hernia without features of strangulation to prevent avoidable increase in morbidity and mortality.
文摘Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 January 2016 to 31 December 2016 of 84 patients operated on for inguinal hernias in the general surgery unit of CSRéf CII. Results: Inguinal hernia accounted for 8% of surgical consultations and hernia repair accounted for 30.22% of surgical procedures. Hernia repair accounted for 30.22% of surgical procedures. The male sex was the most represented with a ratio of 7.40. The average age of our patients was 43.19 years. Recurrence occurred in 10% of cases. The right side was most affected in 71.43% of cases, 19.05% on the left side in;it was bilateral in 09.52%. Local anaesthesia was used in 67.86% of our patients, general anaesthesia in 13.09% of cases and locoregional anaesthesia in 19.05% of cases. The hernia was external oblique in 75% of cases. Shouldice’s technique was the most used with 88%;Bassini’s technique was used in 7% and Mac Vay’s in 5% of cases. The postoperative course was simple in 96.43% of cases, with an early postoperative morbidity rate of 3.57%, one case of wall abscess and two cases of parietal haematoma. No deaths were observed during our study. Conclusion: The new methods of tension-free cure should be used more and more by our users in our facilities.
文摘Introduction: Laryngeal stenosis is partial or circumferential narrowing of the endolaryngeal airway from congenital or acquired causes. It can present with life threatening upper airway obstruction, and the goal of treatment is restoration of good quality voice, respiration and laryngeal competence. We report a case of laryngeal stenosis following strangulation by a trapped overflowed head scarf, whilst being transported on a motor cycle and highlighted the treatment challenges. Methodology: A case of laryngeal stenosis studied, clinical findings, investigation results and treatment analysed. Results: A 70-year-old Nigerian elderly woman presented with three weeks’ history of hoarseness and progressive difficulty in breathing, following pulling of her long head scarf into the back wheel of the motor cycle taking her home. She had immediate loss of consciousness, which lasted for about 60 minutes. There was associated bout of cough while eating. Examination revealed life threatening upper airway obstruction. X-ray soft tissue neck showed soft tissue mass obliterating larygotracheal air column. Flexible nasopharyngolaryngoscopy showed grossly distorted laryngeal inlet with invisible vocal cords. CT scan of the larynx showed multiple and displaced fractures of the laryngeal cartilages. Microlaryngoscopy findings were pin-hole laryngeal lumen with firm collapsed mucosa. Emergency tracheostomy was done to relieve the upper airway obstruction. Attempts were made to excise the collapse mucosa and insert a stent proved difficult. Referral for endoscopic laser excision was caution because of the potential risk of aspiration. She was counselled and coping well with the tracheostomy.
文摘External hernia is one of the commonest causes of intestinal obstruction. Femoral hernia is a relatively uncommon hernia. It has a very high complication rate due to delayed diagnosis caused by deceptive symptomatology and subtle signs. CT scan enables a prompt diagnosis. Rigorous resuscitation followed by prompt surgical intervention is the mainstay of treatment. A case of a strangulated femoral hernia in a patient with complicated co morbid medical disorders is presented to highlight the pitfalls in initial clinical assessment.
