Colonoscopy in the emergency treatment of colonic volvulus in Nigeria

The commonest cause of large-bowel obstruction in Nigeria is sigmoid volvulus. Patients usually present late, dehydrated, and in very poor condition. The mortality of emergency colonic surgery is undoubtedly high, more so in developing countries poorly equipped to cope with such a condition. To reduce the mortality rate and improve management of the patients, a four-year prospective study of detorsion followed by elective surgery after adequate resuscitation and bowel preparation was carried out between January 1979 and December 1982. Volvulus is classified into three groups: torsion, obstruction, and strangulation. Criteria for short colonoscopic detorsion of torsion and obstruction types are discussed, and the contraindication in the case of strangulation type mentioned. This article describes the management of 92 cases of sigmoid volvulus between 1979 and 1982.     

Recurrent cecocolic torsion: radiological diagnosis and treatment.

Recurrent cecocolic torsion may cause recurrent right lower abdominal pain and right-sided thrust dyspareunia. It is seldom considered in the differential diagnosis of pain in this region. The propensity of the cecocolon to torse is secondary to the double developmental defect of a mobile cecocolon compounded by an elongated and overrotated organ that can be eccentrically located in the abdomen. The torsion may result in recurrent obstructions with spontaneous resolutions, but it may proceed to an acute episode of obstruction and strangulation with a more profound morbidity and mortality rate. The diagnosis of recurrent cecocolic torsion is verified by a plain x-ray film of the abdomen, contrast enema, and computed tomography scan. The preferred treatment is outpatient laparoscopic cecocolopexy. Laparoscopic or classical open cecocolectomy and right hemicolectomy are reserved for more complex and morbid presentations.     

Renal allograft torsion associated with prune-belly syndrome

We report a 26-month-old child diagnosed with prune-belly syndrome and end-stage renal disease who received intraperitoneal implantation of an adult cadaveric renal graft which functioned very well for approximately 6 weeks. The patient then presented with acute renal failure which was proved to be secondary to torsion of the graft, twisting the artery and vein. The ureter was wrapped 360° around the graft. These conditions resulted in loss of the graft and nephrectomy. Ours is the second report of such an occurrence; the first was from a living-related kidney donor. We believe the lack of abdominal wall tone contributes to graft mobility and risk of torsion of the kidney. We recommend that nephropexy be considered in these patients. In addition, the risk of torsion must be at the forefront of the differential diagnosis in a prune-belly renal transplant patient with acute onset of oliguria. Renal sonorgraphy with Doppler should be employed as soon as possible so that the graft can be saved.     

Late hormonal function after testicular torsion

Introduction

Testicular torsion may be an important cause of male infertility. We aimed to investigate the late hormonal function in patients with testicular ischemia/reperfusion injury of the testis after orchidectomy or detorsion.

Methods

Twenty patients (mean age, 13.6 years) were prospectively evaluated at a mean of 5 years after testicular torsion. The serum follicle-stimulating hormone, luteinizing hormone (before and after gonadotropin-releasing hormone stimulation), testosterone, and inhibin B were measured. Fifteen age-matched adolescents without evidence of endocrine disease were used as controls for inhibin B values. Data are quoted as mean ± SEM.

Results

Twelve patients were treated with detorsion and orchidopexy, and 8 underwent orchidectomy. Serum follicle-stimulating hormone, luteinizing hormone, and testosterone were all within the reference range. Inhibin B levels were significantly reduced in the 2 groups compared with the controls (34.5 ± 5.2 vs 63.9 ± 12.8 pg/mL, P = .02), but were not significantly different between the orchidectomy group and the group that underwent detorsion (41.3 ± 9.7 vs 30.4 ± 5.9 pg/mL, P = .41).

Conclusion

Hormonal testicular function can be compromised after testicular torsion, although the type of surgery (orchidectomy or orchidopexy) does not seem to change the effect of this ischemia/reperfusion injury.     

Torsed pedunculated hepatic hamartoma

We report a 9-year-old boy with a 6-h history of acute abdominal pain due to torsion of a pedunculated hepatic mesenchymal hamartoma. The lesion was seen, on US and CT, to connect to the liver through a pedicle. Mesenchymal hepatic hamartomas are unusual tumours that may be pedunculated, and this is a unique case complicated by torsion. The radiological and pathological findings, differential diagnosis, and clinical course are discussed.     

Adnexal torsion of mature cystic teratoma with hemorrhagic infarction: helpful findings on successive plain abdominal radiographs

Adnexal torsion is a relatively rare cause of lower abdominal pain in women, but in many cases it leads to a serious condition. We present a case of adnexal torsion of a mature cystic teratoma in which hemorrhagic infarction was reflected by progressive enlargement and wall thickening on successive plain abdominal radiographs. There has been no other report describing such changes of adnexal torsion on plain abdominal radiographs.     

Perinatal testicular torsion: preoperative radiological findings and the argument for urgent surgical exploration

Perinatal testicular torsion is an infrequent event, the management of which has been controversial. Occurrence is rare, estimated at 1 in 7500 newborns (Kaplan, G. W., Silber, I.: Neonatal torsion--to pex or not? In: Urologic surgery in neonates and young infants. Edited by King, L.R. Philadelphia: W.B. Saunders Co., 1988; Chapter 20, pp. 386-395). The frequency of bilateral perinatal torsion is up to 22% (J Urol. 2005;174:1579). Here, we describe two cases of bilateral asynchronous perinatal torsion, in which the only presenting abnormality on exam after birth was a unilateral scrotal mass. These cases illustrate that contralateral perinatal torsion may be present even when physical exam findings suggest unilateral involvement.     

Diagnostic accuracy of hand-held Doppler in the management of acute scrotal pain

We evaluate the reliability of hand-held Doppler (HHD) in the management of acute scrotal pain of 24 h or less duration. Between October 2003 and December 2004, patients presenting with acute scrotal pain were enrolled in this prospective study. After clinical examination, all patients had a HHD assessment. Presence or absence of Doppler arterial signals and its intensity were recorded. A blinded assessor corroborated HHD findings with the clinical, ultrasound, operative findings and final diagnosis. Primary outcome measured were sensitivity and specificity of HHD in the diagnosis of testicular torsion. Twenty-five patients presented during the study period with acute scrotal pain. The final diagnosis was testicular torsion in nine, epididymitis in 13, twisted cyst of Morgagni in two and Henoch–Schoenlein purpura in one patient. The HHD predicted all patients of testicular torsion correctly, preoperatively. HHD is a reliable diagnostic tool in the management of patients with acute scrotal pain.     

睾丸扭转50例临床分析

目的探讨睾丸扭转的早期诊断与治疗方法。方法对运用彩色超声检查确诊为睾丸扭转的50例患者的临床资料进行回顾性分析。结果 5例行睾丸切除术,45例手术复位并行睾丸固定术。术后随访3年,25例患者术后睾丸发生不同程度的萎缩,但尚未发现生育能力受限者。结论彩色多普勒超声检查是早期诊断睾丸扭转的可靠方法,早期诊断、及时治疗对提高睾丸存活率有重要意义。     

EZ取钉器的生物力学测试和临床初步应用

目的 通过生物力学测试和临床初步应用验证EZ取钉器对断钉、打滑螺钉的取出效果。方法 采用新鲜尸骨标本,股骨、胫骨、尺桡骨各4具,并随机分为两组：A组为起子取螺钉扭力组;B组为骨髓腔内灌骨水泥固定螺钉组,其中B1为螺钉打滑时最大扭力组;B2为EZ取钉器一个手柄时取钉器最大扭力组;B3为两个手柄时取钉器的最大扭力组,制成4种生物力学测试模型,内固定螺钉分为4.5 mm和3.5 mm两种类型。在万能材料试验机上测试实验标本,施加轴向载荷2 kN,测量扭转拔出螺钉时的最大扭矩值、扭角及螺钉拔出时功耗大小和效率。实验数据经统计学处理, 进行组间比较。并用EZ取钉器在12例患者中初步应用。结果 A组最大拔出扭矩为1.42～1.96 N·m,B1组为2.87～3.27 N·m,B2组为3.06～4.83 N·m,B3组为4.12～8.36 N·m,各组间均呈显著性差异（P<0.05）。其相对应各组的扭角均值分别为1.59°、0.77°、0.28°和0.16°,各组间有明显差异（P<0.05）。螺钉拔出（旋出）时,各组的功耗均值分别为12、21、32和45J;对应各组间的功率（机械效率）分别为0.20、0.35、0.53和0.75 J/s,组间呈明显差异（P<0.05）。在12例临床断钉和打滑螺钉患者中初步应用,均成功取出,未出现术后并发症。结论EZ取钉器具有足够的抗扭强度和刚度,夹持力大,拔钉稳定可靠,是取出骨骼中断钉和打滑螺钉较理想的工具。