Necrotizing fasciitis as complication of injection into greater trochanteric bursa

Necrotizing fasciitis is a limb- and life-threatening soft-tissue infection that frequently involves the extremities. This article describes the first case of necrotizing fasciitis developing from a single steroid injection of the greater trochanteric bursa. Despite early resuscitation and aggressive surgical management that included a hip disarticulation, the patient expired. Potential contributing factors are reviewed.     

Foreign body stone of the ureter as a complication of acupuncture.

A case of spontaneous passage of a foreign body in the upper urinary tract is reported. Approximately 60 cases have been collected and reported in the world, 18 in Japan. Our case is, however, the first with spontaneous passage. As complications may occur if these foreign bodies are left behind, we advocate the surgical removal as treatment of choice.     

Localized gangrene of the scrotum and penis: a complication of heroin injection into the femoral vessels

Long-term intravenous heroin abusers have problems of vascular access. After the accessible sites are sclerosed, the neck, axillae and groins are then used frequently. We report on 3 heroin abusers who presented with localized gangrene of the genitalia after injection into the femoral vessels. We postulate that the pathophysiology of this entity is related to arterial embolization of particulate matter into the microcirculation of the genitalia, which causes arterial thrombosis leading to localized gangrene. Of the 3 patients 2 were treated with local excision, débridement and primary closure. A fourth addict who injected heroin directly into the scrotum and perineum, presented with Fournier's gangrene, a completely different, more lethal entity.     

False aneurysm of the cavernous carotid artery: a complication of transsphenoidal surgery

Although excellent results currently are being achieved with transsphenoidal surgery, life-threatening complications may occasionally result from this approach. We present a patient with carotid injury sustained during transsphenoidal surgery, who presented 6 weeks postoperatively with a large false aneurysm in the cavernous part of the right internal carotid artery. This lesion was successfully treated by trapping. The pathogenesis of this complication is discussed and the relevant literature is reviewed.     

Foreign body stone of the ureter as a complication of acupuncture: report of a case]

A 47-year-old female was admitted to our clinic with the suspicion of ureteral foreign body. She had undergone acupuncture for left lumbago twelve years earlier. Plain X-ray film revealed a linear shadow and calcified shadows laterally to left third lumber vertebra. Computed tomographic scan and pyelogram showed them located in the left ureter. Left ureterolithotomy was performed successfully. The removed stone was accompanied by an acupuncture needle. Including our case, twelve cases of foreign bodies as a complication of acupuncture in the upper urinary tract reported in the Japanese literature were reviewed.     

Giant abdominal wall abscess dissecting into thorax as a complication of ESWL

Abscess as a complication of extracorporeal shock wave lithotripsy is a rare condition. We present the computed tomography findings of an abdominal wall abscess that occurred after extracorporeal shock wave lithotripsy for which prophylactic antibiotics had not been given. The abscess destroyed the posterior abdominal wall muscles and dissected into the thorax. The muscles were thickened and showed enhancement. A parenchymal defect in the right kidney adjacent to a caliceal stone, with strands extending from this defective region to the abscess, was observed, and was thought to be the result of parenchymal destruction caused by the shock waves. Other parts of the kidney and psoas muscle were normal. Microbiologic examination revealed Escherichia coli.     

Subdural cannulation and local anesthetic injection as a complication of an intended epidural anesthetic.

We report a 52-year-old woman scheduled for laparotomy with combined epidural-general anesthesia who experienced abnormal responses to local anesthetic injections administered via the epidural catheter. The catheter subsequently was found to be in the subdural space. A review of the literature is provided.