Acute necrotizing torsion of the gallbladder

Torsion of the gallbladder is an extremely rare cause of acute surgical abdomen. Although gallbladder torsion has been reported the diagnosis remains elusive and is often missed. A case of necrotizing gallbladder torsion is examined, and the literature is reviewed by the authors. History peak incidence and pathophysiology are discussed, and possible risk factors are identified. We conclude that torsion of the gallbladder is a condition that has minimal clinical findings.     

Chronic encapsulated intracerebral hematoma during infancy: case report

Chronic encapsulated intracerebral hematoma is a rare condition. Only four cases have been reported. The cause of this condition is unclear. A case of chronic encapsulated intracerebral hematoma in an 1-year-old infant is reported, and the characteristic findings and their causes are discussed with a literature survey.     

Torsion of spermatocele: a rare manifestation

Torsion of a spermatocele on its pedicle is an extremely rare clinical condition that mimics acute testicular torsion. This rare condition has not been well characterized. Here, we report a case of torsion of a spermatocele. The present case is the 5th case of torsion of a spermatocele and the first report in a patient with a history of scrotal trauma. A tender cystic mass adjacent to the normally appearing testicle in the scrotum is highly significant for the differentiation from other types of acute scrotum. Torsion of a spermatocele should be considered a differential diagnosis of acute scrotum in adolescents and adults.     

Bilateral intrauterine testicular torsion

Torsion of the testes is the most frequent urogenital emergency in childhood. Bilateral intrauterine torsion of the testes is a rare event. Only 15 cases have been reported up till now. We add two patients. Clinical findings, consequences and therapy of bilateral torsion of the testes are discussed. Etiology and symptomatology of testicular torsion in the newborn and the adult are different. Predisposing factors are lacking in the extravaginal torsion of the newborn but are present in the intravaginal torsion of the adult. The diagnosis is made by inspection, palpation, Doppler sonography and, if necessary, by immediate surgical exploration. Except for the local findings there are usually no symptoms in the newborn. Following bilateral torsion of the testes with consecutive bilateral orchiectomy the loss of exocrine function remains irreversible. Androgenic substitution therapy should begin at the age of 14. The full dose of hormone should not be given before the termination of bone growth. For psychological and cosmetic reasons a testicular prosthesis can be recommended.     

Torsion of a Wandering Spleen Presenting with Acute Abdomen: a Case Report

Wandering spleen is a rare condition characterized by increased splenic mobility due to the absence or laxity of its suspensory ligaments that may present as acute abdomen when it is twisted on its pedicle. Herein we report a case of torsion of a wandering spleen in a 17-year-old male patient with communicating hidrocephalus and ventricu-loperitoneal shunt. The patient presented with suspicious clinical findings of acute abdomen, a laparotomy was performed and the infarcted spleen was removed. Although wandering spleen is a rare clinical entity, the possibility of torsion should be kept in mind in the differential diagnosis of acute abdomen.     

Torsion of a wandering spleen presenting with acute abdomen: a case report

Wandering spleen is a rare condition characterized by increased splenic mobility due to the absence or laxity of its suspensory ligaments that may present as acute abdomen when it is twisted on its pedicle. Herein we report a case of torsion of a wandering spleen in a 17-year-old male patient with communicating hidrocephalus and ventriculoperitoneal shunt. The patient presented with suspicious clinical findings of acute abdomen, a laparotomy was performed and the infarcted spleen was removed. Although wandering spleen is a rare clinical entity, the possibility of torsion should be kept in mind in the differential diagnosis of acute abdomen.     

Neonatal bilateral testicular torsion: a plea for emergency exploration

PURPOSE: Bilateral testicular torsion is a rare condition. Most authors present single case reports. Therefore, the clinical and surgical aspects of bilateral torsion in a neonate have not been subjected to detailed analysis. We performed a retrospective analysis of our experience in the management of bilateral perinatal torsion as well as a collective review of the medical literature. MATERIALS AND METHODS: All cases of neonatal testicular torsion managed at our neonatal surgical center during the last 2 decades (1986 to 2005) were reviewed, and 3 cases of bilateral torsion were identified. In addition, 45 neonatal cases of bilateral torsion were found through the literature search. In all cases data regarding clinical presentation, imaging studies, surgical management, intraoperative and pathological findings, and final outcome were analyzed. RESULTS: Synchronous torsion occurred in 32 of 48 newborns (67%), while asynchronous pathology was reported in 16 (33%), including the 3 presented in this report. All except 1 patient were full-term newborns with normal or above average birth weight. Difficult delivery was noted in 33% of the cases. Despite prompt surgical intervention in 46 infants, the salvage rate was low, with arterial flow confirmed postoperatively in only 3 gonads (3.1%). Four gonads in 3 additional patients were reported to be of normal size on followup. CONCLUSIONS: Asynchronous torsion is not as rare an event as previously reported, and it may pose a diagnostic challenge. In the majority of these cases torsion of the left testis seems to occur later than torsion of the right testis. The role of imaging studies in newborns with bilateral torsion seems to be limited, especially in cases of asynchronous pathology. Urgent bilateral exploration is strongly advised in all newborns presenting with either unilateral or bilateral torsion. Such policy carries diagnostic, potential therapeutic and prognostic implications.     

Appendiceal torsion in an adult: case report and review of the literature

PURPOSE: Torsion of the appendix is a rare cause of acute abdomen with presentation, treatment, and prognosis virtually identical to that of acute appendicitis. METHODS: We present a case of appendiceal torsion in a 44-year-old male, which is to our knowledge the first in an African-American man, and we review all of the reported adult cases in the English language literature. CONCLUSION: This condition may have occurred when a normal appendix is encountered and no other pathologic findings exist.     

Painless inter epididymal testicular torsion of the spermatic cord

Inter epididymal testicular torsion of the spermatic cord is extremely rare and usually diagnosed at surgery. We present an unusual case of spermatic cord torsion in a 14-year-old male patient. It is important to highlight that the torsion occurred only on the distal half of the epididymis leaving the head untwisted and edematous. In addition, the fact that this condition was painless made this case extremely rare and motivated our presentation.     

Twisted cystic artery disclosed by 3-dimensional computed tomography angiography for torsion of the gallbladder

Torsion of the gallbladder is a rare condition that most commonly affects elderly women. The symptoms of torsion mimic acute cholecystitis, but several clinical features and imaging findings can be useful for distinguishing it from typical acute cholecystitis. However, preoperative identification remains difficult. Three-dimensional angiography reconstructed by preoperative multidetector row computed tomography is useful for definitive diagnosis of torsion of the gallbladder. Demonstration of a twisted cystic artery by 3-dimensional computed tomography angiography represents specific and direct evidence of this condition, which allows immediate diagnosis and treatment.     

Partial tubal salvage through neosalpingostomy in a 12-year-old girl with combined ovarian and fallopian tube torsion

The combined torsion of both the ovary and the fallopian tube in the pediatric population has been a rarely encountered pathology. Although detorsion of the twisted adnexa is an option, most torsion cases reported in the pediatric literature have undergone adnexectomy as the primary treatment modality. We believe that, in an attempt to maximize the future reproductive potential, a viable portion of the fallopian tube can be salvaged in selected cases. This is the first reported case where a partially necrotic twisted tube is salvaged through neosalpingostomy after the resection of the necrotic distal portion. In this article, we are presenting a 12-year-old girl with a combined torsion of the right ovary and fallopian tube as well as the surgical management of this rare condition.     

„Akutes Skrotum“ beim Neugeborenen

The most common causes of an 'acute scrotum' in childhood are testicular torsion, torsion of an appendix testis, epididyoorchitis, idiopathic edema, and hematoma. In rare cases a scrotal hematoma can originate from an extra- or intraperitoneal adrenal bleeding. 12 such cases have been described in the literature, yet. We report on 3 further cases, that occurred in our institution between 1992 and 1997. In the first case we performed a scrotal exploration due to a suspected testicular torsion, but only a normal testicle and liquid hematoma were seen. Postoperatively we discovered an ipsilateral adrenal hemorrhage by sonography. In the latter two cases the adrenal bleeding was recognized primarily as causal for the scrotal mass and operation remained undone. In newborns adrenal hemorrhage is mostly due to birth-trauma, large birth-weight, hypoxia, and asphyxia. This was present as well with our 3 children. If the clinical situation of the child is stable, complete restitution under conservative therapy can be expected.     

Gallbladder torsion. A case report

Gallbladder torsion is a rare condition causing acalculus cholecystitis. Its preoperative identification is difficult with current radiological means and it is generally diagnosed at surgery. A case of gallbladder torsion due to an extremely rare anomaly consisting of partial fixation of the fundus to a fore-shortened liver bed is reported. The etiology, diagnosis and treatment of this condition are discussed.     

Acute conditions affecting epiploic appendages. A report of 4 cases

Acute lesions of the epiploic appendages are rare. We present 4 cases of torsion of an appendix epiploica. Aspects of this condition and its complications are discussed.     

Rare cause of subarachnoid hemorrhage: spinal meningeal carcinomatosis. Case report

Subarachnoid hemorrhage (SAH) of spinal origin is a rare entity accounting for approximately 1% of all cases of SAH. Its most frequent causes are trauma and vascular malformations. Although primary spinal tumors, especially ependymomas, are also relatively common causes, SAH secondary to a metastatic spinal tumor arising from outside the central nervous system is an extremely rare condition; only one case has been reported in the literature. The authors present a case of spinal meningeal carcinomatosis secondary to cutaneous malignant melanoma in which the patient presented with only symptoms of SAH. Although very rare, this case underscores several factors. 1) Spinal SAH due to spinal metastases should be considered in the differential diagnosis of patients with previously known malignancy. 2) Spinal SAH may manifest without paraparesis or sensory deficit. 3) Magnetic resonance imaging of the spinal cord may be important to determine the source of SAH in patients in whom four-vessel cerebral angiography demonstrates no abnormal findings.     

Familial torsion of the spermatic cord

Familial spermatic cord torsion is rare. We present the fifth recorded family with this condition. Due to awareness of the condition and its consequences on the part of the family there was minimal delay in presentation and early testicular salvage occurred in all 4 patients.     

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.     

Lung torsion after tracheoesophageal fistula repair: a case report and review of literature

Lung torsion is a very rare event that has been described after trauma, spontaneously, and post-thoracic surgery, with only 8 cases reported in the pediatric literature. We present the first case report of lung torsion complicating tracheoesophageal fistula repair. The diagnosis was suggested on chest ultrasonogram and Doppler and confirmed by computed tomographic scans. On exploration, a 90° rotation of the right middle and lower lobes in a clockwise direction was found. A complete interlobar fissure and an absent inferior pulmonary ligament were identified as predisposing factors. The lobes were untwisted, and lobar fixation was performed to prevent retorsion. Postoperatively, the patient recovered complete lung function, and the patient's chest radiologic and ultrasonographic examination results normalized. Lung torsion is an extremely uncommon event. It causes clinical deterioration in the face of normal arterial blood gases and requires a high index of suspicion for diagnosis. Resection of the twisted lung or lobe may be unnecessary if diagnosis is made early and vascular occlusion is partial. Patients with complete interlobar fissures may benefit from pulmonary lobe fixation as a prophylaxis against occurrence or recurrence of this complication.     

Testicular torsion: a review

Torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular torsion is an acute vascular event causing the rotation of the vascular pedicle of the testis, thereby impeding the blood flow to the testis and the scrotal contents. It could be either within or outside the tunica vaginalis. Testicular torsion causes immediate circulatory changes and long-term sequelae such as testicular function and fertility. It is considered a surgical emergency, as a delay causes irreversible testicular damage. The diagnosis and treatment of testicular torsion are discussed in this review, which also illustrates an algorithm and a scoring system for the diagnosis and management of this condition based on current literature.     

Primary Omental Torsion Is a Diagnostic Challenge in Acute Abdomen—a Case Report and Literature Review

Torsion of greater omentum is a rare cause of acute abdominal pain. It can be primary or secondary. Secondary omental torsions are associated with a number of preexisting conditions like inguinal hernia (most common), tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting along its long axis resulting in impaired blood supply. This condition is rare and predominant in males. Most patients are middle-aged adults. It clinically mimics acute appendicitis. If evaluated properly and diagnosed in time, good results can be achieved. We are presenting herewith a case of primary greater omental torsion and review of available literature.