Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report

IntroductionIn blunt abdominal trauma, lesions of the small bowell and mesentery are often underdiagnosed; although unusual, they represent the third most injured organ, with increasing morbidity and mortality.Presentation of caseThe authors present the case of a 68 years old male, admitted to the emergency department after being hit by a bale of straw, weighing around 300 kg, in the abdomen. After successful ressuscitation, a CT scan was performed, suggesting hemoperitoneum because of vascular lesion of the right colon bleeding. An exploratory laparotomy was performed, confirming the presence of blood in the abdominal cavity and identifying jejunal perforation, an apparently innocent hematoma of the small bowel mesentery (beside the bowel wall) distally to the first lesion and a laceration of the sigmoid serosa; a segmental jejunal resection and suture of the colon serosa were performed. In the early post-operative period, an enteric discharge was noticed, mandating surgical reexploration; a previously unnoticed bowel perforation, in the mesenteric border where the hematoma was identified, justified an additional enterectomy, after what the patients recovery progressed uneventfully.DiscussionIn this case, a sudden increase in abdominal pressure could explain that missed rupture of the mesenteric border of the jejunum, also causing the mesenteric hematoma, or, in spite of that, a state of low perfusion could have lead to total wall ischemia of an already irrigation compromised segment.Only noted after surgical exploration, despite prior evaluation with a computed tomography. Small bowell and mesenteric injuries are potentially missed due to decreased exploratory laparotomies for blunt abdominal trauma.ConclusionAlthough uncommon, small bowel and mesenteric injuries are associated with high morbidity and mortality. High clinical suspicion is essential for an early diagnosis     

Acute femoral artery pseudoaneurysm due to lesser trochanter fragment： an unusual complication of an intertrochanteric fracture

False aneurysm of the femoral artery is a rare complication of intertrochanteric fracture. Most of these situations are due to iatrogenic trauma or the trauma itself and are rarely caused by dislocated bone fragments. Here we report a case of a 72-year-old man who presented acutely with a pseudoaneurysm of the superficial femoral artery from the spike of a lesser trochanter fragment. Percutaneous endovascular treatment of the pseudoaneurysm with a covered stent was undertaken on an urgent basis. Five days later, the patient was operated upon and the lesser trochanter fragment was excised through an anterior incision and the intertrochanteric fracture was fixed using dynamic hip screws. The fracture was united at 10 weeks. At one-year＇s follow-up, there were no graft-related complications. This case illustrates that an intertrochanteric fracture with a dis- placed lesser trochanter fragment can present acutely with bleeding and a pseudoaneurysm of the femoral artery.     

Male fertility following childhood cancer： current concepts and future therapies

Prepubertal boys treated for cancer may exhibit impaired fertility in later life. A number of chemotherapeutic agents have been identified as being gonadotoxic, and certain treatment regimens, such as that used for Hodgkin‘s disease, are particularly associated with subsequent infertility. Radiotherapy may also cause gonadal damage, most notably following direct testicular irradiation or total body irradiation. Because of the varied nature of the cytotoxic insult, it can be difficult to predict the likelihood of infertility in later life. Currently it is not possible to detect gonadal damage early due to the lack of a sensitive marker of gonadal function in the prepubertal age group. Semen cryopreservation is currently the only method of preserving fertility in patients receiving gonadotoxic therapy. This is only applicable to postpubertal patients and can be problematic in the adolescent age group. At present there is no provision for the prepubertal boy, although there are a number of experimental methods currently being investigated. By harvesting testicular tissue prior to gonadotoxic therapy, restoration of fertility could be achieved following treatment, either by germ cell transplantation or by in vitro maturation of the germ cells harvested.Alternatively, rendering the testes quiescent during cytotoxic treatment may protect the germ cells from subsequent damage. In addition to the many scientific and technical issues to be overcome prior to clinical application of these techniques, a number of ethical and legal issues must also be addressed to ensure a safe and realistic prospect forfuture fertility in these patients.     

Brachiocephalic trunk and left brachiocephalic vein injuries following penetrating right sternoclavicular junction trauma： a case report

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.     

A rare complex chromosomal rearrangement in an oligospermic male： a case report and review of the Chinese literature

Dear Editor,
Complex chromosome rearrangements （CCRs） are structural aberrations involving at least three chromosomes with three or more chromosomal breakpoints. CCRs are very rare events in the human population. As reviewed by Pellestor et al.,1 less than 255 cases of CCRs involving three or more chromosomes have been reported. In China, approximately 136 cases of CCRs, including 40 males with reproductive problems, have been reported up to the time this review was compiled.     

单一后尿道损伤:一例罕见的男性性交外伤并发症

描述一例罕见的性行为后外伤并发症。患者为一名29岁年轻男子,有持续三年血精和性交后血尿的病史。在半勃起状态下,使用尿道镜检查,在前列腺尿道处发现一个尿道损伤出血点。我们使用经尿道电烧成功治疗这名病人。我们认为单一的后尿道损伤也可能是性行为后外伤的原因,在阴茎未勃起状态下可能毫无症状,而阴茎勃起后才开始有出血的症状。     

Post-coital gross hematuria： an unusual presentation of benign prostatic hyperplasia

Aim： To describe an unusual symptom of benign prostatic hyperplasia （BPH）. Methods： A patient presented to our urology clinic having experienced post-coital gross hematuria for 2 years. He had not experienced lower urinary tract symptoms （LUTS）. A series of examinations were performed to determine the source of bleeding. Results： The prostate was defined as the active bleeding source responsible for the patient＇s post-coital hematuria. Endoscopic fulguration did not alleviate the symptom. The use of dutasteride, a dual inhibitor of 5α-reductase, solved the problem. Conclusion： This study reports for the first time that post-coital gross hematuria is one of the clinical presentations of BPH, which can be successfully treated with 5α-reductase inhibitor.     

Isolated posterior column dysfunction: an unusual presentation of spondylotic myelopathy

Two patients with previously unreported clinically evident myelopathy caused by herniated intervertebral disks are described. These patients had isolated posterior column dysfunction in the lower extremities without motor deficits, abnormal reflexes, spinothalamic sensory abnormalities, or sphincter changes. The level of cord compression was significantly more cranial than suggested by clinical localization, and the results of initial radiographic studies were unremarkable. Study of posterior column dysfunction using somatosensory evoked potentials was helpful in localizing the lesions and guiding appropriate neuroradiologic studies.     

Female urethral and bladder neck injury after rape: an appraisal of the surgical management

The aim of this study was to discuss the surgical management of urethral and bladder neck injury after urethral coitus during rape. A 21-year-old lady presented with total urinary incontinence of 1-year duration after being raped. On examination, she had urethral laceration and a patulous urethra and bladder neck suggesting urethral coitus during the rape. Her introitus and vagina were however normal. She had repair of her urethral laceration and plication of her urethra and bladder neck via a vaginal approach. She regained her continence and voids without any residual urine. Urethral coitus is rare. Urethral coitus in the presence of a normal introitus and vagina is very rare. The urethral and bladder neck injury resulting from this can be satisfactorily corrected by urethral and bladder neck plication via a vaginal approach with the vaginal incisions positioned to forestall suture line apposition, which may lead to wound failure.     

Pediatric aortoiliac injury following blunt abdominal trauma: A case report

IntroductionThe most common mechanism of aortic injury involves motor vehicle collisions resulting in aortic disruptions, occurring almost exclusively in the chest. Injury to the abdominal aorta following blunt trauma is nearly twenty times less likely to occur than the thoracic aorta. Because of the low incidence, there are few reports regarding the presentation and repair of these particular injuries, especially in the pediatric population.Presentation of caseWe present a case of a 7-year-old boy involved in a high speed motor vehicle accident with an abdominal aorta transection at the aortic bifurcation extending into the left iliac artery. The injury was repaired using bovine pericardium with the adventitia and intima of the vessel approximated over the bovine bridge.DiscussionPrimary repair of thoracic aortic injury has been thoroughly described in the literature with good outcomes yet, abdominal aortic repair remains ambiguous. Few techniques and materials have been described with even less data surrounding the long-term outcomes.ConclusionBovine pericardium is a strong and stable acellular collagenous material with the potential to accelerate endothelialization and tissue regeneration. This remains an interesting field of research as stenosis and pseudo-coarction data have yet to be determined.     

Ureteral trauma: Patterns and mechanisms of injury of an uncommon condition

Background

Traumatic ureteral injuries are uncommon, thus large series are lacking.

Methods

We performed a retrospective analysis of the National Trauma Data Bank (2002-2006).

Results

Of the 22,706 genitourinary injuries, 582 ureteral injury patients were identified (38.5% blunt, 61.5% penetrating). Patients were 84% male, 38% white, and 37% black (mean age, 31 y). Blunt trauma patients had a median Injury Severity Score of 21.5 versus 16.0 for penetrating injury (P < .001). Mortality rates were 9% blunt, and 6% penetrating (P = .166). Penetrating trauma patients had a higher incidence of bowel injuries (small bowel, 46%; large bowel, 44%) and vascular injuries (38%), whereas blunt trauma patients had a higher incidence of bony pelvic injuries (20%) (P < .001).

Conclusions

Ureteral injuries are uncommon, seen in approximately 3 per 10,000 trauma admissions, and occur more in penetrating than in blunt trauma. The most common associated injury for blunt ureteral trauma is pelvic bone fracture, whereas penetrating ureteral trauma patients have more hollow viscus and vascular injuries.     

Massive per rectal bleeding following blunt abdominal trauma: First presentation of Crohn's disease

Introduction

Inflammatory bowel disease is a chronic and relatively common disorder with heterogeneous presentation. Peak incidence occurs in the second and third decades of life. We present a patient with Crohn''s disease whose first presentation was profuse bleeding/rectum following blunt abdominal trauma.

presentation of case

A 29 year old previously healthy man presented one hour after sustaining relatively mild abdominal trauma, due to fall onto the ball during a rugby match. He complained of abdominal pain and one episode of large fresh rectal bleeding. He was pale and distressed with hypotension, tachycardia and abdominal guarding & fresh blood on digital rectal examination. With a provisional diagnosis of intestinal injury he was taken to theatre. Right hemi-colectomy was done for a thickened and inflamed segment of distal ileum, a large adjacent mesenteric haematoma & mesenteric lymph nodes and blood in distal bowel. Histology confirmed the features of Crohn''s disease.

discussion

Crohn''s disease is unusual cause of massive lower gastrointestinal bleeding occurring in 0.9–6% of patients. Rectal bleeding associated with diarrhoea is relatively more common than massive bleeding. The presence of Crohn''s disease in young patients presenting like this is unlikely to be suspected and diagnosis could only be made after laparotomy.