Urocolpos is a urine collection in the vagina, possibly due to vesicovaginal reflux (VVR) or a fistula. Urocolpos is a rare phenomenon in adults, and it is commonly underrecognized by radiologists. The occurrence of urocolpos due to VVR after a Caesarean section in adult females is a rare phenomenon; failure to recognize it may lead to misdiagnosis as vesicovaginal fistula and often leads to unnecessary medical interventions. We report a 37-year-old female who complained of abdominal pain and intermittent daytime urinary incontinence for six months, starting after a Caesarean section for her third baby. An abdominal computed tomography scan revealed a large fluid-filled vagina on a full bladder without anatomical abnormality. A post-voiding scan showed a complete resolution. In conclusion, urocolpos is an underrecognized entity that rarely coexists with VVR. Post-voiding resolution and vaginal contrast reflux are important findings that can aid radiologists in identifying such cases.
The incidence of leiomyosarcomas (LMS) has declined drastically. In fact, the introduction of immunohistochemistry (IHC) helped to differentiate LMS from other gastrointestinal stromal tumors (GIST) by receptor tyrosine kinase (KIT)-mutation detection making gastric LMS a sporadic tumor recently. We report a 60-year-old female who presented with a three-week history of abdominal pain. An abdominal computed tomography scan showed a large exophytic mass (22 ×19 ×15 cm) arising from the greater curvature of the stomach with multiple metastases. A biopsy was taken, and the initial histopathological examination was suggestive of GIST. However, further histopathological examination confirmed a high-grade gastric LMS. The patient refused any surgical intervention. Therefore, the patient had only received chemotherapy. On 9-month follow-up, the patient is still alive without disease progression. In conclusion, gastric LMS is a rare tumor. Due to the possibility of being misdiagnosed with other GIST, extensive pathological evaluation through specialized experts and IHC analysis is recommended.
Enormous oromandibular defects in children remain a reconstructive challenge due to the region's unique features and the scarcity of a perfectly matched recipient site. The osteocutaneous fibula-free flap (OCFFF) is an excellent option for these defects. Most reports on oromandibular reconstruction in children are limited to surgical techniques instead of long-term follow-up, especially in resource-limited settings. We reported a 9-year-old child who presented with a massive oromandibular defect caused by a high-energy gunshot. Firstly, the patient was treated with debridement, lower defect edges approximation, and tracheostomy. After one week, the procedure of OCFFF was performed, and two months later, the lower lip was reconstructed using a tongue flap. The aesthetic outcome was excellent at two years, and the patient could speak and eat without impaired oral function. In conclusion, microsurgical reconstruction using OCFFF for massive oromandibular defects in our child patient was safe with satisfactory facial aesthetics and oral function.
Background Despite thyroidectomy being the preferred approach for retrosternal goiter (RSG), controversies surround its rationale in asymptomatic cases. This study aimed to investigate the treatment of RSG in resource-limited settings. Methods A retrospective study conducted between April 2010 and June 2022 included 28 RSG cases who underwent thyroidectomy using the cervical approach at Al-Nasar Hospital, Ibb, Yemen. A bivariate analysis was performed to investigate the risk factors for postoperative complications. Results The main age was 49.4±9.9 years, and most of them (60.7%) were females. The main symptoms were cervical mass appearance and breathing difficulty in 75 %, and 32.1%, respectively. Twenty-four (86%) cases were classified as Grade 1 (above aortic arch) and four (14%) cases were classified as Grade 2 (aortic arch to the pericardium). All patients underwent total thyroidectomy through the cervical approach without needing sternotomy. The mean operative time was 121.9±26.7min (99-200 min) and the mean intraoperative bleeding was 321.2±137.4 mL. Postoperatively, the malignant entity was histopathologically proven in seven patients (25%). The postoperative complications (14%) were transient hypocalcemia in two (7.1%) and hematoma in two (7.1%). Older age, bigger thyroid mass, extension below the aortic arch (Grade 2), longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications (all p < 0.05). Conclusion Cervical approach for patients with RSG in our experience is an optimum, feasible, and less invasive surgical approach, in a resource-limited setting. Older age, bigger thyroid, extension below the aortic arch, longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications.
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