Testicular torsion involves the testicle twisting which results in an infarcted testis. Emergency surgery is required to salvage the affected testis. There are 2 anatomic pathologies associated with testicular torsion: intravaginal testicular torsion and extravaginal testicular torsion (ETT). Extravaginal testicular torsion is seen perinatally and in neonates; beyond this period, ETT is regarded as exceptionally rare. This case series presents 7 cases of ETT seen in men aged 14 to 20 years. This is the largest and oldest group of patients seen with this pathology. These cases were defined by a pediatric surgeon in an inner city hospital in New York. Two patients' testes were not viable at the time of presentation, and the time of onset to presentation ranged from 30 minutes to 11 hours. Each of these cases had an orchiopexy concomitantly of the contralateral testis. This case series poses key questions regarding the etiology of ETT and the surgical management of such cases.
A transhepatic gallbladder is an exceedingly rare finding that presents unique challenges for the general surgeon who often encounters it unexpectedly. A sonogram will not demonstrate it. A gallbladder that wholly penetrates the right lobe of the liver and is clearly visible on the anterior surface is an enigma. We describe an incidental finding at the time of elective surgery of such a phenomenon. This presented the author with a unique problem - how to remove the entire gallbladder without leaving a hole in the right lobe of the liver through which bowel could herniate. A novel technique was utilized which left a small bridge of cauterized gallbladder fundus wall. This article delves into the embryology of the hepatobiliary system in order to surmise how this could have occurred during development. This transhepatic gallbladder also contained a septum, dividing the gallbladder transversely into unequal parts. We hope that our findings and operative description will assist future surgeons that encounter a similar anatomic problem.
Small bowel adenocarcinoma is a rare malignancy that accounts for a small percentage of gastrointestinal cancers. Diagnosis and management of small bowel adenocarcinoma can be challenging due to its rarity and nonspecific presentation. We present a case of a 51-year-old male with a history of intravenous drug use who presented with worsening abdominal pain and was found to have a small bowel obstruction. Exploratory laparotomy revealed a stricture in the jejunum caused by an intraluminal mass, which was resected. Pathological examination confirmed the diagnosis of intestinal type, moderately differentiated adenocarcinoma. This case highlights the importance of considering small bowel adenocarcinoma as a possible etiology in patients presenting with small bowel obstruction, particularly in high-risk individuals. Early diagnosis and complete resection remain the mainstays of treatment for improved outcomes in small bowel adenocarcinoma.
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