Pyosalpinx is a severe sequel of chronic pelvic inflammatory disease, whereby the fallopian tubes become filled with pus.1 2 Pyosalpinx often affects sexually active women and rarely is seen in celibate adolescent girls.3 We report a case of a 12-year-old girl with no prior sexual history who presented to our emergency department with complaints of severe right lower quadrant pain of 1-day duration. Ultrasonography and CT scan of the abdomen and pelvis revealed free fluid collections in the pelvis without visualisation of the appendix. A preoperative diagnosis of acute ruptured appendicitis was given and she was taken to the operating room. Peroperative findings included bilaterally distended, pus-filled pyosalpinges. A definitive diagnosis of bilateral pyosalpinx was then made. Two-week antibiotic therapy was successful but the patient returned with recurrent pyosalpinx and a pelvic abscess 9 weeks later.
BackgroundOwing to the potential risks associated with missed injury, many blunt trauma patients with suspected cervical spine injury undergo some form of imaging technique which has progressed from primarily using plain radiography to relying on CT. Recently, studies have shown that in certain situations, adding MRI may improve the diagnostic accuracy over solely relying on CT.MethodsRetrospective study of 3468 adult blunt trauma patients at a level I trauma center of which 94 with an initial negative CT scan underwent subsequent MRI. These 94 patients were classified as reliable or unreliable for examination; coded as either having a positive or negative MRI result; and assessed for a change in management.ResultsOf the 94 patients in the study population, 69 (73.4%) were deemed reliable and 25 (26.6%) deemed unreliable for examination. Overall, 65 (69.1%) patients had a positive MRI result—49 (71.0%) reliable and 16 (64.0%) unreliable—with some patients testing positive for more than one finding. There was no significant difference in positive MRI rates between reliable and unreliable patients. None of the 29 patients who had negative MRI had a change in management, while 31 of the 65 (47.7%) patients with positive MRI did have a change in management of either continued cervical collar immobilization or neck surgery.ConclusionsThe use of CT scans should be continued as the primary imaging technique for patients with suspected cervical spine injuries. In cases where obtundation or clinical suspicion exists for a false-negative CT scan, MRI should be considered as a supplement and should not be rejected solely based on the negative result of the CT.Level of evidenceLevel IV.
Observations have been made on the surgical treatment of otitis externa in the dog. The indications for surgical treatment and the choice of operative procedure are discussed. Special consideration is given to the postoperative care of the wound which in this series consists of the topical application of sulphanilamide powder. The number, degree and treatment of surgical breakdown are described. The advantages of the method, both to the patients and to the economics of the procedure, are discussed, and the value of bandaging and other aids to prevent interference with the wound by the patient are re‐appraised. The value of post‐operative tranquillization is discussed. Résumé. L'auteur rapporte son expérience concernant le traitement chirurgical de l'otite aterne du chien. On discute les indications de ce traitement ainsi que le choix du mode opératoire. On considère particulièrement les soins post‐opératoires de la plaie qui consis‐taient dam cette série en l'application locale d'une poudre sulfamidte. La fréquence, le degré, le traitement des états post‐opératoires sont décrits. Les avantages de la méthode aussi bien pour les sujets que du point de vue de l'économie du traitement sont discutés et on estime la valeur des pansements et d'autres mesures empêchant l'animal de souiller la plaie. On envisage également la valeur de la sédation post‐opératoire. Zusammenfassung. Beobachtungen über die chirurgische Behandlung von Otitis externa beim Hunde werden mitgeteilt. Die Indikationen für die chirurgische Behandlung und die Wahl der operativen Methode werden besprochen. Besondere Beachtung wird der post‐operativen Behandlung der Wunde gewidmet, die in den besprochenen Fällen in der örtlichen Anwendung von Sulfanilamidpulver bestand. Die Anzahl, das Ausmass und die Behandlung der chirurgischen Eingriffe werden beschrieben. Die Vorteile der Methode für die Patienten und im Hinblick auf die Wirtschaftlichkeit des Verfahrens werden besprochen und der Wert des Bandagierens und anderer Methoden zur Verhinderung der Störung der Wunde durch den Patienten einer Beurteilung unterzogen. Der Wert der medikamentösen postoperativen Ruhigstellung wird besprochen.
Introduction: Inguinodynia or persistent groin pain, is a common postoperative complication of inguinal hernia repair that may interfere with patients' daily activities. Remedial surgery is often required for management. Based on our review of literature, the use of robotically assisted laparoscopy as an option for remedial surgery appears nonexistent. Case presentation: A 54-year-old male patient with a past history of inguinal hernia repair four years ago presented with severe, burning right inguinal pain that peaked 6 months prior to presentation. History was positive for failed multiple analgesic treatment options. Examination revealed tenderness over the right external ring and a prior right inguinal surgical incision with paresthesia along the distribution of the right ilioinguinal nerve. Based on the history and CT findings, the patient was diagnosed with meshoma and ilioinguinal nerve entrapment. Remedial posterior robotic laparoscopic surgery combined with ilioinguinal neurectomy was performed, resulting in complete resolution of pain post-operatively. Conclusions: In our case of post-inguinal hernia repair of neuropathic inguinodynia, laparoscopic robot-assisted surgery combined with ilioinguinal neurectomy led to excellent results.
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