Rectus sheath hematoma is a rare but important entity in the differential diagnosis of abdominal pain. Interdisciplinary awareness of this condition is essential, as it is frequently difficult to diagnose, leading to delay in treatment or unneeded surgery. Grade 3 hematomas can lead to abdominal compartment syndrome and can be fatal.
The management of undescended testes remains variable, and the use of laparoscopy for localisation is controversial. This study reviews the need for laparoscopy and also assesses the current practice among a cohort of surgeons.A retrospective review of all patients undergoing orchidopexy was performed, together with a postal survey of all members of the Welsh Surgical Society.Of the 139 orchidopexies performed, the testis was deemed impalpable in 39 (28%) cases. All patients were treated with groin exploration, and only in two (5%) patients was the testis not located. From the survey, replies were received from 90 (81%) surgeons, of whom 65 (72%) were still performing orchidopexy. Forty eight (74%) surgeons performed orchidopexy between the age of 2 and 3, and only 32 (36%) performed preoperative investigations. The follow up period was variable with the majority of patients seen at six weeks.Laparoscopy for the impalpable testis is not initially warranted. An inguinal exploration is regarded as the definitive investigation. This has the advantage of providing the diagnosis and treatment in the majority of cases. (Postgrad Med J 2001;77:320-322) Keywords:cryptorchidism; impalpable testis; orchidopexy; laparoscopy Cryptorchidism means hidden or obscure testis, and is generally synonymous with an undescended testis. Of newborn boys, between 1% and 3% have an empty scrotum, 1 thus making cryptorchidism one of the most common surgical disorders in childhood. Although its aetiology is unclear, the definitive treatment for true undescended testes is surgical placement into the scrotum, thereby improving fertility and decreasing the malignant potential.The majority of cryptorchid testes are palpable but incompletely descended into the scrotum. As many as a third of these testes will likely be retractile when examined.2 However, the non-palpable gonad constitutes 20% of all cases.3 It may be located anywhere between the upper scrotum and abdomen, or may even be absent. Accurate preoperative localisation of the non-palpable testes has been diYcult, and its need disputed. We conducted a study to answer the question: was groin exploration a correct method for diagnosis and treatment of the impalpable testis, or is laparoscopy indicated? We set out to look at our own experience and also to evaluate the current practice within a cohort of surgeons. Subjects and methodsThe first part of this study was a retrospective review of a single consultant's (MEF) experience of all patients who underwent orchidopexy between June 1991 and August 1997. The surgeon was a general surgeon who had a special interest in paediatric surgery, and worked in a district general hospital. These patients were identified from clinical coding and theatre registers. Orchidopexy for reasons other than undescended testes were excluded. Case notes were reviewed for details of age, side of undescended testis, preoperative palpability, and the type of operation performed.The second part was a survey comprising a single sheet questionnaire (appendi...
Objective: To examine the current attitudes towards the prevention of venous thromboembolism among a cohort of surgeons. Design: A postal survey, comprising a questionnaire covering various aspects of venous thromboembolism prophylaxis was sent to all (n=84) consultant general surgeons in Wales. Results: Replies were received from 57 surgeons (68%), all of whom routinely used prophylaxis, the most frequent modalities used being heparin (100%) and graded compression stockings (79%). A combination of physical and pharmacological methods was used by over 89% of surgeons, with 60% starting prophylaxis more than two hours before operation. All surgeons continued prophylaxis after surgery, 53% until patients were mobile, 45% until they were discharged, and one surgeon continued prophylaxis for seven days after discharge. The thrombosis risk factors considered most important by surgeons when deciding about prophylaxis were (i) a previous history of venous thromboembolism, (ii) hypercoagulability, and (iii) malignancy. Conclusions: This study confirms that Welsh surgeons conform to standard methods, but also highlights some uncertainties that are present in current surgical practice. Those who responded all routinely used prophylaxis, the timing of which was variable. The main risk factors identified when considering prophylaxis were previous history of deep vein thrombosis/pulmonary embolism, hypercoagulability, and the presence of malignancy. Suggestions for future practice are made. P ostoperative venous thromboembolism represents a serious threat to patients undergoing a surgical procedure. Without antithrombotic prophylaxis, up to 15% of patients after major abdominal surgery develop a deep vein thrombosis (DVT), with the risk of fatal pulmonary embolism approaching 1%.
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