Two cases of the management and pathophysiology of high flow arterial priapism are presented. Both cases were post-traumatic with delayed onset of priapism and both had angiographically diagnosed arteriocorporeal fistulas. Case 1 was managed with selective cavernous artery ligation and case 2 resolved spontaneously, both with excellent return of premorbid levels of erectile function. We propose that the pathophysiological mechanism involves injury to the intracavernous artery, causing ischemic necrosis. After a delay the arterial segment blows out, leading to unregulated blood flow into the corpus cavernosum. Management with surgical ligation is highly selective and nondisruptive to unaffected vessels, offering precise control of the bleeding vessel.
Wandering spleen is a rare entity which may present with symptoms suggestive of other, more common abdominal processes. Torsion of the long pedicle may occur causing abdominal pain. This article describes a case of wandering spleen diagnosed by computed tomography (CT). Liver spleen scintigraphy and sonography supported this diagnosis and suggested torsion. To our knowledge this is only the second case of this entity in which color flow and duplex Doppler findings have been reported.
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