The urethra is a usual site of introduction of foreign bodies for autoerotic stimulation. We present an unusual case of bladder perforation caused by foreign body that was self-inserted in the urethra and consequently slipped inside the bladder in a 29-year-old female patient with psychiatric disease. The patient was referred to our department for macroscopic hematuria and abdominal pain. Imaging studies revealed the presence of a foreign body in the pelvic area which had perforated the left lateral wall of the bladder. The foreign body was removed via open cystotomy. In psychiatric patients hematuria and pelvic pain may result from insertion of a foreign body in the bladder usually during masturbation.
BackgroundLaparoscopic cholecystectomy is the gold standard treatment of gallbladder disease. Post-cholecystectomy syndrome is a severe postoperative complication which can be caused by multiple mechanisms and can present with multiple disorders. The wide use of laparoscopy induces the need to understand more clearly the presentation and pathophysiology of this syndrome. Post-cholecystectomy Mirizzi syndrome is one form of this syndrome and, according to literature, this is the first report that clearly describes it.Case presentationWe describe the case of a 62-year-old Greek woman who underwent laparoscopic cholecystectomy because of gallstone disease. A few days after surgery, post-cholecystectomy syndrome gradually developed with mild bilirubin increase in association with epigastric pain, nausea, and vomiting. After performing ultrasound, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography, we conducted a second laparoscopic surgery to manage the obstruction, which was converted to open surgery because of the remaining inflammation from the post-endoscopic retrograde cholangiopancreatography acute pancreatitis. Four polymeric laparoscopic clips were removed because they were identified as the cause of her post-cholecystectomy syndrome. She had a quick recovery without further complications.ConclusionsPostoperative Mirizzi syndrome induced by the migration of polymer laparoscopic clips is a rare (only one case referring to polymeric clips has been published in the literature) but a well-identified complication of laparoscopic cholecystectomy which can confuse the diagnostic and therapeutic field requiring simultaneous immediate management.
Anomalies of the appendix are rare, and one of the rarest is the double appendixes. Most anomalies of the appendix are observed in adults and are discovered incidentally during surgery that does not primarily involve the appendix. It is usually missed, often with life‐threatening consequences.
A case of a 75-year old male with right-sided exopthalmos is presented. Outside proptosis of the right eye was initially observed 6 years ago. Opthalmological and endocrinological clinical examination as well as laboratory tests revealed no pathology from optic nerve disc, optic bulb and thyroid related hormones. MRI study demonstrated an optic nerve meningioma. The key imaging findings and the differential diagnosis were discussed in this present paper. Case presentationA 75-year old male presents to our department with rightsided exopthalmos. Outside proptosis of the right orbital bulb in comparison with the left was initially observed 6 years ago. The patient visited an ophthalmologist and endocrinologist. Fundoscopic examination revealed no atrophy or oedema of the optic disc and no lesion of the optic bulb. Thyroid related hormones were measured within normal limits. The patient did not proceed to any imaging examinations and returned home. He was under steroid treatment with no response and comes to the hospital nowadays still presenting the same painless symptom (exopthalmos with no prominent change), however claiming visual colour disturbance. Fundoscopy and thyroid hormones still revealed no abnormal findings. MRI study of the orbital cavities was performed. In the MRI protocol T2, T2 with fat saturation, T1, T1 with fat saturation sequences, pre-and post gadolinium injection on axial, sagital and coronal planes were performed. A tubular mass was demonstated in the right orbit showing widening along the length of the nerve sheath and an anterior nerve expansion towards the globe. The mass appeared as isointense to brain and optic nerve tissue on T1 weighted images ( Fig. 1) and slightly hyperintense on T2 weighted images (Fig. 2). On T1 weighted images with fat saturation after intravenous administration of paramagnetic substance (gadolinium) the mass presented a homogeneous intense enhancement suggesting in appearance a "tram track" around the hypointense optic nerve (Fig. 3). There is no intracranial extension of the lesion (Fig. 1) or any evidence of surrounding structures invasion (Fig. 3). The presence of optic nerve sheath meningioma was assumed.
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