Clinically, the cephalic vein is preferred for haemodialysis in patients with chronic renal failure (CRF), to remove waste products from blood. The cut-down of cephalic vein in the deltopectoral groove is preferred when superior vena caval infusion is necessary. However, cephalic veins exhibit a wide array of developmental variations in terms of formation, course, and termination. In this report, we describe a case of an anomalous cephalic vein with a bifid course of terminations on both left and right upper limbs which has not been described by previous literature. During routine gross anatomy dissection of the neck, we observed a rare case of variation of the termination of the cephalic vein in both right and left upper limbs, of a male cadaver. Knowledge of the variations of cephalic vein is important not only for anatomists but also for surgeons and clinicians as the vein is frequently used for different surgical procedures and for obtaining peripheral venous access as well.
A complete penoscrotal transposition (CPST) is a very uncommon congenital maldevelopment that is always associated with other abnormal body variations (malformations). We report a rare case of a term neonate delivered with CPST, which had a flaccid penis and an intact scrotum with unilateral limb and digital deformity, imperforate anus, cardiac malformation a facial deformity. Neonate died two hours after delivery. The foetal abnormality was not detected through routine antenatal services received by the mother.
Background
Disorders of sex development are anomalies in which the development of urogenital ridge is undifferentiated for the male and female child. Imaging plays a vital role in investigating the gross anatomy and associated anomalies. Ultrasonography, such as genitography and magnetic resonance, is the primary modality for demonstrating internal gonads and genitalia. Early multidisciplinary approach in the management of ambiguous genitalia including early surgical intervention is the predominant practice, with few current considerations on deferral of genital reconstruction until adolescent age.
Case presentation
We report the rare case of a 24-year-old adult female from a majority ethnic group of the Volta region, Ghana who was diagnosed and raised as male, now requiring surgical restoration to the female gender. The surgical team decided to assign external genitalia to correspond with the already intact internal organs, thus constructing the vulva. Consent was given by the client and her family members for management and surgical intervention. The surgery was scheduled and duly performed with a successful outcome. Understanding and consent was sought from the patient for the purpose of using her images for teaching, scientific publication, and demonstrations.
Conclusion
The advantages of deferring surgical reconstruction with psychological counseling after early assessment need to be considered to prevent inappropriate gender assignment.
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