Rupture of the superficial vein of penis: therapeutic options.

OBJECTIVE: To report an uncommon clinical case of spontaneous rupture of the superficial dorsal vein of penis. METHOD: A 27-year-old male patient attended the emergency room following spontaneous occurrence of a large hematoma and deformity in the penis. Rupture of cavernous bodies was initially suspected. RESULTS: Surgical examination revealed rupture of the superficial dorsal vein of penis, which was ligated. The patient was admitted to hospital for 24 hours, and showed total cosmetic and functional recovery at 2 weeks. CONCLUSIONS: Rupture of the superficial dorsal vein of penis is an uncommon condition considered in differential diagnosis of penile hematoma. Doppler ultrasound of the penis may allow for its diagnosis and for excluding rupture of corpora cavernosa. Although conservative management appears to be of choice, surgical examination, providing good cosmetic and functional postoperative results, is indicated when a reasonable doubt exists about diagnosis.

Bilateral percutaneous nephrostomy as treatment for severe hemorrhagic cystitis.

OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy. METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported. RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required. CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures.

[Emphysematous cystitis: case report]. / Cistitis enfisematosa:a propósito de un caso.

OBJECTIVE: To report one case of emphysematous cystitis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture. RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved. CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infection of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysematous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysematous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treatment.

[Splenosis simulating a renal mass]. / Esplenosis simulando una masa renal izquierda.

OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin. RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied. CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations.

[Appendiceal mucocele misdiagnosed with infected urachal cyst: a differential diagnosis to keep in mind]. / Mucocele apendicular confundido con quiste de uraco infectado: un diagnóstico diferencial a tener en cuenta.

OBJECTIVE: To report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis. PATIENT: We report the case of a 74-year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal. RESULTS: Exploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele). CONCLUSIONS: Appendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei.

[Brucella orchyoepididymitis: case report]. / Orquiepididimitis brucelosa: a propósito de un caso.

OBJECTIVES: To report one case of unilateral acute orchiepididymitis due to Brucella and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a 37-year-old-male with undulant fever, scrotal pain and swelling and osteoarticular involvement. Diagnosis was obtained by anamnesis, blood cultures and specific serologic tests for Brucella. RESULTS: Antibiotic therapy with orally administered Doxycycline (6 weeks) and im-administered Streptomycin (3 weeks). Complete clinical resolution was achieved. CONCLUSIONS: We must perform an exhaustive anamnesis looking for a history of contact with animals or ingestion of contaminated dairy products in endemic areas of Brucella when facing the case of orchiepididymitis resistant to usual antibiotic therapy. The diagnosis is based on Brucella spp. isolation in blood cultures and on positive serologic tests (Rose Bengal test, standard seroagglutination test, anti-Brucella Coombs test, Brucellacapt test). Doxycycline with Streptomycin or Rifampin for 6 weeks seems to be the most adequate combinations of antibiotics. Surgical treatment only in exceptional cases.