Self-penile amputation: A case of Klingsor Syndrome.

Klingsor Syndrome is an infrequent Surgical and Psychiatric emergency. We present such a case of self-penile amputation with delayed presentation precluding re-plantation. A 48 year-old man on follow-up for Schizophrenia presented 16 hours after peripubic self-penile amputation. Patient was managed by stump-plasty with an option for subsequent perineal urethrostomy. Anatomically, there are three levels of penile amputation: peri-pubic like in our case, proximal shaft and glans. Surgical options are re-plantation, stump-plasty and total penile reconstruction. Complications following re-plantation include urethral stricture, urethral fistula, and diminished sexual function. Concomitant Psychiatric care is paramount.

Primary repair of esophageal perforation: Case report.

INTRODUCTION: Mortality after esophageal perforation is high irrespective of the treatment modality. The rarity of traumatic esophageal perforations has made it difficult to conduct comprehensive studies that can answer pertinent questions with regard to management. PRESENTATION OF CASE: We report a case of through and through thoracic esophageal injury caused by an assailant's arrow in a young physically active male adult. Diagnosis was made on-table. He successfully underwent primary repair of the esophageal injury 16 h post injury via a left thoracotomy. Recurrent lung collapse and pleural effusion was managed with tube thoracostomy and chest physiotherapy. DISCUSSION: Esophageal perforations occur infrequently and may produce vague symptoms leading to diagnostic and therapeutic delays. High index of suspicion particularly in penetrating chest trauma followed by relevant investigations may reduce delay. Principles of management include treatment of contamination, wide local drainage, source control and nutritional support. Source control is achieved surgically or through endoluminal placement of stents. Surgical options include primary repair, creation of a controlled fistula by T-tube or esophageal exclusion. CONCLUSION: Primary repair of traumatic injury to a healthy esophagus is feasible for cases diagnosed early and without significant mediastinal contamination as in our case. Associated injuries are more likely in such cases to lead to increased morbidity and prolonged hospital stay and must be handled carefully.