Neither inguinoscrotal hernia nor hydrocele misunderstood giant testicular neoplasm. Case report and literature review.

AIM: This case experience aims to question the current know-how when a masked testicle malignancy occurs, in order to achieve the correct clinical framework and avoid mistakes during surgical procedures. in the evaluation MATERIALS AND METHODS: A 36-year-old male patient was admitted with an incorrect diagnosis of left-sided incarcerated inguinoscrotal hernia, and then discovered a seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge. RESULTS: The surgery was perceived by the patient as the best possible treatment because the symptoms were relieved. DISCUSSION: A 36-year-old male patient was admitted to our surgical department due to an incorrect diagnosis of leftsided incarcerated inguinoscrotal hernia, consequently to a misguided scrotal ultrasound-doppler exam. During the urgent surgical operation, we realized that we were dealing with an enormous 17x10x9 cm seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge. CONCLUSION: This case report points out that there may be a poor correlation between clinical findings and pathophysiologic processes affecting scrotal structures. Additional radiological investigations, such as CT scan, could clarify and confirm the clinical scenario, improving the preoperative planning and surgical outcomes. KEY WORDS: Inguinal Hernia, Seminoma, Testicular Neoplasm.

The HELLP syndrome: clinical issues and surgical management. A Case Experience.

AIM: This study aims to challenge the current know-how in patients with spontaneous rupture of a liver hematoma, to differentiate amongst patients requiring such specific surgical therapy and avoiding mistakes during surgical operations, in order to terminate pregnancy with beneficial effects on the mother and fetus. MATERIALS AND METHODS: In a emergency scenario we admitted a 37-year-old woman at 35+4 weeks of gestation for emergency cesarean section after the onset of right hypochondrium pain. A diagnosis of hemoperitoneum and severe preeclampsia with liver and splenic bleeding was done and managed with packing of hepatic and splenic hematomas and according to her haemo-dynamic clinical conditions, done in different time. RESULTS: A diagnosis of hemoperitoneum and severe pre-eclampsia with liver and splenic bleeding was done and managed it with 3 xypho-pubic-laparatomy in different time with haemostatic packing. DISCUSSION: In this case report, the patient underwent an emergency caesarean section and was managed with packing of hepatic and splenic hematomas and according to her haemodynamic clinical conditions was operated in different time. The choice of laparotomy and hepatic packing has proved to be a viable option in patients with unstable vital signs and is feasible even in limited resource settings. CONCLUSION: Short interval between diagnosis and management may enhance the feto-maternal survival rate and prevent further morbidity or mortality. The choice of laparotomy and hepatic packing has proved to be a viable option in patients with unstable vital signs and is feasible even in limited resource settings. KEY WORDS: HELLP syndrome, Liver hematoma rupture, Packing.