Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure.

Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients.

Suprapubic cystostomy using optical urethrotome in female patients.

PURPOSE: In many female patients for lower urinary tract reconstructive procedures, a suprapubic cystostomy along with perurethral catheter is required for urinary diversion. We describe a new and simple method of intraoperative suprapubic catheter placement using optical urethrotome wherein distension of bladder is not required. PATIENTS AND METHODS: A total of 26 patients underwent suprapubic catheter placement intraoperatively with the aid of Sachse' optical urethrotome and its outer sheath from January 2005 to May 2008. RESULTS: A 16F Foley catheter could be successfully placed suprapubically in all patients with this method. There were no complications like injury to intraabdominal viscera, retropubic hematoma, hematuria, or catheter dislodgement. CONCLUSION: We describe a new method of intraoperative suprapubic catheter placement in female patients that is minimally invasive, technically safe, simple, and effective, and does not require bladder distension.

Shrapnel injury due to a firecracker causing gastric and gallbladder perforation.

A 14-year-old boy presented with a penetrating injury to the abdomen after trying to light a firecracker. A piece of metal from the tin box in which he had ignited the firecracker had penetrated his abdomen. The patient, who was in a state of shock, underwent ultrasonography (USG) and radiography of the abdomen. USG revealed free fluid in the abdomen, while abdominal radiographs demonstrated free gas and a radiopaque object. Exploration revealed gastric and gallbladder perforations for which repair and cholecystectomy were done, respectively. Visceral injury following a firecracker explosion has not been reported previously. We would like to stress the importance of parental supervision to prevent irresponsible use of firecrackers, which can cause potentially life-threatening visceral injuries.

Management strategy for dirty abdominal incisions: primary or delayed primary closure? A randomized trial.

BACKGROUND AND PURPOSE: It is still a matter of debate whether delayed primary closure (DPC) of dirty abdominal incisions reduces surgical site infections (SSIs) compared with primary closure (PC). Our objective was to determine whether DPC of dirty abdominal incisions reduces SSIs. METHOD: A controlled randomized study was conducted at an academic tertiary care 1,500-bed university hospital in Western India involving 81 consecutive patients with dirty abdominal incisions. Only 77 patients (DPC = 37, PC = 40) were evaluable because of the deaths of four patients. A total of 52 patients had peptic or typhoid perforations, whereas the rest had appendicular perforations/abscesses, penetrating or blunt abdominal injuries with gastrointestinal perforation, or intra-peritoneal abscesses. Patients were randomized to have their surgical incisions (skin and subcutaneous tissue) either closed primarily (PC) or left open with saline-soaked gauze dressings for DPC on the 3(rd) postoperative day or later if the incision conditions were inappropriate for closure. The main outcome measure was the incidence of postoperative SSI. RESULTS: In the entire series, SSI developed after incision closure in 23% of the patients. Infections were significantly more common in the PC group (42.5% vs. 2.7% for DPC; p = 0.0000375). There also were significantly more cases of abdominal dehiscence in the PC group (DPC 1 [2.7%] vs. PC 10 [25%]; p = 0.005). The mean complete incision healing (CIH) time and length of hospital stay (LOS) were longer after PC (18.52 days) than DPC (13.86 days), resulting in a significant difference in the end point of healing and LOS (p = 0.0207). Short-term cosmetic results for PC incisions were significantly inferior to those for DPC (p = 0.03349). CONCLUSIONS: Delayed primary closure is a sound incision management technique that should be utilized for dirty abdominal incisions. It significantly lowers the rate of superficial SSI as well as fascial dehiscence and reduces the mean CIH time and hospitalization. The short-term cosmetic appearance is superior.