RESUMO
Umbilical nodes and cords play a crucial role in fetal development and are essential for the transfer of nutrients and oxygen between the mother and the fetus. Sonographic diagnosis of umbilical nodes and cords has become an integral part of prenatal care, allowing for the early detection of abnormalities and potential complications. The umbilical cord is a vital structure connecting the fetus to the placenta, providing essential nutrients and oxygen for fetal growth and development. Sonographic examination of the umbilical cord and its associated nodes has become an indispensable tool in prenatal care, enabling the early detection of abnormalities and potential complications. This review aims to analyze the current literature on sonographic diagnosis of umbilical nodes and cords, highlighting the key points and advancements in this field. A 37-year-old booked G4P2+1A2 Nigerian woman was registered for prenatal tertiary health care at 12 weeks of gestation. The booking investigations were normal and the booking packed cell volume was 37%. She was compliant with scheduled clinic visits and routine drugs. Pregnancy was carried to term uneventfully. Elective cesarean section was successfully performed at 38 weeks of gestation owing to the patient's prior history of third-degree perineal tear. The intraoperative findings included a loose cord around the neck of the baby and double true knots along the length of the 65 cm umbilical cord. The baby was delivered with appearance, pulse, grimace, activity and respiration (APGAR) scores of 7 in the first minute, 9 in the fifth minute, and the birth weight was 3.0 kg. Mother and baby were discharged 48 h postpartum in stable clinical condition. Although the presence of true double umbilical knots is rare, its coexistence with the nuchal cord is even rarer. There are risk factors associated with true umbilical knots. The possible risk factor implicated in this index case is the gender of the fetus and maternal multiparity. True umbilical knots are usually associated with certain fetal negative outcomes of pregnancy. There are currently no evidence-based treatment options available.
RESUMO
Transverse vaginal septum is a congenital anomaly in which a membrane obstructs the vagina. This can be partial or complete in type. Although rare, it presents peculiar challenges in symptomatology, diagnosis, and ultimate management. To our knowledge, we are the first to report a shortest vaginoplasty-conception interval following successful repair of previously failed repair of partial transverse vaginal septum. A 28-year-old Nigerian married nulliparous lady who presented to us with history of inability of penile-vaginal penetration with the presence of normal menstrual flow after two previous failed attempts at repair. She had a vaginoplasty with placement of a vaginal mold to prevent stenosis. She was subsequently able to have successful sexual intercourse and achieved pregnancy after 2 months, without recurrence of vaginal stenosis. When transverse vaginal septum is encountered in a married nullipara, a thorough clinical evaluation of the viability and feasibility of a vaginoplasty should be made during the first surgery. If repeated failed repair occurs, as in our case, we recommend meticulous and experienced surgical attention from the outset. The originality in this report lies in the very short period between repair and successful conception. Thus, we obtained satisfactory short-term clinical outcome of successful conception at the 2 months follow-up.
RESUMO
Background: Management of urethral stricture disease remains a challenge in the field of urology. Though several options exist for its management, urethroplasty has proved to give the best outcome. Methodology: This is a retrospective study of urethral strictures and urethroplasties for 5years spanning from January 2015 to December 2019 at a tertiary teaching hospital in Anambra, South East Nigeria. Data was retrieved from the case notes of all the urethral strictures cases which presented to our facility in these 5 years and analysed using Microsoft Excel. Results: A total of 186 patients were diagnosed with urethral stricture disease within the 5 years' period. However, only 28 (15.1%) of them had urethroplasty within the period, mostly due to lack of fund. Of those who had urethroplasty, their ages ranged from 4 - 64 years with a median of 29.50 years. Motor vehicular road traffic accident (RTA) was the most common (46.43%) aetiology. Excision and anastomosis was the most common type of urethroplasty performed (71.43%) and the most common complication was stricture recurrence (32.14%). Conclusion: Though urethroplasty techniques have become more refined, accessibility of care continues to hamper treatment in Sub-Saharan Africa due to socioeconomic issues.
RESUMO
Enterovesical fistula represents an abnormal communication between the urinary bladder and the gastrointestinal tract. It can result spontaneously from different disease processes, but can also complicate a surgical procedure. While most involve the large bowel, few involve the small bowel and these present with more clinical problems, as well as challenges in diagnosis and management. The patient is a 50-year-old P8 +0, woman who presented to our facility with a 6 months' history of faecaluria. There was associated history of urinary frequency, urgency, pneumaturia and dysuria. She had subtotal hysterectomy 6 years prior to presentation. Cystography, Abdominal computed tomography scan, and cystoscopy done revealed a small bowel fistula with the bladder. She had exploratory laparotomy which revealed the fistula and extensive intra-abdominal nylon suturing of bladder and jejunum. She was treated and did well postoperatively. Enterovesical fistula can follow wrong suture use in surgical procedures even many years after the procedure. A high index of suspicion and imaging modalities are needed for early diagnosis and prompt management.