Bladder neck rupture following perineal bull horn injury: a surgical challenge.

Pelvic-abdominal injuries caused by goring are serious lesions which require rapid diagnosis and urgent treatment in the context of a polytraumatized patient. The simultaneous rupture of both the bladder and the prostatic-membranous urethra occurs in 10%-29% of males with pelvic fractures but bladder neck injuries in adults are rarer. Unstable pelvic fractures, bilateral fractures of the ischiopubic branches (also referred to as fractures from falling astride) and the diastasis of the pubic symphysis are those that have the greatest likelihood of injuring both the posterior urethra and the bladder. We present a case of perineal bull horn injury with muscle laceration, bone fractures, scrotal avulsion and rupture of the bladder neck involving the right ureter which required two operations to be repaired.

Rotura de riñón en herradura / Horseshoe kidney rupture

OBJETIVO: Presentamos un caso infrecuente de rotura de riñón en herradura.MÉTODOS: Se aporta el caso de un varón de 67 años con riñón en herradura, que presentó una fractura del istmo renal tras caída.RESULTADOS: El diagnóstico se realizó por TAC abdómino-pélvico con contraste. Se somete a laparotomía exploradora debido a la inestabilidad hemodinámica del paciente y a las características radiológicas del TAC. CONCLUSIONES: La rotura de riñón en herradura es una lesión infrecuente. El TAC abdomino-pélvico es la prueba de elección para clasificar el grado de lesión. Dependiendo de la estabilidad hemodinámica del paciente y de los hallazgos encontrados en el TAC se optará por tratamiento conservador o quirúrgico inmediato(AU)

OBJECTIVE: We report a rare case of horses-hoe kidney trauma.METHODS: 67 years old man with a horseshoe kidney, which presented a fracture of the isthmus after falling.RESULTS: The diagnosis was made by IV contrast CT scan. He underwent exploratory laparotomy due to hemodynamic instability and radiologic findings on the CT scan.CONCLUSIONS: The rupture of a horseshoe kidney is a rare injury. CT scan is the test of choice to classify the degree of injury. Depending on the patient’s hemodynamic stability and the findings on the CT scan the options are conservative orimmediate sur-gical treatment(AU)

[Post-traumatic arterial priapism resolved using supraselective embolization]. / Priapismo arterial postraumático resuelto por embolización supraselectiva.

Presentation of a new case of high flow priapism in a patient with recent background of perineal traumatism. Diagnosis, already inferred through anamnesis, was later suspected from the results of blood gasometry in cavernous bodies, and eventually confirmed by Eco-Doppler. A revision of the related literature revealed a total of 20 patients in whom supraselective embolization has been used as the therapeutical approach, Bucrylate being used in only two of them. Finally, a few considerations are contributed on the therapeutical management of these patients and the relevance of a correct diagnosis of the two distinct groups of priapism, since they differ considerably in terms of treatment.

[Ambulatory treatment of lithiasis with Dormia extractor and intraureteral injection with xylocaine gel]. / Tratamiento ambulatorio de la litiasis mediante extractor de Dormia e inyección endoureteral con gel de xylocaina.

Our initial experience in ambulatory extraction of ureteral stones, with local anaesthesia and lubrication with xylocaine gel are reported in this paper. Extraction was thus simplified in all patients and there was no need for further sedation in 97.3% of cases. Overall results, considering the promptitude and simplicity of the methods and significant cost-efficacy ratio can be considered optimal, and their efficacy is not below that of the other current therapeutical alternatives for this type of lithiasis. We therefore conclude that the method, far from being relegated by the various lithotripsy techniques, may on the contrary constitute a useful complement to them, able to solve in an ambulatory fashion more than 60% of cases of ureteral lithiasis.