A 56-Year-Old Woman Presenting 19 Years After Pubic Bone Fracture with a Surgical Screw Foreign Body in the Bladder.

BACKGROUND Non-calculus foreign bodies in the bladder are rare and are usually introduced via the urethra. Reports of the migration of metallic foreign bodies from previous surgery are uncommon and mainly associated with surgical screws used for the internal fixation of pubic bone fracture and total hip replacement. This report is of a 56-year-old woman presenting with a surgical screw foreign body in the bladder 19 years after open surgical reduction and internal plate and screw fixation of traumatic fracture of the pubic bone. CASE REPORT A 56-year-old woman visited a urologist because of gross hematuria. She mentioned a mild pelvic pain and multiple lower urinary tract infections over the past 2 years, with no other symptoms. From the previous history, she had undergone an open reduction and internal fixation of the pelvic ring, with surgical plates and screws following pubic bone's fracture, due to an accident 19 years earlier. Cystoscopy identified the presence of a screw head protruding into the bladder wall. The screw was extracted via open surgery, and the patient was discharged 2 days later. CONCLUSIONS While intravesical foreign bodies are rarely seen in Emergency Departments, clinicians should maintain a level of suspicion in certain cases. The purpose of this case report is to present the unlikely and delayed complication of internal pubic bone fixation resulting in the migration of a fixation screw to the bladder. It also highlights the importance of imaging in diagnosis and localization of the foreign body in the bladder.

Combination of Adenomyoepithelioma and Adenoid Cystic Carcinoma of the Breast: A Case Report of an Uncommon Histopathological Entity.

BACKGROUND Adenomyoepithelioma and adenoid cystic carcinoma are uncommon types of breast tumors. Adenoid cystic carcinoma accounts for 0.1% of breast neoplasms and typically presents as a tender breast tumor, mostly in the subareolar area. Adenoid cystic carcinoma usually appears in women in the fifth or sixth decade of life and predominantly presents as a mixed tumor, with cribriform, tubular, and solid growth characteristics. Adenomyoepithelioma of the breast shows epithelial and smooth muscle characteristics. Adenomyoepithelioma rarely goes through malignant transformation and is an uncommon type of benign breast tumor. CASE REPORT Our study reviews the current published literature regarding the combination of these 2 rare neoplasms of the breast and shows a rare case of a 48-year-old woman with a combination of adenoid cystic carcinoma and adenomyoepithelioma. CONCLUSIONS The combination of adenoid cystic carcinoma and adenomyoepithelioma should be part of the differential diagnosis in breast cancer. More research is needed regarding the optimal therapy, which is currently surgical excision.

The Anatomical Relationship of Inferior Thyroid Artery and Recurrent Laryngeal Nerve: A Review of the Literature and Its Clinical Importance.

BACKGROUND: Thyroidectomy is a quite common daily operation in general surgery. However, the anatomical structures of the region, mainly the relationship of recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) makes the procedure challenging. The current review of the literature aims to report the anatomical variations of this relationship. METHODS: The preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines were used for the systematic review of the articles found after an extensive research through PubMed, Science Direct, EMBASE and Web of Science. A total of 16 studies were included for the statistical analysis. RESULTS: The results showed that the most common type of RLN was posterior to the ITA. However, according to Higgins I2 statistics the heterogeneity of the studies was quite high. CONCLUSIONS: The relationship between the RLN and the ITA is quite variable. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the nerve during thyroidectomy.

Valentino's Syndrome (with Retroperitoneal Ulcer Perforation): A Rare Clinico-Anatomical Entity.

BACKGROUND In the emergency department pain in the right lower quadrant is a frequent finding and is related to a wide variety of diseases, the most common of which is acute appendicitis. An unusual presentation of pain in the right iliac fossa is due to perforation of a duodenal peptic ulcer. The fluid that originates from the perforated ulcer moves through the paracolic sulcus to the right iliac fossa and causes irritation of the peritoneum and even chemical peri-appendicitis, thereby imitating all the usual causes of pain in the right lower quadrant. This condition is known as Valentino's syndrome, named after the Italian actor Rudolph Valentino. CASE REPORT The aim of this case report was to review the current published literature regarding Valentino's syndrome and report on a case involving a 51-year-old male who was admitted to our surgical department with right lower quadrant pain and suspicion of acute appendicitis. An exploratory laparotomy was performed, from which a retroperitoneal perforation of a duodenal ulcer was found; suture closure was then applied. The patient's postoperative course was uncomplicated, and he was discharged 9 days after the operation. CONCLUSIONS Surgeons should be alert for this rare condition imitating acute appendicitis, and the differential diagnosis of right lower quadrant pain should include peptic ulcer perforation.

The Anatomical Characteristics of Corona Mortis: A Systematic Review of the Literature and Its Clinical Importance in Hernia Repair.

BACKGROUND: Inguinal hernia repair is one of the most common daily operations in general surgery. However, the anatomical structures of the region, such as the corona mortis (the crown of death), make this procedure quite challenging. A comprehensive knowledge of its anatomy is essential, since massive hemorrhage may occur if the vessel is injured. The current review of the literature aimed to report the frequency and anatomical variations of vascular corona mortis. METHODS: A substantial study was coordinated through PubMed, Scopus and Google Scholar. The Prisma guidelines were used for the systematic review of the articles found. A total of 13 studies and 1,455 patients were included for the statistical analysis. RESULTS: The results showed that corona mortis was present in about half the hemi-pelvises, and to be more accurate, the prevalence was 46%. Venous corona mortis was more frequent than the arterial type (42% vs. 25%). CONCLUSIONS: Considering the percentages mentioned above, every surgeon who schedules an operation on the retro-pubic area, especially during a hernioplasty procedure, should evaluate the possibility of the presence of corona mortis. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the corona mortis during surgery.