Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion

OBJECTIVE: To analyze the morphology of epididymis and tunica vaginalis as well as their anatomical anomalies in patients with testicular torsion. MATERIALS AND METHODS: We studied 25 patients (50 testes) aged between 12 and 23 years (mean 15.6). Torsion length ranged from 2 hours to 2 days (mean 8 hours). Epididymal anatomy was classified in 6 groups: Type I - epididymis united to the testis by its head and tail; Type II - epididymis totally united to the testis; Type III - disjunction of epididymal tail; Type IV - disjunction of epididymal head; Type V - total disjunction between testis and epididymis, and Type VI - epididymal atresia. The type of torsion was classified in 3 groups: Group A - intravaginal torsion; Group B - extravaginal torsion and Group C - torsion due to long mesorchium. RESULTS: Of the 50 analyzed testes, 40 (80 percent) presented bell clapper deformity (with 21 presenting intravaginal torsion); 8 testes (16 percent) had long mesorchium (4 with torsion), and only 2 (4 percent) presented normal anatomy in the tunica vaginalis. The most frequently found anatomical relationship between testis and epididymis was Type I - 38 cases (76 percent); Type II relationship was found in 6 cases (12 percent) and Type III relationship was found in 6 cases (12 percent). CONCLUSIONS: Intravaginal torsion is the most frequent type, and torsion due to long mesorchium is associated with cryptorchism. The most frequently found anatomical relation between testis and epididymis in the study group was Type I.

Traumatic rupture of adrenal pseudocyst leading to massive hemorrhage in retroperitoneum

We present the case of a patient who had a large pseudocyst in the right adrenal gland, which was ruptured following blunt abdominal trauma, leading to a voluminous hemorrhage in retroperitoneum. A 29-year old female patient was admitted in the emergency room following a fall from stairs with trauma in right flank. She underwent a computerized tomography that evidenced a large retroperitoneal collection, with no apparent renal damage. She was submitted to surgery, where a large ruptured cyst was observed, originating from the upper portion of the right adrenal gland. Cystic diseases of adrenal gland are rare. Highly voluminous cysts can be damaged in cases of blunt trauma to the lumbar region leading to large hematomas in retroperitoneum.

Study on the incidence of testicular and epididymal appendages in patients with cryptorchidism

OBJECTIVE: To study the incidence of testicular and epididymal appendages in patients with cryptorchidism. MATERIALS AND METHODS: We studied 65 patients with cryptorchidism, totalizing 83 testes and 40 patients who had prostate adenocarcinoma and hydrocele (control group), totalizing 55 testes. The following situations were analyzed: I) absence of testicular and epididymal appendages, II) presence of testicular appendage only, III) presence of epididymal appendage, IV) presence of testicular and epididymal appendage, V) presence of 2 epididymal appendages and 1 testicular appendage and VI) presence of paradidymis or vas aberrans of Haller. RESULTS: In patients with cryptorchidism we found testicular appendages in 23 cases (41.8 percent), epididymal appendages in 9 (16.3 percent), testicular and epididymal appendage in 8 (14.5 percent), 2 epididymal appendages and 1 testicular in 1 (1.8 percent) and absence of appendages in 14 (25.4 percent). In the control group, we found testicular appendages in 29 (34.9 percent), epididymal appendages in 19 (22.8 percent), testicular and epididymal appendage in 7 (8.4 percent), and absence of appendages in 28 (33.7 percent), we did not find 2 epididymal appendages in this group, and none of the patients in the 2 groups presented paradidymis or vas aberrans of Haller. CONCLUSION: The occurrence of testicular and epididymal appendages is quite variable. There was no statistically significant difference in the incidence and distribution of the testicular and epididymal appendages between patients with cryptorchidism and those from the control group.

Appendicitis obstructing a ureteral system with incomplete duplication / Apendicite obstruindo um sistema ureteral com duplicação incompleta

A obstrução ureteral é uma complicação bem conhecida da apendicite. Existem relatos de obstruções ureterais unilaterais e bilaterais; entretanto, não existem relatos sobre a apendicite levando à obstrução de um sistema ureteral duplicado. Nós descrevemos um caso de obstrução ureteral em um sistema ureteral com uma duplicação em Y incompleta. Uma mulher branca de 36 anos de idade apresentou-se com quadro de dor no abdomen inferior associado à febre e vômitos por uma semana. A análise da urina revelou hematúria microscópica e piúria. O hemograma revelou sinais de infecção. O primeiro diagnóstico foi de pielonefrite, e a paciente foi tratada com antibióticos apresentando boa resposta. A paciente foi submetida a uma pielografia intravenosa que revelou duplicação ureteral incompleta do lado direito, dilatação do uretér médio e hidronefrose no pólo inferior. Uma pielografia retrógrada foi realizada para confirmar a duplicação em Y incompleta. a tomografia computadorizada do abdomen revelou massa heterogênea no quadrante inferior direito. Uma laparotomia foi realizada e foi possível identificar uma apendicite causando a compressão de um dos ureteres do sistema duplo. A paciente foi submetida à apendicectomia e apresentou evolução sem intercorrências.