Rupture of the superficial vein of penis: therapeutic options.

OBJECTIVE: To report an uncommon clinical case of spontaneous rupture of the superficial dorsal vein of penis. METHOD: A 27-year-old male patient attended the emergency room following spontaneous occurrence of a large hematoma and deformity in the penis. Rupture of cavernous bodies was initially suspected. RESULTS: Surgical examination revealed rupture of the superficial dorsal vein of penis, which was ligated. The patient was admitted to hospital for 24 hours, and showed total cosmetic and functional recovery at 2 weeks. CONCLUSIONS: Rupture of the superficial dorsal vein of penis is an uncommon condition considered in differential diagnosis of penile hematoma. Doppler ultrasound of the penis may allow for its diagnosis and for excluding rupture of corpora cavernosa. Although conservative management appears to be of choice, surgical examination, providing good cosmetic and functional postoperative results, is indicated when a reasonable doubt exists about diagnosis.

Rotura de la vena superficial del pene: opciones terapéuticas / Rupture of the superficial vein of penis: therapeutic options

OBJETIVO: Presentar un caso clínico poco frecuente de rotura de vena dorsal superficial del pene, producida de forma espontánea.MÉTODO: Paciente de 27 años que acude a urgencias tras la aparición espontánea de gran hematoma y deformidad peneana. La sospecha diagnóstica inicial fue rotura de cuerpos cavernosos.RESULTADOS: Se realiza exploración quirúrgica, evidenciando la rotura de la vena dorsal superficial del pene, que se liga. Ingreso hospitalario de 24 horas. Completa recuperación estética y funcional a las 2 semanas.CONCLUSIONES: La rotura de la vena dorsal superficial del pene es una entidad poco frecuente, incluida dentro del diagnóstico diferencial de los hematomas peneanos. La ecografía-doppler peneana puede permitir su diagnóstico y excluir la rotura de cuerpos cavernosos. Aunq-ue el tratamiento conservador parece de elección, ante la duda diagnóstica razonable, está indicada la exploración quirúrgica, la cual ofrece buenos resultados postoperatorios estéticos y funcionales (AU)

OBJECTIVE: To report an uncommon clinical case of spontaneous rupture of the superficial dorsal vein of penis.METHOD: A 27-year-old male patient attended the emergency room following spontaneous occurrence of a large hematoma and deformity in the penis. Rupture of cavernous bodies was initially suspected.RESULTS: Surgical examination revealed rupture of the superficial dorsal vein of penis, which was ligated. The patient was admitted to hospital for 24 hours, and showed total cosmetic and functional recovery at 2 weeks.CONCLUSIONS: Rupture of the superficial dorsal vein of penis is an uncommon condition considered in differential diagnosis of penile hematoma. Doppler ultrasound of the penis may allow for its diagnosis and for excluding rupture of corpora cavernosa. Although conservative management appears to be of choice, surgical examination, providing good cosmetic and functional postoperative results, is indicated when a reasonable doubt exists about diagnosis (AU)

Bilateral percutaneous nephrostomy as treatment for severe hemorrhagic cystitis.

OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy. METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported. RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required. CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures.

Nefrostomía percutánea bilateral como tratamiento de las cistitis hemorrágica severa / Bilateral percutaneous nephrostomy as treatment for severe hemorrhagic cystitis

OBJETIVO: Presentar un caso de cistitis hemorrágica severa tratada exitosamente mediante nefrostomía percutánea bilateral.MÉTODO: Presentamos el caso de una mujer de 67 años que presenta hematuria macroscópica monosintomática con coágulos.RESULTADOS: Fracaso de los tratamientos conservadores habituales y desarrollo de vejiga coagulada. Evacuación endoscópica y electrocoagulación de las áreas sangrantes sin éxito. Dada la persistencia de hematuria y desarrollo de insuficiencia renal e inestabilidad hemodinámica se decide nefrostomía percutánea bilateral. A las 24 horas cesa la hematuria, la paciente recupera la estabilidad hemodinámica y no requiere nuevas transfusiones sanguíneas.CONCLUSIONES: La realización de nefrostomía percutánea bilateral puede ser una opción útil en el tratamiento de la cistitis hemorrágica ante el fracaso de las medidas conservadoras habituales y como paso previo a la realización de otros tratamientos más invasivos(AU)

OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy.METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported.RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required.CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures(AU)

[Emphysematous cystitis: case report]. / Cistitis enfisematosa:a propósito de un caso.

OBJECTIVE: To report one case of emphysematous cystitis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture. RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved. CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infection of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysematous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysematous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treatment.

[Splenosis simulating a renal mass]. / Esplenosis simulando una masa renal izquierda.

OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin. RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied. CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations.

Cistitis enfisematosa. A propósito de un caso / Emphysematous cystitis: Case report

Resumen.- OBJETIVO: Presentar un caso de cistitis enfisematosa y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada.MÉTODO: Presentamos el caso de una mujer de 91 años, diabética tipo II, con ictericia, hematuria, vómitos, dolor abdominal y mal control glucémico. El diagnóstico inicial fue mediante radiografía simple de abdomen y ecografía abdominal, luego confirmado con TC. Urocultivo positivo para Escherichia coli.RESULTADOS: Tratamiento antibiótico intravenoso con piperacilina-tazobactam, sondaje vesical y control estricto de las glucemias. Alta hospitalaria a los 5 días con sonda urinaria y tratamiento antibiótico vía oral durante 14 días con amoxicilina-clavulánico. Completa resolución clínica, radiológica y microbiológica del cuadro.CONCLUSIONES: La cistitis enfisematosa es una entidad poco frecuente, típica de mujeres diabéticas, producida por microorganismos productores de gas, principalmente E.coli. Su presentación clínica es variable. El diagnóstico generalmente se realiza por métodos de imagen, fundamentalmente TC. El tratamiento consiste en drenaje vesical, estricto control glucémico y antibioterapia de amplio espectro. El pronóstico suele ser favorable, salvo en un 10-20% de los casos, en los que se requiere intervención quirúrgica(AU)

OBJECTIVE: To report one case of emphyse-matous cystitis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture. RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved.CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infec-tion of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysema-tous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysema-tous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treat-ment(AU)

Esplenosis simulando una masa renal izquierda / Splenosis simulating a renal mass

OBJETIVO: Presentar un caso de esplenosis y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada.MÉTODO: Presentamos el caso de un varón de 49 años, esplenectomizado a los 22 años. Hallazgo incidental de una masa perirrenal izquierda en RM lumbo-sacra, de probable origen renal. RESULTADOS: Se realiza TC abdómino-pélvico descartando el origen renal de la masa. Dado el antecedente de esplenectomía la sospecha diagnóstica fue de esplenosis. Se realizó gammagrafía hepato-esplénica con hematíes desnaturalizados marcados con 99mTc confirmando el diagnóstico. Se decidió abstención terapéutica.CONCLUSIONES: Ante el hallazgo de masas de origen desconocido, fundamentalmente en la cavidad peritoneal, debe ser tenida en cuenta la posibilidad diagnóstica de esplenosis, sobre todo si existe un antecedente de lesión esplénica traumática o quirúrgica. Para su diagnóstico se pueden emplear pruebas no invasivas elevada especificidad, como la gammagrafía hepato-esplénica, la gammagrafía esplénica con hematíes desnaturalizados, o la RM con ferumóxido, evitando exploraciones quirúrgicas innecesarias(AU)

Summary.- OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin.RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied.CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations(AU)

[Appendiceal mucocele misdiagnosed with infected urachal cyst: a differential diagnosis to keep in mind]. / Mucocele apendicular confundido con quiste de uraco infectado: un diagnóstico diferencial a tener en cuenta.

OBJECTIVE: To report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis. PATIENT: We report the case of a 74-year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal. RESULTS: Exploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele). CONCLUSIONS: Appendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei.

Mucocele apendicular confundido con quiste de uraco infectado: un diagnóstico diferencial a tener en cuenta / Appendiceal mucocele misdiagnosed with infected urachal cyst: a differential diagnosis to keep in mind

Objetivo: Presentar un caso de mucocele apendicular confundido con un quiste de uraco infectado. Revisar su diagnóstico diferencial, tratamiento y pronóstico. Paciente: Presentamos el caso de un varón de 74 años, con dolor abdominal, fiebre y disuria. Imagen compatible con absceso hipogástrico en ecografía y TC. Drenaje percutáneo y tratamiento antibiótico. Enema opaco, colonoscopia y cistoscopia normales. Resultados: Laparotomía exploradora y exéresis de gran masa adherida a ciego, independiente de vejiga. Resección segmentaria apéndice-cecal. Diagnóstico anátomo-patológico de cistoadenoma mucinoso (mucocele) apendicular. Conclusiones: Mucocele apendicular y quiste de uraco son patologías poco frecuentes, asintomáticas en la mayoría de los casos. Los mucoceles secundarios a cistoadenoma o cistoadenocarcinoma suelen ser de gran tamaño, llegando hasta la línea media, confundiéndose con quistes de uraco. Diagnóstico mediante ecografía y/o TC. Tratamiento final quirúrgico en ambos, evitando en el caso del mucocele su apertura, debido al riesgo de pseudomixoma peritoneal (AU)

Objective: To report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis. Patient: We report the case of a 74 year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal. Results: Exploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele). Conclusions: Appendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei (AU)

[Brucella orchyoepididymitis: case report]. / Orquiepididimitis brucelosa: a propósito de un caso.

OBJECTIVES: To report one case of unilateral acute orchiepididymitis due to Brucella and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a 37-year-old-male with undulant fever, scrotal pain and swelling and osteoarticular involvement. Diagnosis was obtained by anamnesis, blood cultures and specific serologic tests for Brucella. RESULTS: Antibiotic therapy with orally administered Doxycycline (6 weeks) and im-administered Streptomycin (3 weeks). Complete clinical resolution was achieved. CONCLUSIONS: We must perform an exhaustive anamnesis looking for a history of contact with animals or ingestion of contaminated dairy products in endemic areas of Brucella when facing the case of orchiepididymitis resistant to usual antibiotic therapy. The diagnosis is based on Brucella spp. isolation in blood cultures and on positive serologic tests (Rose Bengal test, standard seroagglutination test, anti-Brucella Coombs test, Brucellacapt test). Doxycycline with Streptomycin or Rifampin for 6 weeks seems to be the most adequate combinations of antibiotics. Surgical treatment only in exceptional cases.

Orquiepididimitis brucelosa: a propósito de un caso / Brucellar orchyoepididymitis: case report

OBJETIVOS: Presentar un caso de orquiepididimitisaguda unilateral secundaria a brucella y revisar aspectos diagnóstico-terapéuticos en la literatura relacionada. MÉTODO: Presentamos el caso de un varón de 37 añoscon fiebre ondulante, dolor, tumefacción escrotal y afectación osteoarticular. Diagnóstico mediante anamnesis, hemocultivos y serologías específicas para brucella. RESULTADOS: Tratamiento antibiótico con Doxiciclina víaoral (6 semanas) y Estreptomicina intramuscular (3 semanas). Completa resolución clínica del cuadro. CONCLUSIONES: En áreas endémicas de brucella oante la refractariedad al tratamiento antibiótico habitualde una orquiepididimitis debemos realizar una detalladaanamnesis en busca de posibles contactos con ganado oingesta de productos lácteos contaminados. El diagnósticose basa en el aislamiento de brucella spp. en hemocultivos y en la positividad de pruebas serológicas (test rosa de Bengala, test de seroaglutinación estándar, test deCoombs anti-Brucella y test Brucellacapt). Doxiciclina asociadaa Estreptomicina o Rifampicina durante 6 semanasparecen las combinaciones antibióticas de elección.Tratamiento quirúrgico sólo en casos excepcionales

OBJECTIVES: To report one case of unilateral acute orchiepididymitis due to Brucella and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a 37-year-old-male with undulant fever, scrotal pain and swelling and osteoarticular involvement. Diagnosis was obtained by anamnesis, blood cultures and specific serologic tests for Brucella. RESULTS: Antibiotic therapy with orally administered Doxycycline (6 weeks) and im-administered Streptomycin (3 weeks). Complete clinical resolution was achieved. CONCLUSIONS: We must perform an exhaustive anamnesis looking for a history of contact with animals or ingestion of contaminated dairy products in endemic areas of Brucella when facing the case of orchiepididymitis resistant to usual antibiotic therapy. The diagnosis is based on Brucella spp. isolation in blood cultures and on positive serologic tests (Rose Bengal test, standard seroagglutination test, anti-Brucella Coombs test, Brucellacapt test). Doxycycline with Streptomycin or Rifampin for 6 weeks seems to be the most adequate combinations of antibiotics. Surgical treatment only in exceptional cases