Synchronous Appendiceal Triple Primary Neoplasms and Acute Abdomen-A Case Report.

Abdominal pain is a very common presenting symptom in the emergency department (ED). To reach an accurate diagnosis one must consider the possibility of multiple conditions that might cause the presenting symptom. We reported a female patient who came to our ED due to aggravated right lower quadrant abdominal pain for several hours. Multiple diagnosis of right T11 herpes zoster, right urolithiasis with hydronephrosis, appendiceal collision tumors of adenocarcinoma arising from adenoma and neuroendocrine tumor as well as leiomyoma in the surrounding adipose tissue were made. Histological examination and immunohistochemistrysupport these three lesions as separate entities. This case is unique because her multiple combined illness present as abdominal pain. Each one could be the cause of chief complaint, across dermatologic, urologic and neoplastic disorders.

Acute necrotizing ureteritis with obstructive uropathy following instillation of silver nitrate in chyluria: a case report.

Chyluria occurs as a result of communication between the lymphatics and the renal pelvis. It is believed that instillation of silver nitrate into the renal pelvis is a safe, minimally invasive and effective treatment for chyluria. We report an unusual complication of acute necrotizing ureteritis following instillation of silver nitrate in a case of chyluria. It resolved completely with non-surgical intervention. The diagnosis and management of chyluria is discussed, with a brief review of the literature.

Testicular sparing surgery for bilateral epidermoid cysts of the testes: a case report.

We report the case of a 12-year-old boy with bilateral epidermoid cysts of the testes diagnosed preoperatively from ultrasonography, magnetic resonance imaging, and negative tumor markers. The cysts were treated using bilateral testicular sparing surgery through a scrotal approach after intraoperative frozen section. We also discuss the diagnosis and management of epidermoid cyst of the testis and briefly review the literature.

Spontaneous dissecting aneurysm of the renal artery: a case report.

Primary dissecting aneurysms of the renal artery are exceedingly rare. The triad of flank pain, hematuria, and hypertension of acute onset in the absence of urinary obstruction should suggest this rare condition. We report a case of spontaneous dissecting aneurysm of the renal artery treated using conservative medical treatment. The diagnosis, therapeutic management, and outcome are discussed.

Extra-adrenal pheochromocytoma presenting with life-threatening ventricular tachycardia: a case report.

Extra-adrenal pheochromocytoma develops in paraganglion chromaffin cells of the sympathetic nervous system. It probably represents at least 15% of adult and 30% of childhood pheochromocytomas. Although electrocardiographic abnormalities occur in up to 75% of patients with pheochromocytoma, there are only three other reported cases of pheochromocytoma that initially presented with ventricular tachycardia. In this report, we describe a 64-year-old woman with an abdominal para-aortic extra-adrenal pheochromocytoma who presented with pulseless ventricular tachycardia and needed electrical defibrillation initially to keep vital signs. The 24-hour urine vanillylmandelic acid was 35.8 mg. Computerized tomography showed a left retroperitoneal mass. The postoperative course was uneventful. Pheochromocytoma was proved by histologic study.

Leiomyoma of the urinary bladder: a case report.

Leiomyoma of the urinary bladder is a rare tumor and constitutes 35% of benign mesenchymal bladder tumors. Herein, we report a case of leiomyoma of the bladder. A 32-year-old female was incidentally found to have an abnormal bladder mass on abdominal ultrasound during work-up for infertility. Bimanual examination then revealed a mass on the right side near the bladder neck area. On cystoscopic examination, an external compression mass covered with normal bladder mucosa could be seen at the right lateral wall. Computerized tomography revealed a homogeneous solitary tumor protruding into the urinary bladder from the right lateral wall without enlarged lymph nodes. Magnetic resonance imaging showed an intraluminal round mass at the right aspect of the urinary bladder, leading to suspicion of an intramural neurogenic or mesenchymal tumor. Surgical exploration was performed via a lower midline incision and a 5.0 x 4.5 x 2.2 cm mass was excised. The pathologic diagnosis was leiomyoma of the bladder. We discuss the diagnosis and management of leiomyoma of the bladder and briefly review the literature.

Bladder stone in a woman after cesarean section: a case report.

Urinary bladder calculi are rarely seen in women and any history of previous pelvic surgery must, therefore, raise suspicion of an iatrogenic etiology. According to the literature, fewer than 2% of all bladder calculi occur in female subjects and, thus, their presence should provoke careful assessment of the etiology. There have been a number of reports on bladder calculi in women with a history of gynecologic procedures. We report a case of bladder calculus after cesarean section that was treated successfully by open surgery.

Herpes zoster induced neuropathic bladder--a case report.

Herpes zoster infection involving the sacral dermatomes has been associated with bladder dysfunction and, although rarely, with acute urinary retention. Less than 150 cases have been reported in the literature. After reviewing our institute's chart records covering a period of time dating from 1991 to 2001, we found that three of our patients had developed acute urinary retention following herpes zoster skin lesions of the S2-4 dermatomes. Herein we report our findings. These three patients had previously been found to have normal voiding status. However, at the time of complaint urodynamic studies revealed detrusor areflexia or detrusor hyporeflexia with decreased sensation of bladder filling. After micturation recovery, repeat urodynamic studies revealed detrusor pressure and bladder sensation recovery. After one to six weeks of treatment, all three patients could void spontaneously without catheterization. We found that, when treated with antiviral medication, supportive analgesics, and temporary urinary drainage, which included urethral catheterization and suprapubic cystostomy, acute urinary retention associated with herpes zoster has a generally favorable prognosis. In other words, we found that in spite of its rarity, herpes zoster induced neuropathic bladder dysfunction is reversible when treated appropriately.