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The objective of the current study is to conduct a meta-analysis of the existing literature concerning the potential impact of khat on the reproductive systems. Five international databases, Embase, Medline/PubMed, Scopus, Web of Knowledge (ISI), and ProQuest, were searched from inception up to the end of January 2024. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for quality assessment of included studies. After several screening phases,10 articles were included in the final analysis. The pooled meta-analysis showed that women who use khat during pregnancy had a significantly higher chance of having low birth weight (LBW) (OR= 2.51, 95% CI: 1.61-3.95, p-value < 0.001) and congenital anomalies (OR= 3.17, 95% CI: 1.31-7.73, p-value = 0.011) compared to nonusers. The obtained results of the meta-analysis showed that the consumption of khat significantly reduces semen volume (standardized mean difference = -0.903, 95% CI: -1.801 to -0.007, p = 0.048). In conclusion, our study show that significant associations with LBW, congenital anomalies, and reduced semen volume underscores the necessity for additional research to delve deeper into the intricate complexities of how khat affects reproductive health in both women and men.
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BACKGROUND: Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. MATERIALS AND METHODS: A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. RESULT: Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. CONCLUSION: A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations. Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.
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BACKGROUND: In addition to the global rise in the use of hemodialysis (HD) for end-stage renal disease, individuals receiving maintenance HD continue to have higher mortality rates than the general population. The mortality rates among HD patients in Yemen have not been studied because of the lack of a national registry system, and the impact of the disease on the country is yet to be evaluated. Our study aimed to assess the clinical characteristics and factors associated with mortality among patients with HD in a resource-limited setting. MATERIALS AND METHODS: This retrospective study involved 4194 HD patients at the Nephrology Center of Al-Thora General Hospital, Ibb Governate, Yemen, between March 2014 and September 2023. Data on HD patients' demographic characteristics, risk factors, and comorbidities were gathered and analyzed. The Kaplan-Meier and log-rank tests were used to evaluate and compare survival curves, and the proportional Cox hazard model was used to investigate the factors associated with mortality. RESULT: The mean age was 49.2 ± 16.5 years. The majority of cases were male (n= 2604, 62.1%) and from rural areas (3386, 80.7%), with 1226 (29.2%) living outside Ibb Governorate. Hepatitis C and B viruses were positive in 466 (11.1%) and 312 (7.4%) patients. The main comorbidity was hypertension (n= 3152, 75.2%), followed by diabetes mellitus (DM) (n= 1375, 32.8%). Five hundred and forty-eight patients died during the study period between 2017 and 2023, with an estimated mortality rate of 13.1%. The survival rates at 12, 24, 36, 48, and 60 months of follow-up were approximately 97.4%, 93.3%, 91.7%, 86.0%, and 74.6%, respectively. Predictive factors for mortality among HD patients in the Cox regression model were age >65 years (HR:1.41; 95 % CI: 1.15-1.74, p<0.001), cardiovascular disease (HR: 7.28; 95 % CI: 2.68-19.81, p<0.001), coming from other cities (HR: 1.32; 95% CI: 1.11-1.59, p= 0.002), DM (HR: 1.58; 95% CI: 1.23-2.01, p <0.001), and cerebral vascular accidents (HR:1.57; 95 % CI: 1.13-2.18, p= 0.007). CONCLUSION: Instead of a higher mortality rate in this study, coming from other cities, DM, cardiovascular disease, cerebral vascular accidents, and age >65 years were predictive factors for mortality in HD patients. The study underlines the necessity of planning new HD facilities, avoiding and treating comorbidities, managing them early to decrease mortality, and educating regional administrative decision-makers on effective implementation techniques.
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BACKGROUND: Research on Irritable Bowel Syndrome (IBS) among medical students has increased globally, highlighting a high prevalence in this demographic. However, there is a lack of data specifically regarding the prevalence of IBS among medical students in Yemen. This study aimed to investigate the prevalence and associated factors of IBS among Yemeni medical students. METHODS: We conducted a cross-sectional study involving medical students who completed a validated self-administered questionnaire incorporating socio-demographic information, dietary habits, smoking status, sleep patterns, and the Rome IV criteria for IBS. We used bivariate and multivariate logistic regression models to identify IBS's associated factors, estimated as odds ratios (ORs) with 95% confidence intervals (CIs) and average marginal effect (AME) on the predicted probability of IBS. RESULTS: The study included 351 medical students with a mean age of 22.53 ± 2.70 years; 39.60% (139) were females. The prevalence of IBS was 26.21% (92 students), with 67.39% (62) of them classified as IBS-M (mixed). In multivariable analysis, the consumption of carbonated soft drinks remained significantly associated with IBS (OR: 3.35; 95% CI: 1.14-9.88; P = 0.028). In males, coffee consumption had a substantial effect on the predicted probability of IBS (AME: 11.41%; 95% CI: 0.32-22.60). In females, the consumption of carbonated soft drinks had a significant effect on the predicted probability of IBS (AME: 24.91%; 95% CI: 8.34-41.48). CONCLUSION: The consumption of carbonated soft drinks is significantly associated with IBS among medical students, with a particularly notable increase in the predicted probability of IBS in females. These findings highlight the necessity for gender-specific dietary recommendations in IBS management. Further research is essential to investigate IBS in the general population to gain a comprehensive understanding of its prevalence and associated factors.
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Conducta Alimentaria , Síndrome del Colon Irritable , Estudiantes de Medicina , Humanos , Síndrome del Colon Irritable/epidemiología , Femenino , Masculino , Estudios Transversales , Estudiantes de Medicina/estadística & datos numéricos , Adulto Joven , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Adulto , Bebidas Gaseosas/estadística & datos numéricos , Café , Factores Sexuales , Fumar/epidemiología , Modelos LogísticosRESUMEN
INTRODUCTION AND SIGNIFICANCE: The surgical removal of unexploded mortar shells is rarely documented in the literature. Since most cases occur within war or conflict regions, reporting such instances is vital for optimizing and enhancing surgical practices, particularly in low-resource settings. CASE PRESENTATION: We report the case of a 35-year-old man who sustained an injury from a 60 mm unexploded mortar shell, penetrating the patient's right posterior chest in the right paravertebral region of the 4th thoracic vertebra, causing intrathoracic injuries, multiple rib fractures, and a right pneumothorax. The patient was immediately resuscitated and transferred to the operating room. The projectile was removed without direct contact with metal instruments. A right chest tube was then inserted and the injured area was repaired, resulting in an uneventful postoperative recovery. CLINICAL DISCUSSION: Unexploded mortar shell injuries are infrequently documented in the literature. These injuries are seen within war and conflict regions, that have limited accessibility or availability of experienced explosive ordnance disposal (EOD) teams, transporting personnel, and equipped and separated operating theaters. CONCLUSION: Unexploded ordnance and munitions represent an underrecognized and underreported health risk to patients, healthcare providers, and healthcare facilities. These injuries are commonly encountered within regions that lack experienced transport and EOD staff. The need for the establishment of such experienced teams along with providing adequate training for healthcare providers is necessary.
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Background: The preoperative differentiation of benign form malignant cervical lymphadenopathy (CLA) is crucial in determining the need for surgical intervention. This study aims to assess the diagnostic performance of ultrasonography (US), fine-needle aspiration cytology (FNAC), and their combination with the postoperative histopathological diagnoses of CLA. Method: In a retrospective study between April 2021 and May 2023, 214 patients with CLA were assessed with preoperative US and FNAC. The morphological parameters, including tissue margins, vascularity, and fatty hilum echogenicity, were collected and analyzed retrospectively. The diagnostic efficacies of US, FNAC, and their combined use were compared to the postoperative histopathological findings. Result: In the final histopathological examination, 185 cases (86.4%) were found to be benign, while 29 cases (13.6%) were determined to be malignant. The US features of fatty hilum, echogenicity, and vascularity pattern had the highest diagnostic accuracy in characterizing CLA patterns, with values of 88.3%, 85.5%, and 85.0%, respectively. The receiver operating characteristic (ROC) curve showed a significantly higher area under the curve (AUC) value of 0.883 (95% CI: 0.832-0.923; P<0.0001) for the combined use of all US parameters with better sensitivity (93.10%) and specificity (68.65%) than individual parameters. The overall sensitivity, specificity, and accuracy of FNAC were 97.3%, 82.8%, and 95.3%, respectively. Additionally, US parameters and FNAC together showed a significantly higher AUC value of 0.924 (95% CI: 0.880-0.956; P<0.0001) and achieved a sensitivity of 86.21% and specificity of 88.65%. Conclusions: The combined use of US and FNAC provides high sensitivity, specificity, and diagnostic accuracy in characterizing CLA patterns. In limited-resources settings, this approach is feasible, less invasive, and cost-effective, thereby enabling clear management strategies and avoiding additional surgical interventions.
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Key Clinical Message: In the evaluation of acute flaccid paralysis, particularly in pediatric populations within endemic areas for schistosomiasis infection, clinicians must maintain a high index of suspicion for neuroschistosomiasis. Prompt identification is imperative to mitigate the risk of irreversible neurological sequelae. Abstract: Spinal cord involvement in neuroschistosomiasis (NS) is considerably rare, with even fewer reported cases affecting the conus medullaris in children. While NS's neurological sequelae are typically thought to be reversible, delayed diagnosis and treatment can lead to permanent deficits. We report a case of a 9-year-old boy who presented with 3 weeks of progressive bilateral lower extremity weakness. A spinal MRI showed patchy gadolinium enhancement in an expanded conus medullaris, leading to a presumed diagnosis of Guillain-Barre syndrome, and the patient was treated with intravenous immunoglobulin. However, the lack of improvement necessitated surgical laminectomy. The post-operative histopathological examination confirmed the presence of a schistosomal parasite. Despite initiating therapy with corticosteroid and praziquantel, the patient did not exhibit clinical improvement, resulting in persistent flaccid paralysis, bladder, and bowel incontinence. In conclusion, spinal NS should be considered in patients presenting with myeloradicular symptoms in regions endemic for schistosomal infection, as delayed recognition can result in irreversible outcomes.
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Background: Limited evidence is available regarding the management of small bowel obstruction in the virgin abdomen (SBO-VA), with most studies excluding this entity. This study aims to assess the available data on the treatment outcomes and predictors of surgical intervention in SBO-VA. Methods: A retrospective cross-sectional study was conducted between 2015 and 2021, including all diagnosed and managed cases of SBO-VA at Al-Nasar Hospital. Patients were divided according to the treatment approach into surgical or conservative groups. Preoperative laboratory and radiologic data were gathered and compared between groups. Results: During the study period, 67 cases, primarily males (58.2%), with an average age of 52.2±14.4 years were assessed. Common comorbidities included diabetes (20.9%) and hypertension (16.4%). Key symptoms were rebound tenderness (82.1%) and abdominal tenderness (70.1%). The predominant etiology was adhesions (23.9%). About 46.2% received conservative treatment, 53.8% underwent urgent surgery. Conservative treatment failed in 9.4% of cases, and complications arose in 23.9%, with most being fever (17.9%). Factors necessitating surgical management included older age (58.8 ±11.7 vs 44.9 ±13.8 years, p<0.001), previous hospital admission (p<0.001), presence of abdominal tenderness (p=0.030), longer abdominal pain duration (4.0 ±0.9 vs 2.1 ±0.6 days, p<0.001), higher C- reactive protein (p= 0.033), higher white blood cell (p= 0.006), longer time to hospital presentation (75.3 ±17.2 vs 39.0 ±22.8 days, p= <0.001), small bowel thickness ≥3 cm (p=0.009), and reduced bowel enhancement (p <0.001) on computed tomography imaging. In surgical group, the need for ICU admission was higher and hospital stays were shorter than in conservative group and were statistically significant (p<0.05). Conclusion: The main etiology of SBO-VA in our study was adhesions. Older age, previous hospital admission, longer abdominal pain duration, abdominal tenderness, increased inflammatory markers, and alarm signs on CT scans are the main factors for determining the need for urgent surgical exploration in patients with SBO-VA. To achieve prompt identification and intervention, it is crucial to maintain a high level of vigilance and awareness, even in individuals with no prior surgical history.
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Key Clinical Message: High-flow priapism in pediatric population is rare, yet comprehensive clinical evaluation, along with penile Doppler ultrasound, and cavernosal blood analysis are crucial for accurate diagnosis. Conservative therapy is effective as an initial treatment. Abstract: High-flow priapism is considerably rare in the pediatric age group. We report a four-month-old infant presented with a prolonged penile erection. Diagnostic confirmation was achieved through the utilization of Doppler ultrasound and cavernous blood gas analysis. We also review published data on the management of this condition.
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Background Despite thyroidectomy being the preferred approach for retrosternal goiter (RSG), controversies surround its rationale in asymptomatic cases. This study aimed to investigate the treatment of RSG in resource-limited settings. Methods A retrospective study conducted between April 2010 and June 2022 included 28 RSG cases who underwent thyroidectomy using the cervical approach at Al-Nasar Hospital, Ibb, Yemen. A bivariate analysis was performed to investigate the risk factors for postoperative complications. Results The main age was 49.4±9.9 years, and most of them (60.7%) were females. The main symptoms were cervical mass appearance and breathing difficulty in 75 %, and 32.1%, respectively. Twenty-four (86%) cases were classified as Grade 1 (above aortic arch) and four (14%) cases were classified as Grade 2 (aortic arch to the pericardium). All patients underwent total thyroidectomy through the cervical approach without needing sternotomy. The mean operative time was 121.9±26.7min (99-200 min) and the mean intraoperative bleeding was 321.2±137.4 mL. Postoperatively, the malignant entity was histopathologically proven in seven patients (25%). The postoperative complications (14%) were transient hypocalcemia in two (7.1%) and hematoma in two (7.1%). Older age, bigger thyroid mass, extension below the aortic arch (Grade 2), longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications (all p < 0.05). Conclusion Cervical approach for patients with RSG in our experience is an optimum, feasible, and less invasive surgical approach, in a resource-limited setting. Older age, bigger thyroid, extension below the aortic arch, longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications.
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BACKGROUND: Neurological involvement in schistosomiasis presents a significant and serious complication. While the disease is generally considered treatable during the early stages, the rarity of this condition often leads to delays in diagnosis and treatment. This study aims to report the clinical characteristics of pediatric patients with spinal neuroschistosomiasis (NS) in an endemic area to the disease. METHODS: A retrospective cross-sectional review was conducted at Althora General Hospital in Ibb, Yemen, from January 2016 to January 2021. The study examined confirmed pediatric cases of spinal NS, analyzing their clinical characteristics, laboratory and radiological data, treatment approaches, and complications. RESULTS: The study identified 10 cases of spinal NS with a mean age of 10.1± 3.2 years. The majority (90%) were male and from rural areas, all with a history of freshwater exposure, a known risk factor for schistosomiasis. The average time from presentation to treatment was 33.4± 45.6 days (7-150 days). Common symptoms observed in all patients were bladder dysfunction and paresthesia (100%). Intestinal dysfunction was prevalent in 90% of cases, while 80% exhibited limb weakness or inability to walk. The diagnosis was confirmed through cerebrospinal fluid (CSF) serology in 80% of cases, and stool and urine exams yielded positive results in 90% and 30% of cases, respectively. Magnetic Resonance Imaging findings revealed medullary lesions in 50% of cases, cauda equina lesions in 20%, and multiple lesions in 30%. All patients received oral praziquantel and high-dose steroids for at least three days as part of their initial treatment. During the average follow-up period of 5.6±1.7 months, one patient experienced lower extremity paraplegia, while two cases (20%) showed partial improvement with residual deficits including urinary and fecal incontinence. Complete resolution of symptoms was achieved in seven cases (70%). CONCLUSION: Schistosomiasis should be considered in pediatric patients with myeloradicular manifestations, especially in endemic areas. Early identification can be achieved through history, prompt imaging, and CSF serology. In the absence of immediate test results, expert-guided presumptive therapy should be considered to minimize neurological complications.
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INTRODUCTION AND IMPORTANCE: Intra-uterine contraceptive devices (IUCDs) are globally acknowledged for their high utilization and tolerability as contraceptive techniques. However, the uncommon but critical complication of IUCD perforation and migration into the gastrointestinal (GI) system necessitates careful consideration. CASE PRESENTATION: We present a case of IUCD migration culminating in ileal perforation in a 30-year-old female. The patient, with a history of IUCD insertion four years prior, manifested persistent abdominal discomfort lasting for a period of six months. Computed tomography (CT) scans of the abdomen disclosed the presence of an extraneous object perforating the uterine wall and penetrating the ileum. Surgical intervention substantiated the diagnosis, encompassing the removal of the IUCD and subsequent suturing to amend the bowel wall defect. The patient's post-operative recovery proceeded without additional complications. CLINICAL DISCUSSION: Migration and GI perforation of the IUCD are uncommon complications, and require immediate attention and proper management. When there is a suspicion of a missing IUCD, obtaining radiologic confirmation and timely removal is crucial. CONCLUSION: In females of reproductive age, persistent abdominopelvic pain warrants an evaluation of their IUCD placement history and a thorough examination. If the IUCD string is not visible, further radiological investigation is mandated. Any delay in diagnosis and the ensuing treatment may lead to significant, potentially catastrophic, organ damage.
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BACKGROUND: Fournier's gangrene (FG) is a destructive necrotizing infection with a generally poor prognosis. This study aims to share our experience in handling FG patients in a resource-limited setting and identify prognostic factors for FG mortality. METHODS: A retrospective study of thirty-six patients diagnosed with FG and treated at our teaching hospital between Jun 2010 to Oct 2022 was conducted. Laboratory and nonlaboratory data and patients' outcomes were gathered. A univariate analysis was computed for identifying prognostic factors for FG mortality. RESULT: The main age was 68.30 ± 5.61years and most (69.4%) were older than 65 years. The overall survival was 63.9% and the mortality rate was 36.1%. Univariate analysis showed that advanced age (p = 0.02), delayed in hospital presentation (p = 0.024), involvement of larger area (p = 0.001), a history of diabetes mellitus (p < 0.006), end-stage renal disease (p = 0.018), heart failure (p = 0.005), cerebrovascular accident (p = 0.003), liver cirrhosis (p = 0.001), presence of multiple comorbidities (p = 0.001), septic conditions at admission (p = 0.048), need for mechanical ventilation (p = 0.001), hypoalbuminemia (p < 0.001), and elevated blood urea nitrogen (p = 0.002) were found to be risk factors for mortality in patients with FG. CONCLUSIONS: Fournier's gangrene is a fulminant condition with a high mortality rate, especially in resource-limited settings. In this study, the mortality rate was 36.1%. Advanced age, delayed in hospital presentation, involvement of larger area, a history of diabetes mellitus, end-stage renal disease, heart failure, cerebrovascular accident, liver cirrhosis, presence of multiple comorbidities, septic conditions at admission, need for mechanical ventilation, hypoalbuminemia, and elevated blood urea nitrogen were associated with FG mortality.
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Diabetes Mellitus , Gangrena de Fournier , Insuficiencia Cardíaca , Hipoalbuminemia , Fallo Renal Crónico , Accidente Cerebrovascular , Masculino , Humanos , Persona de Mediana Edad , Anciano , Gangrena de Fournier/terapia , Gangrena de Fournier/diagnóstico , Pronóstico , Estudios Retrospectivos , Hipoalbuminemia/epidemiología , Resultado del Tratamiento , Cirrosis Hepática , Insuficiencia Cardíaca/terapiaRESUMEN
Opitz G/BBB syndrome is a rare condition characterized by three significant anomalies; hypertelorism, cleft lip and palate, and hypospadias. However, other anomalies may be associated. Herein, we report a 4-year-old child presented with penoscrotal hypospadias. On examination, hypertelorism and cleft lip and palate were noticed, suggesting a diagnosis of Opitz G/BBB syndrome. The cleft lip was corrected in the first year, and a two-staged surgical approach was implemented for penoscrotal hypospadias. In the first stage, the chordee was corrected and urethral plate was reconstructed using a tabularized incised plate urethroplasty and testicular tunica vaginalis flap. In the second stage, the remanent hypospadias was corrected, and the meatal opening reached its normal location. In conclusion, a two-staged surgical approach for the treatment of penoscrotal hypospadias associated with Opitz G/BBB syndrome may provide excellent outcomes in early-recognized cases. The urologist should pay attention to abnormal facial characteristics in patients with hypospadias.
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Labio Leporino , Fisura del Paladar , Hipertelorismo , Hipospadias , Masculino , Humanos , Preescolar , Hipospadias/diagnóstico , Hipospadias/cirugía , Labio Leporino/cirugíaRESUMEN
Congenital uterine arteriovenous malformations (AVMs) are an uncommon cause of vaginal bleeding in women of reproductive age. In the medical literature, there are few reports of congenital uterine AVMs. This report describes a 23-year-old woman who presented with intermittent vaginal bleeding following a vaginal delivery two years prior. Initially, a molar pregnancy was suspected, but further assessment with magnetic resonance imaging revealed a diagnosis of right uterine AVM. The patient underwent uterine artery embolization, which was repeated three months later. At two-year follow-up, the patient remained free of symptoms. This case highlights the importance of considering congenital uterine AVM as a potential cause of vaginal bleeding and emphasizes the need for clinical examination and radiologic investigations to establish an accurate diagnosis. Treatment depends on disease severity, comorbidities, patient age, and fertility desires.
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Intramural gastrointestinal hematomas are commonly observed following abdominal trauma or are associated with coagulopathy disorders. In contrast, idiopathic gastrointestinal hematoma is rare, and colonic involvement is sporadic, with very few published reports. We report the case of a 29-year-old female who presented with right hypogastric pain over the last three days. Abdominal CT with contrast revealed an 8.5 × 6 × 7.5 cm pre-occlusive intramural hematoma of the ascending colon up to the hepatic flexure with diffuse edematous wall thickening, indicating colonic obstruction. On colonoscopy, the site of the intramural hematoma was identified without active bleeding or obvious pathology, and the colonoscope successfully passed through the region. The patient was managed conservatively. A month later, abdominal CT revealed complete resolution of the colonic hematoma. After two months of follow-up, the patient was free from gastrointestinal symptoms. In conclusion, idiopathic colon intramural hematoma is rare, with a challenge in diagnosis and treatment; efforts should be made to treat it with conservative therapy.
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Hydatid cyst (HC) disease is a parasitic infection produced by cysts containing the Echinococcus granulosus larval phase. Patients with HC disease are typically asymptomatic until incidentally diagnosed or when complications occur. A rare presentation of liver HC is spontaneous cutaneous fistualisation. We report a 63-year-old female patient admitted in a tertiary care hospital in Ibb, Yemen, in 2019 with an infected cutaneous fistula induced by a ruptured HC. The patient underwent laparotomy and partial cystectomy with excision of the fistula tract. Upon 6-month follow-up, there was no HC recurrence. This report highlights the need for physicians to consider this diagnosis when faced with an unusual cutaneous fistula near organs commonly involved in HC, especially in areas where the prevalence of this disease is high.
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Fístula Cutánea , Quistes , Equinococosis Hepática , Equinococosis , Femenino , Humanos , Persona de Mediana Edad , Fístula Cutánea/parasitología , Fístula Cutánea/cirugía , Equinococosis/complicaciones , Equinococosis/cirugía , Equinococosis Hepática/complicaciones , Equinococosis Hepática/diagnóstico , Equinococosis Hepática/cirugíaRESUMEN
Ritual circumcision is associated with a high rate of complications, mainly if performed by an untrained practitioner. Furthermore, excessive skin removal is a rare complication of this procedure that results in penis "trapping" underneath the skin and future sexual dysfunction. Here, we presented a 45-day-old Yemeni newborn with a trapped penis due to total loss of penile skin during a ritual circumcision performed by a traditional untrained practitioner using the guillotine technique one month ago. The patient underwent surgical exploration, and the penis was deliberated, released, and the skin defect was repaired with a single-step scrotal flap advancement over the penile shaft. At the six-month follow-up, the outcome was both functional and cosmetically satisfying. In conclusion, we recommend that the circumcision procedure be performed at the very least by an educated and skilled health professional. Additionally, a scrotal advancement flap is still an option in significant penile skin loss cases.
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Circuncisión Masculina , Procedimientos de Cirugía Plástica , Conducta Ceremonial , Circuncisión Masculina/efectos adversos , Humanos , Recién Nacido , Masculino , Pene/cirugía , Procedimientos de Cirugía Plástica/métodos , Escroto/cirugíaRESUMEN
While double J (DJ) stenting is common worldwide in the urological procedure, it may associate with severe and catastrophic complications. Penetration of the jejunum and upward migration of double J (DJ) stents during cystoscopic DJ stent procedure are rare complications with few reported cases in the literature. We present a 65-year-old male presented with acute renal failure and peritonitis one week after failed cystoscopic removal of DJ stents. Radiographic investigations showed upward migration of the right DJ stent and a total displacement of the left DJ stent to the peritoneal cavity with peritonitis, bladder perforation, and jejunal injuries. The right DJ stent was removed via the ureteroscopic procedure. Then, open abdominal surgery was performed to remove the left DJ stent and repair the injured bladder wall and jejunal segment. In conclusion, synchronous upward DJ stent migration and peritoneal DJ stent malposition with jejunal and bladder injuries are rare and severe complications of the cystoscopic DJ stent procedure. The treatment should be performed depending on the time of diagnosis, nature of the injury, and general clinical conditions of the patient.
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Perforación Intestinal , Peritonitis , Uréter , Anciano , Humanos , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Masculino , Peritonitis/etiología , Peritonitis/cirugía , Stents , Uréter/cirugía , Ureteroscopía , Vejiga UrinariaRESUMEN
BACKGROUND: In the tubularized incised plate (TIP) procedure, flap interposition between the skin and neourethra is highly recommended to decrease the postoperative fistula rate. However, there is no consensus regarding the ideal flap for this procedure. This study aimed to report our experiences in the one-stage TIP hypospadias surgery utilizing dartos flap (DF) (penile skin subcutaneous tissue) and tunica vaginalis flap (TVF) (parietal layer of the testis) as a tissue coverage of neourethra. METHODS: In a retrospective study from Sep 2018 to May 2021, 16 cases of hypospadias with different types, ranging from midpenile to penoscrotal types, were managed with TIP urethroplasty using DF or TVF as a tissue coverage of neourethra were enrolled. The demographic characteristics of the participants, type of hypospadias, outcome, and complications were analyzed and compared. RESULTS: We used TVF and DF as soft tissue coverage in 11 (68.8%) and 5 (31.3%) patients, respectively. The mean age was 56.38 ± 47.83 months. Mid-penile, proximal, and penoscrotal hypospadias were presented in 3 (18.8%), 8 (50.0%), and 5(31.2%) patients, respectively. The total success rate was 14 (87.5%), while 2 (12.5%) patients developed a urethrocutaneous fistula, which required delayed closure later. In comparison between TVF and DF groups: the TVF was applied in all patients with moderate and severe chordee and all patients with penoscrotal hypospadias, and six patients with proximal hypospadias, while only three patients with mild chordee and two patients with proximal hypospadias used the DF and showed statistical significance between groups (p < 0.001 and 0.012) respectively. The success rate was 90.9% vs. 80.0% in TVF and DF groups, respectively, with no statistical significance between groups (p = 1.000). CONCLUSIONS: In the primary TIP repair, the TVF is a practical option as a DF for the interposition cover of a neourethra, especially in penoscrotal and proximal hypospadias with severe chordee.