Wolffian system agenesis with contralateral ejaculatory duct stenosis: First case in the literature.

Congenital agenesis of seminal vesicles and vas deferens is rare and its co-existence with structural abnormality on the contralateral side is even rarer. We report a case of an adult male presenting with infertility due to obstructive azoospermia, in which transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) revealed the agenesis of Wolffian derivatives on the left side with stenosis of the ejaculatory duct on the contralateral side. This dual combination of uncommon anomalies is the rarest phenomenon and poses as a diagnostic dilemma for the radiologist. Emphasis is given to MRI as a one-stop shop modality in the evaluation of complete genitourinary system; as well as on the importance of TRUS as a screening tool in patients with infertility due to obstructive azoospermia.

Large bilateral adrenal leiomyomas presenting as calcified adrenal masses: a rare case report.

We report the case of a 55-year-old woman with bilateral, large, calcified adrenal tumors who was treated by laparoscopic adrenalectomy. The patient presented with upper abdominal discomfort for the past 5 years. Her imaging showed bilateral enlarged adrenal glands up to 10-cm size with punctate calcifications. Positron emission tomography scan demonstrated moderate fluorodeoxyglucose avidity in the left adrenal mass. Bilateral laparoscopic adrenalectomy was performed through a transperitoneal approach. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Histology findings were consistent with adrenal leiomyomatosis.

Laparoscopic single-site synchronous bilateral cortex-preserving adrenalectomy using conventional trocars and instruments for large bilateral adrenal pheochromocytomas.

Laparoendoscopic single-site surgery is being adapted for widespread indications because it offers minimal invasiveness. Herein, we report a case of synchronous bilateral cortex-preserving adrenalectomy for bilateral large adrenal pheochromocytomas. We used conventional laparoscopic instruments and trocars through a single-port site. The total operative time was 110 min. There were no perioperative complications. Single-incision multiport laparoendoscopic surgery, also known as SIMPLE surgery, can be safely used for bilateral adrenalectomy. This modification holds promise with its minimally invasive nature and reduced cost.

Percutaneous nephroscopic management of an isolated giant renal hydatid cyst guided by single-incision laparoscopy using conventional instruments: the Santosh-PGI technique.

INTRODUCTION: Isolated renal hydatid rarely presents, but when it does occur, it requires surgical treatment. We report our experience with a novel technique involving percutaneous management of a giant renal hydatid cyst with single-incision laparoscopic assistance. MATERIAL AND SURGICAL TECHNIQUE: First we performed retrograde ureteropyelogram, which did not show any communication between the cyst and the calyceal. A Veress needle was used for pneumoperitoneum. Three conventional laparoscopic trocars used. Under laparoscopic guidance, we punctured the cyst. The scolicidal solution used was 10% povidone-iodine. The endocyst was removed under vision with grasping forceps through the nephroscope. A Portex drain was placed into the cyst cavity. DISCUSSION: Percutaneous aspiration and instillation of scolicidal agents followed by re-aspiration have been previously reported. This is an attractive procedure because of its acceptable success rates and reduced morbidity. In our case, simple aspiration of the cyst would not have been successful because the cyst was full of daughter cysts. Also, a blind percutaneous puncture of the cyst and dilatation could have perforated the colon or the mesocolon, which is often wrapped over the surface of such giant cysts thereby making laparoscopic guidance and mobilization of the colon imperative. We devised this unique treatment method for this patient involving three conventional ports at a single umbilical site. We believe this is the first reported case of its kind in the world. Not only this technique is minimally invasive, it is also cost-effective, as only conventional laparoscopic ports and instruments are used during the procedure.

Functioning Adrenocortical Carcinoma with Extension upto the Right Atrium Producing Cushing's Syndrome.

Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis. Surgery is the only curative therapy available and overall 5-year survival for patients who undergo a complete resection is 32% to 48%. They are known to produce intravascular invasion and into the inferior vena cava (IVC) and in rare cases they may reach the right atrium. We report a case of functioning ACC extending into the inferior vena cava and right atrium in a female with Cushing's syndrome.

Adrenal artery pseudoaneurysm in pheochromocytoma presenting with catastrophic retroperitoneal haemorrhage.

Spontaneous rupture of adrenal pheochromocytoma is an extremely rare condition which presents as an abdominal catastrophe. Unrecognized, this transformation can rapidly lead to death. We report a case of a 63-year-old male who presented with hemorrhagic shock secondary to ruptured adrenal pheochromocytoma. The clinical course is notable for immediate transarterial catheter embolization for control of bleeding, followed by optimization and elective adrenalectomy. High mortality is associated with an operative intervention in the face of an unrecognized pheochromocytoma. This reinforces the need for maintaining a high index of suspicion in the setting of a suprarenal mass despite hypotension.

Dengue hemorrhagic fever as a rare cause of bleeding following percutaneous nephrolithotomy.

Post percutaneous nephrolithotomy (PNL) bleeding is an uncommon yet serious complication and is almost always related to a surgical cause. Nevertheless, medical cause of bleeding is rarely encountered as a cause of this dangerous complication. Dengue has been rarely reported as a cause of post operative bleeding. Bleeding diathesis in dengue occurs not only due to thrombocytopenia but also due to dysfunctional surviving platelets and increased fibrinolysis. We report a patient who developed bleeding after an uneventful PNL due to dengue hemorrhagic fever. Medical causes of bleeding such as locally endemic viral hemorrhagic fevers should also be kept in mind and evaluated especially when a surgical cause of the bleed is not found or suspected in bleeding after any surgery.