Adnexal torsion leading to death of an infant.

BACKGROUND: Torsion of the uterine adnexa is an uncommon occurrence in infants, but when it does occur, the consequences may be catastrophic. CASE: A 4-month-old female presented with sudden cardiac and respiratory arrest. There were no prior signs of illness. The infant was resuscitated and survived for one day after the event. Autopsy revealed a left ovarian cyst with torsion. Necrosis of the transverse colon was also seen. Other organs revealed signs of shock. The cause of death was felt to be related to the torsion. SUMMARY AND CONCLUSION: Torsion of the uterine adnexa is rare in infants. In the few reported cases, antecedent symptoms were present. Clinicians should be aware of this possibility and include it in the differential diagnosis of death in infancy.

Failure of thumbtacks used in control of presacral hemorrhage.

We report a case of failure of thumbtacks used in achieving last-resort hemostasis in a gunshot injury to the presacral venous plexus/sacrum. Four of five thumbtacks used detached. The exact mechanism of failure is not known. To our knowledge, there are no reports of failure of these hemostatic devices in the literature. This finding suggests to us that thumbtack hemostasis is not without complication. It is not known whether injury to internal viscera and organs occurred secondary to the loose thumbtacks. We suggest that surgeons as well as pathologists use caution when exploring pelvic or abdominal cavities following pelvic vascular trauma due to the considerable danger posed by these sharp objects.