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INTRODUCTION: Ureteral duplication is a common congenital anomaly, although multiple ureters is a rare disorder. Bifid ureter or multiple ureters are diagnosed incidentally and generally associated with obstruction by lithiasis. CASE PRESENTATION: We present a case of ureteral quintuplication converging into a sacculation obstructed by a 7 cm calculus. CONCLUSION: Two or more ureters are more common in women and it is mostly associated with asymptomatic presentation, excepting when related to complications of urinary tract infection or lithiasis. More than four ureters are extremely rare and our case is the first of incomplete quintuplication found so far in the literature.
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INTRODUCTION: Diverticular disease most common site in digestive tract is large intestine, but can also appears in small intestine and esophagus. Esophageal diverticula are divided according to injured portion (pharyngeal, middle or epiphrenic). CASE PRESENTATION: We present a case of large epiphrenic diverticulum in a 71-year-old woman with mild gastrointestinal symptoms managed laparoscopically with diverticulectomy and fundoplication. DISCUSSION: Epiphrenic esophageal diverticulum is rare, originated from unknown increase of intraesophageal pressure. Diagnosis usually occurs with imaging and endoscopic investigation and surgical treatment is indicated for symptomatic patients. CONCLUSION: High suspicion and proper analysis are fundamental for diagnosis and treatment definition, which may include outpatient follow-up or surgery.
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BACKGROUND: Traumatic brain injury (TBI) represents one of the leading public health problems and a significant cause of neurological damage. Unintentional causes of TBI are the most frequent. However, fruit falling over the head causing TBI is extremely rare. In the Amazon region, accidents with ouriços, a coconut-like shell fruit, seem relatively common. However, to the best our knowledge, it has never been described in a scientific journal before. Therefore, we aim to evaluate a series of TBI caused by this tropical fruit. METHODS: This study is a retrospective review of 7 TBI cases due to the fall of ouriços admitted to two tertiary hospitals in the Amazon region from January 2017 to December 2018. The collected data included: age, Glasgow Coma Scale, skull fracture, venous sinus injury, hematoma, surgical treatment, and outcome. RESULTS: All patients were men, with an average age of 38, ranging from 8 to 77-years-old. Four out of seven had skull fractures. Five patients developed an epidural hematoma, and two of them had an associated subdural hematoma. Dura mater injury was observed in two patients, whereas four patients were operated. There was one related death. CONCLUSION: This case series is the first to describe an unconventional but potentially fatal cause of TBI in the Amazon: the falling of the Brazil-nut fruit. Most patients were diagnosed with mild TBI. Nevertheless, patients may have cranial fractures and epidural hematomas, leading to death when there's a delay in medical assistance.
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INTRODUCTION: Diaphragmatic rupture is an uncommon trauma complication and it is associated with chronic diaphragmatic herniation, especially in the left side. Chronic diaphragmatic herniation is usually due to white weapon injury and as consequence of low suspicious and absence of proper investigation. CASE REPORT: We report a chronic diaphragmatic herniation after three years of a stab in the left thoracoabdominal transition, managed through laparotomy. DISCUSSION: Traumatic diaphragmatic rupture is a rare trauma consequence, most common in the left side. The herniation occurs gradually because of negative pressure of the thoracic cavity that works as a suction of the abdominal organs. CONCLUSION: Traumatic diaphragmatic ruptures diagnosis is difficult and might go unnoticed without high suspicious and proper investigation. Chronic herniation is associated with higher morbimortality.
