Video Case Report Research Articles

Combined removal of ovarian teratoma and oocyte retrieval by laparoscopic surgery under regional anesthesia

To describe the simultaneous laparoscopic approach for teratoma removal and oocyte retrieval performed under regional anesthesia in a woman, desiring to preserve fertility. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites, and other applicable sites. Video case report demonstrating the clinical management and laparoscopicteratoma removal combined with oocyte retrievalaccomplished underregional anesthesia. University tertiary care hospital. We present a case of a 31-year-old woman who referred to our Fertility Center with a previous history of right salpingo-oophorectomy for mucinous ovarian cystadenoma and the presence of a large ovarian teratoma of ten centimeters of the contralateral ovary. The ovarian stimulation started in the early follicular phase. Not being able to visualize follicular growth during the ovarian stimulation, it was decided to adopt fixed protocol with antagonist on the 5th day and to proceed, on 15th day, with a laparoscopic pick-up and simultaneous removal of the cyst. Laparoscopic surgery was performed: the left ovary appeared larger in size for the presence of the suspicious mature dermoid cyst and multiple follicles, previously not identified at ultrasound imaging. The follicles contained oocytes that were aspirated with an aspiration needle of 17 G connected to a craft suction pump. Then, practicing the stripping technique, an enucleation of the ovarian cyst was performed. Surprisingly, the removal of the cyst revealed other follicles that were readily aspirated. The patient remained awake during the entire procedure and a low pressure of 10 mmHg was maintained at 15° of Trendelenburg position. A total of seven follicles were aspirated, seven oocytes were retrieved, and six mature oocytes were cryopreserved. The cyst was totally removed and no intracavitary spillage was caused. Simultaneous laparoscopic approach for teratoma removal and oocyte cryopreservation should be considered an effective fertility preservation strategy in patients in whom the presence of an ovarian neoformation does not allow visualization of growing follicles by ultrasound. Laparoscopic oocyte retrieval under regional anesthesia is a safe and well-tolerated technique and should be considered for patients where the transvaginal approach could not be performed.

Early approach for the iatrogenic vesico-vaginal fistula repair: a video case report.

Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases prevail in developing countries, iatrogenic fistulas are more common in industrialised ones, often resulting from pelvic surgeries. The optimal timing for surgical correction of VVF remains debated, often leaning towards delayed intervention. Here we report a successful early laparoscopic repair of an iatrogenic VVF following hysterectomy. The patient, a 54-year-old woman, presented with VVF after a hysterectomy. The laparoscopic repair was performed promptly upon diagnosis. To assess the feasibility and effectiveness of an early repair of a gynaecological-related VVF. First, cystoscopy identified the bladder edge of the VVF. Second, laparoscopy was performed and the vesico-vaginal dissection was carried out. The excision of the previous stitches and of the fibrotic tissue was undertaken to create free flaps for suturing. The bladder was repaired in a double layer, and a single layer was applied to the vagina. Finally, the omentoplasty was done. The patient was discharged on postoperative day 5. No complications occurred. This successful case demonstrates the feasibility and safety of early laparoscopic repair for gynaecological surgery-related vesico-vaginal fistulae. While acknowledging the need for further studies to standardise techniques, this report contributes to the evolving understanding of optimal management for this complex condition.

Open repair of a ruptured abdominal aorta with an aortoiliac vein fistula in a 7-month-old infant and review of the literature

Ruptured abdominal aortic aneurysms are extremely rare in the pediatric population. In this video case report, we describe the successful repair of a ruptured abdominal aortic aneurysm in a 7-month-old female infant.

Laparoscopic transfundal approach to cervical dilation: a novel treatment for cervical stenosis and cervical factor infertility

To demonstrate a novel technique used to restore cervical patency in a patient with severe iatrogenic cervical stenosis. Surgical video case report. A single academic institution. We highlight the case of a 35-year-old nulliparous woman with a history of primary infertility. Her past medical history was significant for focal, invasive, well-differentiated squamous cell carcinoma of the cervix, for which she underwent a loop electrosurgical excision procedure. During her infertility assessment, she was found to have an extremely stenotic cervix that was refractory to conventional treatment options. This video highlights our innovative laparoscopic transfundal technique used to restore her cervical patency. None, as this is a descriptive case report. Postoperatively, the patient had continued cervical patency for >1 year with successful fertility treatment resulting in pregnancy. To our knowledge, this is the first case report describing a laparoscopic transfundal approach used to reestablish cervical patency. This approach may be considered for patients with cervical stenosis who have not responded to standard conservative therapies.

Bilateral robotic nephrectomy using a supine robotic approach without repositioning through 8-18 mm incisions in a young female with focal and segmental glomerulosclerosis: a video case report.

Bilateral robotic nephrectomy using a supine robotic approach without repositioning through 8-18 mm incisions in a young female with focal and segmental glomerulosclerosis: a video case report.

IBC-Oxford University2023_BJSOral_11Video Presentation: Laparoscopic Total Gastrectomy after Single Anastomosis Sleeve Jejunal Bypass

Abstract Introduction Amongst today's bariatric surgery procedures is the single anastomosis jejunal bypass operation (SASJ), which was first introduced by Professors Abdolreza Pazouki and Mohammad Kermansaravi. Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. Obesity is a significant risk factor for cancer incidence and mortality. The number of patients with obesity who undergo bariatric surgery is increasing; however, the impact of such a procedure in affecting the risk of cancer is not completely understood yet. The association between obesity and malignancies has been identified epidemiologically. Meanwhile, the increasing global number of bariatric surgeries is reported annually; bariatric surgery’s effect on different types of cancers is not well understood. Unfortunately, nonspecific presentations and difficulties regarding investigations make diagnosis challenging. Methods In this video case report, the patient was 62-year-old female with an initial BMI 44.2 kg/m2, weight: 116 kg and Height: 162 cm at the time of SASJ 6 years ago, upper gastrointestinal Endoscopy from 2017 before SASJ operation showed reflux esophagitis grade A and erosive erythematous hyperaemic mucosa gastritis. She underwent primary laparoscopic SASJ bypass in 2017. However, she had adequate weight loss for 5 years post-operative, and then she had excessive weight loss during past year. According to the patient history she suffers heart burn, anorexia, nausea and vomiting since1 year back, usually vomiting is present 2 hours postprandial with dark and black coloured content, and now her BMI is 21kg/m2. She had an upper GI endoscopy during past year, the last endoscopy report in 2023 commented on active and focally ulcerative mucosa with some atypical cells with signet ring pattern and chronic inflammatory responses, and biopsy showed adenocarcinoma of the stomach. Thorax, abdomen and pelvic CT scans were normal with no pathology is seen in upper GI contrast study. Laboratory findings were normal. A Laparoscopic Roux-en Y oesophago-jejunal bypass with a 75cm biliopancreatic limb and 75cm alimentary limb were performed. The patient was under complete screening for all over the last 1 so surgery is performed in first after confirmation of histopathology report before chemoradiotherapy (CRT). Results The operative time was 210 min and blood loss were 150ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged on postoperative day 8. Conclusion Laparoscopic total gastrectomy with dissection of all lymph node from gastric stations is performed prior to the chemoradiotherapy for reaching the purpose of early malignancy control.

Repair of a chronic myometrial defect with successful pregnancy outcome

To surgically demonstrate preconceptional laparoscopic repair of a chronic myometrial defect with mesh reinforcement, resulting in a successful pregnancy outcome. Video case report. The Institutional Ethical Committee was consulted, and the requirement for approval was waived because the video describes a modified surgical technique. The patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, and others), and other applicable sites. A referral advanced gynecological endoscopy center. A 27-year-old woman (P0A1) was diagnosed with myomas during pregnancy, resulting in miscarriage at 22 weeks. Laparotomy and myomectomy were performed 2 months later, and three 8-cm myomas were removed. The endometrial cavity opened posteriorly during surgery, and retained products of conceptions were removed. Periconceptional imaging done after two years showed few intramural myomas and a deficient myometrium in the posterior fundal region. Laparoscopy revealed a defect in the posterior fundal aspect of the uterus with leakage of dye, which was converted to laparotomy and myomectomy with the repair of the myometrial defect. After 1 year, follow-up magnetic resonance imaging showed thinned-out posterior myometrium with a focal area of absent myometrium in the midline and endometrial prolapse. The patient was advised on surrogacy, but she wanted to repair the defect again and try for pregnancy, so she was referred to our center. With the background of a few case reports using mesh to reinforce myometrial repair (1, 2), we counseled the patient about the myometrial repair with the additional use of mesh as an off-label use. The risk of uterine rupture after myomectomy is rare (<1%) (3), but it is a severe complication. High-risk cases, like significant myometrial defects or previous ruptures, may require surgical correction. Native repair may not achieve optimal results in all cases. Alternative approaches, like the additional use of mesh or biological materials, have been reported (4). In this case, we demonstrate the use of dual mesh for scar repair. Synthetic mesh over the uterus is used in laparoscopic procedures like sacrohysteropexy and cerclage. We used Parietex (Covidien, New Haven, CT, USA) mesh, a composite macroporous polyester mesh usually used for ventral hernia repair. It has an outer hydrophilic, absorbable collagen barrier that reduces adhesion formation. Laparoscopically, after adhesiolysis, a significant defect was demonstrated on the posterior wall of the uterus (Fig.1). A complete resection of the fibrotic tissue along the edges of the scar defect was done to expose healthy myometrium. Myometrium was repaired in two layers, excluding the endometrium, with a V-Loc (Covidien, Dublin, Ireland) No. 1-0 suture. Parietex mesh was sutured over the repaired posterior myometrium to reinforce it (Fig.2). The postoperative myometrial thickness on imaging and pregnancy outcome. Postoperative ultrasound scan after 6 weeks demonstrated restoration of posterior wall myometrial thickness of 14 mm. The patient was conceived through invitro fertilization techniques 4 months after surgery. Antenatal follow-up was uneventful except for suspicion of posterior placenta accreta. She underwent an elective cesarean section with uterine artery embolization at 34 weeks and delivered a healthy infant weighing 1,950 g. Placental removal was uneventful. On inspection, the posterior surface of the uterus was intact without dehiscence, meshing in situ with minimal adhesions (Fig.3). Myometrial scar defects can cause potential obstetric complications. Native repair of scar defects may not achieve optimal results, as in our case. Mesh repair of myomectomy scar defects can be used as an alternative approach, as exemplified in this case. However, further studies are required to establish the safety and efficacy of this approach.

Moving toes in 28-year-old woman: a video case report

Moving toes in 28-year-old woman: a video case report

Laparoscopic oocyte retrieval for fertility preservation in a patient with squamous cell carcinoma of the vagina

To describe a feasible fertility preservation strategy in a woman with vaginal carcinoma. Video case report demonstrating the diagnostic work-up and laparoscopic oocyte retrieval performed under regional anesthesia. University tertiary care hospital. A 35-year-old nullipara woman presenting with vaginal bleeding and foul-smelling vaginal discharge. After a comprehensive diagnostic work-up, a final diagnosis of squamous cell carcinoma of the vagina stage II (FIGO classification) was made. As per the patient's desire, before undergoing chemo-radiotherapy, the patient underwent oocyte cryopreservation. Transvaginal retrieval of oocytes was not feasible due to stenosis of the vaginal introitus and the potential risk of intracavitary tumor cell spillage. Transabdominal ultrasound-guided oocyte retrieval was not possible due to the body habitus. The patient underwent ovarian stimulation for in vitro fertilization. In order to minimize estrogen levels, letrozole was used during the controlled ovarian stimulation (COS). Laparoscopic oocyte retrieval was performed under spinal anesthesia. Successful laparoscopic egg retrieval and cryopreservation in a woman with squamous cell carcinoma of the vagina. A total follicular count of 9 was estimated before the oocyte retrieval. Eight oocytes were retrieved at laparoscopy, and eight mature oocytes were successfully cryopreserved. No complications were encountered, and the patient was discharged on the same day of surgery. To the best of our knowledge, this is the first published case of fertility preservation using the laparoscopic approach in a patient with vaginal cancer. Letrozole is a valuable strategy to reduce high estrogen in patients with gynecological cancer undergoing COS. Laparoscopy oocyte retrieval, performed under regional anesthesia, can be performed in an ambulatory setting and should be considered an effective fertility preservation strategy in patients with large vaginal tumors.

A230 Retrograde filling of the afferent limb, a very rare complication of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): A video case report

A230 Retrograde filling of the afferent limb, a very rare complication of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): A video case report

Successful Endoscopic Closure of the Appendiceal Orifice

Introduction: Colocutaneous fistulas are severe complications that traditionally are repaired surgically with resection of the fistula followed by end-to-end anastomosis of the bowel. Given the high morbidity of surgery, an alternative approach to consider is endoscopic fistula closure with clips, which is a minimally invasive approach and is safe with high success rates.1–5 Currently, there are no reports in the literature describing endoscopic closure of the appendiceal orifice. This video case report describes a technique for placement of an over the endoscope clip at the appendiceal orifice to effectively close a colocutaneous fistula. Materials and Methods: The patient was a 69-year-old male with Marfan's syndrome who was 5 months status post primary repair of a duodenal perforation with feculent peritonitis. His early postoperative course was complicated by a persistent leak from an unknown source. One month postoperatively, imaging showed a large retroperitoneal abscess that required percutaneous drain placement. At that time, surgical endoscopy was consulted for duodenal evaluation and found no clear evidence of a leak from the duodenum. A percutaneous endoscopic gastrostomy tube with a jejunal feeding extension was placed. Four months after his index operation, he presented to the clinic with a change in drain output character that was suspicious for an enterocutaneous fistula. Fistulogram with contrast injected into the patient's percutaneous drainage catheter demonstrated continuity with the colon in the right lower quadrant. He was taken for a colonoscopy and fluoroscopy for further evaluation of the colocutaneous fistula. After injection of saline at the drain site, saline was seen trickling into the cecum from the appendiceal orifice. The decision was made to close the orifice with a 12/6T over-the-endoscope clip. The percutaneous retroperitoneal drain was removed 5 days postoperatively and he was discharged home 7 days postoperatively on a low residue diet. Results: At 1 month follow-up, the patient was doing well on a regular diet with no abdominal pain or fevers. A routine imaging scan performed 7 weeks postoperatively showed no recurrent retroperitoneal fluid collection. His gastrojejunal feeding tube was removed. Conclusion: Over-the-endoscope clipping of the appendiceal orifice to repair a colocutaneous fistula is technically feasible and appears safe. Endoscopic therapy spared this patient from a potential ileocecectomy. To date, no other similar procedures have been performed by our department in other patients. Further study is necessary to establish the safety of this procedure before its implementation as standard practice. A.H. has no disclosures. E.M.P. is a lecturer for BD, Medtronic, Ovesco, and Boston Scientific. E.M.P. is a consultant for Boston Scientific, Actuated Biomedical, Baxter, Wells Fargo, Cook Biotech, Neptune Medical, Surgimatrix, CMR Surgical, Boehringer Laboratories, Allergan, and Noah Medical. J.S.W. is a consultant for Boston Scientific. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 5 mins 20 secs This video was accepted as a video presentation at the 2023 Society of Gastrointestinal and Endoscopic Surgery on March 29 to April 1, 2023.

Palato-ocular synchrony: Seeing what is behind closed eyelids in palatal tremor (P5-11.010)

<h3>Objective:</h3> To call attention to palato-ocular synchrony, a little-known manifestation of palatal tremor. <h3>Background:</h3> Palatal tremor due to a lesion of the dentato-rubro-olivary pathway (Guillain-Mollaret triangle) may spread to contiguous or remote muscles. When it involves the eyes it is known as oculopalatal tremor (OPT) manifesting as pendular nystagmus, typically vertical and/or torsional, causing oscillopsia. Nystagmus may be minimal or absent with eyes open and appear only under closed eyelids, a phenomenon described in 1976 by Jacobs and Bender, and called palato-ocular synchrony (Arch Neurol;33:289). These authors observed that palato-ocular synchrony was caused by eyelid closure rather than simply the removal of vision. <h3>Design/Methods:</h3> Two illustrative video case reports. <h3>Results:</h3> Following brainstem hemorrhage (patient 1 – midbrain; patient 2 – pons) involving the Guillain-Mollaret triangle, two patients developed hypertrophic olivary degeneration and asymptomatic palatal tremor. In patient 1, there was no nystagmus with eyes open, but under closed eyelids, vertical oscillations were readily apparent. In patient 2, there was very subtle torsional pendular nystagmus without oscillopsia, but large vertical oscillations were apparent with eyelid closure that were synchronous with PT. The mechanism of palato-ocular synchrony is unknown but may be related to the observation that palatal tremor, due to a lesion of the Guillain-Mollaret triangle, is one of the few movement disorders that persist during sleep, and this may simply reflect eyelid closure. <h3>Conclusions:</h3> A lesion, typically stroke, involving the Guillain-Mollaret triangle often leads to delayed development of palatal tremor. Such patients should undergo a careful ocular motor examination looking for oculopalatal tremor; if absent, then the globes should be observed during active eye closure. A visible or palpable ocular oscillation under closed eyelids is known as palato-ocular synchrony, an underappreciated phenomenon that extends the spectrum of manifestations of palatal tremor. <b>Disclosure:</b> Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Best Doctors. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UpToDate. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Enterin. Dr. Reich has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Reich has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Reich has received research support from ninds. Dr. Reich has received publishing royalties from a publication relating to health care. Dr. Reich has received publishing royalties from a publication relating to health care. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer .

Laparoscopic treatment of advanced interstitial pregnancy: key steps for a successful management

To describe a conservative laparoscopic treatment of an advanced case of interstitial pregnancy diagnosed in a woman at 14 weeks of gestational age. Video case report with demonstration of diagnostic work-up and laparoscopic management of rare subtypes of ectopic pregnancy SETTING: University tertiary care hospital. A 32-year-old nulliparous woman at 14 weeks of gestational age, presented with moderate abdominal pain. She reported an history of irregular periods however, no risk factor for ectopic pregnancy were identified. HCG levels was 7345 mIU/mL. Transvaginal ultrasound revealed an empty uterine cavity and a complex heterogeneous mass of 6 cm on the left cornual region. Myometrial thickness surrounding the gestational sac was 4 mm. There were several critical strategies for this laparoscopic approach. To reduce intraoperative bleeding, the peritoneum was opened, the ureters were identified, and bulldog clamps were used to temporarily reduce uterine vascularization. An intramyometrial injection of vasopressin was performed. After a first cornuostomy attempt, we had to get on a cornual resection to achieve a complete removal of the ectopic mass. Multilayer uterine suture and anatomical restoration to prevent adhesion was then accomplished. Institutional review board approval was not required for this case report as per our institution's policy; patient consent was obtained for publication of the case. Description of a laparoscopic management of huge interstitial pregnancy RESULTS: The overall operation time was 55 minutes, and the estimated blood loss was 55cl. A successfully conservative treatment was achieved with no short-term complications. Postoperative ultrasound showed a normal uterus and complete regression of hCG was obtained two weeks after surgery. Interstitial ectopic pregnancy presents a high risk of maternal mortality considering that the interstitial part of the tube, because of its thickness, has a great capacity to expand before rupture.

V04-03 COMBINED ROBOTIC TRANSPERITONEAL AND TRANSVAGINAL PULL-THROUGH FOR REPAIR OF DISTAL VAGINAL ATRESIA: A VIDEO CASE REPORT

You have accessJournal of UrologyCME1 Apr 2023V04-03 COMBINED ROBOTIC TRANSPERITONEAL AND TRANSVAGINAL PULL-THROUGH FOR REPAIR OF DISTAL VAGINAL ATRESIA: A VIDEO CASE REPORT Jeremiah Dallmer, Peris Castaneda, Andrew Freedman, and Paul Kokorowski Jeremiah DallmerJeremiah Dallmer More articles by this author , Peris CastanedaPeris Castaneda More articles by this author , Andrew FreedmanAndrew Freedman More articles by this author , and Paul KokorowskiPaul Kokorowski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Distal vaginal atresia is a unique Mullerian pathology where the urogenital sinus, responsible for the lower 1/3 of the vagina, fails to cannulate during development. Unlike Meyer-Rokitansky-Kuster-Hauser syndrome, which is characterized by agenesis of the upper vagina and uterus, patients with distal vaginal atresia have normal Mullerian development including the uterus and proximal vagina. METHODS: We present the case of a 12 yo female with a three month history of cyclical abdominal pain. Upon outside workup, she was found to have a short, blind ending vagina. MRI showed a 9 cm x 8 cm dilated uterus, open cervix and proximal vagina filled with blood products. She was taken to the operating room for combined perineal and robotic transperitoneal pull-through. RESULTS: An 8.5 mm camera port was placed in the umbilicus and three 8.5 mm working ports were placed using a hidden incision approach below the belt line. We incised the peritoneum and dissected as distally as feasible along the rectovaginal space. At the blind-ending introitus, a U-shaped incision was made to create an anterior flap. This space was dissected proximally, monitoring the correct plane via a finger in the rectum and with direct visualization with the robotic camera. The two planes were connected. A 0-silk was robotically placed to manipulate the vagina. As the vagina was severely dilated from menstrual products, mobility was insufficient to reach the introitus. A small posterior incision on the proximal vagina was made and blood products were partially evacuated. The vesicovaginal space was then dissected robotically, maintaining the lateral attachments as blood supply and avoiding ureteral injury. The vaginal apex was then pulled to the introitus and anastomosed to the anteriorly based flap from the introitus. The patient remained hospitalized for two days with vaginal packing in place. She was trained in the use of vaginal dilators and has been progressively increasing the size without difficulty. CONCLUSIONS: Robotic dissection of the proximal vagina in the setting of distal vaginal atresia using a hidden incision approach allows for orthotopic reconstruction, and superior aesthetics as compared to traditional port placement. This approach obviated the need for the use of tissue grafting or more extensive open dissection. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e338 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeremiah Dallmer More articles by this author Peris Castaneda More articles by this author Andrew Freedman More articles by this author Paul Kokorowski More articles by this author Expand All Advertisement PDF downloadLoading ...

Baclofen-Responsive Task-Specific Dystonia: Video Case Report.

Movement Disorders Clinical PracticeAccepted Articles CLINICAL VIGNETTES BACLOFEN-RESPONSIVE TASK-SPECIFIC DYSTONIA: VIDEO CASE REPORT Antonio Marcos da Silva Catharino, Corresponding Author Antonio Marcos da Silva Catharino catharino.antonio@gmail.com Department of Neurology of Hospital Geral de Nova Iguaçu, PhD student in Neurology at the Federal University of the State of Rio de Janeiro - UNIRIO, Adjunct Professor of Medicine at Iguaçu University - UNIG / Nova Iguaçu, RJ, Brazil Correspondence to: Details Antônio Marcos da Silva Catharino, Rua Gavião Peixoto 70, Room 811, CEP 24.2230- 100, Icaraí, Niterói-RJ, Brazil; Phone: +55 (21) 36203220, E-mail: catharino.antonio@gmail.comSearch for more papers by this authorAna Paula Santos de Assis, Ana Paula Santos de Assis Medical student at Iguaçu University. Iguaçu University - UNIG / RJ, Nova Iguaçu, RJ, BrazilSearch for more papers by this authorFelipe de Castro Felício, Felipe de Castro Felício Medical student at Iguaçu University. Iguaçu University - UNIG / RJ, Nova Iguaçu, RJ, BrazilSearch for more papers by this authorDaniel Antunes Pereira, Daniel Antunes Pereira Medical student at Iguaçu University. Iguaçu University - UNIG / RJ, Nova Iguaçu, RJ, BrazilSearch for more papers by this authorGilberto Canedo Martins Jr, Gilberto Canedo Martins Jr Professor of Neurology - Universidade Iguaçu- UNIG-RJ, Nova Iguaçu - RJ; Physician of the Neurology Service of Nova Iguaçu General Hospital, Nova Iguaçu, RJ, BrazilSearch for more papers by this author Antonio Marcos da Silva Catharino, Corresponding Author Antonio Marcos da Silva Catharino catharino.antonio@gmail.com Department of Neurology of Hospital Geral de Nova Iguaçu, PhD student in Neurology at the Federal University of the State of Rio de Janeiro - UNIRIO, Adjunct Professor of Medicine at Iguaçu University - UNIG / Nova Iguaçu, RJ, Brazil Correspondence to: Details Antônio Marcos da Silva Catharino, Rua Gavião Peixoto 70, Room 811, CEP 24.2230- 100, Icaraí, Niterói-RJ, Brazil; Phone: +55 (21) 36203220, E-mail: catharino.antonio@gmail.comSearch for more papers by this authorAna Paula Santos de Assis, Ana Paula Santos de Assis Medical student at Iguaçu University. Iguaçu University - UNIG / RJ, Nova Iguaçu, RJ, BrazilSearch for more papers by this authorFelipe de Castro Felício, Felipe de Castro Felício Medical student at Iguaçu University. Iguaçu University - UNIG / RJ, Nova Iguaçu, RJ, BrazilSearch for more papers by this authorDaniel Antunes Pereira, Daniel Antunes Pereira Medical student at Iguaçu University. Iguaçu University - UNIG / RJ, Nova Iguaçu, RJ, BrazilSearch for more papers by this authorGilberto Canedo Martins Jr, Gilberto Canedo Martins Jr Professor of Neurology - Universidade Iguaçu- UNIG-RJ, Nova Iguaçu - RJ; Physician of the Neurology Service of Nova Iguaçu General Hospital, Nova Iguaçu, RJ, BrazilSearch for more papers by this author First published: 25 January 2023 https://doi.org/10.1002/mdc3.13669 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/mdc3.13669. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

A unique soft tissue injury with devastating delayed consequences: A video case report.

A 52-year-old male presented to the emergency department (ED) after a fall down 5 stairs resulting in a loss of consciousness. On physical examination, a 4-cm hematoma was identified on the right lateral flank that emergency medical services personnel stated was the size of a golf ball on initial evaluation and appeared to expand over the course of his ED stay. Initial computed tomography (CT) (Figure 1) showed the hematoma; however, a bedside ultrasound (Video 1) and subsequent CT (Figure 2) were performed, demonstrating expansion of the hematoma with active extravasation. The qualities of this hematoma are suspicious for an uncommon condition called a Morel-Lavallée lesion (MLL), a closed degloving injury in which the subcutaneous tissues and fascia are separated by a hematoma that forms most frequently because of shearing forces.1, 2 Previous reports have documented MLLs secondary to motor vehicle collisions1 or biking accidents3 and some in conjunction with traumatic ventral wall hernias.2, 4 Diagnosis of this condition can occur through the use of ultrasound or magnetic resonance imaging, demonstrating a heterogenous fluid collection between the subcutaneous tissue and fascia.3 Although early detection of this condition is critical as the patient may continue to hemorrhage during evaluation, sequelae of this condition can be lifethreatening for a patient. Documented sequelae of MLLs range from infection of the lesion and neurovascular compromise to capsulation and scar tissue formation.3 A high index of suspicion for these lesions in patients with acute or remote trauma is critical as complications can occur up to a year later.3

Percutaneous ultrasound-guided removal of prolonged embedded fishbone: A video case report

Percutaneous ultrasound-guided removal of prolonged embedded fishbone: A video case report

Letter to the Editor Regarding “Stereotactic biopsy and laser ablation of the ganglioglioma using a thulium laser: a video case report”

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Stereotactic biopsy and laser ablation of the ganglioglioma using a thulium laser: a video case report

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Congenital Dysplastic Kidney with Ectopic Ureter to the Uterine Cervix

Study Objective To describe a unique presentation of a patient with an ectopic ureter to the uterine cervix, and its associated congenital dysplastic kidney. To highlight relevant anatomy, demonstrate the surgical technique used to identify and treat the ectopic ureter. Design Video case report. Setting Operating room at an academic hospital. Patients or Participants Single surgical patient. Interventions Endoscopic resection of dysplastic kidney and ectopic ureter. Measurements and Main Results We describe the unusual presentation of a 40-year-old female who was referred to our facility due to the complaint of 6-months of tissue protruding from her vagina. She was noted to have an anterior vaginal mass. In office cystovaginoscopy revealed no left ureteral orifice and large cystic mass adjacent to the cervix on the left. Imaging confirmed the dysplastic left kidney with an ectopic ureter to the uterine cervix associated with a left sided paracervical and paravaginal abscesses. The patient subsequently underwent an uncomplicated robotic-assisted nephrectomy and complete excision of the ureter as well as paravaginal and paracervical abscesses utilizing a multidisciplinary approach. Conclusion In this video case report, we demonstrate a successful surgical technique to identify and excise an ectopic ureter and paravaginal/paracervical abscesses using a multidisciplinary approach with combined nephrectomy. This presentation reviews the pertinent pelvic anatomy and highlights the importance of complete resection of an ectopic ureter at the time of nephrectomy for a dysplastic kidney to prevent recurrence of abscess at the location of the insertion point of the distal ureter. To describe a unique presentation of a patient with an ectopic ureter to the uterine cervix, and its associated congenital dysplastic kidney. To highlight relevant anatomy, demonstrate the surgical technique used to identify and treat the ectopic ureter. Video case report. Operating room at an academic hospital. Single surgical patient. Endoscopic resection of dysplastic kidney and ectopic ureter. We describe the unusual presentation of a 40-year-old female who was referred to our facility due to the complaint of 6-months of tissue protruding from her vagina. She was noted to have an anterior vaginal mass. In office cystovaginoscopy revealed no left ureteral orifice and large cystic mass adjacent to the cervix on the left. Imaging confirmed the dysplastic left kidney with an ectopic ureter to the uterine cervix associated with a left sided paracervical and paravaginal abscesses. The patient subsequently underwent an uncomplicated robotic-assisted nephrectomy and complete excision of the ureter as well as paravaginal and paracervical abscesses utilizing a multidisciplinary approach. In this video case report, we demonstrate a successful surgical technique to identify and excise an ectopic ureter and paravaginal/paracervical abscesses using a multidisciplinary approach with combined nephrectomy. This presentation reviews the pertinent pelvic anatomy and highlights the importance of complete resection of an ectopic ureter at the time of nephrectomy for a dysplastic kidney to prevent recurrence of abscess at the location of the insertion point of the distal ureter.