Post your interesting case here!

A case of left abdomenoscrotal hematocele in a three yrs old patient, originally operated for left UDT with left inguinal hernia. operated through groin incision

A abdominal part of hematocele delivered to groin

B inguinal hernial sac

C cord including vas and vessel

D Lt testis

Thank you , for this report.

How many weeks after the surgery was this discovered

Are there any risk factors identified or suspected.

What are the presentation like

Was the processus vaginalis still patent .

Any identified bleeding source

1 hour ago, drolukayode said:

Thank you , for this report.

How many weeks after the surgery was this discovered

Are there any risk factors identified or suspected.

What are the presentation like

Was the processus vaginalis still patent .

Any identified bleeding source

Thank you for your questions

1- this discovered intraoperatively

2- no risk factors identified

3- presentation is left inguinal hernia

4- there was associated big left hernia sac

5- no bleeding source identified (bleeding was inside abdominal hydrocele, no history of trauma!?!)

case of prof Tariq Altokais from KKUH, Riyadh, Saudi Arabia.

a case of female patient 8m old with black tarry stool since the age of 4m, and on/off milk reflux/vomiting. +ve occult blood in stool, patient is failing to thrive (current weight 6.1kg), -ve Meckel scan and was prepared for upper GI endoscopy by pediatric GI team. presented suddenly two days ago with persistent dark bilious vomiting of large amount. abdominal u/s done and was negative, upper GI contrast study revealed arrest of dye at DJ junction at the time of study, with passage of contrast in the after 1 hrs delayed film. diagnostic laparoscopy done for the patient and a proximal jejunal intussception found just distal to DJ junction, which reduced laparoscopcally, and we found a suspicious thickened dilated segment of proximal jejunum, then umclical incision extended and this jejunal segment delivered outside the abdomen and opened to find a intraluminal polyp, resection anastomosis done.

Pathology result: hamartomatus polyp

Polyp finding in intussception usually find as a leading Point ?

Collection of superficial parotidectomy operative photos from colleagues at Pediatric surgery unit, Menofia university hospitals, Egypt

Cardiac tamponade after subclavian vein porta cath insertion, case for discussion sent by a colleague

male patient 2 yrs old presented with ACUTE LYMPHOBLASTIC LEUKEMIA, presented for porta cath insertion, with low platelets count. After correction of thrombocytopenia, under GA, percutaneous needle inserted to cannulate the right subclavian vein, infra clavicular, succeeded from first trial without issues, then guide wire inserted and position checked with fluoroscopy in the right atrium, followed by catheter insertion smoothly, catheter connected to the porta cath chamber with good inflow and outflow no resistance. Suddenly during skin closure patient became bradycardic then arrested, CPR started and patient returned after few cycles. We repeated portable chest xray in OR while patient still intubated and no clear evidence of hemo or pnemo thorax. Yet patient still hypotensive and about to arrest, so needle decompression tried to right chest nothing came out followed by right chest tube and no blood or air came out. Bed side echo done and cardiac tamponade found. cardiac surgery colleague contacted to join then we inserted subxyphoid needle and aspirated blood 150 cc. Decision made with cardiac surgery to proceed with median sternotomy, pericardium opened blood came out marked amount, cardiac massaging started, heart started beating, on assessment of heart no cardiac injury found and normal svc and ivc, Yet injury found at the innominate veins bifarcation which is repaired, and sternotomy closed. Patient survived but with neurological sequel.

the injury could be due to the guide wire or due to the catheter, the question, is there any thing could be done to avoid this rare complication of central venous insertion?, and weather there is malpractice in the management of this patient ?

case from Dr Usman Akram

What will be the best plan according to you in this case ?

I think it’s quite aggressive to go for reimplementation without a trial of cystoscopy and Deflux injection . You have good function on both kidneys . Will definitely give it a go first

I think it’s better not to rush for reimplementation because you have a good functioning right kidney, I would prefer to do MAG3 rather than DMSA scan as well as you don’t have a reflux. If the curve is showing an obstruction of the right UVJ go a head with the reimplementation, if not, then you have a diagnosis of non-obstructing non-refluxing HUN, in this case you just observe the baby with no surgery…. Very important point is to make sure that this baby does not have a PUV ( I am not sure from the name is he or she).

Good luck

The presence of contrast uptil the kidney indicates non-obstructing reflux on the right. Even though there isn’t much info on urinary stream but the presence of a smooth-outlined bladder and unilateral reflux rules out the possibility of posterior urethral valves. As the boy is only 2 months old with good functioning kidneys, a good approach would be to keep him on low-dose prophylactic antibiotics along with a close 3 monthly follow-up. A lot of VURs resolve with age. In case of breakthrough UTIs or detoriating renal function, a trial of deflux can be given followed by reimplantation if it fails.

On 8/3/2025 at 5:14 PM, admin said:

Post your interesting case here!

Edited yesterday at 06:25 PM1 day by Touby Khan

On 10/29/2025 at 6:51 PM, Ahmed Nabil said:

case of prof Tariq Altokais from KKUH, Riyadh, Saudi Arabia.

a case of female patient 8m old with black tarry stool since the age of 4m, and on/off milk reflux/vomiting. +ve occult blood in stool, patient is failing to thrive (current weight 6.1kg), -ve Meckel scan and was prepared for upper GI endoscopy by pediatric GI team. presented suddenly two days ago with persistent dark bilious vomiting of large amount. abdominal u/s done and was negative, upper GI contrast study revealed arrest of dye at DJ junction at the time of study, with passage of contrast in the after 1 hrs delayed film. diagnostic laparoscopy done for the patient and a proximal jejunal intussception found just distal to DJ junction, which reduced laparoscopcally, and we found a suspicious thickened dilated segment of proximal jejunum, then umclical incision extended and this jejunal segment delivered outside the abdomen and opened to find a intraluminal polyp, resection anastomosis done.

Pathology result: hamartomatus polyp

Any further work up to rule out presence of other such polyps ?