As in Marvin L. Corman’s book (Colon & Rectal Surgery) quotes:

Man should always strive to have his intestines relaxed all the days of his life and that bowel function should approximate diarrhea. This is a fundamental principle in medicine, that whenever the stool is withheld or is extruded with difficulty, grave illnesses result.

Maimonides: Mishneh Torah

Rectal prolapse (a.k.a. Procidentia) is one of the most fascinating surgical pathologies because its complexity in treatment. In 1912 Moschcowitz proposed an herniation of Douglas pouch as a cause for rectal prolapse. Another cause was proposed by Broden and Snellman with the help of defecography described a full thickness rectal intussusception.

Rectal prolapse is 6 times more common in females (as males) aged 50 years or older. Many of male patients has a past medical history of psychiatric disorders. Chronic or lifelong constipation with straining is present in more than 50% of patients.

Patients describe a mass or bulge that they have to push back in after defecation. Often, presentation of rectal prolapse can be dramatic when the prolapsed segment becomes incarcerated below the level of the anal sphincter as in this clinical case and emergency surgical therapy was indicated.

More than fifty types of procedures for repair rectal prolapse have been described, but the treatment is always surgical.

Lakshmi Tatma is a girl who is two years old but she was born with 8 limbs, because she is joined at the pelvis to what is, in fact, a headless, undeveloped twin (parasitic twin or to be more specific, ischiopagus cojoined twin).

This is surely an abnormal feature and it has attracted media attention worldwide.

The 24-hour-long surgery to remove the extra limbs of this Indian girl born with four arms and four legs was a success, doctors announced Wednesday.

A team of more than 30 physicians removed Lakshmi’s extra limbs, salvaged her organs, and rebuilt her pelvis area, Dr. Sharan Patil said from a hospital in the southern Indian city of Bangalore, India.

The organs of a pig are placed within the model.

The model is intubated with an “orotracheal” tube

Abdominal view

Thoracic view

Laparoscopy view

On physical examination we found Grade IV hemorrhoidal disease.

We decide to perform a PPH procedure with an hemorrhoidal circular stapler (33 mm) kit.

Note the tissue removed.

This donut confirms the circular and complete resection of the defect.

On the postoperatory period the patient was in excellent condition without pain and without bleeding.

On the physical exam, we found a 10×15 cm tumor in the left upper quadrant. The tumor is not fixed, it feels solid and well delimited. We did not find any other important data.

Lab work beteween normal ranges. We ordered plain abdominal film, chest x ray and later an abdominal ultrasound and a CT scan.

Rx

Ultrasound

CT Scan

With these findings, we decided to perform an exploratory laparotomy (left subcostal incision) and tumor resection.

Look the size of the tumor and its characteristics.

Note the splenic vein.

The tumor arises from the tail of the pancreas. It was impossible to dissect the spleen, so we had to cut it.

Pathology

Final diagnosis: Benign Solid Pseudopapillary Tumor of the Pancreas of 14 cm, and 1.66Kg.

Solid-pseudopapillary tumor (SPT) of pancreas is a very rare (about 450 cases have been described in the world literature) neoplasm of low malignant potential and unknown origin. It generally occurs in young women and the prognosis is usually good after complete surgical removal.

SPT is also know as Fratz’s tumor

The patient was alert, very anxious, and in severe pain.
blood pressure of 160/120; pulse of 126; respiratory rate of 24; normal temperature; SatO2 of 96% without O2 supplement.
She had a distended upper abdomen and epigastric tenderness without rebound or guarding.

A plain film of the abdomen was ordered and showed gas-filled, grossly dilated stomach.

Pass of nasogastric tube was unsuccessful.

A laparotomy was mandatory.

The patient survived the surgery but 6 months later, she died by causes nonrelated to the surgery

In 1904, Borchardt described the classic triad of gastric volvulus: severe epigastric pain, retching without vomiting, and inability to pass a nasogastric tube.

Eleven weeks premature, both boys were given a little chance of survival – particularly Lincoln, weighing only 1lb 2oz at birth.

But yesterday this twins, now they are five weeks old, are doing well, thanks to the dedicated staff at the Royal Hospital for Women in Sydney.

This is called twin-to-twin transfusion, where one of the blood flow of one of the babies goes from the smaller to the larger twin.

“Lincoln’s chances of survival, I considered, were less than 30 per cent because he was so small.”

But after their birth, both brothers showed an “exceptional will to live,” said Dr Mishra.

“Lincoln initially had a lot of breathing problems and then he had heart problems, so an operation was carried out when he was still about 600g (1lb 5oz).

“But Byron also needed a little bit of help with his breathing before he began to gain proper weight and now he is doing well.

“We’re now watching both boys carefully, particularly little Lincoln, but we hope that he’ll soon start gaining weight much more quickly and get nearer and nearer his brother,” said Dr. Mishra.

Via

Kylie Hodgson gave birth to twin daughters by caesarean section, then she realised a difference between them.

This amazing conception happened after two eggs were fertilised at the same time in the womb.

The odds against of a mixed race couple having twins of dramatically different colour are a million to one.

Skin colour is believed to be determined by up to seven different genes working together. For a mixed-race couple, the odds of either of these scenarios is around 100 to one. But both scenarios can occur at the same time if the woman conceives non-identical twins, another 100 to one chance.

This involves two eggs being fertilised by two sperm at the same time, which also has odds of around 100 to one.

If a sperm containing all-white genes fuses with a similar egg and a sperm coding for purely black skin fuses with a similar egg, two babies of dramatically different colours will be born.

The odds of this happening are 100 x 100 x 100 – a million to one.

She had a surgical complication of the abdominal wall called postincisional hernia and came to surgical consult because of this giant ventral hernia. This is one of the largest hernias I’ve ever seen.

A laparoscopic repair of the defect was made with Prolene mesh (2 sheets of 12″ x 12″) sutured to the fascia and now she is doing very well.

Images courtesy of Mariana Herrera Guerrero, M.D.

A missionary in Eastern Europe recently reported an extremely rare (condylomatosis) skin condition. This disease is called Lewandowsky-Lutz dysplasia. This missionary wrote:

I found this man, and other than his hands and feet, he looked and seemed in good health. As best as I could gather these growths began when he was 14 years old, and began in the area of his wrists. The skin on his wrists and the back of his hands resembles that of a hedgehog – hundreds of spike like growths. The problem is much more severe on his palms and fingers where the growths resemble very much that of nails infected with a fungus. The growths have that same texture, smell and feel. I cut a number of the largest growths off, most of witch did not bleed. Some of the smaller growths did bleed a small amount and he seemed much more sensitive to the cutting of the smaller growths.

It has grown slowly but steadily but has not spread to other parts of his body, just a bit below his knees on his legs. He has other skin growth (many would be skin tags) on his face, and some moles on his chest. The growths are not as bad on his feet but I was told that more than 10 years ago many we cauterized off his feet, and they did not return. I think with repeated soaking and cutting most could be removed but other parts will I think need to be burned away in some form.”

He has 15 skin tags on his face, and a wart in one ear.

Bizarre pictures:

For those who don’t believe in injuries caused by firecrackers explotion. I just saw a patient in the E.R. of my hospital who came because he was walking near a park and some kids were buying firecrakers in the street. A kid ignited a firecracker and it exploted next to the box that containded the firecrackers. The patient was 10 ft away from the box and the explotion cause this right side injuries.

As you can see, the injuries are projectile-like injuries and he didn’t burn. A witness told me that lots of wood sticks and asphalt stones flew far away.

A Plastic Surgeon and I repaired the injuries and noted an irregular perforation at the right cheek, that penetrated towards the floor of the orbit and produced a coronoid apophysis fracture.

After the reparation:

I strongly recommend never play with firecrackers.

The neuropathologist Diana Rivas from Perú runs a Museum of brains and she states that this show is unique in the World.

This museum has an inventory of 2,998 brains and counting. Rivas studies neurological diseases and psychiatric disorders but, unlike prestigious brain banks around the World, she allows entrance to the general public.

There is a brain of the Creutzfeld-Jakob disease.

Her goal is to educate people.

“It’s true. Alcohol and drugs kill brain cells”, she said.

Fact: The greatest brain bank in the World is the Harvard Brain Tissue Resource Center.

His parents call him “Super Toño”. Antonio Vasconcelos -the baby- gained 200 grams in the first three days.

The mother of Antonio, Teresa Alejandra Cruz, of 23 years, is probably diabetic, because seven years ago this woman gave birth to a baby that weighed 5,2 kilograms

According to The Guiness World Records Book the baby who weighed more is of 10.2 kilograms, born in Italy in 1955 and was son of Carmelina Fedele.

Here are the photos of Antonio:

Beware! Gory Image

This amazing invention looks useful, isn’t it?