Letters to Editor
manual reduction to surgical orchiopexy with lysis of adhesions and even orchiectomy, with possible deleterious effects of ectopic position. Traumatic testicular dislocation is frequently associated with other severe injuries such as hip dislocation. Knowledge of such an association by orthopedic surgeon, general surgeon s and emergency medicine physicians will prevent delay in diagnosis. High index of suspicion and thorough physical examination is the key for early diagnosis. Delayed diagnosis or treatment may lead to poor results.
Sanjay Meena, Nilesh Barwar, Buddhadev Chowdhury Figure 1: Anteroposterior (AP) radiograph of the pelvis at the time of presentation showing anterior dislocation of left hip
Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail:[email protected]
REFERENCES 1.
Chang KJ, Sheu JW, Chang TH, Chen SC. Traumatic dislocation of the testis. Am J Emerg Med 2003;21:247-9.
2.
Kochakarn W, Choonhaklai V, Hotrapawanond P, Muangman V. Traumatic testicular dislocation a review of 36 cases. J Med Assoc Thai 2000;83:208-12.
3.
Munter DW, Faleski EJ. Blunt scrotal trauma: Emergency department evaluation and management. Am J Emerg Med1989;7:227-34.
4.
Meena S, Kishanpuria T, Gangari SK, Sharma P. Traumatic posterior hip dislocation in a 16-month-old child: A case report and review of literature. Chin J Traumatol 2012;15:382-4.
5.
Onyemaechi NO, Eyichukwu GO. Traumatic hip dislocation at a regional trauma centre in Nigeria. Niger J Med 2011;20:124-30.
Figure 2: Anteroposterior (AP) radiograph of the pelvis after reduction showing congruent reduction of left hip Access this article online
one of the most common causes of testicular dislocation.[3] Hip position during trauma defines the direction of dislocation.[4,5] The position of patients involved in motorcycle accidents makes them more prone for anterior hip dislocation due to the position of leg. Our patient while riding his motorcycle had hit a stationary truck. Due to this sudden impact, there was wide abuction, external rotation and flexion at hip joint leading to anterior hip joint dislocation. These forces also led to the scrotum hitting the seat/fuel tank, which may have caused testicular dislocation. Diagnosis of testicular dislocation can be made by physical examination when a well-developed but empty scrotal sac is found or an abnormally located testis is palpated. However, other concomitant injuries may preclude disclosure of testicular dislocation. Testicular dislocation can be diagnosed on computed tomography (CT) which reveals empty scrotum or presence of dislocated testis in locations including the inguinal, pubic, penile, perineal, or even intra-abdominal regions. CT or sonography can also reveal testicular dislocation that is masked by severe scrotal edema, hematoma, or associated pelvic injuries. Once testicular dislocation is diagnosed, early treatment should be instituted. A delay in diagnosis of testicular dislocation may convert Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125646
Surgical digestive emergencies in prisoners, about a prospective study Sir, The prison environment is a breeding ground for a number of gastrointestinal diseases. It has been rarely studied and 59
Letters to Editor
publications on this topic are rare. We tried to study the prisoners patients sent to our emergency department by the provincial penitentiary of Marrakech over a period of 1 year. The total number of cases was 15. All patients were men. The average age was 29 years. The most common surgical emergency was voluntary ingestion of foreign bodies, which was found in nine patients (60%). Other diseases were rare, found only in one patient each: acute pancreatitis, primitive peritonitis pyloric stenosis, strangulated inguinal hernia and abdominal wound. A b d o m i n a l p a i n wa s t h e m o s t f r e q u e n t c a u s e o f consultation found in four patients, followed by vomiting (three patients), abdominal distension (one patient) and hematemesis (one patient). All patients had an abdominal X-ray [Figures 1and 2]. Seven patients underwent surgery (46%) and were operated upon by laparotomy: four for ingestion of foreign objects [Figures 3 and 4], one for pyloric stenosis, one for strangulated hernia and one for abdominal wound with evisceration. Other patients had conservative treatment or medial with medical
supervision. The average length of hospital stay was 7 days (2-30 days). Two patients had post-operative complications as infection of necrosis (acute pancreatitis), which required radiologic drainage and a second case of wound infection (case of abdominal wound with evisceration). The prison population is not representative of the general population. This population is usually male, aged 15-44 years, and from the lower classes. Prisoners often have a history of smoking, alcoholism, drug addiction, mental disorders and chronic diseases.[1,2] In most published series, the reported reasons for consultation were dominated by the ingestion of foreign bodies, trauma of the abdomen and proctology disease.[3] In our series, the most common pathology was voluntary ingestion of foreign bodies. Blaho et al. had also found a high incidence of ingestion of foreign bodies by studying two different populations from two prisons over a period of 5 weeks, during which 14 ingestions were observed.[4]
Figure 1 and 2: abdominal X ray showing foreign bodies
Figure 3 and 4 : picture of the ingested foreign body 60
Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Letters to Editor
Youssef Narjis
3.
Smit SJ, Kleinhans F. Surgical practice in a maximum security prison — unique and perplexing problems. S Afr Med J 2010;100:243-6.
Departments of General Surgery, Faculté de médecine et de pharmacie de Marrakech, BP: 7010, Sidi Abbad, Marrakech, Morocco E-mail: [email protected]
4.
Blaho KE, Merigian KS, Winbery SL, Park LJ, Cockrell M. Foreign body ingestion in the Emergency Department: Case reports and review of treatment. J Emerg Med 1998;16:21-6.
REFERENCES 1.
Boyce SH, Stevenson J, Jamieson IS, Campbell S. Impact of a newly opened prison on an accident and emergency department. Emerg Med J 2003;20:48-51.
2.
Levy M. Prison health services. Should be as good as those for the general community. BMJ 1997;315:1394-5.
Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Access this article online Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125647
61
Copyright of Journal of Emergencies, Trauma & Shock is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
manual reduction to surgical orchiopexy with lysis of adhesions and even orchiectomy, with possible deleterious effects of ectopic position. Traumatic testicular dislocation is frequently associated with other severe injuries such as hip dislocation. Knowledge of such an association by orthopedic surgeon, general surgeon s and emergency medicine physicians will prevent delay in diagnosis. High index of suspicion and thorough physical examination is the key for early diagnosis. Delayed diagnosis or treatment may lead to poor results.
Sanjay Meena, Nilesh Barwar, Buddhadev Chowdhury Figure 1: Anteroposterior (AP) radiograph of the pelvis at the time of presentation showing anterior dislocation of left hip
Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail:[email protected]
REFERENCES 1.
Chang KJ, Sheu JW, Chang TH, Chen SC. Traumatic dislocation of the testis. Am J Emerg Med 2003;21:247-9.
2.
Kochakarn W, Choonhaklai V, Hotrapawanond P, Muangman V. Traumatic testicular dislocation a review of 36 cases. J Med Assoc Thai 2000;83:208-12.
3.
Munter DW, Faleski EJ. Blunt scrotal trauma: Emergency department evaluation and management. Am J Emerg Med1989;7:227-34.
4.
Meena S, Kishanpuria T, Gangari SK, Sharma P. Traumatic posterior hip dislocation in a 16-month-old child: A case report and review of literature. Chin J Traumatol 2012;15:382-4.
5.
Onyemaechi NO, Eyichukwu GO. Traumatic hip dislocation at a regional trauma centre in Nigeria. Niger J Med 2011;20:124-30.
Figure 2: Anteroposterior (AP) radiograph of the pelvis after reduction showing congruent reduction of left hip Access this article online
one of the most common causes of testicular dislocation.[3] Hip position during trauma defines the direction of dislocation.[4,5] The position of patients involved in motorcycle accidents makes them more prone for anterior hip dislocation due to the position of leg. Our patient while riding his motorcycle had hit a stationary truck. Due to this sudden impact, there was wide abuction, external rotation and flexion at hip joint leading to anterior hip joint dislocation. These forces also led to the scrotum hitting the seat/fuel tank, which may have caused testicular dislocation. Diagnosis of testicular dislocation can be made by physical examination when a well-developed but empty scrotal sac is found or an abnormally located testis is palpated. However, other concomitant injuries may preclude disclosure of testicular dislocation. Testicular dislocation can be diagnosed on computed tomography (CT) which reveals empty scrotum or presence of dislocated testis in locations including the inguinal, pubic, penile, perineal, or even intra-abdominal regions. CT or sonography can also reveal testicular dislocation that is masked by severe scrotal edema, hematoma, or associated pelvic injuries. Once testicular dislocation is diagnosed, early treatment should be instituted. A delay in diagnosis of testicular dislocation may convert Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125646
Surgical digestive emergencies in prisoners, about a prospective study Sir, The prison environment is a breeding ground for a number of gastrointestinal diseases. It has been rarely studied and 59
Letters to Editor
publications on this topic are rare. We tried to study the prisoners patients sent to our emergency department by the provincial penitentiary of Marrakech over a period of 1 year. The total number of cases was 15. All patients were men. The average age was 29 years. The most common surgical emergency was voluntary ingestion of foreign bodies, which was found in nine patients (60%). Other diseases were rare, found only in one patient each: acute pancreatitis, primitive peritonitis pyloric stenosis, strangulated inguinal hernia and abdominal wound. A b d o m i n a l p a i n wa s t h e m o s t f r e q u e n t c a u s e o f consultation found in four patients, followed by vomiting (three patients), abdominal distension (one patient) and hematemesis (one patient). All patients had an abdominal X-ray [Figures 1and 2]. Seven patients underwent surgery (46%) and were operated upon by laparotomy: four for ingestion of foreign objects [Figures 3 and 4], one for pyloric stenosis, one for strangulated hernia and one for abdominal wound with evisceration. Other patients had conservative treatment or medial with medical
supervision. The average length of hospital stay was 7 days (2-30 days). Two patients had post-operative complications as infection of necrosis (acute pancreatitis), which required radiologic drainage and a second case of wound infection (case of abdominal wound with evisceration). The prison population is not representative of the general population. This population is usually male, aged 15-44 years, and from the lower classes. Prisoners often have a history of smoking, alcoholism, drug addiction, mental disorders and chronic diseases.[1,2] In most published series, the reported reasons for consultation were dominated by the ingestion of foreign bodies, trauma of the abdomen and proctology disease.[3] In our series, the most common pathology was voluntary ingestion of foreign bodies. Blaho et al. had also found a high incidence of ingestion of foreign bodies by studying two different populations from two prisons over a period of 5 weeks, during which 14 ingestions were observed.[4]
Figure 1 and 2: abdominal X ray showing foreign bodies
Figure 3 and 4 : picture of the ingested foreign body 60
Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Letters to Editor
Youssef Narjis
3.
Smit SJ, Kleinhans F. Surgical practice in a maximum security prison — unique and perplexing problems. S Afr Med J 2010;100:243-6.
Departments of General Surgery, Faculté de médecine et de pharmacie de Marrakech, BP: 7010, Sidi Abbad, Marrakech, Morocco E-mail: [email protected]
4.
Blaho KE, Merigian KS, Winbery SL, Park LJ, Cockrell M. Foreign body ingestion in the Emergency Department: Case reports and review of treatment. J Emerg Med 1998;16:21-6.
REFERENCES 1.
Boyce SH, Stevenson J, Jamieson IS, Campbell S. Impact of a newly opened prison on an accident and emergency department. Emerg Med J 2003;20:48-51.
2.
Levy M. Prison health services. Should be as good as those for the general community. BMJ 1997;315:1394-5.
Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Access this article online Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125647
61
Copyright of Journal of Emergencies, Trauma & Shock is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
