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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Before performing vasectomy, the doctor or surgeon should make sure that both husband and wife have been properly counseled as to what vasectomy is all about. Although the operation is normally thought of as minor, both patient and surgeon together should choose the proper anesthesia (general or local) to be used, especially when the patient appears apprehensive about the whole operation. Preoperative preparation should include the patient shaving his scrotum and having a good bath the night before the operation (to get rid of free hairs). Premedication with atropine and a sedative should be considered in the apprehensive patient to prevent vagal stimulation which can lead to cardiac arrest or fainting. 24 hours after the operation, the patient can be advised to return to light work, although it is advisable to take the weekend off. Often, the scrotum feels stiff and uncomfortable. Development of hematoma is the most important and commonest complication of vasectomy. If there is enlargement, the patient should be managed at the hospital; otherwise, a small swelling that is not growing is better left alone. Other possible complications include sepsis, pain and fusiform swelling where the vas was cut, and in some cases, spontaneous recanalization. With respect to reversal of vasectomy, the divided vasa can be reanastamose with or without a splint or assistance of a magnifying loupe. However, although reversal techniques are available and provide some measure of success, couples should be advised that such techniques do not guarantee full restoration of fertility.
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PMID:Vasectomy. 48 35

Sonography has proven to be a useful diagnostic tool in the evaluation of scrotal abnormalities. Three uncommon, interesting abnormalities--epididymoorchitis as the presenting manifestation of Hemophilus influenzae sepsis, torsion of undescended testis, and abdominoscrotal hydrocele--are presented. All had swelling of both the scrotum and the inguinal area. Sonography played a significant role in the evaluation and management of these patients.
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PMID:Uncommon causes of scrotal and inguinal swelling in children: sonographic appearance. 309 41

Giant inguinal herniae present a major challenge in management. This case details clinical features of an enormous inguinoscrotal hernia associated with septic gangrene and elephantiasis of the scrotum. Two initial operations were required for control of sepsis, followed by a two-staged hernial repair, involving a total colectomy and a subsequent neoscrotal repair. The problems of loss of domain within the abdominal cavity and the special features presented by this case are discussed.
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PMID:Giant inguinal hernia. 325 Apr 19

This is the report of a patient with gangrene of the skin and subcutaneous tissue of the scrotum and base of the penis secondary to diverticulitis of the sigmoid colon. Due to high mortality in such patients, the early, rapid, and radical debridement of all devitalized tissues and prompt recognition of the source of sepsis is of utmost importance. Computed tomography (CT) scanning facilitates delineating the extent of disease. Anatomy of the perineal body and pathways of spread are discussed.
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PMID:Gangrene of male external genitalia in a patient with colorectal disease. Anatomic pathways of spread. 401 14

Ecchymosis of the scrotum and lower abdominal wall occurred in four newborn boys. All were anemic. Three had coagulation abnormalities and evidence of sepsis. In two, group B streptococcal septicemia was documented. Intraperitoneal hemorrhage from a ruptured subcapsular hematoma of the liver was the source of blood in the scrotum in three, and most probably in the fourth as well. Two infants died in spite of antibiotics, vigorous blood replacement, including exchange transfusion, and desperation laparotomies for continued intraperitoneal hemorrhage. Newborns with scrotal ecchymosis should be examined for intraperitoneal hemorrhage, ruptured subcapsular hematoma of the liver being the most probable source. Their coagulation status should also be evaluated, and sepsis should be suspected, especially in those with a demonstrated coagulopathy. Group B Streptococcus is a likely primary etiologic agent in these critically ill neonates. Nonoperative treatment, as given the two survivors in this experience, is preferred.
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PMID:Scrotal ecchymosis: sign of intraperitoneal hemorrhage in the newborn. 675 34

This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier's gangrene) and a review of previous publications. Even though found mostly in elderly male patients, the disease spares no age group and can involve the external genitalia in neonates and women as well. The disease is a necrotising fasciitis of infective origin and always has a portal of entry of the infecting organisms even though it may be so trivial as to be undetected. The commonest portals of entry of infection are periurethral sepsis, groin wound sepsis, anorectal sepsis, prostatic sepsis and trauma. The infecting organisms comprise both aerobic and anaerobic organisms such as Escherichia coli, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, enterococci, Bacteroides fragilis and anaerobic streptococcus. Fournier's gangrene is probably the same disease as necrotizing fasciitis occurring in other parts of the body, but modified by the peculiar anatomy of the genitoperineum.
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PMID:The features and aetiology of Fournier's gangrene. 793 50

Vesico-cutaneous fistulas rarely occur in the urinary tract (1.7% of all urinary fistulas). Trauma, neoplasias, inflammation and iatrogenic pathologies are among the principal causes. The external mouth of the fistula is usually found in the hypogastric area, scrotum, perineum and rarely elsewhere. This report describes the case of a 48 year old woman who, after severe trauma suffered bladder laceration, treated only with cystorraphy. Sepsis and gangrene followed involving the pubic area and the right thigh, associated with acute renal and adrenal gland cortex failure. After emergency treatment, the patient was discharged with an indwelling catheter. Ten months later she was referred to our urology clinic because of a suspected bladder-vaginal fistula. The indwelling catheter was removed and the bladder resumed functioning well. Six months later the external mouth of the fistula appeared on the right inner thigh. NMR confirmed the diagnosis of a vesico-cutaneous fistula. Surgery resolved the abnormality.
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PMID:[Vesico-cutaneous fistula of the thigh as a late manifestation]. 802 28

Fournier's gangrene is a necrotising soft-tissue infection of the scrotum and perineal region caused by gram-negative and gram-positive Enterobacteriaceae. The disease is characterised by its unique appearance, its speed of onset, and its high mortality. CASE REPORT. A 26-year-old male presented to the emergency room complaining of a painful, tremendously swollen scrotum and penis (Fig. 1) that had developed within the past 24 h. Later, slurred speech, pallor, and hypotension were recognised, leading to the patient's admission to the intensive care unit. Suspecting a severe internal haemorrhage, vigorous volume therapy was started using crystalloids and colloids until blood and fresh frozen plasma were available. One hour later, septic shock was presumed and therapy augmented by IV antibiotics, tracheal intubation, and mechanical ventilation. Despite all efforts, the patients condition deteriorated rapidly and he died a few hours later due to multiple organ failure in septic shock. Postmortem, a perforated external hemorrhoidal node was found to be the primary focus of sepsis. Microbiologic cultures revealed Escherichia coli in blood and tissue samples. DISCUSSION. Fournier's gangrene is a rare disease; nevertheless, its clinical picture has to be recognised immediately in order to provide appropriate treatment in time. It occurs predominantly in males after minor trauma, colorectal or urological disease, and perineal or abdominal surgery. Fournier's gangrene usually begins with itching and pain in the scrotal region followed by swelling and dark-blueish discolouration of the scrotum and penis, occasionally including the lower abdominal wall. Fever and chills are usually present. The illness progresses to severe prostation and septic shock with a mortality of 20%-50%. Tissue cultures mostly reveal E. coli, gram-positive enterococci, Pseudomonas, Proteus, and various anaerobes. The treatment should include immediate radical surgical debridement, i.v. administration of broad-spectrum antibiotics, and cardiopulmonary support. CONCLUSION. The dramatic course of Fournier's gangrene requires early recognition, extensive surgical debridement, as well as intensive care treatment in order to prevent irreversible septic shock.
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PMID:[Fulminating E. coli sepsis in Fournier's gangrene]. 814 38

We report the thirteenth case of a recto-urethral fistula in Crohn's disease. The patient, a 37-year-old white male, had a 20-year history of intestinal Crohn's disease and had undergone numerous bowel resections. His symptoms were fecaluria, urorrhea and passing of urine from an orifice just outside the base of the scrotum. He had urinary infection and severe ileocolitis. He underwent a diagnostic evaluation (cystourethroscopy, proctoscopy, retrograde pyelography, intravenous urography, voiding cystourethrography) that revealed a fistula comprising the membranous urethra, the rectum, the perineum and the scrotum. He was treated with Metronidazole (20 mg/kg/day/12 mo). At 1 year no signs of intestinal disease and urinary sepsis were noted. The external orifice and the perineal fistulous network were closed, and the drainage from the rectum and the urethra had improved. No side effects limited use of the drug. No relapse was observed in the 3 months, after the therapy was discontinued. We present a review of the literature on the management of rectourethral fistulas in Crohn's disease. Surgeons have used successfully several approaches in the repair of this lesion, but no single procedure has proved optimal or even universally applicable. We emphasize, as the literature suggests, that the management must be individualized. Medical therapy with metronidazole has an important role in a patient with rectourethral fistula and concomitant proctitis, ileocolitis, urinary sepsis and multiple previous surgical procedures.
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PMID:Management of rectourethral fistulas in Crohn's disease. 856

We report a patient with high anorectal anomaly and accessory scrotum. To the best of our knowledge only four other similar cases have been described. The patient also had renal dysplasia, partial prune-belly syndrome, and dismal outcome because of urinary septicemia. To our knowledge, accessory scrotum, high anorectal anomaly, and prune-belly syndrome in the same patient has never been reported.
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PMID:Accessory scrotum and anorectal malformation associated with "pseudo" prune belly in a neonate. 881 37


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