An Anatomic Red Herring Found in the Diagnosis of Functional Vomiting.

This report describes the case of a previously healthy 16-year-old patient who initially presented with emesis of unknown etiology that was refractory to standard medical interventions. The initial imaging revealed duodenum inversum, a rare anatomic abnormality that provided additional diagnostic complexity to this case. Though the final diagnosis was found to be functional vomiting, this case gives an instructive review of this rare anatomic abnormality, the significant effects it may cause, and how making a diagnosis of exclusion can be challenged by unusual turns in an otherwise straightforward presentation.

A Case of Severe Hepatitis in Infant Twins With COVID-19.

We report a case of nine-month-old twins who presented with bright green diarrhea along with progressively worsening jaundice over one week. On initial evaluation, they were found to have significantly elevated liver enzymes, bilirubin, and alkaline phosphatase levels but without signs of liver failure. They were tested for multiple causes of liver injury including autoimmune and infectious etiologies, which were negative as well.

A Rare Case of Salmonella Osteomyelitis in Immunocompetent Toddler Without Risk Factors.

Salmonella infections are common, though rarely cause disseminated or severe disease in immunocompetent children. We present a case of severe salmonella osteomyelitis and epidural abscess in a patient without significant risk factors. This patient presented over the course of multiple visits with nonspecific symptoms of fever, malaise, and eventual joint pain.

Partial Flap Loss in Gender Affirming Phalloplasty.

Background:  Flaps used in phalloplasty are larger than described for other indications, with a design that is tubularized up to two times. While the incidence of partial flap loss (PFL) is well described, current literature lacks granularity comparing donor sites and techniques with minimal discussion of etiology and management. The purpose of this study was to review our experience with PFL in phalloplasty.

Masculinizing Genital Surgery: An Imaging Primer for the Radiologist.

Masculinizing genital surgeries for transgender individuals are currently performed at only a select few centers; however, radiologists in any geographic region may be confronted with imaging studies of transgender patients. The imaging findings of internal and external genital anatomy of a transgender patient may differ substantially from the imaging findings of a cisgender patient. This article provides the surgical and anatomic basis to allow appropriate interpretation of preoperative and postoperative imaging findings.

Phalloplasty: techniques and outcomes.

Phalloplasty is an exceptionally complicated reconstructive procedure that attempts to create a structure that is penis-like. As patient goals vary widely, it is helpful to think about phalloplasty as a modular set of procedures that can be combined, mixed and matched to meet the needs of each individual patient while also taking into account their anatomy. Each module-but particularly the shaft and penile urethra-can be performed using a variety of techniques.

Providing Gender Confirmation Surgery at an Academic Medical Center: Analysis of Use, Insurance Payer, and Fiscal Impact.

Background: Expansion of insurance coverage for gender confirmation surgery (GCS) has led to a large demand for GCS in the US. We sought to determine the financial impact of providing comprehensive GCS services at an academic medical center.

Methods: This was a cross-sectional study of patients older than 18 years who presented for GCS between January 1, 2015 and July 31, 2018 at a single academic medical center.

Differences in Chest Measurements between the Cis-female and Trans-female Chest Exposed to Estrogen and Its Implications for Breast Augmentation.

Background: Gender confirming primary breast augmentation is becoming more common. The purpose of this study was to compare the demographic and anatomical differences in cis-female and trans-female populations.

Methods: This was a retrospective analysis of trans-female patients and cis-female patients undergoing primary breast augmentation at a single institution.

Resident autonomy in the operating room: Does gender matter?

Introduction: Previous data examining the effect of gender on surgical trainee autonomy is lacking. We hypothesized that female general surgery residents have less autonomy than males during laparoscopic cases.

Methods: We retrospectively reviewed factors associated with level of guidance needed during laparoscopic procedures as reported on intraoperative procedure feedback forms and on FLS tasks from one institution from 2013 to 2016.

What is "Nonbinary" and What Do I Need to Know? A Primer for Surgeons Providing Chest Surgery for Transgender Patients.

Background: Most transgender research focuses on patients who identify within the gender binary of either trans-male or trans-female. This largely omits understanding of the "nonbinary" gender identity as it pertains to surgical care.

Objectives: We sought to describe a single-institution experience of chest-affirming procedures performed in nonbinary patients, including patient characteristics, surgical techniques, practice pearls, and outcomes.