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Corona mortis artery avulsion due to a stable pubic ramus fracture.

Orthopedics

January 2012

Department of Orthopedic Surgery, University Hospital San Cecilio, 68 Duero St, 18194, Churriana de la Vega, Granada, Spain.

A 70-year-old woman with osteoporosis fell at home and presented to our emergency department with intense left hip pain. Radiographs revealed a left iliopubic rami fracture and nondisplaced right ischiopubic rami fracture. She was discharged after a 24-hour observation with no clinical changes.

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A rare case of posttraumatic high-flow priapism is presented. A 20-year-old man underwent diagnostic procedure with color Doppler sonography and angiography. On color Doppler sonography and selective and supraselective angiographic images, arteriocavernosal fistula and pseudoaneurysm were detected in the proximal part of the right cavernous body.

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Based on the evaluation of long-term results of supraselective vagotomies (5-20 years after surgery) the authors consider laparoscopic vagotomy by Taylor's method justified in the primary treatment of duodenal ulcers. It was revealed that after open (laparotomic) supraselective vagotomy more than 80% of the patients are for prolonged periods free from complaints. The authors draw attention to the advantages of laparoscopic vagotomies, they discuss their causes and possible relapses of ulcers.

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The report deals with posterior truncus and anterior supraselective vagotomy, performed laparoscopically for the first time in this country. Three patients-2 women and one man-are operated on for duodenal ulcer,complicated with bleeding, controlled conservatively in the first stage. In one female patient the intervention described and cholecystectomy are simultaneously done.

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There is a sound basis for performing EHSV with reference to the "areas of vagotomy" as described and for wider application of EHSV. Most patients with complications of duodenal ulcer disease can be treated successfully by EHSV, with a small incidence of recurrent ulcers. The liberal use of pyloroplasty or drainage procedures is justified, since the potential problems of perioperative infection and postoperative alkaline reflux are not clinically significant.

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