Biomedical subjects
Publications and source records attributed to J Sayfan.
The first reported case of peritoneal encapsulation causing mechanical small bowel obstruction in a child is described. So far, only seven asymptomatic adult patients with this anomaly have been reported on. The embryogenetic basis is discussed. Methods of operative recognition and surgical management are suggested.
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Intraoperative internal spermatic vein phlebography was performed in 20 subfertile patients with a varicocele; 10 patients with varicoceles and left-sided indirect inguinal hernias without fertility problems served as controls. Phlebography was carried out during surgery with the patient supine and in a 45 degree anti-Trendelenburg position to stimulate an "erect" posture. In all 25 patients with a varicocele, valvular insufficiency was demonstrated at the renal-spermatic vein junction. When visualized, the position of the left adrenal vein in all instances was medial to or opposite the renal-internal spermatic vein confluence. This observation, reinforced by simultaneous determinations of cortisol levels in the internal spermatic and antecubital veins, practically excluded the validity of the theory of adrenal hormonal suppression of testicular tissues. In 40% of subfertile patients with a varicocele, double internal spermatic veins and reflux to the distended external spermatic (cremasteric) venous plexus were demonstrated. In no instance were such phenomena observed in the control groups. The not-infrequent failure of operative correction of varicocele seems to relate directly to such overlooked pathology. Broad clinical application of operative phlebography, especially in recurrent, persistent, or clinically advanced cases, will detect such anomalies and should reduce significantly the operative failures in the surgical correction of varicocele.
In the overwhelming majority of cases, varicocele appears in the left scrotum, the reason being the anatomical dissimilarity of the two sides. In patients with right-sided or bilateral varicocele, further investigation to rule out a retroperitoneal pathology, especially neoplastic, is indicated. On rare occasions, however, a vascular anomaly as the underlying pathology must be considered. A patient is presented with a complete situs inversus accompanied by a right-sided varicocele. Intraoperative right internal spermatic phlebography revealed that this vein drained into the right renal vein, and valvular incompetence at their confluence was the etiology of the disease. Intraoperative internal spermatic phlebography in patients with right-sided or bilateral varicoceles is recommended as the simplest and safest means to demonstrate the etiology of this disease.
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