Bacterial resistance to antibiotics is becoming a major public health challenge in the Bahamas. Indiscriminate use of antibiotics by medical practitioners is a major contributor to this problem. We describe a 53-year-old woman who presented with symptoms of a urinary tract infection. Empiric treatment with first- and second-line antibiotics, namely trimethoprim-sulfamethoxazole and ciprofloxacin, respectively, were ineffective in clearing the infection. After culture and sensitivity testing via minimum inhibitory concentration analysis, nitrofurantoin proved to be the only effective oral antibiotic. Show less

Background In adult males, non-communicating hydroceles are non fluctuant scrotal swellings that are formed when there is an imbalance of fluid secretion and absorption between the parietal and visceral layers of the tunica vaginalis. Giant hydroceles are a rare manifestation and have previously been classified as hydroceles that drain more than 1000 mL of fluid. In this report, we describe a case of a giant hydrocele requiring surgical management and highlight a review of the literature. Case Presentation A 34-year-old male presented with complaints of large right-sided scrotal swelling, accompanied by scrotal discomfort. Ultrasound of the right testicle revealed a large hypoechoic space with a complex collection and posterior displacement of the testicle, indicating a possible hydrocele. The patient was taken to the operating room for a right hydrocelectomy. Approximately 2 liters of fluid were drained from the sac.  Discussion Hydroceles are defined as straw-colored fluid collections within the parietal and visceral layers of the tunica vaginalis. Giant hydroceles, defined as fluid collections within the tunica vaginalis exceeding 1000 mL, are rare and the management of such cases is sparsely documented in the literature. While most asymptomatic fluid collections resolve spontaneously, larger collections with inflammatory changes within the testicular wall may require surgical intervention, either laparoscopic or open.  Show less

Introduction A retained surgical towel in the abdomen is a serious postoperative complication and the most avoidable. Known as “gossypiboma”, it may migrate into adjoining cavities like the stomach, small bowel, colon, vagina, urinary bladder, pericardium, and urethra. Case Report A 32-year-old male presented with complaints of abdominal pain, 4 months after a laparotomy for complicated appendicitis. Initial history and presentation gave an impression of a lower urinary tract obstruction. However, symptoms progressed with signs of bowel obstruction and investigations pointed to a possible retained foreign body. This was confirmed on laparotomy with indications of a transmural migration during the period of evaluation. The report discusses the pathophysiology and manifestations of a migratory surgical gossypiboma. Conclusions A rare case of gossypiboma displaying transmural migration is reported. This showed an initially peritoneally placed sponge that migrated into the intestinal lumen with the sudden presentation of obstructive symptoms. Routine practice of the World Health Organization Surgical Safety Checklist can significantly prevent these incidents. Show less

Background Sural neuritis is a recognized and common complication resulting from iatrogenic injury, postsurgical or posttraumatic fibrosis, traction injury, or chronic nerve compression. Previously in a case series by Stockton and Brodsky, sural neuritis was reported as a complication in 16.6% of the patients who underwent peroneal tendon repair. Patients with sural neuritis often report pain and tingling in the distribution of the sural nerve along the lateral posterior leg, lateral foot, and the fifth digit. Symptoms of sural neuritis could be intense and debilitating, necessitating prompt recognition and treatment. Method Patients who underwent peroneal tendon repair between January 2022 to January 2024 by a single surgeon were included in this retrospective case series. Medical charts of the patients included in the study were reviewed. Demographics for all patients included in the study were recorded. Time to onset of sural neuritis, time to resolution, and management of the condition were recorded for patients who developed sural neuritis. Results A total of 39 patients were retrospectively reviewed, of which three patients (7.69%) developed symptoms attributed to sural neuritis post-peroneal tendon repair. Diagnosis of sural neuritis in the three patients ranged from 130 to 191 days post-peroneal tendon repair. Time to resolution of neuritis symptoms in the three patients who developed sural neuritis were 113 to 574 days after the onset. Successful management of sural neuritis were observation, serial injection of a mixture of 1 ml 1% lidocaine, 1 ml 0.5% bupivacaine, and 1 ml dexamethasone (4 mg/mL), and sural neurectomy. Conclusion While conservative treatments may be effective to manage sural neuritis, surgical options may be necessary for patients who fail to respond adequately. Patients suffering from sural neuritis often experience intense and debilitating symptoms that significantly impact their quality of life, highlighting the critical importance of early identification and appropriate management to mitigate long-term disability and ensure optimal outcomes. Show less