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Mediquest - June '07 Edition |
DR. N.MOHAN, CONSULTANT BRS HOSPITAL ,
EMERITUS PROF. OF SURGERY , THE TAMILNADU DR.M.G.R.
MEDICAL UNIVERSITY CHENNAI.
The experiences a medical person derives from his patients sometimes, will be stunning overwhelming and unexpected! Two such experiences of mine, I would like to share with you .
SUBMANDIBULAR DUCT STONE :
A 36 year old male came to the outpatient department with a complaint of pain and ulcer in the floor of the mouth which was present for the past few months. It all started a few months back with severe pain in the mouth and swelling below the mandible, usually associated with eating; pain initially used to subside with antibiotics and anti-inflammatory medicines. In order to get relief from the pain, he had enlarged the submadibular duct orifice with a hairpin! He had dramatic relief because he had performed a sort of ` Stomatoplasty'! But this relief was available for a few months only and the pain returned . Unable to bear the pain, he came to the outpatient department.
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On clinical examination, he had an ulcer involving the submandibular duct orifice on the right side in the floor of the which a stone could be seen and felt. He was admitted for investigation and surgical removal.
Next day morning during the routine rounds, this patient came rushing to me and showed me the stone, which was about 3” in length, simulating the turmeric root. |
He said, he developed severe pain in the floor of the mouth in the night and unable to bear the pain he “extracted the stone himself and obtained some warm water to flush and irrigate the area to remove any left over stones!
Since, he had already done a “Stomatoplasty” with a hairpin months ago the duct orifice was wide open facilitating in removal ! His co patients in the ward told him to discard the stone and throw it away. But he retained it wrapped in a piece of paper to show it to me and I am presenting it as a priced possession.
STONE IN THE URETHRAL DIVERTICULUM AT THE FOSSA NAVICULARIS:
A 76 year old male came to my consultation soon around 12 O clock noon with extreme discomfort and pleaded to do something since, he has not passed a drop of urine since 5.30 am that morning. He was not a diabetic or hypertensive. Local examination revealed an enlargement of the glans penis and tight phimosis. Because of the enlargement, the perputial orifice appeared like a pit at the summit of a hard lumpy distal end of the penis.
After basic investigations, which were normal, he was taken for circumcision and drainage of the urine. Under local anaesthesia at the root of the penis at the peno-scrotal junction, a dorsal slit was performed to expose the glans penis; The urethral orifice appeared normal and there was a hard mass on the ventral surface of the glans penis. To explore the area the ventral surface was incised near the frenum and the stone could be palpated .The opening was enlarged and a large stone of the diameter of 2-1/2” was delivered out. After this procedure a Foley's catheter was passed to drain the urine.
The large stone in the ventral surface of the fossanauicularis is the first one I have seen in my surgical career spanning 32 years! The explanation is - he must have developed a diverticulum's into which urine must have collected over years and due to the concomitant phimosis he was suffering from,the stone must have formed in it and slowly grown over the years. The post operative period was uneventful and the Foley's catheter was removed after two days.
The rare experience I had, I thought, I shall share with you all.
