A. A. Alekseev

Acute scrotal hematoma developing due to spontaneous rupture of the spermatic cord caused by varicocele is a relatively rare complication. Its clinical presentation is similar to testicular torsion, appendix testis torsion and malignant tumor which significantly complicates differential diagnosis. Sudden pain, scrotum enlargement, sometimes cyanosis after intraperitoneal pressure increase or intense physical activity and hematoma on the left should alarm a doctor because they can be signs of vein rupture due to varicocele. Anamnesis of varicocele, character of the injury, color Doppler ultrasound can help in differential diagnosis and to avoid unnecessary orchidectomy. The article presents a review of international literature on a rare complication of varicocele – rupture of the testicular veins.

Acute pyelonephritis is a severe urinary tract infection, fraught with the development of sepsis, septic shock and death. In most cases, uncomplicated acute renal failure is diagnosed clinically and is amenable to etiotropic antibacterial therapy. However, in patients with a high risk of an unfavorable outcome or with delayed treatment, the fusion of microabcesses with the formation of a kidney abscess is possible. The article demonstrates a method of laparoscopic decapsulation of the kidney in a patient with apostematous pyelonephritis. The clinical data of a 48-year-old female patient who was admitted to the clinic on an emergency basis with a clinical picture of acute purulent epistematous pyelonephritis were analyzed. The patient was prepared for surgical treatment in the amount of laparoscopic decapsulation of the kidney, drainage of the abdominal cavity. The duration of the operation was 50 minutes, blood loss was 50 ml. The insurance drain was removed on the second day after the operation. There were no intraoperative complications of Clavien–Dindo ≥III. The patient was discharged on the 4 ^th day after the operation in a satisfactory condition under the supervision of a urologist at her place of residence. The presented clinical case demonstrates the effectiveness and safety of minimally invasive techniques in the surgical treatment of acute purulent pyelonephritis. The presented treatment results correspond to the data of the world literature.