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Muneer Fazea,1,2 Mansour Alhameli,2,3 Faisal Ahmed,4 Mohammad Reza Askarpour,5 Wafa Murshed,2 Azizh Jarwsh,2 Amal Alkbous2 1Department of Radiology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen; 2Department of Radiology, Al-Ma’amon Diagnostic Center, Sana’a, Yemen; 3Department of Radiology, Faculty of Medicine, Sana’a University of Medical Sciences, Sana’a, Yemen; 4Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen; 5Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Faisal Ahmed, Al-Thora General Hospital, Alodine Street, Ibb, Yemen, Email fmaaa2006@yahoo.comAbstract: Pentalogy of Cantrell is a congenital anomaly of the median mesodermal constructions with a poor prognosis. It is characterized by defects of the anterior diaphragm, the lower sternum, the abdominal wall, pericardium, and various congenital heart malformations. We present a case of ectopia cordis and Pentalogy of Cantrell in a newborn of a healthy 35-year-old woman with no history of embryotoxic exposure or smoking. The infant was first diagnosed with the anomaly in the second trimester of pregnancy and was delivered at 35 weeks of gestational age via a caesarian section. Shortly after birth, he was transferred to the neonatal intensive care unit (NICU) due to progressive respiratory failure, which ultimately, along with septicemia, led to infant death on the second day. In conclusion, the Pentalogy of Cantrell should be appropriately assessed for effective prenatal counseling and postnatal management with a multidisciplinary team; since infant survival assessment and early diagnosis give the parents the option of terminating the pregnancy.Keywords: case report, Pentalogy of Cantrell, ectopia cordis

Saif Ghabisha,1 Faisal Ahmed,2 Saleh Al-wageeh,1 Ebrahim Al-shami,2 Khalil Al-naggar,2 Ghamdan Obaid,3 Mohammad Reza Askarpour4 1Department of General Surgery, Ibb University of Medical Science, Ibb, Yemen; 2Urology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Science, Ibb, Yemen; 3Department of Orthopedy, Ibb University of Medical Science, Ibb, Yemen; 4Department of Urology, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Faisal AhmedUrology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Science, Alodine Street, Ibb, YemenTel +967 776089579Email fmaaa2006@yahoo.comAbstract: Cord congenital hernia is a condition in which due to a patent umbilical ring, intestinal components protrude into the umbilical cord. Although post-natal umbilical hernia is not uncommon, its congenital form is an uncommon phenomenon (incidence rate about 0.2%) with an excellent post-surgical prognosis. It is frequently misdiagnosed as a small omphalocele. Additionally, if it is undiagnosed at the time of birth, clamping the umbilical cord can cause iatrogenic atresia of the ileum. Hence, during a physical exam, it is mandatory to look carefully for any skin folds in the form of a collar or defects in the umbilical ring or abdominal wall to avoid misdiagnosis. We report a full-term male newborn present with umbilical cord hernia, who underwent successful open surgery, with extra focus on the management and outcome of this disease.Keywords: abdominal wall, congenital abnormalities, omphalocele, umbilical cord hernia

Faisal Ahmed,1 Saleh Al-Wageeh,2 Ebrahim Al-Shami,1 Khalil Al-Naggar,1 Mohammad Reza Askarpour,3 Mohammed Naji4 1Urology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Science, Ibb, Yemen; 2Department of General Surgery, Ibb University of Medical Science, Ibb, Yemen; 3Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 4Department of Urology, Dar Al-Shefa Hospital, Ibb, YemenCorrespondence: Faisal AhmedAl-Thora General Hospital, Alodine Street, Ibb 70270, YemenTel/Fax +967 4407128Email fmaaa2006@yahoo.comPurpose: Circumcision is one of the most prevalently performed surgeries worldwide. It is a common non-therapeutic procedure, which, based on the cultural and social background of people, could be performed by individuals at different levels of skill ranging from trained medical professionals to non-specialists. Therefore, this surgery could cause complications of varying frequencies and types. For example, penile damage during the circumcision procedure is a severe and rare complication leaving patients with morbidity and life-long consequences. Here, we reported two cases of penile injury during a ritual circumcision.Patients and Methods: This study was approved by the ethics committee of Ibb University of Medical Sciences.Case 1: A 6-month-old child was brought to hospital by parents with complaints of purulent discharge around the penis after ritual circumcision performed 3 days ago with complete skin loss in the whole part of the penis extended to the scrotum and suprapubic area.Case 2: A 2-month-old child was brought to hospital with complaints of penile discharge and gangrene after ritual circumcision performed 10 days ago.Results: Case 1: He was treated with daily debridement and wound irrigation followed by a surgical procedure to bury the penis in the scrotum for future reconstructive surgery.Case 2: A suprapubic cystostomy was inserted into the bladder. Then, daily debridement and wound irrigation was performed for the child. To treat penile gangrene, two options were available. The first option was to bury the penis in the scrotum and do reconstructive surgery later. The second option was to change the child’s anatomical sex from male to female.Conclusion: We suggest that every child, before a circumcision procedure, should be evaluated by a medically trained professional. This procedure should also be carried out in aseptic conditions. Additionally, the circumcision procedure needs to be performed by an experienced medical professional.Keywords: complications, penile injury, ritual circumcision

Faisal Ahmed,1 Saleh Al-wageeh,2 Ebrahim Al-shami,1 Khalil Al-naggar,1 Mohammad Reza Askarpour,3 Mohammed Naji4 1Urology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Science, Ibb, Yemen; 2Department of General Surgery, Ibb University of Medical Science, Ibb, Yemen; 3Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 4Department of Urology, Dar Al-Shifa Hospital, Ibb, YemenCorrespondence: Faisal AhmedAl-Thora General Hospital, Alodine Street, Ibb 71234-44251, YemenTel/Fax +9674407128Email fmaaa2006@yahoo.comAbstract: Penile torsion is a congenital anomaly rarely detected in isolation and mostly accompanied by hypospadias and chordee. It could also happen iatrogenically after penile circumcision. In previous literature, the incidence rate of isolated penile torsion has been reported between 1.7 and 27%. The diagnosis and treatment of penile torsion have been illustrated in the previous published articles. However, there are few published studies on the familial predominance of penile torsion. Additionally, the clinical characteristics and potential hereditary components of penile torsion are not well known. Therefore, we studied a 12-year-old boy with a severe 180-degree penile torsion, which surgically corrected and his one-year-old brother, who had mild penile torsion and surgically corrected during circumcision.Keywords: congenital anomaly, familial, penile torsion, surgery

Saleh Al-wageeh,1 Faisal Ahmed,2 Hossein-Ali Nikbakht,3 Ebrahim Al-shami,2 Mohammad Reza Askarpour,4 Umayir Chowdhury5 1Department of General Surgery, Ibb University of Medical Science, Ibb, Yemen; 2Urology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Science, Ibb, Yemen; 3Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; 4Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 5School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Faisal Ahmed Tel +967776089579Email fmaaa2006@yahoo.comBackground: Thyroid diseases are major health problems in our society, which are manifested by alteration in hormone secretion, enlargement of the thyroid gland, or both. This study was designed to determine thyroid histopathological patterns in patients who underwent thyroid operation.Materials and Methods: This retrospective study was carried out at Sana’a University Hospital over two years, from January 1, 2014, to December 30, 2015. All 260 patients who underwent thyroid surgery were included in this study. Factors such as age, sex, residency, fine needle aspiration biopsy (FNAB) result, and post-operative histopathological patterns were recorded. Patients who only underwent FNA were excluded.Results: The mean age of participants was 40.06± 13.18 years. Females were most commonly affected by thyroid diseases (90%) in comparison to males (10%). Histopathologic patterns were nodular colloid goiter (63.1%), adenoma (4.6%), papillary thyroid neoplasms (20.4%), follicular thyroid carcinoma (3.8%), medullary thyroid carcinoma (1.9%), thyroiditis (5.4%) and anaplastic thyroid carcinoma (0.8%). Papillary thyroid cancer was the most common thyroid cancer, with a prevalence of 53 (20.4%). The accuracy of FNAB and final histopathology in combine was 88.07%. However, FNAB was not precise enough in the pre-operative diagnosis of follicular carcinoma (40%). FNAB sensitivity ranged from 70.8% to 88.8%, while FNAB specificity ranged from 97.1% to 99.9%.Conclusion: Nodular colloid goiter is the most prevalent thyroid disease, while papillary thyroid carcinoma is the most frequent cancer seen in this study. We recommend further studies with a larger population to validate our study.Keywords: goiter, histopathology, papillary carcinoma, thyroidectomy