Surgery Case Reports最新文献

Background

Hydrocarbon products are generally used by drug addict patients in attempt to emulate drug effects or as a means of self-harm. These substances can be assumed through inhalation or by intravenous or intramuscular injection. When hydrocarbons are injected intramuscularly into the limbs, they can cause the compartment syndrome, necessitating surgical intervention.

Cases series

We describe a series of three cases in which compartment syndrome developed following hydrocarbon intramuscular injection of hydrocarbons and was successfully treated with urgent fasciotomy. The cases involve three young men who injected gasoline or diesel fuel in their arms and legs. In each case, urgent fasciotomy was necessary to evacuate the intramuscular collection that was rapidly expanding. The three patients were then discharged from our Surgical Department with no complications and were followed up in outpatient visits.

Conclusion

Intramuscular hydrocarbon injection can mainly lead to compartment syndrome and tissue necrosis. In the three cases we have reported, urgent fasciotomy successfully prevented ischemic damage to the limbs and facilitated the drainage of toxic substances, thereby preventing patient’s systemic poisoning and septic lethal consequences.

Background

Midaortic syndrome is a rare condition characterized by the narrowing of the abdominal aorta. In this article, we present a 32-year-old male patient who was incidentally diagnosed with midaortic syndrome, and whose severe aortic regurgitation and ascending aortic dilatation were successfully treated with the Bentall procedure.

Case report

A 32‐year‐old, male patient was admitted to the emergency department with the complaint of chest pain and dyspnea for 3 months. His medical history was notable for diabetes, hypertension (12 years), and hyperthyroidism. Coronary angiography was normal. Ascending aortic dilatation and interrupted abdominal aorta were revealed with computed tomographic angiography (CTA). The Bentall procedure was performed with median sternotomy.

Conclusion

Our case is the first patient in the literature who had Midaortic Syndrome and underwent the Bentall procedure. Additionally, our patient had extremely poor left ventricular functions (LVEF = 20 %). One of the important problems that could occur in this patient was the need for an intra-aortic balloon pump (IABP) for CPB weaning.

Sarcomas are diverse malignant tumors originating from soft tissues (STS) or bones, with STS being more prevalent. Liposarcoma is the most common type of STS, typically arising in the extremities and retroperitoneum. This case report discusses the management of a rare, giant retroperitoneal liposarcoma (RL) in a 47-year-old man presented with significant abdominal enlargement, post-pharyngeal discharge, and urinary dribbling. Medical history included an inguinal hernia and smoking. Diagnosis through imaging (sonography, CT, MRI) and biopsy confirmed a well-differentiated liposarcoma encasing the left kidney and compressing abdominal organs. The tumor measured 53 × 47 x 20 cm and weighed 24 kg. Surgical management included complete tumor excision, left nephrectomy, iliac artery repair, colectomy, and lymph node dissection. The management of RL is challenging due to its size and proximity to vital organs. Complete surgical resection is crucial for recurrence-free survival. Preoperative radiotherapy can aid in achieving negative margins by defining target volumes and reducing irradiation of adjacent tissues. Chemotherapy is reserved for high-grade tumors with metastatic potential. This report highlights the complexities of managing giant RL, underscoring the importance of thorough surgical planning, multidisciplinary collaboration, and assessing potential adjunct therapies to improve patient prognosis.

Schwannomas are rare benign tumours that develop on the cranial or spinal nerves. They are often asymptomatic and discovered by chance following pelvic pain. MRI provides a positive diagnosis of the tumour, showing T1 hyposignal, T2 hypersignal, and heterogeneous contrast enhancement. An angioscanner and a uroscanner in the preoperative phase are useful to assess the relationship with neighbouring structures.

The ideal treatment for schwannomas is complete excision with negative margins, even if it requires the sacrifice of neighbouring organs, given the risk of malignancy and the possibility of recurrence.

We present a case of a retroperitoneal schwannoma located at the L5-S1 space, diagnosed by MRI following pelvic pain. The treatment involved a laparoscopic transabdominal excision, with a normal postoperative follow-up.

The aim of this case report is to aid different medical teams in the management of schwannomas and to highlight the advantages of the laparoscopic anterior approach for retroperitoneal tumours compared with laparotomy.

Pilomatrixomas are rare tumors arising from the cellular matrix of hair follicles and typically manifest as subcutaneous nodules. This case report highlights a rarer presentation in a 68-year-old female who presented with a protruding, painful left breast mass. After an initial biopsy revealed a benign pilar cyst with keratin material, the tumor exhibited progressive growth, resulting in skin fistulas and calcified material exuding from the skin. Final surgical pathology confirmed a benign pilomatrixoma. This case underscores the importance of timely diagnosis and surgical treatment of this rare tumor to prevent tumor growth, skin erosion, and secondary infection.

Introduction

Appendiceal schwannomas are a rare diagnosis, with little evidence to guide management and follow-up. There are currently no case reports focusing on follow-up for appendiceal schwannomas after complete surgical resection.

Presentation of case

A 64-year-old female presented to the emergency department, febrile, with migratory right iliac fossa pain and focal peritonism, consistent with acute appendicitis. The diagnosis was supported by a computed tomography scan and she underwent a laparoscopic appendicectomy. Histopathology was reported as acute appendicitis associated with a schwannoma at the appendiceal base. The patient underwent a colonoscopy six weeks after her initial surgery with no abnormal findings. Following multidisciplinary team discussion it was decided that no further follow up was required.

Discussion

There are only 15 case reports of appendiceal schwannomas in the literature. As a result, the management and follow up in this case was guided from evidence reported in studies of other schwannomas elsewhere in the gastrointestinal tract, standard management of benign appendiceal lesions and MDT discussion. One retrospective single-centre cohort study of histopathology records collected over a 20 year period showed that in 44 patients with GI schwannomas, there was no malignant transformation or recurrence during a mean follow up period of 5.0 ± 4.31 years (Singh et al., 2022). Based on this study there is a very low risk of malignant transformation associated with these lesions.

Conclusion

Based on limited published data resection remains the mainstay of management of appendiceal schwannomas. Colonoscopy is recommended to exclude any underlying lesion or synchronous pathology.

Hepatic endometriosis is a very rare condition that is characterized by the presence of endometrial-like tissue within the hepatic parenchyma. Preoperative diagnosis is often difficult through cross-sectional imaging. Histopathologic evaluation remains the gold standard for diagnosis. Until now only a handful of cases have been reported in medical literature. We report a case of hepatic endometriosis in a 24-year-old, unmarried girl with a history of recurrent hepatic cysts in the right lobe of the liver after two previous surgeries. She underwent a right hepatectomy. The diagnosis was confirmed through histopathology assessment.

Background

Multifocal osteosarcoma (MFOS) is rare, accounting for approximately 1.5 % of osteosarcomas, and can be synchronous (lesions within six months) or metachronous (lesions after six months). The etiology and optimal treatment for MFOS remain controversial. This report presents four patients with synchronous MFOS and reviews the literature.

Case presentation

Case 1: A 24-year-old female with low back pain was found to have multiple lytic bone lesions with increased FDG uptake in the vertebral column and pelvic bones. Biopsy confirmed osteoblastoma-like osteosarcoma. After chemotherapy, she is alive after 5 months.

Case 2: A 6-year-old girl with right knee pain had a distal femur mass and a calcified inguinal lesion. Biopsies revealed osteoblastic osteosarcoma with metastatic lymph node involvement. Following chemotherapy and surgeries, she experienced recurrence and required further surgery. She is alive after 21 months.

Case 3: A 4-year-old boy with a walking disability had a sclerotic bone lesion in the distal femur and additional lesions in the pelvis and acetabulum. Biopsy confirmed osteoblastic osteosarcoma. Despite treatment, he developed metastases and died 7 months after diagnosis.

Case 4: A 9-year-old girl with right knee swelling had a sclerotic lytic lesion in the distal femur and an acetabular lesion. Biopsies confirmed chondroblastic osteosarcoma. After chemotherapy and surgery, she experienced recurrence and underwent pelvic resection. She died 24 months after diagnosis.

Conclusion

Synchronous MFOS is a highly aggressive osteosarcoma variant with a poor prognosis. Aggressive, individualized treatment may improve outcomes, particularly in metachronous cases. Further research is needed to enhance understanding and management of this rare condition.

Background

A fecaloma is a mass of hardened feces in the colon or rectum, more solid than typical impacted feces, leading to severe intestinal distension. It predominantly affects elderly, frail individuals, children with anorectal deformities, and patients with conditions such as Chagas disease, Hirschsprung's disease, and spinal injuries.

Case Report

We report the case of a 34-year-old man with a history of anal imperforation and subsequent anal stricture, who presented with a massive megacolon due to a giant fecaloma. The patient experienced progressive abdominal distension, colicky pain, and an inability to pass stool for 15 days. Physical examination revealed a tender, distended abdomen and impacted feces in the rectum. Laboratory tests and imaging studies confirmed the diagnosis. An emergency laparotomy revealed a 30 × 30 cm dilated sigmoid colon filled with 15–25 kg of fecal material. The fecaloma was removed via enterectomy, and a Hartmann's procedure with colostomy was performed. Histopathological examination showed no evidence of malignancy. Post-operatively, the patient recovered well and was discharged in good condition.

Conclusion

This case highlights the presentation and surgical management of a giant fecaloma causing megacolon. Prompt surgical intervention is critical in managing severe fecaloma to prevent life-threatening complications.

Introduction

Papillary fibroelastomas (PFE) are benign, rare primary cardiac tumors often discovered incidentally during cardiac imaging or as part of a workup for thromboembolic or obstructive events. We present a case of multiple PFE on the aortic valve's right coronary and non-coronary leaflets, presenting as recurrent cerebrovascular events managed by resection with valve preservation.

Case Summary

A 53-year-old male presented with an acute right frontal cerebrovascular accident and a history of recurrent transient ischemic attacks. A transesophageal echocardiogram (TEE) revealed a 10 × 8 mm mass on the right coronary cusp of the aortic valve. Differential diagnosis included PFE versus thrombus. Following a neurology evaluation, the patient was anticoagulated and scheduled for urgent cardiac surgery. During surgery, an 8 × 7 mm mass was sharply excised from the right coronary leaflet's anterior surface. Further examination revealed additional masses: a 3 mm mass on the underside of the right coronary leaflet, a 2 mm mass on the non-coronary leaflet, and another 2 mm mass on its underside. All masses were excised, and pathology confirmed the diagnosis of PFE. The patient's post-operative course was unremarkable, and a pre-discharge transthoracic echocardiogram (TTE) demonstrated complete removal of the aortic valve masses with normal ventricular and aortic valve function.

Discussion

PFE are rare benign cardiac tumors with a significant risk of thromboembolic or obstructive events, including stroke. Grossly, they are attached to the endocardium by a short fibrous pedicle with multiple papillary fronds resembling a sea anemone. More than 95 % originate from the left heart, most commonly affecting the aortic valve. Diagnosis is primarily through echocardiography, with TEE being more sensitive than TTE. Surgical excision is curative, offering an excellent long-term prognosis.

Conclusion

All patients with suspected embolic cerebrovascular events should undergo echocardiographic evaluation to assess for potential cardiac etiologies. Surgical resection of PFE results in uniformly excellent clinical outcomes, with aortic valve preservation achievable in over 98 % of cases.