Surgery Case Reports最新文献

英文中文

Hypergranulation-induced graft failure in meshed split thickness skin graft: A case report

Surgery Case Reports

Pub Date : 2025-02-14 DOI: 10.1016/j.sycrs.2025.100090

Luis Eduardo Rentas , Karla C. Maita , Gustavo Huaman , Sacha Scott , Ricardo Castrellon

Objective

Meshed split-thickness skin grafts (mSTSG) are frequently used to address skin defects. Effective fixation methods are crucial for optimizing graft integration and minimizing complications. This case report demonstrates the role of negative pressure wound therapy (NPWT) in managing recurrent axillary hidradenitis suppurativa.

Methods

A 65-year-old male with recurrent axillary hidradenitis suppurativa underwent mSTSG placement, followed by NPWT to support graft integration. The initial graft failed due to necrotic hypergranulation, necessitating regrafting and personalized postoperative care.

Results

Initial graft failure occurred due to necrotic hypergranulation at the graft site. After regrafting, NPWT facilitated granulation tissue formation and enhanced healing. Complications such as hypergranulation required continuous monitoring and intervention. The patient ultimately showed significant clinical improvement with successful graft integration.

Conclusion

NPWT can enhance graft survival and wound healing in complex cases of recurrent axillary hidradenitis suppurativa. However, vigilant monitoring is essential to manage complications such as necrotic hypergranulation. Personalized postoperative care and timely interventions are key to overcoming graft failures and achieving optimal outcomes. Tailoring treatment strategies to individual wound healing dynamics is crucial for long-term success.

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引用次数: 0

Clinical improvement of lead poisoning following extraction of retained bullet fragments

Surgery Case Reports

Pub Date : 2025-02-03 DOI: 10.1016/j.sycrs.2025.100092

Ashley Wittmer , Emilia Coffey , Francis Buzad

Lead poisoning presents with variable symptoms, ranging from asymptomatic cases to significant neurological deficits. This report describes a 39-year-old male with chronic symptoms, including abdominal pain, back pain, and mood changes, 12 years after sustaining a gunshot wound to the thigh with retained bullet fragments. Preoperative serum lead levels were mildly elevated at 5.3 µg/dL. Surgical removal of major bullet fragments was performed with fluoroscopic guidance, minimizing tissue trauma. Postoperatively, the patient experienced substantial improvement in symptoms suspected to be caused by lead exposure, including resolution of abdominal pain and fatigue. Serum lead levels gradually declined to 4.4 µg/dL at seven months post-surgery. This case demonstrates the potential benefits of surgical intervention for retained lead fragments when symptoms are suspected to result from lead toxicity. The intervention led to improvement of the patient’s symptoms and reduced serum lead levels. Further research is warranted to establish guidelines for the optimal management of retained bullet fragments, balancing surgical risks with potential clinical benefits.

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引用次数: 0

Mesothelioma disguised as a left inguinal hernia: A case report

Surgery Case Reports

Pub Date : 2025-02-03 DOI: 10.1016/j.sycrs.2025.100091

Kyra Sage Hunsberger , Burke DeLange

We present the case of a 72-year-old female diagnosed with low-grade malignant mesothelioma initially suspected to be a benign left inguinal hernia. The patient presented with progressive left lower extremity swelling and a reducible inguinal mass. Imaging suggested a cystic lesion in the groin, prompting surgical exploration. Pathological findings revealed mesothelioma involving regional lymph nodes. With this case, we aim to highlight an exceedingly rare extra-thoracic presentation and underscore the importance of maintaining a broad differential diagnosis for groin masses. Surgical biopsy and histopathological evaluation remain critical in diagnosing atypical malignancies with unique presentation.

引用次数: 0

Surgical-prosthetic management of an advanced stage IV periodontitis in the aesthetic zone: A case report

Surgery Case Reports

Pub Date : 2024-12-31 DOI: 10.1016/j.sycrs.2024.100087

Samadi Alaa , Kriouach Nada , Er-Raji Samir , El Yamani Amal

Background and objective

Stage IV periodontitis is a severe form of periodontal disease leading to significant bone resorption, potential tooth loss and masticatory dysfunction. The objective of this article is to show the interest of multidisciplinary management in the treatment of tissue deficits caused by advanced stage IV periodontitis.

Results

We report the case of a 29-year-old female patient who lost both upper right incisors due to advanced stage IV periodontitis. Advanced ridge defects caused by periodontitis were managed by two autogenous connective tissue grafts performed in two stages using the pocket technique allowing obtaining a significant increase in height and thickness of the ridge. An associated corrective gingivectomy made it possible to perfect the alignment of the gingival margins and ensure good integration of the future prosthetic rehabilitation.

A temporary bridge of ovoid pontic design helped guiding post-surgical healing and ensure better distribution of occlusal loads while respecting the adaptive threshold of the weakened periodontal terrain and taking into account the patient's physiological anatomical landmarks thanks to the axiographic recording of the sagittal condylar inclination (SCI). One year after complete healing, definitive restorations were able to be placed combining aesthetics and function.

Conclusion

This case report showed that the soft tissue grafting step by step by pouch technique associated with corrective gingivectomy can be considered as an effective therapeutic alternative to guided bone regeneration in the management of advanced ridge defects due to periodontal disease. Additionally, tooth-supported fixed prostheses can lead to better results without the need for implant therapy.

{"title":"Surgical-prosthetic management of an advanced stage IV periodontitis in the aesthetic zone: A case report","authors":"Samadi Alaa , Kriouach Nada , Er-Raji Samir , El Yamani Amal","doi":"10.1016/j.sycrs.2024.100087","DOIUrl":"10.1016/j.sycrs.2024.100087","url":null,"abstract":"<div><h3>Background and objective</h3><div>Stage IV periodontitis is a severe form of periodontal disease leading to significant bone resorption, potential tooth loss and masticatory dysfunction. The objective of this article is to show the interest of multidisciplinary management in the treatment of tissue deficits caused by advanced stage IV periodontitis.</div></div><div><h3>Results</h3><div>We report the case of a 29-year-old female patient who lost both upper right incisors due to advanced stage IV periodontitis. Advanced ridge defects caused by periodontitis were managed by two autogenous connective tissue grafts performed in two stages using the pocket technique allowing obtaining a significant increase in height and thickness of the ridge. An associated corrective gingivectomy made it possible to perfect the alignment of the gingival margins and ensure good integration of the future prosthetic rehabilitation.</div><div>A temporary bridge of ovoid pontic design helped guiding post-surgical healing and ensure better distribution of occlusal loads while respecting the adaptive threshold of the weakened periodontal terrain and taking into account the patient's physiological anatomical landmarks thanks to the axiographic recording of the sagittal condylar inclination (SCI). One year after complete healing, definitive restorations were able to be placed combining aesthetics and function.</div></div><div><h3>Conclusion</h3><div>This case report showed that the soft tissue grafting step by step by pouch technique associated with corrective gingivectomy can be considered as an effective therapeutic alternative to guided bone regeneration in the management of advanced ridge defects due to periodontal disease. Additionally, tooth-supported fixed prostheses can lead to better results without the need for implant therapy.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"4 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Disseminated histoplasmosis causing duodenal obstruction in pediatric patient: A case report

Surgery Case Reports

Pub Date : 2024-12-26 DOI: 10.1016/j.sycrs.2024.100086

Shivani Kamal , Ayesha Baig , James R. Pierce

Introduction

Histoplasmosis in children with associated bowel obstruction is rare, and its clinical management is based on data and experience on adult patients.

Case report

A previously healthy five-year-old girl who recently immigrated to the US from Mexico presented with 5 days of abdominal pain, fever, cough and emesis. On workup, chest x-ray showed diffuse bilateral micro nodules in a miliary pattern, and urine and serum were positive for histoplasma antigen. Barium upper GI series showed distal duodenal obstruction and biopsies taken during endoscopy were positive for histoplasma. Medical therapy with antifungals did not improve the obstruction. On laparotomy, the distal duodenum was obstructed with intrinsic and extrinsic inflammation requiring a diamond duodeno-jejunostomy bypass. Postoperatively, the patient recovered and was discharged home with prolonged antifungals and infectious disease follow up.

Conclusion

Our case emphasizes the need for early surgical consultation and careful selection of contrast for luminal imaging. We advocate for an initial attempt at antifungal management to avoid operative treatment during active inflammation and lower surgical risk.

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引用次数: 0

Micro-drainage for management of extensive subcutaneous emphysema: A case report

Surgery Case Reports

Pub Date : 2024-12-26 DOI: 10.1016/j.sycrs.2024.100085

Majd Oweidat , Iyad Al Jada , Wasef Alhroub , Abdalhakim Shubietah , Mousa Humeedat

Extensive subcutaneous emphysema (ESE) is a rare complication requiring prompt intervention to prevent serious outcomes. We present the case of a man in his sixties with chronic obstructive pulmonary disease and a history of pulmonary tuberculosis, admitted with community-acquired pneumonia and respiratory failure. Following central venous line placement, he developed progressive ESE refractory to standard chest tube drainage. A novel approach using a fenestrated microcatheter was employed to manage the ESE. The catheter, connected to an underwater seal and combined with targeted compressive massage, successfully evacuated approximately 2500 mL of air, leading to complete resolution within 24 hours. This case highlights the efficacy of minimally invasive drainage techniques in managing refractory ESE, offering a safe and effective alternative to surgical interventions.

引用次数: 0

Anterior abdominal wall abscess due to toothpick ingestion: A case report

Surgery Case Reports

Pub Date : 2024-12-26 DOI: 10.1016/j.sycrs.2024.100088

Doğuş Can Ekdal , Ahmet Akmercan , Tevfik Kıvılcım Uprak

Ingestion of foreign bodies represents a common clinical emergency, especially in pediatric and geriatric populations. In the majority of cases, ingested foreign objects pass through the gastrointestinal tract without incident and are expelled without causing symptoms. However, complications can arise depending on the size, shape, and structure of the ingested item. A 53-year-old male with a history of diabetes, hypertension, chronic obstructive pulmonary disease, and obesity was admitted to the hospital due to recurrent subcutaneous abscesses and cellulitis in the right upper quadrant of the anterior abdominal wall. The patient's medical history reveals several times of abscess puncture in the same area. The patient underwent subcutaneous abscess drainage under local anesthesia, and toothpick material fixed to the subcutaneous tissues was detected. Following the removal of the toothpick, debridement of the wound was performed, and the patient was discharged with antibiotherapy. No recurrence was noted during the follow-up outpatient clinic visit three months later. This case report highlights the rare and complex complication of subcutaneous migration following foreign body ingestion, leading to recurrent subcutaneous abscesses. The exact pathogenesis of foreign body migration is not fully understood, but it is probable that the toothpick penetrates the subcutaneous fatty tissue from the transverse colon segment near the anterior abdominal wall, leading to the spontaneous closure of the colonic fistula tract. The foreign body was detected in radiological imaging in approximately 42.6 % of cases. A high level of clinical suspicion and a thorough patient history are essential for the identification of radiolucent foreign bodies.

{"title":"Anterior abdominal wall abscess due to toothpick ingestion: A case report","authors":"Doğuş Can Ekdal , Ahmet Akmercan , Tevfik Kıvılcım Uprak","doi":"10.1016/j.sycrs.2024.100088","DOIUrl":"10.1016/j.sycrs.2024.100088","url":null,"abstract":"<div><div>Ingestion of foreign bodies represents a common clinical emergency, especially in pediatric and geriatric populations. In the majority of cases, ingested foreign objects pass through the gastrointestinal tract without incident and are expelled without causing symptoms. However, complications can arise depending on the size, shape, and structure of the ingested item. A 53-year-old male with a history of diabetes, hypertension, chronic obstructive pulmonary disease, and obesity was admitted to the hospital due to recurrent subcutaneous abscesses and cellulitis in the right upper quadrant of the anterior abdominal wall. The patient's medical history reveals several times of abscess puncture in the same area. The patient underwent subcutaneous abscess drainage under local anesthesia, and toothpick material fixed to the subcutaneous tissues was detected. Following the removal of the toothpick, debridement of the wound was performed, and the patient was discharged with antibiotherapy. No recurrence was noted during the follow-up outpatient clinic visit three months later. This case report highlights the rare and complex complication of subcutaneous migration following foreign body ingestion, leading to recurrent subcutaneous abscesses. The exact pathogenesis of foreign body migration is not fully understood, but it is probable that the toothpick penetrates the subcutaneous fatty tissue from the transverse colon segment near the anterior abdominal wall, leading to the spontaneous closure of the colonic fistula tract. The foreign body was detected in radiological imaging in approximately 42.6 % of cases. A high level of clinical suspicion and a thorough patient history are essential for the identification of radiolucent foreign bodies.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"4 ","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ruptured gastroepiploic artery aneurysm causing massive intraperitoneal hemorrhage: A case report and literature review

Surgery Case Reports

Pub Date : 2024-12-25 DOI: 10.1016/j.sycrs.2024.100084

Marissa Leann Ritter, Tiffany Killblane, David Grantham

Introduction

Visceral artery aneurysms, including gastroepiploic artery aneurysms, are a rare cause of gastrointestinal bleeding. Gastroepiploic artery aneurysms are usually silent with a high chance of rupture and hemorrhage.

Case

We present a case of a man with a ruptured gastroepiploic artery aneurysm following a fall from standing height. On arrival, he was hypotensive with an acute abdomen. Due to hemodynamic instability and a positive FAST exam, an exploratory laparotomy was performed, which revealed pulsatile bleeding at the greater curvature of the stomach and a subserosal hematoma with an active bleeding vessel visible. The gastroepiploic vessels were ligated, and a partial gastrectomy was performed. He recovered well and was discharged after five days.

Discussion

Gastroepiploic artery aneurysms are a rare occurrence, most commonly occurring in males over the age of 50. Causes include arterial dysplasia, perivascular inflammation, and trauma. Trauma was likely the cause in this patient’s case. Most gastroepiploic artery aneurysms are asymptomatic. They are usually found incidentally or once complications arise. Patients with ruptured gastroepiploic artery aneurysms usually present with peritoneal signs and shock. All patients with gastroepiploic artery aneurysms should be treated immediately due to the risk of rupture and subsequent complications. A variety of techniques exist to treat these aneurysms.

Conclusion

Although visceral artery aneurysms are uncommon, they can be life-threatening. Therefore, it is important to remember them as a potential source of intraperitoneal hemorrhage, even from minor trauma.

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引用次数: 0

Utilization of autogenous split rib graft for cranioplasty in a child: A case report

Surgery Case Reports

Pub Date : 2024-12-25 DOI: 10.1016/j.sycrs.2024.100089

Nauman Shah , Muhammad Salman Farsi , Muhammad Sanaan Noor , Muhammad Maaz Bin Zahid , Yasir Aziz , Muhammad Wasim Sajjad , Azam Jan , Nasir Ali

A cranioplasty is a surgical procedure intended to correct cranial abnormalities resulting from prior trauma or surgeries, using various materials to fill up the defect, most commonly a synthetic substance or a fragment of the patient's bone. We present a case of an 8-month-old child, presented with post-traumatic skull injury resulting from a head injury at the age of one month. On physical examination, the patient had soft swelling of the skull, that bulged out through the defect with coughing. The case was taken up for cranioplasty under general anesthesia and the defect was exposed, and the graft bed was prepared. Two rib grafts were harvested before cranioplasty that were split into two halves and spread like an open book which were enough to cover the defect. Each graft was stabilized with a titanium micro screw. In this case report we discuss a case of post-traumatic cranial defect in an 8-month patient treated with cranioplasty using split rib grafts.

引用次数: 0

Multisite neural tube defects: Management of a complex case and review of theories on neural tube closure

Surgery Case Reports

Pub Date : 2024-12-15 DOI: 10.1016/j.sycrs.2024.100083

Ubaid Ullah , Malik W.Z. Khan , Aamina Sher , Hammad Iftikhar , Aizaz Ali , Shandana Ali , Salman Khan , Sajjad Ullah

Background

Neural tube defects (NTDs) result from incomplete neural fold fusion during early embryonic development and can occur at various stages (gastrulation, primary, and secondary neurulation). While rare, NTDs at multiple sites require clinical and imaging assessments for management. The "Zipper closure" and "Multisite closure" theories explain these defects, though some anomalies remain unexplained, calling for more research.

Case Presentation

A two-month-old female presented with two NTDs: occipital meningoencephalocele and lumbar myelomeningocele. Both defects were successfully treated surgically, leading to positive neurological outcomes.

Conclusion

This case supports the multisite closure theory of NTDs and emphasizes the importance of early surgical intervention to prevent complications.

引用次数: 0

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