Surgery Case Reports最新文献

英文中文

Primary aorto-duodenal fistula: A case report and review of literature 原发性主动脉-十二指肠瘘1例报告及文献复习

Surgery Case Reports

Pub Date : 2024-12-07 DOI: 10.1016/j.sycrs.2024.100080

Anubhavv Gupta , Deeksha Kapoor , Ravindra Vats , Suhail Naseem Bukhari , Deep Goel

Introduction

Aortoenteric fistula (AEF) is a rare condition where abnormal communication exists between the abdominal aorta and any part of the GI tract, most commonly, the third/fourth part of the duodenum. The incidence rate of primary aorto-duodenal fistula (PADF) on autopsy is 0.04 to 0.7 %, and the post-operative incidence rate of a secondary AEF is 0.5 to 2.3 %. An AEF can be diagnosed using either an upper gastrointestinal endoscopy (UGIE) or a contrast-enhanced computed tomography (CECT) angiography of the abdomen, and urgent repair is required by surgical or endovascular means.

Methods

We report the case of a 64-year-old gentleman with a bleeding PADF. He was evaluated using UGIE and CT angiography of abdomen and underwent total endovascular repair of the aneurysm.

Discussion

PADF is a rare cause of GI bleeding, accounting for only 0.2 % of all GI bleeds. The patient can initially show signs of a herald bleed but can also present with the classical triad of pulsatile abdominal lump, GI bleed, and abdominal pain. Endoscopy should be the initial investigation of choice for a stable patient. A negative EGD does not rule out the possibility of a PADF. CECT abdominal angiography can also be a useful diagnostic modality; some consider it superior to UGIE or aortography.

Conclusion

PADF is a rare but life-threatening condition that requires prompt recognition and intervention, either by surgery or endovascular repair.

腹主动脉肠瘘（AEF）是一种罕见的疾病，是指腹主动脉与胃肠道的任何部分，最常见的是十二指肠的第三/第四部分之间存在异常的通信。尸检时原发性主动脉-十二指肠瘘（PADF）的发生率为0.04% ~ 0.7%，术后继发AEF的发生率为0.5% ~ 2.3%。AEF可以通过上消化道内窥镜（UGIE）或腹部对比增强计算机断层扫描（CECT）血管造影进行诊断，需要通过手术或血管内手段进行紧急修复。方法我们报告了一位64岁的男性PADF出血的病例。他接受了UGIE和腹部CT血管造影评估，并接受了全血管内动脉瘤修复术。padf是一种罕见的消化道出血原因，仅占所有消化道出血的0.2%。患者最初可表现为先兆性出血，但也可表现为典型的三联征：搏动性腹部肿块、胃肠道出血和腹痛。对于病情稳定的病人，内镜检查应该是首选的初步检查。EGD阴性并不排除PADF的可能性。CECT腹腔血管造影也是一种有用的诊断方式；有些人认为它优于UGIE或主动脉造影术。结论padf是一种罕见但危及生命的疾病，需要及时识别和干预，无论是手术还是血管内修复。

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引用次数: 0

Collision tumor of the pancreas: Extraskeletal Ewing-like sarcoma and solid pseudopapillary tumor 胰腺碰撞瘤：骨骼外wing样肉瘤和实性假乳头状瘤

Surgery Case Reports

Pub Date : 2024-12-05 DOI: 10.1016/j.sycrs.2024.100078

Naveen Kumar Kushwaha , Pradeep Jaiswal , Nihanthy Sreenath , Peeyush Bhatt

A collision tumor involves the coexistence of two histologically distinct neoplasms in one anatomical location. These are rare in the pancreas and are associated with a poor prognosis. We present the first case of an incidentally diagnosed pancreatic collision tumor, consisting of an extraosseous Ewing-like sarcoma and a solid pseudopapillary tumor, in a 43-year-old male. This case emphasizes the diagnostic and therapeutic challenges associated with pancreatic collision tumors. It highlights the necessity of a multidisciplinary approach and adherence to treatment protocols, with a focus on prioritizing treatment based on the more aggressive histology to achieve optimal outcomes.

碰撞瘤包括两个组织学上不同的肿瘤在一个解剖位置共存。这种情况在胰腺中很少见，且预后较差。我们报告第一例偶然诊断的胰腺碰撞瘤，由骨外尤文样肉瘤和实性假乳头状肿瘤组成，患者为43岁男性。本病例强调了与胰腺碰撞肿瘤相关的诊断和治疗挑战。它强调了多学科方法和坚持治疗方案的必要性，重点是根据更具侵袭性的组织学来优先治疗，以达到最佳结果。

引用次数: 0

Amyloidosis presenting as a malignancy: Two case reports and key diagnostic clues 淀粉样变表现为恶性肿瘤：两例报告和关键诊断线索

Surgery Case Reports

Pub Date : 2024-12-02 DOI: 10.1016/j.sycrs.2024.100079

Naveen Kumar Kushwaha , Laleng Mawia Darlong , Sunil Pasricha , Prerna Garg , Prafull Kumar Gamit

Respiratory amyloidosis manifests in three forms: focal/diffuse tracheobronchial, nodular parenchymal, and diffuse parenchymal. Surgical treatment is typically reserved for localized nodular pulmonary amyloidosis, while bronchoscopic techniques, radiotherapy, and medical therapy are preferred for other forms based on the specific subtype. We present two cases of pulmonary amyloidosis that were initially misdiagnosed as malignant based on cytology and imaging studies, but were later confirmed as amyloidosis following surgical resection. These cases highlight the potential role of surgery in such scenarios, extending its therapeutic value beyond conventional indications, as documented in the literature.

呼吸道淀粉样变性表现为三种形式：局灶性/弥漫性气管支气管、结节性实质和弥漫性实质。对于局限性结节性肺淀粉样变性，通常保留手术治疗，而对于其他基于特定亚型的形式，首选支气管镜技术，放疗和药物治疗。我们报告了两例肺淀粉样变，最初根据细胞学和影像学检查误诊为恶性，但后来在手术切除后证实为淀粉样变。这些病例强调了手术在这种情况下的潜在作用，将其治疗价值扩展到传统适应症之外，正如文献所记载的那样。

引用次数: 0

Pseudoaneurysm in the axillary tail of the breast following stereotactic biopsy: A case report and literature review 立体定向活检后乳腺腋尾假性动脉瘤：病例报告和文献综述

Surgery Case Reports

Pub Date : 2024-11-14 DOI: 10.1016/j.sycrs.2024.100070

Hanne-Eva van Bremen , Jorn P. Meekel , Steven P. Kerssemakers , Gerwin A. Fransen , Sandra Muller

Background

Core needle biopsy of the breast is a widely used technique to obtain a specimen for histopathological examination. Stereotactic biopsy occasionally result incomplications such as infection or hematoma. The development of a pseudoaneurysm after breast biopsy; however, is a rare complication.

Case presentation

A 56-year-old postmenopausal woman using a vitamin K antagonist presented with a suspicious lesion in the lateral upper quadrant of the right breast, initially classified as BI-RADS 3. After 24 months, an increase in calcification led to reclassification as BI-RADS 4, prompting stereotactic biopsy without periprocedural complications. One month later, the patient presented with continuous swelling accompanied by pain. Ultrasound and Doppler revealed a concentric collection with a to-and-fro waveform, indicating a pseudoaneurysm. Treatment with thrombin injection successfully induced thrombosis. Follow-up at six weeks demonstrated complete regression of the mass without signs of residual blood flow.

Conclusions

Thrombin injection appears to be a safe and effective treatment for the occurrence of pseudoaneurysm following stereotactic breast biopsy.

背景乳腺芯针活检是一种广泛使用的技术，用于获取标本进行组织病理学检查。立体定向活检偶尔会导致感染或血肿等并发症。然而，乳腺活检后出现假性动脉瘤是一种罕见的并发症。病例介绍一位 56 岁的绝经后妇女在服用维生素 K 拮抗剂后出现右乳房外上象限可疑病变，最初被归类为 BI-RADS 3。一个月后，患者出现持续肿胀并伴有疼痛。超声波和多普勒显示有一个同心的集合体，波形忽高忽低，显示为假性动脉瘤。注射凝血酶的治疗成功诱导了血栓形成。结论注射凝血酶似乎是治疗乳腺立体定向活检术后假性动脉瘤的一种安全有效的方法。

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引用次数: 0

Management of perforated jejunal diverticulitis: A case series and literature review 穿孔性空肠憩室炎的治疗：一个病例系列和文献回顾

Surgery Case Reports

Pub Date : 2024-11-13 DOI: 10.1016/j.sycrs.2024.100071

Tim Baumgartner, Hishaam Ismael, David Young

Small bowel diverticulosis, less common than colonic diverticulosis (incidence 1–2 %), predominantly affects males, and risk increases with age. Approximately 15 % or patients present with complications including bleeding, perforations with peritonitis, or fistulas, and these complications can be fatal with mortality rates as high as 40 % in cases of perforation. While some reports have suggested that patients can avoid surgery with bowel rest and antibiotics, or the use of CT guided aspiration of abscesses related to the disease, this case series examines 5 patients with perforated jejunal diverticulitis at a single institution successfully managed with surgical resection in the emergent and elective settings following recurrence of symptoms. There are limitations to medical management and lifestyle modifications alone, while elective surgical resection is effective in symptom management and risk reduction.

小肠憩室病比结肠憩室病少见（发病率1 - 2%），主要影响男性，风险随年龄增加而增加。大约15%的患者出现并发症，包括出血、腹膜炎穿孔或瘘管，这些并发症可致命，穿孔的死亡率高达40%。虽然一些报告建议患者可以通过肠道休息和抗生素来避免手术，或者使用CT引导下的与疾病相关的脓肿抽吸，但本病例系列在单一机构检查了5例穿孔空肠憩室炎患者，这些患者在症状复发后的紧急和选择性情况下成功地进行了手术切除。仅靠药物治疗和改变生活方式是有局限性的，而选择性手术切除在症状控制和降低风险方面是有效的。

引用次数: 0

High-grade diffuse large B cell non-Hodgkin lymphoma involving the mucosal hemorrhoid tissue: A case report 累及痔粘膜组织的高级别弥漫大 B 细胞非霍奇金淋巴瘤：病例报告

Surgery Case Reports

Pub Date : 2024-11-01 DOI: 10.1016/j.sycrs.2024.100077

Dima Malkawi, Janet Lee, Micheal Shane McNevin

Non-Hodgkin's lymphomas are a diverse group of immune system cancers that can affect any organ in the body. Few reports describe the development of malignant lymphoma in internal or external hemorrhoids. We present the case of a 67-year-old female with a long-standing history of non-bleeding, prolapsing hemorrhoids, and recent significant weight loss. Following an excisional hemorrhoidectomy, pathological analysis revealed high-grade diffuse large B-cell non-Hodgkin lymphoma (DLBCL) involving the mucosal hemorrhoid tissue. The case underscores the importance of considering malignancy in atypical presentations of common conditions. Treatment for anal canal lymphomas remains uncertain, with medical management generally preferred over surgery. Accurate diagnosis requires histopathologic examination due to the overlap of clinical features with other pathologies.

非霍奇金淋巴瘤是一种多种多样的免疫系统癌症，可影响身体的任何器官。很少有报告描述恶性淋巴瘤发生在内痔或外痔。我们介绍了一例 67 岁女性的病例，她长期患有不出血、脱垂的痔疮，近期体重明显下降。痔切除术后，病理分析发现高级别弥漫大 B 细胞非霍奇金淋巴瘤（DLBCL）累及痔粘膜组织。该病例强调了在常见疾病的非典型表现中考虑恶性肿瘤的重要性。肛管淋巴瘤的治疗方法仍不确定，通常首选药物治疗而非手术治疗。由于临床特征与其他病变重叠，准确诊断需要组织病理学检查。

引用次数: 0

A stepwise treatment of gastrobronchial fistula after laparoscopic sleeve gastrectomy: A case report" 腹腔镜袖状胃切除术后胃支气管瘘的分步治疗：病例报告"

Surgery Case Reports

Pub Date : 2024-11-01 DOI: 10.1016/j.sycrs.2024.100076

Behrouz Keleidari , Koorosh Parchami , Erfan Sheikhbahaei , Mohammad ghayoomi

Bariatric surgery has quickly emerged as one of the most effective treatments for obesity in the world and is mostly known as a safe and effective method; however, in some cases, it may lead to life-threatening complications. One of these complications is fistula, which may result in high mortality and morbidity. The treatment methods for this condition have been subject to ongoing discussion, ranging from endoscopic procedures to surgery. However, the outcome of each approach remains uncertain for both patients and surgeons. A 21-year-old man presented with pulmonary symptoms such as cough, pleuritic chest pain, and fever two months after laparoscopic sleeve gastrectomy and in further investigations, the diagnosis of gastrobronchial fistula (GBF) was confirmed. The treatment of the patient was based on endoscopic procedures and prioritizing minimally invasive methods over surgical interventions.

The treatment approach that is recommended for patients with GBF is the stepwise method, in which the next step is performed according to the patient's condition. Also, the treatment was based on minimally invasive procedures like endoscopic-based methods, also it is advisable to avoid conducting invasive treatments such as surgical procedures until the patient has shown a response to either non-invasive or minimally invasive treatments.

Conclusion

The key finding of this case report emphasizes that in situations of acute or unstable conditions or even if there is still hope for treatment, it's better to avoid invasive procedures. Rather, opting for non-invasive or minimally invasive treatments is favored to stabilize the patient's clinical or lab parameters, or to maintain a steady and consistent weight. Therefore, it is advisable to refrain from or delay surgical and invasive procedures during the acute stages or when a GBF is newly diagnosed, allowing the patient to attain a more stable clinical condition and use surgical approaches as a complementary choice besides minimally invasive procedures.

减肥手术已迅速成为世界上治疗肥胖症最有效的方法之一，而且大多被认为是一种安全有效的方法；然而，在某些情况下，减肥手术可能会导致危及生命的并发症。瘘管就是其中一种并发症，可能会导致高死亡率和发病率。针对这种情况的治疗方法一直在讨论之中，从内窥镜手术到外科手术，不一而足。然而，对于患者和外科医生来说，每种方法的结果仍然不确定。一名 21 岁男子在腹腔镜袖带胃切除术后两个月出现咳嗽、胸膜炎性胸痛和发热等肺部症状，进一步检查后确诊为胃支气管瘘（GBF）。对该患者的治疗以内窥镜手术为主，并优先采用微创方法，而不是外科手术。此外，治疗以内窥镜等微创手术为基础，在患者对非侵入性或微创治疗有反应之前，最好避免进行手术等侵入性治疗。相反，选择非侵入性或微创治疗更有利于稳定患者的临床或实验室指标，或保持稳定和持续的体重。因此，在 GBF 的急性期或刚确诊时，建议避免或推迟手术和侵入性治疗，让患者获得更稳定的临床状态，并将手术方法作为微创治疗以外的补充选择。

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引用次数: 0

Corrigendum to “Thrombectomy under deep hypothermic circulatory arrest (DHCA) for renal cell carcinoma with atrio-caval thrombus” [Surg Case Rep: Adv Tech 2 (2024) 1-4, 100036] 深低温循环停滞（DHCA）下血栓切除术治疗伴有心房-腔静脉血栓的肾细胞癌"[《外科病例报告：先进技术 2 (2024) 1-4，100036》]更正

Surgery Case Reports

Pub Date : 2024-11-01 DOI: 10.1016/j.sycrs.2024.100063

Eduardo R. Bautista , Pocholo Carlo R. Bernardo , Tricia Angela G. Sarile , Czarlo M. Dela Victoria , Mary Grace G. Gana , Ana Melissa F. Hilvano-Cabungcal , Ferri P. David-Paloyo , Siegfredo R. Paloyo

引用次数: 0

Endoscopic approach for pancreatobiliary involvement in IgG4 related disease IgG4相关疾病胰胆受累的内镜治疗方法

Surgery Case Reports

Pub Date : 2024-11-01 DOI: 10.1016/j.sycrs.2024.100072

José De Jesús Herrera-Esquivel, Carlos A. Zacaula-Aguilar, Enrique Cortinez-Encarnación, Ana Karen García-Ávila, José Rodrigo Muñoz-Gutiérrez, Miguel Ángel Domínguez-Varela, Manuel A. Pérez-Turrent

Introduction

Immunoglobulin G4-related disease (IgG4-RD) is a rare, systemic autoimmune fibroinflammatory disorder affecting the pancreatobiliary tract, often mimicking malignancies. Diagnosis relies on clinical and histological features, using Mayo Clinic HISORt and Japan Biliary Association criteria.

Case series

Two patients with IgG4-RD presented with abdominal symptoms and abnormal liver function tests. Imaging and endoscopic ultrasound (EUS) revealed bile duct stenosis and pancreatic abnormalities. Elevated serum IgG4 levels and histopathological findings confirmed the diagnosis. Both patients responded well to prednisone, showing clinical improvement and normalization of liver function tests.

Discussion

IgG4-RD represents a diagnostic challenge due to its diverse manifestations. Accurate diagnosis requires a multidisciplinary approach, incorporating clinical, radiological, serological, and histopathological findings. Early recognition and corticosteroid therapy are crucial for achieving remission.

Conclusion

The establishment of diagnostic criteria and advanced imaging techniques has improved the management of IgG4-RD. However, distinguishing it from other biliary disorders remains challenging, necessitating ongoing research and collaboration among medical professionals.

导言免疫球蛋白 G4 相关疾病（IgG4-RD）是一种罕见的、影响胰胆管的全身性自身免疫性纤维炎性疾病，通常会模仿恶性肿瘤。病例系列两名 IgG4-RD 患者出现腹部症状和肝功能检查异常。影像学检查和内镜超声检查（EUS）发现胆管狭窄和胰腺异常。血清IgG4水平升高和组织病理学检查结果证实了诊断。这两名患者对泼尼松反应良好，临床症状有所改善，肝功能检查也趋于正常。准确诊断需要结合临床、放射学、血清学和组织病理学结果的多学科方法。结论诊断标准和先进影像学技术的建立改善了 IgG4-RD 的治疗。然而，将 IgG4-RD 与其他胆道疾病区分开来仍具有挑战性，这就需要医学专业人员不断进行研究和合作。

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引用次数: 0

Acute appendicitis due to extrapulmonary tuberculosis 肺外结核引起的急性阑尾炎

Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.sycrs.2024.100075

Hamidreza Zamani , Seyed Pedram Kouchak Hosseini , Soheil Bagherian Lemraski , Hojatolah Khoshnoudi , Mohammad Aghaei , Alireza Haghbin Toutounchi

Introduction and Importance

Tuberculous appendicitis is very infrequent, estimated to occur in only 0.1 % of all appendectomies. Appendicular tuberculosis can manifest as either a primary or secondary infection. Primary appendicular tuberculosis is even more uncommon and occurs in the absence of any detectable primary focus elsewhere in the body.

Case Presentation

In this report, we present a challenging case of primary tuberculous appendicitis that does not appear to have originated from the lungs. This case highlights the importance of considering tuberculosis in the differential diagnosis of appendicitis, especially in regions where tuberculosis is endemic or in patients with a history of tuberculosis exposure.

Clinical Discussion

Diagnosing tuberculous appendicitis can be challenging due to its rarity and the non-specific nature of its symptoms, which often mimic those of more common conditions such as acute appendicitis and because of these non-specific symptoms, tuberculous appendicitis is mostly diagnosed only after surgical intervention.

Conclusion

This case underscores the need for a high index of suspicion and thorough diagnostic evaluation in patients with atypical presentations of appendicitis specifically in patients with chronic complaints. Treatment typically involves a combination of surgical intervention to remove the affected appendix and a prolonged course of anti-tuberculous medication to eradicate the infection and prevent recurrence.

导言和重要性结核性阑尾炎非常罕见，估计仅占所有阑尾切除术的 0.1%。阑尾结核可表现为原发性或继发性感染。原发性阑尾结核更为少见，而且是在身体其他部位未发现任何原发病灶的情况下发生的。在本报告中，我们介绍了一例原发性结核性阑尾炎的疑难病例，该病例似乎并非来自肺部。本病例强调了在阑尾炎的鉴别诊断中考虑结核病的重要性，尤其是在结核病流行的地区或有结核病接触史的患者。临床讨论由于结核性阑尾炎的罕见性及其症状的非特异性，结核性阑尾炎的诊断可能具有挑战性，其症状往往与急性阑尾炎等更常见疾病的症状相似。治疗通常包括手术切除受影响的阑尾和长期服用抗结核药物以根除感染并防止复发。

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