Surgery Case Reports最新文献

Usually diagnosed post-mortem, aortopulmonary artery fistula is an exceptionally rare and often highly lethal condition. Here, we present a unique case of a 29-year-old woman with no history of aortic aneurysm or previous aortic surgery, referred for surgical management of Laubry-Pezzi syndrome in whom an aorto-pulmonary artery fistula bridging the ascending aorta and the main pulmonary artery was discovered intra operatively. The patient was successfully managed with an uneventful postoperative recovery. Our case outlines the inaugural reported occurrence of an aortopulmonary artery fistula coinciding with Laubry-Pezzi syndrome. Unique features include subtle onset of heart failure over months due to occult left ventricular volume overload, challenging diagnosis alongside known intracardiac shunts, emphasizing the need for vigilance, and demonstration of successful surgical outcomes despite high morbidity and mortality.

A primordial odontogenic tumor (POT) consists of an ellipsoidal mass of dental papilla-like myxoid connective tissue entirely enveloped in an intricate membrane of the ameloblastic epithelium. This case has been particularly interesting due to its unique identity and rare nature. A 5-year-old boy came to the ENT department of a tertiary care hospital complaining of left facial swelling for the past three months. In contrast with clinical, radiological, and histological investigations and following the WHO definition, it was confirmed as a Primordial odontogenic tumor of the maxilla. The ideology and genetic makeup of this disease are still idiopathic and in the early developing phase. The clinical, radiologic, microscopic, and IHC features in this case suggest POT in an infrequent location of the anterior maxillary region.

Introduction

Mesh reinforcement of the hiatus has been shown to reduce the hernia recurrence rate. But serious related complications have been reported including bleeding, erosion or migration, infection, stricture, and adhesions. Complete transmural gastric migrations of the mesh have been rarely cited in the literature.

Case

We herein report a case of a 62-year-old woman who presented for dysphagia and weight loss, 2 years after hiatal hernia repair with mesh cruroplasty. On endoscopy, complete transmural mesh migration into the stomach was identified, but it was difficult to remove. The mesh was then removed surgically.

Discussion

The possible mechanism of mesh erosion can be related to the anatomy of the distal esophagus, fixation, position, and distance of the mesh to the esophagus when placed at surgery. Endoscopic mesh retrieval is the first line of treatment when safe and feasible. Other surgical treatments in case of failure of endoscopic removal are case by case depending on the position of the mesh and the extent of organ injury. Surgery can be done laparoscopically or via laparotomy.

Conclusion

In conclusion, dysphagia may manifest during the early postoperative period after mesh repair antireflux surgery, but such dysphagia usually resolves; if it doesn’t or if it worsens, mesh migration must be excluded

Background

Metastasis of anal adenocarcinoma to inguinal lymph nodes is a rare occurrence and published literature on the optimal management strategy for these patients is limited.

Case presentation

We present a case where the use of total neoadjuvant therapy (long course concurrent chemoradiotherapy followed by chemotherapy alone), surgical resection of primary anal disease and selective inguinal lymph nodes is dissection was used to treat a male in his sixties with anal adenocarcinoma with inguinal lymph node metastasis. This was a novel approach in our centre where the management of rectal adenocarcinoma was extrapolated to treat anal adenocarcinoma.

Conclusion

There is no clear guideline for management of anal adenocarcinoma with metastasis to inguinal lymph nodes. This case offers an approach for future patients with similar pathology that appears feasible in the short term 1 year follow up.

Introduction

Boerhaave's syndrome is a rare clinical condition, characterized by the rupture of the oesophagus following a sudden increase in intraoesophageal pressure. It can occur in various regions of the oesophagus. Its rarity, coupled with the diversity of its possible presentations, makes the diagnosis more challenging and results in non-standardized treatment.

Case presentation

We report the case of a 71-year-old man who resorted to the emergency department with severe epigastric pain after vomiting. The patient's CT scan revealed an oesophageal rupture. A thoracoscopy was performed with pleural debridement and positioning of three pleural drainage. Endoscopic stenting was performed and a nutritional jejunostomy was prepared before admitting the patient to the Intensive Care Unit. The postoperative course was complicated by a para-oesophageal abscess and dislocation of the endoscopic stent. The patient was discharged home on the 46th day, and the endoscopic stents were successfully removed three months later.

Discussion

In the more extensive metanalysis we found, the majority of perforations were in the distal oesophagus, the initial therapeutic management consisted of surgery, followed by endoscopy, surgery and endoscopy together, and conservative treatment in 15 %. Most patients were admitted to ICU and the mortality reached 17 %. The time of diagnosis was crucially associated with clinical outcomes.

Conclusion

The choice of the most suitable approach should be tailored to the patient and should be guided by the time of diagnosis, perforation severity and patient medical condition at presentation, but the management of Boerhaave’s syndrome remains a challenge.

Stereotactic Radiosurgery (SRS) is a non-invasive treatment modality used for various intracranial pathologies including Arteriovenous Malformations (AVMs), high and low-grade gliomas, and brain metastases. This report presents a very rare case of a 29-year-old male who initially presented with headache and insomnia. Subsequent diagnostic investigations revealed a large right temporal lobe AVM that was 45.48 cc in volume, supplied by the superior and inferior truncus of the Middle Cerebral Artery (MCA), as well as anterior and posterior choroidal arteries. The patient underwent volume-staged SRS with a marginal dose of 15 Gy for each stage, conducted in two stages six months apart. The patient achieved near-complete obliteration initially. However, three years later from the last stage presented with a headache that was diagnosed as a subarachnoid hemorrhage, leading to surgical removal of the residual AVM. Subsequently patient presented with seizures and further imaging studies revealed a contrast-bearing mass at the site previously operated. A second operation revealed the mass to be a glioblastoma. Despite chemoradiotherapy patient succumbed to death. Malignant transformations following SRS, although rare, remain one of the most feared and devastating outcomes.

Littoral cell angioma is a rare primary vascular tumor of the spleen taking its origin from littoral cells lining the red pulp venous sinuses of the reticuloendothelial system of the spleen. Throughout the literature, most patients report in an asymptomatic manner with littoral cell angioma presenting as an incidental finding on radiological imaging. Due to their rarity, these tumors can pose diagnostic and therapeutic challenges. The accepted strategies for diagnosis, treatment, and surveillance are based off a limited amount of published data. Our case describes a 61-year-old male who presented to the emergency department for gastrointestinal bleed secondary to gastric ulcers. He subsequently had radiological imaging completed which showed a lesion in his spleen that caused concern for malignancy due to the enhancement patterns on magnetic resonance imaging. The patient wished for surgical resection versus ongoing radiological surveillance and underwent a laparoscopic splenectomy. He was discharged post-operative day one without complications. Pathology confirmed littoral cell angioma. The patient was doing well at follow up. This article provides an in-depth review into the diagnosis and management of a littoral cell angioma of the spleen.

While there are several approaches to cervical screw fixation surgery, the two most common modes of placement are pedicle and lateral mass screws. Both techniques have their respective complications such as neurological deficits, vascular injury, compromise to bone quality, or chronic postoperative pain. This report suggests a novel technique that utilizes the surgical plan of lateral mass screw insertion with modifications to control for the commonly reported complications associated with it. The procedure illustrated in this report was performed on a patient with a history of spine surgery and persistent neurological deficits. When approaching such patients, it is vital to adjust the screw angulation based on the individual’s anatomy. The modified Roy-Camille technique proposed in this report can be applied to other patients undergoing cervical spine surgery and may yield favorable outcomes with respect to minimizing neurovascular injury and maximizing postoperative recovery. This can be accomplished based on each patient’s unique presentation, individual anatomy, symptomatology, and surgical history.

Pigmented villonodular synovitis (PVNS) is benign but locally aggressive proliferative disorder that affects synovial joint, tendon sheaths, and bursae. PVNS is rare in child, while concurrent Anterior Cruciate Ligament (ACL) tear in PVNS is uncommon finding. Previous study reported ACL tear might be a risk factor in adult PVNS but lack of record for pediatric PVNS. We report a case of uncommon concomitant ACL partial tear in an already rare pediatric PVNS. A nine-year old female with pain and swelling on left knee, occurred intermittent every 2 months for 1 year prior to surgery. There was moderate knee movement restriction with history of fall from bicycle 1 year before surgery. No history of knee instability was reported. X-ray only denote joint swelling, while MRI shows intraarticular bodies suspected synovial chondromatosis with hyperintense signal sign of partial ACL tear. The patient underwent arthroscopic evaluation which exhibit intraarticular hyperemic and hypertrophic synovium with loosening anteromedial ACL bundle. Arthroscopic synovectomy was then performed followed by range of motion training and muscle strengthening rehabilitation program. Post-operative histopathological result confirms PVNS assessment. 1 year follow up post-surgery shows no recurrence of pain or swelling with free movement of left knee joint and no disturbance or instability while walking. In this case, partial ACL tear may contribute as risk factor of PVNS in child. Arthroscopic synovectomy with physical rehabilitation program shows good functional result with no recurrence at 1-year follow up.

The case report describes a rare instance of an interrupted aortic arch (IAA) with bicuspid aortic valve stenosis in a 48-year-old male patient with a one-year history of refractory hypertension, chest pain, and numbness in the upper and lower extremities. A single-stage operation was performed through a midline sternotomy, involving aortic valve replacement and posterior pericardial ascending-to-descending aortic bypass. Managing such rare conditions can be challenging due to limited guidelines, no meaningful conclusion may be made as to whether single-stage or two-stage repair is superior. Final management decision in adult patients with IAA must be individualized and depend on the associated malformations, patient preference, and precise anatomy imaging. The single-stage posterior pericardial ascending-to-descending aortic bypass appears as a safe surgical method in such cases when concomitant cardiac procedures are indicated.