Surgery Case Reports最新文献

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.

Background

Post-pancreatectomy hemorrhage (PPH) is among the most severe complications after pancreaticoduodenectomy. Gastroduodenal artery pseudoaneurysm rupture may prove fatal without expeditious invasive treatment, while other causes of PPH can often be treated medically. Pseudoaneurysms may be effectively managed with endovascular stenting or angioembolization techniques. CT imaging allows for non-invasive evaluation prior to intervention but may delay treatment and result in false-negatives.

Materials and methods

Patients who developed PPH after pancreaticoduodenectomy at a high-volume institution over a 24-month span were included. Perioperative factors and clinical management data were analyzed to examine management and imaging utility.

Results

Twelve patients (thirteen bleeds) were evaluated. Six were extraluminal and suspicious for pseudoaneurysm rupture. Three of these bleeds were preceded by sentinel events. Obtaining CT imaging prior to interventional radiological management delayed treatment by a mean of 6.7 h. Four bleeds were treated with endovascular therapy. These were successful interventions without bleed recurrence.

Conclusions

Based on the current findings and limited relevant literature, this manuscript presents recommendations for managing PPH as developed by interdepartmental consensus between surgery and interventional radiology.

Background

Schwannomas, which are also known as neurilemomas, constitute the most common type of peripheral nerve tumors. These tumors can grow slowly and occur as painless swellings over the course of several years before their diagnosis. The aim of this report is to present a case of a very rare plexiform schwannoma originating from second digital nerve and multiple schwannomas from third and fourth digital nerves and palmar cutaneous branch of median nerve with emphasis given on differential diagnosis and treatment strategy.

Case Presentation

A 15-year-old patient presented with soft tissue masses on the volar surface of the hand, initially diagnosed as benign nerve sheath tumors. Surgical excision was performed twice, preserving nerves and tendons. Recurrence occurred, and subsequent biopsy confirmed benign nerve sheath tumors. Microscopic examination revealed multinodular/plexiform schwannoma in the larger lesion and simple schwannomas in others, leading to a diagnosis of multiple schwannomatosis. All surgeries resulted in intact sensory and motor function.

Conclusion

Surgical treatment can be curative and effectively employed for concomitant schwannoma tumors. Nevertheless, with careful planning and execution, surgery remains a promising option for patients with concomitant schwannomas. Further research and long-term follow-up studies are needed to fully understand the outcomes and refine the techniques used in these surgical treatments.

Introduction

Metastasis to the sternum from Follicular Thyroid Carcinoma (FTC) is rare. Only a handful of cases can be found in literature. Delayed metastasis to the bone has been reported but in a setting of a known thyroid primary.

Case report

This is a case of a 51-year-old female, presenting with an anterior chest mass in the background of previous right thyroid lobectomy with isthmusectomy for multinodular colloid adenomatous goiter. Multiple attempts to establish tissue diagnosis were not conclusive, hence outright surgical resection was pursued. She underwent partial sternectomy to include the manubrium sterni and the costochondral junctions of the first and 2nd ribs bilaterally, frozen section and completion thyroidectomy. She also underwent segmental resection of the right 12th rib, phrenicorrhaphy, tube thoracostomy. Subsequently, radioactive iodine therapy was given as part of her definitive treatment.

Discussion

Radical chest wall excision in the form of sternectomy or rib resection together with reconstruction is not the preferred treatment of choice in prior literature for the management of metastatic thyroid carcinoma. However, recent advances in thyroid carcinoma studies have proposed this approach to decrease the burden of the disease as well as improve relapse free survival.

Conclusion

Though unconventional, surgical management for metastatic follicular thyroid carcinoma

provides a viable option to improve the patient’s quality of life. However, further research on its clinical behavior and potential targeted therapies is still needed.

Background

Hepatocellular adenomas are benign liver tumors often associated with risk factors such as oral contraception (OC) in young women of childbearing age. Complications include the risk of hemorrhage and malignant transformation.

Case report

Our surgical ward included a 28-year-old patient with 4 gestures and 4 parts under estroprogestative (OC), conditions who presented with sudden-onset abdominal pain in the right hypochondrium without recent trauma, fever (38.5°), and no weight loss.

The patient had a conscious, blood pressure reading of 100/60 mmHG. Abdominal examination revealed tenderness in the right hypochondrium. An abdominal CT scan revealed a subcapsular hematoma of the liver associated with probable lesion of segment VI.

Hepatic RMI showed a well-limited hepatic lesion of segment VI VII, with a heterogeneous signal in T1 T2, moderate enhancement with gadolinium measuring 73 * 68 * 80, and a large subcapsular hematoma of the liver.

Resection of segment VI was performed. Microscopic examination confirmed the diagnosis of hepatocellular adenoma.

Conclusion

Here, we report the case of a patient with a bleeding hepatocellular adenoma who was treated by surgical resection. the aim of this case report is to show the management of hepatic bleeding adenomas larger than 5 cm.

The case report describes the discovery of a Porto colic fistula incidentally during a CT scan in a 52-year-old male with a complex medical history. Despite initially being admitted for respiratory distress, the patient developed abdominal distention, leading to imaging revealing massive colonic distention and the unexpected finding of a Porto colic fistula. Managing such rare conditions can be challenging due to limited guidelines, often requiring a conservative therapeutic approach. This case emphasizes the diagnostic and therapeutic dilemmas encountered and highlights the importance of further research and reporting to guide clinical practice in such cases.

Renal cell carcinoma accounts for 85–90 % of all primary renal neoplasms and has the propensity to expand and directly invade contiguous structures such as the inferior vena cava predisposing to thrombus formation in approximately 10 % of cases. Overall, 70 % of patients survive for 5 years. While several classifications have been published to characterize the level of thrombus involvement and subsequently define the appropriate surgical treatment, the prognosis of such remains to be ascertained. Furthermore, controversies exist as to the most appropriate surgical approach particularly for atrial thrombus (Level IV). Although traditionally such thrombus level is addressed using cardiopulmonary bypass with or without deep hypothermic arrest, there have been recent reports of a less invasive maneuver using a transdiaphragmatic approach, essentially milking the thrombus down, avoiding sternotomy. We present our initial case of a 59-year-old male having a right renal mass with extensive thrombus from the inferior vena cava up to the right atrium managed with radical nephrectomy and thrombectomy under cardiopulmonary bypass with deep hypothermic circulatory arrest. Patient remains tumor-free after 1 year of follow-up.

Fingertip partial or complete amputations are the most common hand injuries among pediatric population. Different treating options are nowadays available, with microsurgery that has been pushing further and further its technical limits; nevertheless it requires extraordinary surgical skills and experience. We present our step-by-step technique according to Hirase’s composite cooling graft principles as an effective alternative to more complex solutions. This procedure showed excellent results in children, with promising results even in young adults.

Androgen Insensitivity Syndrome (AIS) is a rare genetic condition affecting individuals with 46 XY genotypes. We present a case of Complete AIS (CAIS) in a 16-year-old phenotypically female patient with primary amenorrhea and bilateral inguinal masses. Despite male karyotype (46XY), physical examination and imaging revealed the absence of Müllerian structures and the presence of testes-like structures. The diagnosis was confirmed through hormone profiling and karyotyping. Management involved multidisciplinary collaboration, including surgical interventions (gonadectomy) and counseling. Early recognition and intervention in CAIS can mitigate psychological distress and optimize outcomes. This case also highlighted the importance of considering AIS in the differential diagnosis of primary amenorrhea, particularly in the presence of inguinal hernias.

Congenital lung masses are rare and their clinical presentation is highly variable. If newborns present with respiratory distress immediately after birth, early surgical therapy can be necessary. Here, we present the case of a newborn with a very large left-sided lung tumor. The severe respiratory compromise warranted surgical resection at the age of 11 days. The surgery was conducted by an interdisciplinary team. Cardiopulmonary bypass was used to maintain hemodynamic stability. The postoperative histopathological workup identified the tumor as a Fetal Lung Interstitial Tumor (FLIT). The patient developed well and is doing fine 15 months after surgery.