Surgery Case Reports最新文献

Introduction

Case series

Discussion

Conclusion

Introduction and Importance

Case Presentation

Clinical Discussion

Conclusion

Background

Case Presentation

Discussion

Conclusion

Background

Case Presentation

Conclusion

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.