Surgery Case Reports最新文献_第3页

Re: Primordial odontogenic tumor of the Maxilla: A case report 上颌原发牙源性肿瘤1例

Surgery Case Reports

Pub Date : 2025-11-17 DOI: 10.1016/j.sycrs.2025.100151

Bhushan Sharma , George Koshy , Sonal Grover , Deepti Sharma

引用次数: 0

Two-step treatment with laparoscopic fistula closure for colocutaneous fistula secondary to sigmoid colon diverticulitis without colonic resection: A case report 腹腔镜下两步治疗乙状结肠憩室炎继发结肠皮瘘，不需结肠切除术1例

Surgery Case Reports

Pub Date : 2025-11-17 DOI: 10.1016/j.sycrs.2025.100153

Shima Asano , Chikai Mitsuhara , Masayoshi Nishihara , Naoya Ozawa

Background

Colocutaneous fistula is a rare complication of diverticulitis, typically requiring surgical colonic resection. However, surgery for complicated diverticulitis entails risks such as anastomotic leakage or creation of a stoma, both of which can adversely affect quality of life. Here, we present a case of a colocutaneous fistula treated with a two-step approach: cutaneous drainage with antibiotics followed by laparoscopic fistula closure to avoid colonic resection.

Case Presentation

A man in his 70 s was referred to our emergency room (ER) with a 2-day history of fever and right lower quadrant abdominal pain. A computed tomography (CT) scan revealed sigmoid diverticulitis with an intra-abdominal abscess, and percutaneous drainage was performed. Following drainage and antibiotic therapy, his symptoms improved, and he was subsequently discharged. Seven days later, he returned to the ER with recurrent symptoms and purulent discharge from the drainage site. He was readmitted, and a CT scan revealed an enlarged intra-abdominal mass. Additional drainage was performed by reopening the scar. Contrast imaging revealed a colocutaneous fistula. Following two hospitalizations for intra-abdominal abscess management, an elective laparoscopic fistula closure was undertaken. He was discharged on postoperative day 15 and continued with routine follow-up.

Conclusion

For patients with colocutaneous fistula and diverticulitis, a two-step approach—initial cutaneous drainage with antibiotics followed by laparoscopic fistula closure—offers a viable alternative to immediate colonic resection, minimizing surgical risks and reserving resection as a future option.

背景：结皮瘘是憩室炎的罕见并发症，通常需要结肠手术切除。然而，手术治疗复杂性憩室炎会带来吻合口漏或造口等风险，这两种风险都会对生活质量产生不利影响。在这里，我们提出一个病例的结肠皮瘘治疗两步的方法：皮肤引流抗生素后腹腔镜瘘关闭，以避免结肠切除。病例介绍：一名70岁 的男子因发烧和右下腹疼痛2天被转介到我们的急诊室。计算机断层扫描显示乙状结肠憩室炎伴腹腔内脓肿，行经皮引流术。引流和抗生素治疗后，患者症状好转，随后出院。7天后，患者以复发症状和引流处脓性分泌物返回急诊室。他再次入院，CT扫描显示腹内肿块增大。通过重新打开疤痕进行进一步引流。造影显示一结肠皮肤瘘管。在两次因腹内脓肿住院治疗后，进行了选择性腹腔镜瘘管闭合。术后第15天出院，继续常规随访。结论：对于结皮瘘和憩室炎患者，两步入路——首先用抗生素进行皮肤引流，然后腹腔镜下闭合瘘——是立即结肠切除术的可行选择，可以将手术风险降到最低，并将切除保留为未来的选择。

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引用次数: 0

Surgical resection of inoperable Lynch syndrome-related colorectal cancer following pembrolizumab treatment: Report of two cases 派姆单抗治疗后不能手术的Lynch综合征相关结直肠癌手术切除：2例报告

Surgery Case Reports

Pub Date : 2025-11-17 DOI: 10.1016/j.sycrs.2025.100149

Yuki Matsumi , Kunitoshi Shigeyasu , Daisuke Kadowaki , Yusuke Yoshida , Ryohei Shoji , Yuya Sakurai , Nobuhiko Kanaya , Yoshitaka Kondo , Hideki Yamamoto , Takehiro Tanaka , Fuminori Teraishi , Shunsuke Kagawa , Toshiyoshi Fujiwara

Recent therapeutic advances have dramatically improved outcomes in patients with colorectal cancer (CRC) with mismatch repair deficiency (dMMR) or high microsatellite instability (MSI). Approximately 20 % of patients with MSI-high CRC have Lynch syndrome, but few studies have reported the conversion of unresectable CRC to surgery in patients with Lynch syndrome. Here, we present two patients with dMMR/MSI-high CRC who successfully converted to surgery for tumor resection. Case 1 was a 73-year-old male patient diagnosed with MSI-high rectal cancer, which was unresectable due to extensive posterior infiltration. Pembrolizumab treatment led to a reduction in tumor size, allowing laparoscopic residual rectal resection. Case 2 was a 33-year-old female patient diagnosed with Stage IIIC descending colon cancer with iliopsoas muscle infiltration. The family history suggested a hereditary predisposition to CRC, and MSI testing led to the diagnosis of MSI-high CRC. The iliopsoas muscle infiltration prevented curative resection, but pembrolizumab treatment led to a reduction in tumor size, and the patient underwent laparoscopic partial resection of the descending colon. In both patients, postoperative genetic testing led to the definitive diagnosis of Lynch syndrome. The two cases illustrate the remarkable response of Lynch syndrome-associated CRC to pembrolizumab treatment, which allowed for conversion resection.

最近的治疗进展显著改善了错配修复缺陷（dMMR）或高微卫星不稳定性（MSI）结直肠癌（CRC）患者的预后。大约20% %的msi高CRC患者有Lynch综合征，但很少有研究报道Lynch综合征患者不可切除的CRC转化为手术。在这里，我们报告了两例dMMR/ msi高的结直肠癌患者，他们成功地转化为手术切除肿瘤。病例1是一名73岁男性患者，诊断为msi高直肠癌，由于广泛的后部浸润而无法切除。Pembrolizumab治疗导致肿瘤大小减小，允许腹腔镜残余直肠切除术。病例2是一名33岁的女性患者，诊断为IIIC期降结肠癌伴髂腰肌浸润。家族史提示CRC的遗传易感性，MSI检测导致MSI高CRC的诊断。髂腰肌浸润阻碍了根治性切除，但派姆单抗治疗导致肿瘤大小减小，患者接受了腹腔镜降结肠部分切除术。两例患者术后基因检测均明确诊断为Lynch综合征。这两个病例说明Lynch综合征相关CRC对派姆单抗治疗的显着反应，允许转换切除。

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引用次数: 0

Giant mixed solid cystic parathyroid adenoma – Diagnostic and surgical challenges 巨大混合实性囊性甲状旁腺瘤-诊断和手术挑战

Surgery Case Reports

Pub Date : 2025-11-17 DOI: 10.1016/j.sycrs.2025.100150

Hanifa Akhtar , Ruuzeno Kuotsu , Sankappa P. Sinhasan , Md Jamil , Neizekhotuo Brian Shunyu , Pakesh Baishya , DebKumar Boruah , Nisha Kumari

Background

Giant parathyroid adenomas of cystic or mixed type are rare lesions that may mimic systemic or metabolic conditions such as gout and other musculoskeletal disorders. Overlap of symptoms often results in diagnostic delays and pose surgical challenges. We report a case of woman in her fifties who presented with two-year history of generalised weakness and joint pain, initially treated as gout. She later developed a progressive painful neck swelling and intermittent flank pain. Laboratory evaluation revealed severe hypercalcemia (15.5 mg/dL), markedly elevated parathyroid hormone (1528 pg/mL), and renal dysfunction. Ultrasonography demonstrated a large mixed solid cystic lesion posterior to the left thyroid lobe, and Technetium −99 Sestamibi scan confirmed a left upper parathyroid adenoma. Intraoperatively, a giant cystic mass (6.5 x 4×4 cm) densely adherent to the left thyroid lobe was found, requiring left hemithyroidectomy for complete excision. Histopathology confirmed a mixed solid cystic parathyroid adenoma without malignancy. The patient developed transient post operative hypocalcaemia, which was managed conservatively, and recovered uneventfully. This case underscores the importance of considering giant parathyroid adenomas in patients with hypercalcaemia and atypical local and systemic symptoms, as well as the need of careful surgical planning in managing giant or adherent parathyroid tumours.

巨大的囊性或混合型甲状旁腺瘤是罕见的病变，可能模仿全身或代谢疾病，如痛风和其他肌肉骨骼疾病。症状重叠常常导致诊断延迟，并给手术带来挑战。我们报告一个病例的妇女在她的五十谁提出了两年的全身性虚弱和关节疼痛的历史，最初治疗痛风。她后来出现渐进性颈部疼痛肿胀和间歇性侧腹疼痛。实验室评估显示严重的高钙血症（15.5 mg/dL），甲状旁腺激素显著升高（1528 pg/mL），肾功能不全。超声检查显示左侧甲状腺叶后方有一巨大的混合实性囊性病变，Technetium - 99 Sestamibi扫描证实为左侧甲状旁腺瘤。术中发现一个巨大的囊性肿块（6.5 x 4×4 cm）密集附着于左侧甲状腺叶，需要左侧半甲状腺切除术完全切除。组织病理证实为混合性实性囊性甲状旁腺瘤，无恶性。患者术后出现短暂性低钙血症，经保守治疗后恢复平稳。本病例强调了在高钙血症和非典型局部和全身症状患者中考虑巨大甲状旁腺腺瘤的重要性，以及在治疗巨大或附着的甲状旁腺肿瘤时需要仔细的手术计划。

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引用次数: 0

A unique case of olfactory nerve ganglioglioma in neurofibromatosis type 1 1型神经纤维瘤病嗅觉神经节胶质瘤一例

Surgery Case Reports

Pub Date : 2025-11-17 DOI: 10.1016/j.sycrs.2025.100155

Massimiliano Domenico Rizzaro , Giulio Andrea Bertani , Gianluca Lopez , Federica Natacci , Stefania Elena Navone , Giovanni Marfia , Marco Locatelli

Introduction

Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is an autosomal dominant neurocutaneous disorder caused by pathogenic variants in the NF1 gene. This gene encodes neurofibromin, a tumor suppressor involved in negative regulation of the RAS/mTOR signaling pathway. While cutaneous neurofibromas and gliomas are common manifestations, glioneuronal tumors are rare in NF1.

Case presentation

We report the case of a 33-year-old man with genetically confirmed NF1, who presented with café-au-lait macules, cutaneous neurofibromas, and bilateral sensorineural hearing loss. Follow-up brain MRI revealed two contrast-enhancing lesions: one at the apex of the left petrous ridge, and another intraparenchymal mass in the left frontobasal region involving the ipsilateral olfactory nerve. The frontobasal lesion showed increased FDG uptake on PET imaging. The patient underwent microsurgical resection of this lesion. Intraoperatively, the mass was found to infiltrate the left olfactory bulb. Histopathological analysis confirmed a WHO grade I ganglioglioma, with no evidence of malignant transformation.

Conclusion

To our knowledge, this represents the first reported case of an olfactory nerve ganglioglioma in a patient with NF1. This finding suggests a possible novel association between NF1 and neuronal tumors affecting cranial nerve I. Further studies are warranted to explore the role of NF1 in glioneuronal tumorigenesis.

1型神经纤维瘤病（NF1），也称为von Recklinghausen病，是一种常染色体显性神经皮肤疾病，由NF1基因的致病变异引起。该基因编码神经纤维蛋白，一种参与RAS/mTOR信号通路负调控的肿瘤抑制因子。皮肤神经纤维瘤和胶质瘤是常见的表现，胶质神经元肿瘤在NF1中是罕见的。我们报告一例33岁男性遗传确诊NF1的病例，他表现为卡萨梅-au-lait斑疹、皮肤神经纤维瘤和双侧感音神经性听力损失。后续脑部MRI显示两个增强病变：一个在左侧岩脊顶端，另一个在左侧额基底区实质内肿块，累及同侧嗅神经。额基底病变在PET成像上显示FDG摄取增加。患者接受显微外科手术切除该病变。术中发现肿块浸润左侧嗅球。组织病理学分析证实为WHO一级神经节胶质瘤，无恶性转化迹象。结论：据我们所知，这是NF1患者嗅觉神经节胶质瘤的第一例报道。这一发现表明NF1与影响脑神经i的神经元肿瘤之间可能存在新的联系，需要进一步的研究来探索NF1在胶质神经元肿瘤发生中的作用。

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引用次数: 0

Juvenile granulosa cell tumor of the ovary: Case report 卵巢幼年颗粒细胞瘤1例

Surgery Case Reports

Pub Date : 2025-09-25 DOI: 10.1016/j.sycrs.2025.100144

Wissal Jaafar, Zied Louati, Yasmine Chiba, Medemagh Malak, Ines Hfaiedh, Mehdi Bouassida, Hamed Jemel, Cherifa Ben Sethom, Nahed Khalifa, Mechaal Mourali

Juvenile granulosa cell tumors (JGCTs) are rare ovarian neoplasms belonging to the sex cord–stromal tumor group, accounting for a small proportion of ovarian malignancies in children and adolescents. They may present with abdominal symptoms or signs of hormonal activity. We report the case of a 15-year-old girl with no history of precocious puberty who presented with pelvic pain and progressive abdominal bloating. There were no signs of hyperandrogenism or estrogen excess. Pelvic ultrasound revealed a large unilateral adnexal mass, and tumor markers were within normal limits. The patient underwent exploratory laparotomy, which identified an enlarged ovary with an intact capsule. A unilateral adnexectomy was performed, preserving the contralateral ovary and uterus. Histopathological examination confirmed the diagnosis of a juvenile granulosa cell tumor, characterized by Call-Exner bodies and nuclear grooves. No extra-ovarian spread was observed. The postoperative course was uneventful, and the patient was discharged on day five. Follow-up at six months showed no evidence of recurrence. JGCTs should be considered in the differential diagnosis of ovarian masses in adolescents, even in the absence of hormonal symptoms. Early diagnosis and fertility-sparing surgery can provide favorable outcomes, with close postoperative surveillance essential to detect recurrence.

青少年颗粒细胞瘤（jgct）是一种罕见的卵巢肿瘤，属于性索间质肿瘤组，在儿童和青少年卵巢恶性肿瘤中占很小的比例。他们可能会出现腹部症状或激素活动的迹象。我们报告的情况下，15岁的女孩没有性早熟的历史谁提出盆腔疼痛和进行性腹胀。没有雄激素过多或雌激素过量的迹象。盆腔超声显示单侧附件大肿块，肿瘤标志物正常。患者接受剖腹探查，发现卵巢肿大，包膜完好。行单侧附件切除术，保留对侧卵巢和子宫。组织病理学检查证实了一个少年颗粒细胞瘤的诊断，以Call-Exner小体和核沟为特征。未见卵巢外扩散。术后过程顺利，患者于第5天出院。随访6个月无复发迹象。在青少年卵巢肿块的鉴别诊断中，即使没有激素症状，也应考虑jgct。早期诊断和保留生育能力的手术可以提供良好的结果，密切的术后监测是发现复发的必要条件。

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引用次数: 0

Unusual lesions of the pancreas: A case series and review of the literature 胰腺异常病变：病例系列及文献回顾

Surgery Case Reports

Pub Date : 2025-09-22 DOI: 10.1016/j.sycrs.2025.100147

Kayla R. Widdowson , Max D. Hazeltine , Sebastian K. Chung , Lauren Scarpetti , Michelle Yang , James M. Lindberg

Lesions of the pancreas are commonly found, particularly with increased use of cross-sectional imaging. While there are a few well-described entities, atypical benign masses remain a diagnostic challenge and may mimic malignancy, leading to uncertainty in management. We present four cases of unusual, benign pancreatic lesions managed at a tertiary care center. While initially concerning for malignancy based on imaging and clinical presentation, these cases were ultimately diagnosed as a torsed ectopic splenule, lymphoepithelial cyst, benign simple mucinous cyst, and chronic mass-forming pancreatitis. Evaluation included imaging, endoscopic ultrasound, and tissue sampling. All patients underwent surgical resection, with final diagnoses confirmed through intraoperative findings and histopathology. A brief literature review was conducted for each entity to summarize distinguishing clinical, radiographic, and pathologic features. Further description of these atypical entities may help clinicians with appropriate diagnosis and guide treatment decisions.

胰腺病变是常见的，特别是随着横断面成像的使用增加。虽然有一些描述良好的实体，但非典型良性肿块仍然是诊断上的挑战，可能模仿恶性肿瘤，导致治疗的不确定性。我们提出了四个不寻常的病例，良性胰腺病变管理三级保健中心。这些病例最初根据影像学和临床表现考虑为恶性肿瘤，最终诊断为扭曲异位脾、淋巴上皮囊肿、良性单纯性粘液囊肿和慢性团块性胰腺炎。评估包括影像学、内窥镜超声和组织取样。所有患者均行手术切除，最终诊断通过术中发现和组织病理学证实。我们对每个实体进行了简短的文献回顾，以总结其临床、影像学和病理特征。对这些非典型实体的进一步描述可以帮助临床医生做出适当的诊断和指导治疗决策。

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引用次数: 0

Impacted gallstone at the duodenum: Surgical resolution of Bouveret’s syndrome in the elderly 十二指肠阻生胆结石：老年布韦莱特综合征的手术治疗

Surgery Case Reports

Pub Date : 2025-09-22 DOI: 10.1016/j.sycrs.2025.100143

Syed Saad Ali Chishti, Rimsa Tahir, Muhammad Awais, Hugo Prins, Cornelius Emeka Nzewi

Bouveret’s Syndrome is a rare form of gallstone ileus resulting in gastric outlet obstruction due to migration of a gallstone through a bilioenteric fistula. It most commonly affects elderly female patients and poses diagnostic and therapeutic challenges due to its nonspecific clinical presentation. This report aims to present the case of an elderly female who came with persistent vomiting and upper abdominal pain for 3 weeks, worsening over one week. Contrast-enhanced CT revealed a 4 cm gallstone lodged at the D2-D3 junction, causing duodenal obstruction and proximal distension. Endoscopic evaluation was deferred due to clinical instability and stone’s location and size, above careful consideration using clinical pre-operative tools. She underwent urgent exploratory laparotomy for stone retrieval, and a Heineke-Mikulicz pyloroplasty was performed. While endoscopic treatment is often used, this case highlights the importance of surgical intervention in large, impacted stones or in clinically unstable patients. In this case, CT scan provided a clear diagnosis, and surgical intervention was both necessary and effective. Given the rarity of Bouveret’s Syndrome and its variable presentation, this report contributes to existing literature by reinforcing the importance of high clinical suspicion, timely imaging, and individualized surgical decision-making.

布韦莱特综合征是一种罕见的胆结石性肠梗阻，由于胆结石通过胆肠瘘迁移而导致胃出口梗阻。它最常见于老年女性患者，由于其非特异性临床表现，给诊断和治疗带来了挑战。本报告的目的是提出一个案例的老年女性谁来持续呕吐和上腹部疼痛3周，恶化超过一周。增强CT显示一颗4 cm的胆结石卡在D2-D3交界处，引起十二指肠梗阻和近端扩张。由于临床不稳定性和结石的位置和大小，在使用临床术前工具仔细考虑之前，内镜评估被推迟。她接受了紧急探查性剖腹手术以取出结石，并进行了Heineke-Mikulicz幽门成形术。虽然内镜治疗经常被使用，这个病例强调了手术干预的重要性，在大的，阻生的结石或临床上不稳定的患者。本例CT扫描诊断明确，手术干预是必要且有效的。鉴于布韦莱特综合征的罕见性及其多变的表现，本报告通过强调高度临床怀疑、及时成像和个体化手术决策的重要性，对现有文献做出了贡献。

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引用次数: 0

Synchronous appendicitis and cholecystitis in the setting of intestinal malrotation: A rare presentation of adhesion of the appendix to the gallbladder 小肠旋转不良并发阑尾炎和胆囊炎：罕见的阑尾与胆囊粘连的表现

Surgery Case Reports

Pub Date : 2025-09-22 DOI: 10.1016/j.sycrs.2025.100146

Katie Lee , Hannah Woolley , Gregory Wu , Manuel Martinez

Introduction

Intestinal malrotation is a congenital abnormality that can complicate diagnosis of abdominal conditions. We present the first documented case of concurrent acute appendicitis, acute cholecystitis, and congenital intestinal malrotation.

Presentation of case

A 58-year-old female initially presented with perforated cholecystitis complicated by abscess formation and cholangitis, requiring interventional drainage and endoscopic stenting. Five months later, she returned with concurrent acute cholecystitis and appendicitis. Due to intestinal malrotation, the appendix was located in the right upper quadrant adjacent to the gallbladder and had eroded into the anterior abdominal wall. Laparoscopic subtotal cholecystectomy and appendectomy were successfully performed with pathology confirming both diagnoses.

Discussion

This case demonstrates a need for heightened suspicion of atypical presentations in patients with anatomical variants. Anatomical proximity may predispose to concurrent disease through bacterial spread.

Conclusion

This case reinforces the importance of maintaining broad differential diagnoses and utilizing comprehensive imaging in patients with anatomical variants.

肠道旋转不良是一种先天性异常，可使腹部疾病的诊断复杂化。我们提出了第一例并发急性阑尾炎、急性胆囊炎和先天性肠道旋转不良的病例。病例介绍：一名58岁女性，最初因穿孔性胆囊炎合并脓肿形成和胆管炎，需要介入引流和内镜下支架置入。5个月后，她复发并并发急性胆囊炎和阑尾炎。由于肠道旋转不良，阑尾位于右上象限，毗邻胆囊，并已侵蚀入前腹壁。腹腔镜胆囊次全切除术和阑尾切除术均成功，病理证实两种诊断。本病例表明，需要高度怀疑非典型表现的患者解剖变异。解剖上的接近可能通过细菌传播导致并发疾病。结论本病例强调了在解剖变异患者中保持广泛鉴别诊断和利用综合影像学的重要性。

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引用次数: 0

Pediatric clival chordoma masquerading as meningioma: Diagnostic challenges and surgical considerations. A case report 伪装成脑膜瘤的儿童斜坡脊索瘤：诊断挑战和手术考虑。病例报告

Surgery Case Reports

Pub Date : 2025-09-22 DOI: 10.1016/j.sycrs.2025.100145

Diego Molina-Botello , Edgar Fernando Higuera-González , Zita Elizabeth Salazar-Ramírez , Roberto Casarrubias-Islas , Julio César López-Valdés

Pediatric clival chordomas are rare, malignant skull base tumors known for significant diagnostic and therapeutic challenges. We present a case of a 16-year-old male with progressive headaches and left sixth cranial nerve palsy whose clival mass was initially misdiagnosed as a meningioma by neuroimaging. Intraoperative findings and subsequent histopathology, however, confirmed a conventional chordoma (characterized by physaliferous cells, immunopositivity for cytokeratin, EMA, and S100, with a Ki-67 index of 5–10 %). This case underscores that pediatric clival chordomas can mimic more common lesions, emphasizing the critical role of early, accurate histopathological evaluation and a personalized multidisciplinary strategy for optimizing long-term patient outcomes.

小儿斜坡脊索瘤是一种罕见的恶性颅底肿瘤，诊断和治疗具有重大挑战。我们报告一个16岁的男性，他有进行性头痛和左第六脑神经麻痹，他的斜坡肿块最初被神经影像学误诊为脑膜瘤。然而，术中发现和随后的组织病理学证实为常规脊索瘤（以物理细胞为特征，细胞角蛋白、EMA和S100免疫阳性，Ki-67指数为5-10 %）。该病例强调了儿童斜坡脊索瘤可以模仿更常见的病变，强调了早期，准确的组织病理学评估和个性化多学科策略对优化患者长期预后的关键作用。

引用次数: 0