Surgery Case Reports最新文献_第3页

Endovascular management of a ruptured basilar artery aneurysm in the setting of vertebral artery hypoplasia and post-stent intimal hyperplasia: A case report 椎动脉发育不全和支架后内膜增生的基底动脉动脉瘤破裂的血管内治疗：1例报告

Surgery Case Reports

Pub Date : 2025-07-04 DOI: 10.1016/j.sycrs.2025.100133

Ahmed Hafez Mousa , Aisha Ismail Makandar , Roaa Alharbi , Abdulla Sharaf , Babacar Cisse

Background

Basilar artery aneurysms pose considerable challenges due to their location near vital neurovascular structures. Management becomes more complex with coexisting vertebral artery hypoplasia and intimal hyperplasia (IH)—a response to endovascular intervention marked by smooth muscle proliferation that can lead to stenosis, especially after flow-diverter stent (FDS) placement. This case describes endovascular treatment of a ruptured basilar artery aneurysm complicated by vertebral artery hypoplasia and post-stent IH.

Case presentation

A 38-year-old man presented with severe headache, altered consciousness, and subarachnoid hemorrhage. Imaging revealed a ruptured basilar artery aneurysm and right vertebral artery hypoplasia. An external ventricular drain was placed for hydrocephalus. The aneurysm was treated with coiling and FDS placement via the left vertebral artery to maintain flow and induce aneurysm thrombosis. Post-procedure imaging showed proximal IH without significant flow limitation. The patient was managed with dual antiplatelet therapy. Follow-up demonstrated stable IH, no stenosis, and no aneurysm recurrence.

Conclusion

This case highlights the complexity of managing basilar artery aneurysms in the setting of vertebral artery hypoplasia and IH. Successful treatment depends on meticulous endovascular planning, careful assessment of vascular anatomy, and sustained follow-up. Dual antiplatelet therapy played a key role in preventing IH progression and ensuring a favorable outcome.

基底动脉动脉瘤由于其位置靠近重要的神经血管结构而带来了相当大的挑战。椎动脉发育不全和内膜增生（IH）共存，治疗变得更加复杂，这是对血管内干预的反应，其特征是平滑肌增生，可导致狭窄，特别是在血流分流支架（FDS）置入后。这个病例描述了一个破裂的基底动脉动脉瘤并发椎动脉发育不全和支架后IH的血管内治疗。38岁男性，以严重头痛、意识改变及蛛网膜下腔出血为主。影像显示基底动脉动脉瘤破裂及右侧椎动脉发育不全。脑积水患者行外脑室引流术。动脉瘤通过左椎动脉盘绕和FDS放置来维持血流并诱导动脉瘤血栓形成。术后影像学显示近端IH无明显血流受限。患者接受双重抗血小板治疗。随访显示IH稳定，无狭窄，无动脉瘤复发。结论本病例突出了椎动脉发育不全合并IH的基底动脉瘤治疗的复杂性。成功的治疗依赖于细致的血管内规划、仔细的血管解剖评估和持续的随访。双重抗血小板治疗在预防IH进展和确保良好结局方面发挥了关键作用。

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引用次数: 0

Retro-sigmoid approach for an adult cerebellar hemangioblastoma with foramen magnum extension 乙状结肠后入路治疗伴枕骨大孔扩张的成人小脑血管母细胞瘤

Surgery Case Reports

Pub Date : 2025-07-03 DOI: 10.1016/j.sycrs.2025.100134

Ahmed Hafez Mousa , Badr Ahmed Abdul Hamid , Ayoub Ahmed Abedzadeh , Shaikh Sayeed Iqbal , Ayman Al-Sibaie , Abdulla Qassim , Ameer Alyeldien

Introduction

Cerebellar hemangioblastomas are rare, highly vascular tumors often associated with von Hippel-Lindau (VHL) disease. They typically arise in the cerebellar hemispheres and can affect the brain, spinal cord, and retina.

Case presentation

We report a case of a 36-year-old male presenting with persistent dizziness, initially misdiagnosed as peripheral vertigo. Neuroimaging revealed a right cerebellar mass with unusual extension through the foramen magnum, causing obstructive hydrocephalus. The patient underwent a right far-lateral suboccipital craniotomy. Gross total resection was achieved, and histopathology confirmed hemangioblastoma, with no evidence of VHL.

Conclusion

This case highlights an atypical presentation of cerebellar hemangioblastoma with foramen magnum extension. Surgical challenges in such cases can be mitigated by thorough preoperative planning, including angiography, detailed anatomical understanding, and refined microsurgical technique. Even without intraoperative neuromonitoring, complete resection without postoperative deficits is achievable. Further case reports are essential to enhance surgical strategies for rare tumor locations

小脑血管母细胞瘤是一种罕见的高度血管性肿瘤，常与von Hippel-Lindau （VHL）病相关。它们通常发生在小脑半球，可影响大脑、脊髓和视网膜。我们报告一位36岁男性，以持续头晕为主诉，最初误诊为周围性眩晕。神经影像学显示右侧小脑肿块异常延伸至枕骨大孔，引起梗阻性脑积水。患者接受了右远外侧枕下开颅手术。大体全切除，组织病理学证实为血管母细胞瘤，无VHL证据。结论本病例为不典型的小脑血管母细胞瘤伴枕骨大孔延伸。通过周密的术前计划，包括血管造影、详细的解剖理解和精细的显微外科技术，可以减轻这种情况下的手术挑战。即使没有术中神经监测，也可以实现无术后缺损的完全切除。进一步的病例报告是必要的，以提高手术策略的罕见肿瘤的位置

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引用次数: 0

Incarcerated inguinoscrotal bladder hernia: A case report 嵌顿性腹股沟-阴囊膀胱疝1例

Surgery Case Reports

Pub Date : 2025-07-02 DOI: 10.1016/j.sycrs.2025.100132

Antonella Capomolla , Francesco Zappia , Cristian Lebrino , Daniele Dignitoso , Francesco Mio , Antonietta Posterino , Fabrizio Silvaggio , Francesco Loria , Marcello Ferrari , Matilde Lico , Rosario Maccarone , Angela Teti , Ilaria Trecroci , Giovanni Petracca

Inguinoscrotal bladder hernia is a rare clinical condition, detected in less than 4 % of inguinal hernias. Urinary retention, obesity, advanced age and male gender represent its most significant risk factors. Symptoms may include inguinal pain and swelling, as well as double micturition and volume reduction of the bulge after voiding. Such an unspecific clinical presentation requires a high index of suspicion in order to reach an early diagnosis, essential to prevent major complications. Because of its rareness, literature concerning inguinoscrotal bladder hernia is scarce and its diagnostic and therapeutic care pathways lack standardization. We seek to contribute to the still limited knowledge on the subject, presenting the case of a 75-year-old patient come to our attention complaining of pain and a sense of tension in his right inguinoscrotal region, site of a voluminous incarcerated inguinoscrotal hernia. The patient reported severe urinary retention and, once catheterized, produced abundant cloudy urine. His blood test showed mild neutrophilic leukocytosis. Computed tomography documented a right-sided inguinoscrotal hernia, containing a large bladder diverticulum, confirmed by void cystoscopy. An adequate preoperative assessment, allowed us to perform an open surgical repair with a mesh free of major surgical complications. In doubtful cases or voluminous inguinoscrotal bladder hernia, computed tomography and voiding cystoscopy permit pre-operative diagnosis and accurate operative planning. Hernia repair with a mesh through an open approach appears to be the safest and most effective option.

腹股沟阴囊膀胱疝是一种罕见的临床疾病，在腹股沟疝的检出率不到4 %。尿潴留、肥胖、高龄和男性是其最重要的危险因素。症状可能包括腹股沟疼痛和肿胀，以及排尿后双重排尿和肿胀体积减少。这种不具体的临床表现需要高度的怀疑指数，以达到早期诊断，对预防重大并发症至关重要。由于对腹股沟-阴囊膀胱疝的认识罕见，相关文献较少，诊断和治疗护理途径缺乏规范化。我们试图贡献仍然有限的知识，在这个问题上，提出的情况下，75岁的病人来到我们的注意，抱怨疼痛和紧张感在他的右腹股沟阴囊区，一个巨大的腹股沟腹股沟腹股沟疝的位置。患者报告严重的尿潴留，一旦导尿，产生大量混浊尿。他的血检显示轻度嗜中性粒细胞增多。计算机断层扫描显示右侧腹股沟阴囊疝，含大膀胱憩室，经空腔膀胱镜检查证实。充分的术前评估，允许我们使用网状物进行开放手术修复，无主要手术并发症。在可疑病例或腹股沟-阴囊膀胱疝中，计算机断层扫描和排尿膀胱镜检查有助于术前诊断和准确的手术计划。经开放入路用补片修补疝是最安全、最有效的选择。

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引用次数: 0

Bowel obstruction secondary to low-grade mucinous neoplasm in the right iliac fossa: A case report and literature review 右髂窝低级别黏液性肿瘤继发肠梗阻1例并文献复习

Surgery Case Reports

Pub Date : 2025-07-01 DOI: 10.1016/j.sycrs.2025.100131

Georgios Anargyros Karantzikos , Despoina Chatzopoulou , Nikolaos Kardaras , Vasileios Spapis , Efthymios Koniaris

Mucinous neoplasms are a heterogenous group of epithelial neoplasms with varying malignant potential, ranging from mucoceles to adenocarcinomas. Most originate from the appendix and their clinical manifestation is non-specific. This report aims to present the case of a 56-year-old patient with bowel obstruction secondary to a large low-grade mucinous neoplasm. The patient underwent an emergency laparotomy for the removal of the tumour with en bloc resection of the caecum, part of ascending colon, part of the sigmoid and part of the urinary bladder. The histopathology report was suggestive of Grade 1 peritoneal mucinous neoplasm according to WHO. Interestingly, the appendix could not be identified and the origin of the neoplasm could not be defined. Taking into consideration the rarity of this low-grade mucinous neoplasm in the emergency setting, this case report contributes to the existing literature regarding the description of the features of mucinous neoplasms. There are very few cases of low-grade mucinous tumours of extra-appendiceal origin and their integration into the existing classification system of low-grade mucinous neoplasms should be considered.

黏液性肿瘤是一种异质性的上皮肿瘤，具有不同的恶性潜能，范围从黏液囊肿到腺癌。多数起源于阑尾，临床表现无特异性。本报告的目的是提出一个56岁的病人继发于一个大的低级别黏液性肿瘤肠梗阻的情况。患者接受紧急剖腹手术切除肿瘤，同时切除盲肠、部分升结肠、部分乙状结肠和部分膀胱。组织病理学报告提示1级腹膜黏液性肿瘤。有趣的是，阑尾不能确定，肿瘤的起源也不能确定。考虑到这种低级别黏液性肿瘤在急诊环境中的罕见性，本病例报告有助于现有文献对黏液性肿瘤特征的描述。起源于阑尾外的低级别黏液性肿瘤病例很少，应考虑将其纳入现有的低级别黏液性肿瘤分类体系。

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引用次数: 0

Surgical management of pulmonary mucormycosis caused by steroid-containing herbal supplements 含类固醇草药补品引起的肺毛霉菌病的外科治疗

Surgery Case Reports

Pub Date : 2025-07-01 DOI: 10.1016/j.sycrs.2025.100135

Claire Perez, Vikram Krishna, Federico Sertic, Raffaele Rocco, Andrew R. Brownlee, Harmik J. Soukiasian, Philicia Moonsamy

Pulmonary mucormycosis is a rare, life-threatening fungal infection that predominantly affects immunocompromised patients. Prompt diagnosis, antifungal therapy, and radical surgical intervention are essential to improve survival. We report a unique case of pulmonary mucormycosis in a 45-year-old diabetic man who had been taking an over-the-counter drug for joint and back pain that contains unregulated amounts of steroids. The patient presented with small-volume hemoptysis and was initially treated with antibiotics for cavitary pneumonia. A surgical wedge resection of the cavitary lesion revealed mucormycosis, and he was subsequently treated with amphotericin B. Despite these interventions, the infection rapidly progressed to encompass the entire right lung, and the patient required a right pneumonectomy to achieve source control. This case highlights the role of unregulated supplements as a risk factor for invasive fungal infections and the importance of considering pulmonary mucormycosis in patients who do not improve on antibiotics. Early recognition and aggressive surgical resection of all infected areas remains critical for favorable outcomes.

肺毛霉病是一种罕见的、危及生命的真菌感染，主要影响免疫功能低下的患者。及时诊断、抗真菌治疗和根治性手术干预对提高生存率至关重要。我们报告一个独特的病例肺毛霉菌病在一个45岁的糖尿病人谁一直服用非处方药的关节和背部疼痛，其中含有不规范的类固醇量。患者表现为小容量咯血，最初使用抗生素治疗空洞性肺炎。手术切除腔体病变发现有毛霉病，随后接受两性霉素b治疗，尽管采取了这些干预措施，但感染迅速发展到整个右肺，患者需要进行右全肺切除术以达到源头控制。该病例强调了不受管制的补品作为侵袭性真菌感染的危险因素的作用，以及在抗生素治疗无效的患者中考虑肺毛霉菌病的重要性。早期识别和积极手术切除所有感染区域仍然是取得良好结果的关键。

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引用次数: 0

Multidisciplinary treatment of the edentulous maxillectomy defect after trauma: A case report with a 2.5-year follow-up 创伤后无牙上颌切除缺损的多学科治疗：1例随访2.5年

Surgery Case Reports

Pub Date : 2025-06-06 DOI: 10.1016/j.sycrs.2025.100129

Shandan He , Huihui Zeng , Haidong Fan, Huajing Li, Yuyan Zheng

This clinical report is aimed at describing a novel multidisciplinary management of a 40-year-old male patient presented with a severelyk strophic edentulous ridge, a unilateral maxillary defect and an oroantral fistula induced by trauma. The patient-specifical planning workflow consisted of tooth extractions, guided bone regeneration, maxillary sinus floor elevation, dental and zygomatic implant placement, soft tissue augmentation, oroantral fistula closure, and rehabilitation. Several dental disciplines were embraced through the therapeutic period. During the 2.5-year follow-up period, the morphological and functional disorders were recovered clinically and radiographically without concurrent complications. Therefore, a suitable and thorough plan for complicated clinical situations should include various medical branches or sub-branches to ensure a predictable achievement with long-term stability.

本临床报告旨在描述一种新的多学科治疗方法，治疗一名40岁男性患者，其表现为严重的营养不良无牙嵴，单侧上颌缺损和创伤引起的口窦瘘。患者具体的计划工作流程包括拔牙，引导骨再生，上颌窦底提升，牙齿和颧种植体放置，软组织增强，口窦瘘关闭和康复。在治疗期间接受了几个牙科学科。在2.5年的随访期间，形态学和功能障碍均得到临床和影像学恢复，无并发并发症。因此，对于复杂的临床情况，一个合适的、周密的计划应该包括各个医疗分支或支行，以确保可预测的、长期稳定的成果。

引用次数: 0

Tuberous sclerosis complex with classic clinical triad, subependymal giant cell astrocytoma and subependymal nodules: A case report 结节性硬化症合并典型临床三联征、室管膜下巨细胞星形细胞瘤及室管膜下结节1例

Surgery Case Reports

Pub Date : 2025-06-06 DOI: 10.1016/j.sycrs.2025.100130

Zermina Tanvir , Khitamul Haq , Huzaifa Ali Khan , Waqar Ahmad , Inibehe Ime Okon , Bipin Chaurasia

Tuberous sclerosis complex (TSC) is a rare genetic disorder characterized by benign tumors in multiple organs. We present the case of a 16-year-old male with recurrent headaches, seizures, sebaceous adenomas, and developmental delay—features consistent with the classic triad of Tuberous sclerosis complex (TSC). Imaging revealed multiple subependymal nodules, a subependymal giant cell astrocytoma (SEGA), and mild hydrocephalus. The patient underwent successful ventriculoperitoneal shunt (VP shunt) placement, resulting in resolution of symptoms. This case emphasizes the importance of early diagnosis and imaging in guiding the management of TSC.

结节性硬化症（TSC）是一种罕见的遗传性疾病，以多器官良性肿瘤为特征。我们报告一例16岁男性复发性头痛、癫痫发作、皮脂腺瘤和发育迟缓，其特征符合结节性硬化症（TSC）的经典三征。影像显示室管膜下多发结节，室管膜下巨细胞星形细胞瘤（SEGA）和轻度脑积水。患者成功接受脑室腹腔分流术（VP分流术）放置，症状得到缓解。本病例强调早期诊断和影像学对指导TSC治疗的重要性。

引用次数: 0

A reverse nailed frontal sinus and craniofacial injury: Case report and literature review 额窦反向钉钉致颅面损伤1例报告及文献复习

Surgery Case Reports

Pub Date : 2025-06-02 DOI: 10.1016/j.sycrs.2025.100128

Chizowa Okwuchukwu Ezeaku , Kelechi Michael Azode , Akinpelu Ebenezer Ibukunoluwa , Edward Oluwole Komolafe

Background

Impalement injuries are uncommon in the head region. It can be accidental, following acts of violence, exorcism, or self-inflicted. Various impaling objects, including nails, have been reported. An infrequent presentation is accidental impalement of the frontal sinus with a nail in a reverse pattern, as demonstrated in our patient. Herein, we present possible mechanisms underlying this rare presentation, highlighting our management decision-making process and appraising the available evidence on the nuanced surgical approach and management. In addition, we reviewed the reported cases of frontal sinus impalement injuries.

Case presentation

A 60-year-old male teacher presented to our emergency department with a nail stuck in his forehead while separating a fight between two students. Clinical and radiological investigations were in keeping with frontal sinus nail impingement injury, with a nail head embedded within the sinus. The patient subsequently underwent wound exploration, nail extraction, sinus mucosectomy, and wound closure. The patient was discharged under excellent conditions and is currently being followed up.

Conclusion

Frontal sinus nail impalement injury is a rare presentation of craniofacial injury and poses a significant risk due to its proximity to cerebrovascular structures. Adequate evaluation and timely management are recommended to avoid long-term complications. Owing to the heterogeneous presentation of impaled frontal sinus injuries, the surgical decision process should be on a patient-to-patient basis.

背景：顶部损伤在头部区域并不常见。它可能是意外的，在暴力行为，驱魔，或自己造成的。据报道，有各种各样的刺穿物，包括钉子。一个罕见的表现是意外刺穿额窦的钉子在相反的模式，在我们的病人证明。在此，我们提出了这种罕见表现的可能机制，强调了我们的管理决策过程，并评估了有关细致入微的手术入路和管理的现有证据。此外，我们回顾了报道的额窦穿刺损伤病例。病例介绍一名60岁的男老师在帮助两名学生打架时前额被钉子扎进急诊室。临床和影像学检查与额窦钉撞击伤一致，钉头嵌入窦内。随后，患者接受了伤口探查、指甲拔除、鼻窦粘膜切除术和伤口缝合。该患者出院时情况良好，目前正在接受随访。结论额窦钉入伤是一种罕见的颅面损伤，因其靠近脑血管结构，危险性大。建议充分的评估和及时的处理，以避免长期并发症。由于刺穿额窦损伤的异质表现，手术决策过程应以患者为基础。

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引用次数: 0

Successful removal of a penetrating fish hook eye injury via modified advance-and-cut technique 通过改进的先进和切割技术成功去除穿透性鱼钩眼损伤

Surgery Case Reports

Pub Date : 2025-06-02 DOI: 10.1016/j.sycrs.2025.100125

Ahmet Kaan Şimşek, Ayça Küpeli Çınar, Abdulkadir Can Çınar, Ahmet Kürşad Sakallıoğlu, Rüveyde Garip, Hande Güçlü

Barbed fish hook injuries to the eye are rare but can be serious, especially in children. We report the case of a 10-year-old boy who sustained a penetrating eye injury from a barbed hook. The hook entered the outer edge of his cornea, passed through the iridocorneal angle, and exited the sclera 5 mm from the limbus. On arrival, his best-corrected visual acuity was 0.8(Snellen decimal). Under general anesthesia, a modified advance-and-cut technique was used to remove the hook by guiding the barb through the scleral exit site, avoiding intraocular damage. The corneal and scleral wounds were sutured, and a bandage contact lens was applied to support healing. His recovery was smooth, and his vision improved to 1.0 ten days after suture removal, seven months post-injury. This case shows how a thoughtful surgical approach can effectively treat complex ocular injuries in children and highlights the importance of timely and precise intervention.

有刺的鱼钩伤到眼睛是罕见的，但可能很严重，特别是在儿童中。我们报告的情况下，一个10岁的男孩谁持续刺眼伤从一个有刺的钩子。钩入角膜外缘，穿过虹膜角，离角膜缘5 毫米出巩膜。到达时，他的最佳矫正视力为0.8（Snellen十进制）。在全身麻醉下，采用改良的推进-切割技术，通过引导倒钩穿过巩膜出口来去除钩，避免眼内损伤。缝合角膜和巩膜伤口，并使用绷带隐形眼镜支持愈合。术后7个月，术后10天视力恢复至1.0。本病例显示了一个深思熟虑的手术方法如何有效地治疗儿童复杂的眼部损伤，并强调了及时和精确干预的重要性。

引用次数: 0

Telescopic pancreatojejunostomy after whipple procedure in FRANTZ Tumor: Case report and literature review whipple手术后套筒胰空肠吻合术治疗FRANTZ肿瘤1例并文献复习

Surgery Case Reports

Pub Date : 2025-05-31 DOI: 10.1016/j.sycrs.2025.100127

José Richard Tenazoa-Villalobos , Edgar Fermín Yan-Quiroz , Olga Mercedes Viviana Burgos-García , Gladys Llerena-Cobián

Pseudopapillary solid tumour of the pancreas is a rare neoplasm that mainly affects young women and is categorized as a low-grade malignant tumour. Histologically, it does not present specific epithelial differentiation and can originate anywhere in the pancreas; immunohistochemistry is necessary for a definitive diagnosis. This neoplasm usually manifests itself with abdominal pain and a feeling of abdominal mass. Surgery with total resection, Whipple procedure (duodenopancreatectomy), is the treatment of choice, and 5-year survival exceeds 90 % after radical surgery. An end-to-end telescopic pancreatojejunostomy is a safe technique in which the pancreatic remnant is intussuscepted and fully enclosed into the jejunum lumen. It is ideal for a soft pancreas, reducing the risk of pancreatic leakage. We present the case of a 14-year-old female adolescent who presents with abdominal pain, and through imaging, a large pancreatic head tumour was discovered. The patient underwent a Whipple procedure, and the pathological study confirmed a pseudopapillary tumour or Frantz's tumour of the head of the pancreas. The patient had a favourable outcome after the procedure with no complications and tolerated the diet well with no alterations in lifestyle. There was no necessary chemotherapy, and the patient had a strict follow-up with no signs of recurrence.

胰腺假乳头状实体瘤是一种罕见的肿瘤，主要影响年轻女性，被归类为低级别恶性肿瘤。组织学上，无特异性上皮分化，可起源于胰腺的任何部位；免疫组织化学对明确诊断是必要的。这种肿瘤通常表现为腹痛和腹部肿块的感觉。手术与全切除术，惠普尔手术（十二指肠胰切除术），是治疗的选择，根治性手术后5年生存率超过90% %。端到端伸缩胰空肠吻合术是一种安全的技术，其中胰腺残肢被套接并完全封闭在空肠腔中。这是理想的软胰腺，减少胰腺渗漏的风险。我们提出的情况下，14岁的女性青少年谁提出腹痛，并通过成像，一个大的胰腺头部肿瘤被发现。患者接受了惠普尔手术，病理检查证实为胰腺头部的假性乳头状肿瘤或弗朗茨肿瘤。手术后患者预后良好，无并发症，饮食耐受良好，生活方式无改变。没有必要的化疗，病人有严格的随访，没有复发的迹象。

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引用次数: 0