Surgery Case Reports最新文献

Hepatic endometriosis is a very rare condition that is characterized by the presence of endometrial-like tissue within the hepatic parenchyma. Preoperative diagnosis is often difficult through cross-sectional imaging. Histopathologic evaluation remains the gold standard for diagnosis. Until now only a handful of cases have been reported in medical literature. We report a case of hepatic endometriosis in a 24-year-old, unmarried girl with a history of recurrent hepatic cysts in the right lobe of the liver after two previous surgeries. She underwent a right hepatectomy. The diagnosis was confirmed through histopathology assessment.

Background

Multifocal osteosarcoma (MFOS) is rare, accounting for approximately 1.5 % of osteosarcomas, and can be synchronous (lesions within six months) or metachronous (lesions after six months). The etiology and optimal treatment for MFOS remain controversial. This report presents four patients with synchronous MFOS and reviews the literature.

Case presentation

Case 1: A 24-year-old female with low back pain was found to have multiple lytic bone lesions with increased FDG uptake in the vertebral column and pelvic bones. Biopsy confirmed osteoblastoma-like osteosarcoma. After chemotherapy, she is alive after 5 months.

Case 2: A 6-year-old girl with right knee pain had a distal femur mass and a calcified inguinal lesion. Biopsies revealed osteoblastic osteosarcoma with metastatic lymph node involvement. Following chemotherapy and surgeries, she experienced recurrence and required further surgery. She is alive after 21 months.

Case 3: A 4-year-old boy with a walking disability had a sclerotic bone lesion in the distal femur and additional lesions in the pelvis and acetabulum. Biopsy confirmed osteoblastic osteosarcoma. Despite treatment, he developed metastases and died 7 months after diagnosis.

Case 4: A 9-year-old girl with right knee swelling had a sclerotic lytic lesion in the distal femur and an acetabular lesion. Biopsies confirmed chondroblastic osteosarcoma. After chemotherapy and surgery, she experienced recurrence and underwent pelvic resection. She died 24 months after diagnosis.

Conclusion

Synchronous MFOS is a highly aggressive osteosarcoma variant with a poor prognosis. Aggressive, individualized treatment may improve outcomes, particularly in metachronous cases. Further research is needed to enhance understanding and management of this rare condition.

Background

A fecaloma is a mass of hardened feces in the colon or rectum, more solid than typical impacted feces, leading to severe intestinal distension. It predominantly affects elderly, frail individuals, children with anorectal deformities, and patients with conditions such as Chagas disease, Hirschsprung's disease, and spinal injuries.

Case Report

We report the case of a 34-year-old man with a history of anal imperforation and subsequent anal stricture, who presented with a massive megacolon due to a giant fecaloma. The patient experienced progressive abdominal distension, colicky pain, and an inability to pass stool for 15 days. Physical examination revealed a tender, distended abdomen and impacted feces in the rectum. Laboratory tests and imaging studies confirmed the diagnosis. An emergency laparotomy revealed a 30 × 30 cm dilated sigmoid colon filled with 15–25 kg of fecal material. The fecaloma was removed via enterectomy, and a Hartmann's procedure with colostomy was performed. Histopathological examination showed no evidence of malignancy. Post-operatively, the patient recovered well and was discharged in good condition.

Conclusion

This case highlights the presentation and surgical management of a giant fecaloma causing megacolon. Prompt surgical intervention is critical in managing severe fecaloma to prevent life-threatening complications.

Introduction

Papillary fibroelastomas (PFE) are benign, rare primary cardiac tumors often discovered incidentally during cardiac imaging or as part of a workup for thromboembolic or obstructive events. We present a case of multiple PFE on the aortic valve's right coronary and non-coronary leaflets, presenting as recurrent cerebrovascular events managed by resection with valve preservation.

Case Summary

A 53-year-old male presented with an acute right frontal cerebrovascular accident and a history of recurrent transient ischemic attacks. A transesophageal echocardiogram (TEE) revealed a 10 × 8 mm mass on the right coronary cusp of the aortic valve. Differential diagnosis included PFE versus thrombus. Following a neurology evaluation, the patient was anticoagulated and scheduled for urgent cardiac surgery. During surgery, an 8 × 7 mm mass was sharply excised from the right coronary leaflet's anterior surface. Further examination revealed additional masses: a 3 mm mass on the underside of the right coronary leaflet, a 2 mm mass on the non-coronary leaflet, and another 2 mm mass on its underside. All masses were excised, and pathology confirmed the diagnosis of PFE. The patient's post-operative course was unremarkable, and a pre-discharge transthoracic echocardiogram (TTE) demonstrated complete removal of the aortic valve masses with normal ventricular and aortic valve function.

Discussion

PFE are rare benign cardiac tumors with a significant risk of thromboembolic or obstructive events, including stroke. Grossly, they are attached to the endocardium by a short fibrous pedicle with multiple papillary fronds resembling a sea anemone. More than 95 % originate from the left heart, most commonly affecting the aortic valve. Diagnosis is primarily through echocardiography, with TEE being more sensitive than TTE. Surgical excision is curative, offering an excellent long-term prognosis.

Conclusion

All patients with suspected embolic cerebrovascular events should undergo echocardiographic evaluation to assess for potential cardiac etiologies. Surgical resection of PFE results in uniformly excellent clinical outcomes, with aortic valve preservation achievable in over 98 % of cases.

Mesenchymal chondrosarcoma is a rare, aggressive sarcoma of bone or soft tissue with a high risk of hematogenous spread, leading to significant morbidity and mortality. Surgical resection is the standard treatment for localized cases. Addressing the limited data, we present a case of localized mesenchymal chondrosarcoma in the foot, where upfront surgery risked sacrificing the medial longitudinal arch crucial for weight-bearing. The patient received neoadjuvant chemotherapy and underwent limb salvage surgery using a sensate chimeric anterolateral thigh flap to preserve functionality.

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.