Surgery Case Reports最新文献

Papillary Renal Cell Carcinoma (PRCC) being the second most common histological type of Renal Cell Carcinoma (RCC). Although brain metastasis is rare in RCC, it often results in poorer outcomes compared to metastases in other locations. We present a case of brain metastasis originating from PRCC classified as pT1bN0M1. Subsequently, the patient underwent successful cytoreductive nephrectomy and pazopanib therapy as a follow-up systematic treatment. This case highlights the importance of urologists being aware of brain metastases that can develop in PRCC patients, which typically have a poorer outcome.

Digital locations of hand mycetoma are rare. They are most often described within the broader context of hand mycetoma. Herein, we report three cases of digital mycetoma.

Case 1: A 33-year-old patient presenting with a mycetoma of the middle finger evolving for 5 years with osteitis of P1. A trans-P2 amputation was performed.

Case 2: A 57-year-old patient presenting with a mycetoma of the little finger evolving for 12 years without bone involvement. Management consisted of excision surgery.

Case 3: A 27-year-old patient presenting with a mycetoma of the ring finger evolving for 7 years with osteitis of P1 and fistula. Extension to the base of the little finger was noted. Digital amputation was refused by the patient.

Few case reports have discussed the incidence and management of giant recurrent phyllodes tumors with borderline to malignant features. We report that of a recurrent case in a 57-year-old female who underwent wide excision with en bloc resection of the 3rd to 7th right anterior ribs and upper abdominal wall. Rigid chest wall reconstruction was achieved using methyl methacrylate and synthetic mesh. This is the first reported case wherein three locoregional flaps, namely the latissimus dorsi, thoracoepigastric and extended external oblique flaps were used to cover a defect measuring 1452 cm² in size. With this combination of flaps, deformity was minimized, and the resultant outcome was aesthetically and functionally acceptable. Reconstructive goals of intrathoracic organ protection, restoration of chest wall rigidity, maintenance of adequate respiratory function and soft tissue closure were achieved. Careful planning and individualized treatment together with multidisciplinary collaboration remains vital in the successful management of large recurrent malignant phyllodes tumors.

Background

Proximal row carpectomy (PRC) is often recommended for advanced-stage Kienböck's disease (KD), although there is no standardized treatment protocol. This study aimed to evaluate the efficacy of the PRC in managing KD.

Methods

A literature review and a clinical case study were conducted on a 40-year-old male with stage 3 KD.

Results

Postsurgery, the patient reported mild discomfort but significant functional improvement, with the Disabilities of the Arm, Shoulder, and Hand (DASH) score decreasing from 87 to 44. Observations included reduced pain, enhanced wrist trophism, and an expanded range of motion.

Conclusions

The PRC demonstrated positive outcomes, including symptom alleviation and functional restoration, supporting its viability as a tailored surgical intervention for KD, improving quality of life and reducing hospital stay.

Laparoscopic surgery currently represents the standard approach in colorectal cancer. However, it requires general anesthesia and pneumoperitoneum, which may be contraindicated in patients with impaired lung function. We hereby present a case of tailored minimally invasive surgery for an ascending colon cancer in a patient with Primary Ciliary Dyskinesia, situs inversus totalis, and end-stage lung disease. The surgery was conducted through a 13 cm left transverse incision under locoregional anesthesia, and the patient made an uneventful recovery despite her pre-existing comorbidities. This case proves the importance of tailored surgical and anesthesiologic management to provide good oncological outcomes to all cancer patients.

Background

Congenital trigger finger is a rare pediatric condition characterized by a finger fixed in a flexed position due to tendon anomalies. This rare condition involves multiple trigger fingers in children and is not extensively covered in the medical literature.

Methods

We examined a 2-year-old boy with multiple trigger fingers present since birth. Surgical release of the A1 pulleys was performed.

Results

Surgery resulted in normal finger function at the one-year follow-up.

Conclusions

Although rare, congenital trigger finger is treatable in children. Adaptive and timely interventions can significantly improve outcomes and reduce disability. This case highlights the importance of early and effective treatment strategies.

Introduction

Lymphangiomas are rare benign vascular malformations of the lymphatic system. They are usually located in the head, neck, and axilla and are typically present during the first two years of life. A few cases of inguinal lymphangioma have been reported in adults.

Case presentation

We report a 35-year-old male who presented with left groin swelling for a one-year duration associated with on and off pain. On examination, he had soft, irreducible left inguinal swelling with positive cough impulse and no tenderness on palpation. Ultrasound (US) and magnetic resonance imaging (MRI) were done for him, showing a well-defined lobulated cystic lesion located between subcutaneous and deep fascia measuring around 6.5 × 4.2 × 8.1 cm with multiple internal septations. The lesion shows Low signal intensity in the T1 weighted image and high signal intensity in the T2 weighted image. 97 % alcohol was injected under US guidance and aspirated after 30 min. The swelling significantly decreased in size clinically and radiologically during the follow-up.

Clinical discussion

Lymphangioma rarely occurs in the inguinal region, presenting a diagnostic challenge as it mimics various inguinal conditions. Differential diagnoses include inguinal hernia, hydrocele of the cord, lymphadenopathy, or hematoma. Imaging is used to determine the size, invasion, relation to surrounding structures, and extension to the abdominal cavity. MRI is the diagnostic modality of choice in non-emergency settings. Complete surgical excision is the gold standard for the management with the lowest risk of recurrence. Alternative non-surgical treatment options have been used successfully in poor surgical candidates. Different sclerosing agents have been used with low complications and rates of recurrence. Ethanol is a widely available sclerosing agent, and it was used with no recurrence or side effects during the follow-up period.

Conclusion

Surgeons should have a high index of suspicion when investigating any inguinal mass, considering such a rare presentation as part of the differential. Sclerotherapy is an effective treatment for lymphangioma and should be considered as an alternative modality in non-surgical candidates.

We present a 21yo female with a nausea, vomiting, and weight loss. Her history was remarkable for duodenal atresia repair as an infant. Following extensive evaluation, she was found to have progressive dilation of the proximal duodenum and loss of motility without obstruction (megaduodenum) which eventually lead to substantial weight loss resulting in superior mesenteric artery (SMA) syndrome. Given her symptomatic presentation, she was offered surgery and underwent a lateral duodenal tapering procedure and division of the ligament of Treitz and duodenal derotation (Strong procedure). Through the collaborative efforts of gastroenterology, pediatric surgery, radiology, and acute care surgery, she now has excellent functional status, has gained weight, and is asymptomatic. This case serves as an important example that congenital anomalies are a lifelong consideration when caring for patients

Introduction

Bariatric surgery is the most effective treatment for patients with obesity. Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. Although complication rate is low, thrombosis of the superior mesenteric vein (SMV) may be a rare but life-threatening complication after bariatric surgery.

Presentation of the case

A 33-year-old female patient, BMI 51.8 kg/m², underwent an uneventful LSG at our center for bariatric and metabolic surgery in Hannover, Germany. 70 mg enoxaparin once daily was given as prophylactic anticoagulation until discharge.

After an uneventful postoperative course and discharge at postoperative day 3, the patient presented 9 days later with epigastric and back pain in the emergency room. The CT scan showed thrombosis of the SMV.

After thrombectomy of the SMV, several abdominal washouts, creation of a laparostoma and highly complex treatment at the intensive care unit the patient was discharged 8 weeks after revisional surgery.

Discussion

The incidence of thrombosis of the SMV after bariatric surgery is low, but mortality is high (up to 50 %). In the literature, only case reports and small series are reported. Possible causes and the management of the disease are variable and depend on the patients´ situation.

Although thrombosis of the SMV is a rare complication after bariatric surgery, it should be considered or ruled out, if a patient presents with abdominal pain after a recently performed bariatric procedure. Treatment should be initiated immediately and may include therapeutic anticoagulation, interventional or surgical procedure.

Conclusion

Even if risk factors for thromboembolic events are unknown, every bariatric surgeon should be aware that patients with obesity are at risk.

In the past, surgeries to treat osteosarcoma involved amputation, but now they have become more conservative with prosthesis replacement. To reduce the incidence of complications, it is essential to consider suitable and adequate soft tissue cover. Our patients underwent surgery to resect osteosarcoma of the upper and lower head of the tibia and femur, respectively and were given knee joint prostheses. We chose the anterolateral thigh flap (ALT) as the suitable material to cover the defect and the prosthesis. All flaps were used for the surgery, two of which were fasciocutaneous, and the other two were musculocutaneous. All flaps had good blood supply, and no complications were reported. Conservative surgery for osteosarcoma has become increasingly popular, particularly for bone or joint replacement. The free ALT flaps offer many advantages when reconstructing the soft tissue defect and covering the prosthesis. The lower donor site morbidity of ALT free-flap makes it a more favorable choice for reconstruction after joint replacement.