Surgery Case Reports最新文献

Rationale/objective

This is a rare case of a 54-years-old man affected by chronic erosive sinusitis who developed a large frontal intracerebral hemorrhage after functional endoscopic sinus surgery (FESS). The patient underwent urgent surgical hemorrhage evacuation and anterior skull-base bone defect repair.

Methods

We analyzed the possible causes of this complication following FEES, focusing on anterior skull base bone erosion by chronic sinusitis, anterior ethmoidal artery injury and/or aneurysm, and direct frontal lobe trauma.

Results

The neurological outcome was good, and at three months follow-up, the patient showed only minor cognitive deficit and no cerebrospinal fluid leak.

Conclusion

During FESS, anatomical bone alteration of the anterior skull base such as in patients affected by chronic sinusitis, may increase the risk of severe complications such as intracerebral hemorrhage. A careful preoperative evaluation is mandatory.

Introduction

Urolithiasis in transplanted kidneys is a rare complication. The management of urolithiasis in transplant patients is similar to that in the general population.

Case presentation

A 51-year-old man with end-stage renal failure due to diabetic nephropathy underwent ABO-compatible living-donor kidney transplantation using his younger sister as a donor. The postoperative clinical course was uneventful and the function of the transplanted kidney was excellent during follow-up. In late May 2022, the patient visited our institution with fever, malaise, and oliguria. The function of the transplanted kidney had decreased, with a serum creatinine level of 6.39 mg/dL. Computed tomography demonstrated allograft hydronephrosis and allograft distal ureteral stone. The patient was diagnosed with acute renal failure due to allograft distal ureteral calculi. Moreover, calculous pyelonephritis was also observed. A percutaneous allograft nephrostomy was performed followed by a percutaneous ureteral lithotripsy in early June 2022. The patient underwent an antegrade disposable flexible ureteroscopy, holmium laser lithotripsy, and basket extraction. All stone fragments were surgically removed. After the successful treatment, the allograft kidneys functioned well.

Conclusion

Percutaneous laser lithotripsy was successfully performed without complications.

Simultaneous or synchronous Ewing sarcoma (ES) is the occurrence of multifocal lesions without pulmonary involvement. This is a very rare condition. We present a case of multifocal synchronous ES of the fibula with orbital involvement and adducens nerve palsy. A 17-year-old boy presented with pain and swelling in both legs for 6 weeks. He was unable to walk due to pain. He was pale and cachexic. There was proptosis and ptosis in the right eye. His investigations were consistent with a multifocal malignant tumor. There were lesions in the left fibula, tibia, right tibia, and right orbit. The histopathological diagnosis was Ewing sarcoma (ES). This is the first report of synchronous ES involving the orbit and abducens nerve.

When a retained surgical foreign body occurs, it poses significant risks to patients, potentially resulting in life-threatening complications. This paper presents the case report of dead body of a female of about 32 years of age brought for medicolegal post-mortem examination with a history of sudden death. Internal examinations revealed adhesion present around the right ovary, right fallopian tube, ceacum, omentum and large intestine with 100 ml free fluid in abdominal cavity. On careful blunt dissection of adhesion, a gauze piece was observed in the abdomen cavity that too is having firmly adherent to the surrounding organs. On removing it was of size 29 × 15 cm, yellowish - white in color. This underscores the need for continuous vigilance and adherence to established counting procedures throughout the surgical process to minimize the risk of such adverse events. Excellent communication among surgeons, nurses, and anesthetists during the procedure is key to success.

Background

Pituitary metastasis is a rare entity, with majority of the primary tumors reported from breast or lung origins. We present a case with pituitary metastasis as the first clinical presentation of underlying ovarian carcinoma.

Case

A 48-year-old female presented with visual disturbances and hyponatremic episodes. After management of her hyponatremia and resulting diabetes insipidus, detailed imaging was carried out which revealed a 35 mm x 35 mm x 20 mm (TS x CC x AP) pituitary mass, extending into the cavernous sinuses and suprasellar compartment, causing compression of the optic chiasma. Debulking was performed via the endoscopic trans-sphenoidal approach, and biopsy was consistent with metastatic high-grade ovarian serous carcinoma (WT1 + and estrogen receptor+). A CT chest-abdomen-pelvis revealed a 10 cm right ovarian mass with bilateral adrenal nodules. Postoperatively, patient developed CSF rhinorrhea and meningitis. Despite, reconstructive efforts, the patient continued to decline and was referred to palliation. She succumbed to her illness during her hospital admission.

Conclusion

Our case underscores the importance of considering pituitary metastasis when encountering DI or pituitary insufficiency in a middle-aged patient with a sellar mass.

Aortic valve replacement for severe symptomatic Aortic stenosis is a low-risk procedure, but when compounded with coexisting conditions, procedural risk may increase. We present the case of a middle-aged female patient presenting with a constellation of complexities, including oblique sternum, severe dextroscoliosis, severe symptomatic aortic stenosis with bicuspid aortic valve, aortic root distortion, and a relatively rare blood group. Despite multiple problems, she underwent successful surgical aortic valve replacement. This case highlights the importance of a multidisciplinary approach in complex cardiac patients with the utmost need for a heart team concept for patient-centric decision-making.

Mammary Paget’s disease is a rare form of breast cancer that presents a unique challenge to surgeons for patients who opt for breast-conserving surgery. Due to oncoplastic techniques, the options for breast-conserving surgery have diversified and allow for improved cosmetic outcomes. We present a 68-year-old lady with Mammary Paget’s disease who underwent a modified lateral intercostal artery perforator flap with a skin paddle to reconstruct the new areolar region. With this technique, we achieved complete oncological resection with excellent cosmetic outcome.

We present a rare case of rectal duplication cyst (RDC) in an adult patient who presented with chronic fluctuating bowel habits and rectal bleeding. A faecal immunochemical test (FIT) and a faecal Calprotectin level showed negative results, and no previous abdomen-pelvis CT scan or MRI was identified. A Colonoscopy was performed, showing a benign rectal lesion causing colonic intraluminal compression leading to rectal ulceration and prolapse, and solitary rectal ulcer syndrome was suspected. A Transanal Minimally Invasive surgery (TAMIS) was performed to excise the lesion, with histopathology findings consistent with a rectal duplication cyst. The patient had no intraoperative complications and made an uneventful recovery. A systematic literature review showed 30 30 adult Rectal supplication cyst case reports. In conclusion, The most common presentation of RDC is anal pain and rectal bleeding. The diagnosis of RDC is challenging, and it requires Surgical resection to confirm the diagnosis.

Heterotopic renal transplant is a well-established technique providing reachable access to the iliac vessels and urinary bladder. Rarely though, surgeons may encounter patients with focal or diffuse vascular thrombosis which would require additional technical maneuvers to overcome such obstruction and prevent catastrophic complications. We present a case of a 43-year-old female with complete iliocaval thrombosis prior to transplant precluding a retroperitoneal approach wherein we used a long segment of synthetic graft as a bridge between the graft renal vein and infrahepatic vena cava. The graft had immediate function and follow-up ultrasound demonstrated patent vasculature. This case highlights the value of preoperative imaging and being surgically prepared for nontraditional sites of vascular anastomosis. Selection of venous drainage in such cases should provide adequate venous outflow minimizing the risk of thrombosis and subsequent graft failure.

The auricle represents a complex anatomical region. Over the years, various techniques have been proposed for the reconstruction of different anatomical regions of the auricle. Defects in the upper third of the ear less than 3 cm wide can be reconstructed with superior and inferior pedicle flaps harvested from the postauricular region.

In our Plastic Surgery department we have treated a patient with a 3.5 cm wide squamous cell carcinoma involving all the upper third of the pinna excluding helix. The patient had many comorbidities and asked for a safe reconstruction with low risk of local complications and the possibility to use glasses. For this reason we excluded the option of a superior de-epithelized pedicled post auricular flap that has got a high risk of venous congestion for defects more than 3 cm wide and performed a wide post auricular island flap with subcutaneous pedicle.

At the seven-day follow-up, there was an absence of signs of venous congestion. At the six months follow-up, the patient reported satisfaction with the result and had no issues wearing glasses. Post auricular island flap with subcutaneous pedicle can be considered as an alternative in case of auricle upper third defects more than 3 cm wide.