Surgery Case Reports最新文献

Rationale/objectives

This case report aims to illustrate the methodology involved in the management of a patient with gastrointestinal tuberculosis with an open abdomen with direct peritoneal resuscitation. We present a 49-year-old malnourished male, in septic shock, who presented with mechanical intestinal obstruction from gastrointestinal tuberculosis (GITB) and required delayed abdominal closure. Direct peritoneal resuscitation (DPR) was employed as an adjunct to shorten the interval to closure by reducing organ edema and inflammatory cytokine levels.

Methods

This is a case report describing the procedure of direct peritoneal resuscitation and its use in non-trauma related surgeries requiring delayed abdominal closure.

Results

The patient recovered well from the surgery with the abdomen closed after nine days from the first procedure.

Conclusion

Direct peritoneal resuscitation is a viable adjunct in patients requiring delayed abdominal closure.

Vascular and biliary complications can still occur among liver transplants despite advances in surgical technique and immunosuppression. Rupture of a hepatic artery pseudoaneurysm is a rare but lethal complication after liver transplantation and often manifests as acute gastrointestinal bleeding. It occurs in < 3% of cases with an associated mortality as high as 50% especially if diagnosed late. A high index of suspicion may decrease consequent morbidities and potential graft loss. Infection and type of biliary anastomosis are commonly identified risk factors in the development of a pseudoaneurysm. Angiography usually identifies the location which is commonly at the site of anastomosis. Frequent management options include surgical revascularization requiring re-operation or endovascular intervention with the use of coils and stents. No consensus yet as to the standard treatment has been established. We present a case of a 40-year-old male having a ruptured hepatic artery pseudoaneurysm with an arteriobiliary fistula after performing a deceased donor liver transplant managed with endovascular placement of a stent. Patient remains asymptomatic with patent hepatic artery after 6 months of follow-up.

Managing rare thoracic liposarcomas, accounting for < 1% of soft tissue sarcomas, demands tailored strategies. We explore effective approaches, considering tumor attributes and innovative techniques, and compare NCCN-guided therapies and surgeries. Using PubMed, Embase, and Cochrane Library, we identified studies on thoracic liposarcomas. Data synthesis summarized findings, acknowledging rarity's evidence limitations. This study reports a successful resection of a rare thoracic soft tissue sarcoma. Overcoming challenges through innovative techniques like hyperthermic pleural lavage and Gore-Tex® reconstruction, it underscores neoadjuvant therapies and surgical precision. Thoracic liposarcoma management demands tailored multidisciplinary approaches. Neoadjuvant chemotherapy, surgery, and adjuvant therapies are fundamental. Surgical ingenuity, like extrapleural pneumonectomy and novel reconstructions, ensures thorough tumor removal with minimal complications. Hyperthermic pleural lavage and Gore-Tex® offer promising refinements. Successful outcomes highlight potential for improved prognoses. Further research will optimize strategies for this rare, aggressive cancer.

Post-Covid-19 cholangiopathy is a rare disease characterized by chronic cholestasis, that typically appears after resolution of the covid-19 virus infection. The pathophysiology is not fully understood, and prognosis in severe cases remains poor with liver transplantation remaining the only curative treatment option. We present two patients who developed post-covid-19 cholangiopathy after prolonged intensive care unit stay due to severe COVID-19 pneumonia. Both patients required invasive ventilation for more than a month. After adequate recovery from respiratory failure, the patients developed severe cholestatic jaundice and liver failure. The patients had not history of previous liver disease. Both patients underwent deceased liver transplantation 15 and 29 months after the initial COVID-19 diagnosis. One patient had good recovery and good liver function two years after LT and the other died in the fourth month after LT of disseminated infection and diffuse bleeding.

Background

Peritoneal dialysis for acute kidney injury is not typically a first-line option for mechanically ventilated patients in the intensive care unit. This series investigates the technical feasibility and clinical implications of bedside peritoneal dialysis catheter placement and utilization for mechanically ventilated COVID-19 patients.

Methods

Patient data was retrospectively collected on patient characteristics, hospital course, fluid balance, ventilatory mechanics and associated morbidity and mortality of qualifying patients at a single center from March to April of 2020. Peritoneal dialysis catheters were inserted at bedside in the ICU for use as the primary modality of renal replacement therapy. Ventilatory mechanics were obtained prior to catheter insertion and after the first dwell. Statistics were calculated using GraphPad Prism and Excel.

Results

Seven male ventilated patients ages 52–83 were included. They were primarily Hispanic (71.43%). Comorbidities included chronic kidney disease (14.29%), hypertension (57.14%), hyperlipidemia (42.86%), and diabetes (28.57%). There were no mortalities associated the procedure. All-cause mortality at the time of data collection was 42.8%. Two patients had delayed initiation of peritoneal dialysis due to bleeding. Ventilatory mechanics before and after the first dwell did not demonstrate a significant difference in required FiO₂, PEEP, tidal volumes or PaO₂ to FiO₂ ratios (p = 0.9172, p = 0.7398, p = 0.0924, p = 0.7227).

Discussion

Bedside placement of catheters was performed quickly and safely. Peritoneal dialysis was utilized for the treatment of acute kidney injury in mechanically ventilated patients with COVID-19 without significantly impacting respiratory mechanics. Peritoneal dialysis should be considered for similar ICU patients needing renal replacement therapy.

Colonic lipomas are a benign tumor that can present in multiple ways, including; incidentally, abdominal pain, change in bowel habit, bleeding, intestinal obstruction and intussusception. We present the case of a 48-year-old gentlemen who presented to the emergency department with a 3 day history of abdominal pain and was found to have a 5 cm intramural ischemic pedunculated colonic lipoma causing intussusception and large bowel obstruction. He received initial management with emergency laparoscopic exploration, reduction of intussusception, colotomy and lipoma excision. He made a full recovery. The current approaches to management of colonic lipomas are conservative, endoscopic or surgical. This case highlights the potential consequences of untreated colonic lipomas. In our review of the literature, we highlight that there is a lack of clear consensus on appropriate management of these patients.

Osteosarcoma is a classical malignant bone-forming neoplasm, characterised by osteoid synthesis by malignant osteoblasts. Osteosarcomas have an aggressive clinical course with a high mortality rate, despite their relatively low risk of distant metastases. The jaw bone is the most common site of occurrence in the head and neck region. These neoplasms often show characteristic clinical behaviours, varied radiological appearances, and a wide-ranging histological growth pattern. Early diagnosis and radical surgery, followed by radiotherapy and chemotherapy if required, have been the treatment of choice. This case report emphasises the importance of early diagnosis of this tumour based on clinical features, radiographic examination, and confirmation by histopathology. Confirmation of the final diagnosis of osteosarcoma often requires a histopathological examination of the multiple biopsy specimens. Adjuvant chemotherapy followed by radical surgery resulted in an excellent prognosis in the present case. Considering the rarity of the neoplasm, its fast progression, and its aggressiveness, the present case report would contribute to a better understanding of osteosarcomas involving the jaw bone and the management of the tumour involving the central arch of the mandible with involvement of the adjacent soft tissue structures.

Background

Mucormycosis is a severe fungal infection manifested mostly in immunocompromised hosts. Underlying causes for Mucormycosis include uncontrolled diabetes mellitus (DM), malignancies, chronic corticosteroid use, and organ transplant.

Case report

a 57-year-old Caucasian female, with insulin-dependent DM, presented to otolaryngology casualty complaining about a severe headache and nasal discharge. Clinical, laboratory, imaging, and histopathological investigations confirmed the diagnosis of Mucormycosis due to uncontrolled DM. Mucormycosis was managed pharmacologically, surgically, and by improving glycemic control. Psychological factors leading to non-adherence to insulin therapy were investigated and psychiatric evaluation and counseling were emphasized.

Practical implications

Healthcare providers should be aware of the signs, symptoms, and underlying causes of Mucormycosis and should manage it promptly. Mental health status should be part of the patient's evaluation and treatment plan.

Introduction

Laparoscopic sleeve gastrectomy (LSG) is a procedure that is being increasingly recommended. However, LSG can worsen gastroesophageal reflux disease (GERD) and cause vomiting, and consequently impact the quality of life (QOL) of patients. Abnormal motility of the sleeve gastric tube has been linked to the onset of GERD and vomiting. Hence, this study investigated the peristalsis of the sleeve gastric tube after LSG and its relationship with gastroesophageal reflux. There are only a few reports on the peristalsis of the sleeve gastric tube after LSG.

Methods

We measured the motility function of the sleeve gastric tube using high-resolution manometry (HRM) within 2–4 weeks after LSG. The manometry catheter was positioned in the antrum using fluoroscopy.

Results

This analysis included 18 patients. Postoperative HRM measurement of the sleeve gastric tube was characterized by the absence of gastric body peristalsis in at least 90% of swallows and contractions of the antrum. Furthermore, reverse peristalsis was observed from the pyloric antrum toward the stomach body although the frequency was low.

Conclusions

LSG was associated with characteristic of pressure and peristalsis in sleeve gastric tube. HRM was able to detect and visualize intragastric pressure and peristalsis of the sleeve gastric tube.

Objectives

The stapled suture is used to close the aortic stump during surgery for abdominal aortic infection. The current study aimed to investigate the short- and long-term outcomes of stapled closure of the aortic stump with axillo-bifemoral (AxBF) bypass grafting.

Methods

The short- and long-term outcomes of 11 patients who underwent surgery for abdominal aortic infection were retrospectively analyzed.

Results

Of 11 patients, 7 underwent stapled closure of the aortic stump with AxBF bypass grafting, and four underwent other reconstructive procedures with no aortic stump. Four patients (three who underwent stapled closure of the aortic stump and one who underwent other reconstructive procedures without the aortic stump) had operative death. However, none of the patients had aortic stump blow-out during the same hospitalization for surgery. The 1- and 5-year survival rates of the patients who underwent stapled closure of the aortic stump with AxBF bypass grafting were 57% and 29%, respectively. One patient developed aorto-duodenal fistula at 32 months after surgery. The patient survived for 12 months until bleeding in the recurrent aorto-enteric fistula occurred.

Conclusion

Stapled closure of the aortic stump is durable. The use of a linear stapler is a useful technique for reinforcing the aortic stump in patients who underwent excision of an infected abdominal aortic aneurysm or an infected abdominal graft.