Surgery Case Reports最新文献

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.

A 44-year-old patient was admitted with dyspnea and palpitation. Echocardiography revealed a very large (20 cm) mass in the left atrium. Emergency open-heart surgery was done. The most frequent primary heart tumor is myxoma. Their size varies greatly, and not much is known about how quickly they grow. The present case is unusual because of the size of the tumor (20 cm).

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.