Surgery Case Reports最新文献

英文中文

Chronic osteomyelitis due to retained war-time shrapnel after 16 years: Case report 16年后遗留战争弹片导致慢性骨髓炎：病例报告

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-04-17 DOI: 10.1016/j.sycrs.2025.100111

Madhawa Sasanka Rathnaweera , Kasun Bandara Ekanayake , Sunanda Udagedara

Shrapnel, commonly associated with war-related trauma, is often retained without surgical removal due to its inert nature. However, these retained foreign bodies pose a risk of long-term complications, including chronic osteomyelitis (COM). This case report presents a rare instance of COM caused by retained shrapnel 16 years after a combat injury sustained during the Sri Lankan Civil War. A 55-year-old former soldier presented with fever, right thigh pain, and swelling. He had suffered a right femoral shaft open fracture in a mortar artillery blast in 2008, which was treated with intramedullary nailing. The implant was removed the following year due to infection. Imaging revealed multiple shrapnel fragments and osteomyelitic changes in the right distal femur, with one metal fragment causing erosion of the anterior cortex of the femur. The culture of an abscess of the right anterior thigh yielded methicillin-resistant Staphylococcus aureus, sensitive to vancomycin. The patient underwent abscess drainage, surgical retrieval of some shrapnel, and a 6-week course of oral linezolid. Although retained shrapnel is generally inert, its potential to cause COM necessitates a high index of suspicion. Timely imaging, microbiological cultures, and appropriate surgical and antibiotic management are critical in preventing severe long-term complications.

弹片通常与战争创伤有关，由于其惰性性质，通常无需手术切除即可保留。然而，这些残留的异物会带来长期并发症的风险，包括慢性骨髓炎（COM）。本病例报告提出了一个罕见的病例，在斯里兰卡内战期间遭受战斗伤害16年后，由残留的弹片引起的COM。55岁退伍军人，表现为发烧，右大腿疼痛和肿胀。2008年，他在一次迫击炮爆炸中右股骨干开放性骨折，接受了髓内钉治疗。第二年，由于感染，植入物被取出。影像学显示右侧股骨远端多发弹片碎片和骨髓炎改变，其中一块金属碎片导致股骨前皮质糜烂。右大腿前脓肿培养产生耐甲氧西林金黄色葡萄球菌，对万古霉素敏感。患者接受了脓肿引流，手术取出部分弹片，并口服利奈唑胺6周。虽然保留的弹片通常是惰性的，但其潜在的造成COM的可能性需要高度的怀疑。及时的影像学检查、微生物培养以及适当的手术和抗生素管理对于预防严重的长期并发症至关重要。

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引用次数: 0

Internal hernia through the foramen of Winslow 温斯洛孔内疝

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-03-31 DOI: 10.1016/j.sycrs.2025.100101

Rebecca L. Schwartz, Jessica E. Taylor

Introduction

Internal hernias through the foramen of Winslow are a rare pathology.

Case presentation

We present the case of a patient with a strangulated cecum and terminal ileum secondary to an internal hernia through the foramen of Winslow into the lesser sac.

Conclusion

Foramen of Winslow hernias are an uncommon cause of internal hernias and may be misinterpreted or not clearly delineated on imaging; prompt operative exploration is indicated.

通过温斯洛孔的内部疝是一种罕见的病理。病例介绍：我们报告一例患者的盲肠绞窄和回肠末端继发于通过温斯洛孔进入小囊的内部疝。结论Winslow疝孔是一种少见的内疝原因，在影像学上容易被误解或描述不清；提示及时手术探查。

引用次数: 0

Thoracic surgical approach for retrosternal ectopic thyroid tissue after cervical total thyroidectomy: Case Report and Review of literature. 宫颈甲状腺全切除术后胸骨后异位甲状腺组织的胸外科入路：病例报告及文献复习。

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-04-09 DOI: 10.1016/j.sycrs.2025.100108

Chiara Scorziello , Maria Carola Borcea , Marco Biffoni , Giuseppe De Ruggeri , Alessia Galvano , Eva Iannuzzi , Rossella Melcarne , Luca Ventrone , Cosimo Durante , Fabrizio Consorti , Tiziano De Giacomo , Laura Giacomelli

Thyroidal organogenesis is controlled by specific transcription factors; alterations in their ex-pression can cause developmental abnormalities like ectopia of the gland. Ectopic thyroid tissue can be found anywhere along the line of the obliterated thyroglossal duct, from the tongue to the diaphragm. The thoracic cavity is the most common non-cervical location. We describe the case report of a "forgotten goiter", a retrosternal ectopic thyroid tissue, detected after a cervical total thyroidectomy. Due to the size of the lesion, anatomical localization, and presence of calcifications, the patient underwent a complete surgical resection of the mass via sternotomy. The histological examination showed benign mediastinal ectopic thyroid tissue. The postoperative course was uneventful and without complications. Any surgical initiative in patients with retrosternal ectopic thyroid tissue must be individualized and based upon the size of the goiter, the characteristics of the mediastinal goiter and its anatomical relationships, the risk of complications and reoperations, the experience of the surgeon, the comorbidities of the patient, and the trajectory of growth in active surveillance. To date, there is no universal consensus on the best surgical approach.

甲状腺器官发生受特异性转录因子控制；它们表达的改变会导致发育异常，如腺体异位。异位甲状腺组织可以在从舌头到横膈膜的甲状舌导管沿线的任何地方发现。胸腔是最常见的非颈椎部位。我们描述了一个“遗忘甲状腺肿”的病例报告，一个胸骨后异位甲状腺组织，检测后宫颈甲状腺全切除术。由于病变的大小、解剖定位和钙化的存在，患者通过胸骨切开术对肿块进行了完整的手术切除。组织学检查显示良性纵隔异位甲状腺组织。术后过程平稳，无并发症。胸骨后甲状腺组织异位患者的任何手术计划都必须个体化，并基于甲状腺肿大的大小、纵隔甲状腺肿大的特征及其解剖关系、并发症和再手术的风险、外科医生的经验、患者的合并症以及主动监测的生长轨迹。到目前为止，对于最佳的手术方法还没有普遍的共识。

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引用次数: 0

Ovarian sex cord-stromal tumor: A case report and review of literature 卵巢性索间质瘤1例报告及文献复习

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-04-09 DOI: 10.1016/j.sycrs.2025.100107

Soukayna Bourabaa , Mohamed Taimi , Doaa Riali , Hajar Kandoussi , Youssef Mahdi , Basma El Khannoussi , Hatim Essaber , Rachida Latib , Fouad Tijami , Hafid Hachi , Nezha Elbahaoui

Ovarian sex cord-stromal tumors are rare neoplasms, constituting approximately 7 % of all primary ovarian tumors. They are categorized into three main types: pure sex cord tumors, pure stromal tumors, and mixed sex cord stromal tumors. Among these, adult granulosa cell tumors are the most prevalent malignant variant. Unlike the more common ovarian epithelial cancers, sex cord stromal tumors often present in younger patients and are typically diagnosed at earlier stages, generally leading to more favorable outcomes. However, these tumors have the potential for late recurrence, with some cases reappearing up to 30 years after initial treatment. Although most sex cord stromal tumors exhibit indolent growth patterns, a subset can exhibit more aggressive behavior. This article presents a case of a 71-year-old native Moroccan woman who presented with abdominal pain and metrorrhagia and was found to have a 15 cm solid ovarian mass.

卵巢性索间质瘤是一种罕见的肿瘤，约占所有原发性卵巢肿瘤的7. %。它们主要分为三种类型：纯性索瘤、纯间质瘤和混合性索间质瘤。其中，成人颗粒细胞瘤是最常见的恶性变异。与更常见的卵巢上皮癌不同，性索间质瘤通常出现在年轻患者中，通常在早期阶段被诊断出来，通常会导致更有利的结果。然而，这些肿瘤有可能晚期复发，一些病例在最初治疗后30年再次出现。虽然大多数性索间质肿瘤表现为惰性生长模式，但有一部分肿瘤可能表现出更具侵略性的行为。这篇文章提出了一个71岁的摩洛哥土著妇女谁提出腹痛和子宫出血，并被发现有一个15厘米实心卵巢肿块。

引用次数: 0

Successful removal of a penetrating fish hook eye injury via modified advance-and-cut technique 通过改进的先进和切割技术成功去除穿透性鱼钩眼损伤

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-06-02 DOI: 10.1016/j.sycrs.2025.100125

Ahmet Kaan Şimşek, Ayça Küpeli Çınar, Abdulkadir Can Çınar, Ahmet Kürşad Sakallıoğlu, Rüveyde Garip, Hande Güçlü

Barbed fish hook injuries to the eye are rare but can be serious, especially in children. We report the case of a 10-year-old boy who sustained a penetrating eye injury from a barbed hook. The hook entered the outer edge of his cornea, passed through the iridocorneal angle, and exited the sclera 5 mm from the limbus. On arrival, his best-corrected visual acuity was 0.8(Snellen decimal). Under general anesthesia, a modified advance-and-cut technique was used to remove the hook by guiding the barb through the scleral exit site, avoiding intraocular damage. The corneal and scleral wounds were sutured, and a bandage contact lens was applied to support healing. His recovery was smooth, and his vision improved to 1.0 ten days after suture removal, seven months post-injury. This case shows how a thoughtful surgical approach can effectively treat complex ocular injuries in children and highlights the importance of timely and precise intervention.

有刺的鱼钩伤到眼睛是罕见的，但可能很严重，特别是在儿童中。我们报告的情况下，一个10岁的男孩谁持续刺眼伤从一个有刺的钩子。钩入角膜外缘，穿过虹膜角，离角膜缘5 毫米出巩膜。到达时，他的最佳矫正视力为0.8（Snellen十进制）。在全身麻醉下，采用改良的推进-切割技术，通过引导倒钩穿过巩膜出口来去除钩，避免眼内损伤。缝合角膜和巩膜伤口，并使用绷带隐形眼镜支持愈合。术后7个月，术后10天视力恢复至1.0。本病例显示了一个深思熟虑的手术方法如何有效地治疗儿童复杂的眼部损伤，并强调了及时和精确干预的重要性。

引用次数: 0

A case report on malignant peripheral nerve sheath tumor of vagus nerve: A diagnostic challenge 迷走神经周围神经鞘恶性肿瘤1例：诊断上的挑战

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-04-07 DOI: 10.1016/j.sycrs.2025.100103

Muhammad Farhan , Abdur Rehman , Zainab Zahoor Butt , Anique Ahmad Jamil , Imran Khan , Muhammad Shuaib Khan , Arham Ihtesham , Shahzaib Maqbool , Sudhair Alam

Malignant Peripheral Nerve Sheath Tumor (MPNST) is a rare, aggressive neoplasm with an incidence of 0.001 % and a poor prognosis. Diagnosis is particularly challenging due to its nonspecific clinical, histopathological, and radiological features, often leading to misclassification as a benign lesion. We present the case of a 24-year-old male with a progressively enlarging left-sided neck mass, accompanied by hoarseness, dysphagia, and headaches. Imaging suggested a benign peripheral nerve sheath tumor, such as a schwannoma, and an incisional biopsy further supported this impression. However, the final excisional biopsy unexpectedly confirmed MPNST of the vagus nerve. This highlights the limitations of current diagnostic techniques in distinguishing MPNST from benign mimics and underscores the critical need for a multimodal diagnostic approach, integrating advanced imaging techniques and immunohistochemistry, to improve early and accurate detection of MPNST. Given the tumor’s aggressive nature and high risk of recurrence, early identification is essential for optimizing treatment outcomes.

恶性周围神经鞘瘤是一种罕见的侵袭性肿瘤，发病率为0.001 %，预后较差。由于其非特异性的临床、组织病理学和放射学特征，诊断尤其具有挑战性，经常导致误诊为良性病变。我们报告一个24岁男性的病例，其左侧颈部肿块逐渐增大，并伴有声音嘶哑、吞咽困难和头痛。影像学提示为良性周围神经鞘肿瘤，如神经鞘瘤，切口活检进一步支持这种印象。然而，最终的切除活检却意外地证实了迷走神经的MPNST。这突出了当前诊断技术在区分MPNST和良性模拟方面的局限性，并强调了多模式诊断方法的迫切需要，将先进的成像技术和免疫组织化学相结合，以提高MPNST的早期和准确检测。鉴于肿瘤的侵袭性和高复发风险，早期识别对于优化治疗效果至关重要。

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引用次数: 0

Breast abscess with intrathoracic communication 伴有胸腔内沟通的乳腺脓肿

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-03-27 DOI: 10.1016/j.sycrs.2025.100098

Hannah Dunlop, Simon Mbarushimana, Kevin Etherson, Palanivelraju Gopalakrishnan

We present a rare case of a breast abscess communicating with the thoracic cavity. This was discovered intra-operatively during incision and drainage of the abscess by the general surgery on-call team because of raised inflammatory markers and pyrexia. A chest x-ray was obtained intra-operatively and chest drain inserted, before transfer to cardiothoracics. The patient was subsequently discharged with no further interventions but failed to attend breast care services for follow up. This case highlights the importance of referring all breast abscesses to acute secondary care for assessment and immediate intervention if required. Onward referral to breast outpatient clinic is only appropriate in patients who are clinically well. It also raises the question of whether further imaging should be undertaken in high-risk patients before surgical intervention of acute breast abscesses. While breast abscesses are typically managed successfully in outpatient settings, rare complications, such as intra-thoracic extension into the intrapleural space, can occur. Irrespective of the underlying aetiology, this case report highlights the importance of considering rare complications in the management of breast abscesses, particularly in patients with a history of systemic upset and atypical symptoms. Prompt diagnosis, interdisciplinary collaboration, and timely surgical intervention are crucial in achieving successful outcomes in such challenging scenarios. Further studies and reports on similar cases will contribute to a better understanding of this rare complication and aid in optimising treatment strategies.

我们介绍了一例罕见的乳腺脓肿与胸腔相通的病例。由于炎症指标升高和发热，普外科值班团队在术中切开并引流脓肿时发现了这一情况。术中进行了胸部 X 光检查，并插入胸腔引流管，然后转至心胸科。患者随后出院，没有接受进一步干预，但没有到乳腺护理服务机构接受随访。该病例强调了将所有乳腺脓肿转诊至急诊二级医疗机构进行评估并在必要时立即进行干预的重要性。只有临床状况良好的患者才适合转诊至乳腺门诊。这也提出了一个问题：在对急性乳腺脓肿进行手术治疗前，是否应对高危患者进行进一步的影像学检查。虽然乳腺脓肿通常都能在门诊得到成功治疗，但也会出现罕见的并发症，如胸腔内扩展到胸膜腔内。无论病因如何，本病例报告强调了在治疗乳腺脓肿时考虑罕见并发症的重要性，尤其是对于有全身不适史和非典型症状的患者。在这种具有挑战性的情况下，及时诊断、跨学科合作和及时手术干预是取得成功结果的关键。对类似病例的进一步研究和报告将有助于更好地了解这种罕见的并发症，并有助于优化治疗策略。

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引用次数: 0

Frontal bone resorption after craniofacial reconstruction: Post-surgical complication 颅面重建后额骨吸收：术后并发症

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-05-31 DOI: 10.1016/j.sycrs.2025.100126

Raissa Dias Fares , Jonathan Ribeiro da Silva , Sylvio Luiz Costa De-Moraes

Complex facial fractures are still a challenge for maxillofacial surgeons around the world. This type of surgery requires the actuation of more than one specialty in the surgical center and is frequently associated with brain injuries. This article aims to present a case report of frontal bone resorption in an 18-year-old patient after neurosurgical and maxillofacial approaches involving craniotomy, use of frontal pericranium flap for treatment of anterior cranial fossa fracture, dura mater repair, cranialization, and open reduction and internal fixation. After 5 months of follow-up, the patient began to experience drainage in the right supraorbital rim. At that time, no cerebrospinal fluid was present, and the patient was referred for a second surgical approach to remove the osteosynthesis material. Frontal bone resorption is an infrequently reported complication. The frontal craniotomy combined with the frontal pericranium flap to seal the anterior cranial fossa possibly contributed to the resorption of the frontal bone. The combination of skeletal fixation and the lack of coverage of the frontal bone in the cranio-maxillofacial reconstruction sequence requires better evaluation from the vascular-periosteal point of view, since the loss of contour due to bone resorption generates a stigmatizing deformity for patients.

复杂的面部骨折仍然是世界各地颌面外科医生面临的挑战。这种类型的手术需要在外科中心的多个专业进行，并且经常与脑损伤有关。本文报告一位18岁的患者，经神经外科及颌面入路，包括开颅、使用额骨包瓣治疗前颅窝骨折、硬脑膜修复、开颅、切开复位内固定后出现额骨吸收的病例。随访5个月后，患者开始出现右侧眶上缘引流。当时，没有脑脊液出现，患者被转介进行第二次手术切除骨合成材料。额骨吸收是一种罕见的并发症。额骨开颅联合额骨包瓣封闭前颅窝可能有助于额骨的吸收。在颅颌面重建序列中，骨骼固定和额骨覆盖缺失的结合需要从血管-骨膜的角度进行更好的评估，因为骨吸收导致的轮廓丧失会给患者带来耻辱性畸形。

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引用次数: 0

Endovascular aneurysm repair for abdominal aortic aneurysm: Overcoming anatomical challenges related to horseshoe kidney 腹主动脉瘤的血管内修复：克服与马蹄肾相关的解剖学难题

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-04-10 DOI: 10.1016/j.sycrs.2025.100106

Siong Teng Saw, Mei Fong Tang, Feona Sibangun Joseph, Benjamin Dak Keung Leong

A 70-year-old high-risk male with an asymptomatic 64 mm infrarenal abdominal aortic aneurysm (AAA) and an Eisendrath Type IV horseshoe kidney (HSK) underwent endovascular aneurysm repair (EVAR). Preoperative computed tomography angiography (CTA) revealed accessory renal arteries (ARAs) originating from the iliac arteries and aneurysm sac, necessitating selective preservation. EVAR successfully excluded the aneurysm while maintaining perfusion through a right common iliac artery-derived ARA supplying the renal isthmus. Smaller ARAs (<3 mm) were excluded to reduce endoleak risk. Postoperative imaging confirmed aneurysm exclusion without endoleak, though asymptomatic isthmus infarction occurred due to occlusion of a left iliac ARA. Renal function remained stable at three-year follow-up (2022–2025). This case supports EVAR as a feasible option for complex AAA-HSK anatomy, emphasizing meticulous preoperative planning and selective vessel preservation to balance aneurysm exclusion and renal perfusion. Individualized strategies are critical in anatomically challenging scenarios.

一例无症状64 mm肾下主动脉瘤（AAA）和Eisendrath IV型马蹄肾（HSK）的70岁高危男性患者行血管内动脉瘤修复术（EVAR）。术前计算机断层血管造影（CTA）显示副肾动脉（ARAs）起源于髂动脉和动脉瘤囊，需要选择性保存。EVAR成功地排除了动脉瘤，同时通过供应肾峡的右髂总动脉源性ARA维持灌注。较小的ara （<3 mm）被排除在外以降低内漏风险。术后影像学证实动脉瘤排除无内漏，尽管由于左髂ARA闭塞发生无症状峡部梗死。随访3年（2022-2025），肾功能保持稳定。本病例支持EVAR作为复杂AAA-HSK解剖的可行选择，强调细致的术前计划和选择性血管保存以平衡动脉瘤排除和肾脏灌注。个性化策略在解剖学上具有挑战性的情况下至关重要。

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引用次数: 0

Splenic abscess secondary to pyelonephritis in a diabetic patient: A rare cause of acute abdomen requiring emergency surgery 糖尿病患者继发于肾盂肾炎的脾脓肿：一个罕见的急腹症需要紧急手术的原因

Surgery Case Reports

Pub Date : 2025-07-01 Epub Date: 2025-05-31 DOI: 10.1016/j.sycrs.2025.100124

Grecia Fernanda Hurtado-Miranda , Ana Guadalupe Rodríguez-Aguirre , Dafne Alejandra Torres-Torres , Alan Antonio Leija-Torres

Splenic abscess is a rare but life-threatening condition, often presenting with nonspecific symptoms and occurring more frequently in immunocompromised patients. We report the case of a 68-year-old male with poorly controlled type 2 diabetes mellitus who presented with persistent abdominal pain and fever. Initial imaging suggested a renal mass and urinary tract infection; however, his condition deteriorated, and repeat imaging revealed a large splenic abscess with peritonitis. Emergency open laparotomy was performed due to extensive splenic involvement and septic presentation. Intraoperatively, a ruptured splenic abscess with 80 % parenchymal lysis and 1000 cc of purulent fluid was found. Partial splenic preservation and surgical drainage were achieved. Postoperative imaging confirmed residual abscess cavities, but the patient improved clinically and was discharged for follow-up. This case illustrates the diagnostic and therapeutic challenges of splenic abscess, particularly in diabetic patients. It emphasizes the importance of maintaining suspicion for intra-abdominal infections in immunocompromised hosts, even when initial symptoms suggest a urinary source. Timely imaging, multidisciplinary management, and individualized surgical decisions are crucial for improving outcomes. Open surgery remains a valid treatment option when minimally invasive approaches present a significant risk. This report underscores the need for early recognition and aggressive intervention in complex intra-abdominal infections, especially in patients with multiple risk factors.

脾脓肿是一种罕见但危及生命的疾病，通常表现为非特异性症状，更常见于免疫功能低下的患者。我们报告一例68岁男性2型糖尿病控制不佳，表现为持续腹痛和发烧。初步影像学提示肾肿块和尿路感染；然而，他的病情恶化，反复成像显示一个大的脾脓肿并腹膜炎。由于脾脏广泛受累及脓毒性表现，急诊开腹手术。术中发现脾脓肿破裂，实质溶解80% %，化脓液1000毫升。部分脾保留和手术引流得以实现。术后影像学证实脓肿腔残留，但患者临床好转，出院随访。这个病例说明了脾脓肿的诊断和治疗的挑战，特别是在糖尿病患者。它强调了在免疫功能低下的宿主中保持对腹腔感染的怀疑的重要性，即使最初的症状表明是泌尿源。及时成像、多学科管理和个性化手术决策是改善预后的关键。当微创入路存在显著风险时，开放手术仍然是一种有效的治疗选择。本报告强调了对复杂腹腔内感染的早期识别和积极干预的必要性，特别是对具有多种危险因素的患者。

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引用次数: 0

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