Surgery Case Reports最新文献

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.

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.