Surgery Case Reports最新文献

英文中文

Spontaneous Transanal Small Bowel Prolapse in a Young Patient 自发性经肛门小肠脱垂一例年轻患者

Surgery Case Reports

Pub Date : 2025-04-06 DOI: 10.1016/j.sycrs.2025.100094

Rashed W. Alweshah , Mustafa Abdo , Ahmed Salah , Shaimaa Moustafa , Ahmed Nagi

Transanal small bowel evisceration is an exceedingly rare and life-threatening condition, predominantly affecting elderly patients with chronic rectal prolapse or pelvic floor dysfunction. However, this case report presents an unusual occurrence in a 30-year-old woman with no prior history of rectal prolapse, anorectal surgery, or other predisposing factors. She arrived at the emergency department with a visible small bowel prolapse through the anus, initially mistaking it for hemorrhoids. Emergent laparotomy was performed, involving the reduction of the prolapsed small bowel through a rectal defect, resection of ischemic segments, and primary anastomosis. A temporary diverting sigmoidostomy was created to protect the rectal repair. The patient had an uneventful recovery and was discharged on postoperative day six. We discuss pathophysiology, clinical presentation, and management strategies, emphasizing the role of fecal diversion in optimizing patient outcomes.

经肛门小肠拔出是一种非常罕见且危及生命的疾病，主要发生在慢性直肠脱垂或盆底功能障碍的老年患者中。然而，本病例报告提出了一个不寻常的发生在一个30岁的妇女，以前没有直肠脱垂的历史，肛门直肠手术，或其他易感因素。她来到急诊科时，发现肛门有明显的小肠脱垂，一开始还误以为是痔疮。我们进行了紧急剖腹手术，包括通过直肠缺损复位脱垂的小肠，切除缺血节段，并进行初级吻合。临时乙状结肠造口术以保护直肠修复。患者顺利康复，于术后第6天出院。我们讨论病理生理学，临床表现和管理策略，强调粪便转移在优化患者结果中的作用。

引用次数: 0

Intraductal papillary neoplasm of the bile duct in the middle east: Case report 中东胆管导管内乳头状肿瘤1例

Surgery Case Reports

Pub Date : 2025-04-06 DOI: 10.1016/j.sycrs.2025.100099

Khaled Demyati , Orabi Hajjeh , Amr Khaled , Usama Al Khuffash , Fathi Milhem , Ameer Awashra , Hanood Abu Rass

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare premalignant tumor characterized by papillary growth within the bile ducts, predominantly reported in East Asia. We present a 64-year-old male diagnosed with IPNB with focal stromal invasion, managed successfully with surgical resection. The case highlights unique endoscopic, imaging, and histopathological findings, and provides valuable data describing the unusual presentation of the case and the challenges faced in making the diagnosis. To our knowledge, this is the first reported case from the Middle East, emphasizing the rarity of IPNB in the region. This report underscores the importance of early diagnosis, proper imaging, and clear resection margins for optimal outcomes.

胆管内乳头状肿瘤（IPNB）是一种罕见的以胆管内乳头状生长为特征的癌前肿瘤，主要在东亚报道。我们报告一位64岁男性确诊为IPNB伴局灶性间质浸润，手术切除成功。该病例突出了独特的内窥镜、影像学和组织病理学发现，并提供了有价值的数据，描述了该病例的不寻常表现和做出诊断所面临的挑战。据我们所知，这是中东报告的首例病例，强调了IPNB在该地区的罕见性。本报告强调了早期诊断，正确的影像学检查和明确切除边缘的重要性，以获得最佳结果。

引用次数: 0

Chondromyxoid fibroma in the oro-facial region: A case report 口腔-面部软骨粘液样纤维瘤1例报告

Surgery Case Reports

Pub Date : 2025-04-05 DOI: 10.1016/j.sycrs.2025.100100

H.M. Shahriar Rubel , Mustari Nailah Tabassum , Sadia Sultana Imla , Arpita Biswangree , Esrat Jahan

Chondromyxoid Fibroma (CMF) is an uncommon, slow-growing benign chondroblast tumour with hypocellular or chondromyxoid tissue and multinucleated cells. Similar pathologies to aggressive tumours, such as chondrosarcoma, make CMFs harder to identify. This lesion may cause painful swelling or enlargement for weeks or years or may be identified accidentally during radiological scanning. A 24-year-old girl was diagnosed with CMF affecting the right upper jaw. She came with a developing mass, periodic swelling discomfort, facial asymmetry, and the H/O of surgery at the same region 5 years earlier. The patient had a right-sided Class Ⅲ Maxillectomy performed under General Anaesthesia. There were no immediate post-operative problems however, delayed issues occurred. Chondromyxoid fibroma is uncommon and has various sites, making diagnosis difficult and often exclusionary. However, it has a good prognosis with a recurrence rate of up to 80 % in curettage-only patients and a 2 % chance of malignant transformation. This example emphasizes the importance of a thorough clinical examination and histological comparison of CMFs with comparable lesions for optimal therapy. As shown in our case timely intervention can improve results and quality of life for affected cases.

软骨黏液样纤维瘤（CMF）是一种罕见的、生长缓慢的良性成软骨细胞肿瘤，伴有低细胞或软骨黏液样组织和多核细胞。与侵袭性肿瘤（如软骨肉瘤）相似的病理使CMFs更难识别。这种病变可能会引起疼痛的肿胀或扩大，持续数周或数年，也可能在放射扫描中偶然发现。一名24岁的女孩被诊断患有右上颌骨的CMF。她出现肿块发展，周期性肿胀不适，面部不对称，5年前同一区域手术的H/O。患者在全身麻醉下行右侧ClassⅢ上颌切除术。没有立即出现术后问题，但出现了延迟性问题。软骨粘液样纤维瘤是罕见的，有不同的部位，使诊断困难，往往排他性。然而，它具有良好的预后，在仅刮除的患者中复发率高达80% %，恶性转化的几率为2% %。这个例子强调了彻底的临床检查和CMFs与同类病变的组织学比较对于最佳治疗的重要性。正如我们的病例所示，及时干预可以改善受影响病例的结果和生活质量。

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引用次数: 0

Surgical excision of a lobular capillary hemangioma of the upper lip after percutaneous embolization: A case report 经皮栓塞后手术切除上唇小叶毛细血管瘤1例

Surgery Case Reports

Pub Date : 2025-04-01 DOI: 10.1016/j.sycrs.2025.100096

Paolo Appendino , Luca Guaschino , Marta Bezzi , Luciano Mosso , Ernesto Scatà

A 22-year-old male presented with a nodular subcutaneous lesion on the left upper lip. Ultrasound examination of the superficial tissues (Ecography) revealed a heterogeneously hyperechoic formation with small-caliber, high-flow vessels embedded in a probable adipose component. The suspected diagnosis was a hemangiomatous neoplasm. Given the lesion’s vascular nature and its location in a highly delicate area, a percutaneous embolization was performed prior to surgical excision to reduce intraoperative bleeding risk. Surgery was subsequently carried out without complications. Post-operative istopathological analysis confirmed the diagnosis of lobular capillary hemangioma (LCH), a benign vascular tumor that primarily affects the skin and mucous membranes. LCH is often associated with local trauma and is characterized by rapid growth, which may raise suspicion for malignancy. While surgical excision remains the definitive treatment, the vascular nature of the lesion poses a risk of significant hemorrhage, particularly in highly vascularized regions such as the face and oral cavity. This case highlights the importance of preoperative embolization as a valuable adjunct in the surgical management of LCH. By reducing blood flow to the lesion, embolization minimizes intraoperative bleeding, facilitates complete excision, and improves surgical outcomes. The use of this technique is particularly advantageous in challenging anatomical sites where excessive bleeding could complicate the procedure. Further studies are warranted to explore the broader applicability of embolization in the treatment of vascular tumors in sensitive regions.

一个22岁的男性提出了一个结节皮下病变在左上唇。浅表组织超声检查（Ecography）显示不均匀的高回声形成，小口径、高流量血管嵌入可能的脂肪成分。怀疑诊断为血管瘤性肿瘤。鉴于病变的血管性质及其位于高度脆弱的区域，在手术切除之前进行经皮栓塞以减少术中出血的风险。手术随后进行，无并发症。术后病理分析证实诊断为小叶毛细血管瘤（LCH），一种主要影响皮肤和粘膜的良性血管肿瘤。LCH通常与局部创伤有关，其特点是生长迅速，这可能引起对恶性肿瘤的怀疑。虽然手术切除仍然是最终的治疗方法，但病变的血管性质带来了严重出血的风险，特别是在高度血管化的区域，如面部和口腔。这个病例强调了术前栓塞作为LCH手术治疗中有价值的辅助手段的重要性。通过减少流向病变的血流量，栓塞可以最大限度地减少术中出血，促进完全切除，改善手术效果。使用这种技术是特别有利的挑战解剖部位，过多的出血可能使程序复杂化。栓塞治疗敏感部位血管肿瘤的适用性有待进一步研究。

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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 : 2025-03-31 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

Anterior chest wall Dermatofibrosarcoma protuberans extension to the anterior mediastinum: Case report 前胸壁皮肤纤维肉瘤隆突延伸至前纵隔1例

Surgery Case Reports

Pub Date : 2025-03-29 DOI: 10.1016/j.sycrs.2025.100097

Tesfaye Berhe , Sisay Bekele , Getnet Sahale , Enku shiferaw , Degualem Dessie , Tirsit Negash , Abeje b menjeta

Introduction

Dermatofibrosarcoma protuberans (DFSP) is a tumor of the subcutaneous tissue that grows slowly and invades locally, rarely spreading to other parts of the body but often recurring after surgery.

Case presentation

This case report presents a 59-year-old man with a recurrent, large Dermatofibrosarcoma Protuberans (DFSP) tumor. The tumor had grown significantly, extending from the anterior chest wall into the mediastinum through the foramen of Morgagni and into the left chest cavity, directly invading the left anterior chest wall. The mass was surgically removed, and the resulting chest wall defect was repaired using a latissimus dorsi muscle flap and a split-thickness skin graft. The patient was successfully discharged 10 days after surgery, following the healing of the wound and skin graft.

Clinical discussion

DFSPs represent less than 1 percent of all soft tissue tumors. Over 90 % of DFSP tumors have the chromosomal translocation t(17;22). Typically, Mohs micrographic surgery with continuous histological margin control is needed to reduce local recurrence rates. Adjuvant chemotherapy and radiation therapy may be useful.

Conclusion

Surgical approaches such as Mohs micrographic surgery or wide local excision with 5 cm negative margins are essential to prevent recurrence and minimize the overall impact of the disease. Mohs micrographic surgery is a specialized technique that aims for complete tumor removal while preserving as much healthy tissue as possible.

隆突性皮肤纤维肉瘤（DFSP）是一种生长缓慢且局部侵袭的皮下组织肿瘤，很少扩散到身体的其他部位，但经常在手术后复发。病例报告：本病例报告一例59岁男性复发性大结节性皮肤纤维肉瘤（DFSP）肿瘤。肿瘤生长明显，由胸壁前壁经Morgagni孔进入纵隔，进入左胸腔，直接侵犯左胸壁前壁。手术切除肿块，并使用背阔肌瓣和裂厚皮肤移植修复胸壁缺损。术后10天，患者顺利出院，伤口愈合，植皮。临床讨论dfsps占所有软组织肿瘤的不到1%。90%以上 %的DFSP肿瘤存在染色体易位t（17;22）。通常，需要Mohs显微手术和连续的组织边界控制来减少局部复发率。辅助化疗和放疗可能有用。结论Mohs显微手术或5 cm阴性切缘的广泛局部切除是预防复发和减少疾病整体影响的必要手术方法。莫氏显微摄影手术是一种专门的技术，旨在完全切除肿瘤，同时尽可能多地保留健康组织。

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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 : 2025-03-27 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

When surgery isn't the culprit: A case report of barium poisoning mistaken for a post-operative complication 当手术不是罪魁祸首：一例钡中毒被误认为是术后并发症

Surgery Case Reports

Pub Date : 2025-03-23 DOI: 10.1016/j.sycrs.2025.100095

Maria Mourão , Raquel Lalanda , Vítor Correia , Filipa Nogueira , Pedro Marques , Olavo Gomes

Barium poisoning can progress from gastrointestinal hypermotility (vomiting, abdominal cramps, and diarrhea) to flaccid paralysis, areflexia, respiratory failure, and cardiovascular dysfunction. This report aims to present a case of a 25-year-old woman with severe obesity, who underwent a sleeve gastrectomy complicated by a suture line leak and subsequent gastric stenosis. Following the resolution of the stenosis, the patient experienced recurrent gastrointestinal symptoms without an apparent cause, accompanied by hypokalemia. Over time, she developed generalized muscle weakness. The patient presented to the ED with altered mental status, nystagmus, generalized muscular weakness, and hypokalemia (2.7 mmol/L). A thorough etiological investigation of neurological symptoms was initiated. Testing revealed elevated urinary barium levels (43.9 µg/L) 12 days after admission, suggesting that higher levels would have been identifiable at admission and may have contributed to vomiting and muscular weakness.

钡中毒可从胃肠运动亢进（呕吐、腹部痉挛和腹泻）发展到弛缓性麻痹、反射性松弛、呼吸衰竭和心血管功能障碍。本报告的目的是提出一个25岁的女性严重肥胖，谁接受了袖胃切除术并发缝合线泄漏和随后的胃狭窄。狭窄消退后，患者出现了无明显原因的反复胃肠道症状，并伴有低血钾。随着时间的推移，她出现了全身肌肉无力。患者以精神状态改变、眼球震颤、全身肌无力、低钾血症（2.7 mmol/L）就诊于急诊科。对神经系统症状进行了彻底的病因学调查。入院后12天检测显示尿钡水平升高（43.9 µg/L），提示入院时可识别出较高水平，可能导致呕吐和肌肉无力。

引用次数: 0

Hypergranulation-induced graft failure in meshed split thickness skin graft: A case report 网状裂皮移植中颗粒过多导致的移植失败1例报告

Surgery Case Reports

Pub Date : 2025-02-14 DOI: 10.1016/j.sycrs.2025.100090

Luis Eduardo Rentas , Karla C. Maita , Gustavo Huaman , Sacha Scott , Ricardo Castrellon

Objective

Meshed split-thickness skin grafts (mSTSG) are frequently used to address skin defects. Effective fixation methods are crucial for optimizing graft integration and minimizing complications. This case report demonstrates the role of negative pressure wound therapy (NPWT) in managing recurrent axillary hidradenitis suppurativa.

Methods

A 65-year-old male with recurrent axillary hidradenitis suppurativa underwent mSTSG placement, followed by NPWT to support graft integration. The initial graft failed due to necrotic hypergranulation, necessitating regrafting and personalized postoperative care.

Results

Initial graft failure occurred due to necrotic hypergranulation at the graft site. After regrafting, NPWT facilitated granulation tissue formation and enhanced healing. Complications such as hypergranulation required continuous monitoring and intervention. The patient ultimately showed significant clinical improvement with successful graft integration.

Conclusion

NPWT can enhance graft survival and wound healing in complex cases of recurrent axillary hidradenitis suppurativa. However, vigilant monitoring is essential to manage complications such as necrotic hypergranulation. Personalized postoperative care and timely interventions are key to overcoming graft failures and achieving optimal outcomes. Tailoring treatment strategies to individual wound healing dynamics is crucial for long-term success.

目的：网状裂厚皮肤移植（mSTSG）是修复皮肤缺损的常用方法。有效的固定方法是优化移植物融合和减少并发症的关键。本病例报告显示负压伤口治疗（NPWT）在治疗复发性腋窝化脓性汗腺炎中的作用。方法65岁男性复发性腋窝化脓性汗腺炎患者行mSTSG置入术，并行NPWT支持移植物融合。由于坏死性肉芽过多，首次移植失败，需要再次移植和个性化的术后护理。结果移植失败主要是由于移植部位的坏死性肉芽肿。再移植后，NPWT促进肉芽组织形成并增强愈合。如颗粒过多等并发症需要持续监测和干预。患者最终表现出明显的临床改善，移植物成功融合。结论npwt对复杂的复发性腋窝化脓性汗腺炎具有提高移植物存活和伤口愈合的作用。然而，警惕的监测是必要的，以管理并发症，如坏死性肉芽肿。个性化的术后护理和及时的干预是克服移植物失败和获得最佳结果的关键。根据个体伤口愈合动态量身定制治疗策略对于长期成功至关重要。

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引用次数: 0

Mesothelioma disguised as a left inguinal hernia: A case report 伪装为左腹股沟疝的间皮瘤1例

Surgery Case Reports

Pub Date : 2025-02-03 DOI: 10.1016/j.sycrs.2025.100091

Kyra Sage Hunsberger , Burke DeLange

We present the case of a 72-year-old female diagnosed with low-grade malignant mesothelioma initially suspected to be a benign left inguinal hernia. The patient presented with progressive left lower extremity swelling and a reducible inguinal mass. Imaging suggested a cystic lesion in the groin, prompting surgical exploration. Pathological findings revealed mesothelioma involving regional lymph nodes. With this case, we aim to highlight an exceedingly rare extra-thoracic presentation and underscore the importance of maintaining a broad differential diagnosis for groin masses. Surgical biopsy and histopathological evaluation remain critical in diagnosing atypical malignancies with unique presentation.

我们提出的情况下，72岁的女性诊断为低度恶性间皮瘤最初怀疑是良性左腹股沟疝。患者表现为进行性左下肢肿胀和腹股沟肿块可缩小。影像学提示腹股沟囊性病变，需手术探查。病理显示间皮瘤累及局部淋巴结。在这个病例中，我们的目的是强调一个极其罕见的胸外表现，并强调对腹股沟肿块保持广泛鉴别诊断的重要性。手术活检和组织病理学评估仍然是诊断具有独特表现的非典型恶性肿瘤的关键。

引用次数: 0

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