Surgery Case Reports最新文献

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Surgery Case Reports

Pub Date : 2025-01-01

引用次数: 0

Surgical-prosthetic management of an advanced stage IV periodontitis in the aesthetic zone: A case report 手术修复术治疗美学区晚期IV期牙周炎1例

Surgery Case Reports

Pub Date : 2024-12-31 DOI: 10.1016/j.sycrs.2024.100087

Samadi Alaa , Kriouach Nada , Er-Raji Samir , El Yamani Amal

Background and objective

Stage IV periodontitis is a severe form of periodontal disease leading to significant bone resorption, potential tooth loss and masticatory dysfunction. The objective of this article is to show the interest of multidisciplinary management in the treatment of tissue deficits caused by advanced stage IV periodontitis.

Results

We report the case of a 29-year-old female patient who lost both upper right incisors due to advanced stage IV periodontitis. Advanced ridge defects caused by periodontitis were managed by two autogenous connective tissue grafts performed in two stages using the pocket technique allowing obtaining a significant increase in height and thickness of the ridge. An associated corrective gingivectomy made it possible to perfect the alignment of the gingival margins and ensure good integration of the future prosthetic rehabilitation.

A temporary bridge of ovoid pontic design helped guiding post-surgical healing and ensure better distribution of occlusal loads while respecting the adaptive threshold of the weakened periodontal terrain and taking into account the patient's physiological anatomical landmarks thanks to the axiographic recording of the sagittal condylar inclination (SCI). One year after complete healing, definitive restorations were able to be placed combining aesthetics and function.

Conclusion

This case report showed that the soft tissue grafting step by step by pouch technique associated with corrective gingivectomy can be considered as an effective therapeutic alternative to guided bone regeneration in the management of advanced ridge defects due to periodontal disease. Additionally, tooth-supported fixed prostheses can lead to better results without the need for implant therapy.

背景与目的牙周炎是一种严重的牙周病，可导致严重的骨吸收、潜在的牙齿脱落和咀嚼功能障碍。这篇文章的目的是显示的兴趣多学科管理在治疗组织缺损引起的晚期IV期牙周炎。结果我们报告一位29岁女性病患，因晚期牙周炎而失去右上门牙。由牙周炎引起的牙嵴缺损，采用两种自体结缔组织移植，分两个阶段进行，使用口袋技术，使牙嵴的高度和厚度显著增加。相关的矫正牙龈切除术使牙龈边缘的排列更加完美，并确保未来假肢康复的良好整合。临时卵状桥设计有助于指导术后愈合，确保更好的咬合负荷分布，同时尊重牙周地形减弱的适应阈值，并考虑到患者的生理解剖标志，这要感谢轴向记录矢状髁倾角（SCI）。完全愈合一年后，最终修复能够结合美学和功能。结论在牙周病晚期牙嵴缺损的治疗中，采用眼袋分步软组织移植联合牙龈矫正切除术是一种有效的骨再生治疗方法。此外，牙齿支持的固定假体可以导致更好的结果，而不需要种植治疗。

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引用次数: 0

Disseminated histoplasmosis causing duodenal obstruction in pediatric patient: A case report 小儿播散性组织胞浆菌病致十二指肠梗阻1例

Surgery Case Reports

Pub Date : 2024-12-26 DOI: 10.1016/j.sycrs.2024.100086

Shivani Kamal , Ayesha Baig , James R. Pierce

Introduction

Histoplasmosis in children with associated bowel obstruction is rare, and its clinical management is based on data and experience on adult patients.

Case report

A previously healthy five-year-old girl who recently immigrated to the US from Mexico presented with 5 days of abdominal pain, fever, cough and emesis. On workup, chest x-ray showed diffuse bilateral micro nodules in a miliary pattern, and urine and serum were positive for histoplasma antigen. Barium upper GI series showed distal duodenal obstruction and biopsies taken during endoscopy were positive for histoplasma. Medical therapy with antifungals did not improve the obstruction. On laparotomy, the distal duodenum was obstructed with intrinsic and extrinsic inflammation requiring a diamond duodeno-jejunostomy bypass. Postoperatively, the patient recovered and was discharged home with prolonged antifungals and infectious disease follow up.

Conclusion

Our case emphasizes the need for early surgical consultation and careful selection of contrast for luminal imaging. We advocate for an initial attempt at antifungal management to avoid operative treatment during active inflammation and lower surgical risk.

儿童组织胞浆菌病合并肠梗阻是罕见的，其临床处理是基于成人患者的数据和经验。病例报告：一名先前健康的5岁女孩最近从墨西哥移民到美国，出现腹痛、发烧、咳嗽和呕吐5天。检查时，胸部x线显示双侧弥漫性小结节呈军性征，尿液和血清组织浆抗原阳性。上消化道钡餐显示十二指肠远端梗阻，内镜下活检组织浆阳性。抗真菌药物治疗并没有改善梗阻。开腹手术时，远端十二指肠因内源性和外源性炎症阻塞，需要行钻石十二指肠空肠造口旁路术。术后患者康复出院，并进行了长时间的抗真菌和传染病随访。结论本病例强调了早期手术咨询和谨慎选择造影造影剂的必要性。我们提倡初步尝试抗真菌治疗，以避免活动性炎症和降低手术风险的手术治疗。

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引用次数: 0

Micro-drainage for management of extensive subcutaneous emphysema: A case report 微引流术治疗大面积皮下肺气肿1例

Surgery Case Reports

Pub Date : 2024-12-26 DOI: 10.1016/j.sycrs.2024.100085

Majd Oweidat , Iyad Al Jada , Wasef Alhroub , Abdalhakim Shubietah , Mousa Humeedat

Extensive subcutaneous emphysema (ESE) is a rare complication requiring prompt intervention to prevent serious outcomes. We present the case of a man in his sixties with chronic obstructive pulmonary disease and a history of pulmonary tuberculosis, admitted with community-acquired pneumonia and respiratory failure. Following central venous line placement, he developed progressive ESE refractory to standard chest tube drainage. A novel approach using a fenestrated microcatheter was employed to manage the ESE. The catheter, connected to an underwater seal and combined with targeted compressive massage, successfully evacuated approximately 2500 mL of air, leading to complete resolution within 24 hours. This case highlights the efficacy of minimally invasive drainage techniques in managing refractory ESE, offering a safe and effective alternative to surgical interventions.

广泛的皮下肺气肿（ESE）是一种罕见的并发症，需要及时干预以防止严重的后果。我们提出的情况下，在他的六十多岁的男子慢性阻塞性肺疾病和肺结核的历史，承认与社区获得性肺炎和呼吸衰竭。中心静脉置管后，患者出现进行性ESE，对标准胸管引流难治。一种新颖的方法使用开孔微导管来管理ESE。导管连接到水下密封件并结合有针对性的压缩按摩，成功地抽出了大约2500 mL的空气，在24 小时内完全解决了问题。该病例强调了微创引流技术在治疗难治性ESE方面的有效性，为手术干预提供了一种安全有效的替代方法。

引用次数: 0

Anterior abdominal wall abscess due to toothpick ingestion: A case report 牙签误食致前腹壁脓肿1例

Surgery Case Reports

Pub Date : 2024-12-26 DOI: 10.1016/j.sycrs.2024.100088

Doğuş Can Ekdal , Ahmet Akmercan , Tevfik Kıvılcım Uprak

Ingestion of foreign bodies represents a common clinical emergency, especially in pediatric and geriatric populations. In the majority of cases, ingested foreign objects pass through the gastrointestinal tract without incident and are expelled without causing symptoms. However, complications can arise depending on the size, shape, and structure of the ingested item. A 53-year-old male with a history of diabetes, hypertension, chronic obstructive pulmonary disease, and obesity was admitted to the hospital due to recurrent subcutaneous abscesses and cellulitis in the right upper quadrant of the anterior abdominal wall. The patient's medical history reveals several times of abscess puncture in the same area. The patient underwent subcutaneous abscess drainage under local anesthesia, and toothpick material fixed to the subcutaneous tissues was detected. Following the removal of the toothpick, debridement of the wound was performed, and the patient was discharged with antibiotherapy. No recurrence was noted during the follow-up outpatient clinic visit three months later. This case report highlights the rare and complex complication of subcutaneous migration following foreign body ingestion, leading to recurrent subcutaneous abscesses. The exact pathogenesis of foreign body migration is not fully understood, but it is probable that the toothpick penetrates the subcutaneous fatty tissue from the transverse colon segment near the anterior abdominal wall, leading to the spontaneous closure of the colonic fistula tract. The foreign body was detected in radiological imaging in approximately 42.6 % of cases. A high level of clinical suspicion and a thorough patient history are essential for the identification of radiolucent foreign bodies.

摄入异物是一种常见的临床急症，尤其是在儿科和老年人群中。在大多数情况下，摄入的异物会顺利通过胃肠道，排出体外也不会引起症状。然而，并发症的发生取决于所摄入食物的大小、形状和结构。男，53岁，有糖尿病、高血压、慢性阻塞性肺疾病、肥胖病史，因前腹壁右上象限反复皮下脓肿和蜂窝织炎入院。患者病史显示同一部位多次穿刺脓肿。局部麻醉下行皮下脓肿引流术，检查固定于皮下组织的牙签材料。拔除牙签后，对创面进行清创，患者接受抗生素治疗出院。3个月后门诊随访未见复发。这个病例报告强调了罕见和复杂的并发症皮下迁移后的异物摄入，导致复发性皮下脓肿。异物迁移的确切发病机制尚不完全清楚，但可能是牙签从靠近前腹壁的横结肠段穿透皮下脂肪组织，导致结肠瘘道自发关闭。放射成像检测到异物的病例约为42.6% %。高度的临床怀疑和彻底的病史是鉴别透光异物的必要条件。

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引用次数: 0

Ruptured gastroepiploic artery aneurysm causing massive intraperitoneal hemorrhage: A case report and literature review 胃网膜动脉瘤破裂致大量腹膜内出血1例并文献复习

Surgery Case Reports

Pub Date : 2024-12-25 DOI: 10.1016/j.sycrs.2024.100084

Marissa Leann Ritter, Tiffany Killblane, David Grantham

Introduction

Visceral artery aneurysms, including gastroepiploic artery aneurysms, are a rare cause of gastrointestinal bleeding. Gastroepiploic artery aneurysms are usually silent with a high chance of rupture and hemorrhage.

Case

We present a case of a man with a ruptured gastroepiploic artery aneurysm following a fall from standing height. On arrival, he was hypotensive with an acute abdomen. Due to hemodynamic instability and a positive FAST exam, an exploratory laparotomy was performed, which revealed pulsatile bleeding at the greater curvature of the stomach and a subserosal hematoma with an active bleeding vessel visible. The gastroepiploic vessels were ligated, and a partial gastrectomy was performed. He recovered well and was discharged after five days.

Discussion

Gastroepiploic artery aneurysms are a rare occurrence, most commonly occurring in males over the age of 50. Causes include arterial dysplasia, perivascular inflammation, and trauma. Trauma was likely the cause in this patient’s case. Most gastroepiploic artery aneurysms are asymptomatic. They are usually found incidentally or once complications arise. Patients with ruptured gastroepiploic artery aneurysms usually present with peritoneal signs and shock. All patients with gastroepiploic artery aneurysms should be treated immediately due to the risk of rupture and subsequent complications. A variety of techniques exist to treat these aneurysms.

Conclusion

Although visceral artery aneurysms are uncommon, they can be life-threatening. Therefore, it is important to remember them as a potential source of intraperitoneal hemorrhage, even from minor trauma.

内脏动脉瘤，包括胃网膜动脉瘤，是一种罕见的引起胃肠道出血的原因。胃网膜动脉瘤通常是无声的，有很高的破裂和出血的机会。我们提出一个病例的男子胃网膜动脉瘤破裂后，从站立高度跌落。到达时，他有低血压和急腹症。由于血流动力学不稳定和FAST检查阳性，进行了剖腹探查，发现胃大弯曲处有搏动性出血和浆膜下血肿，可见活动性出血血管。结扎胃网膜血管，行部分胃切除术。他恢复得很好，五天后出院了。星形大网膜动脉瘤是一种罕见的疾病，最常见于50岁以上的男性。病因包括动脉发育不良、血管周围炎症和创伤。在这个病例中，创伤可能是病因。大多数胃网膜动脉瘤是无症状的。它们通常是偶然发现的或在出现并发症时发现的。胃大网膜动脉瘤破裂的患者通常表现为腹膜体征和休克。所有胃大网膜动脉瘤患者应立即治疗，因为有破裂和并发症的风险。治疗这些动脉瘤的技术多种多样。结论内脏动脉瘤虽不常见，但可危及生命。因此，重要的是要记住它们是腹膜内出血的潜在来源，即使是轻微的创伤。

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引用次数: 0

Utilization of autogenous split rib graft for cranioplasty in a child: A case report 自体裂肋移植用于儿童颅骨成形术1例

Surgery Case Reports

Pub Date : 2024-12-25 DOI: 10.1016/j.sycrs.2024.100089

Nauman Shah , Muhammad Salman Farsi , Muhammad Sanaan Noor , Muhammad Maaz Bin Zahid , Yasir Aziz , Muhammad Wasim Sajjad , Azam Jan , Nasir Ali

A cranioplasty is a surgical procedure intended to correct cranial abnormalities resulting from prior trauma or surgeries, using various materials to fill up the defect, most commonly a synthetic substance or a fragment of the patient's bone. We present a case of an 8-month-old child, presented with post-traumatic skull injury resulting from a head injury at the age of one month. On physical examination, the patient had soft swelling of the skull, that bulged out through the defect with coughing. The case was taken up for cranioplasty under general anesthesia and the defect was exposed, and the graft bed was prepared. Two rib grafts were harvested before cranioplasty that were split into two halves and spread like an open book which were enough to cover the defect. Each graft was stabilized with a titanium micro screw. In this case report we discuss a case of post-traumatic cranial defect in an 8-month patient treated with cranioplasty using split rib grafts.

颅骨成形术是一种外科手术，旨在纠正先前创伤或手术导致的颅骨异常，使用各种材料填补缺陷，最常见的是合成物质或患者的骨头碎片。我们提出了一个8个月大的孩子的情况下，提出了创伤后颅骨损伤导致的头部损伤在一个月的年龄。在体格检查中，病人有轻微的颅骨肿胀，由于咳嗽而从缺损处凸出。全麻下行颅骨成形术，暴露缺损，准备移植床。在颅骨成形术前采集了两根肋骨，将其分成两半，像一本打开的书一样展开，足以覆盖缺损。每个移植物用钛微螺钉固定。在这个病例报告中，我们讨论了一个创伤后颅骨缺损的病例，在8个月的病人治疗颅骨成形术使用裂肋移植。

引用次数: 0

Multisite neural tube defects: Management of a complex case and review of theories on neural tube closure 多部位神经管缺损：一例复杂病例的处理及神经管闭合理论综述

Surgery Case Reports

Pub Date : 2024-12-15 DOI: 10.1016/j.sycrs.2024.100083

Ubaid Ullah , Malik W.Z. Khan , Aamina Sher , Hammad Iftikhar , Aizaz Ali , Shandana Ali , Salman Khan , Sajjad Ullah

Background

Neural tube defects (NTDs) result from incomplete neural fold fusion during early embryonic development and can occur at various stages (gastrulation, primary, and secondary neurulation). While rare, NTDs at multiple sites require clinical and imaging assessments for management. The "Zipper closure" and "Multisite closure" theories explain these defects, though some anomalies remain unexplained, calling for more research.

Case Presentation

A two-month-old female presented with two NTDs: occipital meningoencephalocele and lumbar myelomeningocele. Both defects were successfully treated surgically, leading to positive neurological outcomes.

Conclusion

This case supports the multisite closure theory of NTDs and emphasizes the importance of early surgical intervention to prevent complications.

神经管缺陷（NTDs）是由于胚胎早期发育过程中神经褶融合不完全引起的，可发生在不同阶段（原肠胚形成、原发性和继发性神经发育）。虽然罕见，但在多个地点出现的热带病需要临床和影像学评估以进行管理。“拉链闭合”和“多位点闭合”理论解释了这些缺陷，尽管一些异常仍然无法解释，需要更多的研究。一个两个月大的女性表现为两个NTDs：枕骨脑膜脑膜膨出和腰椎脊膜脑膜膨出。手术成功地治疗了这两种缺陷，导致了积极的神经系统预后。结论本病例支持NTDs多部位闭合理论，强调早期手术干预对预防并发症的重要性。

引用次数: 0

Traumatic pseudoaneurysm of the superficial left palmar arch: A case report 外伤性左掌浅弓假性动脉瘤1例

Surgery Case Reports

Pub Date : 2024-12-11 DOI: 10.1016/j.sycrs.2024.100081

Charles Petrus Theron, Collen Sandile Nkosi , Lyndon Grant Biddulph

Pseudoaneurysms in the hands are rare entities, with only a few reported cases in English literature. The majority of these lesions arise from penetrating trauma, previous surgery, or artery puncture. Pseudoaneurysms are frequently missed, hence a strong clinical suspicion is required to make the correct diagnosis in a timely manner. We present a case of traumatic pseudoaneurysm of the superficial palmar arch in a 17-year-old CP child following a fall. The patient had a delayed presentation and was initially misdiagnosed as having a palmar abscess. We performed an ultrasound and CT angiogram to confirm the diagnosis of a superficial palmar arch pseudoaneurysm. We treated the patient surgically, and the wound healed uneventfully. Pseudoaneurysms should be included in the differential diagnosis of palmar masses.

手部假性动脉瘤是一种罕见的实体，在英语文献中只有少数病例报道。这些病变大多是由穿透性创伤、既往手术或动脉穿刺引起的。假性动脉瘤经常被漏诊，因此临床需要强烈的怀疑才能及时做出正确的诊断。我们提出一个病例外伤性假性动脉瘤掌浅弓在一个17岁的CP儿童跌倒后。患者有延迟的表现，最初被误诊为手掌脓肿。我们进行了超声和CT血管造影以确认浅表性掌弓假性动脉瘤的诊断。我们对病人进行了手术治疗，伤口愈合得很顺利。假性动脉瘤应列入掌部肿块的鉴别诊断。

引用次数: 0

Robotic thoracoscopic left paratracheal and cervical lymphadenectomy for recurrent esophageal adenocarcinoma: A case report 机器人胸腔镜下左气管旁颈部淋巴结切除术治疗复发性食管腺癌1例

Surgery Case Reports

Pub Date : 2024-12-11 DOI: 10.1016/j.sycrs.2024.100082

Irene S. Zuin , Junya Kitadani , Jessie A. Elliott , Nadia Haj Mohammad , Jan E. Freund , Jelle P. Ruurda , Richard van Hillegersberg

Background

Despite advancements in surgical techniques and perioperative care, approximately 50 % of patients treated with curative esophagectomy for esophageal cancer will develop recurrence. To date, there is an absence of guidelines for the management of regional lymph node recurrence, reflecting a lack of quality data in the literature.

Case presentation

We present the case of a 59-year-old female who experienced an oligometastatic recurrence involving the level 2 L left paratracheal and level III left cervical nodal stations, after previous perioperative chemotherapy and minimally invasive esophagectomy for esophageal adenocarcinoma four months earlier. The patient was treated with robotic-assisted paratracheal and cervical lymphadenectomy using the Da Vinci XI system. Postoperatively, the patient recovered uneventfully, and short-term follow-up demonstrated no residual disease.

Discussion

This case highlights the complexity of managing recurrent esophageal cancer and the potential role of robotic surgical strategies in improving patient outcomes in the context of oligometastatic recurrence. Additionally, it underscores the need for further research to refine surgical techniques and case selection, and to establish guidelines for the treatment of recurrent esophageal cancer.

Conclusion

Robotic-assisted lymphadenectomy represents a feasible option for managing locoregional recurrence of esophageal adenocarcinoma in select cases. Multidisciplinary team involvement remains critical to individualized treatment planning.

尽管手术技术和围手术期护理有所进步，但大约50% %的食管癌根治性食管切除术患者会复发。到目前为止，还没有区域性淋巴结复发治疗的指南，这反映了文献中缺乏高质量的数据。病例介绍：我们报告一位59岁的女性患者，在四个月前因食管腺癌行围手术期化疗和微创食管切除术后，发生了低转移性复发，涉及2级 L左侧气管旁和III级左侧宫颈结站。患者采用机器人辅助的Da Vinci XI系统进行气管旁和颈部淋巴结切除术。术后患者恢复平稳，短期随访无残留病变。本病例强调了管理食管癌复发的复杂性，以及机器人手术策略在改善少转移性复发患者预后方面的潜在作用。此外，它强调需要进一步研究以改进手术技术和病例选择，并建立治疗复发性食管癌的指南。结论机器人辅助淋巴结切除术是治疗食管癌局部复发的可行选择。多学科团队参与仍然是个性化治疗计划的关键。

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