Background: An enterocutaneous fistula (ECF) is defined as an abnormal communication between the gastrointestinal tract and skin. ECFs are rarely encountered in clinical practice, yet are frequently difficult to treat. Few reports exist regarding the surgical techniques for the treatment of an ECF. Therefore, we report a case of refractory ECF with concomitant severe adhesions, in which we performed combined laparoscopic adhesiolysis and planned open conversion.
Case presentation: A 57-year-old female patient underwent a laparotomy for an ovarian cyst in her 20s. At 46 years, adhesiolysis without bowel resection was performed for adhesive small bowel obstruction (SBO). However, her symptoms did not improve. Eighteen days postoperatively, she underwent a reoperation and jejunostomy. An ECF developed post-reoperation; therefore, stoma closure and radical surgery for the ECF were planned. Due to the severe adhesions, only stoma closure was performed, based on intraoperative assessments. The patient was subsequently referred to our hospital. First, skin care around the fistula was provided during an outpatient visit. Appropriate sizing of the stoma pouch was performed, to improve erosions and ulcers. Thereafter, debridement of the perifistula skin and simple closure of the ECF outlet were attempted; however, the ECF recurred shortly thereafter. After 8 years of regular skin care, with the ECF remaining stable, however, manifesting as symptomatic SBO, she underwent laparoscopic adhesiolysis. This procedure was initiated in the epigastric region, where relatively fewer adhesions were anticipated. Post-open conversion, partial resection of the small intestine at four locations, including the fistula site, was performed. Postoperatively, jejunal edema and peristaltic dysfunction, due to narrowing of the superior mesenteric artery occurred. Regular drainage by percutaneous endoscopic gastrostomy was required. However, she improved and was discharged 3 months post-operatively. Three years post-operatively, the ECF and SBO did not recur.
Conclusions: We reported a case of refractory ECF in which we were able to safely perform surgery, by combining laparoscopic adhesiolysis and a planned open conversion. Therefore, the surgical approach used in this case may be an option for securing a safe surgical field, while avoiding collateral damage.
{"title":"Surgical approach for a refractory enterocutaneous fistula by combining laparoscopic surgery and a planned open conversion: a case report.","authors":"Makoto Hasegawa, Takayuki Ogino, Yuki Sekido, Mitsunobu Takeda, Tsuyoshi Hata, Atsushi Hamabe, Norikatsu Miyoshi, Mamoru Uemura, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1186/s40792-024-01987-7","DOIUrl":"10.1186/s40792-024-01987-7","url":null,"abstract":"<p><strong>Background: </strong>An enterocutaneous fistula (ECF) is defined as an abnormal communication between the gastrointestinal tract and skin. ECFs are rarely encountered in clinical practice, yet are frequently difficult to treat. Few reports exist regarding the surgical techniques for the treatment of an ECF. Therefore, we report a case of refractory ECF with concomitant severe adhesions, in which we performed combined laparoscopic adhesiolysis and planned open conversion.</p><p><strong>Case presentation: </strong>A 57-year-old female patient underwent a laparotomy for an ovarian cyst in her 20s. At 46 years, adhesiolysis without bowel resection was performed for adhesive small bowel obstruction (SBO). However, her symptoms did not improve. Eighteen days postoperatively, she underwent a reoperation and jejunostomy. An ECF developed post-reoperation; therefore, stoma closure and radical surgery for the ECF were planned. Due to the severe adhesions, only stoma closure was performed, based on intraoperative assessments. The patient was subsequently referred to our hospital. First, skin care around the fistula was provided during an outpatient visit. Appropriate sizing of the stoma pouch was performed, to improve erosions and ulcers. Thereafter, debridement of the perifistula skin and simple closure of the ECF outlet were attempted; however, the ECF recurred shortly thereafter. After 8 years of regular skin care, with the ECF remaining stable, however, manifesting as symptomatic SBO, she underwent laparoscopic adhesiolysis. This procedure was initiated in the epigastric region, where relatively fewer adhesions were anticipated. Post-open conversion, partial resection of the small intestine at four locations, including the fistula site, was performed. Postoperatively, jejunal edema and peristaltic dysfunction, due to narrowing of the superior mesenteric artery occurred. Regular drainage by percutaneous endoscopic gastrostomy was required. However, she improved and was discharged 3 months post-operatively. Three years post-operatively, the ECF and SBO did not recur.</p><p><strong>Conclusions: </strong>We reported a case of refractory ECF in which we were able to safely perform surgery, by combining laparoscopic adhesiolysis and a planned open conversion. Therefore, the surgical approach used in this case may be an option for securing a safe surgical field, while avoiding collateral damage.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11322469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Suprapancreatic lymph node metastasis is one of the usual routes for gastric cancer. However, it is rare for the primary lesion to be found several years after resection of the suprapancreatic metastatic lymph node. This is a report of occult gastric carcinoma with microsatellite instability diagnosed 10 years after excision of a metastatic lymph node.
Case presentation: A 55-year-old female presented with suprapancreatic lymph node swelling during a medical examination. Gastroscopy revealed no malignancy. We performed an excisional biopsy via laparotomy and histologically suspected metastatic cancer of unknown origin. After nine and a half years, we detected early gastric cancer by gastroscopy and performed a distal gastrectomy. The gastric tumor was pathologically similar to the previous suprapancreatic tumor. Immunohistochemical examination revealed that both the stomach and suprapancreatic lymph node exhibited microsatellite instability, suggesting that the two lesions were of the same origin.
Conclusions: This case is considered valuable because there have been no previous reports of gastric cancer with characteristics of high microsatellite instability in which the primary tumor was identified a long time after resection of metastatic lesions.
{"title":"Occult gastric carcinoma with microsatellite instability diagnosed 10 years after excision of metastatic lymph node: a case report.","authors":"Yutaka Tamamori, Takuya Mori, Akihiro Tanaka, Takuma Okada, Shogo Tanaka, Yuichi Fumimoto, Kiyotaka Yukimoto, Ryugo Sawada, Hisao Sano, Yoshio Ohta, Hirokazu Taniguchi, Toshimasa Tsujinaka","doi":"10.1186/s40792-024-01988-6","DOIUrl":"10.1186/s40792-024-01988-6","url":null,"abstract":"<p><strong>Background: </strong>Suprapancreatic lymph node metastasis is one of the usual routes for gastric cancer. However, it is rare for the primary lesion to be found several years after resection of the suprapancreatic metastatic lymph node. This is a report of occult gastric carcinoma with microsatellite instability diagnosed 10 years after excision of a metastatic lymph node.</p><p><strong>Case presentation: </strong>A 55-year-old female presented with suprapancreatic lymph node swelling during a medical examination. Gastroscopy revealed no malignancy. We performed an excisional biopsy via laparotomy and histologically suspected metastatic cancer of unknown origin. After nine and a half years, we detected early gastric cancer by gastroscopy and performed a distal gastrectomy. The gastric tumor was pathologically similar to the previous suprapancreatic tumor. Immunohistochemical examination revealed that both the stomach and suprapancreatic lymph node exhibited microsatellite instability, suggesting that the two lesions were of the same origin.</p><p><strong>Conclusions: </strong>This case is considered valuable because there have been no previous reports of gastric cancer with characteristics of high microsatellite instability in which the primary tumor was identified a long time after resection of metastatic lesions.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1186/s40792-024-01983-x
Takahiro Yamanaka, Kenichiro Araki, Hideki Suzuki, Hidenobu Osawa, Ken Shirabe
Background: Gastric venous congestion (GVC) is one of the complications of total pancreatectomy (TP). Here, we report a case of intraoperative severe GVC during TP with a replaced common hepatic artery (RCHA).
Case presentation: A 65-year-old female patient was diagnosed with intraductal papillary mucinous carcinoma. Her CHA branched from the superior mesenteric artery as RCHA. She underwent subtotal stomach preserving TP. The tumor was resected with splenic artery (SpA) and total gastric vein transections. Severe GVC and bleeding from the stomach tube occurred intraoperatively. A strong pulsation was observed in the left gastric artery (LGA), and we suspected an increased blood flow from the celiac artery (CeA) to the LGA after SpA resection. Total gastrectomy (TG) was then performed to control the severe GVC-related bleeding. The patient was discharged without complications 19 days postoperatively.
Conclusion: TP with RCHA may increase the risk of severe GVC due to increased blood flow from CeA to LGA.
{"title":"Intraoperative severe gastric venous congestion during total pancreatectomy with replaced common hepatic artery: a case report.","authors":"Takahiro Yamanaka, Kenichiro Araki, Hideki Suzuki, Hidenobu Osawa, Ken Shirabe","doi":"10.1186/s40792-024-01983-x","DOIUrl":"10.1186/s40792-024-01983-x","url":null,"abstract":"<p><strong>Background: </strong>Gastric venous congestion (GVC) is one of the complications of total pancreatectomy (TP). Here, we report a case of intraoperative severe GVC during TP with a replaced common hepatic artery (RCHA).</p><p><strong>Case presentation: </strong>A 65-year-old female patient was diagnosed with intraductal papillary mucinous carcinoma. Her CHA branched from the superior mesenteric artery as RCHA. She underwent subtotal stomach preserving TP. The tumor was resected with splenic artery (SpA) and total gastric vein transections. Severe GVC and bleeding from the stomach tube occurred intraoperatively. A strong pulsation was observed in the left gastric artery (LGA), and we suspected an increased blood flow from the celiac artery (CeA) to the LGA after SpA resection. Total gastrectomy (TG) was then performed to control the severe GVC-related bleeding. The patient was discharged without complications 19 days postoperatively.</p><p><strong>Conclusion: </strong>TP with RCHA may increase the risk of severe GVC due to increased blood flow from CeA to LGA.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11306704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Appendiceal goblet cell adenocarcinoma (GCA) is a rare subtype of primary appendiceal adenocarcinoma with an incidence of 1-5 per 10,000,000 people per year. Appendiceal tumors are often diagnosed after appendectomy for acute appendicitis. Notably, however, there is currently no standard treatment strategy for GCA, including additional resection. We report a case of appendiceal GCA with perineural extension into the cecum, in which ileal resection was considered effective.
Case presentation: A 41-year-old man was diagnosed with acute appendicitis and underwent appendectomy. Histopathological findings revealed GCA (T3, Pn1). He was referred to our hospital for additional resection. Preoperative examination indicated a diagnosis of GCA cT3N0M0. Laparoscopic ileocecal resection and D3 lymph node dissection were performed 2 months after initial appendectomy. The patient had a good postoperative course and was discharged 8 days after surgery. Histopathological findings showed a GCA invading the cecum, despite an intact appendiceal stump, no lymph node metastasis, no vascular invasion, and no horizontal extension into the submucosa. Direct invasion of the tumor through the serosa was not observed, but perineural extension was conspicuous in the cecum, suggesting that the GCA extended into the cecum via perineural invasion. The resection margins were negative. The patient has survived free of recurrence for a year after ileocecal resection.
Conclusions: The current patient was diagnosed with appendiceal GCA following appendectomy for acute appendicitis. Despite intact of appendiceal stump and no evidence of lymph node or distant metastasis, he underwent laparoscopic ileocecal resection and D3 lymph node dissection 2 months after initial appendectomy, with a favorable outcome. Despite the detection of perineural invasion, the patient declined adjuvant therapy. This case suggests that extensive resection may be required in patients with appendiceal GCA, but the role of adjuvant therapy remains unclear.
{"title":"Appendiceal goblet cell adenocarcinoma with perineural invasion extending into the ileocecal lesion.","authors":"Yuka Hosokawa, Sunao Fujiyoshi, Ken Imaizumi, Kengo Shibata, Nobuki Ichikawa, Tadashi Yoshida, Shigenori Homma, Takeaki Kudo, Nanase Okazaki, Utano Tomaru, Akinobu Taketomi","doi":"10.1186/s40792-024-01984-w","DOIUrl":"10.1186/s40792-024-01984-w","url":null,"abstract":"<p><strong>Background: </strong>Appendiceal goblet cell adenocarcinoma (GCA) is a rare subtype of primary appendiceal adenocarcinoma with an incidence of 1-5 per 10,000,000 people per year. Appendiceal tumors are often diagnosed after appendectomy for acute appendicitis. Notably, however, there is currently no standard treatment strategy for GCA, including additional resection. We report a case of appendiceal GCA with perineural extension into the cecum, in which ileal resection was considered effective.</p><p><strong>Case presentation: </strong>A 41-year-old man was diagnosed with acute appendicitis and underwent appendectomy. Histopathological findings revealed GCA (T3, Pn1). He was referred to our hospital for additional resection. Preoperative examination indicated a diagnosis of GCA cT3N0M0. Laparoscopic ileocecal resection and D3 lymph node dissection were performed 2 months after initial appendectomy. The patient had a good postoperative course and was discharged 8 days after surgery. Histopathological findings showed a GCA invading the cecum, despite an intact appendiceal stump, no lymph node metastasis, no vascular invasion, and no horizontal extension into the submucosa. Direct invasion of the tumor through the serosa was not observed, but perineural extension was conspicuous in the cecum, suggesting that the GCA extended into the cecum via perineural invasion. The resection margins were negative. The patient has survived free of recurrence for a year after ileocecal resection.</p><p><strong>Conclusions: </strong>The current patient was diagnosed with appendiceal GCA following appendectomy for acute appendicitis. Despite intact of appendiceal stump and no evidence of lymph node or distant metastasis, he underwent laparoscopic ileocecal resection and D3 lymph node dissection 2 months after initial appendectomy, with a favorable outcome. Despite the detection of perineural invasion, the patient declined adjuvant therapy. This case suggests that extensive resection may be required in patients with appendiceal GCA, but the role of adjuvant therapy remains unclear.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11303649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Calcifying fibrous tumor (CFT) arising from the pleura is a relatively rare benign lesion in young and middle-aged adults. We report a 31-year-old woman with pleural CFT who underwent successful complete thoracoscopic enucleation.
Case presentation: An asymptomatic woman presented with a mass in the right lower lung field that was incidentally detected on a chest X-ray during a routine medical checkup. Chest computed tomography showed a well-defined mass in the lower mediastinum, with a maximum diameter of approximately 5.5 cm. Esophagogastroduodenoscopy showed no abnormal findings in the esophagus. An endoscopic ultrasonography (EUS) revealed a well-defined tumor with no internal blood flow. EUS-fine needle aspiration failed to establish a definitive diagnosis. Therefore, thoracoscopic tumor enucleation was performed for diagnostic and therapeutic purposes. Based on the histopathological findings of the resected specimen, the presence of a tumor with a high fibrous component in a young woman, and the identification of granulomatous calcifications, a diagnosis of CFT was established.
Conclusions: Complete thoracoscopic tumor enucleation was successfully performed for CFT arising from the pleura in a young adult woman.
背景:胸膜钙化纤维瘤(CFT)是中青年人中较为罕见的良性病变。我们报告了一名患有胸膜钙化纤维瘤的 31 岁女性,她成功地接受了胸腔镜全切术:病例介绍:一名无症状的女性在例行体检时偶然在胸部 X 光片上发现右下肺野有肿块。胸部计算机断层扫描显示,下纵隔有一个轮廓清晰的肿块,最大直径约 5.5 厘米。食管胃十二指肠镜检查显示食管未发现异常。内镜超声检查(EUS)显示肿瘤轮廓清晰,内部无血流。EUS 细针穿刺未能明确诊断。因此,为了诊断和治疗目的,患者接受了胸腔镜肿瘤去核术。根据切除标本的组织病理学结果、一名年轻女性体内肿瘤的高纤维成分以及肉芽肿钙化的鉴定,确定了 CFT 的诊断:结论:为一名年轻女性成功实施了胸腔镜下肿瘤全切术,以治疗胸膜产生的CFT。
{"title":"Successful thoracoscopic enucleation of a calcifying fibrous tumor of the lower mediastinum in a young woman.","authors":"Ryo Yokota, Takeshi Matsutani, Keisuke Mishima, Ryo Yamagiwa, Hirotoshi Kubokura, Norio Motoda, Nobuhiko Taniai, Hiroshi Yoshida","doi":"10.1186/s40792-024-01981-z","DOIUrl":"10.1186/s40792-024-01981-z","url":null,"abstract":"<p><strong>Background: </strong>Calcifying fibrous tumor (CFT) arising from the pleura is a relatively rare benign lesion in young and middle-aged adults. We report a 31-year-old woman with pleural CFT who underwent successful complete thoracoscopic enucleation.</p><p><strong>Case presentation: </strong>An asymptomatic woman presented with a mass in the right lower lung field that was incidentally detected on a chest X-ray during a routine medical checkup. Chest computed tomography showed a well-defined mass in the lower mediastinum, with a maximum diameter of approximately 5.5 cm. Esophagogastroduodenoscopy showed no abnormal findings in the esophagus. An endoscopic ultrasonography (EUS) revealed a well-defined tumor with no internal blood flow. EUS-fine needle aspiration failed to establish a definitive diagnosis. Therefore, thoracoscopic tumor enucleation was performed for diagnostic and therapeutic purposes. Based on the histopathological findings of the resected specimen, the presence of a tumor with a high fibrous component in a young woman, and the identification of granulomatous calcifications, a diagnosis of CFT was established.</p><p><strong>Conclusions: </strong>Complete thoracoscopic tumor enucleation was successfully performed for CFT arising from the pleura in a young adult woman.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11294290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Situs inversus totalis (SIT) is a rare congenital anomaly in which the thoracic and abdominal cavity structures are completely opposite to normal. Performing robot-assisted surgery in these patients is difficult because of these anomalies. A few reports have described robot-assisted surgery for rectal cancer in patients with SIT, but no reports to date have described robot-assisted surgery for colon cancer.
Case presentation: A 74-year-old female presented with abdominal pain and was diagnosed with ascending colon cancer and SIT. We carefully planned the surgical procedure and performed robot-assisted hemi-colectomy. Although we used unusual port placement, the operation was performed safely. The patient was discharged without any complications.
Conclusions: Robot-assisted surgery is safe and efficient for patients with anatomical anomalies.
背景:全腹不对称(Situs inversus totalis,SIT)是一种罕见的先天性畸形,胸腔和腹腔结构与正常完全相反。由于这些畸形,在这些患者身上实施机器人辅助手术非常困难。有几篇报道介绍了用机器人辅助手术治疗 SIT 患者的直肠癌,但迄今为止还没有报道介绍过用机器人辅助手术治疗结肠癌:一名 74 岁的女性因腹痛前来就诊,被诊断为升结肠癌和 SIT。我们精心策划了手术过程,并实施了机器人辅助半结肠切除术。虽然我们使用了不寻常的端口放置方式,但手术还是安全地完成了。患者出院时未出现任何并发症:结论:机器人辅助手术对解剖异常的患者安全有效。
{"title":"Robotic hemi-colectomy for ascending colon cancer in a patient with situs inversus totalis.","authors":"Junki Kato, Takahisa Hirokawa, Kenji Kobayashi, Moritsugu Tanaka, Masahiro Kimura","doi":"10.1186/s40792-024-01982-y","DOIUrl":"10.1186/s40792-024-01982-y","url":null,"abstract":"<p><strong>Background: </strong>Situs inversus totalis (SIT) is a rare congenital anomaly in which the thoracic and abdominal cavity structures are completely opposite to normal. Performing robot-assisted surgery in these patients is difficult because of these anomalies. A few reports have described robot-assisted surgery for rectal cancer in patients with SIT, but no reports to date have described robot-assisted surgery for colon cancer.</p><p><strong>Case presentation: </strong>A 74-year-old female presented with abdominal pain and was diagnosed with ascending colon cancer and SIT. We carefully planned the surgical procedure and performed robot-assisted hemi-colectomy. Although we used unusual port placement, the operation was performed safely. The patient was discharged without any complications.</p><p><strong>Conclusions: </strong>Robot-assisted surgery is safe and efficient for patients with anatomical anomalies.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1186/s40792-024-01963-1
Hiroaki Aizawa, Haruo Yamauchi, Masahiko Ando, Minoru Ono
Background: The simultaneous diagnosis of severe aortic regurgitation and aortic root pseudoaneurysm resulting from traffic injury is extremely rare. This report presents the case of a patient with Marfan syndrome who experienced aortic root pseudoaneurysm and subacute severe aortic regurgitation following a traffic accident.
Case presentation: A 64-year-old woman was diagnosed with Marfan syndrome 16 years ago and is undergoing ongoing follow-up at an outpatient clinic. Eight years previously, the patient underwent total arch replacement combined with J-graft open stent graft® (JGOS; Japan Lifeline Co., Tokyo, Japan) deployment for acute type A dissection. Five months before presentation, the patient suffered a left rib fracture in a traffic accident and received conservative management at a local hospital. The patient presented to the emergency room with worsening shortness of breath and orthopnea. Echocardiography revealed severe aortic regurgitation and moderate tricuspid regurgitation. Computed tomography revealed new-onset pseudoaneurysm at the aortic root. Surgical repair was successfully performed using a modified Bentall procedure with a bioprosthetic valve and tricuspid annuloplasty. Intraoperative findings revealed pseudoaneurysm with perforation of the right sinus of Valsalva. Although the left and right aortic valve leaflets were normal, the noncoronary leaflet exhibited a ruptured fibrous strand of a cusp fenestration, resulting in acute aortic regurgitation.
Conclusions: This case report highlights the rare occurrence of aortic root pseudoaneurysm and subacute aortic regurgitation following a traffic accident. In cases of blunt chest trauma, particularly in patients with Marfan syndrome, frequent examination is crucial to assess the possibility of posttraumatic aortic regurgitation and aortic injury.
背景:同时诊断出因交通事故导致的严重主动脉瓣反流和主动脉根部假性动脉瘤极为罕见。本报告介绍了一例因交通事故导致主动脉根部假性动脉瘤和亚急性重度主动脉瓣反流的马凡综合征患者的病例:一名 64 岁的妇女 16 年前被诊断患有马凡综合征,目前正在门诊接受随访。八年前,患者因急性 A 型夹层接受了全弓置换术,并结合 J-graft open stent graft® (JGOS; Japan Lifeline Co., Tokyo, Japan)。发病前五个月,患者在一次交通事故中左侧肋骨骨折,在当地医院接受了保守治疗。患者因呼吸急促和呼吸困难加重来到急诊室。超声心动图显示主动脉瓣严重反流,三尖瓣中度反流。计算机断层扫描显示主动脉根部新发假性动脉瘤。通过改良的 Bentall 手术,使用生物人工瓣膜和三尖瓣瓣环成形术,成功进行了手术修复。术中发现假性动脉瘤伴有右侧瓦尔萨尔瓦窦穿孔。虽然左、右主动脉瓣叶正常,但非冠状动脉瓣叶出现尖裂纤维股破裂,导致急性主动脉瓣反流:本病例报告强调了在交通事故后发生主动脉根部假性动脉瘤和亚急性主动脉瓣反流的罕见情况。对于钝性胸部创伤病例,尤其是马凡氏综合征患者,经常进行检查对于评估创伤后主动脉瓣反流和主动脉损伤的可能性至关重要。
{"title":"Posttraumatic aortic regurgitation and root pseudoaneurysm following blunt chest trauma: a case report.","authors":"Hiroaki Aizawa, Haruo Yamauchi, Masahiko Ando, Minoru Ono","doi":"10.1186/s40792-024-01963-1","DOIUrl":"10.1186/s40792-024-01963-1","url":null,"abstract":"<p><strong>Background: </strong>The simultaneous diagnosis of severe aortic regurgitation and aortic root pseudoaneurysm resulting from traffic injury is extremely rare. This report presents the case of a patient with Marfan syndrome who experienced aortic root pseudoaneurysm and subacute severe aortic regurgitation following a traffic accident.</p><p><strong>Case presentation: </strong>A 64-year-old woman was diagnosed with Marfan syndrome 16 years ago and is undergoing ongoing follow-up at an outpatient clinic. Eight years previously, the patient underwent total arch replacement combined with J-graft open stent graft<sup>®</sup> (JGOS; Japan Lifeline Co., Tokyo, Japan) deployment for acute type A dissection. Five months before presentation, the patient suffered a left rib fracture in a traffic accident and received conservative management at a local hospital. The patient presented to the emergency room with worsening shortness of breath and orthopnea. Echocardiography revealed severe aortic regurgitation and moderate tricuspid regurgitation. Computed tomography revealed new-onset pseudoaneurysm at the aortic root. Surgical repair was successfully performed using a modified Bentall procedure with a bioprosthetic valve and tricuspid annuloplasty. Intraoperative findings revealed pseudoaneurysm with perforation of the right sinus of Valsalva. Although the left and right aortic valve leaflets were normal, the noncoronary leaflet exhibited a ruptured fibrous strand of a cusp fenestration, resulting in acute aortic regurgitation.</p><p><strong>Conclusions: </strong>This case report highlights the rare occurrence of aortic root pseudoaneurysm and subacute aortic regurgitation following a traffic accident. In cases of blunt chest trauma, particularly in patients with Marfan syndrome, frequent examination is crucial to assess the possibility of posttraumatic aortic regurgitation and aortic injury.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Some congenital diaphragmatic hernias are diagnosed beyond 1 month. A late-presenting congenital diaphragmatic hernia shows a variety of clinical manifestations, and the preoperative clinical course is variable. We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as acute abdomen.
Case presentation: A 5-year-old boy was brought to our hospital because of herniation of the intestine into the left thoracic cavity, which was observed on radiography performed for abdominal pain. Enhanced computed tomography showed herniation of the small intestine and colon into the left thoracic cavity. Emergency laparoscopic surgery was performed based on the diagnosis of left diaphragmatic hernia. The entire small intestine and part of the colon herniated from the posterolateral defect of the diaphragm. We were able to retract the herniated intestine back into the abdomen but confirmed that the diaphragmatic defect and closure of the defect seemed to be technically challenging via laparoscopy; therefore, we converted the procedure to open laparotomy. The diaphragmatic defect was directly closed with interrupted sutures, and the thoracic cavity was degassed. Postoperatively, the left lung was found to be poorly expanded, but pulmonary hypoplasia was not evident in this case.
Conclusions: We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as abdominal pain. Late-presenting congenital diaphragmatic hernias present with a wide variety of symptoms; therefore, it is important to be reminded of these conditions and check chest radiographs in children presenting with acute or chronic respiratory or gastrointestinal symptoms of unknown etiology.
{"title":"A case of late-presenting congenital diaphragmatic hernia diagnosed at 5 years with acute abdomen.","authors":"Ryuta Masuya, Kazuhiko Nakame, Shun Munakata, Shinsuke Takeno, Atsushi Nanashima, Satoshi Ieiri","doi":"10.1186/s40792-024-01980-0","DOIUrl":"10.1186/s40792-024-01980-0","url":null,"abstract":"<p><strong>Background: </strong>Some congenital diaphragmatic hernias are diagnosed beyond 1 month. A late-presenting congenital diaphragmatic hernia shows a variety of clinical manifestations, and the preoperative clinical course is variable. We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as acute abdomen.</p><p><strong>Case presentation: </strong>A 5-year-old boy was brought to our hospital because of herniation of the intestine into the left thoracic cavity, which was observed on radiography performed for abdominal pain. Enhanced computed tomography showed herniation of the small intestine and colon into the left thoracic cavity. Emergency laparoscopic surgery was performed based on the diagnosis of left diaphragmatic hernia. The entire small intestine and part of the colon herniated from the posterolateral defect of the diaphragm. We were able to retract the herniated intestine back into the abdomen but confirmed that the diaphragmatic defect and closure of the defect seemed to be technically challenging via laparoscopy; therefore, we converted the procedure to open laparotomy. The diaphragmatic defect was directly closed with interrupted sutures, and the thoracic cavity was degassed. Postoperatively, the left lung was found to be poorly expanded, but pulmonary hypoplasia was not evident in this case.</p><p><strong>Conclusions: </strong>We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as abdominal pain. Late-presenting congenital diaphragmatic hernias present with a wide variety of symptoms; therefore, it is important to be reminded of these conditions and check chest radiographs in children presenting with acute or chronic respiratory or gastrointestinal symptoms of unknown etiology.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1186/s40792-024-01977-9
Yukihiro Hayatsu, Masaaki Naganuma, Hayate Nomura, Kazuhiro Yamaya, Masaki Hata
Background: Reoperation following aortic root replacement is associated with significantly high operative mortality. Etiologies related to infection are known to increase the operative mortality rate more than other etiologies. In such a clinical setting, a sutureless valve could lower the operative mortality by shortening the cardiac arrest and the operative time.
Case presentation: A 61-year-old male underwent emergent aortic root and total arch replacement with an open stent graft for acute type-A aortic dissection. A bioprosthetic valve was employed for aortic root replacement using the double-sewing ring technique. A fungal infection by Candida parapsilosis was postoperatively detected and improved with intravenous antifungal drug administration. However, he developed congestive heart failure one year later, and the blood cultures turned positive repeatedly for Candida parapsilosis. The prosthetic valve infection was suspected upon identifying vegetation on the bioprosthetic valve through transthoracic echocardiography. The computed tomography scan and operative findings confirmed that the infection was localized on the prosthetic valve. Consequently, the infected valve was removed without a vascular conduit, and a sutureless valve was implanted. The postoperative course was uneventful, without any evidence of recurrent fungal infection, and the patient was discharged on postoperative day 28.
Conclusions: Deploying a sutureless valve can facilitate a more straightforward and minimally invasive redo procedure. Preoperative computed tomography can predict the valve size, which is the key to implanting a sutureless valve successfully after the modified Bentall procedure.
背景:主动脉根部置换术后再次手术与极高的手术死亡率有关。与其他病因相比,与感染有关的病因会增加手术死亡率。在这种临床环境下,无缝合瓣膜可缩短心脏停搏和手术时间,从而降低手术死亡率:一名 61 岁的男性因急性 A 型主动脉夹层接受了急诊主动脉根部和全弓置换术,并使用了开放式支架移植。主动脉根部置换术采用了生物人工瓣膜,并使用了双缝环技术。术后发现了副丝状念珠菌的真菌感染,静脉注射抗真菌药物后病情有所好转。然而,一年后他出现了充血性心力衰竭,血液培养中副丝状念珠菌反复呈阳性。经胸超声心动图检查发现生物人工瓣膜上有植被,怀疑是人工瓣膜感染。计算机断层扫描和手术结果证实感染位于人工瓣膜上。因此,在没有血管导管的情况下切除了受感染的瓣膜,并植入了无缝合瓣膜。患者术后恢复顺利,没有任何真菌感染复发的迹象,并于术后第28天出院:结论:无缝合瓣膜的植入有助于更直接、更微创的重做手术。术前计算机断层扫描可以预测瓣膜的大小,这是改良Bentall术后成功植入无缝合瓣膜的关键。
{"title":"Utilizing a sutureless valve for prosthetic valve endocarditis after aortic root replacement.","authors":"Yukihiro Hayatsu, Masaaki Naganuma, Hayate Nomura, Kazuhiro Yamaya, Masaki Hata","doi":"10.1186/s40792-024-01977-9","DOIUrl":"10.1186/s40792-024-01977-9","url":null,"abstract":"<p><strong>Background: </strong>Reoperation following aortic root replacement is associated with significantly high operative mortality. Etiologies related to infection are known to increase the operative mortality rate more than other etiologies. In such a clinical setting, a sutureless valve could lower the operative mortality by shortening the cardiac arrest and the operative time.</p><p><strong>Case presentation: </strong>A 61-year-old male underwent emergent aortic root and total arch replacement with an open stent graft for acute type-A aortic dissection. A bioprosthetic valve was employed for aortic root replacement using the double-sewing ring technique. A fungal infection by Candida parapsilosis was postoperatively detected and improved with intravenous antifungal drug administration. However, he developed congestive heart failure one year later, and the blood cultures turned positive repeatedly for Candida parapsilosis. The prosthetic valve infection was suspected upon identifying vegetation on the bioprosthetic valve through transthoracic echocardiography. The computed tomography scan and operative findings confirmed that the infection was localized on the prosthetic valve. Consequently, the infected valve was removed without a vascular conduit, and a sutureless valve was implanted. The postoperative course was uneventful, without any evidence of recurrent fungal infection, and the patient was discharged on postoperative day 28.</p><p><strong>Conclusions: </strong>Deploying a sutureless valve can facilitate a more straightforward and minimally invasive redo procedure. Preoperative computed tomography can predict the valve size, which is the key to implanting a sutureless valve successfully after the modified Bentall procedure.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: With recent dramatic developments in chemotherapy, attempts to incorporate surgery into the multidisciplinary treatment of unresectable pancreatic ductal adenocarcinoma with metastasis (UR-M PDAC) have emerged. Maintenance therapy with olaparib after chemotherapy including a platinum-based regimen, which inhibits the poly ADP-ribose polymerase (PARP) involved in DNA repair, was approved for UR-M PDAC with positive BRCA mutations.
Case presentation: A 47-year-old male patient with a high carbohydrate antigen 19-9 (CA19-9) level was diagnosed with PDAC in the pancreatic tail. Staging laparoscopy revealed occult liver metastasis. Because BRCA2 mutation was confirmed, triple combination chemotherapy with SOXIRI (S-1/oxaliplatin/irinotecan) was introduced and continued for 16 weeks, followed by 14 weeks of olaparib. After that, CA19-9 was normalized, and no obvious liver metastases of any size could be seen on imaging studies during chemotherapy. Since staging laparoscopy after chemotherapy proved that the liver metastasis had disappeared, laparoscopic distal pancreatectomy was performed, and curative resection was completed. After adjuvant chemotherapy with olaparib for 12 months, the patient is alive 36 months from his initial diagnosis and 27 months postoperatively without recurrence.
Conclusion: We report a case of PDAC with liver metastasis and BRCA mutation-positivity who underwent conversion surgery and achieved long-term survival after irinotecan-based chemotherapy followed by maintenance therapy with olaparib.
{"title":"Conversion surgery for BRCA-mutated pancreatic ductal adenocarcinoma with liver metastasis treated with platinum-based chemotherapy followed by olaparib.","authors":"Takumi Funo, Daisuke Hashimoto, So Yamaki, Kazuki Matsumura, Hidetaka Miyazaki, Yuki Matsui, Denys Tsybulskyi, Nguyen Thanh Sang, Xu Yaolin, Sohei Satoi","doi":"10.1186/s40792-024-01975-x","DOIUrl":"10.1186/s40792-024-01975-x","url":null,"abstract":"<p><strong>Background: </strong>With recent dramatic developments in chemotherapy, attempts to incorporate surgery into the multidisciplinary treatment of unresectable pancreatic ductal adenocarcinoma with metastasis (UR-M PDAC) have emerged. Maintenance therapy with olaparib after chemotherapy including a platinum-based regimen, which inhibits the poly ADP-ribose polymerase (PARP) involved in DNA repair, was approved for UR-M PDAC with positive BRCA mutations.</p><p><strong>Case presentation: </strong>A 47-year-old male patient with a high carbohydrate antigen 19-9 (CA19-9) level was diagnosed with PDAC in the pancreatic tail. Staging laparoscopy revealed occult liver metastasis. Because BRCA2 mutation was confirmed, triple combination chemotherapy with SOXIRI (S-1/oxaliplatin/irinotecan) was introduced and continued for 16 weeks, followed by 14 weeks of olaparib. After that, CA19-9 was normalized, and no obvious liver metastases of any size could be seen on imaging studies during chemotherapy. Since staging laparoscopy after chemotherapy proved that the liver metastasis had disappeared, laparoscopic distal pancreatectomy was performed, and curative resection was completed. After adjuvant chemotherapy with olaparib for 12 months, the patient is alive 36 months from his initial diagnosis and 27 months postoperatively without recurrence.</p><p><strong>Conclusion: </strong>We report a case of PDAC with liver metastasis and BRCA mutation-positivity who underwent conversion surgery and achieved long-term survival after irinotecan-based chemotherapy followed by maintenance therapy with olaparib.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}