Surgical Case Reports最新文献_第6页

Surgical indication and management of obstructive colonic metastasis from primary lung adenocarcinoma: report of a case and review of the literature 原发性肺腺癌梗阻性结肠转移的手术指征和治疗：一例病例报告和文献综述

IF 0.8 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-18 DOI: 10.1186/s40792-024-02016-3

Mai Watanabe, Shingo Tsujinaka, Tomoya Miura, Yoshihiro Sato, Yoh Kitamura, Kentaro Sawada, Atsushi Mitamura, Hiroto Sakurai, Noriko Kondo, Kazuhiro Takami, Kuniharu Yamamoto, Toru Nakano, Yu Katayose, Naruo Yoshimura, Chikashi Shibata

Colonic metastasis from lung cancer is very rare and is typically associated with poor prognosis. Herein, we report the case of a patient who achieved intermediate-term survival using a multimodal treatment approach, including chemotherapy, immunotherapy, radiotherapy, and surgical resection for obstructive colonic metastasis from primary lung adenocarcinoma. A woman in her 50s presented with anemia and a positive fecal occult blood test. Computed tomography revealed a tumor in the right upper lobe of the lung with mediastinal lymphadenopathy and wall thickening in the transverse colon. Colonoscopy revealed a stricture involving 50% of the colonic lumen. Biopsy revealed a poorly differentiated adenocarcinoma positive for CK-7 and TTF-1, very focally positive for napsin A, and negative for CK-20 and CDX-2. Furthermore, positron emission tomography/CT (PET/CT) showed a high maximum standardized uptake value (SUVmax) of 8.2 in the iliac bone. Based on these findings, the patient was diagnosed with primary lung adenocarcinoma with simultaneous metastasis to the transverse colon and iliac bone (cT4N3M1c, cStage IVB). After receiving first-line chemotherapy with atezolizumab, pemetrexed, and carboplatin, the tumors shrank after 4 courses. Subsequently, the patient received maintenance therapy with atezolizumab and pemetrexed. However, the tumor enlarged after 10 courses. Second-line chemotherapy with docetaxel and ramucirumab (3 courses) failed to achieve tumor reduction. Colonoscopy revealed an impassable colonic tumor. Nineteen months after diagnosis, surgery was planned for imminent intestinal obstruction. We determined that the colonic tumor was resectable, because laparoscopic exploration revealed no other metastases. The tumor was resected by partial colectomy with ileocolonic anastomosis. The postoperative course was uneventful. Pathological examination revealed a resection margin that was negative for malignancy, and the histological type was consistent with metastatic lung adenocarcinoma. The patient then received nab-paclitaxel therapy; however, she developed symptoms of superior vena cava syndrome after 3 courses. The patient received palliative irradiation (30 Gy/10 fr) followed by nivolumab. She soon developed a solitary brain metastasis, and stereotactic irradiation was planned. After 3 courses of nivolumab, the metastasis was reduced significantly, and stereotactic brain irradiation was canceled. The lung tumor and mediastinal lymphadenopathy gradually shrank, and the patient survived for 13 months after surgery without disease progression. In this case, surgical resection of colonic metastasis from primary lung adenocarcinoma may have contributed to the short-term prognosis as a bridge-to-next available multimodal treatment.

肺癌结肠转移非常罕见，通常预后较差。在此，我们报告了一例采用多模式治疗方法（包括化疗、免疫治疗、放疗和手术切除）治疗原发性肺腺癌阻塞性结肠转移的患者，该患者获得了中期生存。一名 50 多岁的妇女因贫血和大便潜血试验阳性就诊。计算机断层扫描显示右肺上叶有肿瘤，纵隔淋巴结病变，横结肠壁增厚。结肠镜检查发现，50%的结肠管腔出现狭窄。活组织检查发现，分化较差的腺癌，CK-7 和 TTF-1 阳性，napsin A 局灶阳性，CK-20 和 CDX-2 阴性。此外，正电子发射断层扫描/CT（PET/CT）显示，髂骨的最大标准化摄取值（SUVmax）高达 8.2。根据这些结果，患者被诊断为原发性肺腺癌，并同时转移至横结肠和髂骨（cT4N3M1c，c IVB 期）。在接受了阿特珠单抗、培美曲塞和卡铂的一线化疗后，肿瘤在 4 个疗程后缩小。随后，患者接受了阿替珠单抗和培美曲塞的维持治疗。然而，10 个疗程后肿瘤增大。多西他赛和雷莫芦单抗的二线化疗（3 个疗程）未能使肿瘤缩小。结肠镜检查发现结肠肿瘤无法通过。确诊后19个月，因即将发生肠梗阻而计划进行手术。我们确定结肠肿瘤可以切除，因为腹腔镜检查没有发现其他转移灶。我们通过部分结肠切除术和回结肠吻合术切除了肿瘤。术后恢复顺利。病理检查显示切除边缘恶性程度为阴性，组织学类型符合转移性肺腺癌。患者随后接受了纳布-紫杉醇治疗，但三个疗程后出现了上腔静脉综合征症状。患者接受了姑息性照射（30 Gy/10 fr），随后又接受了 nivolumab 治疗。不久，她出现了单发脑转移瘤，于是计划进行立体定向照射。经过3个疗程的尼夫单抗治疗后，转移灶明显缩小，于是取消了脑立体定向照射。肺部肿瘤和纵隔淋巴结病变逐渐缩小，患者术后存活了13个月，病情未见进展。在本病例中，原发性肺腺癌结肠转移灶的手术切除可能有助于短期预后，是通往下一个可用的多模式治疗的桥梁。

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引用次数: 0

A case of refractory chylothorax due to an unenclosed esophageal hiatus after subtotal esophagectomy treated with lipiodol lymphangiography 一例食管次全切除术后因食管裂孔未闭合而导致的难治性乳糜胸，采用脂肪碘淋巴管造影术进行治疗

IF 0.8 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-11 DOI: 10.1186/s40792-024-02019-0

Koji Kaneda, Takeshi Miwa, Tomoyuki Okumura, Yoshihisa Numata, Mina Fukasawa, Toru Watanabe, Isaya Hashimoto, Norihito Naruto, Tsutomu Fujii

Chylothorax, a rare but serious complication following esophagectomy, can lead to dehydration, malnutrition, and even mortality. Surgical intervention is considered when conservative treatment is ineffective; however, in some refractory cases, the cause of chylothorax remains unclear. We report a case of refractory chylothorax caused by abdominal chyle leakage into the pleural space via an unenclosed esophageal hiatus. A 66-year-old man was diagnosed with advanced esophageal squamous cell carcinoma. The patient underwent robot-assisted thoracoscopic subtotal esophagectomy in the prone position with retrosternal gastric tube reconstruction following neoadjuvant chemotherapy. The thoracic duct was ligated and resected because of tumor invasion. Chylothorax and chylous ascites were observed 2 weeks after surgery but did not improve despite conservative management with medications and drainage. Lymphoscintigraphy through the inguinal lymph node showed tracer accumulation in the fluid in both the abdominal and pleural spaces. Lipiodol lymphangiography revealed abdominal lymphoid leakage, but no leakage was detected from the thoracic duct or mediastinum. We considered that the chylothorax was caused by chylous ascites flowing into the pleural space via an unenclosed esophageal hiatus, and we performed surgical intervention. Laparotomy revealed abdominal chyle leakage and a fistula at the esophageal hiatus with the inflow of ascites into the thoracic cavity. Lipiodol lymphangiography was additionally performed for treating abdominal lymphorrhea after surgery, and resulted in the improvement of the chylothorax and ascites. The patient was discharged with no recurrence of chylothorax or chylous ascites. Refractory chylothorax can occur due to chylous ascites flowing into the pleural space via an unenclosed esophageal hiatus. When the site of chylothorax leakage is unclear, the possibility of inflowing chylous ascites via the unenclosed esophageal hiatus should be explored. Esophageal hiatus closure and lipiodol lymphangiography could be effective in treating refractory chylothorax of unknown cause after esophagectomy.

乳糜胸是食管切除术后一种罕见但严重的并发症，可导致脱水、营养不良甚至死亡。当保守治疗无效时，就会考虑手术干预；然而，在一些难治性病例中，造成乳糜胸的原因仍不明确。我们报告了一例因腹腔糜烂通过未闭合的食管裂孔渗入胸膜腔而导致的难治性乳糜胸。一名 66 岁的男性被诊断出患有晚期食管鳞状细胞癌。患者在接受新辅助化疗后，在俯卧位接受了机器人辅助胸腔镜下食管次全切除术，并进行了胸骨后胃管重建。由于肿瘤侵犯，胸导管被结扎并切除。术后两周出现了乳糜胸和乳糜腹水，尽管通过药物和引流进行了保守治疗，但情况并未好转。腹股沟淋巴结淋巴管造影显示，腹腔和胸腔积液中均有示踪剂积聚。脂肪碘淋巴管造影显示腹腔淋巴管渗漏，但未发现胸导管或纵隔渗漏。我们认为，乳糜胸是由乳糜腹水经未闭合的食管裂孔流入胸膜腔引起的，因此进行了手术治疗。腹腔镜手术显示腹腔糜烂渗漏，食管裂孔处有瘘管，腹水流入胸腔。术后为治疗腹腔淋巴结肿大，又进行了脂肪碘淋巴管造影，结果改善了乳糜胸和腹水。患者出院后未再出现乳糜胸或乳糜腹水。难治性乳糜胸可能是由于乳糜腹水通过未闭合的食管裂孔流入胸膜腔所致。如果不清楚乳糜胸腔渗漏的部位，则应探讨乳糜腹水通过未闭合的食管裂孔流入胸腔的可能性。食管裂孔闭合术和脂肪碘淋巴管造影术可有效治疗食管切除术后原因不明的难治性乳糜胸。

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引用次数: 0

Laparoscopic transabdominal preperitoneal repair for a patient with Laugier’s and inguinal hernia 腹腔镜经腹腹膜前修补术治疗一名劳吉尔氏疝和腹股沟疝患者

IF 0.8 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-11 DOI: 10.1186/s40792-024-02017-2

Masaaki Yamamoto, Atsushi Takeno, Reishi Toshiyama, Shinji Tokuyama, Kenji Kawai, Yusuke Takahashi, Kenji Sakai, Naoki Hama, Takeshi Kato, Motohiro Hirao

Laugier’s hernia is a very rare atypical femoral hernia and is challenging to diagnose preoperatively. Herein, we report a rare case of inguinal and Laugier’s hernias treated with laparoscopic transabdominal preperitoneal repair. A 63-year-old man was admitted to our hospital with right groin swelling for 4 years. Computed tomography revealed an indirect inguinal hernia with protrusion of the small intestine. The preoperative diagnosis was right indirect inguinal hernia; Laugier’s hernia was unknown. The patient underwent laparoscopic transabdominal preperitoneal repair. During the surgery, part of the perivesical adipose tissue penetrated the lacunar ligament. It was located medial to the typical site of a femoral hernia. Thus, Laugier's hernia was diagnosed. Finally, laparoscopic transabdominal preperitoneal repair was performed for Laugier's hernia and inguinal hernia. The postoperative course was good, without recurrence. To our knowledge, this is the first reported case of inguinal and Laugier’s hernia treated with laparoscopic transabdominal preperitoneal repair. Surgeons should be mindful that inguinal hernias can occur concurrently with other types of hernias, such as femoral hernias, including atypical variants like Laugier's hernia. Additionally, they should actively consider laparoscopic approaches such as transabdominal preperitoneal for femoral hernias. These approaches are beneficial for precise diagnosis, confirming the presence of other hernias, and simultaneously treating all coexisting inguinal hernias.

劳吉尔疝是一种非常罕见的非典型股疝，术前诊断非常困难。在此，我们报告了一例罕见的腹股沟疝和 Laugier疝的腹腔镜经腹腹膜前修补术。一名 63 岁的男性因右腹股沟肿胀 4 年入院。计算机断层扫描显示其腹股沟间接疝伴有小肠突出。术前诊断为右侧间接腹股沟疝，Laugier疝不明。患者接受了腹腔镜经腹腹膜前修补术。手术中，部分腹股沟周围脂肪组织穿透了裂孔韧带。它位于股疝典型部位的内侧。因此，诊断为劳吉尔疝。最后，对 Laugier 疝和腹股沟疝进行了腹腔镜经腹腹膜前修补术。术后疗效良好，没有复发。据我们所知，这是第一例通过腹腔镜经腹腹膜前修补术治疗腹股沟疝和劳吉尔疝的病例。外科医生应该注意，腹股沟疝气可能与其他类型的疝气（如股疝气）同时发生，包括像 Laugier 疝气这样的非典型变异。此外，他们应积极考虑采用腹腔镜方法，如经腹腹膜前法治疗股疝。这些方法有利于精确诊断，确认是否存在其他疝气，并同时治疗所有并存的腹股沟疝气。

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引用次数: 0

Advanced esophagogastric junction mixed neuroendocrine–non-neuroendocrine neoplasm with long-term recurrence-free survival 长期无复发生存的晚期食管胃交界混合型神经内分泌-非神经内分泌肿瘤

IF 0.8 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-11 DOI: 10.1186/s40792-024-02011-8

Shunsuke Takenaka, Toshikatsu Tsuji, Kenta Doden, Saki Hayashi, Mari Shimada, Hiroto Saito, Daisuke Yamamoto, Koichi Okamoto, Hiroko Ikeda, Hideki Moriyama, Jun Kinoshita, Yasunori Sato, Itasu Ninomiya, Noriyuki Inaki

Mixed neuroendocrine–non-neuroendocrine neoplasm (MiNEN) is a rare malignant gastrointestinal tumor. The prognosis of patients with MiNEN is poor because of the high frequency of recurrence and metastases. We report a case of esophagogastric junction MiNEN (EGJ-MiNEN) with a long-term recurrence-free survival of 5.5 years. A 58-year-old male patient underwent thoracoscopic esophagectomy for esophagogastric junction adenocarcinoma. The patient’s postoperative course was uneventful. R0 resection was achieved, and the pathological diagnosis of the surgical specimen was pT3N2M0 Stage IIIA (according to the Japanese Classification of Gastric Cancer, 4th edition). Based on the pathology results, the patient was treated with postoperative adjuvant therapy with oral S-1. The patient maintained recurrence-free survival for 5.5 years postoperatively. However, 6 years postoperatively, the patient visited our department with cachexia. Computed tomography (CT) revealed a large amount of ascites and pleural effusion. He rapidly developed a poor circulatory and respiratory status and died 16 days after admission. An autopsy revealed severe bloody ascites and pleural effusion, as well as numerous nodules on the pleura and mesentery. Immunohistochemistry of the nodules revealed positivity for chromogranin A, Synaptophysin A, neural cell adhesion molecule (NCAM or CD56), and insulinoma-associated protein 1 (INSM1). The specimen showed a mixture of adenocarcinoma and neuroendocrine cell carcinoma and was diagnosed as MiNEN. Retrospective immunostaining of the surgical specimen showed similar results, and we diagnosed the patient with recurrence of EGJ-MiNEN. MiNEN has a poor prognosis; however, in some cases, long-term recurrence-free survival is achieved with radical resection and adjuvant chemotherapy.

神经内分泌-非神经内分泌混合瘤（MiNEN）是一种罕见的恶性胃肠道肿瘤。由于复发和转移的频率很高，MiNEN 患者的预后很差。我们报告了一例食管胃交界处米网状细胞瘤（EGJ-MiNEN）患者，其长期无复发生存期为 5.5 年。一名 58 岁的男性患者因食管胃交界处腺癌接受了胸腔镜食管切除术。患者术后恢复顺利。手术标本的病理诊断为 pT3N2M0 IIIA 期（根据日本胃癌分类，第四版）。根据病理结果，患者接受了口服 S-1 的术后辅助治疗。患者术后 5.5 年无复发。然而，术后 6 年，患者因恶病质来我科就诊。计算机断层扫描（CT）显示大量腹水和胸腔积液。他的循环和呼吸状况迅速恶化，入院 16 天后死亡。尸检发现他有严重的血性腹水和胸腔积液，胸膜和肠系膜上有许多结节。结节的免疫组化显示嗜铬粒蛋白 A、突触素 A、神经细胞粘附分子（NCAM 或 CD56）和胰岛素瘤相关蛋白 1（INSM1）呈阳性。标本显示腺癌和神经内分泌细胞癌的混合体，被诊断为 MiNEN。手术标本的回顾性免疫染色显示了相似的结果，我们诊断患者为 EGJ-MiNEN 复发。米纳恩癌的预后较差，但在某些病例中，通过根治性切除和辅助化疗，可以获得长期无复发生存。

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引用次数: 0

Central pancreatectomy of the remnant pancreas without reconstruction after pancreatoduodenectomy 胰十二指肠切除术后未进行重建的中央残余胰腺切除术

IF 0.8 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-11 DOI: 10.1186/s40792-024-02018-1

Kinji Hirono, Kosei Takagi, Motohiko Yamada, Jiro Kimura, Tomokazu Fuji, Kazuya Yasui, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

There are several reports on the safety and feasibility of pancreatoduodenectomy (PD) without reconstruction of the small remnant pancreas. However, a few studies have explored central pancreatectomy (CP) for non-reconstructed small remnant pancreases after PD. This study presents a case of CP without pancreatic reconstruction after PD. A 58-year-old man with cerebral palsy underwent PD for distal cholangiocarcinoma. Three years postoperatively, a 12-mm tumor was detected in the remnant pancreatic body and diagnosed as a pancreatic neuroendocrine neoplasm. Surgical resection was performed, because the tumor was enlarged and chemotherapy resistant. The afferent loop with pancreatojejunostomy anastomosis was dissected, and CP, including pancreatojejunostomy anastomosis, was performed. Given the remnant pancreas was hard and atrophic, the pancreatic tail was transected using a stapler without reconstructing the small remnant pancreas. The patient experienced no postoperative complications including postoperative pancreatic fistula, and the endocrine function of the pancreas was preserved. We present a case of remnant pancreatic CP that did not require reconstruction after PD. Preservation of the small remnant pancreas without reconstruction during CP may be feasible to maintain endocrine function in select patients after PD.

关于不重建小残余胰腺的胰十二指肠切除术（PD）的安全性和可行性已有多篇报道。然而，只有少数研究探讨了胰十二指肠切除术（PD）后未重建小残余胰腺的中央胰腺切除术（CP）。本研究介绍了一例胰腺切除术后未重建胰腺的 CP 病例。一名 58 岁的脑瘫患者因远端胆管癌接受了腹腔镜手术。术后三年，在残余胰腺体中发现一个 12 毫米的肿瘤，诊断为胰腺神经内分泌肿瘤。由于肿瘤增大且对化疗耐药，患者接受了手术切除。切除了胰腺空肠吻合的传入襻，并进行了包括胰腺空肠吻合在内的胰腺切除术。鉴于残余胰腺坚硬且萎缩，使用订书机横断了胰腺尾部，但没有重建残余的小胰腺。患者术后未出现胰瘘等并发症，胰腺的内分泌功能也得以保留。我们介绍了一例在胰腺切除术后无需重建的残余胰腺 CP。保留小的残余胰腺而不在胰腺切除术中进行重建，可能对部分胰腺切除术后患者保持内分泌功能是可行的。

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引用次数: 0

Successful resection of a rectal gastrointestinal stromal tumor using a transperineal approach: a case report 经会阴成功切除直肠胃肠道间质瘤：病例报告

IF 0.8 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-10 DOI: 10.1186/s40792-024-02007-4

Yoki Endo, Tatsunari Fukuoka, Shintaro Ozawa, Takemi Ishidate, Ken Yonemitsu, Yuki Seki, Hiroaki Kasashima, Yuichiro Miki, Mami Yoshii, Tatsuro Tamura, Masatsune Shibutani, Takahiro Toyokawa, Shigeru Lee, Kiyoshi Maeda

Rectal gastrointestinal stromal tumors (GISTs) complicate surgical approaches because of their anatomical position. We herein report a patient with rectal GIST on the anterior wall of the lower rectum, hat was successfully resected using a transperineal approach. This report describes a unique case of a 73-year-old man who was diagnosed with rectal GIST on the anterior wall of the lower rectum. The tumor was located within 3 cm of the anal verge, a location that would require highly invasive surgery. A transperineal approach was planned to preserve the anal function. Under general anesthesia, the patient was placed in a lithotomy position and a Mercedes-Benz incision was made in the perineum. Excision of the tumor was performed. The post-operative course was uneventful, and the patient remained free from recurrence. This case highlights the importance of performing minimally invasive and safe surgery. With some surgical refinements, a transperineal approach may be an option for surgical procedures in patients with rectal GIST on the anterior wall of the lower rectum.

直肠胃肠道间质瘤（GIST）因其解剖位置而使手术方法复杂化。我们在此报告了一名直肠下段前壁直肠 GIST 患者，该患者采用经会阴入路成功切除了肿瘤。本报告描述了一例独特的病例，患者是一名 73 岁的男性，被诊断为直肠下段前壁直肠 GIST。肿瘤位于肛门边缘 3 厘米以内，这个位置需要进行高创手术。为了保留肛门功能，计划采用经会阴入路手术。在全身麻醉的情况下，患者取平卧位，在会阴部做了一个奔驰切口。手术切除了肿瘤。患者术后恢复顺利，没有复发。该病例强调了微创和安全手术的重要性。经过一些手术改进，经会阴入路可能是直肠下段前壁直肠 GIST 患者手术治疗的一种选择。

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引用次数: 0

A parasitic leiomyoma of the sigmoid mesentery with schwannoma-like image findings 乙状结肠系膜上的寄生性肌瘤，伴有分裂瘤样影像发现

IF 0.8 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-10 DOI: 10.1186/s40792-024-02015-4

Koki Fujiwara, Chisato Takagi, Michio Sato, Toshiki Tokuda, Masato Tomita, Atsunori Sugita, Kohei Furuya, Makoto Jinushi, Toshiyuki Mitsuya, Nobutoshi Ando

Parasitic leiomyoma (PL) consists of uterine fibroids separate from the uterus that grow in extrauterine tissues such as the peritoneum and mesenterium. The diagnosis of PL requires a thorough medical history of laparoscopic myomectomies using a morcellator and the identification of typical magnetic resonance imaging (MRI) findings as uterine fibroids. Imaging diagnosis of PL is occasionally difficult when PL degenerates in various ways, owing to atypical findings on computed tomography (CT) and MRI. A 29-year-old woman with a history of laparoscopic myomectomy visited a local hospital with lower abdominal pain. A mesenteric tumor on the sigmoid mesentery was suspected on MRI, and she was referred to our hospital. CT scan showed strong early contrast uptake in the center of the tumor, and MRI T2-weighted images showed high signals at the tumor margins and low signals in the center, suggesting a schwannoma. PL was also part of the differential diagnosis because of the patient’s history of laparoscopic myomectomy. With a preoperative diagnosis of a sigmoid colon mesenteric tumor undeniably of malignant origin, laparoscopic resection of the sigmoid mesenteric tumor was performed. Histopathological examination revealed it to be a PL. We report a case of PL of the sigmoid mesentery with schwannoma-like findings on imaging that was treated laparoscopically. PL is sometimes difficult to distinguish from schwannomas because of the variety of imaging findings, such as uterine fibroids. PL should be considered in the differential diagnosis of mesenteric tumors following laparoscopic myomectomies, even if it does not show typical imaging findings, such as uterine fibroids.

寄生性子宫肌瘤（PL）是指生长在腹膜和肠系膜等子宫外组织中、与子宫分离的子宫肌瘤。要确诊腹腔镜子宫肌瘤，需要详细了解使用碎肌机进行腹腔镜子宫肌瘤剔除术的病史，并确定典型的磁共振成像（MRI）结果为子宫肌瘤。由于计算机断层扫描（CT）和核磁共振成像（MRI）检查结果不典型，当PL以各种方式退化时，PL的影像诊断有时会很困难。一名曾做过腹腔镜子宫肌瘤切除术的 29 岁女性因下腹疼痛到当地医院就诊。核磁共振检查怀疑她的乙状结肠系膜上有一个肠系膜肿瘤，于是她被转诊到我院。CT 扫描显示肿瘤中心早期造影剂摄取较强，MRI T2 加权图像显示肿瘤边缘高信号，中心低信号，提示为裂孔瘤。由于患者有腹腔镜子宫肌瘤切除术的病史，因此PL也是鉴别诊断的一部分。由于术前诊断乙状结肠肠系膜肿瘤无疑是恶性的，因此进行了腹腔镜乙状结肠肠系膜肿瘤切除术。组织病理学检查显示该肿瘤为 PL。我们报告了一例乙状结肠肠系膜鳞状上皮细胞瘤病例，该病例的影像学检查结果类似于分裂瘤，并通过腹腔镜进行了治疗。PL有时很难与子宫肌瘤等分裂瘤相鉴别，因为其影像学表现多种多样。腹腔镜肌瘤剔除术后肠系膜肿瘤的鉴别诊断中应考虑到PL，即使它没有典型的影像学表现，如子宫肌瘤。

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引用次数: 0

Laparoscopic sleeve gastrectomy as a bridge to colorectal cancer surgery for obese patients: a case report. 腹腔镜袖带胃切除术作为肥胖患者通往结直肠癌手术的桥梁：病例报告。

IF 0.7 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-09 DOI: 10.1186/s40792-024-02012-7

Yume Minagawa, Manabu Amiki, Keisuke Yuki, Kazuharu Watanabe, Ichitaro Mochizuki, Yasuhiro Ishiyama, Yoshiaki Hara, Kazuhiro Narita, Yasumitsu Hirano

Background: Severe obesity greatly influences the difficulty of colorectal cancer surgery and has been reported to prolong operative time, increase the rate of laparotomy, and elevate increase postoperative complications. We investigated the efficacy of laparoscopic sleeve gastrectomy (LSG) for preoperative weight loss to ensure safe colorectal cancer surgery.

Case presentation: A 51 year-old female with a body mass index of 43.5 kg/m² was referred to our hospital due to a positive fecal occult blood test. She was diagnosed as having a laterally spreading tumor of the cecum by colonoscopy. Endoscopic submucosal dissection was attempted but proved difficult due to the size of the lesion and its proximity to the appendiceal orifice. We planned bariatric surgery prior to colorectal surgery, and she underwent LSG without any complications. Seven months after the LSG, she had lost 30.7 kg, and her final preoperative body mass index was 27.8 kg/m². Single-incision laparoscopic ileocecal resection was then performed safely. The pathological diagnosis was adenocarcinoma in adenoma of the cecum, TisN0M0.

Conclusion: LSG was effective in reducing visceral fat and making it possible to perform safe surgery for colorectal cancer in a severely obese patient.

背景：严重肥胖极大地影响了结直肠癌手术的难度，有报道称严重肥胖会延长手术时间、增加开腹率、增加术后并发症。我们研究了腹腔镜袖带胃切除术（LSG）术前减重的疗效，以确保结直肠癌手术的安全：一名体重指数为 43.5 kg/m2 的 51 岁女性因大便潜血试验呈阳性转诊至我院。通过结肠镜检查，她被诊断为盲肠横向扩散肿瘤。我们尝试在内镜下进行粘膜下剥离，但由于病灶较大且靠近阑尾孔，手术难度很大。我们计划在结直肠手术前进行减肥手术，她在没有任何并发症的情况下接受了LSG手术。LSG 术后七个月，她的体重减轻了 30.7 公斤，术前体重指数为 27.8 公斤/平方米。随后，她安全地接受了单切口腹腔镜回盲部切除术。病理诊断为盲肠腺瘤中的腺癌，TisN0M0：结论：LSG 能够有效减少内脏脂肪，使重度肥胖患者能够安全地接受结直肠癌手术。

{"title":"Laparoscopic sleeve gastrectomy as a bridge to colorectal cancer surgery for obese patients: a case report.","authors":"Yume Minagawa, Manabu Amiki, Keisuke Yuki, Kazuharu Watanabe, Ichitaro Mochizuki, Yasuhiro Ishiyama, Yoshiaki Hara, Kazuhiro Narita, Yasumitsu Hirano","doi":"10.1186/s40792-024-02012-7","DOIUrl":"10.1186/s40792-024-02012-7","url":null,"abstract":"Background: Severe obesity greatly influences the difficulty of colorectal cancer surgery and has been reported to prolong operative time, increase the rate of laparotomy, and elevate increase postoperative complications. We investigated the efficacy of laparoscopic sleeve gastrectomy (LSG) for preoperative weight loss to ensure safe colorectal cancer surgery.Case presentation: A 51 year-old female with a body mass index of 43.5 kg/m2 was referred to our hospital due to a positive fecal occult blood test. She was diagnosed as having a laterally spreading tumor of the cecum by colonoscopy. Endoscopic submucosal dissection was attempted but proved difficult due to the size of the lesion and its proximity to the appendiceal orifice. We planned bariatric surgery prior to colorectal surgery, and she underwent LSG without any complications. Seven months after the LSG, she had lost 30.7 kg, and her final preoperative body mass index was 27.8 kg/m2. Single-incision laparoscopic ileocecal resection was then performed safely. The pathological diagnosis was adenocarcinoma in adenoma of the cecum, TisN0M0.Conclusion: LSG was effective in reducing visceral fat and making it possible to perform safe surgery for colorectal cancer in a severely obese patient.","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"211"},"PeriodicalIF":0.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11383887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154974","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}

引用次数: 0

Robot-assisted laparoscopic hepatectomy for hepatocellular carcinoma with Fontan-associated liver disease: a world-first case report. 机器人辅助腹腔镜肝切除术治疗伴有丰坦相关性肝病的肝细胞癌：世界首例报告。

IF 0.7 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-09 DOI: 10.1186/s40792-024-02014-5

Takuma Ishikawa, Shinji Itoh, Takeo Toshima, Shohei Yoshiya, Yuki Bekki, Norifumi Iseda, Yuriko Tsutsui, Ichiro Sakamoto, Kotaro Abe, Tomoharu Yoshizumi

Background: Fontan-associated liver disease (FALD) encompasses hepatic complications following the Fontan procedure, ranging from fibrosis to hepatocellular carcinoma (HCC). Despite advancements in surgical techniques and perioperative care, robot-assisted laparoscopic hepatectomy (RALH) for HCC in patients with FALD has not been previously reported owing to concerns about the Fontan circulation.

Case presentation: We present the first case of RALH for recurrent HCC in a 45-year-old man after the Fontan procedure. The preoperative evaluation confirmed good cardiac function. The procedure involved meticulous monitoring and management of central venous pressure and was successfully completed with minimal blood loss. Postoperative recovery was uneventful. With thorough preoperative cardiac assessment and close collaboration between cardiologists and anesthesiologists, RALH can be safely performed in selected patients with FALD.

Conclusions: Even if a patient has a history of FALD, RALH can be safely performed in selected patients under appropriate conditions.

背景：丰坦相关肝病（FALD）包括丰坦手术后的肝脏并发症，从肝纤维化到肝细胞癌（HCC）。尽管手术技术和围手术期护理取得了进步，但由于对丰坦循环的担忧，以前还没有报道过用机器人辅助腹腔镜肝切除术（RALH）治疗FALD患者的HCC：我们介绍了首例在丰坦手术后对一名45岁男性进行RALH治疗复发性HCC的病例。术前评估证实患者心功能良好。手术过程中对中心静脉压进行了细致的监测和管理，并在失血量极少的情况下顺利完成。术后恢复顺利。通过全面的术前心脏评估以及心脏科医生和麻醉科医生之间的密切合作，RALH可以安全地为选定的FALD患者实施：结论：即使患者有 FALD 病史，在适当的条件下，RALH 也可以安全地为选定的患者实施。

{"title":"Robot-assisted laparoscopic hepatectomy for hepatocellular carcinoma with Fontan-associated liver disease: a world-first case report.","authors":"Takuma Ishikawa, Shinji Itoh, Takeo Toshima, Shohei Yoshiya, Yuki Bekki, Norifumi Iseda, Yuriko Tsutsui, Ichiro Sakamoto, Kotaro Abe, Tomoharu Yoshizumi","doi":"10.1186/s40792-024-02014-5","DOIUrl":"10.1186/s40792-024-02014-5","url":null,"abstract":"Background: Fontan-associated liver disease (FALD) encompasses hepatic complications following the Fontan procedure, ranging from fibrosis to hepatocellular carcinoma (HCC). Despite advancements in surgical techniques and perioperative care, robot-assisted laparoscopic hepatectomy (RALH) for HCC in patients with FALD has not been previously reported owing to concerns about the Fontan circulation.Case presentation: We present the first case of RALH for recurrent HCC in a 45-year-old man after the Fontan procedure. The preoperative evaluation confirmed good cardiac function. The procedure involved meticulous monitoring and management of central venous pressure and was successfully completed with minimal blood loss. Postoperative recovery was uneventful. With thorough preoperative cardiac assessment and close collaboration between cardiologists and anesthesiologists, RALH can be safely performed in selected patients with FALD.Conclusions: Even if a patient has a history of FALD, RALH can be safely performed in selected patients under appropriate conditions.","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"210"},"PeriodicalIF":0.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11383910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154975","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}

引用次数: 0

A case of preoperative embolization for a giant hypervascular pancreatic serous cystic neoplasm in pancreaticoduodenectomy. 一例在胰十二指肠切除术中对巨大的高血管性胰腺浆液性囊性瘤进行术前栓塞的病例。

IF 0.7 Q4 SURGERY

Surgical Case Reports

Pub Date : 2024-09-06 DOI: 10.1186/s40792-024-02009-2

Takahito Matsuyoshi, Naoki Ikenaga, Kohei Nakata, Daisuke Okamoto, Takashi Matsumoto, Toshiya Abe, Yusuke Watanabe, Noboru Ideno, Keizo Kaku, Nao Fujimori, Kenoki Ohuchida, Yasuhiro Okabe, Yoshinao Oda, Kousei Ishigami, Masafumi Nakamura

Background: Preoperative vascular embolization is an effective strategy for managing meningiomas, neck paragangliomas, renal cell carcinomas, and bone metastasis by reducing the intraoperative bleeding volume and operation time. Although hypervascular tumors also occur in the pancreas, preoperative embolization for these tumors is not commonly practiced. We herein present a case of a giant serous cystic neoplasm (SCN) of the pancreas with significant arterial vascularity that was managed with preoperative interventional radiology and subsequently resected via pancreaticoduodenectomy.

Case presentation: A 60-year-old man presented with an 8-cm hypervascular tumor located at the head of the pancreas, identified as an SCN on pathologic examination. The tumor had increased by 13 mm over 5 years, necessitating surgical intervention. Computed tomography revealed a substantial blood supply to the tumor from the dorsal pancreatic artery and gastroduodenal artery, both branches of the superior mesenteric artery. To mitigate the risk of severe intraoperative bleeding from this giant hypervascular tumor, branches of the dorsal pancreatic artery and gastroduodenal artery were embolized using metallic coils and further secured using a gelatin sponge 1 day prior to pancreatectomy. During the laparotomy, the tumor appeared to have decreased in size, likely because of reduced distension and congestion. Despite significant adhesions to surrounding tissues secondary to prolonged compression and inflammation, the pancreaticoduodenectomy was completed successfully in 5 h and 15 min with blood loss of 763 mL. The patient was discharged on postoperative day 15 without complications.

Conclusions: Preoperative arterial embolization for hypervascular pancreatic tumors might control the risk of massive intraoperative bleeding, contributing to a favorable postoperative outcome. Utilizing interventional radiology for preoperative inflow control is one of the beneficial strategies for pancreatectomy in patients with a giant SCN.

背景：术前血管栓塞是治疗脑膜瘤、颈部副神经节瘤、肾细胞癌和骨转移瘤的有效策略，可减少术中出血量和手术时间。虽然高血管肿瘤也发生在胰腺，但对这些肿瘤进行术前栓塞治疗并不常见。我们在此介绍一例具有明显动脉血管的胰腺巨大浆液性囊性肿瘤（SCN）的病例，该病例通过术前介入放射学处理，随后通过胰十二指肠切除术进行了切除：一名 60 岁的男性因胰腺头部 8 厘米的高血管肿瘤就诊，病理检查确定为 SCN。5 年来，肿瘤增大了 13 毫米，因此必须进行手术治疗。计算机断层扫描显示，肿瘤的大量血液供应来自胰背动脉和胃十二指肠动脉，这两条动脉都是肠系膜上动脉的分支。为了降低这个巨大高血管肿瘤造成术中大出血的风险，在胰腺切除术前一天，使用金属线圈栓塞了胰背动脉和胃十二指肠动脉的分支，并用明胶海绵进一步固定。在开腹手术中，肿瘤似乎缩小了，这可能是由于胀大和充血程度降低。尽管长时间的压迫和炎症导致周围组织严重粘连，但胰十二指肠切除术仍在 5 小时 15 分钟内顺利完成，失血量为 763 毫升。患者于术后第 15 天出院，未出现并发症：结论：术前动脉栓塞治疗高血管性胰腺肿瘤可控制术中大量出血的风险，有助于获得良好的术后效果。利用介入放射学进行术前血流控制是巨型胰腺肿瘤患者胰腺切除术的有利策略之一。

{"title":"A case of preoperative embolization for a giant hypervascular pancreatic serous cystic neoplasm in pancreaticoduodenectomy.","authors":"Takahito Matsuyoshi, Naoki Ikenaga, Kohei Nakata, Daisuke Okamoto, Takashi Matsumoto, Toshiya Abe, Yusuke Watanabe, Noboru Ideno, Keizo Kaku, Nao Fujimori, Kenoki Ohuchida, Yasuhiro Okabe, Yoshinao Oda, Kousei Ishigami, Masafumi Nakamura","doi":"10.1186/s40792-024-02009-2","DOIUrl":"10.1186/s40792-024-02009-2","url":null,"abstract":"Background: Preoperative vascular embolization is an effective strategy for managing meningiomas, neck paragangliomas, renal cell carcinomas, and bone metastasis by reducing the intraoperative bleeding volume and operation time. Although hypervascular tumors also occur in the pancreas, preoperative embolization for these tumors is not commonly practiced. We herein present a case of a giant serous cystic neoplasm (SCN) of the pancreas with significant arterial vascularity that was managed with preoperative interventional radiology and subsequently resected via pancreaticoduodenectomy.Case presentation: A 60-year-old man presented with an 8-cm hypervascular tumor located at the head of the pancreas, identified as an SCN on pathologic examination. The tumor had increased by 13 mm over 5 years, necessitating surgical intervention. Computed tomography revealed a substantial blood supply to the tumor from the dorsal pancreatic artery and gastroduodenal artery, both branches of the superior mesenteric artery. To mitigate the risk of severe intraoperative bleeding from this giant hypervascular tumor, branches of the dorsal pancreatic artery and gastroduodenal artery were embolized using metallic coils and further secured using a gelatin sponge 1 day prior to pancreatectomy. During the laparotomy, the tumor appeared to have decreased in size, likely because of reduced distension and congestion. Despite significant adhesions to surrounding tissues secondary to prolonged compression and inflammation, the pancreaticoduodenectomy was completed successfully in 5 h and 15 min with blood loss of 763 mL. The patient was discharged on postoperative day 15 without complications.Conclusions: Preoperative arterial embolization for hypervascular pancreatic tumors might control the risk of massive intraoperative bleeding, contributing to a favorable postoperative outcome. Utilizing interventional radiology for preoperative inflow control is one of the beneficial strategies for pancreatectomy in patients with a giant SCN.","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"208"},"PeriodicalIF":0.7,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141120","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}

引用次数: 0