Surgical Case Reports最新文献

Introduction: Nipple-sparing mastectomy (NSM) has been increasingly used therapeutically for breast cancer patients in whom the nipple-areolar complex is not involved, being associated with better esthetic results and QOL than skin-sparing mastectomy. Robotic nipple-sparing mastectomies (R-NSM) using da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) with immediate breast reconstruction (IBR) has been reported as a suitable surgical treatment for early breast cancers. We present a patient who underwent R-NSM and IBR, with excellent results. To our knowledge, this is the 1st reported case of R-NSM and IBR using the da Vinci SP surgical system in Japan.

Case presentation: We performed R-NSM for a 41-year-old Japanese woman with cTisN0M0 breast cancer. NSM and IBR to place a tissue expander (TE) into the post-pectoral pocket were performed using the da Vinci SP surgical system with the double bipolar method.

Conclusions: This is the 1st reported case of R-NSM using da Vinci SP surgical system in Japan.

Introduction: Fulminant amebiasis is a rare, potentially lethal condition caused by Entamoeba histolytica. It causes intestinal perforation and generalized peritonitis, and treatment requires an emergency operation and the administration of anti-amoebic drugs. Although E. histolytica infections are more commonly reported in men who have sex with men, we report a successfully treated case of fulminant amebiasis in a female commercial sex worker (CSW). This report presents a review of previously reported cases.

Case presentation: A 41-year-old woman with a 4-year history as a CSW presented to the emergency department with abdominal pain and diarrhea. She was admitted with acute colitis of unknown etiology. Stool tests performed after admission revealed E. histolytica, confirming the diagnosis of amoebic colitis, and treatment with metronidazole was initiated. On day 8 of treatment, the patient's respiratory status worsened. Abdominal CT revealed a perforation of the transverse colon, leading to the diagnosis of fulminant amebiasis. Emergency laparotomy including subtotal colectomy and ileostomy was performed. Postoperatively, the patient's condition gradually improved without complications, and she was discharged on POD 97 after finding housing. We reviewed and analyzed 52 reported cases of fulminant amebiasis, including the present case, treated with bowel resection in Japan since 2000. According to our literature review, the mortality rate was 28.8% and only 9.6% of patients were diagnosed with amebiasis at the time of hospital admission. Gastrointestinal perforation or necrosis requiring surgical intervention occurred after admission in 72.9% of patients. The mortality rate was 23.0% in patients who received anti-amoebic agents preoperatively compared to 30.7% in those who did not. Notably, the mortality rate reached 100% for patients where anti-amoebic agents were not administered, suggesting that such treatment is essential for survival (p = 0.005).

Conclusions: Here, we present a successfully treated case of fulminant amebiasis in a female CSW. Analysis of previously reported cases suggests that the early administration of anti-amoebic agents is important for survival.

Introduction: Bladder irritation after inguinal hernia repair is typically associated with mesh migration into the bladder. Notably, no previous cases have described bladder irritation symptoms in the absence of direct mesh penetration. This report presents a rare instance of bladder symptoms caused by a folded mesh, despite normal cystoscopic and cystographic findings.

Case presentation: A 49-year-old woman presented with urinary urgency, incontinence, and chronic right inguinal pain for 3 years, 8 years after undergoing inguinal hernia repair using the modified Kugel method. Although cystoscopy and cystography revealed no abnormalities, pelvic CT and MRI demonstrated a curved fatty tissue protruding toward the bladder. Laparoscopic exploration confirmed the presence of a folded mesh adjacent to the bladder wall. The mesh was successfully removed and a new mesh was placed, resulting in complete resolution of the urinary symptoms and pain without postoperative complications.

Conclusions: In patients presenting with bladder symptoms after inguinal hernia repair, mechanical irritation of the bladder wall by mesh should be considered-even when cystoscopic and radiographic findings are normal.

Introduction: Hereditary antithrombin deficiency is a rare congenital disorder associated with an increased risk of venous thromboembolism, particularly during high-risk situations such as surgery. Effective perioperative anticoagulation management is critical to prevent thromboembolic complications in these patients.

Case presentation: A 55-year-old female with a history of deep vein thrombosis and hereditary antithrombin deficiency presented with an anterior mediastinal tumor. Imaging findings suggested a benign cystic lesion; however, malignancy could not be completely excluded. A perioperative management strategy involving recombinant human antithrombin and heparin therapy was employed to safely perform uniportal robotic-assisted thymic cyst resection via a 4-cm incision in the right 5th intercostal space. Postoperative assessment, including clinical monitoring and follow-up imaging, confirmed the absence of thromboembolic complications. Histopathological examination revealed a benign thymic cyst.

Conclusions: This case highlights the importance of individualized perioperative anticoagulation management in patients with hereditary antithrombin deficiency undergoing thoracic surgery. The combination of recombinant human antithrombin and heparin therapy provided effective anticoagulation, allowing successful surgical intervention without thromboembolic events. Establishing standardized protocols for the management of such high-risk patients is essential for improving surgical safety and outcomes.

Introduction: Pectus excavatum (PE) is the most common anterior chest wall deformity, but surgical intervention during infancy is rarely indicated. In patients with complex congenital heart disease (CHD), however, PE may severely compromise mediastinal capacity, particularly after repeated sternotomies. Although delayed sternal closure is a standard approach to address postoperative hemodynamic instability, in cases where chest wall deformity directly compresses the heart, definitive thoracic reconstruction may be required.

Case presentation: We report a 9-month-old boy with right atrial isomerism, single atrium, single ventricle, and total anomalous pulmonary venous connection (TAPVC). After initial TAPVC repair with pulmonary artery banding at 2 months of age, he developed progressive PE. At reoperation for pulmonary venous stenosis release and pulmonary artery re-banding, correction of mediastinal rotation returned the enlarged heart to the midline. Attempts at chest closure resulted in abrupt elevation of central venous pressure and systemic hypotension due to direct cardiac compression by the sternum and costal cartilages. Temporary skin-only closure was performed. Definitive thoracic reconstruction was undertaken 48 hours later using a modified Rehbein technique with a bioabsorbable poly-L-lactic acid (PLLA) mesh plate, molded into a convex shape and fixed anterior to the sternum. This approach increased mediastinal volume and allowed stable chest closure. Postoperatively, right phrenic nerve palsy required noninvasive ventilatory support for 3 weeks. The patient recovered and was discharged 2 months later in good condition.

Conclusions: This case demonstrates that in infants with complex CHD, severe PE may render chest closure impossible, leading to life-threatening hemodynamic compromise. Thoracic reconstruction using an absorbable PLLA mesh plate provided temporary but effective external fixation, securing mediastinal space without impairing growth. This growth-sparing strategy may represent a valuable salvage option when conventional closure fails in pediatric cardiac surgery.

Introduction: Neuroblastoma is commonly seen in children younger than 5 years but is extremely rare in adults. There are only 23 reported cases of mediastinal neuroblastoma in adults, and no standard treatment strategy has been established.

Case presentation: A 79-year-old man was referred to our hospital for the investigation of an abnormal shadow observed on a routine chest radiograph. CT revealed a 5.5 × 5.0-cm mass in the anterior mediastinum, and fluorodeoxyglucose-PET demonstrated increased fluorodeoxyglucose uptake. Surgical resection was performed to obtain a definitive diagnosis and local control. Histopathological examination confirmed that the mass was a poorly differentiated neuroblastoma with invasion into the surrounding mediastinal fat. Postoperative radiotherapy was administered. The patient remains alive without recurrence at more than 5 years after surgery.

Conclusions: Neuroblastoma arising in the anterior mediastinum of adults is extremely rare and the long-term prognosis remains unclear. Complete resection followed by radiotherapy may contribute to prolonged disease-free survival in selected adult patients.

Introduction: Autoimmune neutropenia (AIN) is a rare disease that causes neutropenia due to autoantibodies directed against neutrophils. Neutropenia is associated with an increased risk of infection, such as surgical site infection or febrile neutropenia. To our knowledge, however, there are few reports of surgical or neoadjuvant chemotherapeutic treatments for colorectal cancer with AIN. Herein, we present a case with AIN undergoing multidisciplinary treatment of cecal cancer and metachronous liver metastases.

Case presentation: A 74-year-old woman with AIN presented to our hospital with epigastric pain lasting for 3 weeks. Abdominal CT showed obstructive cecal cancer and swollen regional lymph nodes. She had been under observation for primary AIN in the hematology department in our institution. The blood test revealed white blood cell count of 2300/μL, neutrophil count of 19.4%, and thus absolute neutrophil count of 446/μL. Granulocyte-colony stimulating factor (G-CSF; filgrastim 75 μg) was administered to lower the risk of infectious complications before surgery. After the absolute neutrophil count levels increased sufficiently, laparoscopic ileocecal resection was performed. Pathological findings showed T3N1aM0, pStage IIIB (UICC 8th edition), HER2 score 0, and a RAS codon 12S mutation. Six months after curative surgery, multiple liver metastases appeared. A total of 8 cycles of mFOLFOX6 with bevacizumab, combined with G-CSF (filgrastim 75 μg) were administered. After preoperative chemotherapy, the patient underwent right anterior sectionectomy and partial resection of segment 6. She was uneventful in the postoperative course. Throughout the perioperative period and chemotherapy, no infectious complications were observed.

Conclusions: The administration of G-CSF to prevent neutropenia allowed the patient with AIN to safely undergo multidisciplinary treatment.

Introduction: Thyroid angiosarcoma (TAS) is an extremely rare and highly aggressive cancer, representing less than 1% of all sarcomas. Typically diagnosed in individuals aged 50-80, with a higher incidence in women, TAS has a poor prognosis due to its tendency to metastasize, leading to a low 5-year survival rate. Due to its rarity, standardized treatment approaches are lacking, often involving a combination of surgery, chemotherapy, and radiation. This report presents TAS in a Japanese male.

Case presentation: A 78-year-old male with pre-existing conditions presented with a 30-year history of a slow-growing thyroid tumor that exhibited rapid enlargement 4 months prior to surgery. Initial fine-needle aspiration cytology was no malignancy. Examinations revealed a firm, poorly mobile 10 cm mass in the anterior neck, and left pleural effusion. Notably, papules developed at the aspiration site and progressively enlarged. Preoperative imaging indicated a malignant thyroid tumor, prompting a right thyroid lobectomy with resection of anterior neck muscles and overlying skin. Histological analysis confirmed a highly hemorrhagic angiosarcoma with infiltration into surrounding tissues. Immunohistochemical findings supported the diagnosis of TAS. A comprehensive genomic profiling testing yielded no specific therapeutic recommendations. Paclitaxel therapy was initiated 2 months after surgery, resulting in the shrinking of pulmonary nodules and the decreasing left pleural effusion. The patient subsequently died from septic shock due to a urinary tract infection 5 months after starting chemotherapy, without evidence of cervical recurrence or neutropenia during treatment.

Conclusions: This case highlights the perioperative management of a rare primary TAS. In the absence of established treatment guidelines, surgical resection followed by paclitaxel administration could be a potential therapeutic strategy to control disease progression. An accumulation of case reports is needed to better understand this aggressive malignancy and to facilitate the development of optimized therapeutic strategies.

Introduction: There are few reports of treatment strategies for ascending colon cancer after total gastrectomy. We report a case of intracorporeal anastomosis was performed for ascending colon cancer after total gastrectomy with Roux-en-Y reconstruction.

Case presentation: A 70-year-old man was referred to our institution due to a primary complaint of blood stool. A colonoscopy showed a Type 2 tumor near the hepatic fold of the ascending colon. The clinical diagnosis was ascending colon cancer. He had a history of open total gastrectomy (Roux-en-Y, retrocolic route) and cholecystectomy for gastric cancer in his 40s. Laparoscopic right hemicolectomy with intracorporeal anastomosis was performed. To perform an extracorporeal anastomosis, it was necessary to release adhesions between the reconstructed jejunum and the left-sided transverse colon and mobilize the splenic flexure. If the reconstructed jejunum was damaged, there will be a possibility of redoing the esophago-jejunostomy. By performing an intracorporeal anastomosis, surgery was accomplished with minimal mobilization and without requiring adhesion release between the reconstructed jejunum and the transverse colon. The patient's postoperative course was uneventful, and he was discharged at 8 days postoperatively.

Conclusions: Intracorporeal anastomosis may represent a useful and safe option when performing laparoscopic right colectomy in patients with a history of total gastrectomy.

Introduction: Thyroglossal duct cysts (TGDCs) are the most common congenital midline neck masses encountered in pediatric populations and are usually located anterior to the hyoid bone, making them readily identifiable by both superficial ultrasonography and skin palpation. However, intraoperative identification can be challenging in cases in which the cyst is located on the dorsal side of the hyoid bone or near the base of the tongue, which increases the risk of incomplete excision or rupture. This report describes the pediatric case of a TGDC located between the hyoid bone and the foramen cecum that was safely excised under intraoperative transoral ultrasonography (TOUS) guidance to facilitate identification of the entire cyst.

Case presentation: An 11-year-old boy was referred for evaluation of an incidentally detected midline neck mass. Neck ultrasonography and MRI revealed the presence of a 7-mm cyst located between the hyoid bone and the foramen cecum, consistent with the characteristics of a TGDC, and a Sistrunk procedure was scheduled. Intraoperatively, the cyst was successfully identified using TOUS with a small convex probe, which provided a stable and continuous view from the oral side throughout the dissection. A transverse cervical incision was made, the central hyoid bone was removed, and the cyst was visualized on its dorsal side under TOUS guidance. En bloc resection of the entire cyst and tract was completed without rupture, and histopathology confirmed the diagnosis of TGDC. The postoperative course was uneventful, and no recurrence was observed at the 4-month follow-up assessment.

Conclusions: The use of TOUS enabled real-time visualization of a deep TGDC structure that was difficult to identify via superficial ultrasonography after neck incision. Thus, TOUS can serve as a reliable guide during the Sistrunk procedure, reducing the risk of cyst rupture and incomplete resection, thereby enabling safe and complete excision. The experience of this case highlights the potential benefit of using TOUS in managing deep TGDCs located on the dorsal side of the hyoid bone, especially in pediatric patients.