Surgery Journal最新文献

Phyllodes is a rare tumor found exclusively in females. It can be classified into benign, intermediate, or malignant variety based on the aggressive nature of the disease. With adequate preoperative clinical assessment combined with histopathology and radiological investigations the adequate treatment strategy can be formulated to avoid future recurrences. Complete androgen insensitivity syndrome (CAIS) is associated with a genotypic male, which can be confirmed by karyotyping, with phenotypic female characteristics. The present case is the first case of bilateral breast phyllodes tumor in a patient with CAIS. Preoperative assessment was suggestive of bilateral phyllodes tumor with bilateral gonads in the inguinal region which was confirmed to be testis postoperatively on histopathological analysis. A brief case report with review of literature is presented.

Introduction  Hip arthroscopy is a rising surgical technique due to the increase in hip diseases, especially femoroacetabular impingement. One of the several complications related to such procedures is heterotopic ossifications (HO). The aim of this study is to describe the prevalence of HO after hip arthroscopy in a series of patients with femoroacetabular impingement and to compare its preoperative and intraoperative variables with a matched control group of patients without HO. Methods  All patients who underwent hip arthroscopy for femoroacetabular impingement between 2010 and 2017 with a minimum follow-up of 2 years were included in this analysis. Radiographic examinations were recorded to select cases with HO. A case-control analysis was performed comparing preoperative and intraoperative variables between cases with HO and a matched control group without HO. Results  A total of 700 cases were included in the analysis. HO was found in 15 (2.14%) of subjects. Cases with HO showed more severe cartilage injuries, less cam morphology ratio, and a higher proportion of partial labrectomies than the control group. No significant differences were observed in preoperative hip pain or function between groups. Conclusions  The prevalence of HO after hip arthroscopy in subjects with femoroacetabular impingement was 2.14%. Cases with HO had more severe cartilage injuries, lower ratio of cam morphology, and higher proportion of partial labrectomies than the control cases without HO. Level of Evidence  Level III.

Pheochromocytoma is a rare catecholamine-secreting tumor derived from chromaffin cells. The diagnosis is usually suggested by its classic history, presence of a strong family history, or discovery of an incidental mass on imaging in an asymptomatic patient. Hemorrhage into an occult pheochromocytoma is a rare complication with ∼1 to 2 per 100,000 individuals diagnosed annually. We report a case of a 29-year-old woman, who presented with abdominal pain (with no other significant history) due to a right hemorrhagic pheochromocytoma. Computed tomographic imaging and magnetic resonance imaging revealed the source of retroperitoneal hemorrhage as the right adrenal mass. They lacked the typical features of a pheochromocytoma which was eventually proven by the biochemical tests. The patient underwent preoperative stabilization with α and β adrenergic receptor blockers for 7 days following which laparoscopic adrenalectomy was performed successfully with an uneventful postoperative period. This is the eighth reported case in literature managed laparoscopically. Histopathology confirmed it as pheochromocytoma. The treacherous and deceptive nature of pheochromocytomas and its hemorrhage make it crucial to detect and treat it promptly; otherwise, it will almost certainly be fatal from cardiovascular complications or metastasis.

Objective  Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand. Methods  The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses. Results  A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%, p -value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days. Conclusion  Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.

Background  Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the alimentary tract. They are usually manifested by GI bleeding. Case Presentation  A 53-year-old male patient was admitted to the hospital for elective inguinal hernia repair. The patient did not have any history of GI symptoms in the past. A day after open inguinal hernia repair, the patient developed recurrent attacks of hematemesis resulting in hemodynamic instability and admission to the intensive care unit. An upper GI endoscopy identified a small bleeding gastric lesion. After multiple failed attempts to control the bleeding endoscopically, an emergency exploratory laparotomy was performed. An unexpected large fungating bleeding gastric mass was detected. The mass measured approximately 40 × 30 cm, and multiple peritoneal deposits were also discovered. A wedge resection of the anterior gastric wall along with the mass was performed. Histopathology revealed a high-grade (G2) GIST. Discussion  GISTs appear in variable sizes and may lead to a variety of complications including abdominal pain, GI obstruction, and bleeding. This case highlights the unexpected presentation and sudden bleeding of a large GIST in a totally asymptomatic patient undergoing elective hernia surgery. It also illustrates that GIST can be asymptomatic and grow to large sizes before developing clinical manifestations. Conclusion  The case report highlights a common complication of GIST with unexpected timing, immediately after routine hernia surgery.

Introduction  This study analyzes barriers to the adoption of emergency laparoscopy (EL), safety, and accessibility in a low-resource setting of a low- and middle-income country (LMIC). Methods  In this prospective observational study, patients with blunt trauma abdomen (BTA) who required exploration were included and divided into two groups-open exploration (open surgery [OSx]) and laparoscopic exploration (laparoscopic surgery [LSx]). Data were compiled and analyzed. Results  Out of 94 BTA patients, 66 required exploration, and the rest were managed conservatively. Out of 66 patients, 42 were in OSx and 24 were in LSx, reason for not selecting LSx was the surgeon's preference for OSx in 26 patients and the lack of availability of operation theater (OT) slots in 16 patients. LSx even after indication was less likely if patients had preoperative evidence of perforation peritonitis. Conclusion  Lack of resources (OT availability and trained personnel) are barriers to the adoption of emergency LSx in low-resource settings.

Background  Neurosurgery residency became one of the most competitive specialties in the medical field worldwide, which is increasing with time in contrast to the limited positions. Therefore, the requirements for the program have increased. There are different criteria for each program, which are determined by specific factors. It has become increasingly important for medical students to be aware of the factors that affect their acceptance into the program. There was a lack of data regarding the factors that contribute to the selection of neurosurgery residents in Oman Methods  A questionnaire composed of 14 questions was conducted, using the SurveyMonkey Web site, among neurosurgeons in Oman which was distributed to the five hospitals that have neurosurgery departments in Oman. SPSS software was used in the analysis of the collected data. Results  Forty-four participants responded to the survey. Ninety-five percent of them answered all the questions. Out of all participants, only two were female participants. Standardized international exam scores, such as the United State Medical Licensing Examination and Medical Council of Canada Qualifying Examination, ranked as the most important factor with a percentage of 44, followed by interview performance with a percentage of 33. While the least important factor was the age of applicants, which 46% of the participants ranked 8. Conclusion  Most of the participants agreed that standardized exams are the most important factor in the selection of neurosurgery residents followed by interview performance, although there was no significant statistical difference between the two.

Retained surgical foreign bodies are unanticipated events culminating from inadvertent operating room errors and may cause severe medical and legal problems between the patient and the doctor. Here, we report detecting a surgical instrument fragment 13 years after an open abdominal hysterectomy in a quadragenarian during her evaluation of a month-old complaint of lower abdominal and right thigh pain. A computed tomography scan of the abdomen demonstrated a radio-opaque linear foreign body traversing the right obturator foramen with extension into the pelvis cranially and the adductor compartment of the right thigh caudally. The metallic foreign body, identified as a fragmented handle of a uterine tenaculum forceps with a slender sharp-tip hook, could be removed laparoscopically from the pelvis after a diagnostic laparoscopy, preventing significant complications. The minimally invasive approach enabled a smooth recovery, and the patient could go home on the second postoperative day.

Introduction  Primary synovial sarcoma (SS) of the prostate is the rarest variety of prostate sarcoma. The first documented and confirmed case of SS of the prostate was published by Iwasaki et al in the year 1999; since then, only a few cases of primary SS of the prostate have been published in English literature. Case Report  We report a unique case of primary SS in a young patient who presented with acute urinary retention and underwent emergency suprapubic catheterization, and on evaluation was diagnosed with primary SS of the prostate. Patient was managed with radical cystoprostatectomy and resection of the anterior wall of rectum infiltrated by the tumor with bilateral pelvic lymph node dissection and adjuvant chemotherapy. Patient died after 2 months of surgery. Conclusion  Primary SS of the prostate is a rare disease and important clinical entity to be included in differential diagnosis of acute urinary retention in young patients. It is associated with high local recurrence and poor prognosis, which warrants multidisciplinary approach of treatment.

Hemangioma is a common tumor accounting for 8 to 10 % of benign neoplasm. However, hemangioma arising from blood vessels is rare and even rarer if the vessel involved is anterior jugular vein (AJV). AJV hemangioma can be confused with jugular phlebectasia, laryngocele, thyroglossal cyst, simple cyst, or other vascular malformation of same origin. They should be considered in differential of midline/paramedian neck swelling. Surgical resection is the treatment of choice whenever possible, and even allows for histopathological evaluation and a confirmatory diagnosis. Being an extremely rare entity, there is paucity in literature about it and more publications are required to extend understanding and eliminate existing doubts about the pathology. We present an extremely rare case of AJV hemangioma that presented as a painless midline swelling and was initially confused as simple neck cyst on radiological assessment. We believe that this is the second only case of AJV hemangioma reported in English literature.