Journal of Surgical Case Reports最新文献

A 59-year-old male was admitted to hospital for workup of a high-grade atrioventricular block, where he had recurrent episodes of symptomatic bradycardia and hypotension. Imaging performed in anticipation of pacemaker insertion demonstrated a right-sided neck mass obliterating the jugular vein and compressing the carotid artery. He continued to have episodes of hemodynamic instability despite transvenous pacing. Decision was made to proceed with excisional biopsy and surgical debulking as a therapeutic attempt for suspected mass effect on the carotid sinus. Intraoperatively, there was gross vagus nerve invasion and no hemodynamic response to direct manipulation of the carotid sinus. The vagus nerve was transected to eliminate tumor-related parasympathetic neurotransmission. Pathology revealed a squamous cell carcinoma. The patient had radiographic and clinical improvement after treatment with chemoradiation. In a small number of similar cases, surgical resection of the tumor or intracranial section of the vagus nerve resulted in resolution of vasomotor symptoms, in conjunction with adjunctive treatments.

Stevens-Johnson syndrome and toxic epidermal necrosis (TEN) are used to describe a spectrum of acute mucocutaneous reactions primarily affecting the skin and mucous membranes, resulting in painful blisters and epidermal detachment. Swift diagnosis followed by management of the damaged epidermis is vital to prevent further infection, which if left untreated can become life-threatening. We report a case of TEN in a 42-year-old female who presented with 55% epidermal loss. Over the course of 41 days, the affected regions were treated with ovine forestomach matrix (OFM) grafts, which led to epithelial restoration of the lesions in 1-2 weeks with good functional and cosmetic outcomes. This case is the first documented use of OFM in the treatment of TEN lesions.

Acute appendicitis is the most frequent non-obstetrical surgical emergency during pregnancy. Anatomical displacement of the appendix and atypical symptoms complicate diagnosis, often delaying treatment and increasing maternal-fetal risks. A retrospective study of seven pregnant women treated for acute appendicitis at National Maternal and Child Health Center between 01 January 2023 and 31 December 2024. Epidemiological, clinical, diagnostic, therapeutic, and outcome data were analyzed using descriptive and inferential statistics. Mean age was 31 years (SD 7.2; range 21-42). Most cases occurred in the third trimester (57%). Four cases were recorded in 2023 and three in 2024. Farmers represented 57% of patients, workers 29%, and housewives 14%. Geographically, cases originated from six provinces, with Tboung Khmum contributing the highest number (29%). Consultation delay was longer in complicated appendicitis (mean 5.2 vs. 2.3 days, P < .05). Elevated C-Reactive Protein (CRP) (>50 mg/L) was significantly associated with advanced forms (χ² = 4.9, P = .027). Ultrasound confirmed appendicitis in 86% of cases, with atypical localization more frequent in the third trimester (P < .05). All patients underwent open surgery: McBurney (1 case), para-median (1 case), or modified McBurney (5 cases). Antibiotic regimens were tailored to severity. No maternal deaths occurred; one fetal death with premature delivery at 31 weeks was noted. Inferential analysis confirms that delayed consultation and elevated CRP are predictors of complicated appendicitis in pregnancy. Systematic ultrasonography and rapid intervention are essential to reduce morbidity.

To report a patient with incision suture rejection who was successfully treated using the innovative `8'-Shaped Deep-Layered suture method. A 33-year-old female patient presented with a severe suture rejection，the incision had dehisced and was unable to heal. The innovative suturing method was applied, involving the use of 2-0 absorbable sutures in an `8'-Shaped Deep-Layered suture method in the deep layers (muscle and subcutaneous tissue layers). Once the wound had healed, the sutures in the subcutaneous and muscle layers were completely removed in a single procedure from the outside of the skin. The `8'-Shaped Deep-Layered suture method is an effective innovative technique that overcomes the limitations of traditional suturing methods and effectively prevents incision suture rejection in patients.

Pyogenic granuloma (PG) is a benign lobular capillary proliferation of mucocutaneous tissues that usually arises in response to local irritation. It typically occurs on the gingiva, with extragingival sites such as the soft palate being very rare. We report a 69-year-old female on Apixaban who presented with sudden, profuse oropharyngeal bleeding. Examination revealed a friable, sessile erythematous mass on the right soft palate that was actively bleeding. The lesion was surgically excised with electrocautery under local anesthesia after appropriate management of anticoagulation. Histopathology confirmed lobular capillary hemangioma (PG). No recurrence was observed at follow-up. This case highlights the importance of prompt recognition and complete excision of PG in anticoagulated patients, as even small lesions may precipitate life threating hemorrhage.

Thymic hyperplasia is a benign condition in which the thymus enlarges in response to various stimuli. It occasionally occurs after chemotherapy for hematologic malignancies or in association with hyperthyroidism, but no previous reports describe cases in which multiple causes coexist. We present two cases of thymic hyperplasia occurring after chemotherapy for ovarian malignancy, both accompanied by concurrent hyperthyroidism. Case 1 was a 29-year-old woman with ovarian dysgerminoma, Stage IC1, and Case 2 was a 46-year-old woman with ovarian high-grade serous carcinoma, Stage IIIB; both patients received surgery and chemotherapy. Twelve and twenty-four months after completion of chemotherapy, computed tomography revealed an anterior mediastinal mass. Additional imaging showed no malignant features. They were diagnosed with thymic hyperplasia. Screening tests later identified hyperthyroidism in both women, and medical therapy was initiated. These cases highlight that thyroid function testing should be considered when thymic hyperplasia is detected in young female patients with malignancy.

Postoperative complications following elective laparoscopic cholecystectomy are rare but can have serious clinical consequences. Major complications include bleeding, bile duct injury, bile leakage, as well as bowel and vascular injuries. This case describes a 68-year-old patient in whom elective laparoscopic cholecystectomy was complicated by bile leakage and fatal retroperitoneal hemorrhage. Computed tomography was performed due to postoperative abdominal pain and revealed both intraperitoneal and retroperitoneal fluid. Diagnostic laparoscopy identified free intraperitoneal bile without active signs of bile leakage. Endoscopic retrograde cholangiopancreatography showed no evidence of bile leakage or choledocholithiasis. Computed tomography was obtained due to acute liver failure and demonstrated increased retroperitoneal fluid causing compression of the pancreatic head, duodenum, inferior vena cava, and porta hepatis. Anatomical variations of the hepatic arterial vasculature were also observed. The patient deceased due to multi-organ failure. Autopsy revealed massive retroperitoneal hemorrhage.

Imperforate hymen is a rare neonatal anomaly that can cause hydrocolpos and urinary obstruction. We report a newborn girl who presented on day three with abdominal distension and was found to have severe hydrocolpos from an imperforate hymen, leading to bilateral hydronephrosis but with preserved renal function. A hymenal incision effectively drained the accumulated secretions, resulting in rapid clinical improvement and complete resolution on follow-up imaging. Hydrocolpos occurs due to fluid accumulation behind a vaginal obstruction such as an imperforate hymen, and early recognition is essential to prevent complications like hydronephrosis and renal impairment. In this case, timely imaging and focused examination enabled prompt hymenotomy and immediate decompression. This highlights the importance of clinical suspicion, early imaging, and careful genital examination in female neonates. Neonatal imperforate hymen can cause significant hydrometrocolpos and hydronephrosis, emphasizing the need for early recognition and intervention.

Pseudoaneurysms are false aneurysms that develop following arterial wall injury and are characterized by a contained hematoma with turbulent flow. While commonly presenting with typical vascular symptoms, in rare cases, they can mimic soft tissue tumors, especially in chronic post-traumatic settings. We report the case of a 23-year-old male who presented with progressive swelling in the right thigh. Initially suspected to be an aggressive soft tissue malignancy. Chronic pseudoaneurysms may present with features mimicking malignant soft tissue tumors both clinically and radiologically, especially in the absence of classic signs like pulsatility or bruit. magnetic resonance imaging findings, particularly flow artifacts and absence of solid enhancement, and bedside Doppler ultrasound are key diagnostic tools. Misdiagnosis can lead to inappropriate and potentially dangerous interventions.

Pulmonary thromboendarterectomy (PTE) is the only curative treatment for chronic thromboembolic pulmonary hypertension. While combining PTE with a single cardiac procedure is well established, evidence for performing it with multiple major procedures is limited. We report a successful bilateral PTE with coronary artery bypass grafting, ascending aortic and hemiarch repair, patent foramen ovale closure, and left atrial appendage ligation. The patient recovered uneventfully, with marked functional and hemodynamic improvement at 6 months. This case demonstrates the safety and feasibility of complex cardiac surgery with PTE, underscoring the value of thorough, multidisciplinary preoperative planning.