Journal of Surgical Case Reports最新文献

Bochdalek hernias arise from a developmental failure of the pleuroperitoneal canal to close, allowing abdominal contents to herniate into the thorax and compress the developing lung parenchyma. In rare cases, Bochdalek hernias may arise in adults and usually present with symptoms related to the hernia. Treatment consists of either open, laparoscopic, or robotic repair to close the defect. We present an unusual case in which an elderly patient presented with a large left-sided Bochdalek hernia containing both an incarcerated stomach and spleen following an uncomplicated robotic left nephrectomy. The hernia was successfully reduced and reconstructed with mesh via open abdominal repair with minimal complications. Repairing these hernias is challenging and, as in this case, required a complex reconstruction of diaphragm with mesh attachment to the ribs. Further reports on acute management of iatrogenic Bochdalek hernias in adults are warranted to better understand long-term post-operative outcomes and optimize management.

We present a pioneering case of a duplication of the common bile duct associated with agenesis of the dorsal pancreas in a 66-year-old man. After an episode of cholestatic jaundice, radiological investigations revealed complex vascular and biliary anomalies, redefining the therapeutic strategy. Instead of risky surgery, endoscopic biliopancreatic drainage resolved the symptoms. This rare and complex case offers new perspectives for the management of such anomalies, underlining the importance of a personalized, multidisciplinary approach.

Placement of a laparoscopic adjustable gastric band (LAGB) is a procedure used in bariatric surgery. Despite its decrease in popularity due to its high reoperation rate and suboptimal clinical response, managing the complications of LAGBs remains an important component of general and bariatric surgeons' work. Only two case studies describe return to theatre to excise scarring, which has continued to cause symptoms after LAGB removal. We report the case of a 72-year-old female presenting with persistent dysphagia nine years post removal of her LAGB. Laparoscopic excision of a fibrotic scar at the site of her previous LAGB resulted in complete resolution of her symptoms. This case report draws attention to the possibility of ongoing symptoms from scarring despite LAGB removal and how this can be managed. Further, it may suggest the importance of dividing a fibrotic scar found under a LAGB on removal.

An 84-year-old lady presented with 1 day history of sudden onset generalized abdominal pain, fevers, and peritonism. Computed tomography was suggestive of a mid-small bowel perforation associated with a distal ovoid soft tissue density structure without pneumobilia. An urgent laparotomy demonstrated two areas of jejunal diverticula necrosis and perforation associated with a 3 cm luminal mass in the proximal ileum, and proximal small bowel dilatation. A 100 cm small bowel resection incorporating the mass and perforated jejunal diverticula and primary stapled anastomosis were performed. Histopathology surprisingly demonstrated cholelithiasis consistent with a gallstone ileus and necrotic, perforated jejunal diverticulitis. The patient had no recurrent symptoms at 6 weeks follow-up. The authors report an uncommon and unexpected occurrence of small bowel diverticulitis perforation as a rare complication of gallstone ileus.

Mesonephric-like adenocarcinoma (MLA) is a rare and newly recognized subtype of ovarian and endometrial carcinomas, introduced in the 2020 World Health Organization Classification. This tumor likely originates from Müllerian-derived tissues and often mimics more common ovarian cancers, leading to frequent misdiagnosis. This case study details a 36-year-old woman who presented with urinary symptoms following a hysterectomy. Imaging revealed a significant left ovarian mass, initially misdiagnosed as carcinosarcoma. Pathological evaluation ultimately confirmed MLA, characterized by diverse architectural patterns and specific immunohistochemical markers. The patient underwent chemotherapy due to the locally advanced disease. This case highlights the diagnostic challenges of MLA and emphasizes the need for awareness among clinicians to prevent misdiagnosis. Given its aggressive nature and tendency to early recurrence, further research is essential for establishing standardized diagnostic criteria and treatment protocols for this rare malignancy.

Spinal dysraphism is the incomplete fusion of the neural arch, which can be seen as an occult or open neural tube defect. Meningoceles are a form of open neural tube defect characterized by cystic dilatation of the meninges containing cerebrospinal fluid without the involvement of neural tissue. Neurosurgical intervention is necessary in the newborn period since survival in advancing ages is often impossible. Therefore, meningoceles are rarely reported in adulthood. Here, we discussed a case of a 23-year-old female who presented with a meningocele in the lumbosacral area since birth, which had not been operated on. Surgical management and intraoperative findings are also discussed.

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy commonly associated with Epstein-Barr virus infection. While bone, liver, and lung metastases are well-documented, central nervous system (CNS) involvement, particularly spinal and meningeal metastases, is extremely rare. We present a 41-year-old male with nasal obstruction and diplopia, diagnosed with locally advanced NPC. After treatment with chemotherapy and intensity-modulated radiotherapy, the patient achieved excellent locoregional control. However, months later, he developed persistent back pain, and imaging revealed metastatic deposits in the spine and meninges. Histopathological analysis confirmed metastatic NPC despite resolution of the primary tumor. The patient received palliative radiotherapy and intrathecal chemotherapy, but disease progression highlighted the aggressive nature and poor prognosis of CNS metastases in NPC. This case underscores the need for advanced imaging, histological confirmation, and tailored therapies in managing rare NPC metastases, with long-term follow-up and innovative therapies critical for improving outcomes in advanced disease.

Isolated maxillary fungal pathologies involve a variety of clinical entities. These include invasive and non-invasive variants, where each has a unique pathogenesis, clinical manifestation, and approach for management. The aim of this case series is to investigate the several ways that fungal infections of the maxillary sinus might present, with the approach to diagnose and manage these conditions. Several discrete maxillary fungal diseases were studied, including fungal ball, acute fulminant invasive fungal sinusitis, allergic fungal sinusitis, and chronic invasive fungal sinusitis at a hospital. For every condition, several treatment options, clinical manifestations, and diagnostic strategies were investigated, which are greatly influenced by the degree of invasiveness as well as the patient's immunological status. Optimizing patient outcomes, especially in more aggressive types of the disease, requires an early and proper diagnosis. Understanding the various symptoms of these fungal infections is critical for a timely management.

Intervertebral thoracic disk herniation (TDH) is a rare occurrence and presents with a wide variety of symptoms. Errors in diagnosis are thought to be frequent due to the variable clinical presentations. We herein present two unusual cases of TDH presenting with abdominal pseudohernias, abdominal pain, and hypoesthesia along the T11-T12 dermatomes due to TDH at the same level. Both patients were managed conservatively, using a combination of analgesics and muscle relaxants. At 10 months of follow-up, the first patient reported complete resolution of abdominal bulge and no residual pain. The second patient reported residual paresthesia of T11-T12 dermatome, with non-limiting back pain and almost complete resolution of abdominal bulge. In conclusion, TDH may present with an abdominal wall bulge mimicking hernia, hypoesthesia, and radicular pain along the affected dermatome. Conservative management can be considered as first-line treatment.

This case report describes a 66-year-old male diagnosed with a giant retroperitoneal lymphangioma, presenting with an abdominal mass confirmed via magnetic resonance imaging (MRI). Laparoscopic surgery was successfully performed to excise the mass, with histopathological examination confirming the diagnosis. The patient's postoperative recovery was uneventful, with no signs of recurrence or metastasis observed at the three-month follow-up. This case underscores the feasibility and advantages of utilizing laparoscopic techniques in the management of large retroperitoneal lymphangiomas.