Journal of Surgical Case Reports最新文献

Neuroendocrine tumors (NETs) are notably rare and frequently arise from the gastrointestinal tract. Generally asymptomatic, NETs uncommonly result in acute abdominal pain. We present a case of known metastatic NET manifesting as acute-on-chronic mesenteric ischemia due to the involvement of the superior mesenteric artery (SMA) and vein (SMV). A 63-year-old female with metastatic NET presented with acute-onset abdominal pain. The patient was hemodynamically stable but uncomfortable appearing with significant pain. Imaging demonstrated decreased enhancement of several small bowel loops within the right lower quadrant concerning for bowel ischemia with a mesenteric mass encasing the SMA and SMV. Surgical intervention revealed a nonviable loop of small bowel. Second-look laparotomy was performed with viable remaining bowel, and an ileocolic anastomosis was successfully created. Acute-onset abdominal pain in a patient with NET warrants urgent. Mesenteric ischemia, while rare, should not be overlooked, as timely diagnosis and intervention are imperative.

In this report, we discuss a rare case of pleomorphic adenoma in the accessory parotid gland of a 39-year- old male, which is generally a difficult tumor to manage because of the danger of facial scarring and nerve injury from external incisions. A minimally invasive trans-oral surgical technique was used, resulting in a successful resection without the usual complications, demonstrating a promising option that focuses on cosmetic and functional benefits. The importance of complete preoperative evaluations is emphasized, as is the possibility for broader applicability with additional study, establishing the technique's efficacy to improve outcomes for patients in similar circumstances.

A 57-year-old male presented with dyspnea and an enlarged cardiac silhouette on a chest X-ray. Further evaluation with contrast-enhanced computed tomography revealed a giant heterogeneous mediastinal mass, ~8.9 × 7.3 × 12.2 cm, with peripheral calcifications. Surgical resection was performed via a left thoracotomy approach using the left fifth intercostal space. Cardiopulmonary bypass was established through the femoral vessels for safer and more controlled resection. The tumor, contiguous with the left atrium, was successfully excised using two Endo GIA staplers. Pathological examination confirmed the diagnosis of schwannoma. This case demonstrates that the left thoracotomy approach with cardiopulmonary bypass and the use of Endo GIA staplers is a feasible and effective option for resecting large, well-defined cardiac schwannomas.

A giant inguinal hernia is a rare clinical presentation in patients refusing hernia repair for different reasons during a long period. The appearance is remarkable, and the preoperative preparation and the surgery itself might be challenging. They can present in an emergency (hernia incarceration) or elective setting. Most of the patients are male, but exclusions exist. This is a rare case of a female patient with a giant inguinal hernia left untreated for 40 years.

Obturator schwannomas are rare and often misdiagnosed as intraperitoneal pelvic masses. The optimal surgical approach for their resection is unclear. This study presents a case demonstrating the safe use of robotics for resecting a benign pelvic schwannoma and reviews the literature on robotic cases. Here, a 40-year-old woman with right lower quadrant pain underwent imaging, revealing a 4.6 × 3.3 × 3.6 cm pelvic mass. She had a robotic-assisted laparoscopic excision, with pathology confirming a benign schwannoma. Complete tumor resection is the gold standard. The use of minimally invasive robotic-assisted surgery is increasing due to improved visualization, efficient movement, and safety, making it a viable option for resecting obturator schwannomas.

Angiomyolipoma is a benign mesenchymal tumour of kidney that consists of adipose tissue, muscle cells and blood vessels. Renal angiomyolipomas represent almost one percent of all renal tumours. We reported a case of a 50-year-old woman complaining of mild abdominal discomfort with no other symptoms and no remarkable medical history. Clinical examination was inconclusive and no lump was palpable in abdomen. Ultrasonography raised the suspicion of existence of a large, homogeneous, hyperechoic tissue mass arising from right kidney. Abdominal computed tomography scan suggested the presence of giant angiomyolipoma of right kidney. The histopathological examination confirmed the diagnosis of renal angiomyolipoma. The patient underwent open simple nephrectomy to remove the tumour without any complications. We documented a rare case of retroperitoneal angiomyolipoma with extrusion of fat content from the renal hilum breaching the cortex as peculiarity which presented just as mild abdominal discomfort.

Compound pheochromocytoma refers to a rare adrenal tumor that includes neuroblastic components and is a rare catecholamine-producing tumor from chromaffin cells, typically found in the adrenal medulla. It usually presents with symptoms like tachycardia, headache, and intermittent diaphoresis, although its clinical manifestations can vary. Diagnosis involves biochemical studies and imaging such as catecholamines, metanephrines, CT scans, and positron emission tomography (PET). The surgical management is the definitive, being the laparoscopic approach of choice in most cases. This case report discusses a 45-year-old male who presented with tachycardia and palpitations, diagnosed with left pheochromocytoma exhibiting neuroblastoma differentiation, surgically treated through anterior laparoscopy without any trans-surgical complications and with low bleeding. Postoperative recovery was uneventful, and pathology confirmed the diagnosis. Timely diagnosis and surgical removal are crucial, with laparoscopy being the preferred approach for tumor resection.

Tonsillar marginal zone hyperplasia may mimic mucosa-associated lymphoid tissue lymphoma, a rare diagnosis in children. Histologically, both entities can demonstrate expansion of the marginal zone with disruption of follicular architecture. However, marginal zone hyperplasia may appear polyclonal by flow cytometry. We present two pediatric tonsillectomy cases with tonsillar marginal zone hyperplasia and discuss the diagnostic challenges this poses in the pediatric population. Both tonsillectomies demonstrated expansion of marginal zones with partial architectural effacement, and flow cytometric analysis of both cases detected lambda light chain restricted, CD20(bright) B cells without CD38. Authors have suggested that the lambda restricted B cells in this setting represent naïve, unmutated B cells with preferential, but polyclonal, lambda expression. Our cases are in line with this thought. While robust, BIOMED-2 primer PCR can show dominant IgK peaks, which may be misinterpreted. This presents a diagnostic pitfall in the workup of pediatric tonsils that community pathologists must consider.

A 73-year-old man was diagnosed with central serous chorioretinopathy (CSCR). He had atypical features including a normal indocyanine green angiography (ICG) and fundus fluorescein angiography (FFA), uncommon age group for initial diagnosis and a finding of intraretinal fluid. This case report is the first of our knowledge that exemplifies this type of unusual clinical presentation for CSCR.

We report the laparoscopic removal of a foreign body that was embedded in the abdominal wall. To the best of our knowledge, this is the first reported case of a foreign body in the abdominal wall being laparoscopically removed. A 27-year-old man working at a forging factory presented to our hospital with abdominal pain. He reported that three hours before presentation, a metal fragment came flying from an operating power hammer and penetrated his lower right abdomen. Abdominal CT revealed a 7 mm-sized radiopaque object near the peritoneum. The foreign body was successfully removed laparoscopically with real-time fluoroscopic guidance. Percutaneous removal is usually performed when a foreign body is present in the soft tissue; however, laparoscopic removal should be considered when the foreign body is located in the abdominal wall near the peritoneum. We provide principles for the safe and minimally invasive removal of foreign bodies based on this case.