Journal of Surgical Case Reports最新文献

Robotic splenectomy (RS) is an advanced alternative to conventional laparoscopy, offering advantages such as 3D vision and superior articulation, which are crucial in complex cases like splenomegaly. We present the case of a 22-year-old woman with a giant splenic cyst measuring ~13 cm. Robotic-assisted splenectomy was performed using the multi-port Da Vinci Xi system. The robotic approach facilitated the precise dissection of the splenic hilum and the short gastric vessels, allowing the spleen to be extracted intact with minimal bleeding in 2 h. Robotic splenectomy proved to be a safe and effective technique, associated with an efficient operative time and rapid postoperative recovery. This case supports the use of robotic splenectomy in specialized centers for selected, complex cases, demonstrating its technical advantage for large splenic pathology.

Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal chromaffin cells. Although often silent, functional paragangliomas may present with catecholamine hypersecretion and life-threatening complications. Their incidental discovery during cancer staging is exceptionally uncommon and poses unique therapeutic challenges. We report the case of an 82-year-old woman presenting with breast cancer, in whom staging investigations revealed a 6-cm functional paraganglioma of the celiac space. A multidisciplinary team prioritized paraganglioma resection before oncologic breast surgery. Preoperative alpha-adrenergic blockade was administered for 15 days. Surgery was complicated by catecholamine surges requiring intensive hemodynamic and critical care support. Postoperative recovery was uneventful. Histopathological analysis confirmed paraganglioma, and the patient was subsequently referred back for breast surgery. This case illustrates the rare incidental discovery of a hormonally active celiac paraganglioma during breast cancer staging. It highlights the need for multidisciplinary planning and emphasizes the role of perioperative critical care in optimizing outcomes of functional paragangliomas.

Osgood-Schlatter disease (OSD) is a self-limiting traction apophysitis in adolescents. While most resolve with conservative care, a subset of skeletally mature athletes may develop chronic anterior knee pain from persistent ossicles. Surgical excision is considered when nonoperative measures fail. This study aims to report outcomes of unresolved OSD treated with arthroscopic tibial ossicle excision. Three male patients, aged 34, 45, and 51, presented with anterior knee pain persisting for over one year despite standard non-surgical treatments. Imaging confirmed tibial ossicles. Arthroscopic removal was performed using anteromedial and anterolateral portals under fluoroscopic guidance. All surgeries were uneventful. Patients ambulated immediately postoperatively and returned to sports within 4-5 weeks. At 6-month follow-up, they were pain-free, could kneel comfortably, had full range of motion, and no tibial tubercle tenderness. No complications occurred. Arthroscopic excision is a safe, minimally invasive alternative to open surgery, allowing early recovery and return to sport.

Urachal carcinoma is a rare malignant epithelial neoplasm with an estimated incidence of one in 5 million people. Due to the rarity of these cases, no universally accepted staging system or standardized surgical and oncological treatment protocols currently exist. En bloc surgical resection of the umbilicus, urachal ligament, and involved portion of the bladder remains the preferred treatment. The addition of adjuvant chemotherapy may be considered in the setting of metastatic disease. Here, we present a case of urachal adenocarcinoma in a 67-year-old male who initially presented with purulent umbilical drainage.

Conjoined nerve roots (CNRs) represent a common yet frequently underdiagnosed congenital anomaly of the lumbar spine that increases the risk of iatrogenic injury. We present two cases of incidentally discovered CNRs successfully managed with full endoscopic spine surgery (ESS). While often missed on preoperative imaging, ESS provides a distinct advantage in managing these variants due to its magnified, high-definition visualization through a minimally invasive approach. This technique allows for the precise identification and safe decompression of unexpected CNRs, serving as both a diagnostic and therapeutic tool. The enhanced clarity and anatomical preservation offered by ESS highlight its vital role in navigating anomalous anatomy, positioning it as a cornerstone for the future of minimally invasive spine surgery.

Libman-Sacks endocarditis (LSE) is noninfectious verrucous vegetation lesion that can mimic infective endocarditis and the mitral valve is commonly involved. Although the exact pathogenesis remains unclear, the presence of LSE is associated with primary antiphospholipid syndrome (APS) and APS secondary to systemic lupus erythematosus (SLE). The presentation varies from mild symptoms to fulminant disease with high thromboembolic risk. Here, we present a case of LSE in female patient presented with shortness of breath and recurrent strokes but no clinical features of SLE. High index of suspicion remains a key factor in making the correct diagnosis.

Primary squamous cell carcinoma (SCC) of the stomach is an exceptionally rare tumor, comprising <0.5% of gastric malignancies. Diagnosis requires strict histopathologic and immunohistochemical confirmation to distinguish it from adenosquamous carcinoma or esophageal extension. We report a 30-year-old woman with chronic anemia and recurrent upper gastrointestinal bleeding. Endoscopy revealed a large gastric polypoid lesion, and computed tomography showed an exophytic mass invading the pancreatic tail and spleen. The patient underwent total gastrectomy with distal pancreatectomy, splenectomy, and colectomy, initiated laparoscopically and converted to open surgery for en bloc resection. Histopathology confirmed a moderately differentiated pure squamous carcinoma with lymphovascular and perineural invasion. Despite postoperative complications, the patient recovered after multiple re-explorations. This case underscores the diagnostic challenge and clinical significance of primary gastric SCC, highlighting the importance of accurate identification to guide appropriate surgical management.

Endometrial cancer is common especially among females. It could disseminate through direct, lymphatic, and hematogenous spread. On the other hand, cutaneous metastases are extremely rare. We reported a case of a 70-year-old female with a history of early-stage endometrial carcinoma (Stage IB, Grade 2) who developed a rare skull metastasis sparing lymph nodes. Given the patient's poor performance status and comorbidities, she was deemed unfit for systemic chemotherapy. Palliative care was initiated, focusing on symptom management. This case underscores the importance of considering atypical metastatic presentations in endometrial cancer and highlights the challenges in diagnosis and management.

Kidney transplantation in individuals with congenital skin fragility diseases is exceedingly uncommon due to perioperative concerns such as compromised wound healing, respiratory complications, and issues with vascular access. Herein, we report a case of successful living-donor kidney transplantation in a 37-year-old male with dystrophic epidermolysis bullosa and end-stage renal disease. Multidisciplinary planning, customized anesthesia, and protective intraoperative measures are essential to avoid these problems. Epidural anesthesia combined with mild sedation facilitated surgery without the need for airway instrumentation, while meticulous handling maintained skin integrity. The operation and recovery were unremarkable, and the graft function was maintained at 12 months. This case demonstrates that complex transplantation is achievable in environments with limited resources, through personalized perioperative treatment and interdisciplinary cooperation.

We describe a 58-year-old male with severe posttraumatic osteoarthritis and distal femoral recurvatum deformity following adolescent fracture fixation. Preoperative imaging demonstrated a healed malunion stabilized by a lateral locking plate and tricompartmental osteoarthritis with 12° recurvatum. A single-stage robotic-assisted kinematically aligned total knee arthroplasty was performed using cementless cruciate-retaining components while retaining the femoral plate. Careful preoperative planning and intraoperative adjustment of bone resections enabled restoration of joint line orientation, balanced soft tissues, and stable press-fit fixation without stems or osteotomy. At two-year follow-up, the patient reported excellent function and pain-free mobility, with outcome scores including KOOS JR 91.98, Oxford Knee Score 47, and Forgotten Joint Score 100. This case highlights the feasibility of robotic-assisted, hardware-retaining, cementless TKA in the setting of complex extra-articular deformity, avoiding staged hardware removal or constrained implants while achieving durable clinical outcomes.