Journal of Surgical Case Reports最新文献

Sialolipomas are uncommon benign lipomatous neoplasm of the salivary glands, representing under 1% of parotid tumors. They are typically indolent and asymptomatic, often resembling simple lipomas on imaging. We report the case of a 54-year-old male presented with an asymptomatic enlargement in the left parotid region incidentally discovered. Magnetic resonance imaging displayed a well-circumscribed lipomatous growth sized at approximately 4.6 cm, with incremental growth to 6 cm over three years and involvement of the parapharyngeal space. Due to continued growth and cosmetic concerns, a complete left parotidectomy was carried out with preservation of the facial nerve. Histopathology affirmed sialolipoma. Recognition of this rare entity and its distinction from other similar lipomatous masses, including lipoadenoma, is vital for accurate diagnosis. Full resection yields an excellent prognosis, with recurrence being exceedingly rare.

Stoma prolapse is a frequent complication following stoma formation in pediatric patients and often necessitates surgical intervention. The buttonpexy technique offers a minimally invasive, low-cost, and anesthesia-sparing alternative to formal stoma revision. This case series highlights its safety and effectiveness in managing pediatric stoma prolapse. Five pediatric patients with stoma prolapse secondary to various underlying conditions, including anorectal malformation, Hirschsprung's disease, and Currarino syndrome, were managed using the buttonpexy technique. In each case, the prolapsed bowel was gently reduced, and pledgets derived from intravenous tubing were secured above and below the skin margins to anchor the stoma locally. The procedures were performed under local anesthesia, and all patients tolerated them well. Four patients demonstrated complete resolution without recurrence during follow-up, while one experienced partial prolapse that was successfully corrected with a repeat buttonpexy. None of the patients required conversion to formal stoma revision, and no complications such as infection, necrosis, or bleeding were observed. Follow-up ranged from one to eight months, confirming sustained stoma stability until definitive closure. The buttonpexy technique is a simple, safe, reproducible method for managing pediatric stoma prolapse. It can be performed under local anesthesia, minimizing anesthetic exposure and hospital stay. This approach provides a practical first-line option before considering formal revision, especially in resource-limited or pediatric settings where minimizing surgical and anesthetic risks is paramount.

Epidermolysis bullosa is a rare genetic disorder that leads to skin fragility and the formation of blisters from the slightest trauma. There are 4 major types that have been described, with junctional and dystrophic types being more prone to result in genitourinary tract complications. The most common complication is meatal stenosis. Others include urethral stricture, urinary retention, ureteral stricture, bladder hypertrophy, and urinary tract infections. We report the successful outcome of urethroplasty using buccal graft mucosa for a 34-year-old male with epidermolysis bullosa who suffered from pan-urethral stricture.

Mechanical small bowel obstruction (SBO) secondary to acute appendicitis is rare, described only in isolated reports. Herein we present a photo-documented case illustrating this mechanism. A 39-year-old female presented postoperative day 6 from laparoscopic myomectomy with periumbilical abdominal pain and distention. Computed tomography showed possible SBO, and after 24 h without improvement, exploratory laparoscopy was performed revealing a necrotic-appearing appendix completely encircling and obstructing the small bowel proximal to the terminal ileum. Appendectomy was performed facilitating patient recovery. Acute appendicitis can cause SBO through several mechanisms. Mechanical obstruction by an inflamed appendix is a rare etiology that's been variably called appendicular knot, appendico-ileal knot, appendicular band syndrome, or appendicular tie syndrome. This may be associated with closed-loop obstruction and bowel strangulation warranting prompt surgery. Although rare, acute appendicitis should be considered as a possible cause of SBO of unknown etiology.

An inverted appendix is a rare incidental finding on colonoscopy, often misinterpreted as a neoplastic lesion. A 74-year-old woman underwent routine screening colonoscopy that revealed a cecal polypoid lesion near the appendiceal orifice. Initial biopsies showed nonspecific inflammation, and a subsequent contrast-enhanced computed tomography (CT) scan reported only sigmoid diverticulosis. During a repeat in-hospital colonoscopy, the lesion was re-evaluated and identified as an inverted appendix, preventing unnecessary resection. Retrospective review of the CT images confirmed the diagnosis. Appendiceal inversion may result from surgical manipulation, intussusception, or rarely congenital causes, and is characterized endoscopically by origin at the appendiceal orifice, normal mucosa, and distinctive imaging features. Rarely, it may be associated with mucinous, neuroendocrine, or endometriotic lesions. Awareness of this entity is vital, as biopsy or removal of benign-appearing lesions is not indicated and may result in bleeding or perforation. Careful endoscopic assessment and imaging review are essential to avoid unnecessary resection.

Acute appendicitis is a common surgical emergency, sometimes revealing incidental neoplastic lesions such as serrated polyps, which have malignant potential through the serrated pathway of colorectal carcinogenesis. A 41-year-old healthy female presented with one-day abdominal pain, initially periumbilical then localized to the right lower quadrant, with nausea and vomiting. Imaging confirmed acute appendicitis, and laparoscopic appendectomy was performed. Histopathology showed acute inflammation and an incidental serrated polyp confined to the mucosa, without dysplasia or malignancy. The patient recovered uneventfully and was referred for colonoscopy to assess for synchronous colorectal lesions. Routine histopathological evaluation of appendectomy specimens is essential, especially in patients over 40. Incidental serrated polyps, though rare, require further investigation due to their association with colorectal neoplasia. Early detection enables appropriate surveillance and may contribute to colorectal cancer prevention.

De Garengeot hernia is uncommon, contributing to ~0.5%-5% of all femoral hernias. A healthy 31-year-old male patient presented with a 3-day history of migrating right lower quadrant pain, nausea, and vomiting. Acute appendicitis was identified on a computed tomography scan. On the Diagnostic laparoscopy, the appendix was extremely inflamed and herniated in the femoral canal, a diagnostic feature of a De Garengeot hernia. The appendix was reduced gently; however, the hernia was not repaired in this index surgery. The patient had an uneventful recovery and was discharged on the first postoperative day. An elective laparoscopic femoral hernia repair was scheduled. De Garengeot hernia with complicated acute appendicitis is an operative and diagnostic challenge. This case is unique due to the patient's young age. Accurate early diagnosis and an individualized operative plan were key factors in achieving an excellent outcome.

Hydrocele of the canal of Nuck is a rare pathology seen in adult women. Homologous with the processus vaginalis in men, pathologies of the canal of Nuck arise from a failure of obliteration of this tract. More commonly they present in children but rarely manifest in adults typically presenting as a painful lump which can be difficult to distinguish clinically from hernias. Cross-sectional imaging is key in diagnosis and surgery is the mainstay of treatment as it allows of excision of the hydrocoele and reinforcement of the defect to prevent subsequent hernias. While often the pathology is benign, malignancies have been documented and once excised the hydrocele should undergo pathological analysis to exclude such malignancies. Herein we present the case of a 44-year-old women who presented with a symptomatic hydrocele of the canal of Nuck confirmed on imaging that was successfully treated with a laparoscopic transabdominal preperitoneal approach.

Neglected congenital clubfoot in adults is difficult to manage. Multi-joint arthrodesis is often required but is invasive and associated with complications. We report an adult case treated with ankle arthrodesis and midfoot derotational osteotomy. A 59-year-old man with untreated idiopathic clubfoot since birth presented with severe hindfoot varus and rigid midfoot inversion, leading to wheelchair dependence. Imaging showed correctable hindfoot deformities but rigid midfoot inversion with talonavicular subluxation. Surgery consisted of Achilles tendon lengthening, ankle and subtalar arthrodesis with a retrograde intramedullary nail, and midfoot derotational osteotomy, resulting plantigrade. Bony union was confirmed at one year. At 3 years, plantigrade alignment remained without recurrence. Callosities resolved, and the patient regained pain-free walking. Clinical scores improved: Japanese Society for Surgery of the Foot ankle/hindfoot (4.0 to 66.0), Japanese Society for Surgery of the Foot midfoot (0.0 to 73.0), self-administered foot evaluation questionnaire (89.2 to 366.0). This is the first report of midfoot derotational osteotomy for neglected congenital clubfoot, offering a less invasive option for selected adults.

Colon adenocarcinoma is a well-studied surgical pathology with a streamlined treatment regimen. The typical areas of disease metastasis include liver and lungs, however, there have been reports of unusual locations of disease spread. This includes metastases to the breast, thyroid and testes, which often lead to deferral from conventional treatments. An 83-year-old female presented to her general practitioner with dizziness, fatigue, and altered bowel motions. Subsequently, a surgeon is confronted with this case of mucinous adenocarcinoma with axillary metastasis, diagnosed by FluoroDeoxyGlucose (FDG) Positron Emission Tomography (PET) with Computed Tomography (CT) and confirmed with biopsy. Her tumour was found to be both microsatellite instability/mismatch repair (MSI/MMR) deficient and KRAS A146V positive. How should this influence treatment? We discuss this pathology, its treatment implications, as well as a brief literature review. This is the first case of metastatic colorectal cancer to the axilla in Australia and the only reported of such cases in literature with both MSI/MMR deficiency and KRAS146V mutation.