Journal of Surgical Case Reports最新文献

Colorectal cancer is a prevalent malignancy; it ranks as the third leading cause of cancer-related deaths globally. Despite the effectiveness of surgical intervention for primary tumors, ~30% of patients develop metastases, commonly in the regional lymph nodes, liver, lungs, and peritoneum. Bone metastasis is relatively rare but can occur, typically affecting vertebrae, pelvis, femur, and humerus. This study presents a 68-year-old patient with a history of locally advanced colon cancer who presented with a rapidly enlarging, painful sternal mass. Imaging and biopsy confirmed metastatic colon adenocarcinoma in the sternum. The patient was treated with radiation therapy, resulting in significant symptomatic relief and tumor reduction. This case highlights the rarity of sternal metastasis from colorectal cancer. Given the poor prognosis associated with skeletal metastases in colorectal cancer, this case emphasizes the need for vigilance in monitoring for atypical metastatic sites and the importance of tailored palliative care strategies.

Situs inversus totalis is a rare congenital abnormality characterized by a mirror-image transposition of both the abdominal and the thoracic organs. Splenic infarctions are considered a rare cause of abdominal pain, although the exact prevalence is unclear. We present a rare case of a 62-year-old male who presented to the emergency department with abdominal pain and was found to have large splenic infarcts with situs inversus totalis on computed tomography. The patient was admitted and treated conservatively. In conclusion, diagnosing situs inversus in cases of emergency is important because patients will present with abnormally located symptoms, and splenic infarction should be kept in mind when considering the differential diagnosis of abdominal pain despite its rarity.

Annular pancreas is a rare congenital abnormality that is often considered a neonatal condition, though in few cases it can present in adulthood. Patients diagnosed with annular pancreas in adulthood are often asymptomatic and diagnosed incidentally from radiologic studies. While there is no existing treatment protocol for symptomatic annular pancreas, multiple surgical approaches have been documented in the literature. In this case study we present a 49-year-old female patient who presented with gastric outlet obstruction secondary to annular pancreas. The patient was treated with nasogastric decompression and open side-to-side gastrojejunostomy with an antecolic approach to bypass the obstructed duodenal segment. The surgery was successful, followed by an uneventful postoperative course and discharge on postoperative Day 4. By 5-week outpatient follow-up the patient had resolution of her symptoms and achieved weight gain.

The Chevrel technique is a well-established procedure for open repair of midline incisional hernia. This retrospective single-center case series aims to present the outcome of patients with midline incisional hernia treated with a modified Chevrel technique. The modification itself comprehended the use of a single-layer continuous suture for the inverted anterior rectus abdominis muscle sheet for the creation of the "new linea alba" without overlapping. Between January 2017 and December 2023, 40 patients were operated. The overall postoperative morbidity rate was 65%. Hernia recurrence occurred in three patients (7.5%). When the basic principles of the Chevrel technique are respected and conducted, this leads to satisfactory results. The postoperative outcome of this case series showed rates of complications and recurrences in concordance with the already published literature. Therefore, this technique should always be considered for the open approach for midline incisional hernia repair.

We report a case of massive chest wall bleeding after lung wedge resection caused by a protruding staple. On the third postoperative day, the patient experienced sudden left posterior back pain without any apparent trigger, accompanied by signs of shock. Computed tomography imaging revealed a significant accumulation of blood in the pleural cavity on the side of the surgery. A reoperation was performed, during which we identified active arterial bleeding from a small vessel at the second intercostal space on the posterior chest wall. Hemostasis was achieved using electrocautery. Further examination revealed a protruding staple at the left upper lobe resection margin, which we speculated was likely causing abrasion against the chest wall and leading to the bleeding. This case reveals the potential risk posed by protruding staples. Appropriate precautions should be taken to prevent this rare but dangerous occurrence.

Pancreaticoduodenectomy after esophagectomy is a challenging procedure given the need to preserve the vascularization of the gastric plasty. We describe a case of a modified Longmire III procedure in a 68-year-old patient who underwent an esophagectomy with gastric conduit reconstruction in 2019 for esophageal adenocarcinoma. Two years later, an adenocarcinoma of the ampulla of Vater was diagnosed, necessitating pancreaticoduodenectomy with preservation of the gastric conduit. The patient presented no postoperative complications. Hepatic recurrence was observed 13 months after surgical resection. At 24 months follow-up, new liver metastases were observed. Preservation of the gastroduodenal and right gastric arteries was achieved, enabling conservation of the gastric plasty. Given the limitations of lymphadenectomy, the indication for this surgery must always be carefully considered. In the context of complex surgery, a complete preoperative workup to precisely determine the vascular anatomy as well as any anatomical variations is essential to establish the best operative strategy.

Ellis-van Creveld syndrome (EVC) is a rare disorder with marked valgus knee deformity, and orthopedic surgeons may experience challenges with lower limb treatment. Most previous reports have focused on EVC in childhood and few on its treatment in adulthood. Our patient was a 23-year-old woman with bilateral knee pain and gait abnormalities, with no history of orthopedic treatment. Valgus knee deformities with anterolateral depression of the lateral tibial plateaus and external rotation deformities of the lower legs were observed on radiography. We performed extra-articular osteotomy of the femurs and tibias and soft tissue release. Although the correction of each femur and tibia was good, mild valgus deformity of the lower limbs remained. This may be because the depression of the lateral tibial plateau was not repaired, and no postoperative remodeling was performed. However, 10 years post-surgery, no recurrence of the deformity was observed and walking was stable without pain.

Richter's hernia is a rare but serious surgical emergency involving the entrapment or strangulation of part of the bowel's circumference in the hernial orifice, often without causing complete luminal obstruction. This case report describes a man in his 70s presenting with a 3-day history of abdominal pain and vomiting, despite normal bowel movements. Blood results revealed raised inflammatory markers, and computed tomography imaging suggested small bowel obstruction due to an incarcerated left inguinal hernia. Emergency surgery confirmed a Richter's hernia with a strangulated but viable bowel loop. Early surgical intervention led to a positive outcome. This case underscores the importance of high suspicion, early referral, and timely imaging in managing Richter's hernia to prevent severe complications, such as gangrene and perforation. Despite the absence of obstructive symptoms, early surgical intervention is critical when there is clinical concern regarding strangulation.

Alkaptonuric ochronosis, characterized by the deposition of homogentisic acid in connective tissues, is commonly linked with alkaptonuria, a rare genetic disorder resulting from homogentisate 1,2-dioxygenase deficiency. Despite its association with alkaptonuria, ochronosis can occur in individuals without a prior diagnosis. This case report discusses a 64-year-old female with severe aortic valve stenosis and coronary artery disease who was found to have ochronotic pigmentation in the aortic and mitral valves, as well as in the aortic root intima and papillary muscles. This case emphasizes the need to consider ochronosis in the differential diagnosis of valvular disease when alkaptonuria is suspected.

Calcifying pseudoneoplasm of the neuraxis (CAPNON) is an uncommon entity and a rare cause of third cranial nerve palsy. We review the case of a 17-year-old male with a 9-month history of progressive left third cranial nerve palsy. Cerebral magnetic resonance image showed a left clinoidal lesion with low signal intensity in T2 and T1 sequences with signs of calcification in the computed tomography and without vascular lesion in AngioMRI. A left pterional approach was performed with posterior clinoidectomy and total resection of the lesion. Calcifying pseudoneoplasm of the neuraxis is an infrequent pathology that presents in the skull base and spine that requires surgical treatment in the presence of compressive phenomena and differential diagnosis as meningioma, chordoma, and metastasis should be considered.