Journal of Surgical Case Reports最新文献

Ganglioneuromas (GN) are tumours of ectodermal origin, derived from the neural crest cells. Appendiceal GN are extremely rare, with only eight contemporary case reports in the literature. Being benign and indolent, the necessity of resection for GNs is often debated. However, obtaining tissue to confirm the diagnosis can be challenging, frequently leading to surgical resection. We present a case of an 85-year-old male with an enlarging appendiceal nodule diagnosed endoscopically. Further investigation with computed tomography (CT) scan failed to define the pathology. A laparoscopic appendicectomy was performed, which confirmed the diagnosis of appendiceal GN.

We report the case of a 77-year-old woman with jaundice but no evidence of choledocholithiasis or other alterations of the biliary tree except for a duodenal diverticulum. Lemmel's syndrome was diagnosed and an endoscopic sphincterotomy with stenting was performed. Lemmel's syndrome is a rare disease that must be considered as a cause of obstructive jaundice.

Pelvic lipomatosis (PL) involves nonmalignant excess fat growth in perirectal and perivesical areas, gaining recognition over three decades. This review addresses its clinicopathological aspects amid controversies, emphasizing the need for a comprehensive examination of current literature. This report outlines a 42-year-old man's diagnostic journey for persistent urological symptoms, ultimately identified as PL. PL, if untreated, adversely impacts the urinary system, affecting kidney function and causing systemic complications. Management involves accurate diagnosis through radiological methods and surgical intervention, aiming to alleviate symptoms and enhance affected individuals' quality of life.

This case report describes a rare instance of muscle cysticercosis in a 16-year-old vegetarian female from an endemic region, highlighting the challenges in diagnosing atypical presentations of the disease. The patient presented with a 2-month history of persistent pain and swelling in the right forearm, which did not respond to over-the-counter analgesics. A clinical examination identified a non-tender, immobile swelling, and imaging studies suggested cysticercosis. Despite treatment with albendazole and non steroidal anti-inflammatory drugs (NSAIDs), the swelling persisted, necessitating surgical intervention. The excised cyst was confirmed as cysticercosis through histopathological examination. This case underscores the importance of considering cysticercosis in the differential diagnosis of soft tissue swellings, particularly in endemic areas, and emphasizes the role of imaging and histopathology in ensuring accurate diagnosis. Preventive measures such as improved sanitation and hygiene are crucial in controlling the spread of cysticercosis.

Paragangliomas are rare neuroendocrine tumors originating from extra-adrenal paraganglia that often require intricate surgical resection. Specifically, when paragangliomas are localized within the thorax and coexist with cardiovascular structures, they can be challenging to surgically resect. Here, we aimed to review three cases of paragangliomas intruding the aortopulmonary (AP) window that required cardiopulmonary bypass (CPB) as an effective surgical approach. All patients were diagnosed using preoperative biochemical analysis, computed tomography-positron emission tomography (CT-PET) scans, endobronchial ultrasounds, and biopsies. Within these three cases of female patients presenting with paragangliomas within the AP window, we observed a high success rate in complete surgical resection and no long-term recurrence following resections with CPB. Overall, these cases showed that surgical resection of paragangliomas which are intruding vital cardiovascular structures within the AP window can achieve positive long-term patient outcomes when using CPB.

Penetrating neck injury (PNI), involving disruption of the platysma muscle, accounts for 10% of trauma cases and poses significant morbidity and mortality risks. This case report details the management of a 45-year-old male who sustained a 270-degree circumferential neck incision from an industrial accident. The patient presented with a deep neck laceration, severe blood loss, and hypovolemic shock. Pre-hospital care included intubation, oxygen supplementation, and fluid resuscitation. At the hospital, under general anesthesia, surgical interventions involved ligation of posterior neck vessels, hemostasis, muscle repair with Vicryl 1-0, drainage tube placement, and skin closure. Postoperative care included intensive monitoring, neurological assessments, and pain management. Effective management of severe PNI requires a multidisciplinary approach, combining prompt pre-hospital care, meticulous surgical techniques, and comprehensive postoperative management. Future research should focus on standardizing PNI management protocols and advancing surgical and diagnostic techniques to improve outcomes in similar critical cases.

Coronary-pulmonary artery fistulas are rare congenital anomalies that can lead to significant clinical complications, especially when associated with coronary artery disease. We present a case of a 61-year-old male who presented with progressive dyspnea and chest discomfort. Imaging revealed a coronary-pulmonary artery fistula with 60% stenosis in the proximal left anterior descending artery. Due to the size and complexity of the fistula, along with the need for coronary artery revascularization, the patient underwent surgical ligation of the fistula combined with coronary artery bypass grafting. The patient had an uneventful recovery and was discharged on postoperative Day 6. At the 3-month follow-up, he reported a complete resolution of symptoms. This case illustrates the importance of surgical intervention in managing complex coronary fistulas with associated coronary artery disease and highlights the need for individualized treatment approaches.

Acute appendicitis and acute cholecystitis are among the commonest pathologies in acute general surgery. They are characterized by distinct symptoms, clinical examination findings and typical elements of the history which direct further investigations. In the absence of these classic findings, these diagnoses can be missed, particularly where they occur synchronously. Here we present the interesting case of a 63-year-old male who presented to the emergency department with epigastric pain and vomiting with no classical appendicitis or cholecystitis findings who was found to have both appendicitis with a 3 cm collection and gangrenous cholecystitis, managed with urgent laparoscopic appendicectomy and cholecystectomy. This patient had a background of Type 2 Diabetes which may have reduced awareness of symptoms. Given the increasing prevalence of Type 2 Diabetes and the risk of rapid deterioration in these patients, this case demonstrates the importance of prompt assessment of the entire abdomen when these patients present with acute abdomen.

Abdominal lymphangiomas are benign congenital abnormal dilatation and proliferation of lymphatic spaces primarily seen in children. The wide spectrum of symptoms challenges preoperative diagnoses. We present a rare case of a 2-year-old boy presented to pediatrician with massive abdominal distention and left scrotal swelling since the age of 1½ years. Diagnosed and treated as ascites, the patient was referred to pediatric surgery for ascitic tap and hydrocele repair. An abdominal CT scan revealed a giant omental cyst. Laparotomy was performed to excise the cyst extending into left scrotum, and deep left inguinal ring was closed from within. Lymphangioma was histopathologically confirmed. To the best of our knowledge to date, only one case of an omental cystic lymphangioma presenting as bilateral hydroceles without abdominal symptoms has been reported. Nevertheless, this case is unique for the presentation of pseudoascites and a unilateral hydrocele.

Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is a type of invasive fungal rhinosinusitis that is characterized by the presence of pathologic findings of non-caseating granulomas in the paranasal sinuses. This article describes two cases of CGIFRS with fatal outcomes. The first case was for a 36-year-old man who presented with headache, dizziness, and vomiting for 1 month. This patient had received the traditional treatment, although the patient's condition suddenly deteriorated after 1 week of surgery and died due to the disease's complications. Similarly, the second case was for a 31-year-old man who presented with bilateral nasal obstruction and left eye proptosis for 1 year. This patient had a recurrence of CGIFRS after the first presentation, which was complicated by a cerebral abscess after 2 months of surgery. This study, therefore, underscores the severity of CGIFRS as a potentially fatal disease.