Journal of Surgical Case Reports最新文献

Pott's disease typically presents with back pain and systemic symptoms, but atypical presentations can obscure diagnosis. We describe a rare manifestation where the initial presentation was acute small bowel obstruction. A 20-year-old female presented with acute abdominal pain, distension, and vomiting, with a 3-month history of intermittent lower back pain. Computed tomography scan revealed distal ileal obstruction due to wall thickening adjacent to a left psoas abscess and a large paravertebral abscess. Aspirated pus confirmed Mycobacterium tuberculosis. The diagnosis was small bowel obstruction secondary to ileal thickening from an adjacent psoas and paravertebral abscesses. She was managed conservatively with abscess drainage and anti-tuberculous therapy. Intestinal obstruction is a rare presentation of spinal tuberculosis. In endemic areas, tuberculosis should be considered in the differential diagnosis of acute abdomen. Prompt imaging and microbiological confirmation, coupled with multidisciplinary management, are essential to achieve favorable outcomes.

A young woman developed a large hematoma after submental liposuction, causing swallowing and breathing issues. The patient reported shortness of breath (SOB), along with neck pain, swelling, bruising, and reduced range of motion (ROM). Lab tests showed elevated leukocytes [14.1 × 10³/μL (4.50-10.00), normal hemoglobin (12 g/dL (12-16 g/dL), normal platelets (270 × 10³ U/L (150-450 × U/L)], and positive CRP. Treatment included antibiotics, hydrocortisone, and clot removal. Regular examinations showed significant improvement without lesions. By the 10th day, edema had completely resolved, with marked improvement in bruising, respiratory symptoms, and neck mobility. Thorough evaluation of candidates for submental liposuction is vital. A doctor's expertise in techniques and anatomical knowledge can prevent vascular damage. Timely diagnosis and intervention can effectively manage complications and enhance liposuction results.

The epiploic appendix is rarely found in the cecum of children as a cause of abdominal pain in children due to torsion or inflammation. The purpose of this study was to reveal the preoperative diagnostic difficulties of cecal epiploic appendix torsion in children. We present the case of a 12-year-old girl who was misdiagnosed preoperatively with acute appendicitis and who was found upon surgical exploration to have a torsion of pedunculated tumor-like mass in the cecum. The uninflamed vermiform appendix and torqued mass-like tumor in the cecum were removed. The mass was confirmed to be a hemorrhagic infraction of the epiploic appendix of the cecum due to torsion. Pediatric surgeons should consider more often magnetic resonance image or eventually computed tomography of the abdomen and pelvis as the best diagnostic tool for cecal epiploic appendix torsion, especially when ultrasound reveals a non-inflamed vermiform appendix to avoid unnecessary surgical exploration.

We present the case of a 58-year-old male with a complex suprarenal and infrarenal aortoabdominal aneurysm and multiple renal arteries. Due to anatomical constraints that precluded endovascular repair, bilateral renal in situ reimplantation was performed, followed by the successful deployment of a physician-modified endograft. Despite postoperative complications, the patient recovered fully and was discharged in stable condition. This case highlights the feasibility and clinical value of combining open and endovascular techniques in high-risk vascular patients when standard endovascular approaches are not viable.

A 71-year-old diabetic man presented with progressive cholestatic jaundice secondary to a Bismuth II hilar cholangiocarcinoma. Surgical exploration revealed a tumor confined to the biliary confluence. A limited en bloc resection of the confluence with multiple biliary reconstructions by end-to-side hepaticoduodenostomy was performed without hepatic resection. The postoperative course was uneventful. This case illustrates the feasibility of limited hilar resection with direct biliary reconstruction in selected frail patients when extended hepatectomy is contraindicated.

Schwannomas are tumors that arise from Schwann cells in the neural sheath. They are usually benign tumors and rarely occur in the retroperitoneal space. Retro rectal schwannomas often lack specific symptoms and present non-orienting radiologic imaging characteristics, making the diagnosis challenging. We herein report the case of a 66-year-old female patient who presented with abdominal pain and urinary retention. A presacral mass was detected on imaging and the patient underwent a surgical excision of the tumor. The diagnosis of such lesions is rigorous due to their uncommon location and very unspecific symptoms, and complete surgical resection remains the curative treatment.

Chronic idiopathic megacolon is a rare disorder characterized by persistent colonic dilatation without obstruction or secondary causes. It is usually diagnosed in childhood, often linked to Hirschsprung's disease; adult-onset cases are exceedingly rare, especially with familial predisposition. We report a man in his 30s with progressive abdominal distension, prior adolescent colectomy, and family history suggesting genetic susceptibility. After excluding secondary causes, chronic idiopathic megacolon was diagnosed. Conservative management failed, necessitating subtotal colectomy with ileorectal anastomosis, leading to complete symptom resolution. Histopathology confirmed normal ganglion cells. Adult-onset idiopathic megacolon poses diagnostic and therapeutic challenges and may have a genetic basis. Subtotal colectomy is safe and effective in refractory cases.

This case report presents a highly unusual case of a primary high-grade malignant peripheral nerve sheath tumor (MPNST) of esophagus, a neoplasm of extreme rarity, with fewer than twenty histologically confirmed cases reported worldwide to date; detailing the successful management of this tumor through Orringer's transhiatal esophagectomy, complemented by comprehensive histopathologic and immunohistochemical evaluation. Our report emphasizes the crucial the role of immunohistochemistry, specifically the diagnostic value of S100, SOX10, and the exclusion of gastrointestinal stromal tumors markers (DOG1, CD117) in distinguishing MPNST, from morphologically similar esophageal submucosal tumors.

A profunda femoris artery aneurysm (PFAA) is an extremely rare peripheral arterial lesion, often first detected following rupture or swelling of the groin or thigh region. We report a 74-year-old man who presented with acute thigh pain caused by thrombotic occlusion of a left PFAA associated with a common femoral artery aneurysm (CFAA). Contrast-enhanced computed tomography at presentation demonstrated complete left PFAA thrombosis and partial thrombus formation within the left superficial femoral artery. The aneurysms' diameters were 30 mm for the left CFAA and 35 mm for the left PFAA. The patient's symptoms stabilized after systemic heparinization. Considering the recurrent thrombosis and potential aneurysmal rupture risks, an elective surgical intervention was performed. This procedure consisted of PFAA ligation, prosthetic graft replacement of the CFAA, and lateral circumflex femoral artery branch reconstruction. The patient's postoperative course was uneventful, and follow-up imaging confirmed excellent graft patency and preserved thigh perfusion.

Meckel's diverticulum (MD) is the most common congenital abnormality of the small bowel, present in about 2% of the population. While typically asymptomatic, MD can cause complications such as small bowel obstruction (SBO), particularly in adults. Giant MD, defined as a diverticulum larger than 5 cm, is a rare cause of SBO and may lead to torsion, volvulus, or kinking of adjacent bowel. Preoperative diagnosis is often challenging as imaging findings are nonspecific, and MD may be misdiagnosed unless complications like inflammation or torsion occur. Surgical intervention, usually resection, is the treatment of choice for symptomatic MD, particularly in cases causing obstruction or containing ectopic mucosa. Although MD can be asymptomatic, the risk of complications in larger diverticula supports early surgical management in symptomatic cases to prevent severe outcomes like perforation or ischaemia. In this case report, SBO secondary to a giant MD requiring laparoscopic surgery is described.