Journal of Surgical Case Reports最新文献

Basal cell carcinomas are common facial malignancies with minimally invasive treatment approaches effective in the majority of cases. Recurrent aggressive lesions pose significant challenges and need wide local excision with major reconstruction. Geriatric patient with multiple comorbidities needs customized reconstructions to minimize morbidity. We present a case of longstanding invasive confluent basal cell carcinoma involving right cheek, ear lobule, and retroauricular area. The perforator plus variant of supraclavicular flap was successfully used for closure of the large defect.

The recurrence rate of inguinal hernia is 1-10%, most often in the inguinal region, and seldom in different locations. A 72-year-old man with a large soft swelling in the right ventrolateral abdominal region without swelling in the scrotum, operated on right inguinal hernia at pediatric age. Clinical findings revealed a giant right ventrolateral hernia and abdominal CT showed weakness of the abdominal wall with a 25 cm long hernial sac with an apex under the right costal arch and a base at the deep inguinal opening, that was diagnosed as a recurrent inguinal hernia with unusual presentation. Hernioplasty without opening the hernial sac was performed in an atypical manner. The patient was discharged from the hospital without pain or discomfort at the follow-up. The common presentation of recurrent inguinal hernia is inguinal-scrotal but an unusual presentation should be reconsidered with a proper diagnosis and adequate surgical treatment.

Anal melanoma is a rare malignancy, accounting for 0.4% to 1.6% of all melanomas. Its atypical presentation, low incidence, and non-specific symptoms make it a challenging diagnosis, which can lead to delayed treatment with an unfavorable impact on clinical outcomes. Treatment should be multidisciplinary and may include surgical resection with adjuvant therapy, chemotherapy, and radiotherapy. We present the case of a male patient who presented to the emergency department due to foreign body sensation and transanal bleeding. The patient underwent an anal exploration under anesthesia, where a hyperpigmented canal-dependent tumor lesion with extension into the perianal skin was found. After a wide local excision, histopathological study confirmed the diagnosis of invasive nodular melanoma. The patient was discharged without complications for follow-up and management in the outpatient medical oncology clinic.

Superficial duodenal epithelial tumors were previously considered rare. Laparoscopic and endoscopic cooperative surgery for duodenal tumors (D-LECS) has been developed to achieve successful endoscopic treatment. Patients who have undergone living-donor liver transplantation (LDLT) may have severe abdominal adhesions, and immunosuppressive agents (IAs) may affect the degree of postoperative abdominal adhesions and wound healing, but their effects remain unclear. Herein, we present the first case of D-LECS for duodenal adenoma after LDLT. A 66-year-old man underwent D-LECS for a non-ampullary duodenal high-grade adenoma after LDLT with an IA. The patient's condition was uneventful 36 months after the surgery. In gastrointestinal surgery, IAs may affect the resected duodenal repair process. For duodenal neoplasms in high-risk patients, D-LECS may be better than endoscopic submucosal dissection alone. D-LECS after LDLT is a feasible and less invasive procedure.

Atypical femoral fractures (AFF) are rare stress fractures with specific diagnostic criteria, as outlined in a report published by the American Society for Bone and Mineral Research. These criteria are categorized into major and minor features, and AFF can be classified as either complete or incomplete. Bisphosphonates have been shown to increase the risk of AFF, and most cases of AFF are associated with bisphosphonate use. We present a unique case of AFF in a young woman with no history of bisphosphonate use. She was taking oral contraceptive pills and inhaled corticosteroids for asthma. Later, she was diagnosed with nutritional osteomalacia. The patient was managed surgically with bilateral intramedullary nailing, resulting in a favorable outcome.

Given the intricacy involved in diagnosing prostatic abscess and the associated risk of severe complications, we present a case involving a 72-year-old male patient initially suspected of urinary retention due to benign prostatic enlargement, only to reveal multiple prostatic abscesses during surgical intervention. The objective is to raise awareness among clinicians regarding the potential presence of latent prostatic abscess and to prevent the occurrence of serious complications. Timely implementation of aggressive antimicrobial therapy and surgical drainage has been shown to significantly enhance patient prognosis and mitigate the risk of serious complications.

We report a 3-year-old patient with urethral cut injury and iatrogenic vesicovaginal fistula following a pelvic fracture; managed with Mitrofanoff procedure. Our patient presented with straining on urination with continuous colorless discharge on her diaper for the past 4 months. Investigations identified vesicovaginal fistulization making a definitive diagnosis of complete urethral injury. It was managed with the Mitrofanoff procedure to preserve the patient's urinary continence. Our case is to our knowledge the youngest reported case of a complete traumatic urethral cut in a female; an already rare encounter in this population. This is also the first such case to be managed via the Mitrofanoff procedure. Although the management was delayed, it was successful.

Giant rhinoliths are uncommon, mineralized concretions that usually develop around an intranasal foreign substance in the nasal canal. These lesions frequently cause respiratory problems, foul-smelling discharge, and nasal blockage. Clinical examination, endoscopy, and radiological imaging are used to make the diagnosis, and surgical removal is the only effective therapy. A giant rhinolith was discovered in a 42-year-old female patient with metastatic breast cancer came with nasal blockage. After 6 months, there were no complications or recurrences following the surgical removal of the calcified tumor. The significance of taking rhinoliths into account in individuals who have prolonged symptoms and unilateral nasal blockage is demonstrated by this case study. Consequently, early diagnosis and management are necessary to avoid potential complications and ensuring an excellent outcome.

Low anterior resection syndrome (LARS) is a challenging complication following sphincter-preserving rectal surgery, characterized by bowel dysfunctions such as urgency, frequency, and incontinence. This case series investigates the potential role of lactose intolerance in exacerbating LARS symptoms. Three patients who developed LARS after rectal resections showed persistent symptoms despite conventional management with bulking agents, physiotherapy, and loperamide. However, all three experienced significant improvement in symptomatology, reflected by reductions in their LARS scores, after eliminating cow's milk from their diets. These findings suggest a potential link between lactose intolerance, including possible late-onset forms, and LARS symptoms. This study highlights the effectiveness of dietary modifications, particularly lactose elimination, as a simple and non-invasive strategy for managing LARS. The findings also support the need for dietary screening processes and recommendations for milk substitutes to enhance clinical care. Further research is necessary to validate these observations and refine therapeutic strategies.

Synchronous colorectal cancer is a rare disease. It remains challenging for diagnosis and treatment. This paper reports a case of a 75-year-old Chinese male patient presenting with intestinal obstruction, alongside primary thrombocytopenia and a diagnosis of small B-cell lymphoma. Computed tomography scans revealed space-occupying lesions in both the sigmoid colon and ascending colon. The patient initially underwent a transverse colostomy procedure to alleviate the intestinal obstruction and then underwent laparoscopic radical tumor resection. The patient exhibited favorable prognosis and maintained satisfactory bowel function at the nearly 8 months' postoperative follow-up. Multiple colonoscopies are crucial in the management of synchronous colorectal cancer, and radical surgical resection remains the sole curative option when surgical intervention is deemed tolerable. A thorough preoperative examination and evaluation are crucial for successful surgery. The selection of surgical procedures for synchronous colorectal cancer should be based on the patient's medical condition.