Journal of Surgical Case Reports最新文献

The penis is a structure that requires both anatomical and functional reconstruction. Being a three-dimensional structure that changes in volume, it presents a reconstructive challenge for the plastic surgeon. Currently, various alternatives are available for covering these complex defects, such as grafts, flaps, and dermal matrices. The objective of this study is to present a case report describing a complex post-traumatic penile defect in which three combined strategies were implemented for the first time (spiral full-thickness grafts, nanolipoinjection, and negative pressure therapy). These strategies have been described in the literature for defect coverage, achieving satisfactory anatomical and functional results.

Inguinal masses are common presentations in clinical practice, often attributed to hernias. However, atypical features may lead to diagnostic difficulties and delayed intervention. We present a case of a 32-year-old Ethiopian woman with a prolonged history of a growing groin mass 2 months following childbirth, her diagnosis potentially challenged by her recent obstetric history. Despite previous evaluations suggesting inguinal hernia, her symptoms worsened, prompting an emergency department visit. Further investigation revealed an unexpected diagnosis of intraabdominal tuberculosis, manifesting as a large iliopsoas abscess. This case underscores the importance of considering uncommon etiologies in the differential diagnosis of inguinal masses, particularly in high-risk populations with comparable situations, to ensure timely diagnosis and intervention.

Although endovascular management has been increasingly adopted for basilar apex aneurysms (BAAs), microsurgery still represents an amenable treatment option. In this case series, six female patients (median age: 46 years) with six saccular high-riding BAAs (50% ruptured) were included. The median neck size was 5.3 mm (range: 2.9-7.9), and the median length from base to dome was 7.25 mm (range: 5.2-11.4). Preoperative complications included hydrocephalus (22%) and rebleeding (22%). All patients underwent clipping with a pterional craniotomy with extension into the temporal bone base. Intraoperative aneurysm rupture occurred in one patient (17%). Postoperative complications occurred in two patients (34%), of which one died because of extensive cerebral vasospasm and hospital-acquired pneumonia. At the 6-month follow-up, all remaining patients had modified Rankin scale scores ≤ 2. Microsurgery remains a viable option for BAAs in limited-resource settings. Technical success depends on delicate tissue work, in-depth anatomical knowledge, and maneuverability in narrow corridors.

Colorectal cancer is a common cancer with a large burden of disease. Adenocarcinomas account for majority of colorectal cancers, arising from glandular epithelium. Other malignancies including neuroendocrine, adenosquamous, spindle cell and squamous cell carcinomas (SCCs) are seldomly encountered. Primary colorectal SCC was first reported in 1919 and is particularly rare. It is difficult to manage as patients present late, with locally invasive or metastatic disease. We present the case of a woman in her 40s with a previously resected sigmoid adenocarcinoma and a new splenic flexure mass. Histopathology revealed an SCC without evidence of extra-colonic disease. The patient underwent resection with clear margins, however, did not tolerate systemic adjuvant treatment and developed local recurrence within twelve months. We add our patient's case to the small compilation of cases of primary colorectal SCC along with a summary of its clinical and histological characteristics, strategies in management and considerations for future research.

This is the first report of acute avulsion fracture of the ischial tuberosity (AFIT) treated by suture anchor fixation using the suture bridge technique. A 13-year-old boy developed sudden, severe right hip pain while running a short distance. Pelvic images revealed the avulsion fracture of the right ischial tuberosity with displacement of the avulsed fragment by 35 mm. We performed open reduction and reconstruction fixation 5 days after the injury using the subgluteal approach with longitudinal skin incision. Four suture anchors were set at the ischial tuberosity, and the avulsed fragment was repositioned and fixed using the suture bridge technique. At 1 year postoperatively, the avulsion fracture was bony fused, and he had returned to his preinjury competitive level. Use of multiple suture anchors increases the strength of fixation, which overcomes the problem of anchor loosening and makes open reduction and reconstruction fixation an effective treatment for acute avulsion fracture of the ischial tuberosity.

Ehlers-Danlos syndrome (EDS) is an inherited disorder of collagen creation and function which can affect many organs. Surgical management of EDS spectrum remains a significant challenge for surgeons, including the vascular type of EDS (vEDS). There do not exist specific guidelines for the management of vEDS, which proves difficulty given the devastating pathology and potential outcomes. This case report emphasizes the need for further research in many areas including the need for certain screenings to identify any vascular aneurysms or dissections prior to rupture, as well as asking should there be a screen for this gene mutation in COL3A1 included at birth. Our case report is one of few reports that link the spontaneous colonic rupture that may trigger the subsequent vascular catastrophe leading to devastating mortality.

Pulmonary mucormycosis (PM) is a rare and life-threatening condition, most prevalent in immunocompromised patients. Early signs and symptoms are often nonspecific. A high index of suspicion in at risk patients should prompt early infectious work-up, including bronchoscopy, followed by aggressive antifungal therapy and early surgical resection when indicated. We demonstrate these core tenants of diagnosis and management of PM via two patient presentations, the first involving a kidney transplant recipient who presented with a mild cough, found to have a lung lesion with rapid growth over a few weeks; the second involving a patient with acute lymphoblastic leukemia who presented with hemoptysis and imaging revealing a 5 cm perihilar mass obliterating the left pulmonary artery. Both patients were managed with aggressive surgical therapy.

Neuroendocrine tumours of bronchial origin account for ~1%-2%. They can be typical or atypical in nature and are likely to be endobronchial in growth. We report a case of a 37-year-old woman with a carcinoid tumour in the bronchus intermedius with a background of aberrant bronchial anatomy. The tumour was removed by sleeve resection and histopathology confirmed a typical carcinoid tumour. This report describes successful surgical management of this carcinoid tumour despite aberrant bronchial anatomy.

A splenic artery pseudoaneurysm (SAP) is a rare vascular entity that is becoming increasingly recognized as a potential complication of bariatric surgery. This is a case of a 36-year-old woman brought by ambulance to a regional emergency department with abdominal pain, collapse, and gross haemodynamic instability 2 years post-laparoscopic sleeve gastrectomy. She received aggressive resuscitation in the emergency department but could not be stabilized and so underwent an emergency laparotomy. Intra-operatively, she was found to have a ruptured SAP with active bleeding, which was managed with a splenectomy. A high index of suspicion is required in any patient presenting with abdominal pain and circulatory collapse in the context of previous bariatric surgery. In rural or regional settings without immediate access to interventional radiology services, the most appropriate management option will almost invariably be an emergency laparotomy and splenectomy due to the risk of deterioration during patient transfer.

Infantile hemangiomas are the most common type of vascular tumors, affecting ~5% of infants within the first weeks of life. In rare instances, these tumors can lead to Kasabach-Merritt phenomenon (KMP), a life-threatening consumptive coagulopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, and hypofibrinogenemia. In the present case, a 20-month-old patient is diagnosed with KMP. This case report highlights the challenges in diagnosis and management, reinforcing the importance of multidisciplinary approach.