Journal of Surgical Case Reports最新文献

Paragangliomas, a type of extra-adrenal tumour, albeit rare, are dangerous due to their high metastatic potential and risk of hypertensive crisis from massive catecholamine release. It typically presents with sympathetic overdrive symptoms such as diaphoresis, headache, and palpitation, accompanied by substantially high plasma metanephrines level and mass on contrasted computed tomography abdomen and pelvis, whilst some are found incidentally. In this report, we discuss a case of an extra-adrenal lesion located near susceptible major structures with extensive vascularisation, in a patient with near-death experience. Complete excision of the pulsatile mass with minimal bleeding and no complications, was made possible utilizing the da Vinci Robotic System. Robotic surgery, being a part of a multidisciplinary approach, leads to better patient outcomes and shorter hospitalisations. Moreover, it offers enhanced dexterity and improved depth perception compared to conventional methods. However, further studies are needed to validate its application in standard practice.

The literature regarding robotic-assisted radical cystectomy in kidney transplant recipients is limited. We present the first reported case of robotic-assisted radical cystectomy with a full intracorporeal orthotopic neobladder in a kidney transplant recipient. A 36-year-old man was diagnosed with muscle-invasive urothelial carcinoma 12 years after kidney transplantation. His immunosuppressive regimen consisted of everolimus, mycophenolate mofetil, and prednisolone. After cystectomy and left lymph node dissection, we used a U-shaped neobladder technique slightly modified to adapt to the fixed position of the renal transplant ureter. The surgical time was 305 min, and the blood loss was 200 ml. The patient was discharged 16 days after hospitalization with no surgical complications. Histological analysis revealed no UC (pT0N0) with disseminated carcinoma in situ. Seven months after the surgery, no signs of recurrence or distant/lymph node metastasis were observed. No urinary leakage with complete bladder emptying was reported. Serum creatinine clearance rate was 51 ml/min. Immunosuppressive regimen was not modified after surgery.

Histiocytic necrotizing lymphadenitis (HNL) is a rare condition presenting with lymphadenopathy and fever. We report a case of a 61-year-old male with a history of perianal abscess surgery who developed HNL postoperatively. The patient was treated with corticosteroids, leading to resolution of fever and alleviation of symptoms. This case emphasizes the need for clinical vigilance for HNL in patients with a history of perianal abscess surgery and postoperative fever with lymph node enlargement.

Gallbladder cancers (GBC) are insidious, malignant, and associated with poor prognosis, with a 5-year survival rate of 5%. Long-term survival in advanced GBC is rare. Here, we report a case of a 45-year-old female who presented with intermittent right upper quadrant pain for 1 month. A gallbladder mass and two liver masses were identified on a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast, which was highly suspicious for GBC. The patient underwent extended radical surgery, and a low to moderately differentiated gallbladder adenocarcinoma was diagnosed through pathology. Postoperatively, the patient received chemotherapy with gemcitabine and cisplatin but only tolerated one cycle. The patient has been disease-free for over 7 years, representing an unusually long survival.

Neurenteric cysts, rare benign tumors, are most often found in the cervical or thoracic spinal cord, with intracranial occurrences being extremely uncommon. This case report describes a 52-year-old female with a neurenteric cyst in the cerebellopontine angle, presenting with headaches and balance disturbances. Magnetic resonance imaging (MRI) revealed a cystic lesion causing hydrocephalus, and surgical removal was performed using a retrosigmoid approach. Histopathological analysis confirmed the cyst as Type A neurenteric, characterized by ciliated columnar epithelium and goblet cells. Postoperatively, the patient showed significant improvement with resolved symptoms. Neurenteric cysts can mimic other cystic lesions radiologically, complicating diagnosis. Management typically involves surgical excision, although complete removal is often challenging due to cyst adherence to nearby structures. Recurrence rates remain high, necessitating long-term follow-up. This case highlights the importance of differential diagnosis and careful surgical planning in managing neurenteric cysts to optimize patient outcomes.

Endobronchial lipoma is an extremely rare benign tumor, accounting for 0.1%-0.5% of all lung tumors. This case report presents a patient diagnosed with endobronchial lipoma, a condition that can lead to significant bronchial obstruction and subsequent parenchymal damage. Patients usually exhibit symptoms including cough, dyspnea, and recurrent respiratory infections, which initially mimic more common pulmonary conditions such as chronic obstructive pulmonary disease. However, in our case patient presented with non-specific cardiac symptoms. Diagnosis was confirmed through bronchoscopy, revealing a well-circumscribed mass obstructing the bronchus. Due to severe parenchymal inflammation, treatment involved left-sided thoracotomy and upper lobectomy which successfully relieved the obstruction and alleviated the patient's symptoms. Histopathological examination identified the tumor as a lipoma. This case underscores the importance of considering endobronchial lipoma in differential diagnoses for patients with unexplained cardiac or respiratory symptoms, as early detection and treatment can prevent significant complications.

This case report highlights the rare presentation of an acute thoracic disc herniation in a 27-year-old male. Thoracic disc herniations are uncommon, accounting for less than 1% of all disc herniations, and acute presentations have scantly been recorded in literature. The patient, a mechanic, presented with a sudden onset of dorsal pain and bilateral lower limb weakness after lifting heavy equipment, leading to a sudden cease of most motor functions in the patient's lower limbs. Magnetic resonance imaging revealed a severe T9/T10 herniation with significant spinal cord compression. Emergency surgical decompression via a right-sided transpedicular thoracic approach was performed, resulting in progressive neurological recovery. This case underscores the importance of early diagnosis, timely surgical intervention, and multidisciplinary management in achieving favorable outcomes for this rare condition.

Pemphigus vulgaris (PV) is a subtype of pemphigus and life-altering disorder that results in the formation of intraepithelial blisters in mucosa and skin. Though the etiology is not well understood, it is an autoimmune disorder resulting in acantholytic blisters due to auto-antibodies targeting proteins of keratinocyte adhesion. Rapid diagnosis and restoration of the epidermal layer is imperative for patients with PV as widespread epidermal damage can lead to high morbidity and mortality rates. This case report presents the treatment of PV in a 53-year-old female who presented after 9 months of worsening symptoms and 30% total body surface area blistering. Most of the lesion was re-epithelialized in 1 week, with complete healing in 4 weeks following a single application of ovine forestomach matrix (OFM) graft. This case represents the first report of the use of OFM to aid regeneration of epithelial lesions resulting from an autoimmune bullous disease.

Extracranial carotid artery aneurysm (ECAA) is a relatively rare vascular lesion of the neck, and is usually found incidentally and is usually asymptomatic. Surgery is currently the first choice for symptomatic or growing ECAA, including open resection of the entire aneurysm, with or without arterial replacement and insertion of grafts. Ischemic stroke is the most serious complication after resection of ECAA. The preoperative Matas test facilitates the collateral circulation through the circle of Willis， which allows the brain to adapt to the hypoxic situation and effectively reduces ischemic stroke. We report a case of a young patient who underwent a staged surgery to treat it (the first stage was prophylactic carotid artery blockade, so called open Matas test), and achieved good results.