Journal of Surgical Case Reports最新文献

Fulminant amoebic colitis is a rare complication of amoebiasis that carries a high mortality rate. Its diagnosis is challenging and requires a high index of suspicion, and its early recognition is a priority to provide timely medical and surgical treatment. We present the case of a male patient who came to the emergency department with unspecific clinical presentation of abdominal pain, systemic inflammatory response and imaging study showing intestinal perforation of the right colon. Fecal peritonitis and perforation at the level of the hepatic flexure were observed, so a right hemicolectomy with terminal ileostomy was performed. Despite adequate medical and surgical treatment, the patient presented progressive deterioration and died. Colon perforation due to Entamoeba histolytica was the final diagnosis.

Primary pulmonary follicular lymphoma is an extremely rare subset of extra-nodal non-Hodgkin's lymphoma. We present a successful work-up and surgical management of this disease entity. The patient is a 74-year-old man who presented with an enlarging ground glass opacity on his computed tomography scan. Percutaneous biopsy was not diagnostic for malignancy, but given the underlying malignant potential, he underwent definitive operative resection rather than additional invasive diagnostic testing. Our case highlights challenges in the management of nondiagnostic preliminary pathology as well as the role of a multidisciplinary approach to treatment of a rare lung pathology.

Video capsule endoscopy has become the gold standard for the evaluation of small bowel pathology. Capsular retention remains the most significant risk of this intervention. Here, we present two cases of retained capsules and our minimally invasive approach to retrieval. We also review the literature pertaining to retained endoscopy capsules and highlight a range of medical, surgical, and preventative strategies utilized in its management.

Presacral tumors are uncommon, particularly in the pediatric population, and can arise from various germ cell types during embryologic development. Tailgut cysts, or retrorectal cystic hamartomas, represent rare congenital anomalies resulting from defective regression of hindgut remnants. We present a unique case of a 13-year-old female with pelvic symptoms, initially suspected to have a tailgut cyst based on imaging findings. However, surgical exploration revealed a mature cystic teratoma, a rare occurrence in this age group. Surgical excision was performed using an anterior approach, revealing adhesions and necessitating meticulous dissection for complete removal. Histopathological examination of the mass unexpectedly confirmed a mature cystic teratoma, characterized by a fibrovascular cyst wall containing smooth muscle and lobules resembling salivary acini, the cyst's surface exhibited squamous and respiratory-type epithelium. The accurate diagnosis of presacral masses, rather than relying solely on diagnostic measures, underscores the importance of prioritizing surgical exploration for definitive assessment and management.

According to the American Association for the Surgery of Trauma, distal pancreatectomy or pancreatic duct drainage is recommended for grade III traumatic pancreatic injuries. We report a case of traumatic pancreatic injury involving the main pancreatic duct in which this method failed to drain fluid from the area distal to the injury site. A 19-year-old woman presented with a bruised upper left abdomen after a bicycle fall. Computed tomography revealed a linear area of poor contrast in the pancreatic body, leading to the diagnosis of grade III pancreatic injury. Endoscopic retrograde pancreatography revealed damage to the pancreatic duct, prompting endoscopic pancreatic stent placement. We added abdominal cavity drainage, peritoneal lavage, and endoscopic ultrasound-guided transgastric pseudocyst drainage. In the patient with pancreatic duct injury, drainage distal to the injury site was unattainable with a pancreatic duct stent; therefore, alternative drainage sites were utilized, thereby obviating the need for surgery.

Anal melanoma is a rare and highly aggressive malignancy that carries a poor prognosis. Due to its variable and ambiguous presentation, it is often misdiagnosed as a hemorrhoid, polyp, or an ulcer with a concomitant rectal prolapse. Clinicians usually have a low suspicion of anal melanoma due to its rarity and most people present with metastatic disease at the time of diagnosis. We report a case of a patient incidentally found to have anal melanoma. Prompt surgical resection with wide local excision versus abdominoperineal resection remains the mainstay of treatment as the added benefit of adjuvant chemoradiation or immunotherapy has been controversial.

Acupuncture, a well-established traditional medical practice in East Asia, is rarely associated with complications associated with broken needles. A 45-year-old woman had received acupuncture treatment 3 months before presentation to relieve back pain and complained of persistent epigastric pain. Radiological studies revealed chronic cholecystitis with stones and a broken acupuncture needle in the pancreatic head. Laparoscopic cholecystectomy and foreign body removal were performed, and the patient recovered quickly during a short hospital stay. We confirm that a needle found in the pancreas can usually be safely removed with minimally invasive surgery.

A rectus sheath haematoma (RSH) is a relatively rare cause of acute abdominal pain that is becoming more prevalent due to an increase in anticoagulant therapy. Of its associated complications, acute obstructive uropathy is exceedingly rare. This is a case of a 62-year-old lady who presented with abdominal pain caused by an RSH which then led to obstructive uropathy. She had undergone laparoscopic removal of a gastric band 6 days prior and due to a mechanical mitral valve, required ongoing anticoagulation. Initially, she had a contained RSH, but this subsequently decompressed into the extraperitoneal space, causing acute obstructive uropathy secondary to external compression. She was managed with ureteric stenting and her anticoagulation was appropriately modified throughout her admission. This case highlights that the challenging aspect of RSH management involves tailoring treatment to address individual patient factors and the location of the haematoma itself.

Few reports in the literature explore the efficacy of bariatric surgery in patients post simultaneous kidney and pancreas transplant (SKPT). This case report entails a patient who had SKPT because of end-stage renal disease and type I diabetes. The transplant failed, and the patient gained weight. The report explains the approach and the outcome of laparoscopic sleeve gastrectomy in this patient as a preparation for a re-transplant. The patient was having grade 2 obesity, insulin-dependent, on hemodialysis, and had obstructive sleep apnea on bilevel positive airway pressure. A multidisciplinary team approach was implemented, and the procedure was completed with no immediate postoperative complications. The patient lost ~10 kg and was able to stop insulin.

Biliary stent insertion during endoscopic retrograde cholangiopancreatography is a therapeutic intervention to relieve obstruction and facilitate flow through the biliary tree. In rare circumstances, these stents can migrate and result in distal gastrointestinal perforation, which may necessitate endoscopic or surgical intervention. We report a case involving a 79-year-old female who presented with peritonitis due to sigmoid colon perforation following biliary stent migration. The stent was placed to treat acute cholangitis with choledocholithiasis. Two weeks following stent placement, gastroenterology attempted scheduled stent removal, but was unable to visualize the stent on endoscopy. Eleven days later, the patient was emergently taken to the operating room for an exploratory laparotomy and a Hartmann's procedure for stent migration and subsequent sigmoid perforation. No established protocol exists for managing migratory biliary stents to avoid perforations. We emphasize the need for follow-up imaging and individualized clinical decision-making based on patient stability.