Journal of Surgical Case Reports最新文献

Pancreatic acinar cell carcinoma (PACC) is a rare malignancy accounting for 0.2%-4.3% of pancreatic tumours, typically affecting older men. Cystic variants are exceptionally uncommon and often mimic benign pancreatic lesions, posing diagnostic challenges. We report a 37-year-old woman who was incidentally found to have a large multiseptated lesion involving the pancreas, spleen, and retroperitoneal structures. Surgical exploration demonstrated multiple peritoneal and hepatic nodules. Distal pancreatectomy, splenectomy, omentectomy, and resection of hepatic lesions were performed. Histopathology confirmed poorly differentiated pancreatic acinar cell carcinoma with extensive peritoneal metastases. Postoperative recovery was uneventful. This case highlights a rare cystic presentation of PACC in an atypical demographic. Clinicians should maintain a high index of suspicion for rare pancreatic malignancies in the differential diagnosis of complex cystic abdominal lesions.

Laparoscopic Roux-en-Y gastric bypass is a common bariatric operation proven to result in significant weight loss. One recognized serious complication is that of an internal hernia (IH), in which the small bowel protrudes through one of two mesenteric defects created by the Roux-en-Y anatomy. In this case report, we present a successful laparoscopic repair of a symptomatic IH in a patient in the third trimester of pregnancy. This case highlights the challenges in diagnosing vague abdominal pain and emesis during pregnancy, and technical considerations for safe laparoscopic access and monitoring throughout minimally invasive surgery in late gestation.

Colon lipoma is a benign non-epithelial neoplasm. It manifests clinically at an average age of 65 years when it is >2 cm. Treatment depends on its dimensions and complications and consists of endoscopic or surgical resection. One of its complications is intestinal intussusception, which is rare; in adults it represents 5% of all intestinal intussusceptions and only 0.08% of all abdominal surgeries. Here we report the case of a 32-year-old woman with ileocecal intussusception due to a giant submucosal lipoma of the colon, who underwent surgery through a right hemicolectomy with ileostomy, which allowed a favorable outcome for the patient. He has been followed up with no complications identified to date.

A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that may remain silent until rupture, often leading to acute heart failure. Surgical intervention is advised for unruptured SVAs when large, progressive, or associated with aortic regurgitation (AR). We report a 72-year-old woman with a 25-mm right coronary SVA and severe symptomatic AR. Transthoracic echocardiography confirmed severe AR with preserved ventricular function. A Bentall procedure using a bioprosthetic valve and Valsalva graft was performed, with coronary button reimplantation with the Carrel patch technique. The postoperative course was uneventful, and the patient remained free of recurrence at 2-year follow-up. This case highlights the Bentall procedure as a durable option for unruptured SVA with root distortion and valve involvement, offering reliable prevention of late AR and reintervention.

Human papillomavirus (HPV)-mediated rectal adenocarcinoma is a rare variant of colorectal adenocarcinoma that has only been described in a few case reports and series, with most originating from South America and the Middle East. This report, from North America, details the presentation, workup, and management of a 59-year-old Caucasian female who initially presented to her primary care with rectal bleeding who underwent interval colonoscopy and was found to have a T2 or early T3 rectal adenocarcinoma 1.2 cm from her anal verge. The tumor's unique pathologic feature demonstrated adenocarcinoma strongly positive for p16 protein, suggesting mediation by HPV. She is currently undergoing total neoadjuvant chemotherapy and radiation for this pathology-proven, HPV-mediated low rectal adenocarcinoma. Based on a thorough literature review, she is likely one of the first patients with HPV-mediated adenocarcinoma to be managed with total neoadjuvant chemotherapy and radiation with hopes for a complete clinical response.

A man in his sixties with locally advanced prostate cancer underwent ultra-low pressure robotic-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) and was safely discharged the same day. This is the first reported UK case of day-case RARP with PLND performed at 6 mmHg. The patient experienced no complications and reported minimal discomfort postoperatively. We highlight that, with appropriate patient selection, patient's counselling, perioperative optimization, and ultra-low pressure techniques, same-day discharge after RARP with PLND is feasible, safe, and potentially scalable within NHS pathways.

We report the case of a 70-year-old man with a gastric gastrointestinal stromal tumour who subsequently developed two rare metastatic recurrences to the subcutaneous tissue and skeletal muscle following initial curative resection and adjuvant imatinib therapy. This case illustrates the potential for atypical metastatic patterns in gastrointestinal stromal tumour and emphasizes the importance of long-term surveillance, even after extended disease-free intervals.

Breast sarcomas are rare malignancies, accounting for <1% of all breast malignancies and <5% of all soft tissue sarcomas. Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas that arise from peripheral nerves. Their occurrence in the breast is exceedingly rare. This is the fourth published case of mammary MPNST in a male patient. We present a case of a 93-year-old male with a three-year history of a progressively enlarging and painful right breast mass. Examination revealed a 20 × 30 cm immobile, fungating, and ulcerating mass with purulent discharge. Histopathological assessment confirmed a high-grade spindle cell sarcoma, and immunohistochemistry revealed positivity for vimentin, S100 protein, and p63 in a focal pattern, confirming the diagnosis of MPNST. The patient underwent a right mastectomy, achieving a surgical clearance. After 3 months, he passed away with malignant pleural effusion due to lung metastasis.

Rapunzel syndrome is a rare form of trichobezoar, typically associated with an underlying and often untreated psychiatric disorder such as trichotillomania. This case report describes a 24-year-old female patient previously diagnosed with trichotillomania and trichophagia, who presented with abdominal distension and vomiting due to a large gastric bezoar extending into the duodenum. Diagnostic evaluation included upper endoscopy and computed tomography, confirming complete upper gastrointestinal obstruction. Emergency laparoscopic management was successfully performed, allowing complete extraction of the trichobezoar, followed by gastric repair. Postoperative recovery was favorable, and psychiatric follow-up was initiated to address the underlying condition and reduce the risk of recurrence. Timely diagnosis enables successful minimally invasive surgical treatment and underscores the need for coordinated multidisciplinary management.