Journal of Surgical Case Reports最新文献

The presence of an appendix in the femoral hernia, known as De Garengeot hernia, was first described by a French surgeon named Rene Jacques Croissant de Garengeot in 1731. It is a rare surgical entity occurring in only 0.5-5% of all femoral hernias. It presents typically as an irreducible lump in the groin which may be difficult to differentiate from incarcerated inguinal hernia. The risk of incarceration is high due to the narrow femoral defect which can result in extraluminal compression of the appendix causing acute appendicitis. We have presented a 71-year-old woman with a 24 hour history of incarcerated De Garengeot hernia who underwent successful open femoral hernia repair with laparoscopic appendicectomy. While open femoral hernia repair with open appendicectomy is regarded as the commonly used surgical approach, we have highlighted the importance of pre-operative and intra-operative findings in predicting definitive surgical management.

Spigelian hernias are rare clinical entities; vague symptomatology and unreliable clinical examination ensure difficult diagnosis. Computed tomography (CT) is critical for accurate diagnosis. Surgical repair is mandated given the high risk of visceral organ incarceration. Few cases have reported herniation of the ovary or fallopian tube. A 76-year-old female presented with bilateral lower quadrant pain associated with tenderness and no palpable bulge. A CT scan identified a right lower quadrant Spigelian hernia containing the right ovary and fallopian tube. A laparoscopic transabdominal preperitoneal repair with mesh was performed. Intraoperative evaluation showed a congested ovary. The patient was discharged postoperative Day 1. Spigelian hernias can involve the small intestine, greater omentum, or colon, while cases involving the gynecologic organs are rare. CT is key to diagnosis. A minimally invasive surgical approach should be considered given its potential benefits of decreased wound complications and its diagnostic and therapeutic utility.

A 44-year-old gentleman presented with severe ischemic cardiomyopathy and mitral regurgitation post-inferior myocardial infarction. Echocardiography and magnetic resonance imaging revealed a dilated left ventricle with a large left ventricular aneurysm (9.3 × 9.5 cm) and associated thrombus. Severe mitral regurgitation due to leaflet tethering and a left ventricular ejection fraction (LVEF) of 25% were also seen. The patient underwent successful aneurysmectomy with patch repair and papillary muscle approximation. Following initial weaning from cardiopulmonary bypass, 6 days of postoperative temporary veno-arterial extracorporeal membrane oxygenation support were required. The patient was subsequently discharged on postoperative day sixteen with improved cardiac function (LVEF of 45%) and trace residual mitral regurgitation, highlighting the efficacy of geometric restoration in addressing such mitral regurgitation, avoiding conventional intervention on the mitral valve itself.

Subarachnoid haemorrhage from aneurysmal rupture is a common emergency in neurosurgery. Depending on aneurysm position, morphology, size, associated clot, and symptoms, it is either managed by endovascular occlusion or by clipping. Here we report the first known case of secondary Moyamoya phenomenon following the clipping of a supraclinoid internal carotid artery Aneurysm. After making a complete recovery following clipping, this patient developed headaches 6 years later. Angiographic imaging revealing Moyamoya phenomenon characterized by total distal arterial occlusion and development of anastomotic collaterals. This phenomenon may be caused by neuroinflammation and suggests a tailored neuroimaging follow-up is required for such patients.

Extraskeletal osteosarcoma (ESOS) represents a rare soft tissue entity, accounting for ⁓1% of all soft tissue malignancies. It is generally considered to have an even worse prognosis than bone osteosarcoma, therefore detailed investigations and proper treatment are required. ESOSs arising in the subcutaneous tissue are even rarer than the ones positioned in deep tissues, and they are considered to have far better outcomes. We present a case of a 49-year-old patient diagnosed with subcutaneous ESOS and Paget disease of the bone, which is not typical for the patient's age, considering that Paget disease of the bone tends to affect a population above 50 years. The coexistence of these two entities in a single patient and all their features make this case unique, and to the best of our knowledge, this is the first case reported.

Pseudoepitheliomatous hyperplasia (PEH) is a rare histopathological reaction. Cases of PEH have been infrequently reported, and it's even rare to appear as a postsurgical complication. This case report describes the development of multiple masses and purulent discharge around an abdominal scar following surgery for hepatocellular carcinoma, which morphologically resembles squamous cell carcinoma (SCC), though pathology revealed no signs of malignancy. The underlying mechanism of PEH has not been fully characterized. This case report may alert clinicians and pathologists to rare diseases and update the list of postoperative complications.

Isolated sphenoid sinus disease (ISSD) is a rare condition that accounts for roughly 3% of all sinusitis cases. ISSD is predominantly caused by infectious and inflammation processes, with underlying fungal pathologies. This case series aims to illustrate the endonasal endoscopic management of different isolated sphenoid fungal pathologies. We described four distinct case presentations of ISSD at a tertiary hospital in Dammam, Saudi Arabia. These cases included isolated sphenoid fungal ball, allergic fungal sinusitis, and acute invasive fungal sinusitis. The management of isolated sphenoid fungal pathologies differs depending on the type of the disease necessitating early identification and adequate treatment. The endonasal endoscopic approach is successful with minimal complications and favorable outcomes.

We report a case of distal anterior cerebral artery (DACA) aneurysm presenting with subdural hematoma (SDH) without subarachnoid hemorrhage (SAH). A patient in his fifties presented with headache. Fluid-attenuated inversion recovery magnetic resonance imaging revealed SDH in the interhemispheric fissure and left frontotemporal region. SAH was not detected. Computed tomographic angiography revealed aneurysms in the left internal carotid artery (ICA) and DACA. The patient underwent frontotemporal craniotomy, which confirmed an unruptured ICA aneurysm, followed by bilateral frontal craniotomy for clipping of DACA aneurysm. The left DACA aneurysm was identified as the source of the SDH. Intraoperative findings showed adhesion between the aneurysm body and falx cerebri, explaining the SDH formation. Literature review identified only six reported cases of SDH without SAH due to DACA aneurysm. Evidence suggests that DACA aneurysms have a relatively higher propensity to cause SDH without SAH, likely due to the anatomical characteristics of the parent vessel and aneurysm projection.

We document a case of a 75-year-old patient with a history of hypercholesterolemia and hypertension, who underwent endovascular aortic repair (EVAR) for an infrarenal abdominal aortic aneurysm (AAA) with common iliac artery ectasia. Despite an initially successful procedure, the patient experienced recurrent episodes of acute limb ischemia in his right leg. Subsequent imaging revealed thrombus formation distal to the stent graft, constituting a potential source of embolization, which warranted a reevaluation of the treatment strategy. This case highlights some of the complexities associated with managing AAA patients. In the context of EVAR, it emphasizes the significance of careful patient selection, meticulous endograft implantation, and watchful follow-up while tailoring treatment according to individual patient needs and anatomical considerations.

Internal herniation through the foramen of Winslow (FoW) is a rare, life-threatening diagnosis. We present a case of intestinal obstruction due to herniation of the ileum, cecum, appendix, and ascending colon through the FoW. We reduced the herniation using a small colotomy and preserved the entirety of the bowel. We closed the FoW and colotomy and secured the bowel to the lateral abdominal wall by suture cecopexy. Due to the rarity of this pathology, the literature remains unclear about the benefits of prophylactic measures, hence, we recommend continued reporting of cases and research on prophylactic measures. Further, our own treatment strategy outlined in this report may provide further insight into the misdiagnosis and management of FoW hernias.