Journal of Surgical Case Reports最新文献

Bloody nipple discharge in children is rare and often alarms families because of its malignant associations in adults. We describe two prepubertal boys (3 and 5 years) with unilateral, spontaneous, painless bloody nipple discharge without trauma, infection, systemic symptoms, or exogenous hormone exposure. Examinations showed only mild unilateral breast change, with no masses, skin or nipple abnormalities, or lymphadenopathy. Breast ultrasonography was the primary investigation: one child had retroareolar ductal dilatation with cystic change consistent with mammary duct ectasia; the other had normal breast architecture. When obtained, laboratory, microbiologic, and cytologic studies were unremarkable. Both patients were managed conservatively with caregiver counseling and structured clinical/sonographic follow-up. Discharge resolved spontaneously within 14 and 8 months, respectively, with complete clinical and imaging resolution and no recurrence. These cases support ultrasound-based assessment and expectant management when no concerning features are present.

Neurofibromatosis type 1 is an autosomal dominant disorder associated with an increased risk of tumours, including gastrointestinal stromal tumours. These are usually asymptomatic and discovered incidentally. Small bowel obstruction due to gastrointestinal stromal tumour in neurofibromatosis 1 is rare, especially in young adults. We report a 24-year-old man with neurofibromatosis type 1 who presented with right upper quadrant pain and biochemical features of acute cholecystitis. During laparoscopic cholecystectomy, unexpected small bowel dilatation prompted conversion to laparotomy, revealing obstruction from a large multifocal jejunal gastrointestinal stromal tumour. This case highlights the rarity of such a presentation and the importance of surgical adaptability intraoperatively.

Meckel's diverticulum (MD) is a common developmental abnormality of the gastrointestinal tract that, in adults, is usually asymptomatic but can present with complications including malignancy. Although malignancy in MD is rare overall, MD is recognized a high-risk site for tumorigenesis compared to the surrounding ileum. Neuroendocrine neoplasms are the most common malignancy arising in MD and are often associated with nodal metastases, even if the primary tumor is small. We report the case of a 66-year-old male who underwent exploratory laparotomy for small bowel obstruction and was intraoperatively found to have MD causing an internal hernia. Pathologic examination of the diverticulectomy specimen revealed a well-differentiated neuroendocrine tumor, grade 1, pathologic stage pT2. The case highlights the role of resection for incidentally found and symptomatic MD due to the elevated risk of malignancy at this site.

We present a novel local groin flap approach for phalloplasty with minimal visible scarring. The presented patient is a 32-year-old transgender male with a prior metoidioplasty. He desired phalloplasty to optimized standing micturition and sexual function but was unwilling to undergo standard radial forearm or anterolateral thigh due to high visible scar burden. A staged approach to phalloplasty was employed, using a lower abdominal random pattern flap to construct the phallus. Once healed, future stages will create a urethral channel with full thickness skin graft from the thigh to maintain a low scar burden. Although this technique does not provide an option for direct neurotization of the construct, burial of the clitoral structures is expected to provide adequate sexual function. This technique can be considered for patients who do not desire the typical visible scarring with traditional phalloplasty methods.

Solitary fibrous tumours can cause non-islet cell tumour-induced hypoglycaemia, a paraneoplastic syndrome resulting from extrapancreatic tumours secreting insulin-like growth factor -II. This is also known as Doege-Potter syndrome. A male patient in his 70s presented to our hospital with loss of consciousness because of a second relapse of the solitary fibrous tumour with Doege-Potter syndrome. A third surgery was performed after transcatheter arterial embolization. After surgery, blood glucose levels stabilized. Repeated relapses can occur in solitary fibrous tumours even after the complete resection. Embolization of the feeding arteries before resection may be effective in avoiding massive haemorrhage and reducing complications.

Schistosomiasis is a neglected tropical disease with significant morbidity, yet appendicitis secondary to schistosomal infestation remains rare, even in endemic regions. We report a series of five cases of acute appendicitis in adult patients, where histopathological examination revealed schistosomal appendicitis. All patients presented with classical features of acute appendicitis, underwent appendectomy, and recovered uneventfully. One case demonstrated mural calcifications on preoperative imaging, raising suspicion of schistosomiasis preoperatively. Histology confirmed the diagnosis in all cases. This report highlights the importance of routine histopathological examination of appendectomy specimens in endemic areas, as schistosomiasis may mimic common surgical emergencies and requires targeted antiparasitic treatment postoperatively to prevent further complications.

Developmental venous anomalies (DVAs) are the most common cerebral vascular malformation, with age-dependent prevalence variation in the pediatric population. We report a case of an incidentally discovered left anterior temporal DVA with associated white matter changes in a previously healthy 7-year-old girl following minor head trauma. Initial computed tomography revealed a temporal lobe hypodensity, prompting magnetic resonance imaging (MRI), which demonstrated a classic DVA with adjacent T2/Fluid-Attenuated Inversion Recovery (FLAIR) hyperintense white matter changes without restricted diffusion, blooming susceptibility, or abnormal enhancement. The patient remained asymptomatic throughout follow-up, with serial magnetic resonance imaging showing stability of both the DVA and parenchymal abnormalities. The association of DVAs with white matter changes is attributed to chronic venous hypertension or altered hemodynamics. While generally benign, DVAs can occasionally cause seizures or rarely hemorrhage in children. This case highlights the characteristic imaging features and typically benign course of DVAs with white matter changes in children, supporting conservative management with clinical and radiological surveillance.

Bronchiolo-arterial fistulae are rare occurrences that can lead to hemoptysis. In general, persistent hemoptysis has a broad range of causes and management options. Surgery is often used in cases where conservative approaches have failed. In this case study, we present a 43-year-old woman with Loeys-Dietz syndrome, a connective tissue disorder, who developed chronic persistent hemoptysis after multiple aortic operations. The hemoptysis did not resolve with antibiotics, corticosteroids, and coil embolization. Based on multidisciplinary consensus, a left upper lobectomy was performed, with no recurrence of hemoptysis after 2 years of follow-up. Pathology revealed a bronchiolo-arterial fistula.

Deep fibrous histiocytoma (DFH), also termed deep benign fibrous histiocytoma, is an uncommon fibroblastic neoplasm that typically arises in the dermis or subcutis. Occurrence in deep soft tissues is rare and retroperitoneal presentation is exceptional. Distinguishing DFH from soft tissue sarcomas can be challenging when lesions show atypical morphology or focal lipogenic change. We report a giant retroperitoneal DFH displaying low-grade myxoid and dedifferentiated liposarcoma-like area and summarize diagnostic pearls and management considerations. A 53-year-old man presented with postprandial dyspepsia and increased bowel movements. Imaging revealed a multilobulated retroperitoneal mass (35 × 32 × 18 cm) displacing the inferior vena cava, aorta, and bowel loops, with the left kidney ectopically located in the right paramedian pelvis. Through a xipho-pubic laparotomy, a well-encapsulated 12-kg tumor was excised en bloc without rupture. Histology showed a spindle-cell proliferation with storiform and meningothelial-like architecture consistent with DFH, with foci of low-grade myxoid change and areas mimicking dedifferentiated liposarcoma. Immunohistochemistry demonstrated CD34 positivity and negativity for S100 and smooth muscle actin in the fibrohistiocytic component. The early postoperative course was uneventful. Retroperitoneal DFH is a diagnostic mimic of liposarcoma and other sarcomas. Correlation of morphology with an appropriate immunophenotype and clinical-radiologic context is essential to avoid overtreatment. Complete surgical excision is the mainstay of therapy; long-term surveillance is advisable given the deep location and size.

Giant ventral hernia represents a surgical challenge, particularly in oncologic patients in remission, due to large fascial defects and loss of domain. Botulinum toxin has been incorporated as an adjuvant to facilitate fascial closure through chemical relaxation of the abdominal wall. We describe four oncologic patients in remission with giant ventral hernia treated with preoperative botulinum toxin and repair using component separation with retromuscular polypropylene mesh placement. The procedures were performed without intraoperative complications or early recurrence. The technique allowed tension-free fascial closure with favorable postoperative outcomes. Botulinum toxin appears to be a useful and safe tool for the repair of complex ventral hernias in oncologic patients in remission, promoting fascial approximation and reducing the need for more invasive procedures.