Journal of Surgical Case Reports最新文献

The preoperative diagnosis of ovarian lymphoma, a rare pathology, is often difficult. Consequently, laparotomy is usually performed under the presumptive diagnosis of ovarian cancer. In cases where the initial curative surgery for ovarian cancer is challenging, diagnostic laparoscopy is performed. Herein, we report a case in which single-port laparoscopic surgery effectively diagnosed primary ovarian lymphoma. A 55-year-old woman presented with abnormal uterine bleeding. PET-CT findings suggested ovarian cancer with multiple metastases. Single-port laparoscopic surgery was performed because curative surgery was deemed difficult. She had an uneventful recovery and was discharged on the fourth postoperative day. After the pathological diagnosis was made, she was referred to the hematology department for treatment. Diagnostic laparoscopy is recommended for advanced ovarian cancer to facilitate early postoperative treatment. This case highlights the utility of single-port laparoscopic surgery in the accurate diagnosis and early treatment of intraperitoneal malignancies.

The purpose of this clinical case was to test the efficacy and safety of the long-pulsed 1064-nm neodymium-YAG laser in the treatment of multiple angiokeratomas on the labia majora of the vulva. Benign vascular neoplasms known as angiokeratomas are characterized by well-defined, hyperkeratotic, reddish-black papules, or plaques. The patient underwent one treatment session with a long-pulsed 1064-nm neodymium-YAG laser. A clinical photographic assessment was performed immediately after the laser session and at 14 days follow-up. At the follow-up appointment, the patient reported no significant discomfort and physical examination revealed complete resolution of all angiokeratomas. The skin of the labia majora appeared healthy, with no visible scarring or pigmentation changes. The patient expressed high satisfaction with the cosmetic outcome. This case supports the use of laser systems for managing angiokeratomas in delicate areas like the genital region, providing significant aesthetic improvement and patient satisfaction.

Complications of acute pancreatitis can be disastrous if appropriate treatment is not initiated. Pancreatic necrosis can occur without the presence of symptoms; however, in some cases, it can be accompanied by organic failure, abscess, pseudocyst, fistulas, and pancreatic exocrine disfunction. The surgical treatment of pancreatic necrosis can be managed with open surgical debridement of necrotic tissue. Hence, complications after surgery can appear even in patients without clinical background; complications mostly appear if the surgical technique is not done properly. We present a case of a 47-year-old woman who appeared with abdominal pain, nausea, vomiting, and oral intake intolerance. Symptoms were present for 1 week; she was admitted to the nearest clinic, and surgical management was offered. The patient went to an open pancreatic necrosectomy; however, she presented purulent exudate from the surgical wound and drains. Was referred to our center; on abdominal contrasted computed tomography, a transmesenteric defect and cutaneous-pancreatic fistula were found.

Giant thrombotic aneurysms of the anterior cerebral artery (ACA) are rare and pose significant challenges due to their variable clinical presentations. While complications following surgical interventions for these aneurysms are known, they have not been fully characterized. We present a novel case of postoperative infarction in the recurrent artery of Heubner (RAH) following resection of a thrombotic giant aneurysm in the ACA. A 53-year-old man with no prior systemic illnesses presented with progressive weakness in his left hand and foot, along with slurred speech. Imaging studies revealed a giant thrombotic aneurysm in the proximal A2 segment of the right ACA, which was completely occluded. Additionally, a chronic infarction was identified in the territory of the right ACA. The patient underwent successful surgical resection of the aneurysm. However, he subsequently developed an infarction in the RAH territory, a complication rarely reported in the literature. This case highlights the importance of comprehensive preoperative evaluation and underscores the need to anticipate and manage potential complications following surgery.

An intragastric balloon is often used as a temporary solution for weight loss. It is endoscopically placed into the stomach and filled with air or saline to encourage fullness and reduce meal intake. A 23-year-old female with a history of a gastric balloon procedure presented to the emergency department with generalized abdominal pain and recurrent vomiting. Initial imaging with ultrasound and computed tomography scans revealed a collapsed migrated gastric balloon causing a small bowel obstruction. Despite initial conservative management, the patient required surgical intervention, which involved laparoscopic exploration, mini laparotomy, and enterotomy to extract the migrated balloon. Postoperatively, the patient had an uneventful recovery and was discharged with a stable condition. This case underscores the importance of considering device-related complications in patients with gastric balloons presenting with gastrointestinal symptoms and highlights the need for prompt imaging and appropriate surgical management. Intragastric balloon migration leading to small bowel obstruction is a rare but serious complication that should be considered in patients presenting with abdominal pain and vomiting following a gastric balloon procedure. Prompt imaging and surgical intervention are crucial for effective management and favorable outcomes.

A 58-year-old man presented with alcohol-induced acute pancreatitis. Imaging revealed complete necrosis of the pancreatic parenchyma. After initial non-operative management, the patient developed a duodenal ulcer and an upper gastrointestinal bleed and later spontaneously formed a fistula between the pancreas and the first segment of the duodenum. Through this fistula, the entire pancreatic necrosum migrated to the distal small bowel, where it became entrapped as a bezoar, causing a high-grade small bowel obstruction. The patient then proceeded to laparotomy, where the obstruction was resolved by removing the necrosum through an enterotomy. No surgical intervention to the pancreatic bed or duodenum was required, and he was ultimately discharged home on insulin and pancreatic enzymes. This is the first reported case in the medical literature of a spontaneous duodenal fistula leading to small bowel obstruction due to a bezoar of pancreatic necrosum.

Oncocytic lipoadenomas are a rare sub-category of fat-containing tumors of the salivary glands. These tumors are characterized by their oncocyte-predominant epithelial component admixed with mature adipocytes. This condition has been rarely reported to affect the parotid and the submandibular glands. We report a case of a 69-year-old male who presented to our otolaryngology outpatient department with a complaint of a gradually growing right-sided infra-auricular neck mass. A surgical full mass excision was performed, and a histopathological evaluation yielded a tumor with oncocytes organized in tubular structures. This paper presents the fourth unusual case of a giant oncocytic lipoadenoma of the parotid gland measuring 11.5 × 10.5 × 11.5 cm in anteroposterior, transverse, and cranial planes, respectively.

Gastrointestinal pathology in adult patients with Marfan Syndrome is rarely reported in literature. Nevertheless, it could be life threatening when it occurs. In our paper, we are presenting the first reported case of caecal volvulus in an adult patient with Marfan Syndrome, our findings and management. We also discuss the more common radiological findings that may enhance decision making amongst surgical clinicians. A high index of suspicion and a multidisciplinary approach is advised when encountering these group of patients.

Abdominal wall endometriosis (AWE) within the scar of a trocar insertion is seldom reported as a complication of laparoscopy. We describe the case of a 46 year-old woman suffering from uterine leiomyomas who underwent laparoscopic hysterectomy. One year later, she developed a painful abdominal wall mass, beneath the scar of suprapubic port-site trocar insertion. The diagnostic work-up, consisting in ultrasonography, magnetic resonance imaging and needle biopsy led to a diagnosis of AWE. Initially, a progestogen therapy was administered, obtaining relief from pain symptoms but insignificant reduction of lump' size. Therefore, the patient underwent a laparotomic resection of the mass. Pathologic findings showed endometriotic tissue mixed with smooth muscle cells, leading to the diagnosis of extrauterine adenomyoma. Six months after surgery, neither AWE relapse nor incisional hernia was found. To our knowledge, no case of parasitic adenomyoma development in a trocar scar following a laparoscopy has been described before in literature.

We present the first published account of a pseudoaneurysm of the Marginal artery of Drummond (MAoD) following an emergency open surgical repair of an inflammatory abdominal aortic aneurysm, in which the inferior mesenteric artery was ligated. This was hypothesized to be an iatrogenic injury secondary to retraction of the colonic mesentery during dissection of the aneurysm neck. The risk of pseudoaneurysm growth and rupture versus bowel ischaemia were evaluated in the post-operative phase. Ultimately, the patient underwent successful interventional embolization of the MAoD with no signs of bowel ischaemia post-intervention.