Journal of Surgical Case Reports最新文献

Popliteal artery pseudoaneurysms are rare, especially from acupuncture-related trauma. We report a 67-year-old male with hypertension, diabetes, chronic kidney disease, and an abdominal aortic aneurysm (AAA), who developed a popliteal pseudoaneurysm after acupuncture. Imaging confirmed the pseudoaneurysm and a 55 mm AAA. Urgent surgical repair with a Gore-Tex graft led to a smooth recovery. This case emphasizes the vascular risks of acupuncture and the importance of early diagnosis, multidisciplinary care, and personalized follow-up in patients with complex comorbidities.

Persistent ascending mesocolon (PAM) is a rare congenital anomaly in ⁓2%-4% of individuals. PAM is associated with various complications, including volvulus of the colon and caecum, bowel perforation, intestinal obstruction, and adhesions. This case is reported on a 48-year-old woman who reported to the Ho Teaching Hospital specialist clinic with a 13-year history of initial painless and reducible paraumbilical swelling. Management was based on a surgical approach. The content of the hernia sac was unusual with a viable appendix, caecum, ascending and transverse colons inclusive, and ascending mesocolon was persistent. The repair was done through an anterior component separation technique. An onlay mesh repair was fashioned with a 30 cm × 30 cm polypropylene mesh. This case report highlights the complexities of managing a giant paraumbilical hernia in a morbidly obese patient with a PAM, a rare congenital anomaly.

A 17-year-old female presented with a mass in the right nasal fossa and eye protrusion. Imaging revealed a large osseous mass originating from the right turbinates, causing exophthalmos without tissue invasion. A partial resection via the Caldwell-Luc approach was performed, but hemodynamic instability halted the procedure, leaving a residual mass. Histopathology confirmed an osseous lesion with osteoblasts in a hypocellular stroma. The patient required blood transfusions postoperatively due to significant blood loss, but recovered well with antibiotics and supplements and was discharged after mild nausea was managed.

Neuroendocrine tumors (NENs) originate from neuroendocrine cells and predominantly occur in the gastrointestinal tract, lungs, and pancreas. Although the liver is commonly involved in NEN metastasis, primary hepatic neuroendocrine tumors (PHNETs) are rare. Herein, we report a case of a 52-year-old female who presented with slowly enlarging, cystic, multiple PHNETs. Two tumors in segments 6 (S6) and S7 were noted on computed tomography (CT), and an additional S7/8 tumor was found on magnetic resonance imaging. Additionally, CT during hepatic arteriography (CTHA) revealed a small tumor in S8. No other primary tumors were detected in other organs. Posterior segmentectomy and S8 partial resection were performed for the tumors. The postoperative pathological diagnosis was a grade 2 neuroendocrine tumor. The patient showed no recurrence of tumor 3 years postoperatively. In this study, CTHA was more effective than other examinations in detecting small tumors, which could be resected without any residual tumors.

Gestational gigantomastia (GG) is a rare and severe clinical complication of pregnancy. It is characterized by dramatic and uncontrolled growth of the breasts, often leading to physical discomfort, psychological distress and significant surgical complications. Its pathophysiology is poorly understood; management options include conservative pharmacological and surgical interventions. Pseudoangiomatous stromal hyperplasia of the breast is a very rare, incidental, and histological diagnosis seen predominantly in women aged 30-40 years old, with the management generally involving surgical excision. The authors herein discuss an unusual case of bilateral GG complicated by pseudoangiomatous stromal hyperplasia in a premenopausal Caribbean woman, which is the second reported case in this population, with the first reported by one of our authors.

Angiosarcomas are a type of malignant tumor of vascular origin. They represent <1% of all primary bone tumors. The multicentric or metastatic does not differ in its high aggressiveness and poor prognosis. A 72-year-old male with bone angiosarcoma initially located in proximal femur. After biopsy in a non-expert sarcoma center, he presented tumor involvement in the needle trajectory and multicentric/metastatic involvement at the sacro-coccygeal level. He associated tumoral-hypercalcemia and was referred to our sarcoma center. He was treated by tumoral resection and tumor prosthesis. In the follow-up he presented pulmonary metastasis and new implants, dying 2 months later. Multicentric or metastatic bone involvement in angiosarcomas has only theoretical relevance for their management. Biopsy should be performed in sarcoma centers due to the risk of dissemination. Although hypercalcemia in sarcomas is uncommon, we highlight its investigation.

Sialolithiasis is a common cause of salivary gland obstruction, leading to symptoms such as pain and swelling. In cases of intraparenchymal submandibular stones and proximal ductal stones larger than 7 mm, interventional sialendoscopy may fail, necessitating sialoadenectomy. As an alternative, intraoral stone extraction can be performed with CT-guided navigation. This case report describes a 52-year-old male with previous sialadenitis complaints. Imaging confirmed a fixed intraparenchymal stone measuring 21 × 18 mm. Using CT navigation, the stone was located and removed intraorally. Salivary flow resumed through Wharton's duct on the same day postoperatively and the patient was discharged without further complaints or new stone formation during a 1-year follow-up. This minimally invasive method, utilizing CT navigation, allows for the preservation and functional recovery of the submandibular gland, avoiding skin scarring and reducing the risk of nerve damage.

The single anastomosis duodenal-ileal switch (SADI-S) has become a safe alternative to Roux-en-Y gastric bypass (RYGB) in the treatment for morbid obesity. A known complication after bariatric surgery is the development of marginal ulceration. The current literature demonstrates an overwhelmingly low incidence of ulceration in patients who underwent SADI-S. The management and prevention is an ongoing subject of debate with no clear algorithm. The conversation of SADI-S to RYGB has been accomplished; however, this procedure has not been previously reported for marginal ulceration.

The use of video-assisted thoracic surgery (VATS) has increased in recent years. We herein report a case wherein suspected intramammary lymph node (IM) recurrence of breast cancer was treated using the thoracic approach (VATS). A 53-year-old woman had undergone right total mastectomy, axillary lymph node dissection, and implant-based reconstruction for right breast cancer 19 years ago. Hormone therapy was commenced postoperatively. Positron emission tomography as health check up performed at another hospital 1 year prior to presentation revealed enlargement of the right IMs, suggesting recurrence of breast cancer. IM biopsy was performed using VATS to preserve the artificial breast implant. The operative time and blood loss were 157 min and 20 ml, respectively. The postoperative course was favourable. IM biopsy revealed reactive enlargement owing to inflammation. In conclusion, VATS is a safer approach that yields superior outcomes in terms of appearance care.

Mucinous ovarian cystadenomas are rare epithelial benign tumors that can reach significant sizes. They are often asymptomatic and are discovered incidentally during an ultrasound examination. We present two clinical cases of mucinous ovarian cystadenomas with abdominal distention. Complicated variants can mimic an acute surgical abdomen and often require the involvement of a multidisciplinary team in operative treatment. Timely diagnosis and treatment are of utmost importance to prevent complications and malignancy.