Journal of Surgical Case Reports最新文献

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.

Soft tissue defects with exposed tendons present unique challenges in surgical reconstruction, as tendons are vulnerable to desiccation, infection, and necrosis. We present a single-center, retrospective case series of 10 patients with exposed tendons who underwent surgical reconstruction with ovine forestomach matrix (OFM) grafts. Medical records were reviewed to establish patient demographics, co-morbidities, injury characteristics, and post-operative outcomes. OFM grafts were applied for staged reconstruction, for closure via secondary intention, as implants with primary closure or fasciocutaneous flaps, and as a circumferential tendon-protective layer. The median time to granulation tissue coverage was 3 weeks (IQR: 2, 4), and to full epithelialization 4 weeks (IQR: 1, 6). The median follow-up period was 29 weeks (IQR: 6, 61). Long-term assessments evaluated tissue pliability and active range of motion. Overall, OFM provided good surgical utility, promoting rapid coverage, wound closure, and favorable functional outcomes in complex tendon exposure cases.

Rectal diverticulum is an exceedingly rare clinical entity, typically occurring as a solitary lesion or, less frequently, as up to three diverticula. Its development is often associated with underlying conditions such as obstructive defecation syndrome, rectal malignancy, pelvic floor weakness, chronic rectal impaction, obesity, or infection-related muscular atrophy. Although uncommon, rectal diverticulitis represents a surgical emergency requiring timely recognition and management. In this case, a female patient presented with rectal bleeding and secondary anemia. During the clinical course, the patient developed pelvic sepsis secondary to rectal diverticulitis. Appropriate surgical intervention, combined with antimicrobial therapy and supportive management, led to a favorable outcome. Rectal diverticulitis is a rare but potentially life-threatening condition. Awareness of this entity and early diagnosis are essential to prevent severe complications such as perforation and pelvic sepsis. This case highlights the importance of considering rectal diverticulum in the differential diagnosis of lower gastrointestinal bleeding and pelvic infections.

Chronic lymphatic leukemia (CLL) is the most common type of leukemia in the West, with an incidence of 4.2 per 100 000 population. Penile prepuce involvement at presentation, as the first manifestation of CLL, is extremely rare. We have seen a 69-year-old male patient who presented with a non-healing ulcer on the foreskin of the penis for 6 weeks. Biopsy revealed the diagnosis of small lymphocytic lymphoma. His hematological work-up uncovered an underlying CLL. He was treated with acalabrutinib, a Bruton tyrosine kinase inhibitor, resulting in complete remission after 7 weeks. In the vast majority of patients with CLL, the disease primarily involves bone marrow, peripheral blood, lymph nodes, and spleen; extramedullary and extranodal involvement is rarely seen. This case highlights the importance of keeping leukemic involvement into consideration in patients with penile lesions, as it can be the first manifestation of underlying CLL.

Delay in replacement of missing teeth might lead to pathological movement of teeth resulting in malocclusion. Such cases require extensive management option to rehabilitate the patient. Overlay denture provides a relatively quick and simple management option for patients not willing to go for proposed treatment options and having economical barriers. This case report series elaborates the management of the cases of partially dentate arch with misaligned teeth in young women. It was a combination of overlay removable cast partial denture in maxillary arch and conventional removable cast partial denture in mandibular arch. Porcelain veneers were bonded to metal framework to improve esthetics in one case. The end result successfully met patient's demand of better retention of dentures, improved esthetics, and masticatory ability.

Elbow dislocations are rare in children, comprising 3%-6% of pediatric elbow injuries, with posteromedial dislocations being particularly uncommon. We describe an 8-year-old boy who sustained a posteromedial elbow dislocation with an associated displaced lateral humeral condyle fracture after a fall. Although closed reduction restored joint alignment, the condylar fragment remained displaced and required fixation with two Kirschner wires. At 6 weeks, radiographs confirmed union, and the wires were removed. By 6 months, the patient had regained full, painless motion with a normal carrying angle and no growth disturbance. This rare injury pattern may be overlooked due to overlapping ossification centers, highlighting the importance of prompt diagnosis and appropriate surgical management.