Journal of Surgical Case Reports最新文献

Post-cholecystectomy clip migration is a rare but significant complication of laparoscopic cholecystectomy that can manifest years after the initial surgery. We report the case of a 56-year-old female who presented with chronic upper abdominal pain, nausea, and vomiting eight years following laparoscopic cholecystectomy. Laboratory investigations demonstrated markedly elevated liver enzyme levels, and imaging studies revealed a stone in the common bile duct. Endoscopic retrograde cholangiopancreatography identified a surgical clip embedded within the stone, serving as a nidus for stone formation. Successful treatment was achieved through biliary sphincterotomy and stone retrieval, resulting in complete symptomatic relief and normalization of liver function tests. This case highlights the importance of considering clip migration as a potential etiology in post-cholecystectomy patients presenting with unexplained biliary symptoms, even many years after the initial surgical procedure.

Foreign body ingestion is a common clinical issue, but swallowing a full-sized toothbrush is exceptionally rare. We report a case of a 32-year-old Sudanese male with a three-year history of an accidentally ingested toothbrush. The patient presented with mild epigastric pain and intermittent dysphagia but no acute complications. Imaging, including X-ray and computed tomography, failed to identify the foreign body. Esophagogastroduodenoscopy revealed a complete toothbrush lodged in the stomach, with its head extending into the duodenum. The object was successfully removed intact using a polypectomy snare under conscious sedation, without mucosal injury or complications. This case highlights the diagnostic challenges posed by radiolucent foreign bodies and underscores the key role of endoscopy in both diagnosis and treatment. It also demonstrates that delayed endoscopic removal can be safely accomplished, though early retrieval remains essential to prevent serious outcomes such as perforation or obstruction.

Hyperammonemia syndrome is a rare, life-threatening complication following orthotopic liver transplantation. While most cases result from graft dysfunction, metabolic disorders, or portosystemic shunting, infectious etiologies are infrequently recognized. Ureaplasma species, typically urogenital commensals, have recently emerged as important pathogens. We describe the first reported case of Ureaplasma parvum-associated hyperammonemia syndrome following isolated orthotopic liver transplantation. A 63-year-old man developed severe hyperammonemia and encephalopathy on postoperative day 14, despite preserved graft function and embolization of a large splenorenal shunt. In the absence of other causes and with rapid clinical decline, empiric doxycycline was initiated. U. parvum was subsequently detected via bronchoalveolar lavage and plasma cell-free DNA testing. Continued doxycycline led to normalization of ammonia levels and neurologic recovery. This case underscores the importance of considering Ureaplasma infection in post-orthotopic liver transplantation hyperammonemia and supports early empiric antimicrobial therapy to prevent fatal outcomes.

Delayed presentation of retained foreign bodies with sequelae of chronic inflammation is a rare but well documented phenomenon. Here we present the unusual case of a 23-year-old female with a retained wooden splinter in the buttock region presenting more than 10 years post injury. A foreign body was not identified on initial imaging. Only after surgical exploration and targeted ultrasound was a wooden splinter identified and removed.

Postoperative chylous fistula in abdominal surgery for benign pathologies is an extremely rare complication. This condition usually develops after extensive resections, chest or neck surgery, and is characterized by lymphatic leakage outside the abdominal cavity. In the following report, we describe two cases of patients undergoing non-oncologic abdominal surgery who developed a chylous fistula during the postoperative period and who responded adequately to conservative management.

We present the first reported case of robotic-assisted radical cystoprostatectomy and ileal conduit formation in a patient with prior total colectomy and J-pouch. The anatomy posed significant technical risk due to end artery pouch perfusion and changes in the posterior plane. Intraoperative strategies, including rectal indocyanine green and a short discard segment when constructing the conduit enabled successful outcomes. The procedure was completed without complication, and the patient had a favourable oncologic and functional status postoperatively. This case demonstrates the technical considerations of cystectomy in patients with previous large bowel resection and reconstruction, and the outlined strategies are relevant across multiple clinical settings.

Appendico-ileal knotting is a rare cause of small bowel obstruction, usually complicated by strangulation and resection of bowel. A 32-year-old woman presented with 24-hour abdominal pain, bilious vomiting, distension, and obstipation. Visible peristalsis was noted on physical examination; a radiograph showed multiple air-fluid levels and a dilated small bowel. Emergency laparotomy revealed an inflamed appendix, which formed a constricting ring around a loop of 15 cm of distal ileum, which was viable. The knot was released with retrograde appendectomy without bowel resection. A follow-up 1 year later revealed no complications and a complete recovery. Early recognition and appropriate timely intervention can help in the preservation of bowel viability in appendico-ileal knotting, and hence organ-sparing management can be achieved.

We present the case of a 13-year-old boy who developed heterotopic ossification along the pedicle of a fibula osteocutaneous free flap used for complex midface reconstruction following a ballistic injury. While rare in pediatric patients, this complication resulted in severe trismus, which required surgical excision of the pedicle. This case highlights the importance of long-term surveillance and periosteal management strategies in children undergoing fibula flap reconstruction of the maxilla.

Benign peripheral nerve sheath tumors are growths that develop in the protective sheath that surround peripheral nerves. In rare circumstances, they can cause mass effect on surrounding structures intra-abdominally. We report an otherwise healthy 62-year-old female who presented for constipation and recurrent bouts of diverticulitis. The patient had known about her nerve sheath tumor but did not want it removed. The initial plan was to perform a robotic Sigmoidectomy; however, this was not feasible given the size of the tumor intra-operatively. The procedure was subsequently aborted. A multi-disciplinary team of vascular surgery, neurosurgery, and colorectal surgery then took the patient to the operating room for an open resection of the schwannoma and concurrent sigmoidectomy. There have only been several staged attempts described in the literature, but none that describe simultaneous resection of both the nerve sheath tumor and the sigmoid colon.