Journal of Surgical Case Reports最新文献

Pulmonary hypertension is a known perioperative risk factor that carries a high morbidity and mortality rate. Severe pulmonary hypertension is related to high morbidity after general anaesthesia. We are reporting three patients with underlying severe pulmonary hypertension, who presented with intestinal obstruction managed with different perioperative approaches. In case 1, a 38-year-old man with Eisenmenger syndrome and severe pulmonary hypertension underwent exploratory laparotomy, right hemicolectomy, and double barrel stoma for obstructed right-sided colonic tumour. He passed away on Day 6 post-operation. In case 2, a 52-year-old man with Eisenmenger syndrome and severe pulmonary hypertension presented with obstructed rectosigmoid tumour and jejunojejunal intussusception and underwent exploratory laparotomy and Hartmann's procedure. He succumbed after 33 days of fighting with cardiovascular and respiratory complications. In case 3, a 65-year-old woman, with strangulated paraumbilical hernia, underwent mini laparotomy, small bowel resection, primary anastomosis, and paraumbilical hernia repair under monitored sedation and local anaesthesia. She was discharged home after 7 days of hospitalization.

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare entity identified in ~1% of patients undergoing appendectomy. The presentation often varies, making diagnosis challenging. Timely identification and treatment are critical to prevent rupture, which may lead to pseudomyxoma peritonei. We describe the case of a 41-year-old male who presented for evaluation of acute right lower quadrant abdominal pain. The clinical impression was consistent with appendicitis with a clinical suspicion for underlying malignancy. The patient was brought to the operating room for an exploratory laparotomy and right hemicolectomy, revealing low-grade appendiceal mucinous neoplasm. The diagnosis of low-grade appendiceal mucinous neoplasm can be challenging given the variable presentation and imaging findings. Early recognition and treatment are imperative to prevent progression to pseudomyxoma peritonei. Our case report seeks to contribute to the ongoing literature and provide a review of the current knowledge.

The authors presented a case of duodenal obstruction in a 61-year-old man, resulting from an annular pancreas diagnosed on imaging (computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound). The patient underwent a diagnostic laparoscopy. Intraoperatively, given a straightforward appearance and anatomy of the annular pancreas overlying the second part of the duodenum, and due to extensive adhesions in the abdomen, a primary division of the annular pancreas was performed, instead of a bypass procedure such as gastrojejunostomy. He had some residual symptoms 1 week postoperatively which was treated with duodenal dilatation endoscopically. On review and follow-up at 1 year, he has remained well with resolution of symptoms, supported by radiological improvement on a computed tomography performed at 4 months post-operatively. We believe this approach has resulted in less morbidity and a shorter period of recovery as compared to a bypass procedure and represents a reasonable therapeutic option for annular pancreas.

Mucinous adenocarcinoma of the appendix (MAA) is a rare primary malignancy with an incidence of 0.01-0.2% and often presents as acute appendicitis. We present a case of a 61-year-old male who initially presented with right iliac fossa pain, worsening over 3 days, accompanied by appetite loss but no other symptoms. The patient's history included a splenectomy and epilepsy. Physical examination and computed tomography scan suggested a picture of acute appendicitis. He underwent an emergency laparoscopic appendectomy that was converted to open right hemicolectomy due to the mass's adherence to the cecum. The mass, at the cecum, originating from the appendix, measured 10 × 7 × 7 cm. Pathology confirmed a moderately differentiated MAA. Accurate diagnosis requires a combination of imaging and histopathology. The patient recovered well and was discharged on Day 6 postoperatively. We aim to highlight the importance of distinguishing MAA from acute appendicitis and the need for careful preoperative evaluation.

First webspace contractures are common indications for reconstructive burn surgery. Commonly performed procedures for this indication include either the four- or five-flap variations of the z-plasty, which involves the transposition of flaps about a central limb in order to obtain greater length, and thus, improve the thumb's important contribution to coordinated and precise hand function. This paper outlines the predominant reason for favouring the five-flap variation for this indication. This conclusion is derived from the notion that although the gain in length may be greater for the four flap, to make the comparison it assumes that the length of the central limbs are the same for the two techniques. For most cases, however, the central limb cannot exceed much >3 cm for a four-flap z-plasty, while 4 cm may be utilized for a 'jumping man' procedure.

Sciatic nerve pain, affecting 12%-27% of the general population, often arises from a myriad of etiologies due to the complex anatomy of the sciatic region. The intricate relationship between the sciatic nerve and surrounding structures in the pelvis poses significant challenges in both diagnosis and surgical management. We report two cases of adult female patients presenting with chronic sciatic pain, refractory to conservative treatment. Imaging studies, including magnetic resonance imaging and computed tomography, identified retroperitoneal lipomas exerting compressive effects on the sciatic nerve. Both patients underwent surgical excision of the lipomas via a transgluteal approach with complete resection of the benign tumors in both cases. The successful outcomes in these cases underscore the potential of the transgluteal approach as a novel and effective treatment strategy in the management of complex retroperitoneal tumors causing sciatic pain.

Femoral hernias are at a high risk of strangulation due to their narrow necks. They are an exceptionally rare occurrence in males. In many cases, differentiation between a femoral and inguinal hernia is difficult. We present the case of a bilateral strangulated femoral hernia in a 70-year-old male. To our knowledge, there has been only one previously published report of such a case in males. Our patient presented with generalized abdominal pain and bilateral irreducible groin swellings, originally thought to be bilateral strangulated inguinal hernia. Upon initial inguinal incision, a diagnosis of a strangulated femoral hernia was made. A modified lower midline laparotomy incision was made to gain access to and diagnose both femoral hernias and allow for bowel resection and abdominal washout. Our case highlights the importance of modifying the surgical approach when encountering with a different diagnosis intraoperatively.

Pneumoperitoneum, characterized by the presence of air in the peritoneal cavity, is usually associated with severe clinical conditions, such as perforations of hollow viscera, often requiring urgent surgical intervention. However, in rare cases, pneumoperitoneum occurs without an identifiable cause, thus classified as idiopathic pneumoperitoneum. We present two clinical cases of women who developed pneumoperitoneum after extensive gynecological surgeries. In the first case, a 63-year-old woman underwent elective hysterectomy and bilateral adnexectomy due to a large adnexal mass. In the second case, a 55-year-old woman had a similar surgical history. Both patients were treated conservatively, with a positive outcome. Idiopathic pneumoperitoneum is a diagnostic and therapeutic challenge, especially in the postoperative context. The cases presented underscore the importance of rigorous diagnostic evaluation and a cautious therapeutic approach, suggesting that idiopathic pneumoperitoneum may represent a benign and self-limiting phenomenon rather than a surgical emergency.

Allergic fungal rhinosinusitis (AFRS) stands out as the predominant form of fungal sinusitis, primarily attributable to a hypersensitive response to fungal invasion. AFRS Characterized by symptoms of rhinosinusitis. The expanding mass in the disease leads to bony restructuring and implicating adjacent anatomical structures. AFRS may extend beyond the sinus cavities, leading to compression of nearby structures like the orbit, optic and abducens nerves which leads to many complications such as nerve palsies and proptosis. Diagnosis of AFRS typically necessitates radiographic assessment initially, with histopathological examination serving as the confirmatory modality. The management of AFRS typically entails a multifaceted approach integrating surgical intervention alongside medical therapy. This case report illustrates a distinctive manifestation of abducens nerve palsy secondary to allergic fungal sinusitis which had dramatic improvement and resolution of the diplopia after the Endoscopic sinus surgery. Steroids and nasal saline irrigation have been prescribed post operatively to prevent the recurrence.

Lipomas are common benign tumors, typically affecting subcutaneous tissues in the head, neck, trunk, and upper limbs, particularly in individuals over 40 years old. However, visceral involvement, such as mesenteric lipomas, is exceedingly rare, with fewer than 50 pediatric cases reported in the English literature. Mesenteric lipomas are generally asymptomatic but may present with non-specific symptoms like abdominal distension or signs of partial or complete intestinal obstruction. Imaging modalities such as abdominal ultrasound and CT scan often reveal a well-differentiated fatty tumor, but histological confirmation is essential for diagnosis and management. We present a case of a 3-year-old female who experienced progressive abdominal distension over the course of a year. Imaging identified a large lipomatous tumor, which was surgically excised. Histopathological examination confirmed the diagnosis of a mesenteric lipoma.