Journal of Surgical Case Reports最新文献

Volvulus is the rotation or twisting of the intestine around its vascular pedicle. The occurrence of descending volvulus after sigmoidectomy is extremely rare. We report a case of a 35-year-old male who presented with abdominal distention, cramping, and no passage of feces or gas for three days. He had a history of recurrent sigmoid volvulus, previously treated with sigmoidectomy. On this occasion, clinical examination and imaging revealed a distended bowel with air-fluid levels. During exploratory laparotomy, descending colon volvulus, a rare finding, was confirmed. The patient underwent a left hemicolectomy and transverse stoma and recovered well postoperatively. Descending colon volvulus is a rare but serious complication after sigmoidectomy, and early diagnosis is essential. In volvulus-endemic regions, awareness of this condition is critical to prevent delayed diagnosis and complications.

Deep femoral artery aneurysms are very rare; particularly when isolated and occur simultaneously in both limbs. We report such a case of a misdiagnosed 16-year-old male presenting after hematoma evacuation was attempted for painful swelling in the left groin. Once the diagnosis was confirmed by computed tomography angiography (CTA), an emergency aneurysmectomy with deep femoral artery (DFA) ligation was performed on the left limb. Subsequently, an elective aneurysmectomy with DFA ligation was done for the contralateral limb during the same admission, with no postoperative complications. Echocardiography, performed with suspicion for infective endocarditis as the cause for possible mycotic aneurysm, revealed Chronic Rheumatic Valvular Heart Disease, without evidence of vegetations, abscesses, or intracardiac thrombi. This case report seeks to discuss the patient's clinical presentation, CTA findings, and surgical management in a low-resource setting, underscoring the risks of this rare condition if misdiagnosed.

Achieving satisfactory nipple esthetics following skin-sparing or nipple-sparing mastectomy is an important element of ensuring positive patient outcomes. Several techniques used to reconstruct the nipple-areolar complex have been described in previous literature and have had success in securing good cosmetic outcomes. For patients with macrothelia, surgeons may employ a number of options in reducing nipple size. Existing studies have shown common preferences among individuals surveyed regarding breast cosmesis, specifically related to the nipples and areolae. However, for individuals with disproportionately large areolae following areolar-sparing mastectomy, there is scant literature to suggest methods of reducing the size of the areolae, and current practice appears to be based upon fixed diameters of areolar sizers. In this technical report, we describe a suture-only technique that successfully reduced areola diameter and recreated the appearance of a nipple with a small central projection following areolar-sparing mastectomy.

This case report discusses a 32-year-old woman with no significant medical history who underwent elective bilateral breast reduction with auto-augmentation and abdominoplasty. Initially, her recovery was smooth, but on the third postoperative day, she exhibited tachycardia, tachypnea, and mild shortness of breath, while other vital signs remained stable. A chest X-ray revealed pneumoperitoneum, and a subsequent abdominal CT confirmed moderate pneumoperitoneum without gastrointestinal leakage. Due to the lack of peritoneal signs and normal bowel sounds, conservative management was chosen. Over 2 days, her condition improved, and she was discharged without complications. This case emphasizes the need to recognize nonsurgical pneumoperitoneum after recent abdominal surgery and suggests that conservative management can be effective in the absence of perforation. This report is the first documented instance of spontaneous pneumoperitoneum following breast augmentation and abdominoplasty, highlighting the need for awareness in similar cases.

Palmoplantar hyperhidrosis is a functional disease with an unknown pathogenesis, making it challenging to find a lasting and effective treatment. This article reports a case of a 43-year-old patient with palmoplantar hyperhidrosis treated with computed tomography (CT)-guided radiofrequency neurotomy (RFN) of bilateral T3-4 sympathetic chain combined with bilateral L3 sympathetic ganglion. The optimal puncture level and skin entry point were selected, and measurements were taken using a CT tool to determine needle depth, angle, and distance from the midline. A sympathetic needle was inserted through the T4 intercostal space to the outer side of the T4 rib head. The needle position was adjusted to achieve a tissue resistance, confirmed through sensory, motor stimulation, and three-dimensional reconstruction. RFN was performed, and this process was repeated for 1-2 cycles. Subsequently, a similar procedure was performed at the L3 sympathetic ganglion under CT guidance, resulting in improved sweating symptoms in the patient's hands and feet.

Giant lipomas, rare benign tumours composed of mature adipose tissue, represent only 1% of all lipomas, typically exceeding 10 cm in diameter or weighing over 1000 g. These tumours can cause nerve compression, discomfort, or functional impairment, necessitating surgical excision. We report a 52-year-old male with a giant intramuscular lipoma in the periscapular region, initially identified following significant weight loss after bariatric surgery. Clinical evaluation revealed a 15 × 20 cm mass, confirmed via computed tomography (CT) scan. Surgical excision was performed, followed by histopathological analysis, which confirmed a benign lipoma. Postoperative management was complicated by seroma formation, requiring drainage. This case underscores the importance of early diagnosis, imaging, and appropriate surgical management for large lipomas to prevent complications and recurrence while ensuring optimal cosmetic outcomes.

Hematoma formation is a rare complication following axillary osmidrosis surgery, and its delayed liquefaction can pose significant risks to flap viability, leading to complications such as necrosis. This study examines two cases of postoperative hematomas, highlighting the importance of appropriate drainage management. In both cases, the initial hematomas were evacuated and treated with Penrose drains, but complications arose due to delayed liquefaction. The first case experienced delayed flap necrosis after premature removal of the drain, while the second case benefited from a proactive approach by reintroducing the drain on the sixth postoperative day. This strategy allowed for the prevention of toxic hematoma buildup, improving flap survival. The findings emphasize the need for vigilant postoperative monitoring and drainage management to minimize risks associated with hematoma liquefaction and optimize flap healing. Further research is required to establish standardized protocols for managing postoperative hematomas in axillary osmidrosis surgery.

Peptic ulcer perforations are common in surgical emergencies, whereas double perforations are rare, and triple peptic perforations are even exceedingly rare, with only a few cases documented. While undetected perforation during surgery can be fatal, the absence of standardized procedures for managing multiple perforations remains an ongoing challenge for surgeons. Herein, we describe a rare case of simultaneous triple peptic perforations in an elderly man with a prolonged history of analgesic and corticosteroid use. This case underscores the importance of screening multiple peptic perforations intraoperatively. Subtotal gastrectomy is suggested as an effective option when simple closure of perforations is infeasible.

Preduodenal portal vein (PDPV) is a rare congenital vascular malformation, which was first described by Knight in 1921 as an anomalous vein that lies in front of the duodenum, common bile duct, and hepatic artery instead of beneath them. This abnormal position may result in congenital duodenal obstruction and puts it in danger during operations around this region. PDPV is typically associated with other congenital anomalies, mainly intraabdominal and cardiac ones. The surgical management is usually determined intraoperatively based on evidence that the PDPV is the real cause of obstruction. We report two cases of PDPV each with a different presentation and management approach.

Biliary stents are widely used following endoscopic management of choledocholithiasis. Removal is recommended within 3-6 months to prevent complications. This study analyzed cases of retained biliary stents managed at our institution. Data on patient demographics, duration of stent retention, complications, and management outcomes were collected and analyzed. The mean age of the patients was 60 years (range: 50-82), and the mean stent retention duration was 29.5 months (range: 12-52 months). Acute cholangitis (83.3%) was the most frequent clinical presentation. Endoscopic stone removal was successful in two cases (33.3%), while the remaining four required open bile duct exploration due to technical challenges. Retained biliary stents are associated with severe complications such as recurrent choledocholithiasis and acute cholangitis, often necessitating invasive interventions. These findings underscore the critical importance of timely stent retrieval to minimize morbidity.