Journal of Surgical Case Reports最新文献

Penetrating cardiac trauma is one of the most critical emergency injuries, characterized by rapid progression and extremely high mortality. This article reports a case of a patient who sustained a gunshot wound that traversed the heart and lodged in the pericardial cavity, and was successfully rescued due to timely surgery.

Male circumcision is common in Muslim-majority Malaysia but can pose risks when penile anomalies such as buried penis go unrecognized. We report a 9-year-old obese Malay boy with a pre-existing buried penis who underwent routine circumcision. Due to his condition, the initial procedure left an uncircumcised appearance, prompting a revision circumcision. This led to total loss of the shaft skin, resulting in trapped penis with penile skin infection. On presentation, he was febrile with erythematous suprapubic skin. He underwent surgical release, anchoring of the penile shaft, and shaft skin reconstruction using a fenestrated split-thickness skin graft from the thigh. Three months postoperatively, he showed satisfactory urinary and erectile function with minimal contracture and good cosmetic outcome. This case highlights the importance of timely recognition of penile anomalies by healthcare providers and traditional practitioners, appropriate referral, and surgical options for reconstruction following complicated circumcision, especially in high-demand settings.

Lower back pain (LBP) is a leading cause of disability worldwide and a major contributor to healthcare costs. Diagnosing non-specific mechanical LBP remains difficult and often relies on exclusion. Current magnetic resonance imaging (MRI) reports typically emphasize disc degeneration, an age-related and often asymptomatic finding, while overlooking more clinically relevant factors like the state of the muscle. Fat infiltration and muscle wasting seen on MRI scans are common in LBP patients and are potentially reversible with targeted exercise rehabilitation. In a recent case, MRI revealed significant fat infiltration and muscle atrophy, yet the report focused solely on disc changes, missing the elephant in the room: the correctable muscular dysfunction. Since exercise is the cornerstone of LBP management, ignoring modifiable muscle health while highlighting irreversible and non-pathological age-related changes limits targeted treatment guidance. Routine reporting of muscle condition could lead to more precise rehabilitation and improved patient outcomes.

Hepatic artery aneurysm (HAA) is a rare but potentially lethal condition, accounting for ~20% of visceral aneurysms, with a reported rupture rate of up to 44%. Its pathophysiology remains incompletely understood, though risk factors include atherosclerosis, trauma, infection, connective tissue disorders, and iatrogenic causes. Clinical presentation varies from asymptomatic to abdominal pain, gastrointestinal symptoms, or biliary obstruction. Angiography-CT is the diagnostic modality of choice. Management is guided by symptoms, aneurysm size, and rupture status, ranging from observation to endovascular or surgical interventions. We report a case of hemoperitoneum due to a ruptured HAA that was incidentally discovered during a laparoscopic cholecystectomy.

Interstitial ectopic pregnancies account for 1%-3% of ectopic pregnancies and carry a high risk of morbidity due to delayed diagnosis and potential catastrophic haemorrhage. Sonographic identification is challenging and may be further confounded by distorted pelvic anatomy, including adenomyosis, which can present with myometrial cysts or sub-endometrial microcysts that mimic a gestational sac. We describe a 36-year-old woman presenting with early-pregnancy bleeding whose initial ultrasounds suggested a possible intrauterine pregnancy due to adenomyosis-related cystic changes. Serial serum human chorionic gonadotropin (hCG) levels rose sub-optimally, and specialist ultrasound ultimately confirmed a right interstitial ectopic pregnancy. She underwent successful laparoscopic uterine wedge resection and bilateral salpingectomy with the use of intramyometrial vasopressin and tranexamic acid to minimize blood loss. This case highlights the importance of vigilance in pregnancies of unknown location, particularly when adenomyosis distorts sonographic anatomy, and demonstrates the role of minimally invasive techniques and haemostatic adjuncts in reducing morbidity.

Liquid nitrogen-infused 'Dragon's Breath' snacks have gained popularity despite their potential to cause serious gastrointestinal injury. We report the case of a 14-year-old boy who presented to the emergency department of a tertiary care hospital, two hours after ingestion of 'Dragon's Breath' candy with severe abdominal pain and distension leading to generalized peritonitis and sepsis. Abdominal X-ray showed massive pneumoperitoneum, raising suspicion of hollow viscus perforation. Emergency laparotomy performed, and there was a 3 × 2 cm gastric perforation along the lesser curvature. Primary repair was performed with drain placement, and the initial postoperative course was uneventful, leading to discharge on day 6. Three days later, he re-presented with hematemesis, melena, and haemoglobin of 8 g/dl. Upper gastrointestinal endoscopy showed mild erosive gastritis without active bleeding. This case highlights the significant morbidity associated with liquid nitrogen ingestion and emphasizes the need for safety regulations and postoperative endoscopic follow-up.

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.