Journal of Surgical Case Reports最新文献

One of the most frequent post-extraction complications of posterior maxillary teeth is oroantral communication, which consists of direct communication between the maxillary sinus and the oral cavity. The recommendation is to make an immediate closure within the first 48 hours to avoid possible complications that may include an oroantral fistula or chronic sinus disease. Currently, different techniques have been described for closing communication, including various types of materials. Some of the techniques are exclusively oriented toward closure, while others seek to achieve bone regeneration by using bone substitutes for the subsequent placement of dental implants. The aim of this study is to describe a simple surgical technique for managing oroantral communication using a collagen sponge with hydroxyapatite and ribose and covering it with overlapping double layers of ribose cross-linked collagen membrane without fixation.

Hepatocellular carcinoma is the third leading cause of cancer deaths worldwide, with a 5-year survival rate of 20.3%, while colorectal cancer is a major cause of morbidity and mortality worldwide, being the third most common cancer in men and the second in women. In addition, multiple primary tumors, involving cancers at different sites and histologies, occur in 2.4% to 17% of cases. We report a case of a 74-year-old man with colon cancer presented at the Emergency Department with asymptomatic anemia post chemotherapy and surgical intervention two years ago. He reported experiencing paleness, dizziness, exertional dyspnea, and fatiguability for the past month. Therefore, chest computed tomography was performed to rule out pulmonary embolism; however, the image revealed an incidental finding of two hepatic lesions in segment II. After further investigations, the decision was to perform hepatic segmentectomy. Postoperative pathology revealed residual Hepatocellular carcinoma and metastatic colonic-type adenocarcinoma with mucinous differentiation.

Stanford A aortic dissection is one of the most devastating acute medical conditions due to its high morbidity and mortality. We describe a 77-year-old male patient with a medical history of surgical aortic valve replacement with a still functioning Starr-Edwards caged-ball valve 40 years prior. The patient was promptly diagnosed with an ascending aortic aneurysm and dissection, and an emergency Bentall procedure in deep hypothermic circulatory arrest was performed. This is, to the best of our knowledge, the first Stanford A dissection case described in the literature in a patient with Starr-Edwards valve, and the longest still functioning caged-ball valve to have been replaced with the Bentall procedure. We also discuss the caged-ball valve's unfavorable hemodynamics as a potential predisposing factor of the dissection, as well as the patient's supposed initial bicuspid aortic valve disease which could also predispose to aortic aneurysm formation and dissection.

This case report presents the treatment of a 36-year-old male patient with massive anal condyloma lata following lung transplantation due to cystic fibrosis. The patient, under long-term immunosuppressive therapy, developed extensive wart-like lesions around the anal canal. A modified circular hemorrhoidectomy with mucosal bridges was performed to excise the affected tissue while preserving functional integrity. The surgery, conducted under general anesthesia, successfully removed all lesions without complications. Postoperatively, the patient experienced no pain, bleeding, incontinence, or recurrence during follow-up. The preservation of mucosal bridges helped prevent common complications such as anal stenosis and mucosal ectropion. Histology confirmed the diagnosis of condyloma lata. This case underscores the effectiveness of circular hemorrhoidectomy, particularly in patients with circular anal canal lesions, and highlights the role of mucosal bridges in minimizing postoperative complications while ensuring complete lesion excision. This technique should be considered in similar cases of extensive anal lesions.

In a quarter of patients with ureterovaginal fistula (UVF), a concurrent associated vesicovaginal fistula (VVF) can also be found. An increased clinical suspicion should be arised in cases of urinary vaginal discharge accompanied with unilateral flank pain following a gynecological procedure. A 43-year-old female patient diagnosed with a complex postoperative UVF and VVF following a total hysterectomy. After an unsuccessful initial conservative approach with the placement of a nephrostomy tube, an ureterocystotomy with antireflux reimplantation of the ureter was decided. The patient experienced an uneventful postoperative period and a year later, the patient remains asymptomatic without any evidence of fistula recurrent. Our case reports the relatively rare presence of a concurrent postoperative complex UVF and VVF formation in order to rise clinical suspicion in clinicians regarding the diagnostic approach and optimal management.

Peptoniphilus asaccharolyticus is a typical gram-positive commercial microorganism of the skin that depending on the occasion can also be detected in the gut and in the genitourinary system. There is a paucity in the literature regarding the role of P. asaccharolyticus in spine infections and the potential impact in postoperative implications. A case report of a patient suffering from infection of spinal instrumentation of the uncommon pathogen above is presented.

A 19-year-old woman presented with abdominal pain and a palpable mass, initially suspected to be a gastrointestinal stromal tumor (GIST) based on imaging. Surgical excision revealed a sclerotic spindle cell neoplasm with minimal cytological atypia, but immunohistochemistry (IHC) was negative for GIST-specific markers. The pan-negative IHC profile, along with calcification foci and low Ki67 index (<1%), led to a diagnosis of calcifying fibrous tumor (CFT). This case highlights the importance of precise diagnostic evaluation and consideration of rare entities like CFT. Comprehensive histopathological evaluation and IHC are essential diagnostic tools, as they can distinguish between GIST and CFT, leading to accurate treatment and patient management. This case underscores the value of thorough pathological assessment in resolving diagnostic challenges.

Thymolipomas are benign lesions in the anterior mediastinum that most commonly present in the first three decades of life. They often are asymptomatic and can be very large at time of diagnosis. After incidental detection of a thoracic mass on an abdominal ultrasound, an otherwise well 10 years old male was evaluated with further imaging, including a cardiac-gated magnetic resonance imaging (MRI) study. This demonstrated that the mass was intimate with but did not appear to invade the pericardium, likely originating from the thymus. Despite the large size, the patient underwent robotic resection of the mass and we include photographs illustrating the minimally invasive approach and highlighting critical structures. The patient tolerated the procedure well and recovered quickly. Final pathology was consistent with a giant thymolipoma. In summary, workup of giant thymolipomas is optimized with cardiac gated imaging. Despite their large size, these can be safely managed in a minimally invasive fashion in pediatric patients.

Pilonidal sinuses are chronic inflammation and/or infection of the intergluteal region. Recurrent disease is common and is a source of significant morbidity for affected patients. We present a case of an eighteen-year-old male with extensive recurrent pilonidal disease. A novel technique of a double Limberg flap repair was used, with the vertical axes of each flap positioned to optimise wound tension. The cranio-caudal length of the disease in the natal cleft would have resulted in a large amount of excised normal tissue laterally if a single Limberg flap was considered. To avoid this, we used two Limberg flaps over the craniocaudal length to minimise the laterally excised tissue. The patient made an uneventful recovery with no recurrence at 3 months follow-up. This technique demonstrates the flexibility of the Limberg flap, and that a double flap may be successfully used in extensive disease.

The incidence and prevalence of syphilis are rising worldwide. Rectal syphilis is a rare condition with few reported cases in the literature and therefore often missed from differential diagnosis of atypical anorectal ulceration. We report a case of a 64-year-old male who presented with change in the bowel habit and a palpable rectal mass on examination. Colonoscopy revealed a small, ulcerated lesion in the rectum. However, histopathological analysis and radiological assessments were inconclusive. A cutaneous ulceration prompted a repeat biopsy and staining for spirochaetes, which was diagnostic of syphilitic proctitis. He was successfully treated with first line antibiotics via the Genitourinary Medicine clinic. With its increasing incidence, syphilis should be considered as a potential diagnosis of atypical anorectal ulceration. A complete sexual history including relevant risk factors should be taken and a full clinical examination performed actively looking for signs and symptoms of disease.