Journal of Surgical Case Reports最新文献

We describe the case of a 43-year-old woman presented with an 8-month history of intermittent non-specific abdominal pain. She had an Intrauterine Contraceptive Device (IUCD) inserted 4-years ago and the device was still in-situ. After initial gynaecological assessment, further clinical radiological investigations, computerized tomography imaging showed that the intraluminal part of the radiological foreign body was seen to be possibly perforating the sigmoid colon after having migrated. Diagnostic laparoscopy confirmed this and a laparotomy was performed to remove the foreign body (IUCD) followed by primary closure of the defect in the sigmoid colon.

Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis. We present the case of a male patient in his late 20s who presented to his general practitioner with symptoms of recurrent urinary tract infection (UTI). Upon investigation his estimated glomerular filtration rate was found to be 61 ml/min/1.75 m² and an ultrasound scan of the kidney, ureters, and bladder revealed a left sided hydronephrosis. A computerized tomography urogram confirmed upper and lower pole lesions of the left kidney with ureteric changes and lymphadenopathy consistent with chronic atypical infection. A urine acid-fast bacilli culture was positive for urinary tuberculosis (TB). The patient's disseminated TB was treated with conventional anti-TB medications. Our case report highlights the value in considering genitourinary tuberculosis amongst the list of differential diagnoses in younger patients presenting with symptoms of recurrent UTI.

Carotid body tumors (CBTs) are rare head and neck paragangliomas that arise from the carotid body chemoreceptor at the common carotid bifurcation. These neoplasms are generally benign, slow-growing, nonsecreting, and well-vascularized. Metastasis occurs in ~5% of cases. Here, we report a case of a 35-year-old female presenting with 1-year history of a growing left neck mass, consistent with a CBT. Patient ultimately underwent surgical excision and was found to have a malignant paraganglioma with metastases to cervical lymph nodes. She was further treated with a left modified radical neck dissection and adjuvant radiotherapy and remains disease-free at the time of follow-up 2 years later. We discuss the roles of preoperative assessment, concomitant selective neck dissection and tumor resection, and subsequent modified radical neck dissection as part of the diagnosis and surgical management of malignant CBTs.

Bladder foreign bodies (BFB) are uncommon in the pediatric population. They typically arise from self-insertion, iatrogenic factors, or trauma. Cystoscopy is the preferred intervention. A 16-year-old female presented with a [2-]day history of dysuria, suprapubic pain, and a palpable rectal foreign body. Imaging revealed an 8.2 cm radiopaque object in the bladder. Diagnostic laparoscopy confirmed no perforation. Cystoscopy identified and removed a lead pencil from the bladder. A small bladder perforation was noted post-removal. The patient had a smooth recovery and was discharged with a Foley catheter, which was later removed following normal postoperative imaging results. Prompt diagnosis and intervention are crucial for managing pediatric BFBs to prevent complications. Imaging and cystoscopy play key roles in treatment.

Hibernomas are rare, benign neoplasms characterized by the presence of brown adipose tissue. Although these tumors may arise in any region of brown fat, they predominantly occur in the thigh, shoulder, back, and neck. Hibernomas are rarely found in mammary tissue, with a higher prevalence in females than males. This case report highlights a unique presentation of a 20 cm hibernoma mass found in the right breast of a 31-year-old male. A diagnostic bilateral mammogram, unilateral MRI, and ultrasound were used to evaluate the mass. The patient underwent an intra-operative ultrasound-guided needle biopsy and left total mastectomy, revealing the diagnosis of hibernoma with fat necrosis. This report aims to delineate the pathological, diagnostic, and clinical features associated with breast hibernomas and to offer a comprehensive review of the literature on the subject. This case report also serves to expand the differential for breast mass in male patients, with a focused aim to prevent delayed diagnosis and treatment.

The frequency of bronchial branching abnormalities is about 0.6%, of which about 75% are related to the right upper lobe. The frequency of left B^1 + 2 transition bronchus is even rarer, but a few cases have been reported. A 43-year-old man, who presented with an abnormal pulmonary nodule suspected to be lung cancer in the left S4 segment, underwent video-assisted thoracoscopic segmentectomy of S3 plus lingular segment. Preoperative three-dimensional contrast-enhanced computed tomography (CT) revealed a displaced B^1 + 2 bronchus arising from the left main bronchus, which ascends behind the main pulmonary artery. Video-assisted thoracic surgery was performed successfully, and the nodule was pathologically diagnosed as a lymphoma. Preoperative three-dimensional contrast-enhanced CT was very useful to detect this rare bronchial abnormality. In the present case, three-dimensional CT allowed us to safely operate on a patient with a rare B^1 + 2 displaced bronchus in the left upper lobe.

Colo-cutaneous fistulas are a rare complication of diverticular disease. Percutaneous drainage offers a promising alternative to surgical intervention in the management of complicated diverticular disease with abscess formation. Recent case studies and literature reviews support its efficacy in achieving abscess resolution and reducing the need for surgery. However, careful patient selection, technical proficiency, and multidisciplinary management are critical to optimizing outcomes. As the body of evidence grows, percutaneous drainage is likely to play an increasingly important role in the therapeutic arsenal against complicated diverticular disease; however, the risk of complications, particularly fistula formation, must be carefully considered. Our case presents a rare incident of a colo-cutaneous fistula occurring after CT-guided percutaneous drainage of a pericolic abscess secondary to perforated sigmoid diverticulitis that failed medical management. The patient ultimately underwent Hartmann's procedure where the diseased sigmoid colon, adhered small bowel, and fistula tract were excised with an end colostomy creation.

A thoracic kidney is a scarce type of ectopic kidney. We report the case of a 76-year-old man who developed cancer of the ureter, ipsilateral to the thoracic kidney. He presented with abdominal pain in the right upper quadrant. Computed tomography revealed a right hydronephrotic kidney located in the thorax with elevation of the diaphragm. Further examination uncovered a cT2N0M0 ureteral cancer in the right upper ureter. A laparoscopic radical right nephroureterectomy was performed using a retroperitoneal approach. The retroperitoneal space was created for the usual port placement. A port between the 11th and 12th ribs was added to facilitate handling the suprahilar area, specifically the dissection of the superior aspect and separation of the kidney without accompanying pneumothorax. To our knowledge, this is the first report of a successful complete laparoscopic surgery via the retroperitoneal approach for a malignant disease associated with a thoracic kidney.

Laparoscopic cholecystectomy is the preferred method for treating acute cholecystitis. Although the incidence of postoperative infections in laparoscopic cholecystectomy is low, serious postoperative surgical site infections are still reported. Hepatic abscesses, particularly fungal, can occur post-cholecystectomy leading to significant mortality and morbidity. We report a case of a 58-year-old female who underwent laparoscopic cholecystectomy and subsequently developed fever, jaundice, and right upper quadrant pain. Laboratory results showed deranged liver function tests with raised inflammatory markers. Radiographic investigations, including CT and MRI, revealed an irregular hilar lesion with periportal changes suggestive of an abscess with portal vein thrombosis. Histopathological examination of the biopsy obtained from the hilar lesion showed a fungal hepatic infection, and particularly conidiobolomycosis. To our best knowledge, this is the first case that reports this fungal infection as a complication of laparoscopic cholecystectomy. The patient was managed with a combination of intravenous antibiotics and antifungals, which yielded mild improvement. Unfortunately, the patient decided to leave the hospital against medical advice, limiting the information on the disease course.

The diffuse large B-cell lymphoma (DLBCL) mimicking an epidural hematoma in the cervical spine is an extremely unique case. We present a case of a 42-year-old man, who presented to the emergency department with symptoms of tetraparesis after a session of spinal manipulation therapy. magnetic resonance imaging visualized a lesion located at C3-C7 causing spinal cord compression with surrounding soft tissue edema suggesting epidural hematoma. The patient was admitted to the Neurosurgery Department and emergent laminectomy was performed. Intraoperatively, an infiltrating tumor was found, which was partially resected and sent for post-op histopathological examination, determining it to be a DLBCL. Our work aims to increase awareness of such cases, which may make it easier to make the proper diagnosis.