Journal of Surgical Case Reports最新文献

Benign peripheral nerve sheath tumors are growths that develop in the protective sheath that surround peripheral nerves. In rare circumstances, they can cause mass effect on surrounding structures intra-abdominally. We report an otherwise healthy 62-year-old female who presented for constipation and recurrent bouts of diverticulitis. The patient had known about her nerve sheath tumor but did not want it removed. The initial plan was to perform a robotic Sigmoidectomy; however, this was not feasible given the size of the tumor intra-operatively. The procedure was subsequently aborted. A multi-disciplinary team of vascular surgery, neurosurgery, and colorectal surgery then took the patient to the operating room for an open resection of the schwannoma and concurrent sigmoidectomy. There have only been several staged attempts described in the literature, but none that describe simultaneous resection of both the nerve sheath tumor and the sigmoid colon.

Pheochromocytomas and extra-adrenal paragangliomas are rare neuroendocrine tumors typically characterized by excess secretion of epinephrine and/or norepinephrine. Dopamine secreting tumors are even more uncommon and predominantly extra-adrenal, with only a few solid adrenal 'dopaminomas' reported. To the best of our knowledge, we present the first case of a giant right adrenal pseudocystic tumor with autonomous dopamine secretion, incidentally discovered on computed tomography. The lesion was successfully excised via a 3-trocar posterior retroperitoneoscopic adrenalectomy, with an uneventful postoperative course. The patient, previously misdiagnosed with primary hypertension and sinus tachycardia, experienced complete resolution of cardiovascular symptoms postoperatively and discontinued antihypertensives and the b-blocker. Postoperative normalization of dopamine levels confirmed the tumor as the origin of the excess secretion. This case highlights the potential for dopamine-induced secondary hypertension and tachycardia, emphasizing the importance of including dopamine assays in the routine hormonal evaluation of adrenal masses, particularly when large or associated with hypertension and/or tachycardia.

We present seven pediatric cases of open knee synovectomy for tenosynovial giant cell tumor (TGCT)-four diffuse (D-TGCT) and three nodular (N-TGCT). The mean patient age at surgery was 11.3 ± 4.77 years. Five cases were diagnosed and treated within the past 2 years, indicating an unusually high incidence of TGCT in our institution. Subtotal synovectomy was performed through an anterior parapatellar approach, while posterior lesions were accessed between the semitendinosus and medial gastrocnemius muscles. The mean follow-up period was 39 ± 62.3 months (minimum 12 months). No recurrences were detected on follow-up MRI. Six patients regained full knee range of motion, and none exhibited postoperative monoarthritis. These favorable outcomes support open synovectomy as a safe and effective treatment for knee-localized D-TGCT and N-TGCT, especially in cases with posterior or retrocondylar localization.

A young female presented with acute epigastric pain radiating to the back, with associated symptoms of vomiting and a 2-year history of similar intermittent upper abdominal symptoms with no alcohol use history, smoking, or chronic illness. Laboratory investigations revealed elevated serum amylase and lipase, while imaging studies demonstrated acute-on-chronic pancreatitis with a dilated main pancreatic duct. Magnetic resonance cholangiopancreatography revealed a ductal anomaly, ansa pancreatica, characterized by a looping communication between the main and accessory pancreatic ducts draining via the minor papilla. Conservative management of symptoms continued to fail; therefore, a surgical procedure, Frey's procedure, was performed, which showed improved clinical outcomes. This case highlights the clinical significance of ansa pancreatica as a rare but often misdiagnosed cause of recurrent pancreatitis in young patients without an alcohol use history.

Medullary thyroid carcinoma (MTC) is typically diagnosed through elevated calcitonin levels, whereas procalcitonin (PCT) is mainly considered an infection marker. However, emerging evidence suggests that PCT may also have diagnostic value in MTC. We report the case of a 63-year-old man with recurrent biliary colic and persistently elevated PCT levels (up to 16.8 ng/ml) despite the absence of clinical or radiological signs of infection. This unexpected abnormality prompted further evaluation, leading to the incidental identification of a multinodular goiter with a suspicious thyroid nodule. Calcitonin was markedly elevated, and cytology was consistent with MTC (TIR 3B). The patient underwent total thyroidectomy with central lymphadenectomy, resulting in rapid normalization of both calcitonin and PCT postoperatively. This case highlights how unexplained PCT elevation in a non-endocrine clinical setting may provide an early clue to MTC. Persistent PCT elevation without infection should therefore prompt consideration of MTC, as combined assessment of calcitonin and PCT may improve diagnostic accuracy.

Left paraduodenal hernia is the most common congenital internal hernia and a rare cause of acute small-bowel obstruction. Delay in diagnosis may lead to strangulation and bowel necrosis requiring urgent surgery. We report the case of a 30-year-old man presenting to a field hospital with sudden severe abdominal pain, vomiting, tachycardia, and generalized peritonism. Abdominal computed tomography demonstrated a cluster of jejunal loops in the left upper quadrant beneath the superior mesenteric vein, consistent with left paraduodenal hernia and closed-loop obstruction. Emergency midline laparotomy revealed a necrotic jejunal segment strangulated within the hernia sac. Approximately 60 cm of jejunum was resected, and a hand-sewn end-to-end anastomosis performed. A planned second-look laparotomy 48 hours later demonstrated complete bowel viability. Despite limited diagnostic resources in the conflict-zone field hospital, early operative intervention resulted in an uncomplicated recovery. This case underscores the need for high clinical suspicion and prompt surgery when internal hernia is suspected.

Biliary anatomy is highly variable, and aberrant anatomy increases the risk of bile duct injury during cholecystectomy. Awareness of anatomical variation is essential to prevent avoidable complications. A 37-year-old male with acute gallstone pancreatitis underwent laparoscopic cholecystectomy. Anatomy on intra-operative cholangiography was unclear, prompting conversion to open, where repeat cholangiogram showed the common hepatic duct draining into the gallbladder infundibulum. A subtotal cholecystectomy preserving the infundibulum was performed. The patient developed a bile leak requiring re-look laparotomy and hepaticojejunostomy on post-operative day 5, later revised after anastomotic breakdown. He recovered fully and was well at 1-month follow-up. Cholecystohepatic duct is a rare biliary anomaly that is difficult to detect pre-operatively. Magnetic resonance cholangiopancreatography may help, but is not routine, so a high index of suspicion is crucial. Intra-operative cholangiography and a critical view of safety help to prevent injury. Surgical management depends on anatomy, but generally hepaticojejunostomy is recommended.

An 86-year-old woman with a history of hepatocellular carcinoma was brought to our emergency department after an indoor fall. Her chief complaint was pain in the left thigh and chest. The patient was diagnosed with a pathological femoral shaft fracture, bone metastasis, and acute myocardial infarction. She underwent preoperative embolization and percutaneous coronary intervention, followed by internal fixation on the same day as the injury. The patient was discharged without postoperative myocardial infarction and was able to walk independently using a walker. Femoral diaphyseal fractures and coronary events require urgent intervention, and their coexistence makes it particularly difficult to determine the treatment sequence and timing. In addition, if the fracture is pathological due to bone metastasis, management becomes even more challenging. A multidisciplinary team is essential for the successful management of such complex cases.

Metastatic prostate cancer seldom involves the gastrointestinal tract, with simultaneous peritoneal and mesocolic nodal spread and is unreported in literature. We describe the case of a 93-year-old man with stable metastatic prostate cancer who presented with sigmoid obstruction secondary to sigmoid adenocarcinoma. Pathological assessment of the specimen confirmed sigmoid adenocarcinoma as well as prostate cancer deposits in colonic serosa, peritoneum, and mesocolic nodes that was not evident on preoperative imaging. This case highlights a previously undocumented metastatic pattern, the limitations of conventional imaging, and the importance of intra-operative vigilance in dual malignancies.